证
妇人乳汁不通有二种∶有血气壅盛，乳脉涩而不行者；有血气虚弱，乳脉绝少者。夫虚者补之，
以钟乳粉、猪蹄、鲫鱼之类；盛者行之，用通草、漏芦之类。
乳硬者，多因乳母不知调养所致。盖乳房阳明之经，乳头厥阴所属。忿怒所逆，郁闷所遏，浓味
所酿以成。厥阴之气不行，故窍闭而汁不通；阳明之血沸腾，故热甚而化为脓。或因所乳之子，膈
有滞痰，含乳而睡，口气炊热所致。而成结核，初便忍疼，揉令核软，吮令汁透则散，否则结成矣。
治
治以青皮，疏厥阴之滞，石膏清阳明之热，生甘草行污浊之血，栝蒌子消导肿毒，或加没药、青橘叶、
皂角刺、金银花、当归尾，或散或汤，须以少酒佐之。若加艾火三壮，于痛处灸之，尤妙。华元化灸三
里穴三壮，甚妙。
乳岩始有核，肿如棋子之大，不痛不痒，五七年方成疮。初便宜多服疏气行血，须情思如意则可愈。
如成疮之后，则如岩穴之凹，或如人口之唇，赤汁浓水浸淫，胸胁气攻疼痛，用五灰膏去其
蠹肉，生新血，渐渐收敛。此疾多生于忧郁积忿，中年妇人未破者尚可治，成疮者终不治。宜服十六味流气饮。
方
通乳汤
猪蹄（下节四双） 通草（二两） 川芎（一两） 穿山甲（十四片，炒） 甘草（一钱）
上用水五升，煮汁饮之。忌生冷，避风寒，夜卧不宜失盖，更以葱汤频洗乳房。
玉露饮 治产后乳脉不行，身体壮热疼痛，头目昏痛，此凉膈压热，下乳之剂也。
当归（一钱五分） 川芎（五钱） 白芍（一钱五分） 人参（二钱五分） 白芷（五钱）
白茯（二钱五分） 桔梗（炒，五钱） 甘草（二钱五分）
上锉，水煎服。如烦热甚，大便结，加大黄（一钱二分），金银花（三钱）；乳脉不行，结成痛肿疼
痛，加黄 、当归、金银花、甘草（各二钱半），入酒半钟，食后温服。
胡桃散 治妇人少乳，乳汁不行。
用胡桃仁去皮十个捣烂，入穿山甲炒末一钱，黄酒调服。
通草汤 治乳汁不通。
通草（七分） 瞿麦 柴胡 天花粉（各一钱） 桔梗（二钱） 木通 青皮 香白芷
赤芍 连翘 甘草（各五分）
上锉一剂，水煎细饮，更摩乳房。
连翘饮子（薛立斋传） 治乳内结核。
连翅 川芎 栝蒌仁（研） 皂角刺（炒） 橘叶 青皮（去白） 甘草节 桃仁（各一钱半）
上水煎，食远服。
最效散（刘柏亭传） 治妇人吹乳，神效。
螃蟹去足，用盖烧存性为末。每服二钱，黄酒下。
熨法膏（秘方） 治吹乳、乳痈，顿时立消。
葱连根捣烂，铺乳患处，上用瓦罐盛灰火盖葱上，一时蒸热，出汗即愈。
一方（刘前溪传） 治吹乳肿痛不可忍。
用生山药捣烂，敷上即消。消即去之，迟则肉腐。
消毒散〔批〕（按此方治吹乳乳痈之剂） 治吹乳、乳痈。憎寒壮热头痛
者，先服人参败毒一二剂，方可服此药。如无前证，即服本方二三剂。或肿不消，宜服托里药。
当归 白芷 青皮（炒） 天花粉 贝母 柴胡 僵蚕（炒） 金银花（各三钱）
上锉一剂，水煎服。
神效栝蒌散（薛五斋方） 治乳痈初起肿痛，及一切痈疽，或脓出后余毒，亦宜用之。
黄栝蒌（一个，用子多者） 当归（半两） 生甘草（半两） 没药（一钱，另研）
上酒、水各一钟，煎至八分，食后服。
十六味流气散 治乳岩，及痘后余毒作痈肿。
当归 川芎 白芍 黄 人参 官桂 浓朴 桔梗 枳壳 乌药 木香 槟榔 白芷 防风 紫苏 甘草
上锉各等分。水煎服。如乳痈，加青皮尤妙。
Syndrome
There are two types of lactation obstruction in women: one is caused by excessive blood and qi, leading to stagnation and涩 (astringent/stagnant) milk vessels where milk does not flow; the other is due to deficiency of blood and qi, resulting in very little milk in the milk vessels. For deficiency syndromes, tonification is used, employing substances such as Congru Pulvis (Ossis Mastodi), pig trotters, and crucian carp; for excess syndromes, promotion of flow is used, employing herbs such as Tongsao (Medulla Tetrapanacis) and Loulu (Radix Euphorbiae Humifusae).
Hardness of the breast often results from the nursing mother's failure to maintain proper regimen. The breast belongs to the Foot-Yangming Stomach Meridian, and the nipple is associated with the Foot-Jueyin Liver Meridian. Anger causes qi rebellion, depression causes qi obstruction, and rich flavors brew damp-heat, thereby forming the disease. When Jueyin qi fails to circulate, the orifices close and milk cannot pass; when Yangming blood boils, heat becomes severe and transforms into pus. It may also be caused by the infant being nursed having phlegm-stasis in the chest-diaphragm, sleeping while holding the nipple, and the hot breath blowing on it. This leads to the formation of nodules. Initially, one should endure the pain, massage until the nodule softens, and suckle until milk flows freely, which will dissipate the nodule; otherwise, it will harden into a mass.
Treatment
Use Qingpi (Pericarpium Citri Reticulatae Viride) to relieve stagnation in the Jueyin meridian, Shigao (Gypsum Fibrosum) to clear heat in the Yangming meridian, Sheng Gancao (Radix Glycyrrhizae Preparata) to move turbid blood, Gualouzi (Semen Trichosanthis) to resolve swelling and toxicity, or add Moyao (Resina Myrrhae), Qingjuye (Folium Citri Reticulatae), Zaojiaoci (Spina Gleditsiae Sinensis), Jinyinhua (Flos Lonicerae Japonicae), and Dangguwei (Radix Angelicae Sinensis Cum Cauda). These can be prepared as powders or decoctions, and must be taken with a small amount of wine as a vehicle. If three moxa cones are applied via moxibustion at the painful site, the effect is particularly excellent. Hua Yuanhua (Hua Tuo) applying three moxa cones to Zusanli (ST36) is also very effective.
Ru Yan (Breast Cancer) begins with a nodule the size of a chess piece, without pain or itching, which ulcerates after five to seven years. In the early stage, it is appropriate to take more herbs that regulate qi and promote blood circulation; recovery is possible if the patient maintains emotional well-being. After ulceration, the wound resembles a cave depression or everted lips, with red fluid and thick watery discharge oozing out, accompanied by qi-stabbing pain in the chest and hypochondrium. Use Wuhui Gao (Five Ashes Plaster) to remove necrotic tissue, generate new blood, and gradually promote healing. This disease often arises from chronic depression and accumulated anger. It is treatable in middle-aged women before ulceration, but incurable once ulcerated. One should take Shiliuwei Liuqi Yin (Sixteen-Ingredient Qi-Moving Decoction).
Formulas
Tongru Tang (Lactation-Promoting Decoction)
Zhu Ti (Pig Trotter, lower segment, four pairs), Tongcao (2 liang), Chuanxiong (1 liang), Chuanshanjia (14 slices, stir-fried), Gancao (1 qian).
Boil the above ingredients in five sheng of water and drink the juice. Avoid raw and cold foods, protect against wind and cold, ensure adequate covering during sleep, and frequently wash the breasts with scallion water.
Yulu Yin (Jade Dew Drink)
Treats postpartum lactation obstruction, high fever and body pain, dizziness and headache. This is a formula for cooling the diaphragm, clearing heat, and promoting lactation.
Danggui (1.5 qian), Chuanxiong (5 qian), Baishao (1.5 qian), Renshen (2.5 qian), Baizhi (5 qian), Baifu Ling (2.5 qian), Jiegeng (stir-fried, 5 qian), Gancao (2.5 qian).
Cut into pieces, decoct in water, and take orally. If烦热 (restlessness and heat) is severe and stool is constipated, add Dahuang (1.2 qian) and Jinyinhua (3 qian); if lactation is obstructed with painful swelling, add Huangqi (Astragali Radix), Danggui, Jinyinhua, and Gancao (each 2.5 qian), add half zhong of wine, and take warm after meals.
Hutao San (Walnut Powder)
Treats oligogalactia and lactation obstruction in women.
Take ten peeled walnut kernels, pound them into a paste, add one qian of powdered stir-fried Chuanshanjia, and take mixed with yellow wine.
Tongcao Tang (Tongcao Decoction)
Treats lactation obstruction.
Tongcao (0.7 qian), Qumai, Chaihu, Tianhuafen (each 1 qian), Jiegeng (2 qian), Mutong, Qingpi, Xiang Baizhi, Chishao, Lianqiao, Gancao (each 0.5 qian).
Cut into pieces for one dose, decoct in water, sip slowly, and simultaneously massage the breasts.
Lianqiao Yinzi (Lonicera Decoction, transmitted by Xue Lizhai)
Treats intramammary nodules.
Lianqiao, Chuanxiong, Gualou Ren (crushed), Zaojiaoci (stir-fried), Jiuye, Qingpi (deprived of white pith), Gancao Jie, Taoren (each 1.5 qian).
Decoct in water and take long after meals.
Zui Xiao San (Most Effective Powder, transmitted by Liu Boting)
Treats "blown breast" (acute mastitis) in women, with miraculous efficacy.
Remove the legs of a crab, roast the carapace until carbonized but retaining its nature, and powder it. Take 2 qian per dose, washed down with yellow wine.
Yifa Gao (Plaster for Fomentation, Secret Recipe)
Treats "blown breast" and Ru Yong (breast abscess), causing immediate resolution.
Pound green onions with roots into a paste, spread it over the affected breast area, cover with a clay pot containing hot ashes placed on top of the onions, steam until hot, and cure upon sweating.
One Prescription (Transmitted by Liu Qianxi)
Treats unbearable pain and swelling from "blown breast".
Pound fresh Dioscorea rhizome into a paste, apply externally. Remove immediately after resolution; delay leads to tissue rot.
Xiaodu San [Commentary] (Note: This formula treats "blown breast" and Ru Yong)
Treats "blown breast" and Ru Yong. For patients with aversion to cold, high fever, and headache, first administer Renshen Baidu San (Ginseng Detoxifying Powder) for one to two doses before taking this medicine. If these preceding symptoms are absent, take this formula for two to three doses. If swelling does not subside, use formulas to support interior and expel pus.
Danggui, Baizhi, Qingpi (stir-fried), Tianhuafen, Beimu, Chaihu, Jiangcan (stir-fried), Jinyinhua (each 3 qian).
Cut into pieces for one dose, decoct in water, and take orally.
Shenxiao Gualou San (Formula of Xue Wuzhai)
Treats initial swelling and pain of Ru Yong, as well as all kinds of carbuncles and sores, or residual toxins after pus discharge.
Quan Gualou (one whole fruit, preferably with many seeds), Danggui (0.5 liang), Sheng Gancao (0.5 liang), Moyao (1 qian, separately ground).
Decoct with one zhong of wine and one zhong of water until reduced to 0.8 zhong, and take after meals.
Shiliuwei Liuqi San (Sixteen-Ingredient Qi-Moving Powder)
Treats Ru Yan and carbuncles/swellings caused by residual toxins after smallpox/variolous eruptions.
Danggui, Chuanxiong, Baishao, Huangqi, Renshen, Guanzi Gui, Nongpo, Jiegeng, Zhike, Wuyao, Muxiang, Binglang, Baizhi, Fangfeng, Zisu, Gancao.
Cut into equal parts. Decoct in water and take orally. If treating Ru Yong, adding Qingpi is especially effective.