《圣济总录》曰∶足阳明之脉,自缺盆下
于乳。又冲脉者,起于气街,并足阳明经,夹脐上行,至胸中而散。妇人以冲任为本,若失于将理,冲任不和,
阳明经热,或为风邪所客,则气壅不散,结聚乳间,或硬或肿,疼痛有核,皮肤 肿,寒热往来,谓之乳痈。
风多则硬肿色白,热多则 肿色赤。不治,血不流通,气为壅滞,或乳内津液相抟,腐化为脓,宜速下乳汁,
导其壅塞,散其风热,则病可愈。
张子和曰∶乳痈发痛者,亦生于心也。俗乎曰吹乳是也。吹者,风也。风热结薄于乳房之间,血脉凝注,
久而不散,溃腐为脓也。
慎斋按∶以上二条,序乳痈属于风热外邪为病也。
《妇人良方》曰∶经云乳头属足厥阴肝经,乳房属足阳明胃经。若乳房忽然壅肿痛,结核色赤,数日之外,
痛胀溃,稠脓涌出,此属胆胃热毒,气血壅滞,名曰乳痈,为易治。
《家居医录》按∶乳痈初起,肿痛发于肌表,肉色 赤,或发寒热,或头痛烦渴,用人参败毒散、神效栝蒌
散、加味逍遥散治之,自消散。若脓成溃窍,稠脓涌出,脓尽自愈。若气血虚弱,或误用败毒,久不收敛,脓
清脉大,则难治。
薛立斋又按∶乳痈治法,初起寒热 痛,即发表散邪,疏肝清胃为主。或不作脓,脓成不溃,宜用托里。或
肌肉不生,脓水清稀,宜补脾胃。或脓出反痛,恶寒发热,宜补气血。或肿 作痛,晡热,宜补阴血。或饮食
少,反作呕,宜补胃气,切不可用克伐,复伤脾胃也。
《圣济总录》说:足阳明胃经的经脉,从缺盆穴向下经过乳房。另外冲脉(奇经八脉之一,调节十二经气血),起于气街穴,与足阳明胃经并行,夹着肚脐向上运行,到达胸中后分散。妇女以冲脉和任脉(奇经八脉之一,主胞胎)为根本,如果调理失当,导致冲任二脉不和,或者阳明经有热邪,又或受到风邪侵袭,就会导致气机壅滞不散,结聚在乳房之间,出现乳房硬结或肿胀,疼痛且有核块,皮肤红肿,伴有寒热往来等症状,这被称为乳痈(急性乳腺炎)。如果风邪偏盛,则表现为硬肿且颜色发白;如果热邪偏盛,则表现为红肿且颜色发红。如果不及时治疗,血液运行不畅,气机壅滞,或者乳房内的津液相互搏结,腐败化为脓液,应当迅速疏通乳汁,引导解除壅塞,疏散风热,这样病就可以痊愈。
张子和说:乳痈发生疼痛,也是由于心的原因。民间所说的“吹乳”就是这种情况。“吹”指的是风邪。风热之邪结聚在乳房之间,血脉凝滞,时间久了不消散,就会溃烂腐败化为脓液。
《妇人良方》说:医经记载乳头归属于足厥阴肝经,乳房归属于足阳明胃经。如果乳房突然壅滞、肿胀、疼痛,出现结核且颜色发红,过了几天之后,疼痛肿胀溃破,流出稠厚的脓液,这属于胆经和胃经的热毒,导致气血壅滞,名叫乳痈,这种病情容易治疗。
《家居医录》按语:乳痈初起时,肿痛发生在肌表,肌肉颜色发红,或者出现恶寒发热,或者头痛、心烦口渴,用人参败毒散、神效栝蒌散、加味逍遥散治疗,可以使肿块自行消散。如果脓液形成并溃破,稠厚的脓液涌出,脓液排尽后自然愈合。如果气血虚弱,或者误用攻伐解毒的药物,导致伤口久久不能收敛,脓液清稀、脉象洪大,这就难以治疗。
薛立斋又按语:乳痈的治疗方法,初起时有寒热疼痛,应以发表散邪、疏肝清胃为主。如果肿块不化脓,或者脓成但不溃破,宜用托里透脓法。如果肌肉不生新,脓水清稀,宜补益脾胃。如果脓液排出后反而疼痛,伴有恶寒发热,宜补益气血。如果肿块作痛,午后发热(晡热),宜补益阴血。如果饮食减少,反而呕吐,宜补益胃气,千万不可使用克伐攻下的药物,以免再次损伤脾胃。
The *Shengji Zonglu* states: The Foot-Yangming Stomach Meridian descends from the Quepen (ST12) acupoint to the breast. Furthermore, the Chong Mai (Penetrating Vessel), one of the Eight Extraordinary Vessels that regulates the Qi and Blood of the Twelve Regular Meridians, originates at the Qichuan area, runs parallel to the Foot-Yangming Stomach Meridian, ascends flanking the umbilicus, and disperses upon reaching the chest. In women, the Chong Mai and Ren Mai (Conception Vessel, one of the Eight Extraordinary Vessels governing pregnancy and fetus) serve as the root. If proper regulation is neglected, leading to disharmony between the Chong and Ren Mai, or if there is Heat in the Yangming Meridian, or if invaded by Wind Pathogens, Qi stagnation may occur and fail to disperse. This results in accumulation and knotting within the breasts, presenting as hardness or swelling, pain with palpable nodules, skin redness and swelling, and alternating chills and fever. This condition is termed Ru Yong (Acute Mastitis). If Wind predominates, the presentation is hard swelling with a white color; if Heat predominates, it presents as red swelling. If left untreated, Blood circulation becomes obstructed, Qi becomes stagnant, or the body fluids in the breast interact and corrupt into Pus. It is advisable to rapidly promote lactation to guide the resolution of obstruction and dissipate Wind-Heat, whereby the disease can be cured.
Zhang Hezi stated: The pain arising from Ru Yong also originates from the Heart. What is commonly referred to as "Blown Breast" is precisely this condition. "Blowing" refers to Wind. Wind-Heat pathogens condense and thin out between the breasts, causing Blood vessels to coagulate and stagnate. Over time, without dispersing, they ulcerate and corrupt into Pus.
Shen Zhai commented: The above two passages outline that Ru Yong is caused by external Wind-Heat pathogens.
The *Furen Liangfang* states: Medical classics record that the nipples belong to the Foot-Jueyin Liver Meridian, while the breasts belong to the Foot-Yangming Stomach Meridian. If the breasts suddenly become obstructed, swollen, painful, with nodules appearing red, and after several days, the pain and swelling ulcerate with thick Pus flowing out, this belongs to Heat-Toxin of the Gallbladder and Stomach, causing Qi and Blood stagnation. Named Ru Yong, this condition is relatively easy to treat.
The *Jiaju Yilu* commented: At the onset of Ru Yong, swelling and pain manifest on the surface of the skin, with reddish muscle tissue, or accompanied by aversion to cold and fever, headache, restlessness, and thirst. Treatment with Renshen Baidu San (Ginseng Decoction for Resolving Toxins), Shenxiao Gualou San (Miraculous Trichosanthes Powder), or Jiawei Xiaoyao San (Modified Free Wanderer Powder) will allow the lump to dissipate spontaneously. If Pus forms and ulcerates, with thick Pus flowing out, healing occurs naturally once the Pus is exhausted. However, if Qi and Blood are deficient, or if toxic-resolving drugs are mistakenly used, leading to failure of the wound to heal over a long period, with clear Pus and a large pulse, the condition becomes difficult to treat.
Xue Lizhai further commented: The treatment method for Ru Yong, when initially presenting with chills, fever, and pain, should primarily focus on releasing the exterior to scatter pathogens and soothing the Liver while clearing the Stomach. If the mass does not suppurate, or if Pus forms but does not ulcerate, interior-supporting methods (Tuoli) should be employed. If new flesh fails to grow and the Pus water is clear and thin, the Spleen and Stomach should be tonified. If pain recurs after Pus discharge, accompanied by aversion to cold and fever, Qi and Blood should be tonified. If swelling causes pain with afternoon fever (Buhu), Yin and Blood should be tonified. If food intake decreases and vomiting occurs, Stomach Qi should be tonified. One must absolutely avoid using harsh attacking or draining methods, which would further damage the Spleen and Stomach.