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Xue Ji stated: The breast belongs to the Foot-Yangming Stomach Meridian, and the nipple belongs to the Foot-Jueyin Liver Meridian. In men, excessive sexual activity or anger damages the Liver and Kidney; in women, pregnancy, childbirth, or depression damages the Liver and Spleen. Both can lead to breast diseases. If swelling and pain are caused by violent anger or the breath of an infant, one should soothe the Liver and promote Qi circulation. If pain is accompanied by aversion to cold and fever, release the exterior pathogenic factors. For severe swelling and pain, clear the Liver and detoxify, and moxibustion with garlic partition is appropriate. If pus has not formed, soothe the Liver and promote Qi circulation. If pus does not form or the sore does not ulcerate, focus on supporting the interior to expel pus. If it ulcerates but does not heal, or if the pus is thin, focus on greatly tonifying the Qi and Blood of the Spleen and Lung.

Regarding treatment methods: If pain recurs after pus discharge, or if chills and fever occur, it indicates deficiency of Qi and Blood; use Shiquan Dabu Tang (Complete Great Tonifying Decoction). If there is fatigue and dry mouth, it indicates deficiency of Middle Qi; use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). If there is afternoon fever or internal heat, it indicates deficiency of Yin Blood; use Bazhen Tang (Eight-Treasure Decoction) added with Wuweizi (Schisandra Fruit). If there is nausea or vomiting, it indicates deficiency of Stomach Qi; focus on tonifying the Stomach, or use Xiangsha Liujunzi Tang (Aucklandia and Amomum Six-Gentlemen Decoction). If there is poor appetite and vomiting, it indicates deficiency-cold of Stomach Qi; add Ganjiang (Dried Ginger) to the previous formula. If there is poor appetite and diarrhea, it indicates deficiency-cold of Spleen Qi; use Lizhong Tang (Regulate the Middle Decoction) or add Renshen (Ginseng Root) and Fuzi (Prepared Aconite Root). If swelling and pain result from overwork, it indicates that Qi and Blood have not yet recovered; use Bazhen Tang with increased doses of Renshen, Baizhu (Atractylodes Macrocephala Rhizome), Danggui (Angelica Sinensis Root), and Shaoyao (White Peony Root). If swelling and pain result from anger, it indicates Liver Fire damaging Blood; use Bazhen Tang added with Chaihu (Bupleurum Root) and Zhizi (Gardenia Fruit). If there is induration due to Liver Fire and Blood deficiency, use Siwu Tang (Four-Substance Decoction) added with Chaihu and Shengma (Cimicifuga Rhizome). If there is induration due to joint deficiency of Qi and Blood in the Liver and Spleen, use Sijunzi Tang (Four-Gentlemen Decoction) added with Xiong (Ligusticum Chuanxiong Rhizome), Danggui, Chaihu, and Shengma. If induration results from depression injuring the Spleen, use Guipi Tang (Restore the Spleen Decoction) combined with Shenxiao Gualou San (Miraculous Efficacy Trichosanthes Powder). If swelling and pain are caused by an infant's breath, one must suckle to unblock and massage to disperse; otherwise, a carbuncle will form. If other symptoms coexist, treat according to the aforementioned methods. If a woman has induration due to depression and anger injuring the Liver and Spleen, which is neither itchy nor painful and only ulcerates after one or two years, it is called Ru Yan (Breast Rock/Cancer), which is the most difficult to treat.

Regarding another treatment method: If anger injures the Liver, and rich foods accumulate heat, causing Qi stagnation and orifice obstruction, leading to milk stasis, it condenses into Liver pain, which is Heat in the Blood of the Yangming channel. Severe cases result in flesh rotting into pus. Once pus forms, puncture it immediately to avoid the risk of widespread ulceration of multiple locules. There are also cases where the nursing child has phlegm-stagnation in the chest, hot breath, and falls asleep while sucking, blowing hot air into the breast, resulting in swelling and pain. At the initial stage, one must suckle to ensure patency or endure pain to massage it away; failure to treat promptly will inevitably lead to a carbuncle. Use Qingpi (Green Tangerine Peel) to relieve stagnation in the Jueyin channel, Shigao (Gypsum Fibrosum) to clear Heat in the Yangming channel, Gancao Jie (Licorice Knot) to move turbid blood, and Gualou Zi (Trichosanthes Seed) to reduce swelling and guide out toxins. Adding Moyao (Myrrh), Juye (Tangerine Leaf), Zaojiaozhen (Gleditsia Spine), Jinyinhua (Honeysuckle Flower), and Danggui is even more suitable; adjust the prescription based on the syndrome. Still, use a small amount of wine as an assistant, and apply moxibustion with garlic partition for particularly swift effects. If pus is present, puncture it; otherwise, after spontaneous rupture, healing will be difficult.

For Ru Yong (Breast Carbuncle), use Pugongying (Dandelion Herb) and Rendongteng (Honeysuckle Stem), decocted with a little wine. Sleepiness after ingestion indicates its efficacy; upon waking, the illness resolves. (See *Waike Xinfa*)

A woman suffered from Ru Yong with chills, fever, and headache. She was given one dose of Jingfang Baidu San (Elsholtzia and Saposhnikovia Powder to Overcome Toxins), followed by a handful of Pugongying mashed, mixed with two or three cups of wine, re-mashed, and the juice taken hot. The residue was applied hot to the affected area, leading to resolution. Danxi said: This herb dissipates heat and toxins, reduces swelling and nodules, disperses stagnant Qi, and is a holy medicine for resolving mineral poison toxicity.

A woman had a peach-sized swelling inside her left breast, without pain or color change, accompanied by fever and gradual emaciation. She took over 100 doses of Bazhen Tang added with Xiangfu (Cyperus Rhizome), Yuanzhi (Polygala Root), Qingpi, and Chaihu, and intermittently took over 30 doses of Shenxiao Gualou San. Pus discharged, and she recovered. It is common for patients to blame the slow effect, or fail to understand the role of Seven Emotions and medication, and neglect the differentiation of meridians and deficiency/excess; such cases are difficult to treat. Generally, this condition is especially difficult to treat in those over forty, because Yin Blood declines daily.

A woman experienced swelling, pain, and fever in her left breast due to anger. Excessive diaphoresis exacerbated the heat. After several doses of Yiqi Yangying Tang (Tonify Qi and Nourish Ying Decoction), the heat subsided and pus formed. She refused needle drainage, so the swelling, heat, and thirst worsened. Upon puncturing, a large amount of pus drained. She continued with the previous decoction and healed after more than a month.

A man had severe swelling, hardness, and pain in his left breast. Pain ceased after two doses of Xianfang Huoming Yin (Immortal Formula for Saving Lives Decoction). Pus formed after four doses of Shixuan San added with Qingpi, and he healed after puncture. If pus has formed but not ruptured, and a thin skin peels up at the sore head, apply a needle-inducing agent to raise the skin, cover with a plaster, and pus will discharge spontaneously. However, timely puncture prevents massive ulceration. If pus discharge is obstructed, add herbs that search for pus and resolve toxins. If muscle-regenerating agents are used before pus and blood are exhausted, they will instead aid the pathogen. Even if early closure occurs, recurrence is inevitable. One must be cautious.

A postpartum woman took medication to promote lactation, resulting in breast swelling, fever, and thirst resembling Taiyang disease. She recovered after being treated with Yulu San (Jade Dew Powder) to tonify. Milk is transformed from Qi and Blood; above it becomes milk, below it becomes menstruation. If the Chong and Ren vessels are vigorous and Spleen-Stomach Qi is strong, milk is abundant and rich; if weak, milk is scanty and thin, and the nursing child is weak and prone to illness. This is natural law. Some women who have had multiple births produce milk initially but cease later, or experience constipation due to fluid exhaustion. *Sanyin Lun* states there are two causes for blocked lactation: obstruction due to excess Qi and Blood, or sluggishness due to deficient Qi and Blood. Deficiency requires tonification; excess requires unblocking. For excess, use Tongcao (Tetrapanax Pith), Loulu (Radix Euphorbiae Humifusae), and Tuguagen (Root of Melon); for deficiency, use refined Zhongru Fen (Stalactitum) and foods like pig trotters and crucian carp. (All noted by Xue Ji)

A woman with long-term depression had three nodules in her right breast that did not resolve for over a year, accompanied by morning chills and evening fevers, and loss of appetite. This was Ru Yan. It is a syndrome of Liver Qi and Blood exhaustion caused by the Seven Emotions. Treatment should involve herbs that tonify Qi and Blood and resolve depression. She took over 100 doses of Yiqi Yangying Tang, gradually restoring Qi and Blood; then underwent moxibustion with Muxiang Bing (Costus Cake). Fortunately, she was diligent in her care, and the nodules resolved after over a year. If attacking agents were used, further damaging Qi and Blood, nothing could be preserved.

A maternal relative, a former palace maid, had a walnut-sized nodule in her breast. She rejected the previous formula and instead used Liuqi Yin and Baidu San from a surgeon. Three years later, it grew as large as an inverted bowl, hard as stone, wept fluid, failed to ulcerate, and she died. Generally, depression blocks Spleen Qi and reverses Liver Qi, forming hidden nodules that are neither itchy nor painful. People often ignore them, making them hardest to treat. If such a nodule appears, one must regulate the Seven Emotions, avoid rich foods, resolve depression, and treat with herbs that nourish Qi and Blood to preserve life; otherwise, it is incurable. Some ulcerate after several years and sink inward; all are called Ru Yan, likely because their shape resembles rock caves and they are highly toxic. With caution, one might save one or two out of ten. (Note by Xue Ji)