【方歌】疽历痈在乳旁生，结核红肿硬焮疼，包络痰凝脾气郁，
治宜温舒化坚凝。
【注】此证生于乳旁，初肿坚硬，形类结核，发长缓慢，渐增
焮肿，色红疼痛。由包络寒痰，脾气郁结而成，系寒证
非热证也。治宜温和舒郁化坚，以内补十宣散服之，外
敷回阳玉龙膏消之，如不消，脓势将成也。内外治法，
即按痈疽肿疡、溃疡门。
方剂：内补十宣散
组成：人参 黄耆
当归（各二钱） 桔梗
厚朴（姜制） 川芎
白芷 肉桂
防风 甘草（炙，各一两）
共研末，每服三钱，热黄酒调服。不饮酒者，木香
煎汤调下。
【方歌】内补十宣诸肿毒，已成令溃未成消，参耆桔朴芎归草，
芷桂防风热酒调。
又方：回阳玉龙膏（见肿疡门）
【方歌】吹乳乳毒乳肿疼，内吹胎热痛焮红，外吹子鼻凉气袭，
寒热烦渴结肿疼。
【注】乳房属胃，乳头属肝，而有内吹、外吹之分。内吹者，
怀胎六、七月，胸满气上，乳房结肿疼痛，若色红者，
因多热也；不红者，既因气郁，且兼胎旺也。多热者，
宜服柴胡清肝汤；气郁者，宜服逍遥散，外俱敷冲和膏
必消。或初肿失于调治，或本人复伤气怒，以致大肿大
痛，其势必欲成脓，宜用逍遥散加黄耆、白芷、连翘以
养血排脓治之。脓溃之后，宜调养血气，待生产后，按
溃疡治法，方得收口。妊娠用药禁忌，另有歌诀，详载
首卷。外吹者由乳母肝、胃气浊，更兼子吮乳睡熟，鼻
孔凉气，袭入乳房，与热乳凝结肿痛，令人寒热往来，
烦躁口渴。初宜服荆防牛蒡汤，外用隔蒜灸法；俟寒热
退仍肿者，服橘叶栝蒌散，外敷冲和膏消之。其肿消之
不应者，将欲作脓，即用透脓散。其余内服、外敷之法
，俱按痈疽肿疡、溃疡门。又有至如内未怀胎，外未行
乳而生毒者，系皮肉为患，未伤乳房，此肝、胃湿热凝
结而成乳毒也，治当按疮疖治之，无有不效者。
方剂：荆防牛蒡汤
组成：荆芥 防风
牛蒡子（炒，研） 金银花
陈皮 花粉
黄芩 蒲公英
连翘（去心） 皂刺（各一钱）
柴胡 香附子
甘草（生，各五分）
水二钟，煎八分，食远服。
【方歌】荆防牛蒡乳外吹，寒热肿疼俱可推，银花陈草柴香附，
花粉芩蒲翘刺随。
又方：橘叶栝蒌散
组成：橘叶（二十个） 栝蒌（量证用半个或一个）
川芎 黄芩
栀子（生，研） 连翘（去心）
石膏（〔火段〕） 柴胡
陈皮 青皮（各一钱）
甘草（生，五分）
水二钟，煎八分，食远服，滓再煎服。紫肿焮痛用
石膏，红肿者去之。
【方歌】橘叶栝蒌吹乳证，凉袭热乳凝结成，芎芩栀草连翘等，
石膏柴与陈皮青。
又方：柴胡清肝汤（见头部鬓疽）
逍遥散（见背部上搭手）
冲和膏、透脓散（见肿疡门）
隔蒜灸法（见首卷灸法内）
【方歌】疽历痈生于乳房旁边，表现为结核状的红肿、坚硬和灼热疼痛。这是由于心包络寒痰凝结与脾气郁结所致。治疗应当采用温通舒缓、化解坚凝的方法。
【注】此病证发生在乳房旁边，初期肿胀坚硬，形状类似结核，发病生长缓慢，逐渐增加红肿程度，颜色发红且疼痛。这是由心包络的寒痰以及脾气的郁结所形成，属于寒证而非热证。治疗宜用温和之法以舒展郁结、化解坚凝，内服内补十宣散，外敷回阳玉龙膏以消散肿块；如果肿块不消退，说明脓势即将形成。内外治法，即参照痈疽肿疡、溃疡章节中的方法。
方剂：内补十宣散
组成：人参、黄耆、当归（各二钱）、桔梗、厚朴（姜制）、川芎、白芷、肉桂、防风、甘草（炙，各一两）
共研为末，每次服用三钱，用热黄酒调服。不饮酒者，用木香煎汤调服。
【方歌】内补十宣散治疗各种肿毒，已成脓者令其溃破，未成脓者使其消散，方中含有人参、黄耆、桔梗、厚朴、川芎、当归、甘草，配以白芷、肉桂、防风，用热酒调服。
【方歌】吹乳是指乳房毒邪引起的乳房肿胀疼痛。内吹因胎热导致疼痛红肿灼热；外吹因婴儿吸吮时鼻孔凉气侵袭，伴有寒热、烦躁、口渴及结块肿痛。
【注】乳房归属于胃，乳头归属于肝，因此有内吹和外吹之分。内吹发生于怀孕六、七个月时，出现胸满气逆，乳房结块肿胀疼痛，如果颜色发红，是因为多热；如果不红，则是由于气郁，且兼有胎气旺盛。多热的情况，适宜服用柴胡清肝汤；气郁的情况，适宜服用逍遥散，外用冲和膏敷贴，必定能消散。或者初期肿胀未能及时调理治疗，或产妇再次因生气伤气，导致肿大疼痛加剧，病情势必欲成脓，宜用逍遥散加黄耆、白芷、连翘以养血排脓进行治疗。脓溃之后，宜调养气血，待生产后，按照溃疡的治疗方法，才能收口愈合。妊娠用药禁忌另有歌诀，详细记载在首卷中。外吹是由于乳母肝、胃之气浊滞，再加上婴儿吸吮时睡熟，鼻孔中的凉气袭入乳房，与热乳凝结导致肿痛，使人出现寒热往来、烦躁口渴的症状。初期适宜服用荆防牛蒡汤，外用隔蒜灸法；等到寒热退去但仍有肿胀时，服用橘叶栝蒌散，外敷冲和膏以消散。如果消肿无效，说明即将化脓，即用透脓散。其余内服、外敷的方法，均参照痈疽肿疡、溃疡章节。又有如内未怀孕、外未哺乳却生毒疮者，这是皮肉受患，未伤及乳房，这是由肝、胃湿热凝结而成的乳毒，治疗应当按疮疖治疗，没有不有效的。
方剂：荆防牛蒡汤
组成：荆芥、防风、牛蒡子（炒，研）、金银花、陈皮、花粉、黄芩、蒲公英、连翘（去心）、皂刺（各一钱）、柴胡、香附子、甘草（生，各五分）
水两钟，煎至八分，饭后服用。
【方歌】荆防牛蒡汤治疗乳房外吹，寒热肿痛皆可推演，方中含金银花、陈皮、甘草、柴胡、香附，配以花粉、黄芩、蒲公英、连翘、皂刺。
又一方：橘叶栝蒌散
组成：橘叶（二十个）、栝蒌（根据病情用量半个或一个）、川芎、黄芩、栀子（生，研）、连翘（去心）、石膏（煅）、柴胡、陈皮、青皮（各一钱）、甘草（生，五分）
水两钟，煎至八分，饭后服用，药渣再煎服用。若见紫肿灼痛用石膏，红肿者去掉石膏。
[Prescription Verse] Juli Yong (Ulcerative Carbuncle) arises beside the breast, presenting as a tubercle with redness, swelling, hardness, and burning pain. This is caused by the congealing of phlegm in the Pericardium Collateral and Qi stagnation of the Spleen. The treatment should aim to warm, soothe, and resolve the induration.
[Note] This condition arises beside the breast. Initially, it presents as hard swelling resembling a tubercle, developing slowly, gradually increasing in redness, swelling, red color, and pain. It is formed by cold-phlegm in the Pericardium Collateral and Qi stagnation of the Spleen; it is a Cold syndrome rather than a Heat syndrome. Treatment should employ mild methods to soothe stagnation and resolve induration. Internally administer Neibu Shixuan San (Internal Tonifying Ten-Exertion Powder), and externally apply Huiyang Yulong Gao (Restore Yang Jade Dragon Ointment) to dissipate it. If it does not dissipate, pus formation is imminent. Internal and external treatments follow the protocols for Ulcerative Sores and Ulcers sections.
Formula: Neibu Shixuan San (Internal Tonifying Ten-Exertion Powder)
Composition: Ren Shen (Ginseng Radix et Rhizoma), Huang Qi (Astragali Radix), Dang Gui (Angelicae Sinensis Radix) [2 qian each], Jie Geng (Platycodonis Radix), Hou Po (Magnoliae Officinalis Cortex, processed with ginger), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Bai Zhi (Angelicae Dahuricae Radix), Rou Gui (Cinnamomi Cortex), Fang Feng (Saposhnikoviae Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried) [1 liang each].
Grind into powder. Take 3 qian per dose, mixed with hot yellow wine. For those who do not drink alcohol, mix with decoction of Mu Xiang (Aucklandiae Radix).
[Prescription Verse] Neibu Shixuan San treats various swellings and toxins; if pus has formed, it promotes drainage; if not, it resolves the swelling. It contains Ginseng, Astragalus, Platycodon, Magnolia Bark, Ligusticum, Angelica, Licorice, plus Angelica Root, Cinnamon Twig, and Saposhnikovia, taken with hot wine.
Another Formula: Huiyang Yulong Gao (Restore Yang Jade Dragon Ointment) (See Ulcerative Sores Section)
[Prescription Verse] Chuiru (Blowing Breast) refers to breast toxicity causing breast swelling and pain. Neichui (Internal Blowing) results from fetal heat causing painful, red, and burning swelling. Waichui (External Blowing) results from cool air entering through the infant's nostrils during sucking, accompanied by alternating chills and fever, irritability, thirst, and nodular swelling pain.
[Note] The breast belongs to the Stomach, and the nipple belongs to the Liver, hence the distinction between Neichui and Waichui. Neichui occurs during the sixth or seventh month of pregnancy, characterized by chest fullness and upward rushing of Qi, resulting in breast nodular swelling and pain. If the color is red, it indicates excess Heat; if not red, it is due to Qi stagnation combined with vigorous fetal Qi. For cases with excess Heat, Chaihu Qinggan Tang (Bupleurum Liver-Clearing Decoction) is suitable. For Qi stagnation, Xiaoyao San (Free and Easy Wanderer Powder) is suitable, applied externally with Chonghe Gao (Harmonizing Ointment), which will surely dissipate the swelling. Alternatively, if initial swelling was neglected or the patient suffered emotional injury again, leading to severe swelling and pain, pus formation is inevitable. Use Xiaoyao San added with Huang Qi, Bai Zhi, and Lian Qiao to nourish blood and drain pus. After pus rupture, nourish Qi and Blood. After delivery, treat according to ulcer protocols to achieve healing. Pregnancy medication contraindications are detailed in another verse in Volume One. Waichui is caused by turbid Qi in the Liver and Stomach of the nursing mother, compounded by cool air from the sleeping infant's nostrils entering the breast during sucking, condensing with hot milk to cause swelling and pain, leading to alternating chills and fever, irritability, and thirst. Initially, Jingfang Niubang Tang (Schizonepeta, Saposhnikovia, and Arctostemon Decoction) is suitable, with external Garlic-Separator Moxibustion. When chills and fever subside but swelling remains, Ju Ye Gua Lou San (Tangerine Leaf and Trichosanthes Powder) is taken, with Chonghe Gao applied externally. If swelling does not resolve, indicating impending pus formation, Tou Nong San (Pus-Penetrating Powder) is used. Other internal and external treatments follow the Ulcerative Sores and Ulcers sections. There are also cases where toxicity arises without pregnancy or lactation; this affects skin and flesh without injuring the breast itself, caused by Damp-Heat condensation in the Liver and Stomach forming breast toxicity. Treat according to carbuncle and furuncle protocols, with effective results.
Formula: Jingfang Niubang Tang (Schizonepeta, Saposhnikovia, and Arctostemon Decoction)
Composition: Jing Jie (Schizonepetae Spica), Fang Feng (Saposhnikoviae Radix), Niu Bang Zi (Arctii Fructus, stir-fried and ground), Yin Hua (Lonicerae Japonicae Flos), Chen Pi (Citri Reticulatae Pericarpium), Fen Hua (Trichosanthis Radix), Huang Qin (Scutellariae Radix), Pu Gong Ying (Taraxaci Herba), Lian Qiao (Forsythiae Fructus, heart removed), Zao Ci (Gleditsiae Spina) [1 qian each], Chai Hu (Bupleuri Radix), Xiang Fu (Cyperi Rhizoma), Gan Cao (Glycyrrhizae Radix et Rhizoma, raw) [5 fen each].
Decoct 2 zhong of water to 8 fen. Take after meals.
[Prescription Verse] Jingfang Niubang Tang treats external blowing of the breast, addressing chills, fever, swelling, and pain. It contains Lonicera, Citrus Peel, Licorice, Bupleurum, and Cyperus, along with Trichosanthes Root, Scutellaria, Taraxacum, Forsythia, and Gleditsia Spine.
Another Formula: Ju Ye Gua Lou San (Tangerine Leaf and Trichosanthes Powder)
Composition: Ju Ye (Citri Reticulatae Folium) [20 leaves], Gua Lou (Trichosanthis Fructus) [half or one whole fruit depending on condition], Chuan Xiong (Ligustici Chuanxiong Rhizoma), Huang Qin (Scutellariae Radix), Zhi Zi (Gardeniae Fructus, raw and ground), Lian Qiao (Forsythiae Fructus, heart removed), Shi Gao (Gypsum Fibrosum, calcined), Chai Hu (Bupleuri Radix), Chen Pi (Citri Reticulatae Pericarpium), Qing Pi (Citri Reticulatae Pericarpium Viride) [1 qian each], Gan Cao (Glycyrrhizae Radix et Rhizoma, raw) [5 fen].
Decoct 2 zhong of water to 8 fen. Take after meals. Decoct the dregs again and take. Use Gypsum for purple, swollen, and burning pain; omit Gypsum for red swelling.
[Prescription Verse] Ju Ye Gua Lou San treats blowing breast syndrome, where cool air attacks and hot milk condenses. It contains Ligusticum, Scutellaria, Gardenia, Licorice, Forsythia, etc., plus Gypsum, Bupleurum, Citrus Peel, and Citrus Peel Viride.
Another Formula: Chaihu Qinggan Tang (Bupleurum Liver-Clearing Decoction) (See Head and Temple Carbuncle Section)
Xiaoyao San (Free and Easy Wanderer Powder) (See Upper Back Hand-Attacking Carbuncle Section)
Chonghe Gao (Harmonizing Ointment), Tou Nong San (Pus-Penetrating Powder) (See Ulcerative Sores Section)
Ge Suan Jiu Fa (Garlic-Separator Moxibustion Method) (See Moxibustion Methods in Volume One)