一妇形脉稍实。性躁。难于后姑。乳生隐核。以本草单味青皮汤。间以加减四物汤。加
行经络之剂。治两月而安。
一后生作劳。风寒夜热。左乳痛。有核如掌。脉细涩而数。此阴滞于阳也。询之。已得
酒。遂以栝蒌子、石膏、干葛、台芎、白芷、蜂房、生姜同研。入酒服之。四帖而安。
薛立斋治一儒者。两乳患肿。服连翘饮。加坚硬。食少内热。胸肋作痛。日晡头疼。小
便赤涩。此足三阴虚而兼郁怒。前药复损脾肺。先用六君加芎、归、柴、栀。四十余剂。元
气复而自溃。乃作痛恶寒。此气血虚也。用十全大补、六味地黄而愈。
封君袁阳泾。左乳内结一核。月余赤肿。此足三阴虚兼怒气所致。用八味加柴、栀、丹
皮。四剂。赤肿渐退。内核渐消。又用清肝解郁汤而愈。时当仲秋。两目连札。肝脉微弦。
此肝经火盛而风动也。更加龙胆草五分。并六味地黄丸而愈。若用清热败毒。化痰行气。鲜
不误者。
一儒者两胁作胀。两乳作痛。服流气饮、栝蒌散。半载后。左胁下结一块如核。肉色不
变。劳则寒热。此郁结气伤而为患。虚而未能溃也。八物加柴胡、远志、贝母、桔梗。月余
色赤作痛。脓将成矣。又服月余。针之。出脓碗许。顿然作呕。此胃气虚而有痰也。令时
啖生姜。服六君子汤。呕止。加肉桂而疮愈。彼后出宰。每伤劳怒。胸乳仍痛。并发寒热。
服补中益气加炒山栀。愈。
一妇人内热胁胀。两乳不时作痛。口内不时辛辣。若卧而起急。则脐下牵痛。此带脉为
患。用小柴胡汤加青皮、黄连、山栀。二剂而愈。
一妇人久郁。右乳内肿硬。用八珍汤加远志、贝母、柴胡、青皮。及隔蒜灸。兼服神效
栝蒌散。两月余而消。
一妇人禀实性躁。怀抱久郁。左乳内结一核。按之微痛。以连翘饮子二十余剂。少退。更以
八珍加青皮、香附、桔梗、贝母。二十余剂而消。
一妇人发热作渴。至夜尤甚。两乳忽肿。肝脉洪数。乃热入血室也。用加味小柴胡汤
热止肿消。
一妇人因怒。左乳作痛。发热。表散太过。肿热益甚。用益气养荣汤数剂。热止脓成。
不从用针。肿胀热渴。针脓大泄。仍以前汤。月余始愈。此证若脓未成未破。有薄皮剥起者
用代针之剂。其脓自出。不若及时用针。不致大溃。若脓血未尽。辄用生肌。反助其邪。
慎之。
一妇人脓清肿硬。面黄食少。内热晡热。自汗盗汗。月经不行。此肝脾气血俱虚。用十
全大补加远志、贝母。及补中益气各三十余剂。外用葱熨患处。诸证寻愈。
一妇人脓成胀痛。欲针之不从。数日。始针出败脓三四碗许。虚证蜂起。几至危殆。用
大补两月余而安。若元气虚弱不作脓者。用益气养荣汤补之。脓成即针。若肿痛寒热。怠惰
食少。或至夜热甚。用补中益气兼逍遥散补之为善。
一产妇因乳少。服药通之。致乳房肿胀。发热作渴。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。则乳汁多而脓。衰则淡而少。所
乳之子。亦弱而多病。又有屡产无乳。或大便涩滞。乃亡津液也。当滋化源。
一妇人右乳内结三核。年余不消。朝寒暮热。饮食不甘。此乳岩。用益气养荣汤百余剂
更以木香饼熨之。年余而消。
一妇人年二十有五。素虚弱。多郁怒。时疫后脾胃愈虚。饮食愈减。又值气忿。右乳胁
下红肿。应内作痛。用炒麦麸熨之。肿虽少散。内痛益甚。转侧。胸中如物悬坠。遂与加减
四物汤。内肿如鹅卵。外大如盘。胸胁背心相应而痛。夜热势甚。时治者皆以攻毒为言。薛
云。此病后脾弱。而复怒伤肝。治法惟主于健脾气。平肝火。则肿自消而病自愈矣。方以八
物加陈皮、黄 、柴胡、山栀、白芷。服八剂。病减六七。去白芷。加青皮、木香、桔梗。
又六剂而全愈。若用攻毒之剂。病胡能瘳。
〔附〕一妇产后忽两乳细小。下垂过小腹。痛甚。名乳悬。用芎、归各一斤。内用八两
水煎。余用烧烟熏口鼻。二料乃效。
一位妇女形体和脉象稍显充实，性格急躁，难以侍奉婆婆。乳房中生出隐蔽的硬结。使用本草中的单味青皮汤治疗，并间歇服用加减四物汤，加入疏通经络的药物，经过两个月的治疗而痊愈。
一位年轻男子因劳累，感受风寒，夜间发热，左侧乳房疼痛，有手掌大小的硬块，脉象细涩而数。这是阴气阻滞于阳分所致。询问得知，他近期饮酒。于是用栝蒌子、石膏、干葛、台芎、白芷、蜂房、生姜一同研磨，调入酒中服用。服用四帖后痊愈。
薛立斋诊治一位读书人，双侧乳房患肿胀，服用连翘饮后，肿块变得更加坚硬，食欲减少且内热，胸胁疼痛，傍晚时分头痛，小便赤红涩痛。这是足三阴经虚弱兼有郁怒所致，之前的药物又损伤了脾肺。先用六君子汤加川芎、当归、柴胡、栀子，服用四十多剂，元气恢复后脓肿自然溃破。随后出现疼痛和恶寒，这是气血虚弱的表现。使用十全大补汤、六味地黄丸而痊愈。
封君袁阳泾，左乳内结成一个硬核，月余后红肿。这是足三阴经虚弱兼怒气所致。用八味地黄丸加柴胡、栀子、丹皮，服用四剂，红肿逐渐消退，内核逐渐消散。后又服用清肝解郁汤而痊愈。当时正值仲秋，双眼频繁眨动，肝脉微弦。这是肝经火盛而生风。再加龙胆草五分，配合六味地黄丸而痊愈。如果采用清热败毒、化痰行气的疗法，很少有不误事的。
一位读书人两胁胀满，两乳疼痛，服用流气饮、栝蒌散。半年后，左胁下结成一核如卵，皮肤颜色不变，劳累时出现寒热。这是郁结伤气所致，正气虚弱未能溃破。用八物汤加柴胡、远志、贝母、桔梗，月余后局部色赤疼痛，脓液即将形成。又服药月余，进行针刺，排出约一碗脓液。突然发生呕吐，这是胃气虚弱且有痰湿。令其时常吃生姜，服用六君子汤，呕吐停止。加入肉桂后疮口愈合。后来他出任官职，每次因劳累和愤怒，胸乳仍痛，并发寒热。服用补中益气汤加炒山栀而愈。
一位妇人内热胁胀，两乳不时疼痛，口中不时感到辛辣，若躺下后起身急促，则脐下牵拉疼痛。这是带脉为患。用小柴胡汤加青皮、黄连、山栀，二剂而愈。
一位妇人长期抑郁，右乳内肿硬。用八珍汤加远志、贝母、柴胡、青皮，并配合隔蒜灸，兼服神效栝蒌散，两个多月后消散。
一位妇人禀赋充实，性格急躁，怀抱长期抑郁，左乳内结一核，按压微痛。用连翘饮子二十多剂，稍见减退。再用八珍汤加青皮、香附、桔梗、贝母，二十多剂后消散。
一位妇人发热口渴，夜间尤为严重，两乳突然肿胀，肝脉洪数，这是热入血室。用加味小柴胡汤，热止肿消。
一位妇人因愤怒，左乳疼痛，发热，因发散太过，肿痛更加严重。用益气养荣汤数剂，热止脓成。患者未听从针刺建议，导致肿胀热渴加剧，针刺排脓大量流出，仍用前汤，月余才痊愈。此证若脓未成未破，有薄皮剥起者，可用代针之剂，脓自出，不如及时针刺，不致大面积溃烂。若脓血未尽，辄用生肌药，反而助长邪气，务必谨慎。
一位妇人脓液清稀，肿胀坚硬，面色黄，食欲少，内热及傍晚发热，自汗盗汗，月经不行。这是肝脾气血俱虚。用十全大补汤加远志、贝母，以及补中益气汤各三十多剂，外用葱熨患处，诸证随即痊愈。
一位妇人脓成胀痛，欲针刺而未从，数日后始针刺排出败脓三四碗左右，虚证蜂拥而起，几乎危殆。用大补法两个多月才安定。若元气虚弱不能化脓者，用益气养荣汤补之。脓成即针。若肿痛寒热，怠惰食少，或至夜热甚，用补中益气兼逍遥散补之为善。
一位产妇因乳汁少，服药通乳，导致乳房肿胀，发热口渴，用玉露散补益而愈。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；衰则淡而少。所哺乳的婴儿，也弱而多病。又有屡产无乳，或大便涩滞，乃亡津液也。当滋化源。
一位妇人右乳内结三核，年余不消，朝寒暮热，饮食不甘。这是乳岩。用益气养荣汤百余剂，更以木香饼熨之，年余而消。
一位二十五岁妇人，素来虚弱，多郁怒，时疫后脾胃更虚，饮食更少，又值气忿，右乳胁下红肿，应内作痛。用炒麦麸熨之，肿虽少散，内痛益甚，转侧时胸中如物悬坠。遂与加减四物汤，内肿如鹅卵，外大如盘，胸胁背心相应而痛，夜热势甚。当时治者皆以攻毒为言。薛云：此病后脾弱，而复怒伤肝，治法惟主于健脾气，平肝火，则肿自消而病自愈矣。方以八物加陈皮、黄芪、柴胡、山栀、白芷，服八剂，病减六七，去白芷，加青皮、木香、桔梗，又六剂而全愈。若用攻毒之剂，病何能瘳。
A woman with a slightly full constitution and pulse, irritable in nature, and unable to serve her mother-in-law well, developed hidden nodules in the breasts. She was treated with a single-herb decoction of Qingpi (Green Tangerine Peel) from Bencao, interspersed with Jiawei Siwu Tang (Modified Four Substance Decoction) and herbs that promote the circulation of meridians. After two months of treatment, she recovered.
A young man, exhausted by labor and exposed to wind-cold, suffered from night fevers and pain in the left breast with a palm-sized nodule. His pulse was fine, choppy, and rapid. This indicated Yin stagnation obstructing Yang. Upon inquiry, it was found that he had recently consumed alcohol. He was prescribed a mixture of Lougualzi (Trichosanthis Semen), Shigao (Gypsum Fibrosum), Gange (Puerariae Radix), Taixiong (Ligusticum Chuanxiong Rhizoma), Baizhi (Angelicae Dahuricae Radix), Fengfang (Apis Ceranae Cellum), and Shengjiang (Zingiberis Rhizoma Recens), ground together and taken with wine. After four doses, he recovered.
Xue Lizhai treated a scholar who suffered from swelling in both breasts. After taking Lianqiao Yin (Forsythia Decoction), the masses became harder, accompanied by poor appetite, internal heat, chest and hypochondriac pain, headache at dusk, and dark, scanty urination. This was due to deficiency of the three Foot-Yin meridians combined with emotional depression. The previous medicines further damaged the Spleen and Lung. Initially, Liujunzi Tang (Six Gentlemen Decoction) plus Xiong (Chuanxiong Rhizoma), Gui (Danggui Root), Chai (Bupleuri Radix), and Zhi (Gardeniae Fructus) were administered for over forty doses. Once Yuanqi (Original Qi) recovered, the abscess spontaneously ruptured. Subsequently, pain and aversion to cold appeared, indicating Qi and Blood deficiency. He was cured using Shiquan Dabu Tang (Ten Complete Tonifying Decoction) and Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill).
Lord Yuan Yangjing had a nodule forming inside his left breast, which became red and swollen after more than a month. This was caused by deficiency of the three Foot-Yin meridians and anger. Baweihuangdi Wan (Eight-Ingredient Rehmannia Pill) plus Chai (Bupleuri Radix), Zhi (Gardeniae Fructus), and Danpi (Moutan Cortex) were used. After four doses, the redness and swelling gradually subsided, and the inner nodule diminished. He then took Qingjie Jieyu Tang (Clear Liver and Resolve Depression Decoction) and recovered. At that time, during mid-autumn, his eyes twitched frequently, and his Liver pulse was slightly wiry. This indicated excessive Fire in the Liver meridian stirring Wind. An additional 5 fen of Longdancao (Gentianae Radix) was added along with Liuwei Dihuang Wan, leading to recovery. If clearing heat and detoxifying or resolving phlegm and moving Qi had been used, errors would have been frequent.
A scholar experienced distension in both hypochondria and pain in both breasts. After taking Liuqi Yin (Flowing Qi Decoction) and Gualou San (Trichosanthes Powder), half a year later, a nodule like an egg formed under the left hypochondrium without skin discoloration. Fatigue triggered chills and fever. This was due to Qi injury from depression and obstruction, with deficiency preventing rupture. Bayi Tang (Eight Substance Decoction) plus Chaihu (Bupleuri Radix), Yuanzhi (Polygalae Radix), Beimu (Fritillariae Bulbus), and Jiegeng (Platycodonis Radix) were given. After more than a month, the area turned red and painful, indicating impending suppuration. After another month of medication, acupuncture was performed, draining about one bowl of pus. Suddenly, vomiting occurred, indicating deficient Stomach Qi with Phlegm. He was instructed to eat fresh ginger frequently and take Liujunzi Tang (Six Gentlemen Decoction). Vomiting ceased. Adding Rougui (Cinnamomi Cortex) healed the sore. Later, upon taking office, fatigue and anger caused recurring chest and breast pain with chills and fever. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus fried Zhizi (Gardeniae Fructus) cured him.
A woman suffered from internal heat, hypochondriac distension, intermittent breast pain, occasional spicy taste in the mouth, and pulling pain below the umbilicus when rising quickly from lying down. This was a disorder of the Dai Mai (Girdle Vessel). Xiao Chaihu Tang (Minor Bupleurum Decoction) plus Qingpi (Green Tangerine Peel), Huanglian (Coptidis Rhizoma), and Zhizi (Gardeniae Fructus) were used. She recovered after two doses.
A woman with long-term depression had swelling and hardness in the right breast. Bazhen Tang (Eight Treasure Decoction) plus Yuanzhi (Polygalae Radix), Beimu (Fritillariae Bulbus), Chaihu (Bupleuri Radix), and Qingpi (Green Tangerine Peel) were used, along with garlic-separated moxibustion and Shenxiao Gualou San (Miraculous Trichosanthes Powder). After more than two months, the swelling resolved.
A woman with a robust constitution and irritable temperament, suffering from long-term emotional depression, had a nodule in the left breast that was slightly tender to pressure. Lianqiao Yinzi (Forsythia Decoction) for over twenty doses reduced it slightly. Then, Bazhen Tang (Eight Treasure Decoction) plus Qingpi (Green Tangerine Peel), Xiangfu (Cyperi Rhizoma), Jiegeng (Platycodonis Radix), and Beimu (Fritillariae Bulbus) were used for over twenty doses, resulting in resolution.
A woman with fever and thirst, worse at night, suddenly developed breast swelling. Her Liver pulse was surging and rapid, indicating Heat entering the Blood Chamber (Xueshi). Jiawei Xiao Chaihu Tang (Modified Minor Bupleurum Decoction) stopped the fever and reduced the swelling.
A woman, angered, suffered from left breast pain and fever. Excessive dispersing treatments worsened the swelling and heat. Yiqi Yangrong Tang (Benefit Qi and Nourish Ying Decoction) for several doses stopped the fever and formed pus. Ignoring the advice to lance it led to increased swelling, heat, thirst, and copious pus drainage upon eventual lancing. Continuing the previous decoction led to recovery after a month. For such cases, if pus has not yet formed or ruptured but thin skin is peeling, a needle-replacing agent can be used to induce spontaneous drainage rather than timely lancing to prevent extensive ulceration. If pus and blood are not fully drained, using flesh-regenerating agents prematurely aids the pathogenic factor; caution is advised.
A woman with clear pus, hard swelling, sallow complexion, poor appetite, internal heat, evening fever, spontaneous sweating, night sweats, and amenorrhea suffered from dual deficiency of Liver and Spleen Qi and Blood. Shiquan Dabu Tang (Ten Complete Tonifying Decoction) plus Yuanzhi (Polygalae Radix) and Beimu (Fritillariae Bulbus), along with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), each for over thirty doses, were used. External application of scallion warming (Congyun) on the affected area led to recovery.
A woman with painful swelling due to formed pus refused initial lancing. Days later, lancing drained three to four bowls of foul pus, causing numerous deficiency symptoms and near-critical condition. Major tonification for over two months stabilized her. For those with weak Yuanqi unable to form pus, Yiqi Yangrong Tang should be used. Lance promptly once pus forms. For pain, swelling, chills, fever, lethargy, poor appetite, or severe night fever, combining Buzhong Yiqi Tang with Xiaoyao San (Free Wanderer Powder) for tonification is advisable.
A postpartum woman, taking medicine to increase scanty milk, developed breast swelling, fever, and thirst. Yulu San (Jade Dew Powder) restored health. Milk is transformed from Qi and Blood; above it becomes milk, below it becomes menstruation. If Chong and Ren vessels are vigorous and Spleen/Stomach Qi is strong, milk is abundant and rich; if weak, it is thin and scant. Infants nursed may be weak and prone to illness. Repeated childbirth with no milk or constipation indicates loss of Body Fluids. One must nourish the source of transformation.
A woman had three nodules in the right breast persisting for over a year, with morning chills and evening fevers, and poor appetite. This was Ruyan (Breast Rock/Cancer). Yiqi Yangrong Tang (Benefit Qi and Nourish Ying Decoction) for over a hundred doses, combined with warming with Muxiang Bing (Costus Cake), resolved it after a year.
A twenty-five-year-old woman, constitutionally weak and prone to depression and anger, suffered weakened Spleen and Stomach after an epidemic, further reducing food intake. Anger caused redness, swelling, and deep pain in the right breast and hypochondrium. Warming with fried wheat bran reduced swelling slightly but increased internal pain. Turning caused a sensation of hanging weight in the chest. Jiawei Siwu Tang (Modified Four Substance Decoction) was prescribed. Internally, the swelling resembled a goose egg; externally, it was plate-sized. Pain corresponded across the chest, hypochondrium, and back. Night fever was severe. Other physicians advocated toxic-clearing methods. Xue stated: Post-illness Spleen weakness combined with Liver injury from anger requires strengthening Spleen Qi and calming Liver Fire to resolve swelling and cure disease. Bajunzi Tang (Eight Substance Decoction) plus Chenpi (Tangerine Peel), Huangqi (Astragali Radix), Chaihu (Bupleuri Radix), Zhizi (Gardeniae Fructus), and Baizhi (Angelicae Dahuricae Radix) was given for eight doses, reducing the disease by six or seven parts. Baizhi was removed, and Qingpi (Green Tangerine Peel), Muxiang (Aucklandiae Radix), and Jiegeng (Platycodonis Radix) were added. Six more doses led to full recovery. Toxic-clearing agents would have failed.
[Appendix] A woman suddenly developed small, drooping breasts extending below the lower abdomen after childbirth, with severe pain, named Ruxuan (Hanging Breast). Using one jin each of Xiong (Chuanxiong Rhizoma) and Gui (Danggui Root), eight liang were decocted in water for internal use, while the remainder was burned to smoke the nose and mouth. Two courses proved effective.