立斋曰∶乳房属足阳明胃经，乳头属足厥阴肝经。男子房劳恚怒伤于肝肾，妇人胎产忧
郁损于肝脾，皆能致之。若因暴怒或儿口气所吹肿痛者，宜疏肝行气。 痛发寒热者，发散
表邪。 肿痛甚者，清肝消毒，并宜隔蒜灸。未成脓者，疏肝行气。不作脓或不溃者，托
里为主。溃而不敛或脓清者，宜大补脾肺气血为主。
又治法曰∶若脓出反痛，或作寒热，气血虚也，十全大补汤。体倦口干，中气虚也，补
中益气汤。晡热内热，阴血虚也，八珍汤加五味子。欲呕作呕，胃气虚也，补胃为主，或用
香砂六君子汤。食少作呕，胃气虚寒也，前汤加干姜。食少泄泻，脾气虚寒也，理中汤或加
人参、附子。若劳碌以致肿痛，气血未复也，八珍汤倍用参、 、归、术。若因怒气以致肿
痛，肝火伤血也，八珍汤加柴胡、山栀。若肝火血虚而结核不消者，四物汤加柴胡、升麻。
若肝脾气血俱虚而结核者，四君子加芎、归、柴胡、升麻。郁结伤脾而结核者，归脾汤兼神
效栝蒌散。若为儿所吹而发肿 痛，须吮通揉散，否则成痈矣。若兼余证，亦当治以前法
。若妇人郁怒伤肝脾而结核，不痒不痛，一二载始溃者，名曰乳岩，最难治疗。
又治法曰∶若忿怒伤肝，浓味积热，以致气不行，窍不通，乳不出，则结而为肝为痛，
此阳明之血热。甚则肉腐为脓。若脓一成，即针出之，以免遍溃诸囊之患。亦有所乳之子，
膈有滞痰，口气 热，含乳而睡，热气所吹，遂成肿痛。于初起时，须吮咂使通，或忍痛
揉散之，失治必成痈患。宜用青皮以疏厥阴之滞，石膏以清阳明之热，甘草节以行污浊之血，
栝蒌子以消肿导毒。或加没药、橘叶、皂角针、金银花、当归更宜，随证消息加减而治。仍
用少酒佐之，更用隔蒜灸之，其效尤捷。若有脓即针之，否则通溃难于收敛。
乳痈，用蒲公英忍冬藤，入少酒煎服，即欲睡，是其功也，及觉而病安矣。（见《外科心法》）
一妇人患乳痈，寒热头痛，与荆防败毒散一剂，更与蒲公英一握捣烂，入酒二三盏再捣
，取汁热服， 热罨患处而消。丹溪云∶此草散热毒，消肿核，又散滞气，解金石毒之圣药。
一妇人左乳内肿如桃，不痛，色不变，发热，渐消瘦，以八珍汤加香附、远志、青皮
、柴胡百余剂，又间服神效栝蒌散三十余剂，脓溃而愈。常见患者责效太速，或不解七情
及药，不分经络虚实者，俱难治。大抵此证四十以外者尤难治，盖因阴血日虚也。
一妇人，因怒左乳内肿痛发热，表散太过，致热益甚，以益气养营汤数剂，热止脓成。
欲用针，彼不从，遂肿胀大热发渴。始针之，脓大泄，仍以前汤，月余始愈。
一男子，左乳肿硬痛甚，以仙方活命饮二剂而痛止，更以十宣散加青皮四剂，脓成，针
之而愈。此证若脓成未破，疮头有薄皮剥起者，用代针之剂点起皮处，以膏药贴之，脓亦自
出。但不若及时针之，则不致大溃。如脓出不利，更 入搜脓化毒之药。若脓血未尽，辄
用生肌之剂，反助邪气。纵早合，必再发。不可不慎也。
一产妇因乳少服药通之，致乳房肿胀发热作渴，状类伤寒，以玉露散补之而愈。夫乳汁乃
气血所化，在上为乳，在下为经。若冲任之脉盛，脾胃之气壮，则乳汁多而浓，衰则少而
淡，所乳之子亦弱而多病，此自然之理。亦有屡产有乳，再产却无，或大便涩滞，乃亡津液
也。《三因论》云，产妇乳脉不行有二，有血气盛闭而不行者，有血气弱涩而不行者，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。（俱薛按）
一妇人久郁，右乳内结三核，年余不消，朝寒暮热，饮食不甘，此乳岩也。乃七情所
伤，肝经气血枯槁之证，宜补气血解郁结药治之。遂以益气养营汤百余剂，血气渐复；更
以木香饼灸之。喜其谨疾，年余而消。若用克伐之剂以复伤血气，则一无可保者。
一外家，乃放出宫人，乳内结一核如栗，欲用前汤，彼不信，乃脓疮科流气饮及败毒散，
三年后大如覆碗，坚硬如石，出水不溃而殁。大抵郁闷则脾气阻，肝气逆，遂成隐核，不痛
不痒，人多忽之，最难治疗。若一有此，宜戒七情，远浓味，解郁结，更以养血气之药治之
，庶可保全，否则不治。亦有数载方溃而陷下者，皆曰乳岩，盖其形似岩穴而最毒也，慎之
则可保十中之一二。（薛按）
薛己说：乳房归属于足阳明胃经，乳头归属于足厥阴肝经。男子因房事过度或愤怒而损伤肝肾，妇人因怀孕生产或忧郁而损伤肝脾，都能导致乳病。如果是因暴怒或婴儿口气吹袭导致的肿痛，应当疏肝行气。疼痛发作伴有寒热的，发散表邪。肿痛严重的，清肝解毒，并适宜用隔蒜灸法。脓未形成的，疏肝行气。不化脓或不溃破的，以托里透脓为主。溃破后不愈合或脓液清稀的，以大补脾肺气血为主。
又论治法说：如果脓出后反而疼痛，或出现寒热，是气血虚弱，用十全大补汤。身体疲倦口干，是中气虚弱，用补中益气汤。傍晚发热或内热，是阴血虚弱，用八珍汤加五味子。想呕吐或已呕吐，是胃气虚弱，以补胃为主，或用香砂六君子汤。饮食减少且呕吐，是胃气虚寒，在前一方基础上加干姜。饮食减少且腹泻，是脾气虚寒，用理中汤或加人参、附子。如果因劳累导致肿痛，是气血尚未恢复，用八珍汤加倍使用人参、白术、当归、白芍。如果因怒气导致肿痛，是肝火伤血，用八珍汤加柴胡、山栀。如果肝火旺兼血虚而有结核不消，用四物汤加柴胡、升麻。如果肝脾气血俱虚而有结核，用四君子汤加川芎、当归、柴胡、升麻。郁结伤脾而有结核，用归脾汤兼服神效栝蒌散。如果是被婴儿吹气导致肿痛，必须吸吮通畅并揉散，否则就会成痈。如果兼有其他症状，也应当用上述方法治疗。如果妇人因郁怒损伤肝脾而有结核，不痒不痛，一两年后才溃破的，名叫乳岩，最难治疗。
又论治法说：如果因愤怒伤肝，厚味积热，导致气机不行，窍道不通，乳汁不出，则凝结为肝经之痛，这是阳明经的血热。严重时肉腐化为脓。如果脓已形成，立即针刺排出，以免遍溃各个囊袋的祸患。也有因为哺乳的孩子，膈间有滞痰，口气热，含着乳头睡觉，热气吹入，遂成肿痛。在初起时，必须吸吮使乳汁通畅，或忍痛揉散它，失治必然成为痈患。适宜用青皮来疏解厥阴经的郁滞，石膏来清阳明经的热，甘草节来行污浊之血，栝蒌子来消肿导毒。或者加没药、橘叶、皂角针、金银花、当归更适宜，根据证候斟酌加减治疗。仍然用少量酒佐助，再用隔蒜灸法，效果尤其快捷。如果有脓就针刺，否则通溃后难以收敛。
乳痈，用蒲公英、忍冬藤，加入少量酒煎服，服后就想睡，这是它的功效，等到醒来病就好了。（见《外科心法》）
一个妇人患乳痈，寒热头痛，给荆防败毒散一剂，再给一把蒲公英捣烂，加入二三盏酒再捣，取汁热服，趁热敷患处而消散。丹溪说：这种草能散热毒，消肿核，又能散滞气，是解金石毒的圣药。
一个妇人左乳内肿如桃子，不痛，颜色不变，发热，逐渐消瘦，用八珍汤加香附、远志、青皮、柴胡百余剂，又间断服用神效栝蒌散三十余剂，脓溃而愈。常见患者责怪疗效太慢，或不理解七情致病及药物作用，不分经络虚实，都难治。大抵此证四十岁以上的人尤其难治，这是因为阴血日渐虚弱。
一个妇人，因愤怒左乳内肿痛发热，发汗太过，导致热势更甚，用益气养营汤数剂，热止脓成。想用针刺，她不同意，于是肿胀大热口渴。开始针刺，脓大量流出，仍用前一方，月余才痊愈。
一个男子，左乳肿硬痛甚，用仙方活命饮二剂而痛止，再用十宣散加青皮四剂，脓成，针刺而愈。此证如果脓成未破，疮头有薄皮剥起的，用代针之剂点起皮处，贴膏药，脓也会自出。但不如及时针刺，则不会大溃。如果脓出不利，再加入搜脓化毒的药。如果脓血未尽，就用生肌的药，反而助长邪气。即使早愈合，必会复发。不可不慎。
一个产妇因乳汁少服药通之，导致乳房肿胀发热口渴，状似伤寒，用玉露散补益而愈。乳汁乃气血所化，在上为乳，在下为经。如果冲任脉盛，脾胃之气壮，则乳汁多而浓，衰则少而淡，所哺乳的孩子也弱而多病，这是自然之理。也有屡产有乳，再产却无，或大便涩滞，这是亡津液。《三因论》说，产妇乳脉不行有二种，有血气盛闭而不行的，有血气弱涩而不行的，虚当补之，盛当疏之。盛者当用通草、漏芦、土瓜根之类，虚者当用炼成钟乳粉、猪蹄、鲫鱼之类，概可见矣。（以上均为薛己按语）
一个妇人久郁，右乳内结三个核，一年多不消，早晨怕冷晚上发热，饮食无味，这是乳岩。乃七情所伤，肝经气血枯槁之证，宜用补气血解郁结药治疗。遂用益气养营汤百余剂，血气渐复；再用木香饼灸之。庆幸她谨慎治病，年余而消。如果用克伐之剂以再次损伤血气，则一无可保。
一个岳母，是放出宫的宫女，乳内结一核如栗子，想用前一方，她不信任，乃用脓疮科流气饮及败毒散，三年后大如倒扣的碗，坚硬如石，出水不溃而死。大抵郁闷则脾气阻，肝气逆，遂成隐核，不痛不痒，人多忽视，最难治疗。如果一有此症，宜戒七情，远离厚味，解郁结，再用养血气之药治疗，庶可保全，否则不治。也有数年才溃而陷下的，都叫乳岩，大概其形状像岩穴而最毒，谨慎则可保十中之一二。（薛己按）
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)