证
妇人乳汁不通有二种∶有血气壅盛，乳脉涩而不行者；有血气虚弱，乳脉绝少者。夫虚者补之，
以钟乳粉、猪蹄、鲫鱼之类；盛者行之，用通草、漏芦之类。
乳硬者，多因乳母不知调养所致。盖乳房阳明之经，乳头厥阴所属。忿怒所逆，郁闷所遏，浓味
所酿以成。厥阴之气不行，故窍闭而汁不通；阳明之血沸腾，故热甚而化为脓。或因所乳之子，膈
有滞痰，含乳而睡，口气炊热所致。而成结核，初便忍疼，揉令核软，吮令汁透则散，否则结成矣。
治
治以青皮，疏厥阴之滞，石膏清阳明之热，生甘草行污浊之血，栝蒌子消导肿毒，或加没药、青橘叶、
皂角刺、金银花、当归尾，或散或汤，须以少酒佐之。若加艾火三壮，于痛处灸之，尤妙。华元化灸三
里穴三壮，甚妙。
乳岩始有核，肿如棋子之大，不痛不痒，五七年方成疮。初便宜多服疏气行血，须情思如意则可愈。
如成疮之后，则如岩穴之凹，或如人口之唇，赤汁浓水浸淫，胸胁气攻疼痛，用五灰膏去其
蠹肉，生新血，渐渐收敛。此疾多生于忧郁积忿，中年妇人未破者尚可治，成疮者终不治。宜服十六味流气饮。
方
通乳汤
猪蹄（下节四双） 通草（二两） 川芎（一两） 穿山甲（十四片，炒） 甘草（一钱）
上用水五升，煮汁饮之。忌生冷，避风寒，夜卧不宜失盖，更以葱汤频洗乳房。
玉露饮 治产后乳脉不行，身体壮热疼痛，头目昏痛，此凉膈压热，下乳之剂也。
当归（一钱五分） 川芎（五钱） 白芍（一钱五分） 人参（二钱五分） 白芷（五钱）
白茯（二钱五分） 桔梗（炒，五钱） 甘草（二钱五分）
上锉，水煎服。如烦热甚，大便结，加大黄（一钱二分），金银花（三钱）；乳脉不行，结成痛肿疼
痛，加黄 、当归、金银花、甘草（各二钱半），入酒半钟，食后温服。
胡桃散 治妇人少乳，乳汁不行。
用胡桃仁去皮十个捣烂，入穿山甲炒末一钱，黄酒调服。
通草汤 治乳汁不通。
通草（七分） 瞿麦 柴胡 天花粉（各一钱） 桔梗（二钱） 木通 青皮 香白芷
赤芍 连翘 甘草（各五分）
上锉一剂，水煎细饮，更摩乳房。
连翘饮子（薛立斋传） 治乳内结核。
连翅 川芎 栝蒌仁（研） 皂角刺（炒） 橘叶 青皮（去白） 甘草节 桃仁（各一钱半）
上水煎，食远服。
最效散（刘柏亭传） 治妇人吹乳，神效。
螃蟹去足，用盖烧存性为末。每服二钱，黄酒下。
熨法膏（秘方） 治吹乳、乳痈，顿时立消。
葱连根捣烂，铺乳患处，上用瓦罐盛灰火盖葱上，一时蒸热，出汗即愈。
一方（刘前溪传） 治吹乳肿痛不可忍。
用生山药捣烂，敷上即消。消即去之，迟则肉腐。
消毒散〔批〕（按此方治吹乳乳痈之剂） 治吹乳、乳痈。憎寒壮热头痛
者，先服人参败毒一二剂，方可服此药。如无前证，即服本方二三剂。或肿不消，宜服托里药。
当归 白芷 青皮（炒） 天花粉 贝母 柴胡 僵蚕（炒） 金银花（各三钱）
上锉一剂，水煎服。
神效栝蒌散（薛五斋方） 治乳痈初起肿痛，及一切痈疽，或脓出后余毒，亦宜用之。
黄栝蒌（一个，用子多者） 当归（半两） 生甘草（半两） 没药（一钱，另研）
上酒、水各一钟，煎至八分，食后服。
十六味流气散 治乳岩，及痘后余毒作痈肿。
当归 川芎 白芍 黄 人参 官桂 浓朴 桔梗 枳壳 乌药 木香 槟榔 白芷 防风 紫苏 甘草
上锉各等分。水煎服。如乳痈，加青皮尤妙。
证候
妇女乳汁不通有两种情况：一种是血气壅盛，导致乳脉涩滞而乳汁不行；另一种是血气虚弱，导致乳脉中乳汁极少。对于虚证应当补益，使用钟乳粉、猪蹄、鲫鱼等药物或食物；对于实证应当疏通行气，使用通草、漏芦等药物。
乳房坚硬，多因乳母不懂得调养所致。乳房属于足阳明胃经，乳头归属于足厥阴肝经。愤怒导致气机逆乱，郁闷导致气机郁遏，厚味饮食酿生湿热，从而形成此病。厥阴肝气运行不畅，所以乳窍闭塞而乳汁不通；阳明胃经之血沸腾，所以热势严重而化为脓液。也有可能是因为所哺乳的婴儿，胸膈有停滞的痰饮，含着乳头睡觉，呼出的热气熏蒸所致。从而形成结核，起初便忍受疼痛，揉按使结节变软，让乳汁通畅流出则结节消散，否则就会结成硬块。
治疗
用青皮疏解厥阴肝经的气滞，石膏清泄阳明胃经的热邪，生甘草通行污浊之血，栝蒌子消导肿毒，或者加入没药、青橘叶、皂角刺、金银花、当归尾，可以制成散剂或汤剂，必须用少量酒作为引子送服。如果加上艾灸三壮，在疼痛处施灸，效果尤其好。华元化（华佗）灸足三里穴三壮，也非常妙。
乳岩（乳腺癌）开始时有一个核，大小如棋子，不痛不痒，经过五七年才溃烂成疮。初期适宜多服用疏理气机、运行血液的药物，只要心情舒畅即可痊愈。如果已经溃烂成疮，则像岩穴一样凹陷，或者像人的嘴唇外翻，赤色汁液和浓稠的水样分泌物浸淫流淌，胸胁部气攻作痛，使用五灰膏去除腐烂的肉芽，促进新血生长，逐渐收敛愈合。这种病多生于忧郁积怒之中，中年妇女未破溃者尚可治疗，一旦溃烂成疮则最终无法治愈。宜服用十六味流气饮。
方剂
通乳汤
猪蹄（下节四双）、通草（二两）、川芎（一两）、穿山甲（十四片，炒制）、甘草（一钱）。
以上用水五升，煮取汁液饮用。忌食生冷，避免风寒，夜间睡觉不宜失去覆盖，还要用葱汤频繁清洗乳房。
玉露饮 治疗产后乳脉不通，身体高热疼痛，头目昏痛，这是凉膈泻热、下乳的方剂。
当归（一钱五分）、川芎（五钱）、白芍（一钱五分）、人参（二钱五分）、白芷（五钱）、白茯苓（二钱五分）、桔梗（炒制，五钱）、甘草（二钱五分）。
以上切碎，水煎服。如果烦热严重，大便干结，加大黄（一钱二分）、金银花（三钱）；如果乳脉不通，结成肿痛，加黄芪、当归、金银花、甘草（各二钱半），加入半钟酒，饭后温服。
胡桃散 治疗妇人少乳，乳汁不通。
用胡桃仁去皮十个捣烂，加入炒制的穿山甲末一钱，用黄酒调服。
通草汤 治疗乳汁不通。
通草（七分）、瞿麦、柴胡、天花粉（各一钱）、桔梗（二钱）、木通、青皮、香白芷、赤芍、连翘、甘草（各五分）。
以上锉碎一剂，水煎细细饮服，同时按摩乳房。
连翘饮子（薛立斋传授） 治疗乳内结核。
连翘、川芎、栝蒌仁（研碎）、皂角刺（炒制）、橘叶、青皮（去白）、甘草节、桃仁（各一钱半）。
以上水煎，饭后远时服用。
最效散（刘柏亭传授） 治疗妇人吹乳，神效。
螃蟹去掉足，用蟹盖烧存性后研为粉末。每次服用二钱，用黄酒送下。
熨法膏（秘方） 治疗吹乳、乳痈，顿时立即消除。
葱连根捣烂，铺在乳房患处，上面用瓦罐盛放灰火覆盖在葱上，一时蒸热，出汗即愈。
一方（刘前溪传授） 治疗吹乳肿痛不可忍受。
用生山药捣烂，敷在上面即消退。消退后立即去掉，迟了则肉会腐烂。
消毒散〔批注〕（按：此方是治疗吹乳、乳痈的方剂） 治疗吹乳、乳痈。如果有憎寒壮热头痛的症状，先服用人参败毒散一二剂，才可以服用本药。如果没有前述症状，直接服用本方二三剂。如果肿胀不消，宜服用托里透脓的药物。
当归、白芷、青皮（炒制）、天花粉、贝母、柴胡、僵蚕（炒制）、金银花（各三钱）。
以上锉碎一剂，水煎服。
神效栝蒌散（薛五斋方） 治疗乳痈初起肿痛，以及一切痈疽，或者脓出后的余毒，也适宜使用。
全栝蒌（一个，选用子多的）、当归（半两）、生甘草（半两）、没药（一钱，另研）。
以上用酒、水各一钟，煎至八分，饭后服用。
十六味流气散 治疗乳岩，以及痘疹后余毒发作成的痈肿。
当归、川芎、白芍、黄芪、人参、官桂、浓朴、桔梗、枳壳、乌药、木香、槟榔、白芷、防风、紫苏、甘草。
以上锉碎各等分。水煎服。如果是乳痈，加入青皮尤其妙。
Syndrome
There are two types of lactation obstruction in women: one is caused by excessive blood and qi, leading to stagnation and涩 (astringent/stagnant) milk vessels where milk does not flow; the other is due to deficiency of blood and qi, resulting in very little milk in the milk vessels. For deficiency syndromes, tonification is used, employing substances such as Congru Pulvis (Ossis Mastodi), pig trotters, and crucian carp; for excess syndromes, promotion of flow is used, employing herbs such as Tongsao (Medulla Tetrapanacis) and Loulu (Radix Euphorbiae Humifusae).
Hardness of the breast often results from the nursing mother's failure to maintain proper regimen. The breast belongs to the Foot-Yangming Stomach Meridian, and the nipple is associated with the Foot-Jueyin Liver Meridian. Anger causes qi rebellion, depression causes qi obstruction, and rich flavors brew damp-heat, thereby forming the disease. When Jueyin qi fails to circulate, the orifices close and milk cannot pass; when Yangming blood boils, heat becomes severe and transforms into pus. It may also be caused by the infant being nursed having phlegm-stasis in the chest-diaphragm, sleeping while holding the nipple, and the hot breath blowing on it. This leads to the formation of nodules. Initially, one should endure the pain, massage until the nodule softens, and suckle until milk flows freely, which will dissipate the nodule; otherwise, it will harden into a mass.
Treatment
Use Qingpi (Pericarpium Citri Reticulatae Viride) to relieve stagnation in the Jueyin meridian, Shigao (Gypsum Fibrosum) to clear heat in the Yangming meridian, Sheng Gancao (Radix Glycyrrhizae Preparata) to move turbid blood, Gualouzi (Semen Trichosanthis) to resolve swelling and toxicity, or add Moyao (Resina Myrrhae), Qingjuye (Folium Citri Reticulatae), Zaojiaoci (Spina Gleditsiae Sinensis), Jinyinhua (Flos Lonicerae Japonicae), and Dangguwei (Radix Angelicae Sinensis Cum Cauda). These can be prepared as powders or decoctions, and must be taken with a small amount of wine as a vehicle. If three moxa cones are applied via moxibustion at the painful site, the effect is particularly excellent. Hua Yuanhua (Hua Tuo) applying three moxa cones to Zusanli (ST36) is also very effective.
Ru Yan (Breast Cancer) begins with a nodule the size of a chess piece, without pain or itching, which ulcerates after five to seven years. In the early stage, it is appropriate to take more herbs that regulate qi and promote blood circulation; recovery is possible if the patient maintains emotional well-being. After ulceration, the wound resembles a cave depression or everted lips, with red fluid and thick watery discharge oozing out, accompanied by qi-stabbing pain in the chest and hypochondrium. Use Wuhui Gao (Five Ashes Plaster) to remove necrotic tissue, generate new blood, and gradually promote healing. This disease often arises from chronic depression and accumulated anger. It is treatable in middle-aged women before ulceration, but incurable once ulcerated. One should take Shiliuwei Liuqi Yin (Sixteen-Ingredient Qi-Moving Decoction).
Formulas
Tongru Tang (Lactation-Promoting Decoction)
Zhu Ti (Pig Trotter, lower segment, four pairs), Tongcao (2 liang), Chuanxiong (1 liang), Chuanshanjia (14 slices, stir-fried), Gancao (1 qian).
Boil the above ingredients in five sheng of water and drink the juice. Avoid raw and cold foods, protect against wind and cold, ensure adequate covering during sleep, and frequently wash the breasts with scallion water.
Yulu Yin (Jade Dew Drink)
Treats postpartum lactation obstruction, high fever and body pain, dizziness and headache. This is a formula for cooling the diaphragm, clearing heat, and promoting lactation.
Danggui (1.5 qian), Chuanxiong (5 qian), Baishao (1.5 qian), Renshen (2.5 qian), Baizhi (5 qian), Baifu Ling (2.5 qian), Jiegeng (stir-fried, 5 qian), Gancao (2.5 qian).
Cut into pieces, decoct in water, and take orally. If烦热 (restlessness and heat) is severe and stool is constipated, add Dahuang (1.2 qian) and Jinyinhua (3 qian); if lactation is obstructed with painful swelling, add Huangqi (Astragali Radix), Danggui, Jinyinhua, and Gancao (each 2.5 qian), add half zhong of wine, and take warm after meals.
Hutao San (Walnut Powder)
Treats oligogalactia and lactation obstruction in women.
Take ten peeled walnut kernels, pound them into a paste, add one qian of powdered stir-fried Chuanshanjia, and take mixed with yellow wine.
Tongcao Tang (Tongcao Decoction)
Treats lactation obstruction.
Tongcao (0.7 qian), Qumai, Chaihu, Tianhuafen (each 1 qian), Jiegeng (2 qian), Mutong, Qingpi, Xiang Baizhi, Chishao, Lianqiao, Gancao (each 0.5 qian).
Cut into pieces for one dose, decoct in water, sip slowly, and simultaneously massage the breasts.
Lianqiao Yinzi (Lonicera Decoction, transmitted by Xue Lizhai)
Treats intramammary nodules.
Lianqiao, Chuanxiong, Gualou Ren (crushed), Zaojiaoci (stir-fried), Jiuye, Qingpi (deprived of white pith), Gancao Jie, Taoren (each 1.5 qian).
Decoct in water and take long after meals.
Zui Xiao San (Most Effective Powder, transmitted by Liu Boting)
Treats "blown breast" (acute mastitis) in women, with miraculous efficacy.
Remove the legs of a crab, roast the carapace until carbonized but retaining its nature, and powder it. Take 2 qian per dose, washed down with yellow wine.
Yifa Gao (Plaster for Fomentation, Secret Recipe)
Treats "blown breast" and Ru Yong (breast abscess), causing immediate resolution.
Pound green onions with roots into a paste, spread it over the affected breast area, cover with a clay pot containing hot ashes placed on top of the onions, steam until hot, and cure upon sweating.
One Prescription (Transmitted by Liu Qianxi)
Treats unbearable pain and swelling from "blown breast".
Pound fresh Dioscorea rhizome into a paste, apply externally. Remove immediately after resolution; delay leads to tissue rot.
Xiaodu San [Commentary] (Note: This formula treats "blown breast" and Ru Yong)
Treats "blown breast" and Ru Yong. For patients with aversion to cold, high fever, and headache, first administer Renshen Baidu San (Ginseng Detoxifying Powder) for one to two doses before taking this medicine. If these preceding symptoms are absent, take this formula for two to three doses. If swelling does not subside, use formulas to support interior and expel pus.
Danggui, Baizhi, Qingpi (stir-fried), Tianhuafen, Beimu, Chaihu, Jiangcan (stir-fried), Jinyinhua (each 3 qian).
Cut into pieces for one dose, decoct in water, and take orally.
Shenxiao Gualou San (Formula of Xue Wuzhai)
Treats initial swelling and pain of Ru Yong, as well as all kinds of carbuncles and sores, or residual toxins after pus discharge.
Quan Gualou (one whole fruit, preferably with many seeds), Danggui (0.5 liang), Sheng Gancao (0.5 liang), Moyao (1 qian, separately ground).
Decoct with one zhong of wine and one zhong of water until reduced to 0.8 zhong, and take after meals.
Shiliuwei Liuqi San (Sixteen-Ingredient Qi-Moving Powder)
Treats Ru Yan and carbuncles/swellings caused by residual toxins after smallpox/variolous eruptions.
Danggui, Chuanxiong, Baishao, Huangqi, Renshen, Guanzi Gui, Nongpo, Jiegeng, Zhike, Wuyao, Muxiang, Binglang, Baizhi, Fangfeng, Zisu, Gancao.
Cut into equal parts. Decoct in water and take orally. If treating Ru Yong, adding Qingpi is especially effective.