〔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、有时不通畅的情况，都是由气血虚弱、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，导致乳汁枯竭无汁。如果乳汁充盈溢出，可以泼洒在东墙的高处。有的产妇产后必然有乳汁，如果乳房虽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。必须服用清热利湿的药物才能使乳汁通行。如果多次分娩后仍然没有乳汁，是因为津液耗竭的缘故。必须服用滋润补益的药物来促进乳汁生成。如果虽然有乳汁，但量却不多，必须服用通经活络的药物来推动乳汁运行，同时配合肉汤引导药力。因为妇女的乳汁依赖于冲脉，且与胃经相通。也有多次分娩而乳汁常多的情况，这也是妇人血气旺盛自然的结果。大抵上，如果妇人素有冲任经脉的疾病，乳汁就会少且颜色发黄，所生的孩子体弱多病。
【三因方】产妇有两种乳汁脉络不通的情况：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涩滞而不行。虚证应当补益，实证应当疏泄。实证应当使用通草、漏芦、土瓜根之类的药物；虚证应当使用炼制的钟乳粉、猪蹄、鲫鱼之类的食物。大概可以看出治疗原则了。
【薛己】前面的证候如果是气血虚弱而不能化生乳汁，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。夫乳汁是由气血化生的，在上方化为乳汁，在下方化为月经。如果多次生产后无乳汁，或者大便涩滞，应当滋生化之源。
漏芦散：治疗乳妇气脉壅塞，乳汁不行，以及经络凝滞，乳房胀痛，留蓄邪毒，或形成痈肿。此药服用后，自然内部消散，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）。
以上研为细末，用温酒调服二钱，不拘时候。服药后立即喝猪蹄羹。《经验方》中有牡蛎，烧存性。另一方法只用牡蛎末，酒调服。
又一方：
葵菜子（炒香）、缩砂仁（各等分）。
以上研为细末，每次服二钱，热酒调服。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）。
以上用水八升，煎取二升，分三次温服，忌口如常规方法。另一方加桂心，并研为末，酒服方寸匕。
下乳汁方：用京三棱三个，水二碗，煎取一碗用来清洗乳房，取汁内服为度，效果极好。
涌泉散：成都教授单骧的方子。治疗产乳无汁，也治疗乳结痈肿。
穿山甲（洗净，一两，灰中炒燥）研为细末，酒调服方寸匕。
《必用方》说：漏芦、栝蒌都是要药。有人说：多吃猪蹄羹。栝蒌取子洗净，炒至香熟，捶破取仁，铺在瓦上晒成白色，研为细末，温酒调服一钱。服完后面向下躺一会儿，未见效再服。
另一方：栝蒌一枚，熟捣碎，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，乳汁绝少。
成炼钟乳粉（研细），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，都淘净）、生甘草（半两）。
用水二升，煎汁一升，去滓分三次服，立刻见效。
【薛己】一位产妇因乳汁少，服药通乳，导致乳房肿胀，发热口渴。我认为这是血气虚，用玉露散补益而痊愈。
玉露散：治疗乳脉不行，身体壮热疼痛，头目昏痛，大便涩滞等证候。
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）。
以上为一服量，水二盅，煎至一盅，饭后服。如果头热甚，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。
瞿麦穗、麦门冬（去心）、龙骨、穿山甲（炮制变黄）、王不留行（各等分）。
以上研为细末，每次服一钱，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，根据前述方法。
又一方：治疗奶汁少。
栝蒌根、薄荷干身（等分）。
以上为粗末，先吃羊蹄汁一碗，然后服药，后再吃葱丝羊羹汤少许，立刻见效。
有人乳汁不行，已经十七天，诸药无效，遇到有人送赤豆一斗，于是时常煮粥吃，当晚乳脉就通行了。
又一方：麦门冬不拘多少，去心焙干为末，用酒磨犀角约一钱许，暖热的犀角酒调门冬末二钱服之，不超过两服，乳汁便下来。
【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。如果乳汁多、温热、胀满、急痛，用温热的布熨烫它。《产宝》有这种论述，却没有方子治疗它。如果有这种证候，仅用漏芦散也可以。有未产前乳汁自行流出的，称为“乳泣”，生子大多不能养活，经书中未曾论及。
【薛己】前面的证候气血俱虚，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，昏昧吐痰，这是阳气虚而厥逆。灌服独参汤而苏醒，再用十全大补汤数剂而安顿。如果妇人气血正盛，乳房作胀，或者没有婴儿吸吮导致胀痛，憎寒发热，用麦芽二三两，炒熟，水煎服立刻消散。其耗散血气如此厉害，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 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).