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Chen Yuangong stated: There are cases where the left breast suddenly swells to the size of a peach, without pain or redness of the skin, accompanied by fever and gradual emaciation. People attribute this to phlegm-qi stagnation. Little do they know it is due to Liver qi not flowing freely. The breasts belong to the Yangming channel; thus, breast swelling should typically be attributed to Yangming. Yet I exclusively attribute it to the Liver, which might raise doubts among people. This is because Yangming Stomach Earth most fears Liver Wood. When Liver qi is stagnant, the Stomach, seeing the stagnation of Wood, fears being overcome, acting timidly, hiding rather than manifesting. Since the breasts are near the hypochondrium—the domain of the Liver—and even when distant from the Liver, the qi shrinks back不敢 (dares not) flow freely, how much more so when adjacent to the Liver? It dares not expand its qi. Thus, qi stagnation leads to swelling, and the fear of expanding qi manifests as a lack of pain and redness, precisely reflecting this state of fear. The treatment does not need to target the Stomach; treating the Liver alone will cause the swelling to subside spontaneously. Use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder): Chai Hu (Bupleuri Radix) 2 qian, Bai Shao (Paeoniae Radix Alba) 5 qian, Chen Pi (Citri Reticulatae Pericarpium) 5 fen, Dang Gui (Angelicae Sinensis Radix), Gua Lou (Trichosanthis Fructus), Ban Xia (Pinelliae Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Fu Shen (Poria cum Radice et Lignum) each 3 qian, Ren Shen (Ginseng Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma), Chuan Xiong (Ligustici Chuanxiong Rhizoma) each 1 qian. Decoct in water and take orally. After ten doses, the swelling subsides internally. Removing Gua Lou and taking another ten doses prevents recurrence. This formula resolves Liver stagnation; once the Liver is resolved, the Stomach qi flows freely without specific intervention. Additionally, Gua Lou and Ban Xia specifically treat accumulated phlegm in the chest; removing the phlegm facilitates the resolution of the swelling. (From *Bing Jian*)

Chen Shigong stated: Ru Pi (Breast Mass/Lump) refers to nodules within the breast, shaped like pills or eggs, sometimes heavy and painful, sometimes painless, with unchanged skin color. The nodule grows or shrinks with emotions such as anger or joy. It is mostly caused by overthinking injuring the Spleen, and anger/irritation injuring the Liver, leading to stagnation.

Dou Hanqing stated: Nai Li (Milk Chestnut/Breast Lump) often occurs in girls aged fifteen or sixteen as their menstruation approaches, or if menstruation occurs twice a month or is delayed. It frequently affects those with weak constitutions and deficient qi and blood. If there is only one nodule on the breast, it is treatable; if it spreads into three or four, it is difficult to treat. Treatment should regulate menstruation and relieve stagnation, primarily using Xia Ku Cao (Prunellae Spica).

He also stated: Ru Pi often occurs in elderly people aged fifty or sixty. It does not suppurate; cooling medicines should not be applied externally or taken internally, as forcing the toxin into the zang-fu organs creates danger.

Feng Luzhan stated: Nai Li is the same as Ru Li, also known as Ru Pi. Cases that have ulcerated rarely heal. One must use large doses of Ren Shen (Ginseng Radix), Huang Qi (Astragali Radix), Dang Gui (Angelicae Sinensis Radix), and Bai Shao (Paeoniae Radix Alba) to tonify greatly and detoxify. Externally, Ding Xiang (Caryophylli Flos) powder should be applied. (From *Jin Nang*)

Shen Douyuan stated: In women near or past fifty years of age, with declining qi and blood and current emotional depression, nodules form in the breasts causing pain during cloudy weather, named Ru He (Breast Nodule). After a year or half, if they ulcerate and discharge profuse pus, failing to heal for a long time, it is named Ru Lou (Breast Fistula). (From *Qi Xuan*)

Tian Shi Qi stated: When a man's breast suddenly swells like a woman's, with severe pain upon pressure, and shows no improvement after years of treatment, it is due to Yangming toxic qi accumulating between the breasts. However, this toxin is not a sore toxin but a phlegm toxin. If it were a sore toxin, it would inevitably ulcerate externally over time. Since it persists swollen for years, it must be a phlegm toxin. The method should eliminate phlegm and unblock stasis, yielding results as swiftly as an echo. Use Huasheng Tongzhi Tang (Miraculous Transformation Decoction for Unblocking Stagnation) as the main prescription. The brilliance of this formula lies in Jin Yin Hua (Lonicerae Japonicae Flos) and Pu Gong Ying (Taraxaci Herba) entering the Yangming channel directly, assisted by herbs that clear phlegm and unblock stagnation. Fu Zi (Aconiti Lateralis Radix Praeparata) acts as a guiding herb, striking straight in, breaking all hardness. Why worry about the failure to resolve phlegm accumulation? Some doubt the use of Fu Zi due to its great heat, arguing that all pains belong to fire and thus it seems unsuitable. However, without Fu Zi, one cannot penetrate the utmost hardness. Moreover, Zhi Zi (Gardeniae Fructus) and Bai Shao (Paeoniae Radix Alba) possess sour and cold properties, which mitigate the fierce nature of Fu Zi despite its heat. Why then suspect it of being excessively hot? (From *Mi Lu*)