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[Chen] In women, milk flow that is sometimes patent and sometimes obstructed is caused by deficiency of Qi and Blood and irregularity of the meridians. Do not let milk fall to the ground, as insects and ants consuming it will cause the milk to cease. If milk overflows, it may be poured on the eastern wall (which is considered auspicious). Some postpartum women necessarily have milk; if the breasts are distended but milk secretion is insufficient, this is due to wind-heat in young women experiencing childbirth and lactation for the first time. Medicines that clear heat and promote diuresis should be taken to facilitate milk flow. If a woman has had multiple births yet still has no milk, it is due to the loss of body fluids. Tonifying and moistening medicines must be administered to stimulate production. If there is some milk but the quantity is insufficient, medicines that unblock the meridians should be used to promote flow, accompanied by meat broth as a vehicle. This is because women's milk originates from the Chong Mai (Penetrating Vessel) and connects with the Stomach Meridian. There are also cases where women who have had multiple births produce abundant milk, which is due to their robust Qi and Blood. Generally speaking, if a woman has chronic diseases affecting the Chong and Ren Mai (Conception Vessel), her milk will be scanty and yellowish, and her child will be frail and prone to illness.

[San Yin Fang] There are two types of obstructed milk ducts in postpartum women: one type involves excess Qi and Blood causing stagnation and obstruction; the other involves deficient Blood and weak Qi causing sluggish flow. Deficiency patterns require tonification, while excess patterns require dispersing. For excess patterns, Tong Cao (Tetrapanacis Medulla), Lou Lu (Euphorbiae Humifusae Herba), and Tu Gua Gen (Trichosanthis Radix) should be used. For deficiency patterns, refined Zhong Ru (Calcium Carbonatum), pig trotters, and crucian carp should be used. The distinction is evident.

[Xue] Regarding the aforementioned conditions, if Qi and Blood are deficient and unable to transform into milk, the Spleen and Stomach should be strengthened. If anger stirs the Liver and Gallbladder causing breast swelling and leakage, Liver Fire should be cleared. Milk is transformed from Qi and Blood; above it manifests as milk, below it manifests as menstruation. If there is no milk after multiple births or if stool is dry and difficult, the source of transformation should be nourished.

Lou Lu San (Euphorbia Humifusa Powder): Treats postpartum women with obstructed Qi and blood vessels, non-flowing milk, stagnant meridians, breast distension and pain, retention of pathogenic toxins, or formation of carbuncles. Taking this medicine naturally resolves internal stagnation and promotes milk flow.
Ingredients: Lou Lu (Euphorbiae Humifusae Herba, 2.5 liang), She Tui (Bombyx Batryticatus, 10 pieces, roasted), Gua Lou (Trichosanthis Fructus, 10 pieces, rapidly burned until charred outside but retaining internal properties).
Preparation and Administration: Grind the above ingredients into powder. Take 2 qian with warm wine at any time. Immediately after taking the medicine, consume pig trotter broth. The *Jing Yan Fang* (Experience Formula) includes Mu Li (Ostreae Concha), burned to retain properties. Another method uses only Mu Li powder mixed with wine.

Another Formula:
Kui Zi (Abutilonis Semen, stir-fried until fragrant) and Suo Sha Ren (Amomi Fructus Rotundus, equal parts).
Preparation and Administration: Grind into fine powder. Take 2 qian with hot wine. This formula nourishes Qi, blood vessels, Ying and Wei, and promotes fluid circulation. This is a formula by Zhang Buyu from Shangcai, commonly used and highly effective.

*Chan Bao* (Precious Prescriptions for Childbirth) treats postpartum absence of milk:
Tu Gua Gen (Trichosanthis Radix) and Lou Lu (Euphorbiae Humifusae Herba, each 3 liang), Gan Cao (Glycyrrhizae Radix et Rhizoma, 2 liang), Tong Cao (Tetrapanacis Medulla, 4 liang).
Preparation and Administration: Add 8 sheng of water, decoct to obtain 2 sheng. Divide into three warm doses. Observe usual dietary restrictions. Another version adds Gui Xin (Cinnamomi Ramulus) and grinds all into powder; take 1 fang cun bi with wine.

*Chan Shu* (Book of Childbirth) promotes milk flow:
Grind Tu Gua Gen (Trichosanthis Radix) into powder; take 1 qian mixed with wine, 3-4 times daily.

Another method to promote milk flow: Use 3 Jing San Leng (Przwalskii's Burreed Rhizome); add 2 bowls of water, decoct to 1 bowl. Use the liquid to wash the breasts and drink the juice. This is extremely effective.

Yong Quan San (Surging Spring Powder): A formula from Professor Shan Xiang of Chengdu. Treats postpartum absence of milk and also breast nodules and carbuncles.
Ingredients: Chuan Shan Jia (Manis Squama, washed, 1 liang, fried in ash until dry).
Preparation and Administration: Grind into fine powder. Take 1 fang cun bi mixed with wine.

*Bi Yong Fang* (Essential Formulas) states: Lou Lu (Euphorbiae Humifusae Herba) and Gua Lou (Trichosanthis Fructus) are essential medicines. Some say: eat more pig trotter broth. Wash Gua Lou seeds thoroughly, stir-fry until fragrant and cooked, crush to extract the kernels, spread them on tiles until white, grind into fine powder. Take 1 qian with warm wine. After taking, lie face down for a short while. If ineffective, repeat.
Another method: One Gua Lou (Trichosanthis Fructus), mash熟ly, boil in 1 dou of white wine to obtain 4 sheng. Remove dregs and drink 1 sheng warm, three times daily.

Cheng Lian Zhong Ru San (Refined Calcium Carbonatum Powder): Treats postpartum women with deficient Qi and depleted Blood, sluggish pulse, and very scanty milk.
Ingredients: Cheng Lian Zhong Ru Fen (Refined Calcium Carbonatum Powder, finely ground).
Preparation and Administration: Take 2 qian mixed with strong decoction of Lou Lu Tang (Euphorbia Humifusa Decoction).

*Ling Yuan* (Spirit Garden) immediate-effect formula for promoting milk flow:
Jing Mi (Oryzae Glutinis Semen), Nuo Mi (Oryzae Glutinosa Semen, each half he), Wo Ju Zi (Lactucae Semen, one he, thoroughly washed), Sheng Gan Cao (Raw Glycyrrhizae Radix et Rhizoma, half liang).
Preparation and Administration: Add 2 sheng of water, decoct to obtain 1 sheng. Remove residue and divide into three doses. Effect is immediate.

Another method: One pair of pig trotters, Tong Cao (Tetrapanacis Medulla, 4 liang). Add 1 dou of water, cook into a soup/congee. Highly effective.

[Xue] A postpartum woman with scanty milk took medicines to promote flow, resulting in breast swelling, fever, and thirst. I diagnosed this as Qi and Blood deficiency and treated her with Yu Lu San (Jade Dew Powder) to tonify, leading to recovery.

Yu Lu San (Jade Dew Powder): Treats obstructed milk ducts, severe body heat and pain, dizziness and headache, and dry/stiff stool.
Ingredients: Chuan Xiong (Ligustici Chuanxiong Rhizoma), Jie Geng (Platycodonis Radix), Bai Zhi (Angelicae Dahuricae Radix, each 2 qian), Shao Yao (Paeoniae Radix Alba), Dang Gui (Angelicae Sinensis Radix, each 1.5 qian), Ren Shen (Ginseng Radix), Bai Fu Ling (Poria), Gan Cao (Glycyrrhizae Radix et Rhizoma, each 1 qian).
Preparation and Administration: One dose. Add 2 zhong of water, decoct to 1 zhong. Take after meals. If head heat is severe or constipation exists, add Da Huang (Rhei Radix et Rhizoma, 3 qian).

Luo Shi Yong Quan San (Luo's Surging Spring Powder): Treats women with scanty milk due to extreme Qi deficiency.
Ingredients: Qu Mai Sui (Dianthi Caulis et Flos), Mai Men Dong (Ophiopogonis Radix, heart removed), Long Gu (Fossilia Ossis Mastodi et Scapulae), Chuan Shan Jia (Manis Squama, processed until yellow), Wang Bu Liu Xing (Vaccariae Semen, equal parts).
Preparation and Administration: Grind into fine powder. Take 1 qian with hot wine, followed by a small amount of pig trotter broth. Additionally, comb both breasts left and right with a wooden comb 20-30 times. Take three times daily, following the previous methods.

Another method: Treats scanty milk.
Ingredients: Gua Lou Gen (Trichosanthis Radix) and Bo He Gan Shen (Menthae Haplocalycis Herba dried stem, equal parts).
Preparation and Administration: Grind into coarse powder. First drink one bowl of Yang Ti Zhi (Shepherd's Purse Juice), then take the medicine, followed by a small amount of scallion and mutton soup. Effect is immediate.

A case of a woman with non-flowing milk for seventeen days, unresponsive to various medicines, occurred when someone gifted a dou of red beans. She frequently boiled them into porridge and ate them. That night, her milk ducts became patent.

Another method: Mai Men Dong (Ophiopogonis Radix) in any quantity, remove heart, roast and grind into powder. Grind Xi Jiao (Rhinocerotis Cornu) with wine to about 1 qian. Mix the warm rhinoceros horn wine with 2 qian of Ophiopogon powder and take. Within two doses, milk will flow.

[Milk Self-Flow]
[Chen] Postpartum spontaneous milk flow is generally caused by bodily deficiency. Tonifying medicines should be taken to stop it. If the breasts are full, warm, tight, and painful, apply warm cloth compresses. *Chan Bao* discusses this condition but provides no formula. If this symptom occurs, Lou Lu San (Euphorbia Humifusa Powder) can also be used. Spontaneous milk flow before delivery is called "Ru Qi" (Milk Weeping); children born under such circumstances often do not survive. This topic is not discussed in classical texts.

[Xue] For the aforementioned conditions, if Qi and Blood are both deficient, use Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction). If Liver Meridian Blood Heat exists, use Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder). If Liver Meridian Fire Anger exists, use Si Wu Tang (Four Substances Decoction) plus Ren Shen (Ginseng), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Chai Hu (Bupleuri Radix), and Zhi Zi (Gardeniae Fructus). If Liver-Spleen Depression and Anger exist, use Jia Wei Gui Pi Tang (Modified Restore the Spleen Decoction). A postpartum woman who overexerted herself suddenly experienced gushing milk, unconsciousness, and phlegm vomiting. This was a Jue syndrome due to Yang Qi deficiency. She revived after being灌ed with Du Shen Tang (Single Ginseng Decoction) and stabilized after several doses of Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction). If a woman's Qi and Blood are vigorous, causing breast distension, or pain/fullness due to lack of infant suckling, accompanied by aversion to cold and fever, use 2-3 liang of Mai Ya (Hordei Fructus Germinatus), stir-fried, decocted in water. It dissipates immediately. Its ability to dissipate Qi and Blood is so strong; why is it widely used in formulas for Spleen-Stomach weakness and indigestion?

Lou Lu San (See above.)