敷铁箍散不效，反加喘闷；九月产一女，溃势益大而乳房烂尽，延及胸腋，脓水稠粘，出
脓几六七升，略无敛势。十一月始归就医，改用解毒和平中剂，外掺生肌散，龙骨、寒水
石等剂，脓出不止，流溅所及，即肿泡溃脓，两旁紫黑，疮口十数，胸前腋下皆肿溃，不
可动侧，其势可畏。余谓∶产后毒瓦斯乘虚而炽，宜多服黄 解毒补血、益气生肌。而医
不敢用。十二月中旬后益甚，疮口二十余，诸药尽试不效，始改用予药，时脓秽粘滞，煎
楮叶猪蹄汤沃之顿爽。乃治一方，名黄 托里汤，黄 之甘温以排脓，益气生肌为君；甘
草补胃气解毒，当归身和血生血为臣；升麻、葛根、漏芦为足阳明本经药，及连翘、防风
皆散结疏经，栝蒌仁、黍粘子，解毒去肿，皂角刺引至溃处，白芷入阳明，败脓长肌，又
用川芎三分，及肉桂、炒柏为引。用每剂入酒一盏煎，送白玉霜丸，疏脓解毒，时脓水
稠粘，方盛未已，不可遂用收涩之药。理宜追之，以翠青锭子外掺。明日脓水顿稀，痛
定秽解，始有向安之势。至辛未新正，患处皆生新肉，有紫肿处，俱用葱熨法，随手消
散，但近腋足少阳分，尚未敛，乃加柴胡一钱，青皮三分及倍川芎。脓水将净者即用搜
脓散掺之，元宵后遂全安。 万历癸卯二月，时侍御赵盖庵提学南畿，托敝悬令致意，约
会于茅山，予以馆谊不容辞，特往赴之，则有病欲求治也。袒其胸，左乳侧疮口大如碗，
恶肉紫黯，嶙峋嵌深，宛如岩穴之状，臭不可近。予问何从得此？曰∶馆试屡下，意不
能无郁，夏月好以手捋乳头，遂时时有汁出。或曰是真液也，不可泄，因覆之以膏药，汁
止而乳旁有核，既南来校阅劳神，乳核辄肿
痛。一书吏颇知医，谓汁欲出而为膏药所沮，又不得归经，故滞为核，闻妇人血上为乳汁，
今汁亦血类也，宜饮芎归酒，行其滞血，核自消矣。吾以为然而饮之，核如故而吐血、衄
血大作。饮京口张医药，吐衄止而肠风作，张矜自功，谓血从下出者顺。然体则重困矣。复
饮他医药，便血亦止，乳核之势日益张，遂至于溃。一草泽医，能炼砒治痔漏，私计此
亦漏疮也，纳药其中，痛欲死，溃不可支，故至此。予意在法为不治，而见其精神尚王，饮
啖自如，无甚恶候，尚可延引岁月，为之定方而别。后校士广陵，不相闻问，遂改用它
医药，至八月初，以滞下发哕死。夫男子患乳岩者少矣，其起又甚微眇，而三为盲医所
误遂至此。砒，诚不可纳也，芎、归何罪乎！不可不书之以为后鉴。
蒲公英草，捣烂 患处，神妙。天南星末以温酒调涂之。治妇人乳痛成痈，以益母
草为末，水调涂乳上，一宿自瘥；生捣烂敷之，亦得。 妇人吹乳，用桑树皮和饭，捣
成膏贴之。 乳头裂破，丁香末敷之。
乳痈 针乳中穴，（在乳下中，针入，分沿皮向后一寸半，灸泻。）
〔甲〕 乳痈寒热，短气
卧不安，膺窗主之。 乳痈凄素寒热，痛不可按，乳根主之。 大惊乳痛，梁丘主之。乳
痈有热，三里主之。 （乳痈诸药不能止痛者，三里针入五分，立止。） 女子乳痈惊，巨虚、下廉
主之。（《千金》云∶臂肿重，足蹈不收，跟痛。） 乳痈，太冲及复溜主之。 妒乳，太渊主之。
妇人乳余疾，盲门主之。
使用铁箍散外敷没有效果，反而加重了气喘胸闷的症状；九月时产下一名女婴，溃烂的趋势更加严重，乳房组织完全腐烂，并蔓延至胸部和腋下，脓液稠厚粘稠，排出的脓量多达六七升，完全没有收敛愈合的迹象。直到十一月才来找我就医，我改用解毒且药性平和的中剂内服，外用生肌散，配合龙骨、寒水石等药物，但脓液仍然不止，流溅到的地方随即出现肿胀水泡并溃破化脓，疮口两侧呈现紫黑色，有十多个疮口，胸前和腋下全部肿胀溃烂，身体无法转动侧卧，病情形势令人畏惧。我对他说：“产后毒邪趁虚炽盛，应当多服用黄芪以解毒补血、益气生肌。”但医生不敢使用。十二月中旬后病情更加严重，疮口增至二十多个，各种药物都尝试过无效，才开始改用我的药方。当时脓液污秽粘滞，用煎煮的楮叶猪蹄汤冲洗患处，顿时感觉清爽舒适。于是制定一方，名为黄芪托里汤，以甘温的黄芪为君药，以排出脓液、益气生肌；甘草补益胃气并解毒，当归身调和血液并生血作为臣药；升麻、葛根、漏芦是足阳明胃经的本经药物，连翘、防风都能散结疏通经络，栝蒌仁、黍粘子（牛蒡子）能解毒消肿，皂角刺引导药力到达溃烂处，白芷入阳明经，败脓长肉，又加入川芎三分，以及肉桂、炒黄柏作为引经药。每剂药加入一盏酒煎煮，送服白玉霜丸，以疏泄脓液、解毒。此时脓水稠粘，病势正盛未止，不可立即使用收敛固涩的药物。理应采用追蚀之法，外用翠青锭子掺敷。第二天脓水顿时变稀，疼痛停止，秽浊解除，开始出现向好的趋势。到了辛未年新年期间，患处都长出了新肉，对于仍有紫肿的地方，全部采用葱熨法，随手消散。只有靠近腋下的足少阳胆经部位尚未收敛，于是加用柴胡一钱，青皮三分及加倍的川芎。脓水即将排净时就用搜脓散掺敷，元宵节后就完全痊愈了。
万历癸卯年二月，时任侍御赵盖庵在南畿担任提学，委托我的一位县令朋友致意，约定在茅山会面，因为我们有馆阁同僚的情谊，不能推辞，特意前往赴约，原来他是带着疾病求治。袒露他的胸部，左侧乳房侧面有一个大如碗口的疮口，恶肉紫暗，嶙峋深陷，宛如岩穴的形状，气味臭不可近。我问他是如何得此病的？他说：因为在馆试中屡次落第，心中难免抑郁，夏天喜欢用手捋乳头，于是时常有乳汁流出。有人说这是真液，不能泄露，因此覆盖膏药，乳汁停止流出，但乳旁出现了硬核。后来南下来校阅试卷，劳神费力，乳核就经常肿痛。一位书吏略懂医术，认为乳汁欲出而被膏药阻滞，又不能归经，所以停滞形成硬核，听说妇人血上行化为乳汁，现在这汁液也是血类，适宜饮用川芎当归酒，行其滞血，硬核自然会消。我认为有理便饮用了，结果硬核依旧，却吐血、鼻衄大作。又请京口张医生医治，吐衄停止却引发了肠风便血，张医生自夸功劳，说血从下出是顺证。然而身体已经沉重困顿。又请其他医生医治，便血也停止了，但乳核的势头日益嚣张，终于导致溃烂。一位民间医生，擅长炼制砒霜治疗痔疮瘘管，私下盘算这也算是漏疮，便将药纳入疮口中，痛不欲生，溃烂无法支撑，所以到了这种地步。我本打算按法则判定为不治之症，但见其精神尚好，饮食自如，没有严重的恶候，还可以拖延时日，于是为他定下方剂后告别。后来我在广陵校勘士子文章，不再互通音讯，他便改用了其他医生的药，到八月初，因气滞引发呃逆而死。男子患乳岩的很少，发病又很微小，却被三位庸医误治至此。砒霜，确实不可纳入体内，川芎、当归有什么罪过呢！不可不记录下来作为后人的鉴戒。
蒲公英草，捣烂敷于患处，疗效神奇。天南星粉末用温酒调匀涂抹。治疗妇人乳痛成痈，将益母草研末，用水调匀涂在乳房上，一夜自然痊愈；生捣烂敷用也可以。妇人吹乳（急性乳腺炎），用桑树皮和米饭一起捣成膏贴敷。乳头裂破，用丁香末敷贴。
乳痈针刺乳中穴，（位于乳下正中，进针，沿皮向后平刺一寸半，施灸泻法。）
〔甲〕 乳痈伴有寒热，短气，睡眠不安，由膺窗穴主治。乳痈凄怆恶寒发热，疼痛不可按压，由乳根穴主治。受大惊刺激引起的乳痛，由梁丘穴主治。乳痈有热象，由足三里穴主治。（乳痈诸药不能止痛者，足三里针入五分，立止。）女子乳痈惊悸，由上巨虚、下廉穴主治。（《千金方》说：臂肿重，足部僵硬不收，脚跟痛。）乳痈，由太冲穴及复溜穴主治。妒乳（哺乳期乳汁淤积），由太渊穴主治。妇人乳房余疾，由盲门穴主治。
If applying Tiegu San (Iron Hoard Powder) is ineffective, it may instead exacerbate symptoms such as wheezing and chest oppression. In the ninth month, a daughter was born, but the ulceration worsened significantly, with the entire breast tissue rotting away and spreading to the chest and axilla. The pus was thick and sticky, with an output of nearly six or seven sheng (a traditional Chinese unit of volume), showing no signs of healing. It was not until the eleventh month that she sought medical treatment from me. I switched to a moderate-dose decoction for detoxification with mild properties, applied Shengji San (Flesh-Regenerating Powder) externally, and used herbs such as Longgu (Dragon Bone) and Hanshuishi (Calcitum). However, pus continued to flow profusely; areas splashed by the pus developed swollen blisters that ulcerated and suppurated. The sides turned purple-black, with over ten open sores. The chest and axilla were all swollen and ulcerated, making it impossible to turn or lie on one side; the condition was terrifying. I stated: "Postpartum toxic pathogens have flared up due to deficiency. She should take large doses of Huangqi (Astragali Radix) to clear toxicity, nourish blood, boost qi, and generate flesh." However, her previous physician dared not use it. After mid-December, the condition deteriorated further, with more than twenty sores. All other medications had failed. Only then did they switch to my prescription. At that time, the pus was foul and viscous. Washing the area with a decoction of Zhiye (Paper Mulberry Leaf) and pig trotters provided immediate relief. I then prescribed a formula named Huangqi Tuoli Tang (Astragalus Supporting the Interior Decoction). Huangqi (Astragali Radix), being sweet and warm, serves as the sovereign herb to expel pus, boost qi, and generate flesh; Gancao (Glycyrrhizae Radix et Rhizoma) tonifies stomach qi and clears toxicity, while Danggui Shen (Angelicae Sinensis Radix) harmonizes and generates blood, serving as the minister herbs; Shengma (Cimicifugae Rhizoma), Gegen (Puerariae Radix), and Loulu (Euphorbiae Humifusae Herba) are herbs specific to the Foot-Yangming Stomach meridian; Lianqiao (Forsythiae Fructus) and Fangfeng (Saposhnikoviae Radix) both dissipate nodules and unblock meridians; Gualou Ren (Trichosanthis Semen) and Shunianzi (Arctii Fructus) clear toxicity and reduce swelling; Zaogao Ci (Gleditsiae Spina) guides the medicine to the ulcerated site; Baizhi (Angelicae Dahuricae Radix) enters the Yangming meridian, eliminates foul pus, and promotes tissue growth; additionally, Chuanxiong (Ligustici Chuanxiong Rhizoma) in small dosage, along with Rougui (Cinnamomi Cortex) and Chao Baihu (Phellodendri Cortex prepared with stir-frying) are used as guiding herbs. Each dose is decocted with one cup of wine, and accompanied by Bayu Shuang Wan (White Jade Frost Pills) to drain pus and clear toxicity. Since the pus was still thick and viscous and the pathogenic factor was at its peak, astringent medicines should not be used immediately. Instead, it is appropriate to apply Cuqing Dingzi (Emerald Green Plaster) externally. The next day, the pus became thin, pain subsided, and foulness cleared, indicating a trend toward recovery. By the New Year of the Xinwei year, new flesh had grown over the affected areas. For any remaining purple swelling, the Congyun method (Onion Moxibustion) was applied, resulting in immediate resolution. However, the area near the axilla, corresponding to the Foot-Shaoyang Gallbladder meridian, had not yet healed. Therefore, Chaihu (Bupleuri Radix) and Qingpi (Citri Reticulatae Pericarpium Viride) were added, along with double the amount of Chuanxiong. As the pus neared clearance, Sou Nong San (Pus-Searching Powder) was applied externally. After the Lantern Festival, full recovery was achieved.
In the second month of the Gui Mao year (Wanli era), Zhao Gai'an, a Censor serving as Director of Education in Southern Jili, sent greetings through a county magistrate friend and invited me to meet at Maoshan. Due to our shared history as colleagues in the Hanlin Academy, I could not decline and traveled there specifically. He was seeking treatment for an illness. Upon exposing his chest, a sore on the left side of the breast was found, large as a bowl, with dark purple necrotic tissue deeply embedded, resembling a rocky cave, emitting a foul odor. I asked how he contracted this. He replied: "After failing multiple examinations at the academy, I felt depressed. In summer, I often rubbed my nipple with my hand, causing fluid to leak occasionally. Someone told me this was 'true essence' that must not be lost, so I covered it with a plaster. The leakage stopped, but a lump formed beside the breast. Later, while traveling south to supervise exams, mental strain caused the lump to swell and hurt frequently. A clerk who knew some medicine said that the fluid was blocked by the plaster and could not return to its proper channel, stagnating into a lump. He cited that women's blood rises to become milk, and since this fluid is also blood-like, drinking Xiongui Wine (Chuanxiong and Danggui Wine) would move the stagnant blood and dissolve the lump. I agreed and drank it, but the lump remained, and I began to vomit blood and suffer severe epistaxis. I then consulted Dr. Zhang from Jingkou. His treatment stopped the bleeding but induced intestinal wind (hematochezia). Dr. Zhang boasted that bleeding from below was a favorable sign, though my body became heavy and debilitated. Another doctor treated me, stopping the bloody stool, but the breast lump grew increasingly aggressive until it ulcerated. A folk healer, skilled in using arsenic for hemorrhoids, privately reasoned this was also a fistula, inserted the drug into the wound, causing excruciating pain and uncontrollable ulceration, leading to this state. I initially considered it incurable by standard methods, but seeing his spirit was intact and diet normal, without severe adverse signs, I thought he could survive for some time. I prescribed a formula and departed. Later, while examining scholars in Guangling, we lost contact. He switched to other doctors' prescriptions and died in early August from qi stagnation inducing hiccups. Men rarely suffer from Ru Yan (Breast Cancer/Rock Tumor). The onset was subtle, yet three incompetent physicians misdiagnosed him, leading to this tragedy. Arsenic indeed should never be inserted internally, but what fault do Chuanxiong and Danggui have? This must be recorded as a warning for posterity.
Dandelion (Pugongying) grass, crushed and applied to the affected area, yields miraculous results. Powdered Tian Nan Xing (Arisaematis Rhizoma) mixed with warm wine and applied topically treats breast abscesses in women. For breast pain developing into an abscess, Yimu Cao (Leonuri Herba) powdered and mixed with water, applied to the breast overnight, cures the condition spontaneously; fresh crushed application is also effective. For Ru Chui (Acute Mastitis/Lactational Breast Abscess), mulberry bark mixed with rice paste, pounded into a poultice and applied. For cracked nipples, Dingxiang (Caryophylli Flos) powder is applied.
For Ru Yong (Breast Abscess), needle the Ruzhong point (located centrally below the nipple; insert needle and glide horizontally backward 1.5 cun; apply moxibustion with draining method.)
[Alpha] For Ru Yong with chills and fever, shortness of breath, and restless sleep, Yingchuang (ST16) is indicated. For Ru Yong with aversion to cold and fever, and pain intolerable to touch, Rugen (ST18) is indicated. For acute breast pain following great fright, Liangqiu (ST34) is indicated. For Ru Yong with heat sensations, Zusanli (ST36) is indicated. (For Ru Yong where herbal medicines fail to relieve pain, needling Zusanli to a depth of 0.5 cun stops pain immediately.) For female Ru Yong with palpitations/fright, Shangjuxu (ST37) and Xiaolian (ST39) are indicated. (The *Qianjin Fang* states: for arm heaviness/swelling, inability to flex the foot, and heel pain.) For Ru Yong, Taichong (LR3) and Fuliou (KI7) are indicated. For Du Ru (Nipple Retraction/Obstruction), Taiyuan (LU9) is indicated. For residual ailments of the female breast, Mangmen (BL46) is indicated.