暴怒、或儿口气所吹，痛肿者，疏肝行气。
肿 痛甚者，清肝消毒。 痛发寒热者，发散表邪。
未成脓者，疏肝行气。不作脓或不溃，托里为主。
溃而不敛，或脓清者，大补气血。
一妇禀实性躁，怀抱久郁，左乳内结一核不消，按之微痛，以连翘饮子，二十余剂少
退；更以八珍汤，加青皮、桔梗、香附、贝母，二十余剂而消。
一妇发热作渴，至夜尤甚，两乳忽肿，服败毒药热反炽，诊之，肝脉洪数，乃热入血室。
以加味小柴胡治之，热止肿消。
一妇两乳内时常作痛，口内常辣，卧起若急，脐下牵痛，以小柴胡加青皮、黄连、栀
子而愈。
一妇郁久，左乳内结核如杏许，三月不消，心脉涩，脾脉大，按之多力，以八珍汤
加贝母、远志、香附、柴胡、青皮、桔梗，五十余剂而溃，又三十余剂而愈。
一妇久郁，右乳内结三核，年余不消，朝寒暮热，饮食不甘，此乳岩也，乃七情所伤，肝
经血气枯槁之证，宜补气血，解郁结。遂以益气养荣汤，百余剂，血气渐复；更以木香饼灸
之，嘉其谨疾而消。
一妇脓成不溃，胀痛，予欲针之，令毒不侵展，不，又数日，痛极始针，涌出败毒三四
碗，虚证蜂起，几殆，用大剂补之，两月余始安。
夫乳者有囊橐，有脓不针，则遍患诸囊矣，少壮者得以收敛，老弱者多致不救。
一妇肿而不作脓，以益气养荣汤加香附、青皮，数剂脓成，针之，旬日而愈。
一妇右乳肿，发热，怠惰嗜卧，无气以动，至夜热尤甚，以补中益气汤兼逍遥散而痊。
一产妇因乳少，服药通之，致乳房肿痛而胀，发热作渴，状若伤寒，以玉露散而愈。
夫乳汁，气血行化者，在上为乳，在下为经。若冲任脉盛，脾胃气壮，则乳汁多而浓；
血衰，则少而淡，所乳之子，亦弱而多病，此自然之理也。亦有屡产有乳，再产无乳，或
大便涩滞，乃亡津液也。《三因论》云∶产妇乳脉不行有二，有气血盛，闭而不行者，有
气血弱，涩而不行者。虚当补之，盛当疏之。盛者，当用通草、漏芦、土瓜根辈，虚者，当
用炼成钟乳粉、猪悬蹄、鲫鱼之类，概可见矣。亦有乳汁不止者，多属于虚不约束也。
一妇乳痈愈后发热，服养气血药不应，八珍汤加炮干姜，四剂而愈；仍以前汤加黄 、
香附，三十余剂而安。
一妇乳痈脓成，针刺之及时，不月而愈。
一妇因怒两乳肿，兼头痛寒热，以人参败毒散，二剂表证以退；以小柴胡加芎归、桔梗、
枳壳，四剂而痊。
一妇郁久，乳内结核，余年不散，日晡微热，饮食不思，治以益气养荣汤，嫌缓，乃
服行气之剂，势愈甚，溃而日出清脓不止，复求治。诊之脉洪而数，辞不治，又年余，果殁。
一妇产次子而无乳，服下乳药，但作胀。予谓∶乳皆血气所化，今胀而无乳，是气血
竭而津液亡也，当补气血，自有乳矣。与八珍汤，倍加参术，少加肉桂，二十余剂，乳遂生。
后因劳役伤竭。
盖初产有乳，再而无，其气血只给一产耳，其衰可知。间有产后乳出不止，亦为气虚，宜
补药止之。其或断乳，儿不吮亦能作胀，用麦芽炒为末，白汤调服，以散之。若儿吮破乳头，
成疮，用蒲公英末或黄连胡粉散掺之，若乳头裂破，以丁香末或蛤粉、胭脂末敷之，并效。
一妇郁久，右乳肿硬，以八珍汤加远志、贝母、柴胡、青皮，及隔蒜灸，兼服神效栝蒌
散，两月而消。
一妇左乳内肿如桃许，不痛，色不变，发热，渐消瘦，以八珍汤加香附、远志、青皮、
柴胡，百余剂，又间服神效栝蒌散，三十余剂，脓溃而愈。
患者或责效大速，或不戒七情，俱难治。大抵四十余后者，尤难治，盖因阴血日虚也。况医
用药，不分经络虚实，未有能保痊也。
一妇乳内肿一块，如鸡子大，劳则作痛，久而不消，服托里药不应，此乳劳证也，肝经血
少所致。先与神效栝蒌散，四剂，更隔蒜灸，肿少退；再服八珍汤，倍加香附、夏枯草、蒲
公英，仍间服前散，月余而消。
又有乳疽一证，肿硬木闷，虽破而不溃，肿亦不消，尤当急服此散，及隔蒜灸。此二证，
乃七情所伤，气血所损，亦荣证也。宜戒怒，节饮食，慎起居，否则不治。
一妇年逾二十，禀弱，乳内作痛，头疼脉浮，与人参败毒散，倍参，一剂表证悉退，但
饮食少思，日晡微热，更以小柴胡同六君子，二剂热退食进，方以托里药加柴胡，十余剂，针出
脓而愈。
一妇亦患此，予谓须多服养气血、解郁结药，可保无害，不信，乃服攻伐之剂，及大如碗
口，出脓乃清，
不敛而没。
一妇因怒左乳作痛，内肿发热，表散太过，致热益甚，以益气养荣汤，数剂热止，脓成
痛，针之，不从，遂肿胀大热发渴，始针，脓大泄，以前汤百余剂始愈。
一人因怒左乳肿痛，肝脉弦数，以复元通气散，二剂少愈，以柴胡汤加青皮、芎归而消。
一后生作劳风寒夜发热，左乳痛，有核如掌，脉细涩而数，此因阴滞于阳也，询之，以酒
得，遂以栝蒌子、石膏、干葛、川芎、白芷、蜂房、生姜同研，入酒饮之，四帖而安。
夫乳头厥阴所经，乳房阳明所属。厥阴者，肝也，乃女子致命之地，宗筋之所，且各有
囊橐，其始 肿虽盛，受患止于一二橐，若脓成不刺，攻溃诸囊矣。壮者犹可，弱者多致不
救，所以必针而后愈。用蒲公英、忍冬藤少入酒煎服，即欲睡，是其功也，及觉而病安矣。
未溃，以青皮加栝蒌、桃仁、连翘、川芎、橘叶、皂角刺、甘草节，随证加减煎服。已溃，以
芎、归、参、 、白芍、青皮、连翘、栝蒌、甘草节煎。
一妇乳痈，气血颇实，但疮口不合，百法不应，与神效栝蒌散，四帖少可，更与四帖，
及豆豉饼灸而愈。
一妇乳痈，寒热头痛，与荆防败毒散一帖，更以蒲公英一握，入酒二三盏，再捣，取酒热
服，渣热罨患处而消。此因头痛发热，乃表证也，故用表散。蒲公英俗呼孛孛丁，夏秋间开黄
花似菊，散热毒，消肿核，散滞气，解金石毒圣药。乳硬，多因乳母不知调养所致，或忿怒所逆，
郁闷所遏，浓味所酿，以致厥阴之气不行，故窍闭而汁不通，阳明之血沸腾，故热甚而化脓。
或因乳子膈有滞痰，含乳而睡，口气 热所吹，而成结核，初便忍痛，揉软吮令汁透可散，否
则结成矣。治以青皮疏厥阴之滞，石膏清阳明之热，生甘草节行浊滞之血，栝蒌子导毒消肿，
或加没药、青橘叶、皂角刺、金银花、当归，或汤或散，佐以少酒，若加艾火两三
壮于痛处尤妙。粗工便用针刀，必惹崛病。
Anger, or being blown by an infant's breath, causing pain and swelling in the breast: treat with soothing the Liver and promoting Qi circulation.
If swelling and pain are severe: clear the Liver and detoxify.
If pain is accompanied by chills and fever: disperse exterior pathogens.
If pus has not yet formed: soothe the Liver and promote Qi circulation.
If pus does not form or does not ulcerate: focus on supporting the interior (Zang-Fu) to expel toxins.
If ulcerated but not healing, or if pus is thin: greatly tonify Qi and Blood.
A woman with a robust constitution and irritable temperament, suffering from long-term emotional depression, had a lump in her left breast that did not resolve; it was slightly tender upon palpation. She took Lianqiao Yin (Forsythia Decoction) for over twenty doses, resulting in slight improvement; subsequently, she took Bazhen Tang (Eight-Treasure Decoction) with added Qingpi (Green Tangerine Peel), Jiegeng (Platycodon Root), Xiangfu (Cyperus Rhizome), and Beimu (Fritillaria Bulb). After another twenty-plus doses, the lump disappeared.
A woman experienced fever and thirst, worse at night, with sudden swelling of both breasts. After taking detoxifying herbs, her heat intensified. Her Liver pulse was surging and rapid, indicating Heat entering the Blood Chamber (Xueshi). Treatment with Jiawei Xiaochaihu Tang (Modified Minor Bupleurum Decoction) stopped the fever and reduced the swelling.
A woman frequently experienced pain in both breasts, a spicy sensation in the mouth, and pulling pain below the umbilicus when rising or lying down hastily. She was cured using Xiaochaihu Tang (Minor Bupleurum Decoction) with added Qingpi, Huanglian (Coptis Rhizome), and Zhizi (Gardenia Fruit).
A woman with long-term depression had a tubercle in her left breast, the size of an apricot kernel, persisting for three months without resolution. Her Heart pulse was choppy, and her Spleen pulse was large and forceful upon pressure. She took Bazhen Tang with added Beimu, Yuanzhi (Polygala Root), Xiangfu, Chaihu (Bupleurum Root), Qingpi, and Jiegeng. After fifty-plus doses, it ulcerated; after another thirty-plus doses, she recovered.
A woman with long-term depression had three nodules in her right breast persisting for over a year. She experienced morning chills and evening fevers, and loss of appetite. This was Ruyan (Breast Cancer/Tumor), caused by emotional injury leading to exhaustion of Qi and Blood in the Liver Meridian. The treatment should tonify Qi and Blood and resolve stagnation. She took Yiqi Yangrong Tang (Qi-Nourishing and Spirit-Supporting Decoction) for over one hundred doses, gradually restoring Qi and Blood. Subsequently, Muxiang Bing Jiu (Musk-fragrant Cake Moxibustion) was applied. Due to her careful self-care, she recovered.
A woman had formed pus but did not ulcerate, experiencing distending pain. I intended to puncture it to prevent toxin spread, but she refused. Several days later, the pain became extreme, and puncture was performed. Three to four bowls of foul pus drained out. Deficiency syndromes arose rapidly, nearly causing death. Large doses of tonic herbs were used, and she stabilized after more than two months.
The breast contains sac-like structures. If pus forms and is not punctured, it will infect all sacs. Young and strong individuals may recover through contraction, but the old and weak often die.
A woman had swelling without pus formation. She took Yiqi Yangrong Tang with added Xiangfu and Qingpi. After several doses, pus formed. Puncture led to recovery within ten days.
A woman had right breast swelling, fever, lethargy, and weakness. Fever was worse at night. She recovered using Buzhong Yiqi Tang (Midway-Uplifting Qi-Boosting Decoction) combined with Xiaoyao San (Free Wanderer Powder).
A postpartum woman, due to low milk supply, took medication to promote lactation, resulting in breast swelling, pain, distension, fever, and thirst, resembling Taiyang disease (Exterior Syndrome). She was cured using Yulu San (Jade Dew Powder).
Breast milk is transformed from Qi and Blood. Above, it becomes milk; below, it becomes menstruation. If Chong and Ren meridians are vigorous and Spleen-Stomach Qi is strong, milk is abundant and thick. If Blood is deficient, milk is scant and thin, and the nursing child will be weak and prone to illness. This is natural law. Some women have milk after multiple births but none after subsequent ones, or experience constipation due to fluid depletion. *San Yin Lun* states there are two causes for blocked lactation: excess Qi and Blood causing blockage, or deficiency causing sluggish flow. Deficiency requires tonification; excess requires unblocking. For excess, use Tongcao (Tetrapanax Pith), Loulu (Radix Euphorbiae Humifusae), and Tuguagen (Radix Trichosanthis Kirilowii); for deficiency, use refined Zhongru Fen (Stalactite Powder), Zhu Xuanti (Swine Trotter Hoof), and Crucian Carp. There are also cases of excessive lactation, usually due to deficiency failing to constrain.
A woman had fever after recovering from Ru Yong (Breast Abscess). Tonifying Qi and Blood herbs were ineffective. Bazhen Tang with Paogansjiang (Pounded Dried Ginger) cured her in four doses. She then took the same formula with Huangqin (Scutellaria Root) and Xiangfu for thirty-plus doses to stabilize.
A woman with formed pus in Ru Yong was punctured promptly and recovered within a month.
A woman had bilateral breast swelling, headache, and chills/fever due to anger. Ren Shen Bai Du San (Ginseng Detoxifying Powder) resolved the exterior syndrome in two doses. Xiaochaihu Tang with Xiongkuai (Ligusticum Rhizome), Danggui (Angelica Sinensis), Jiegeng, and Zhike (Aurantii Fructus) cured her in four doses.
A woman had long-term depression with a breast tubercle persisting for over a year. She had afternoon low-grade fever and poor appetite. Treatment with Yiqi Yangrong Tang was deemed too slow, so she took Qi-moving herbs, worsening the condition. It ulcerated with continuous discharge of clear pus. Upon re-evaluation, her pulse was surging and rapid. I declined treatment. She died over a year later.
A postpartum woman had no milk after her second child. Taking lactation-promoting herbs only caused distension. I stated that milk is derived from Qi and Blood; distension without milk indicates exhaustion of Qi, Blood, and fluids. Tonification was needed. She received Bazhen Tang with doubled Renshen (Ginseng) and Baizhu (Atractylodes Macrocephala Rhizome), plus a little Rougui (Cinnamon Bark). After twenty-plus doses, milk appeared. Later, labor exhausted her again.
Generally, milk appears after the first birth but not the second, as Qi and Blood suffice only for one production; their decline is evident. Occasionally, postpartum lactation is excessive due to Qi deficiency; tonics should stop it. For weaning, if engorgement occurs without suckling, fried Maiya (Hordeum Vulgare Sprout) powder taken with warm water disperses it. If the nipple is broken by the infant, forming a sore, Pugongying (Dandelion) powder or Huanglian Hufen (Scutellaria and Lead White Powder) can be applied. For cracked nipples, Dingxiang (Clove) powder or Ge Fen (Concha Margaritifera) and Yanzhi (Vermilion) powder are effective.
A woman with long-term depression had hard swelling in her right breast. She took Bazhen Tang with Yuanzhi, Beimu, Chaihu, and Qingpi, along with Gexuanjiu (Garlic-Separated Moxibustion) and Shenzhou Gualou San (Miraculous Trichosanthes Powder). Resolution occurred in two months.
A woman had a peach-sized swelling in her left breast, non-tender, unchanged in color, with fever and gradual emaciation. She took Bazhen Tang with Xiangfu, Yuanzhi, Qingpi, and Chaihu for over one hundred doses, interspersed with Shenzhou Gualou San for thirty-plus doses. Pus drained, and she recovered.
Patients demanding rapid results or failing to regulate emotions are difficult to treat. Those over forty are especially difficult due to daily decline of Yin Blood. Physicians who do not distinguish between meridian patterns and deficiency/excess cannot ensure cure.
A woman had an egg-sized lump in her breast, painful upon exertion, persisting for a long time. Interior-supporting herbs failed. This was Ru Lao (Breast Labor/Chronic Breast Disease), caused by Liver Blood deficiency. She first took Shenzhou Gualou San for four doses, followed by garlic-separated moxibustion, reducing swelling slightly. Then she took Bazhen Tang with doubled Xiangfu, Xiakucao (Prunella Spike), and Pugongying, interspersed with the previous powder. Resolution occurred in over a month.
Another condition, Lu Ju (Breast Carbuncle), presents with hard, numb, and stifling swelling. Even if broken, it does not ulcerate or reduce swelling. Urgent administration of this powder and garlic-separated moxibustion are required. These two conditions result from emotional injury and Qi/Blood damage, belonging to Ying (Nutritive) disorders. Anger must be avoided, diet regulated, and lifestyle guarded; otherwise, they are incurable.
A woman over twenty, with weak constitution, had breast pain, headache, and floating pulse. Ren Shen Bai Du San with doubled Ginseng resolved the exterior syndrome in one dose. However, she had poor appetite and afternoon low-grade fever. Xiaochaihu Tang combined with Liujunzi Tang (Six-Gentlemen Decoction) stopped fever and improved appetite in two doses. Finally, interior-supporting herbs with Chaihu cured her in over ten doses after puncturing pus.
Another woman had this condition. I advised prolonged use of Qi/Blood tonics and emotion-resolving herbs to ensure safety. She refused, taking attacking/draining herbs instead. An abscess the size of a bowl opened, draining clear pus. She did not heal and died.
A woman had left breast pain, internal swelling, and fever due to anger. Over-dispersing exterior herbs worsened the heat. Yiqi Yangrong Tang stopped fever in several doses. When pus formed and pain persisted, she refused puncture. Swelling, intense heat, and thirst ensued. Puncture finally released large amounts of pus. She recovered after over one hundred doses of the previous formula.
A man had left breast swelling and pain due to anger. His Liver pulse was wiry and rapid. Fuyuan Tongqi San (Restoring Flow and Promoting Qi Powder) improved him in two doses. Chaihu Tang with Qingpi, Chuanxiong (Szechwan Lovage Rhizome), and Danggui resolved the condition.
A young man suffered night fever and left breast pain with a palm-sized nodule after labor and wind-cold exposure. His pulse was fine, choppy, and rapid. This was Yin stagnating in Yang. Inquiry revealed alcohol consumption. He took Gualouzi (Trichosanthes Seed), Shigao (Gypsum Fibrosum), Gange (Pueraria Lobata Root), Chuanxiong, Baizhi (Angelica Dahurica Root), Fengfang (Honeycomb), and Shengjiang (Fresh Ginger), ground together and drunk with wine. He stabilized after four doses.
The nipple belongs to the Jueyin Meridian (Liver), and the breast belongs to the Yangming Meridian (Stomach). Jueyin is the Liver, the vital organ for women, and the site of Zongjin (Sinews). Each has sac-like structures. Initial swelling, though severe, affects only one or two sacs. If pus forms and is not punctured, it attacks other sacs. Strong individuals may survive; the weak often die. Hence, puncture is necessary for cure. Pugongying (Dandelion) and Rendongteng (Japanese Honeysuckle Stem) decocted with a little wine induce sleep, demonstrating its efficacy. Upon waking, the patient is well.
Before ulceration: Qingpi, Gualou, Taoren (Peach Kernel), Lianqiao (Forsythia Fruit), Chuanxiong, Juye (Tangerine Leaf), Zaocispina (Gleditsia Spine), and Gancaojie (Licorice Joint) decocted with modifications.
After ulceration: Chuanxiong, Danggui, Renshen, Huangqi (Astragalus Root), Baishao (White Peony Root), Qingpi, Lianqiao, Gualou, and Gancaojie decocted.
A woman with Ru Yong had sufficient Qi and Blood but the wound would not close despite various methods. Shenzhou Gualou San improved her in four doses. Another four doses, plus Douchi Bing Jiu (Fermented Soybean Cake Moxibustion), cured her.
A woman with Ru Yong had chills, fever, and headache. Jingfang Bai Du San (Schizonepeta and Saposhnikovia Detoxifying Powder) was given for one dose. A handful of Pugongying was mixed with 2-3 cups of wine, pounded, and the hot wine drunk. The dregs were applied hot to the affected area, resolving the swelling. Headache and fever indicated an exterior syndrome, hence dispersing method was used. Pugongying (Dandelion), blooming yellow flowers like chrysanthemum in summer/autumn, clears heat-toxin, reduces swelling/nodules, moves stagnant Qi, and is a holy medicine for mineral poison. Hardness of the breast is often due to the mother's lack of care, anger, depression, or rich food, causing Jueyin Qi stagnation, blocking ducts and stopping flow. Yangming Blood boils, causing intense heat and pus formation. It can also result from phlegm-stagnation in the infant's diaphragm; sleeping while holding the breast and blowing hot breath creates tubercles. Initially, enduring pain and massaging/sucking to allow flow can disperse them; otherwise, they solidify. Treat with Qingpi to move Jueyin stagnation, Shigao to clear Yangming heat, raw Gancaojie to move turbid blood, and Gualouzi to guide out toxin and reduce swelling. Add Moyao (Myrrh), Qingjuye (Green Tangerine Leaf), Zaocispina, Jinyinhua (Honeysuckle Flower), or Danggui. Use decoction or powder, aided by a little wine. Adding 2-3 moxa cones to the painful spot is excellent. Crude practitioners using needles/knives inevitably cause stubborn diseases.