庄右 脉左寸关弦数不静，右寸关濡滑而数，舌苔剥绛，乳岩肿硬已久，阴液亏而难复，肝阳旺而易升，血
不养筋，营卫不得流通，所以睡醒则遍体酸疼，腰腿尤甚。连投滋阴柔肝，清热安神之剂，尚觉合度，仍守原
意出入。
西洋参（另煎汁冲服，二钱） 朱茯神（三钱） 蛤粉炒阿胶（一钱五分） 丝瓜络（二钱） 霍山石斛（三钱）
生左牡蛎（八钱） 嫩白薇（一钱五分） 鲜竹茹（二钱） 大麦冬（二钱） 青龙齿（三钱） 全栝蒌（切，四钱）
鲜枇杷叶（去毛、包，三张） 鲜生地（四钱） 川贝母（二钱） 生白芍（一钱五分） 香谷芽露（后入，半斤）
外用金箍散、冲和膏，陈醋、白蜜调敷。
二诊 脉象尺部细弱，寸关弦细而数，舌质红绛，遍体酸痛，腰膝尤甚，纳谷减少，口干不多饮，腑行燥
结，小溲淡黄，乳岩依然肿硬不消，皆由阴液亏耗，血不养筋，血虚生热，筋热则酸，络热则痛。况肝主一身之
筋，筋无血养，虚阳易浮，腹内作胀，亦是肝横热郁，阳
明通降失司。欲清络热，必滋其阴，欲柔其肝，必养其血，俾得血液充足，则络热自清，而肢节之痛，亦当轻减矣。
西洋参（另煎汁冲服，二钱） 生左牡蛎（八钱） 蛤粉炒 阿胶（一钱五分） 霍山石斛（三钱）
青龙齿（二钱） 羚羊片（另煎汁冲服，四分） 大麦冬（三钱） 生白芍（二钱） 嫩白薇（一钱五分）
鲜生地（四钱） 甜瓜子（三钱） 鲜竹茹（二钱） 嫩桑枝（一两） 丝瓜络（五钱，二味煎汤代水）
另∶真珠粉二分，用嫩钩钩三钱，金器一具，煎汤送下。
三诊 遍体酸疼，腰膝尤甚，溲黄便结，纳谷减少，口干不多饮，乳岩依然肿硬不消，皆由阴液亏耗，血不
养筋。筋热则酸，络热则痛，病情夹杂，难许速效。再拟养血清络。
西洋参（二钱） 羚羊片（另煎汁冲服，八分） 黑芝麻（三钱） 霍山石斛（三钱） 左牡蛎（八钱）
青龙齿（三钱） 蛤粉炒阿胶（二钱） 大地龙（酒洗，三钱） 大麦冬（二钱） 生白芍（一钱五分）
嫩桑枝（一两） 首乌藤（三钱） 鲜生地（四钱） 川贝母（五钱） 甜瓜子（三钱） 丝瓜络（五钱，二味
煎汤代水）
另∶真珠粉二分，用朱灯心两扎，金器一具，煎汤送下。
四诊 乳岩起病，阴血亏虚，肝阳化风入络，肢节酸疼，心悸气逆，时轻时剧，音声欠扬，舌质光红，苔薄
腻黄，脉象左弦数右濡数，病情夹杂，还虑增剧。姑拟养肝体以柔肝木，安心神而化痰热。
西洋参（一钱五分） 朱茯神（三钱） 川象贝（各二钱） 柏子仁（三钱） 黑芝麻（三钱） 霍山石斛（三钱）
青龙齿（三钱） 栝蒌皮（二钱） 凤凰衣（一钱五分） 夜交藤（四钱） 真珠母（六钱） 生地（蛤粉拌，三钱）
嫩钩钩（后入，三钱） 蔷薇花露（一两） 香稻叶露（四钱，二味后入）
另∶真珠粉二分，朱灯心二扎煎汤送下。
王右 肝郁木不条达，挟痰瘀凝结，乳房属胃，乳头属肝，肝胃两经之络，被阻遏而不得宣通，乳部结块，
己延三四月之久，按之疼痛，恐成乳岩。姑拟清肝郁而化痰瘀，撤消通气饮合逍遥散出入。
全当归（二钱） 京赤芍（二钱） 银柴胡（八分） 薄荷叶（八分） 青陈皮（各一钱） 苦桔梗（一钱）
全栝蒌（切，四钱） 紫丹参（二钱） 生香附（二钱） 大贝母（三钱） 炙僵蚕（三钱） 丝瓜络（二钱）
青橘叶（一钱五分）
Mr. Zhuang, Right Side: The pulse at the left Cun and Guan positions is wiry (Wiry) and rapid (Rapid), indicating unrest; the pulse at the right Cun and Guan positions is soggy (Soggy) and slippery (Slippery) with a rapid rate. The tongue coating is peeled and crimson. The breast cancer (Ru Yan, carcinoma of the breast) has been swollen and hard for a long time. Yin fluids are deficient and difficult to restore, while Liver Yang is hyperactive and prone to rising. Blood fails to nourish the sinews, and Ying (Nutritive) and Wei (Defensive) Qi fail to circulate freely. Consequently, upon waking, there is generalized body soreness and pain, particularly severe in the lower back and legs. Continuous administration of formulas that nourish Yin, soften the Liver, clear heat, and calm the spirit appears appropriate. We shall continue with the original intent, making modifications as needed.
American Ginseng Radix et Rhizoma (decocted separately, juice taken to mix, 2 qian)
Bai Shen Fu Shen (Poria with Stimulating Cordyceps, coated with Cinnabar, 3 qian)
Ejiao (Donkey-hide Gelatin, stir-fried with clam powder, 1.5 qian)
Lo Gou Luo (Luffa Fruit Fiber, 2 qian)
Huo Shan Shi Hu (Dendrobium officinale Stem, 3 qian)
Sheng Mu Li (Oyster Shell, raw, 8 qian)
Nen Bai Wei (Cibotii Rhizoma, tender, 1.5 qian)
Xian Zhu Ru (Fresh Bamboo Shavings, 2 qian)
Da Mai Dong (Ophiopogonis Radix, 2 qian)
Qing Long Chi (Fossilized Bones and Teeth, 3 qian)
Quan Gua Lou (Trichosanthis Fructus, sliced, 4 qian)
Xian Pi Pa Ye (Fresh Loquat Leaf, de-hairy and wrapped, 3 leaves)
Xian Sheng Di Huang (Fresh Rehmanniae Radix, 4 qian)
Chuan Bei Mu (Fritillariae Cirrhosae Bulbus, 2 qian)
Sheng Bai Shao (Paeoniae Radix Alba, raw, 1.5 qian)
Xiang Gu Ya Lu (Valerian Sprout Dew, added later, 0.5 jin)
External application: Jin Gu San (Golden Hoop Powder) and Chong He Gao (Harmonizing Paste), mixed with aged vinegar and white honey for topical application.
Second Visit: The pulse at the Chi position is fine and weak; at the Cun and Guan positions, it is wiry, fine, and rapid. The tongue body is red and crimson. Generalized body soreness and pain persist, especially in the waist and knees. Appetite is reduced. There is dry mouth but little desire to drink. Stool is dry and constipated; urine is pale yellow. The breast cancer remains swollen and hard without subsiding. This is all due to the depletion of Yin fluids, blood failing to nourish the sinews, and blood deficiency generating internal heat. Heat in the sinews causes sourness/aching; heat in the collaterals causes pain. Furthermore, the Liver governs the sinews of the whole body. Without blood nourishment, deficient Yang floats easily. Abdominal distension also results from Liver Qi stagnation and heat constraint, leading to dysfunction of the descending and diffusing actions of the Yangming channels. To clear collateral heat, one must nourish Yin; to soften the Liver, one must nourish Blood. Once blood volume is sufficient, collateral heat will naturally clear, and limb/joint pain should alleviate.
American Ginseng Radix et Rhizoma (decocted separately, juice taken to mix, 2 qian)
Sheng Mu Li (Oyster Shell, raw, 8 qian)
Ejiao (Donkey-hide Gelatin, stir-fried with clam powder, 1.5 qian)
Huo Shan Shi Hu (Dendrobium officinale Stem, 3 qian)
Qing Long Chi (Fossilized Bones and Teeth, 2 qian)
Ling Yang Pian (Antelope Horn Slice, decocted separately, juice taken to mix, 0.4 qian)
Da Mai Dong (Ophiopogonis Radix, 3 qian)
Sheng Bai Shao (Paeoniae Radix Alba, raw, 2 qian)
Nen Bai Wei (Cibotii Rhizoma, tender, 1.5 qian)
Xian Sheng Di Huang (Fresh Rehmanniae Radix, 4 qian)
Tian Gua Zi (Benincasae Semen, 3 qian)
Xian Zhu Ru (Fresh Bamboo Shavings, 2 qian)
Nen Sang Zhi (Toona Sinensis Branch, tender, 1 liang)
Si Gua Luo (Luffa Fruit Fiber, 5 qian; these two ingredients decocted to replace water)
Separately: Zhen Zhu Fen (Pearl Powder, 0.2 fen), decocted with Nen Gou Teng (Uncaria rhynchophylla Caulis cum Uncis, tender, 3 qian) and a gold vessel, taken with the decoction.
Third Visit: Generalized body soreness and pain, especially in the waist and knees. Urine is yellow, stool is constipated. Appetite is reduced, dry mouth with little desire to drink. Breast cancer remains swollen and hard. This is due to Yin fluid depletion and blood failing to nourish the sinews. Heat in sinews causes sourness; heat in collaterals causes pain. The condition is complex and mixed, making rapid recovery unlikely. Again, we propose nourishing blood and clearing collaterals.
American Ginseng Radix et Rhizoma (2 qian)
Ling Yang Pian (Antelope Horn Slice, decocted separately, juice taken to mix, 0.8 fen)
Hei Zhi Ma (Sesamum indicum Seed, 3 qian)
Huo Shan Shi Hu (Dendrobium officinale Stem, 3 qian)
Zuo Mu Li (Oyster Shell, 8 qian)
Qing Long Chi (Fossilized Bones and Teeth, 3 qian)
Ejiao (Donkey-hide Gelatin, stir-fried with clam powder, 2 qian)
Da Di Long (Pheretima, washed with wine, 3 qian)
Da Mai Dong (Ophiopogonis Radix, 2 qian)
Sheng Bai Shao (Paeoniae Radix Alba, raw, 1.5 qian)
Nen Sang Zhi (Toona Sinensis Branch, tender, 1 liang)
Shou Wu Teng (Polygoni Multiflori Caulis, 3 qian)
Xian Sheng Di Huang (Fresh Rehmanniae Radix, 4 qian)
Chuan Bei Mu (Fritillariae Cirrhosae Bulbus, 5 qian)
Tian Gua Zi (Benincasae Semen, 3 qian)
Si Gua Luo (Luffa Fruit Fiber, 5 qian; these two ingredients decocted to replace water)
Separately: Zhen Zhu Fen (Pearl Powder, 0.2 fen), decocted with Zhu Deng Xin (Acori Tatarinowii Rhizoma stem core, dyed with cinnabar, 2 bundles) and a gold vessel, taken with the decoction.
Fourth Visit: Onset of breast cancer involves deficiency of Yin and Blood. Liver Yang transforms into Wind entering the collaterals, causing limb/joint soreness and pain. Palpitations and rebellious Qi occur, fluctuating in severity. Voice is low and not resonant. Tongue body is bare and red; coating is thin, greasy, and yellow. Pulse is wiry and rapid on the left, soggy and rapid on the right. The condition is complex and mixed; we fear exacerbation. Temporarily, we propose nourishing the Liver substance to soften Liver Wood, calming the Spirit, and resolving Phlegm-Heat.
American Ginseng Radix et Rhizoma (1.5 qian)
Bai Shen Fu Shen (Poria with Stimulating Cordyceps, coated with Cinnabar, 3 qian)
Chuan Xiang Bei (Fritillariae Cirrhosae Bulbus and Fritillariae Thunbergii Bulbus, each 2 qian)
Bai Zi Ren (Biota Seed, 3 qian)
Hei Zhi Ma (Sesamum indicum Seed, 3 qian)
Huo Shan Shi Hu (Dendrobium officinale Stem, 3 qian)
Qing Long Chi (Fossilized Bones and Teeth, 3 qian)
Gua Lou Pi (Trichosanthis Pericarpium, 2 qian)
Feng Huang Yi (Silkworm Cocoon Skin, 1.5 qian)
Ye Jiao Teng (Polygoni Multiflori Caulis, 4 qian)
Zhen Zhu Mu (Mother of Pearl, 6 qian)
Sheng Di Huang (Rehmanniae Radix, stir-fried with clam powder, 3 qian)
Nen Gou Teng (Uncaria rhynchophylla Caulis cum Uncis, tender, added later, 3 qian)
Qiang Wei Hua Lu (Rose Flower Dew, 1 liang)
Xiang Dao Ye Lu (Fragrant Rice Leaf Dew, 4 qian, added later)
Separately: Zhen Zhu Fen (Pearl Powder, 0.2 fen), decocted with Zhu Deng Xin (Acori Tatarinowii Rhizoma stem core, dyed with cinnabar, 2 bundles), taken with the decoction.
Ms. Wang: Liver Qi stagnation leads to unsmooth flow of Wood Qi, carrying Phlegm and Blood Stasis to coagulate. The breast belongs to the Stomach channel, and the nipple belongs to the Liver channel. The collaterals of the Liver and Stomach channels are obstructed and cannot diffuse and communicate. A lump has formed in the breast, persisting for three to four months, painful upon pressure. We fear it may develop into breast cancer (Ru Yan). Temporarily, we propose clearing Liver stagnation and resolving Phlegm-Stasis, using Che Xiao Tong Qi Yin combined with Xiao Yao San, modified.
Quan Dang Gui (Angelicae Sinensis Radix, 2 qian)
Jing Chi Shao (Paeoniae Radix Rubra, 2 qian)
Yin Chai Hu (Stellariae Radix, 0.8 fen)
Bo He Ye (Menthae Haplocalycis Folium, 0.8 fen)
Qing Chen Pi (Citri Reticulatae Pericarpium Viride and Citri Reticulatae Pericarpium, each 1 qian)
Ku Jie Geng (Platycodonis Radix, 1 qian)
Quan Gua Lou (Trichosanthis Fructus, sliced, 4 qian)
Zi Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma, 2 qian)
Sheng Xiang Fu (Cyperi Rhizoma, raw, 2 qian)
Da Bei Mu (Fritillariae Thunbergii Bulbus, 3 qian)
Zhi Jiang Can (Bombyx Batryticatus, honey-fried, 3 qian)
Si Gua Luo (Luffa Fruit Fiber, 2 qian)
Qing Ju Ye (Citri Reticulatae Folium Viride, 1.5 qian)