Infantile pigeon chest refers to a high, deformed chest resembling the chest of a chicken; because the chest also resembles the convex shape of a tortoise shell, it is also known as "tortoise breast (chicken breast)."

Tortoise back (hunchback) refers to a child's spine that is curved and protruding, deformed, resembling the back of a tortoise, also known as "kyphosis," commonly referred to as "hunchback." Since the two conditions are related in terms of disease cause and symptoms, they are combined into one differential diagnosis.

bubble_chart Pattern Analysis

1. Lung Accumulation of Phlegm-Heat︰In addition to the forward protrusion of the thorax and an increase in the anteroposterior diameter, leading to deformity, symptoms also include cough, wheezing, a distended and elevated chest, copious phlegm, flushed face and red lips, spontaneous sweating, emaciation, sparse and yellowish hair, a red tongue with scanty yellow coating, rapid pulse, and purple stagnant finger venules. This condition primarily arises from children's dietary indiscretion, leading to food stagnation and phlegm production. When unresolved phlegm-heat combines with wind pathogen invasion, it attacks the chest and diaphragm, resulting in this disease. Clinically, it often manifests as cough, wheezing, a distended and elevated chest, profuse phlegm, flushed face and red lips, and over time, gradual emaciation. Treatment should focus on promoting qi movement, clearing heat, and resolving phlegm. Initially, Kuanqi Yin can be used, followed by Lily Bulb Dan. Once the phlegm-heat is cleared, the chest distension will subside, after which tonification and regulation can be applied to gradually restore the thorax.
2. Spleen Deficiency and Bone Weakness︰In addition to the forward protrusion of the thorax resembling a chicken's chest, there are also signs of emaciation or puffiness, a large square forehead, delayed fontanel closure, dull complexion, distended abdomen, curved lower limbs, spinal kyphosis or scoliosis, delayed teething, sitting, standing, walking, and other developmental milestones, a pale tongue with white coating, slow and weak pulse, and faint fingerprints. This condition is mainly caused by the mother's poor health, improper infant nutrition, damp and dark living conditions, insufficient sunlight, and postnatal maladjustment, leading to delayed growth and development, weak bones, and loose muscles, resulting in the deformity of the thorax known as pigeon breast. Symptoms such as pale complexion, large square forehead, and curved lower limbs are often observed. Treatment should focus on strengthening the spleen and kidneys, fortifying bones, and nourishing vitality. The Fuyuan Powder can be used to tonify and replenish qi and blood. Once spleen qi is restored, the Kidney-Reinforcing Rehmannia Pill can be administered to nourish the bones, thereby curing pigeon breast.
3. Fetal Timidity and Weakness︰The child is born with deformities of the chest and back, which become increasingly apparent with age. The posture is hunched, capable of bending forward but not extending backward. Growth and development are delayed, with a thin physique, poor appetite, intolerance to cold and heat, a pale tongue with thin coating, weak and rapid pulse, and faint, sluggish finger venules. This condition is often caused by insufficient essence inherited from the parents, deficiency of primordial yang, or the mother's weakness and frequent illnesses during pregnancy. It may also result from premature labor or other factors that injure the fetal vitality. Consequently, after birth, the child exhibits protrusion of the sternum and ribs, gradually forming a chicken-like chest, with the thoracic vertebrae progressively protruding and the bones withering, unable to support the body, leading to curvature and bulging, with the back arched like a bow. Since this condition originates from congenital factors, the focus should be on nourishing and strengthening the mother's body. Once the child is born, it often becomes a lifelong chronic ailment. Treatment primarily focuses on tonifying the kidneys, preferably with the Great Life-Endowing Pill (Bu Tian Dan) , supplemented by external moxibustion on the lung shu (BL 13), heart shu (BL 15), and diaphragm shu (BL 17) points.
4. Evil Invading the Spine︰The spine and back cannot support or lift, with spinal pain and rigidity, shoulders raised and chest thrust forward, gradually leading to a curved back that protrudes like a tortoise shell. In the advanced stage, a hunchback deformity may appear. The tongue is pale red or bright red, with a white coating or scanty moisture; the pulse is deep, thin, and rapid, and the finger veins appear pale and sluggish or purple and sluggish. This condition often develops postnatally. It may occur due to weak bones in infants who are forced to sit alone and are then attacked by wind pathogens, which contend with qi and blood, invade the bone marrow, and stagnate without dispersing, causing the back to bulge like a tortoise shell (hunchback). Alternatively, it may result from Xieke due to pulmonary tuberculosis affecting the spine, gradually manifesting steaming bone fever, tidal fever, emaciation, night sweats, a red tongue, and a thin, rapid pulse—signs of yin deficiency pulmonary tuberculosis—accompanied by spinal pain and rigidity, backward protrusion of the spine, and the formation of a hunchback. For cases caused by wind-cold invading the spine, the priority is to disperse wind and expel cold. Internally, Songrui Dan can be taken, and external moxibustion may be applied. For cases of yin deficiency pulmonary tuberculosis, treatment may reference the approach for flowing phlegm (tuberculosis of bone and joint).

bubble_chart Documentation

1. 《Infant and Child Hundred Questions. Tortoise Back (Hunchback) Tortoise Breast (Chicken Breast) and Crane's Knee Delayed Walking》: "The Sacred Benevolence Treatise states that tortoise back (hunchback) refers to a condition where a child, not yet half a year old, is forced to sit early, leading to the invasion of external wind into the spine, causing the back to rise like a tortoise's shell. There is a moxibustion method that can treat this."
2. Youke Tiejing ．Tortoise Breast (Chicken Breast)》: "Tortoise breast (chicken breast)... or if the wet nurse consumes too much spicy food and feeds the child with hot milk in summer, this condition can also develop. It is advisable to treat with Kuan Qi Transformation Phlegm Pills."
3. Youyou Jicheng ．Tortoise Breast (Chicken Breast) and Tortoise Back (Hunchback) Treatment》: "I note that tortoise breast (chicken breast) can be treated, but tortoise back (hunchback) is an incurable condition. Previous treatments have not been entirely effective. Although it is said that external wind enters the bones, early sitting causes strain, and lung deficiency from coughing, the root cause of the disease has not been fully understood, as it is only described based on current observations. In children with sufficient innate vitality, it is common to see them naked, sitting in the wind and dew, and after half a year, sitting in a chair, yet there has never been a case of external wind entering the bones, early sitting causing strain, or prolonged coughing leading to tortoise back (hunchback). This condition is mostly seen in children whose parents have insufficient essence and blood, and a deficiency in primordial yang."