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The *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) states: If a woman has a pre-existing *zheng* mass (a fixed abdominal mass with definite location and pain), and her menstruation stops for less than three months, yet she suffers from continuous vaginal bleeding, and the fetal movement is felt above the umbilicus, this indicates that the *zheng* mass is causing harm. If fetal movement occurs at six months of pregnancy, and the menstruation was smooth and regular during the first three months, it is a normal fetus. If there is bleeding, it means the menstruation has stopped for three months. The reason the bleeding does not stop is that the *zheng* mass has not been eliminated. One should purge the *zheng* mass, and Guizhi Fuling Wan (Cinnamon Twig and Poria Pill) is the primary prescription.

Xu Zhongke said: When a woman is menstruating, if she encounters cold, blood stagnates to form a *zheng* mass. A *zheng* mass is tangible and verifiable. However, women often have *zheng* diseases; if they are not in the uterus, conception can occur during menstruation, and the cessation of menstruation signifies pregnancy. "Less than three months" refers to approaching the third month. Once pregnant, if bleeding appears, it is called "leaking down." If bleeding continues without stopping before three months, it damages the blood nourishing the fetus, causing fetal movement. If the fetus were below the umbilicus, it would be on the verge of miscarriage. Now, since it is above the umbilicus, the new blood gathered monthly is obstructed by the *zheng* qi, leading to leaking down. This is actually not a disease of the fetus, hence it is called "harm by an entrenched condition." "Guo" (entrenched) refers to a chronic disease; "hai" (harm) refers to its detrimental effect. By the sixth month, fetal movement is expected. Comparing this to the period when menstruation was smooth in the first three months, although the fetus moves and bleeds, and menstruation has ceased for three months, the continued bleeding indicates that previous leaking has depleted new blood, while the *zheng* mass remains firm and unremoved. Therefore, purging it is necessary for peace. The rationale for using Guizhi Fuling Tang (Cinnamon Twig and Poria Decoction) is as follows: Guizhi (Cinnamon Twig) and Baishao (White Peony Root) represent Yin and Yang; Fuling (Poria) and Mudanpi (Moutan Cortex) represent Qi and Blood. They harmonize cold and heat and support healthy Qi. Taoren (Peach Seed) breaks down bad blood and eliminates *zhijia* (masses), without fear of harming the fetus, because the disease bears the brunt of the treatment. Furthermore, the initial formation of *zheng* is due to cold; Guizhi transforms Qi and dispels the root cold. The formation of *zheng* involves damp-heat forming a nest; Fuling clears dampness, Mudanpi clears blood heat, and Shaoyao (Peony Root) astringes Liver Blood and supports Spleen Qi, enabling the Spleen to control blood. Supporting healthy Qi is the way to eliminate pathogenic factors.

The *Chan Yun Ji* (Collection of Obstetrics and Pregnancy) states: There are cases where a pregnant woman's menstruation continues without damaging the fetus. When asked about this, obstetrician Xiong Zonggu replied: Women with abundant Blood and deficient Qi tend to be obese. After conception, menstruation may continue while the fetus remains stable. If treated as "leaking fetus," the fetus will likely miscarry. If not treated as such, the fetus may not miscarry. Analyzing Xiong Zonggu's words reveals profound meaning. Chao Yuanfang stated: If a woman's menstruation is irregular or absent, with no other discomfort, it indicates pregnancy. Menstrual blood is stored to nourish the fetus and transforms into milk. Once pregnant, blood is stored for nourishment; why should it flow again? The reason is that even if menstruation occurs during pregnancy, it is not necessarily due to abundant Blood. If a woman's Ying (Nutritive) Channel is affected by Wind, menstrual blood tends to flow due to the nature of Wind. Since the Ying Channel is dominated by Wind, the discharged blood is not the blood nourishing the fetus. If treated as leaking fetus, one would administer tonifying and stabilizing medicines. Since the fetus is not damaged, forcing nourishment upon it constitutes "reinforcing excess," making miscarriage inevitable. If a physician understands the principle of Wind in the Ying Channel, treating only the Wind with a single herb can stop menstruation, or even without medication, the fetus remains safe. However, there are cases where the fetus is inherently unstable, and due to excessive sexual activity, leakage precedes miscarriage; these must be treated as leaking fetus, requiring careful differentiation.

Note: If Wind in the Liver Channel causes blood to scatter and fail to return to the vessels, use Fangfeng Wan (Saposhnikovia Pill). If Heat in the Liver Channel causes reckless blood flow, use fried Tiaohuangqin (Scutellariae Radix) ground into powder, taken with wine.