陈远公曰∶有左乳内忽大如桃，又不疼，色亦不赤，身发热，体渐瘦损，人以
为痰气郁结也。谁知肝气不舒乎？夫乳属阳明，乳肿宜责阳明矣。而余独谓之肝，不
起世人之疑乎？夫阳明胃土最畏肝木，肝气亦不舒矣。盖胃见木之郁，唯恐来克，畏
首畏尾，伏而不扬；乳又近两胁，两胁肝之位也，与肝相远尚退缩不敢舒，今与肝
为邻，亦何敢吐气哉？气不舒而肿满之形成，气不敢舒而畏惧之色现，不疼不赤，正
见畏惧也。治法不必治胃，但治肝而肿自消矣。用加味逍遥散∶柴胡二钱，白芍五
钱，陈皮五分，当归、栝蒌、半夏、白术、茯神各三钱，人参、甘草、川芎各一钱，水
煎服。十剂内消矣。去栝蒌又十剂，不再发矣。此方解肝之滞，肝解而胃气不解而
自舒；盖以栝蒌、半夏专治胸中积痰，痰去肿尤易消也。《冰鉴》）
陈实功曰∶乳癖乃乳中结核，形如丸卵，或坠重作痛，或不痛，皮色不变，其
核随喜怒消长，多由思虑伤脾，怒恼伤肝，郁结而成也。
窦汉卿曰∶奶 ，是十五六岁女子经脉将行，或一月两次，或过月不行，多生
寡薄形体虚弱。乳上只有一核可治；若串成三四个难治。宜调经开郁治之，多用夏
枯草。
\r乳痞\p04-a41a138.bmp\r
又曰∶乳癖，乃五六十岁老人多生此疾，不成脓不可用凉药敷服，逼令毒入脏腑则危。
冯鲁瞻曰∶奶栗即乳栗，又名乳癖。破者少有生，须用参、 、归、芍大补兼解毒，外以丁香末敷之。（《锦囊》）
申斗垣曰∶如妇人年近五十以外，气血衰败，当时郁闷，乳中结核，天阴作痛，
名曰乳核。久之一年半载，破而脓水淋漓，日久不愈，名曰乳漏。（《启玄》）
岐天师曰∶男子乳房忽然壅肿如妇人之状，按之疼痛欲死，经年累月不效者，乃
阳明之毒瓦斯结于乳房之间也。然此毒非疮毒，乃痰毒也。若疮毒何能经久，必然外
溃，今经年累月，壅肿如故，非痰毒而何？法当消其痰，通其瘀，自然奏功如响矣。以
化圣通滞汤主之。此方妙在金银花与蒲公英直入阳明之经，又得清痰通滞之药为佐，
附子引经，单刀直入，无坚不破，又何患痰结之不消。或疑附子大热，诸痛皆属于火，似不可用，殊不知非附子不能入
于至
坚之内，况又有栀子、芍药之酸寒，虽附子大热，亦解其性之烈矣，又何疑于过热哉。（《秘录》）
陈远公说：有人的左侧乳房突然肿大如桃子，但不疼痛，颜色也不发红，身体发热，形体逐渐消瘦，人们认为是痰气郁结所致。谁知这是肝气不舒畅呢？乳房归属于阳明经，乳房肿胀本应责之于阳明经。但我唯独称之为肝气问题，难道不会引起世人的疑惑吗？因为阳明胃土最畏惧肝木的克制，肝气如果不舒畅，胃土见到肝木的郁滞，唯恐受到克制，畏首畏尾，伏藏而不张扬；乳房又靠近两胁，两胁是肝的部位，与肝相距尚且退缩不敢舒展，如今与肝为邻，又怎么敢吐气舒展呢？气机不舒畅而肿满形成，气不敢舒展而表现出畏惧的神色，不疼不红，正是表现这种畏惧之象。治疗方法不必治胃，只要治疗肝，肿块自然消退。使用加味逍遥散：柴胡二钱，白芍五钱，陈皮五分，当归、栝蒌、半夏、白术、茯神各三钱，人参、甘草、川芎各一钱，水煎服。十剂后肿块内消。去掉栝蒌再服十剂，就不再复发了。此方解开肝气的郁滞，肝气解除了，胃气不用特意调理也自然舒展；加上栝蒌、半夏专门治疗胸中的积痰，痰去除了，肿块更容易消退。（出自《冰鉴》）
陈实功说：乳癖是乳房中的结核，形状像丸卵，有的沉重作痛，有的不痛，皮肤颜色不变，这个核块随着情绪喜怒而消长，多由思虑伤脾，愤怒恼怒伤肝，导致气机郁结而成。
窦汉卿说：奶栗（即乳癖），多见于十五六岁女子月经即将来潮时，或者一个月来两次，或者超过月份不来，多发生在形体虚弱、气血寡薄的人身上。乳房上只有一个核块的可以治愈；如果串连成三四个则难治。应当用调经开郁的方法治疗，多用夏枯草。
又说：乳癖，多见于五六十岁的老人患此病，不能化脓，不可用凉药敷贴或服用，逼迫毒邪进入脏腑就会危及生命。
冯鲁瞻说：奶栗即乳栗，又名乳癖。破溃的很少能痊愈，必须用人参、黄芪、当归、白芍大补元气兼解毒，外用丁香末敷贴。（出自《锦囊》）
申斗垣说：如妇人年近五十岁以上，气血衰败，当时心情郁闷，乳房中出现结核，阴天时作痛，名叫乳核。拖延一年半载，破溃后脓水淋漓，日久不愈，名叫乳漏。（出自《启玄》）
岐天师说：男子乳房突然壅肿像妇女一样的状况，按压时疼痛欲死，经过长年累月治疗无效的，是阳明的毒瓦斯结聚在乳房之间。然而这种毒不是疮毒，而是痰毒。如果是疮毒怎么能经久不愈，必然会在外部溃破，如今经过长年累月，壅肿依旧，如果不是痰毒是什么？治法应当消除痰浊，疏通瘀血，自然会像回声一样迅速见效。以化圣通滞汤为主方。此方的妙处在于金银花与蒲公英直接入阳明经，又得到清化痰浊、疏通滞碍的药物作为辅助，附子作为引经药，单刀直入，无坚不摧，又何必担心痰结不能消散呢？有人怀疑附子大热，各种疼痛都属于火证，似乎不可使用，殊不知非附子不能进入至坚的内部，况且又有栀子、芍药的酸寒之性，虽然附子大热，也能解除其烈性，又何必怀疑过热呢？（出自《秘录》）
Chen Yuangong stated: There are cases where the left breast suddenly swells to the size of a peach, without pain or redness of the skin, accompanied by fever and gradual emaciation. People attribute this to phlegm-qi stagnation. Little do they know it is due to Liver qi not flowing freely. The breasts belong to the Yangming channel; thus, breast swelling should typically be attributed to Yangming. Yet I exclusively attribute it to the Liver, which might raise doubts among people. This is because Yangming Stomach Earth most fears Liver Wood. When Liver qi is stagnant, the Stomach, seeing the stagnation of Wood, fears being overcome, acting timidly, hiding rather than manifesting. Since the breasts are near the hypochondrium—the domain of the Liver—and even when distant from the Liver, the qi shrinks back不敢 (dares not) flow freely, how much more so when adjacent to the Liver? It dares not expand its qi. Thus, qi stagnation leads to swelling, and the fear of expanding qi manifests as a lack of pain and redness, precisely reflecting this state of fear. The treatment does not need to target the Stomach; treating the Liver alone will cause the swelling to subside spontaneously. Use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder): Chai Hu (Bupleuri Radix) 2 qian, Bai Shao (Paeoniae Radix Alba) 5 qian, Chen Pi (Citri Reticulatae Pericarpium) 5 fen, Dang Gui (Angelicae Sinensis Radix), Gua Lou (Trichosanthis Fructus), Ban Xia (Pinelliae Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Fu Shen (Poria cum Radice et Lignum) each 3 qian, Ren Shen (Ginseng Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma), Chuan Xiong (Ligustici Chuanxiong Rhizoma) each 1 qian. Decoct in water and take orally. After ten doses, the swelling subsides internally. Removing Gua Lou and taking another ten doses prevents recurrence. This formula resolves Liver stagnation; once the Liver is resolved, the Stomach qi flows freely without specific intervention. Additionally, Gua Lou and Ban Xia specifically treat accumulated phlegm in the chest; removing the phlegm facilitates the resolution of the swelling. (From *Bing Jian*)
Chen Shigong stated: Ru Pi (Breast Mass/Lump) refers to nodules within the breast, shaped like pills or eggs, sometimes heavy and painful, sometimes painless, with unchanged skin color. The nodule grows or shrinks with emotions such as anger or joy. It is mostly caused by overthinking injuring the Spleen, and anger/irritation injuring the Liver, leading to stagnation.
Dou Hanqing stated: Nai Li (Milk Chestnut/Breast Lump) often occurs in girls aged fifteen or sixteen as their menstruation approaches, or if menstruation occurs twice a month or is delayed. It frequently affects those with weak constitutions and deficient qi and blood. If there is only one nodule on the breast, it is treatable; if it spreads into three or four, it is difficult to treat. Treatment should regulate menstruation and relieve stagnation, primarily using Xia Ku Cao (Prunellae Spica).
He also stated: Ru Pi often occurs in elderly people aged fifty or sixty. It does not suppurate; cooling medicines should not be applied externally or taken internally, as forcing the toxin into the zang-fu organs creates danger.
Feng Luzhan stated: Nai Li is the same as Ru Li, also known as Ru Pi. Cases that have ulcerated rarely heal. One must use large doses of Ren Shen (Ginseng Radix), Huang Qi (Astragali Radix), Dang Gui (Angelicae Sinensis Radix), and Bai Shao (Paeoniae Radix Alba) to tonify greatly and detoxify. Externally, Ding Xiang (Caryophylli Flos) powder should be applied. (From *Jin Nang*)
Shen Douyuan stated: In women near or past fifty years of age, with declining qi and blood and current emotional depression, nodules form in the breasts causing pain during cloudy weather, named Ru He (Breast Nodule). After a year or half, if they ulcerate and discharge profuse pus, failing to heal for a long time, it is named Ru Lou (Breast Fistula). (From *Qi Xuan*)
Tian Shi Qi stated: When a man's breast suddenly swells like a woman's, with severe pain upon pressure, and shows no improvement after years of treatment, it is due to Yangming toxic qi accumulating between the breasts. However, this toxin is not a sore toxin but a phlegm toxin. If it were a sore toxin, it would inevitably ulcerate externally over time. Since it persists swollen for years, it must be a phlegm toxin. The method should eliminate phlegm and unblock stasis, yielding results as swiftly as an echo. Use Huasheng Tongzhi Tang (Miraculous Transformation Decoction for Unblocking Stagnation) as the main prescription. The brilliance of this formula lies in Jin Yin Hua (Lonicerae Japonicae Flos) and Pu Gong Ying (Taraxaci Herba) entering the Yangming channel directly, assisted by herbs that clear phlegm and unblock stagnation. Fu Zi (Aconiti Lateralis Radix Praeparata) acts as a guiding herb, striking straight in, breaking all hardness. Why worry about the failure to resolve phlegm accumulation? Some doubt the use of Fu Zi due to its great heat, arguing that all pains belong to fire and thus it seems unsuitable. However, without Fu Zi, one cannot penetrate the utmost hardness. Moreover, Zhi Zi (Gardeniae Fructus) and Bai Shao (Paeoniae Radix Alba) possess sour and cold properties, which mitigate the fierce nature of Fu Zi despite its heat. Why then suspect it of being excessively hot? (From *Mi Lu*)