（见下利中）
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妇人宿有症病，经断未及三月，而得漏下不止，胎动在脐上者，为症痼害。妊娠六月
动者，前三月经水利时，胎也；下血者，后断三月，衃也。所以血不足者，其症不去
故也，当下其症，桂枝茯苓丸主之。
【注】
经断有孕，名曰妊娠。妊娠下血，则为漏下。妇人宿有症痼之疾而育胎者，未及三月
而得漏下，下血不止，胎动不安者，此亦症痼害之也，已及六月而得漏下，下血胎动
不安者，此亦症痼害之也。然有血衃成块者，以前三月经虽断，血未盛，胎尚弱，未
可下其症痼也。后三月血成衃，胎已强，故主之桂枝茯苓丸，当下其症痼也。此示人
妊娠有病当攻病之义也。此条文义不纯，其中必有阙文，姑存其理可也。
【集注】
娄全善曰：凡胎动，多当脐，今动在脐上者，故知是症也。
程林曰：此有症病而怀胎者，虽有漏血不止，皆症痼之为害，非胎动胎漏之证，下其
症痼，妊娠自安。此『内经』所谓：有故无殒，亦无殒也。
方氏曰：胎动胎漏皆下血，而胎动有腹痛，胎漏无腹痛，故胎动宜行气，胎漏宜清热
。
魏荔彤曰：胎与衃之辨，当于血未断之前三月求之。前三月之经水顺利，则经断必是
胎。前三月有曾经下血者，则经断必成衃。
(See the section on "Diarrhea with Blood")
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If a woman has a pre-existing mass disease (Zheng Bing, accumulation of blood stasis and phlegm), and her menses have ceased for less than three months, yet she experiences continuous dripping bleeding, and feels fetal movement above the umbilicus, this is harm caused by an entrenched mass. If fetal movement occurs at six months of pregnancy, and the menses were regular and smooth during the three months prior to cessation, it is a true fetus; if there is bleeding after cessation for three months due to the presence of clotted blood (Pui, dark coagulated blood), it is not a true fetus but rather blood stasis. The reason for the insufficiency of blood is that the mass has not been removed; therefore, the mass should be purged/removed, and Guizhi Fuling Wan (Cinnamon Twig and Poria Pill) should be administered as the primary treatment.
[Annotation]
Cessation of menses accompanied by conception is termed pregnancy. Bleeding during pregnancy is termed leaking down (Lou Xia). For women who conceive while suffering from an entrenched mass disease, if they experience leaking down, continuous bleeding, and restless fetus before three months have passed, this is also harm caused by the mass. If leaking down, bleeding, and restless fetus occur at six months, this is likewise harm caused by the mass. However, if there are formed blood clots, because although menses ceased three months ago, the blood qi was not yet abundant and the fetus was still weak, one should not purge the mass at this time. By the later three months, when blood has formed clots and the fetus has become strong, it is appropriate to use Guizhi Fuling Wan to purge the entrenched mass. This illustrates the principle that in pregnancy complicated by disease, one must treat the disease first. The meaning of this clause is not pure; there must be missing text within it, so we may tentatively preserve its theory.
[Collected Annotations]
Lou Quanshan stated: Generally, fetal movement occurs around the umbilicus. Since the movement here is above the umbilicus, we know it is a mass disease.
Cheng Lin stated: This refers to a case where a woman has a mass disease and is pregnant. Although there is continuous leaking blood, it is all harm caused by the entrenched mass, not merely restless fetus or leaking fetus syndromes. Removing the mass will naturally stabilize the pregnancy. This corresponds to what the *Neijing* states: "Because there is pathology (gu), there will be no injury [to the mother], nor will there be injury [to the fetus]."
Fang Shi stated: Both restless fetus and leaking fetus involve bleeding, but restless fetus is accompanied by abdominal pain, whereas leaking fetus is not. Therefore, restless fetus is suitable for promoting qi circulation, and leaking fetus is suitable for clearing heat.
Wei Litong stated: To distinguish between a true fetus and clotted blood (Pui), one should look back to the three months prior to the cessation of menses. If the menstrual water was smooth during these three months, then the cessation of menses must be due to pregnancy. If there had been bleeding during these three months previously, then the cessation of menses must have resulted in the formation of clotted blood.