〔大〕凡妇人乳汁或行或不行者，皆由气血虚弱，经络不调所致也。乳汁勿令投于
地，虫蚁食之，令乳无汁。若乳盈溢，可泼东壁上佳。或有产后必有乳，若乳虽胀而产
后作者，此年少之人，初经产乳，有风热耳。须服清利之药则乳行。若累经产而无
乳者，亡津液故也。须服滋溢之药以动之。若虽有乳，却又不甚多者，须服通经之药以动
之，仍以羹 引之。盖妇人之乳资于冲脉，与胃经通故也。有屡经产而乳汁常多者，亦妇
人血气不衰使然也。大抵妇人素有疾在冲任经者，乳汁少而其色带黄，所生之子怯弱而
多疾。
〔三因〕产妇有二种乳脉不行，有气血盛而壅闭不行者，有血少气弱涩而不行者。虚
当补之，盛当疏之。盛者当用通草、漏芦、土瓜根辈；虚者当用炼成钟乳粉、猪蹄、鲫鱼
之属。概可见矣。
〔薛〕前证若气血虚弱而不能化生，宜壮脾胃。怒动肝胆而乳肿汁出，宜清肝火。夫
乳汁乃气血所化，在上为乳，在下为经。若屡产无乳，或大便涩滞，当滋化源。
漏芦散 疗乳妇气脉壅塞，乳汁不行，及经络凝滞，奶乳胀痛，留蓄邪毒，或作痈肿。
此药服之，自然内消，乳汁通行。
漏芦（二两半） 蛇蜕（十条，炙） 栝蒌（十枚，急火烧焦存性）
上为末，温酒调下二钱，无时候。服药后即以猪蹄羹投之。《经验方》有牡蛎，烧存
性。一方只用牡蛎 末酒调。
又方
葵菜子（炒香） 缩砂仁（各等分）
上为细末，每服二钱，热酒调下。滋益气脉荣卫，行津液。上蔡张不愚方，常用极
有验。
《产宝》疗产后乳无汁方。
土瓜根 漏芦（各三两） 甘草（二两） 通草（四两）
上水八升，煎取二升，分温三服，忌如常法。一方加桂心，并为末，酒服方寸匕。
《产书》下乳汁。
土瓜根为末，酒调服一钱，日三四服。
下乳汁。以京三棱三个，水二碗，煎取一碗洗，取汁下为度，极妙。
涌泉散 成都教授单骧方。疗产乳无汁，亦治乳结痈肿。
穿山甲（洗净，一两，灰炒燥） 为细末，酒调
服方寸匕。
《必用方》云∶漏芦、栝蒌皆要药。或云∶多食猪蹄羹。栝蒌取子净洗，炒令香熟，捶
破取仁，瓦上摊 令白色，研为细末，温酒调下一钱。服了合面卧少时，未效再作。
一方 栝蒌一枚，熟捣，以白酒一斗，煮取四升，去渣温饮一升，日三。
成炼钟乳散 疗乳妇气少血衰，脉涩不行，乳汁绝少。
成炼钟乳粉（研细） 浓煎漏芦汤调下二钱。
《灵苑》下乳汁立效方。
粳米 糯米（各半合） 莴苣子（一合，并淘净） 生甘草（半两）
用水二升，煎汁一升，去滓分三服，立下。
又方 猪蹄（一双） 通草（四两） 水一斗，煮作羹食之妙。
〔薛〕一产妇因乳少，服药通之，致乳房肿胀，发热作渴。余谓血气虚，以玉露散
补之而愈。
玉露散 治乳脉不行，身体壮热疼痛，头目昏痛，大便涩滞等证。
川芎 桔梗 白芷（各二钱） 芍药 当归（各一钱半） 人参 白茯苓 甘草（各一钱）
上作一服，水二盅，煎至一盅，食后服。如头热甚，大便秘者，加大黄三钱。
罗氏涌泉散 治妇人乳汁因气绝少。
瞿麦穗 麦门冬（去心） 龙骨 穿山甲（炮黄） 王不留行（各等分）
上为细末，每服一钱，热酒调下，后吃猪蹄羹少许。又用木梳于左右乳上各梳三二
十梳。日三服，根据前法。
又方 治奶汁少。
栝蒌根 薄荷干身（等分）
上为粗末，先吃羊蹄汁一碗，次服药，后再吃葱丝羊羹汤少许，立效。
有人乳汁不行，已十七日，诸药无效，遇有人送赤豆一斗，遂时常煮粥食之，当夜乳
脉通行。
又方 麦门冬不拘多少，去心焙为末，以酒磨犀角约一钱许，暖犀角酒调门冬末二钱
服之，不过两服，乳汁便下。
〔乳汁自出〕
〔大〕产后乳汁自出，盖是身虚所致，宜服补药以止之。若乳多温满急痛者，温帛
熨之。《产宝》有是论，却无方以治之。若有此证，但以漏芦散亦可。有未产前乳汁自出
者，谓之乳泣，生子多不育，经书未尝论及。
〔薛〕前证气血俱虚，用十全大补汤。肝经血热，用加味逍遥散。肝经怒火，用四
物、参、术、柴、栀。肝脾郁怒，用加味归脾汤。一产妇劳役，忽乳汁如涌，昏昧吐
痰，此阳气虚而厥也。灌以独参汤而苏，更以十全大补汤数剂而安。若妇人气血方盛，乳
房作胀，或无儿饮胀痛，憎寒发热，用麦芽二三两，炒熟，水煎服立消。其耗散血气如
此，何脾胃虚弱，饮食不消方中多用之？
漏芦散（见前。）
【陈氏】凡是妇女乳汁有时通畅、有时不通畅，都是由于气血虚弱、经络不调所导致的。乳汁不要让它滴落在地上，否则虫蚁会食用它，导致乳汁枯竭。如果乳汁充盈溢出，可以泼洒在房屋的东墙上（为佳）。有的产妇产后必然有乳汁，如果乳房虽然胀满但乳汁分泌不足，这是年轻女性初次经历产乳，体内有风热所致。需要服用清热利湿的药物才能使乳汁通行。如果多次生产却仍然没有乳汁，是因为津液耗损的缘故。必须服用滋补盈润的药物来促进乳汁生成。如果虽然有乳汁，但量却不多的情况，需要服用通经活络的药物来推动乳汁运行，同时配合肉汤作为药引。因为妇女的乳汁源于冲脉，并与胃经相通。也有多次生产而乳汁常常过多的情况，这也是妇人血气旺盛未衰的表现。大抵而言，妇人如果素有冲任经脉的疾病，乳汁就会减少且颜色偏黄，所生的孩子也会体弱多病。
【三因方】产妇有两种乳脉不通的情况：一种是气血旺盛但壅滞闭塞导致乳汁不行；另一种是血少气弱导致乳汁涩滞不行。虚证应当补益，实证应当疏泄。实证应当使用通草、漏芦、土瓜根这类药物；虚证应当使用炼制的钟乳粉、猪蹄、鲫鱼这类食物或药物。大概可以看出其中的区别了。
【薛己】上述病症如果是气血虚弱不能化生乳汁，应当强壮脾胃。如果是愤怒触动肝胆导致乳房肿胀、乳汁流出，应当清泻肝火。乳汁是由气血化生的，在上部表现为乳汁，在下部表现为月经。如果多次生产后无乳汁，或者大便干结涩滞，应当滋生化之源。
漏芦散：治疗乳妇气脉壅塞，乳汁不通，以及经络凝滞，乳房胀痛，邪毒留蓄，或者形成痈肿。此药服用后，自然能内消积滞，使乳汁通行。
组成：漏芦（二两半）、蛇蜕（十条，炙烤）、栝蒌（十枚，急火烧焦保留药性）。
制法与用法：以上药物研为细末，用温酒调服二钱，不拘时候。服药后立即喝猪蹄汤送服。《经验方》中有牡蛎，烧存性。另一方法只用牡蛎末，用酒调服。
又一方：
葵菜子（炒香）、缩砂仁（各等分）。
制法与用法：以上研为细末，每次服用二钱，用热酒调服。此方能滋益气脉荣卫，运行津液。这是上蔡张不愚的方子，常用非常有效。
《产宝》治疗产后无乳汁的方子：
土瓜根、漏芦（各三两）、甘草（二两）、通草（四两）。
制法与用法：用水八升，煎取二升，分三次温服，忌口如常法。另一方加桂心，研为末，用酒服用方寸匕。
《产书》下乳汁的方法：
土瓜根研为末，用酒调服一钱，每日三四次。
下乳汁的另一法：用京三棱三个，水两碗，煎取一碗汁液，用来清洗乳房，并取汁内服，效果极好。
涌泉散：成都教授单骧的方子。治疗产后无乳汁，也治疗乳结痈肿。
组成：穿山甲（洗净，一两，用灰炒燥）。
制法与用法：研为细末，用酒调服方寸匕。
《必用方》说：漏芦、栝蒌都是要药。有人说：多吃猪蹄汤。栝蒌取子洗净，炒至香熟，捶破取仁，放在瓦上摊开使其变白，研为细末，用温酒调服一钱。服完后面向下躺一会儿，如果没有效果再服用。
另一方：栝蒌一枚，捣烂，用白酒一斗，煮取四升，去渣温饮一升，每日三次。
成炼钟乳散：治疗乳妇气少血衰，脉涩不行，乳汁极少。
组成：成炼钟乳粉（研细）。
制法与用法：用浓煎的漏芦汤调服二钱。
《灵苑》下乳汁立效方：
粳米、糯米（各半合）、莴苣子（一合，都淘洗干净）、生甘草（半两）。
制法与用法：用水二升，煎汁一升，去滓分三次服，立刻见效。
又一方：猪蹄（一双）、通草（四两），水一斗，煮作羹食之，效果妙。
【薛己】一位产妇因为乳汁少，服用通乳药后，导致乳房肿胀，发热口渴。我认为这是血气虚弱，用玉露散补益她而痊愈。
玉露散：治疗乳脉不通，身体壮热疼痛，头目昏痛，大便涩滞等症状。
组成：川芎、桔梗、白芷（各二钱）、芍药、当归（各一钱半）、人参、白茯苓、甘草（各一钱）。
制法与用法：以上为一服量，用水二盅，煎至一盅，饭后服用。如果头部热甚，大便秘结者，加大黄三钱。
罗氏涌泉散：治疗妇人乳汁因气绝少。
组成：瞿麦穗、麦门冬（去心）、龙骨、穿山甲（炮制至黄色）、王不留行（各等分）。
制法与用法：以上研为细末，每次服用一钱，用热酒调服，随后吃少许猪蹄羹。另外用木梳在左右乳房上各梳理三二十下。每日三次，根据前面的方法。
又一方：治疗奶汁少。
组成：栝蒌根、薄荷干身（等分）。
制法与用法：以上研为粗末，先喝一碗羊蹄汁，然后服药，之后再吃少许葱丝羊羹汤，立刻见效。
有人乳汁不通，已经十七天，各种药物无效，遇到有人送一斗赤豆，于是经常煮粥吃，当晚乳脉就通行了。
又一方：麦门冬不拘多少，去心焙干研为末，用酒磨犀角约一钱许，用暖热的犀角酒调服门冬末二钱，不超过两服，乳汁就会下来。
【乳汁自出】
【陈氏】产后乳汁自行流出，大概是身体虚弱所致，宜服用补药以止住。如果乳汁过多、温热、胀满、急痛，用温热的布巾熨烫它。《产宝》中有这种论述，却没有方子治疗。如果有这种症状，也可以用漏芦散。有产前乳汁自行流出的，称为“乳泣”，生子大多不能存活，经书中未曾论及。
【薛己】上述病症气血俱虚，用十全大补汤。肝经血热，用加味逍遥散。肝经怒火，用四物汤加人参、白术、柴胡、栀子。肝脾郁怒，用加味归脾汤。一位产妇劳累过度，忽然乳汁如涌出，神志昏昧吐痰，这是阳气虚衰导致的厥证。灌服独参汤后苏醒，再用十全大补汤数剂后安定。如果妇人气血正盛，乳房作胀，或者因为没有婴儿吸吮而胀痛，憎寒发热，用麦芽二三两，炒熟，水煎服立刻消散。其耗散血气的功效如此之大，为什么脾胃虚弱、饮食不消的方子中多用它呢？
漏芦散（见前文。）
[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.)