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[Chen] In general, when a woman's milk flows intermittently or is blocked, it is caused by deficiency of Qi and Blood and irregularity of the meridians. Do not let milk drop to the ground, as insects and ants may consume it, causing the milk to cease flowing. If milk overflows, it can be splashed on the eastern wall. Some women necessarily have milk after childbirth; if the breasts are distended but milk production 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 must be taken to facilitate milk flow. If there is no milk after multiple deliveries, it is due to the loss of body fluids. Medicines that nourish and moisten must be taken to stimulate secretion. If there is some milk but the volume is low, medicines that unblock the meridians must be taken to promote flow, accompanied by meat broth to guide the medicinal action. This is because women's milk relies on the Chong Mai (Penetrating Vessel) and connects with the Stomach Meridian. There are also cases where women who have delivered multiple times have abundant milk, which is naturally due to robust Qi and Blood. Generally, 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 blocked milk ducts in postpartum women: one type involves excess Qi and Blood causing stagnation and blockage, preventing milk flow; the other type involves scanty Blood and weak Qi causing涩 (astringency/stagnation) and lack of flow. Deficiency patterns require tonification, while excess patterns require dispersing. For excess patterns, Tongcao (Tetrapanax Pith), Loulu (Euphorbia Fissurana Root), and Tugua Gen (Cocculus Trifolius Root) should be used; for deficiency patterns, refined Zhongru Fen (Calcitriolum), pig trotters, and crucian carp should be used. The principles are thus 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 milk leakage, Liver Fire should be cleared. Milk is transformed from Qi and Blood; above it becomes milk, below it becomes menstruation. If there is no milk after multiple births, or if bowel movements are constipated, the source of transformation should be nourished.

Loulu San (Euphorbia Fissurana Powder): Treats qi and blood vessel obstruction in nursing women, blocked milk flow, meridian stagnation, breast distension and pain, retention of pathogenic toxins, or formation of abscesses. Taking this medicine naturally resolves internal stagnation and promotes milk flow.
Ingredients: Loulu (2.5 liang), Shetui (Snake Slough, 10 strips, roasted), Gualou (Trichosanthes Fruit, 10 pieces, quickly burned until charred but retaining efficacy).
Grind all ingredients into powder. Take 2 qian mixed with warm wine, at any time. Immediately after taking the medicine, consume pig trotter broth. The *Jingyan Fang* includes Muli (Oyster Shell), calcined. Another method uses only Muli powder mixed with wine.

Another Prescription:
Kuicaizi (Abutilon Seed, stir-fried until fragrant), Suosharen (Amomum Fruit, equal parts).
Grind into fine powder. Take 2 qian each time, mixed with hot wine. It nourishes Qi and Blood vessels, protects Wei Qi, and promotes fluid circulation. This is a formula by Zhang Buyu from Shangcai, commonly used with great efficacy.

*Chanbao* Formula for Postpartum Lack of Milk:
Tugua Gen (Cocculus Trifolius Root), Loulu (each 3 liang), Gancao (Licorice Root, 2 liang), Tongcao (Tetrapanax Pith, 4 liang).
Add 8 sheng of water, decoct to obtain 2 sheng. Divide into three warm doses. Observe usual dietary restrictions. Another version adds Guixin (Cinnamon Twig), grinds all into powder, and takes with wine using a "fangcun bi" measure.

*Chanshu* Formula for Promoting Milk Flow:
Tugua Gen powder, taken with wine, 1 qian per dose, 3-4 times daily.

Formula for Promoting Milk Flow: Use three Jing Sanleng (Burreed Rhizome), decoct in two bowls of water to obtain one bowl. Wash the breasts with this liquid and drink the juice. This is extremely effective.

Yongquan San (Surging Spring Powder): A formula by Professor Shan Xiang from Chengdu. Treats lack of milk after childbirth and also treats breast nodules and abscesses.
Shanjiapia (Pangolin Scale, washed, 1 liang, fried in ashes until dry). Grind into fine powder. Take a fangcun bi measure mixed with wine.

*Biyong Fang* states: Loulu and Gualou are essential herbs. Some suggest eating more pig trotter broth. For Gualou, extract the seeds, wash thoroughly, stir-fry until fragrant and cooked, crush to extract the kernels, spread on tiles until white, grind into fine powder. Take 1 qian mixed with warm wine. After taking, lie face down for a short while. If ineffective, repeat.

Another Method: One Gualou fruit, mashed ripe, boiled in one dou of white wine to obtain four sheng. Strain and take one sheng warm, three times daily.

Chenglian Zhongru San (Refined Calcitrium Powder): Treats nursing women with deficient Qi and declining Blood, sluggish pulse, and extremely scanty milk.
Refined Zhongru Fen (Calcitrium Powder, finely ground). Take 2 qian mixed with strong decoction of Loulu Tang.

*Lingyuan* Immediate Effect Formula for Promoting Milk Flow:
Jingmi (Rice Grain), Nuomi (Glutinous Rice, each half he), Wojuzi (Lettuce Seed, one he, all washed clean), Sheng Gancao (Raw Licorice Root, half liang).
Add two sheng of water, decoct to obtain one sheng. Strain and divide into three doses. Effect is immediate.

Another Method: One pair of pig trotters, Tongcao (4 liang). Boil in ten dou of water to make a soup/congee. Highly effective.

[Xue] A postpartum woman had scanty milk. After taking medicine to promote flow, her breasts became swollen, with fever and thirst. I diagnosed Qi and Blood deficiency and treated her with Yulu San (Jade Dew Powder) to tonify, resulting in recovery.

Yulu San: Treats blocked milk ducts, severe body heat and pain, dizziness and headache, constipation, etc.
Chuanxiong (Szechwan Lovage Rhizome), Jiegeng (Platycodon Root), Baizhi (Angelica Dahurica Root, each 2 qian), Shaoyao (Peony Root), Danggui (Chinese Angelica Root, each 1.5 qian), Renshen (Ginseng Root), Baifuling (Poria, each 1 qian), Gancao (Licorice Root, 1 qian).
Take as one dose. Add two zhong of water, decoct to one zhong. Take after meals. If head heat is severe or constipation exists, add Dahuang (Rhubarb Root) 3 qian.

Luo Shi Yongquan San (Luo's Surging Spring Powder): Treats women with extremely scanty milk due to Qi deficiency.
Qumai Sui (Dianthus Flower Spike), Maidong (Ophiopogon Tuber, heart removed), Longgu (Fossilized Bones), Shanjiapia (Pangolin Scale, processed until yellow), Wangbuliuxing (Vaccaria Seed, equal parts).
Grind into fine powder. Take 1 qian each time, mixed with hot wine, followed by a small amount of pig trotter broth. Additionally, comb both breasts left and right with a wooden comb 30-20 times. Take three times daily, following the previous methods.

Another Method: Treats scanty milk.
Gualou Gen (Trichosanthes Root), Bohe Qingshen (Mint Stem, dried, equal parts).
Grind into coarse powder. First drink one bowl of Yangti Zhi (Shepherd's Purse Juice), then take the medicine, followed by a little Congsi Yanggeng Tang (Scallion and Mutton Broth). Effect is immediate.

A patient had blocked milk flow for seventeen days with no effect from various medicines. Someone gave him one dou of Red Beans (Adzuki Beans). He frequently cooked them into porridge and ate them. That night, his milk flow resumed.

Another Method: Maidong (Ophiopogon Tuber) as needed, remove heart, roast and grind into powder. Mix with approximately 1 qian of Rhinoceros Horn (Xijiao) ground in wine. Warm the Rhinoceros Horn wine and mix with 2 qian of Maidong powder. Take. Within two doses, milk will flow.

[Milk Spontaneous Leakage]
[Chen] Postpartum spontaneous milk leakage is generally caused by bodily weakness. Tonifying medicines should be taken to stop it. If the breasts are full, warm, tight, and painful, apply warm cloth compresses. *Chanbao* discusses this condition but provides no formula. If this syndrome occurs, Loulu San can also be used. Spontaneous milk leakage before childbirth is called Ruqi (Breast Weeping); children born under this condition 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 Shiquan Dabu Tang (Ten Substance Great Tonifying Decoction). If Liver Meridian Blood Heat is present, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). If Liver Meridian Fire Anger is present, use Siwu Tang (Four Substance Decoction) plus Renshen, Baizhu, Chaihu, and Zhizi. If Liver-Spleen Depression and Anger are present, use Jiawei Guipi Tang (Modified Restore the Spleen Decoction). A postpartum woman suffered from overwork and suddenly had milk gushing out, accompanied by confusion and vomiting phlegm. This was Yang Qi deficiency leading to Jue (collapse). She revived after being administered Dushen Tang (Single Ginseng Decoction) and stabilized after several doses of Shiquan Dabu Tang. If a woman's Qi and Blood are flourishing, causing breast distension, or pain/fullness due to lack of infant suckling, accompanied by aversion to cold and fever, use 2-3 liang of Maiya (Sprouted Barley), stir-fried, decocted in water. The symptoms will dissipate immediately. Given its ability to dissipate Qi and Blood so effectively, why is it widely used in formulas for Spleen-Stomach weakness and indigestion?

Loulu San (See above).