疠痈在乳旁生，结核红肿硬 疼，包络痰凝脾气郁，治宜温舒化坚凝。
【注】此证生于乳旁，初肿坚硬，形类结核，发长缓慢，渐增 肿，色红疼痛。由包
络寒痰，脾气郁结而成，系寒证非热证也。治宜温和舒郁化坚，以内补十宣散服之，外敷
回阳玉龙膏消之，如不消，脓势将成也。内外治法，即按痈疽肿疡、溃疡门。
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内补十宣散
人参 黄 当归（各二两） 桔梗 浓朴（姜制） 川芎 白芷 肉桂 防风 甘草（炙，各一两）
共研末，每服三钱，热黄酒调服。不饮酒者，木香煎汤调下。
【方歌】内补十宣诸肿毒，已成令溃未成消，参 桔朴芎归草，芷桂防风热酒调。
回阳玉龙膏（见肿疡门）
吹乳乳毒乳肿疼，内吹胎热痛 红，外吹子鼻凉气袭，寒热烦渴结肿疼。
【注】乳房属胃，乳头属肝，而有内吹、外吹之分。内吹者，怀胎六七月，胸满气上，
乳房结肿疼痛，若色红者，因多热也；不红者，既因气郁，且兼胎旺也。多热者，宜服
柴胡清肝汤；气郁者，宜服逍遥散，外俱敷冲和膏必消。或初肿失于调治，或本人复伤
气怒，以致大肿大痛，其势必欲成脓，宜用逍遥散加黄 、白芷、连翘以养血排脓治之。
脓溃之后，宜调养血气，待生产后，按溃疡治法，方得收口。妊娠用药禁忌，另有歌诀，
详载首卷。外吹者，由乳母肝、胃气浊，更兼子吮乳睡熟，鼻孔凉气，袭入乳房，与热
乳凝结肿痛，令人寒热往来，烦躁口渴。初宜服荆防牛蒡汤，外用隔蒜灸法；俟寒热退
仍肿者，服橘叶栝蒌散，外敷冲和膏消之。其肿消之不应者，将欲作脓，即用透脓散。其
余内服、外敷之法，俱按痈疽肿疡、溃疡门。
又有至如内未怀胎，外未行乳而生毒者，系皮肉为患，未伤乳房，此肝、胃湿热凝结而
成乳毒也，法当按疮疖治之，无有不效者。
荆防牛蒡汤
荆芥 防风 牛蒡子（炒，研） 金银花 陈皮 花粉 黄芩 蒲公英 连翘（去心） 皂刺
（各一钱） 柴胡 香附子 甘草（生，各五分）
水二盅，煎八分，食远服。
【方歌】荆防牛蒡乳外吹，寒热肿疼俱可推，银花陈草柴香附，花粉芩蒲翘刺随。
橘叶栝蒌散
橘叶（二十个） 栝蒌（量证用半个或一个） 川芎 黄芩 栀子（生、研） 连翘（去心） 石膏
（） 柴胡 陈皮 青皮（各一钱） 甘草（生，五分）
水二盅，煎八分，食远服，渣再煎服。紫肿 痛用石膏，红肿者去之。
【方歌】橘叶栝蒌吹乳证，凉袭热乳凝结
成，芎芩栀草连翘等，石膏柴与陈皮青。
柴胡清肝汤（见头部鬓疽）
逍遥散（见背部上搭手）
冲和膏 透脓散（俱见肿疡门）
隔蒜灸法（见首卷灸法内）
Li Yong (Leprous Carbuncle) arises beside the breast, presenting as a tubercle with redness, swelling, hardness, and pain. This is caused by the condensation of cold-phlegm in the pericardium collateral and the stagnation of Spleen Qi; treatment should focus on warming to disperse, soothing to relieve stagnation, and softening to resolve hard masses.
[Note] This condition occurs beside the breast. Initially, it presents as a hard, swollen lump resembling a tubercle, growing slowly. The swelling gradually increases, becoming red and painful. It is formed by cold-phlegm in the Pericardium Collateral and the stagnation of Spleen Qi; it is a Cold syndrome rather than a Heat syndrome. Treatment should employ mild methods to soothe stagnation and resolve hardness. Internally, Neibu Shixuan San (Internal Tonifying Ten-Insulation Powder) should be taken; externally, Huiyang Yulong Gao (Return-Yang Jade Dragon Ointment) should be applied to dissipate the mass. If the mass does not subside, it indicates that pus is about to form. The internal and external treatment methods follow those described in the sections on Carbuncles and Ulcers (Swelling/Ulcerated stages).
Neibu Shixuan San (Internal Tonifying Ten-Insulation Powder)
Ren Shen (Ginseng Radix), Huang Qi (Astragali Radix), Dang Gui (Angelicae Sinensis Radix) (each 2 liang), Jie Geng (Platycodonis Radix), Nong Po (Magnoliae Officinalis Cortex, processed with ginger), Chuan Xiong (Chuanxiong Rhizome), Bai Zhi (Angelicae Dahuricae Radix), Rou Gui (Cinnamomi Cortex), Fang Feng (Saposhnikoviae Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried) (each 1 liang).
Grind all into fine powder. Take 3 qian per dose, mixed with hot yellow wine. For those who do not drink alcohol, mix with decoction of Mu Xiang (Aucklandiae Radix).
[Fang Ge - Formula Song] Neibu Shixuan San treats various swellings and toxins; if pus has formed, it promotes drainage; if not yet formed, it resolves the swelling. It contains Ren Shen, Jie Geng, Hou Po, Chuan Xiong, Dang Gui, and Gan Cao, along with Bai Zhi, Rou Gui, and Fang Feng, taken with hot wine.
Huiyang Yulong Gao (See section on Swelling/Ulcerated Stage)
Chui Ru (Blowing Breast) involves breast toxins, swelling, and pain. "Nei Chui" (Internal Blowing) is caused by fetal heat, resulting in pain and redness. "Wai Chui" (External Blowing) is caused by the invasion of cool air from the infant's nostrils during suckling, leading to alternating chills and fever, irritability, thirst, and painful nodular swelling.
[Note] The breast belongs to the Stomach, and the nipple belongs to the Liver, hence the distinction between Nei Chui and Wai Chui. Nei Chui occurs during the sixth or seventh month of pregnancy, characterized by chest fullness and upward rushing of Qi, causing nodular swelling and pain in the breasts. If the area is red, it indicates excess Heat; if not red, it is due to Qi stagnation combined with vigorous fetal Qi. For cases with excess Heat, Chai Hu Qing Gan Tang (Bupleurum Liver-Clearing Decoction) is appropriate; for Qi stagnation, Xiao Yao San (Free and Easy Wanderer Powder) is appropriate, applied externally with Chonghe Gao (Harmonizing Ointment), which will surely dissipate the swelling. If initial swelling is neglected or if the patient suffers emotional injury (anger) again, leading to massive swelling and severe pain, pus formation is inevitable. In this case, use Xiao Yao San added with Huang Qi, Bai Zhi, and Lian Qiao to nourish blood and drain pus. After the pus drains, tonify Qi and Blood. After delivery, treat according to ulcer protocols to achieve healing. Contraindications for medication during pregnancy are detailed in another verse in Volume 1. Wai Chui results from turbid Qi in the Liver and Stomach of the nursing mother, compounded by cool air from the sleeping infant's nostrils invading the breast during suckling. This coagulates with hot milk, causing swelling, pain, alternating chills and fever, irritability, and thirst. Initially, Jing Fang Niu Bang Tang (Schizonepeta, Saposhnikovia, and Arctium Decoction) should be taken, with external application of Garlic-Separator Moxibustion. Once chills and fever subside but swelling persists, Ju Ye Gua Lou San (Citrus Leaf and Trichosanthes Powder) should be taken, with external application of Chonghe Gao. If the swelling does not resolve, indicating impending pus formation, Tou Nong San (Pus-Penetrating Powder) should be used immediately. Other internal and external treatments follow the sections on Carbuncles and Ulcers.
In cases where neither pregnancy nor lactation has occurred, yet a toxin arises, it is a disorder of the skin and flesh, not affecting the breast tissue itself. This is a "Ru Du" (Breast Toxin) caused by the condensation of Damp-Heat in the Liver and Stomach. It should be treated as a boil/furuncle, which is invariably effective.
Jing Fang Niu Bang Tang (Schizonepeta, Saposhnikovia, and Arctium Decoction)
Jing Jie (Schizonepetae Spica), Fang Feng (Saposhnikoviae Radix), Niu Bang Zi (Arctii Fructus, stir-fried and crushed), Yin Hua (Lonicerae Japonicae Flos), Chen Pi (Citri Reticulatae Pericarpium), Fen Hua (Trichosanthis Radix), Huang Qin (Scutellariae Radix), Pu Gong Ying (Taraxaci Herba), Lian Qiao (Forsythiae Fructus, heart removed), Zao Ci (Gleditsiae Spina) (each 1 qian), Chai Hu (Bupleuri Radix), Xiang Fu (Cyperi Rhizoma), Gan Cao (Glycyrrhizae Radix et Rhizoma, raw) (each 5 fen).
Add two cups of water, decoct to obtain eight-tenths of a cup. Take after meals.
[Fang Ge - Formula Song] Jing Fang Niu Bang Tang treats external blowing of the breast; alternating chills, fever, swelling, and pain can be addressed. It contains Yin Hua, Chen Pi, Gan Cao, Chai Hu, and Xiang Fu, accompanied by Fen Hua, Huang Qin, Pu Gong Ying, Lian Qiao, and Zao Ci.
Ju Ye Gua Lou San (Citrus Leaf and Trichosanthes Powder)
Ju Ye (Citri Reticulatae Folium) (20 leaves), Gua Lou (Trichosanthis Fructus) (dose according to condition: half or one fruit), Chuan Xiong (Chuanxiong Rhizome), Huang Qin (Scutellariae Radix), Zhi Zi (Gardeniae Fructus, raw and crushed), Lian Qiao (Forsythiae Fructus, heart removed), Shi Gao (Gypsum Fibrosum) (omit if absent), Chai Hu (Bupleuri Radix), Chen Pi (Citri Reticulatae Pericarpium), Qing Pi (Citri Reticulatae Pericarpium Viride) (each 1 qian), Gan Cao (Glycyrrhizae Radix et Rhizoma, raw) (5 fen).
Add two cups of water, decoct to obtain eight-tenths of a cup. Take after meals. Decoct the dregs again and take. Use Shi Gao if the swelling is purple and painful; omit Shi Gao if the swelling is red.
[Fang Ge - Formula Song] Ju Ye Gua Lou San treats blowing breast conditions caused by cool air invading and coagulating with hot milk. It contains Chuan Xiong, Huang Qin, Zhi Zi, Gan Cao, Lian Qiao, etc., along with Shi Gao, Chai Hu, Chen Pi, and Qing Pi.
Chai Hu Qing Gan Tang (See section on Temporal Furuncle)
Xiao Yao San (See section on Upper Back Hand Carbuncle)
Chonghe Gao, Tou Nong San (Both see section on Swelling/Ulcerated Stage)
Ge Suan Jiu Fa (Garlic-Separator Moxibustion Method) (See Moxibustion section in Volume 1)