Breast Lump Like a Goose Egg, Red and Painful? Doctor Xue Lizhai Treats Mastitis After Anger by Strengthening the Spleen and Calming the Liver (Eight-Ingredient Decoction, Cured in Fourteen Doses)
Search terms this page answers: breast lump / hard lump in the breast / breast red and painful / breast pain / breast pain after getting angry / mastitis / inflamed breast / fever at night / quick to anger / swallowing anger
Medical terms: mastitis (ru yong) · acute mastitis · liver qi stagnation with spleen deficiency · liver qi stagnation · breast lump / breast cancer (ru yan)
Opening: a hard lump the size of a goose egg swells up in the breast
Today’s case was treated by Doctor Xue Lizhai (Xue Ji), head of the Imperial Academy of Medicine in the Ming dynasty, and it is collected in his chapter on mastitis and breast lumps (“ru yong ru yan”). Before telling the case itself, Doctor Luo Dalun notes how early the ancients understood this kind of illness — in ancient China, doctors recognized women’s breast diseases very early on.
💬 Note from Doctor Luo: The ancient term “ru yan” — the “yan” character is in fact the same as the modern word for cancer (“ai”). When breast cancer finally ulcerates, the skin becomes bumpy and hard, like rock, and extremely hard to remove — that is why it was called “ru yan,” the “rock of the breast.” Already in Zhu Danxi’s time, records noted that this disease was linked to emotion — the ancients knew long ago that it had everything to do with “qi,” with one’s temper. And the nodules inside the breast were also discussed by the ancients, all filed under “ru yong ru yan” (mastitis and breast lumps).
Who was the patient? A twenty-five-year-old wife, constitutionally frail from the start
This case record was written by the patient’s husband himself. At the end of the text he styles himself “your junior, You Zhiying,” and because he knew his wife’s condition intimately, he wrote with unusual care: his wife was twenty-five years old, constitutionally weak by nature — not the robust type at all; and she was prone to melancholy and anger — her mood was not optimistic, she was easily depressed, easily angered, quick-tempered.
💬 Note from Doctor Luo: Look at the opening: one line about the body, one line about the temperament — these are the keys to the whole case. Why do breast problems have so much to do with emotion? Because the breast is connected to two pathways: one is the spleen and stomach, the other is the liver channel (gan jing). When liver qi stops flowing smoothly, the breast is the first thing affected. So emotion has an enormous influence on breast health. We all understand this today: women are especially susceptible to emotion. Some things a man might not even register — he laughs it off and it’s over, maybe a cigarette and a drink dissolves it. A woman has no such outlet; the moment she hears something that displeases her, she starts to brood. That is why I keep saying: women must look after their emotions — too many women’s illnesses are tied to bad moods. Some TCM doctors who have cured breast cancer tell their patients, “Ladies, drink some flower tea at home from time to time.” That is no joke — there is real truth in it.
Where did the illness start? After a cold, she had a fit of anger
The young wife’s illness developed step by step. First came the aftermath of an epidemic illness — after a flu-like external illness, her spleen and stomach grew weaker and weaker, her appetite shrank, her body became weak and soft, and she could barely eat; then came a fit of anger — something made her furious.
💬 Note from Doctor Luo: How many case records have I told where the patient fell ill precisely after a fit of anger! Isn’t that how it goes in real life? So many people, when they analyze their own illness, say: “That period I was really worried” or “I really lost my temper back then.” It truly is so. When this wife lost her temper, her right breast and flank became red, swollen and painful — the right breast and the side of the trunk below it both swelled, and there was pain inside the chest too.
How did the earlier doctors treat her? Each treatment made it worse
The family was frantic. First they tried a folk remedy: fomenting the area with wheat bran to disperse the swelling. Afterward the swelling seemed to spread a little, but the pain inside grew worse — when she turned over in bed, it felt as if something inside her chest was being tugged and dragged, an indescribable misery.
So the family called in a physician. He took one look and prescribed an adjusted Si Wu Tang (Four Substances Decoction) — his idea was to nourish the blood. Doctor Luo Dalun’s comment: this prescription was not well judged at all — moving liver qi and regulating qi would have been closer to the mark; what did nourishing blood have to do with it? Sure enough, this treatment made things far worse: inside, the breast swelled to the size of a goose egg; outside, it swelled as large as a plate. Pain ran all the way through the chest, ribs and back, and by night she burned with fever all over.
💬 Note from Doctor Luo: At this point everyone around her said: this is no small matter — quickly clear heat, resolve toxins, attack the poison! Look how swollen it is — it must be inflammation, it needs cooling down. Even the husband had his doubts, but in the end he decided to go and call on Doctor Xue Lizhai, and ask this head of the Imperial Academy of Medicine to take a look. That step saved his wife’s life.
What did Doctor Xue Lizhai think? “This illness follows spleen weakness after disease, with renewed anger injuring the liver”
Doctor Xue Lizhai took one look and said two things that laid out the whole illness from beginning to end: “Ci bing hou pi ruo, er fu nu shang gan” — “This illness follows weakness of the spleen after disease, and renewed anger injuring the liver.” In other words: after her illness, this woman’s spleen and stomach were already weak and her upright qi insufficient; then anger injured the liver, the liver qi could not flow, and it turned around to bully the spleen and stomach again — the spleen and stomach were hurt still more, a vicious circle.
💬 Note from Doctor Luo: The ordinary doctor, seeing any swelling, abscess or sore, thinks only of clearing heat and resolving toxins. What did Doctor Xue Lizhai think of? He thought first: this swelling must have a cause, and very likely an internal cause — spleen and stomach weakness. So his method, in the original text, was “chiefly to strengthen the spleen” — restore the spleen’s qi quickly, and at the same time calm the liver fire; when the spleen and stomach are strong, qi and blood resume their normal flow, and the swelling disperses by itself. This is what is called “supporting the upright” (fu zheng) — lift up your upright qi, and the illness cures itself. This is one of Doctor Xue Lizhai’s most important scholarly ideas for treating swellings and sores of this kind.
The prescription: Ba Wu Tang as the base — tonify the spleen and calm the liver at the same time
The formula Doctor Xue Lizhai used was called Ba Wu Tang (Eight-Ingredient Decoction). What is it? Simply Si Wu Tang plus Si Jun Zi Tang — what later generations usually call Ba Zhen Tang (Eight Treasures Decoction). Si Wu Tang nourishes the blood; Si Jun Zi Tang (ren shen ginseng, bai zhu atractylodes, fu ling poria, gan cao licorice) tonifies the spleen. Together they build the foundation by tonifying both qi and blood. On top of this base, he added herbs:
- Huang qi (astragalus) — helps tonify the qi;
- Chen pi (aged tangerine peel) — moves and regulates the qi. Tonifying herbs can stagnate and clog, especially when the qi mechanism is stuck in the middle burner; chen pi dissolves that blockage;
- Chai hu (bupleurum) — soothes the liver and moves qi, releasing the constraint of the shaoyang channel;
- Shan zhi zi (gardenia fruit) — drains heart fire and the fire of the triple burner;
- Bai zhi (angelica dahurica) — disperses wind and dampness, and also moves qi and stops pain.
💬 Note from Doctor Luo: Notice the balance of this formula: spleen-tonifying ingredients are the main force, and of the attacking herbs that soothe the liver and drain fire, there are only two — chai hu and zhi zi — and they would not be given in large amounts. Why? Because this patient’s spleen and stomach were too weak. Imagine if she had been treated along the previous doctors’ lines: a pile of bitter, cold heat-clearing and toxin-resolving herbs. Bitter and cold herbs defeat the stomach — they would depress the spleen and stomach function further, perhaps collapse it altogether, and the patient would be ruined. That is where Doctor Xue Lizhai’s brilliance lies: support the upright qi as the main thrust, and use just a tiny bit of attacking medicine — that is all that is needed.
Adding one herb, jie geng: like a boat that carries the medicine upward
After eight doses, the illness was sixty to seventy percent better. Now Doctor Xue Lizhai adjusted the prescription: he removed bai zhi and added qing pi (green tangerine peel), mu xiang (costus root) and jie geng (platycodon root). Qing pi moves qi and breaks stagnation, mu xiang moves qi — both target the constrained liver qi and stagnant qi mechanism; and jie geng is a particularly interesting herb.
💬 Note from Doctor Luo: Jie geng is usually used to diffuse the lungs, soothe the throat, and expel phlegm from the lung channel. But the ancients also credited it with another power: carrying medicines upward — like a boat (the ancients called it a “zhou ji” — a vessel-and-oar herb), ferrying the medicinal properties of the whole formula to the upper parts of the body. It passes especially through the upper burner and the lung channel, between the chest and the lungs; once that passage is opened, the medicines are absorbed more easily, and the body’s waste (phlegm, pus and other pathological products) is also expelled more easily. When treating illness of the middle and upper burners, adding a single jie geng shows exactly this skill.
Cured in fourteen doses: the husband writes, “so wondrous in effect, so swift in result”
With the qi-moving herbs added, she took six more doses — fourteen in all, about two weeks — and the illness was completely cured: the goose-egg-sized lump in the breast dissolved, and the redness, swelling, heat and pain all returned to normal.
The patient’s husband, You Zhiying, wrote four words in his excitement: “奏功之奇，获效之速，概出于寻常万万也” — “the wonder of the effect and the swiftness of the result are a hundred thousand times beyond the ordinary.” He appended this case record to the book as his thanks to Doctor Xue.
💬 Note from Doctor Luo: To be honest, if this case came up today, many mediocre TCM doctors would follow exactly the earlier physicians’ path — clear heat and resolve toxins, invigorate blood and dissolve stasis, plus a bit of qi-moving herbs. Would that work? Very easily it would complicate the illness: this woman’s spleen and stomach were so weak that bitter, cold herbs would collapse her; the more you attack, the more she collapses, and you could genuinely turn this into a fatal mess. Where is Doctor Xue Lizhai’s strength? He thought about the person, not the disease. With the person here, the disease can be cured; if all you see is the disease — “my god, that lump is huge!” — and you attack it with everything you have, the person’s body may simply collapse. What everyone should learn here is the big direction: once the body’s upright qi is lifted up, recovery can be extraordinarily fast. Sometimes a single good night’s sleep makes the illness much lighter the next day. The body’s own healing power is far stronger than we imagine — you just never gave it the chance to recover before.
Bonus: bad emotions are the source of all illness
Doctor Xue Lizhai left behind an enormous number of case records — over three thousand — covering gynecology, pediatrics and surgery. In fact he was a master surgeon, with a great many surgical cases too. Doctor Luo Dalun says we may not be able to learn his pinpoint precision, but we must remember the great direction.
💬 Note from Doctor Luo: This is especially for the women listening. Bad emotions truly are the source of all illness. Throughout Doctor Xue Lizhai’s case records he keeps writing about the patient’s emotions — how they were, how they changed — and this is not idle filler. A senior TCM doctor once told me: when he examines patients, he finds many pain points in the body — almost every time a person gets angry, it creates a stagnation point somewhere in the body. No fit of anger is ever wasted; every one leaves its trace, and on some people you can find a hundred or more congestion points. So let us do our best: first, keep an optimistic mood; second, regularly open the channels — scrape (gua sha), exercise, stretch; third, use some gentle qi-regulating food therapy to regulate yourself, and try not to let stagnation pile up inside. Upright qi is the root of the body; emotion is the switch of the body — look after these two, and many illnesses will simply walk around you on their own.
Compiled from Doctor Luo Dalun’s commentary on the case records of Doctor Xue Lizhai (Xue Ji); the case is from Xue’s Medical Cases (《薛氏医案》), Ming dynasty.