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Chanbao Baiwen (Hundred Questions on Childbirth) states: During pregnancy, when the fetus is formed but the fetal qi is not yet solid, it may be due to sexual intercourse, fright or shock, or excessive labor and exertion, which damages the fetal sac. It may also be caused by consuming toxic foods, leading to a deficiency and slipping of the uterus, resulting in dripping menstrual blood. If not treated urgently,敗血 (defective blood) will rush to the heart, endangering both mother and child.

Chen Liangfu states: Pregnancy leakage (Tai Lou) refers to the condition where, several months into pregnancy, menstruation still occurs intermittently. This is caused by the deficiency of the Chong Mai (Penetrating Vessel) and Ren Mai (Conception Vessel), which fail to restrain the blood of the Hand-Taiyang Small Intestine Meridian and Hand-Shaoyin Heart Meridian. The Chong and Ren vessels are the sea of meridians, originating from inside the Bao Gong (Uterus). The Hand-Taiyang Small Intestine Meridian and Hand-Shaoyin Heart Meridian are exterior-interior pairs; their qi ascends to form milk and descends to form menstruation. In pregnant women, menstruation stops because blood and qi are congested to nourish the fetus. If the qi of the Chong and Ren vessels is deficient, the interior of the uterus leaks, failing to control menstrual blood, thus causing intermittent menstruation, known as Bao Lou (Fetal Sac Leakage); if the blood is exhausted, death ensues. Additionally, due to overwork, uncontrolled emotions (anger, joy, sorrow, happiness), irregular diet of cold/raw foods, or exposure to wind-cold, fetal movement may occur. If the mother has chronic diseases, the Zang Zang (Uterus) is invaded by wind-cold pathogens, leading to imbalance of qi and blood, making the fetus unstable and causing bleeding.

Zhu Danxi states: Fetal leakage is mostly caused by Blood Heat (Xue Re), but there are cases of Qi Deficiency and Blood Deficiency. Therefore, in Liangfang (Excellent Prescriptions), it is discussed that taking cooling-blood medicines can exacerbate bleeding, accompanied by poor appetite and fatigue, which indicates Spleen Qi Deficiency failing to control the blood.

Daquan (General Collection) states: In pregnancy, sudden discharge of yellow fluid resembling glue or bean juice occurs, accompanied by fetal movement and abdominal pain.

Xue Lizhai's commentary: The aforementioned symptoms belong to Damp-Heat in the Liver and Spleen, treated with Sheng Yang Chu Shi Tang (Yang-Raising Damp-Removing Decoction). If it is Wind-Heat in the Liver and Spleen, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). For Liver-Spleen Stagnation and Anger, use Jiawei Guipi Tang (Modified Restore the Spleen Decoction). For Spleen-Stomach Qi Deficiency, use Qian Shi Baizhu San (Qian’s Atractylodes Macrocephala Powder). If Spleen Qi sinks, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). For Liver Meridian Wind-Heat, use Fangfeng Huangqin Wan (Saposhnikovia and Scutellaria Pill); if wind enters the intestines and stomach, use Weifeng Tang (Stomach Wind Decoction).

Xue Lizhai states: Continuous bleeding during pregnancy is called Tai Lou (Fetal Leakage). For Blood Deficiency, use Erhuang San (Two Yellow Powders); for significant blood loss, use Bazhen Tang (Eight Treasures Decoction); if ineffective, use Buzhong Yiqi Tang. If bleeding occurs due to emotional or physical agitation, use Zhike Tang (Citrus Aurantium Decoction) added with Sheng Dihuang (Rehmannia Root, Raw) and Shu Dihuang (Rehmannia Root, Prepared); if ineffective or pain develops, add Danggui (Angelica Sinensis). If bleeding persists, use Bazhen Tang added with Ejiao (Donkey-hide Gelatin) and Aiye (Mugwort Leaf). If caused by anger, use Xiaochaihu Tang (Minor Bupleurum Decoction). If caused by Wind-Heat, use Yiwu Fengfeng Wan (Single Herb Saposhnikovia Pill). If caused by Blood Heat, use Yiwu Ziqing Wan (Single Herb Scutellaria Seed Pill). If Spleen Qi is weak, use Liujunzi Tang (Six Gentlemen Decoction). If Middle Qi sinks, use Buzhong Yiqi Tang. If bleeding occurs despite abundant Qi and Blood, it is because the fetus consumes less nourishment, so no medicine is needed. Qianjin Fang (Essential Prescriptions Worth a Thousand Gold) treats continuous bleeding in pregnancy, called Lotou (Leaking Fetus), where exhaustion of blood leads to fetal death; the formula uses eight liang of Shengdi (Raw Rehmannia Root), pounded with clear wine to extract juice, taken at any time, preferably in larger doses.

Shenzhai's commentary: The above seven items describe the syndrome of fetal leakage and bleeding before delivery. Regarding pregnancy fetal leakage, Jingui Yaolue (Essential Prescriptions of the Golden Cabinet) attributes it to Bing Gu Hai (chronic disease hindrance), while Chao Shi (Chao Yuanfang) attributes it to Feng (Wind) in the Ying Jing (Nutritive Vessels), categorizing these as pathogenic excess factors. In contrast, Chanbao, Daquan, and Zhu Danxi attribute it to Qi Deficiency and Blood Deficiency, categorizing these as internal injury and insufficiency. Observing Xue Lizhai’s prescription guidelines, the treatment for excess and deficiency syndromes is already distinguished.