〔脉经〕妇人经月下，但为微少，师脉之反言有躯，其后审然，其脉何类？何以别
之？师曰∶寸口脉阴阳俱平，荣卫调和，按之滑，浮之则轻，阳明、少阴各如经法，身
反洒淅，不欲食饮，头痛心乱，呕哕欲吐，呼则微数，吸则不惊，阳多气溢，阴滑气盛，滑
则多实，六经养成，所以月见阴见。阳精汁凝胞散，散者损堕，设复阳盛，双妊二胎，今
阳不足，故令激经也。（滑脉主血有余，今经又少，故知孕也。）大抵妊娠经来不多，而饮食精神如
故，六脉和缓滑大无病者，血盛有余也。儿大能饮，自不来矣。
〔大全〕夫妊娠漏胎者，谓妊娠数月而经水时下也。此由冲任脉虚，不能约制手太
阳、少阴之经血故也。冲任之脉，为经络之海，起于胞内，手太阳小肠脉也，手少阴心
脉也，是二经为表里，上为乳汁，下为月水，有娠之人，经水所以断者，壅之养胎，蓄之
以为乳汁也。冲任气虚，则胞内泄不能制其经血，故月水时下，亦名胞漏，血尽则人毙
矣。又有因劳役，喜怒哀乐不节，饮食生冷，触冒风寒，遂致胎动。若母有宿疾，子脏为
风冷所乘，气血失度，使胎不安，故令下血也。曾有以娠妇月信不绝，而胎不损，问
产科熊宗古，答曰∶妇人血盛气衰，其有必肥，既娠之后，月信当来而胎不动，若据晚
进观之，便以为漏胎，若作漏胎治之，则胎必堕。若不作漏胎治，则其未必堕。今推宗
古之言，诚有旨也。巢氏云∶妇人经闭不利，别无所苦者，是谓有子，以其经血蓄之以养
胎，拥之为乳汁也。有子之后，蓄以养胎矣，岂可复能散动耶。所以然者，有妊而月信每
至，是亦未必因血盛也。若谓妇人荣经有风，则经血喜动，以其风胜则可也，既荣经为风
所胜，则所来者非养胎之血，以此辨之，若作漏胎治之，必服保养补胎之药，且胎不损，
强以药滋之，乃所谓实实虚虚也，其胎终堕宜矣。若医者知荣经有风之理，专以一药治
风，经信可止，或不服药，胎亦无恙。然而有胎本不固，而因房室不节，先漏而后堕者，
须作漏胎治之，此又不可不审也。
〔丹〕胎漏因气虚，因血虚，因血热。
〔薛〕前证若因风热，用防风黄芩丸。若因血热，用加味逍遥散。若因血虚，用二
黄散。若因血去太多，用八珍汤；未应，补中益气汤。若因肝火，用柴胡山栀散。若因
脾火，用加味归脾汤。若因事下血作痛，用八珍汤加阿胶、熟艾。若因脾胃虚弱，用补
中益气汤加五味子。若因脾胃虚陷，用前汤倍用升麻、柴胡。若晡热内热，宜逍遥散。
妊娠卒然下血，若因怒气，用小柴胡汤。若因风热，用一味防风丸。若因血热，用一味
子芩丸。若因脾气虚弱，用六君子汤。若因中气下陷，用补中益气。若气血盛而下血者，
乃因儿小饮少也，不必服药。一妊妇下血，服凉血之药，下血益甚，食少体倦，此脾气
虚而不能摄血，余用补中益气汤而愈。后因怒而寒热，其血仍下，此肝火旺而血沸腾，用
加味逍遥散血止，用补中益气汤而安。一妊妇下血，发热作渴，食少体倦，属脾气虚
而肝火所侮，用四君子加柴胡、山栀。血止，因怒复作，用六君加柴胡、山栀、升麻而安
一妊娠六月，每怒下血，甚至寒热头痛，胁胀腹疼，作呕少食。余谓寒热头痛，乃肝火
上冲；胁胀腹痛，乃肝气不行；作呕少食，乃肝侮脾胃；小便下血，乃肝气火血热。用小
柴胡加芍药、炒黑山栀、茯苓、白术而愈。一妊娠六月，体倦食少，劳役下血，用六君
加当归、熟地黄、柴胡、升麻而愈。江应宿治王祠部安人孕三月，腰腹递痛，漏下不
止，气涌胀闷，速江诊视。六脉弦数，平昔脉极沉细，此必怒动肝火，挟相火而生内热，
喜脉不滑，未至离经，犹可保也。以条芩、白术、枳壳、香附、茯苓、阿胶、白芍、当归、
陈皮，煎调鹿角 ，酒淬细末一钱，更进抑青丸一服痛已，数剂平复。仲景云∶妇人有
漏下者，有半产后因续下血都不绝者，有妊娠下血者。假令妊娠腹中痛为胞阻，芎归胶
艾汤主之。（方见血崩。）
《大全方》治妊娠三四月，腹痛时时下血。
续断（二两） 艾叶 当归 干地黄（各六两） 竹茹 阿胶 鸡苏（各一两）
水一升，煎取六合，空心再服。
《广济》安胎。胎病漏血腹痛。
当归 川芎 阿胶（炙） 人参（各一两） 大枣（二十个）
上切，以水三升，酒四升，煮二升半，分三服，五日一剂，频服三四剂无妨。
济生如圣汤 治胎动腹痛，或为漏胎。
鲤鱼皮 当归（酒浸） 熟地黄（酒蒸） 白芍药 阿胶（蚌粉炒） 川芎
续断（酒浸） 甘草（炙，各等分） 一方有干姜、竹茹。
上 咀，每服四钱，水一盏，苎根少许，姜五片，煎温服。《济生》有续断，无干姜、
竹茹。
桑寄生散 治胎漏经血妄行，淋沥不已。
桑寄生 当归（去芦，酒浸） 川芎 川续断（酒浸） 阿胶（蛤粉炒） 香附子（炒去毛）
茯神（去木） 白术（各一钱） 人参 甘草（炙，各半钱）
上作一服，水二盅，生姜五片，煎至一盅，不拘时服。
郑氏人参散 治漏胎败血凑心，日渐胎干，子母危困。
人参 黄 （炙） 阿胶（炒，各五钱） 竹茹 木香 炙甘草 附子（炮，各半钱） 川芎
陈皮 苎根（各二钱半） 生姜（三钱，炮黑）
上 咀，每四钱，糯米三七粒，水煎热服。忌生冷、鸡、鸭、鱼、面。
梅师治胎动下血，心腹疼，死生不知，服此汤活即安，死即下。即催生佛手散，方见
胎产大法。（即川芎、当归等分为散也。）
妊娠无故卒下血不止，取阿胶三两，炙、捣末，酒一升半，煎令消，一服愈。
罗氏立圣散 治妊娠下血不止。
鸡肝三个，用酒一升煮熟，共食之，大效。
二黄散 治胎漏。
生地黄 熟地黄（等分，锉） 水三盏，煎半干，去滓服。
治胎漏下血。
阿胶（二两） 捣末，生地黄（半斤） 捣取汁，以清酒三升，绞汁、分三服。
治胎漏下血不止，胎干即死，宜急治之。
生地黄汁（一升） 陈酒（五合）
上同煎三五沸，温、三服，以止为度。
地黄汤 治经血妄行，及鼻衄不止。
生地黄（酒擂取汁，半两） 薄荷（三钱） 甘草（一钱）
上二味为末，新汲水合地黄汁调，食后服。
《续易简》治漏血。
用野苎根（二两，锉炒，家种亦可） 金银（各一两许）
为一剂。酒水准，煎耗半，温服。若闪 胎动欲漏，砂仁皮炒令热透，为末，（二钱，）
酒或盐汤下。
保命枳壳汤 治妇人胎漏下血，及因事下血。
枳壳 黄芩（各半两） 白术（一两）
上为粗末，每服七钱，水一盏，煎七分，食前服。
子芩丸 治肝经有热，妄行下血。
细条黄芩炒为末，每服一钱，以秤锤烧赤，淬酒热调服。若脾胃虚不宜用。
防风丸 治肝经有风，以致血得风而流散不归经。
用防风为末，每服一钱，白汤调服。
防风黄芩丸 治肝经有风热，致血崩、便血、屎血。
用条芩炒焦，防风等分为末，酒糊丸桐子大。每服三、五十丸，食远或食前米饮或
温酒送下。
仲景云∶妇人宿有 病，经断未及三月，而得漏下不止，胎动在脐上者，为 痼害。妊
娠六月动者，前三月经水利时胎。下血者后断三月 也。所以血不止者，其 不去故也。
当下其 ，桂枝茯苓丸主之。
桂枝茯苓丸方
桂枝 茯苓 牡丹（去心） 桃仁（去皮尖，熬） 芍药（各等分）
上五味末之，炼蜜和丸如兔屎大。每日食前服一丸，不知，加至三丸。
治胎下血不止。取桃树上干不落桃子，烧灰和水服，瘥。（《本草》云∶桃奴破血，又治伏梁、积气。）
榆白皮散 治妊孕胎漏去血，恐其难产，常宜服之。
榆白皮 葵根 瞿麦（各二钱） 大麻仁（去壳） 木通（各一钱） 牛膝（去芦，酒浸焙，一钱半）
上作一服，水二盅，煎至一盅，不拘时服。
[The Pulse Classic] When a woman's menstruation occurs but is scanty, and the physician palpates the pulse and predicts pregnancy, which is later confirmed, what kind of pulse is this? How can it be distinguished? The physician says: The Cun (inch) position of the radial artery shows balanced Yin and Yang pulses, with Ying (Nutrient) and Wei (Defensive) Qi harmonious. Deep pressure reveals a slippery quality, while light pressure feels floating and light. The Yangming and Shaoyin pulses conform to standard methods. The body experiences chills (Saxi), loss of appetite, headache, mental restlessness, nausea, retching, rapid exhalation, and normal inhalation. Yang Qi is abundant and overflowing, while Yin pulses are slippery indicating vigorous Qi and Blood. A slippery pulse indicates excess Blood; given the scanty menstruation, pregnancy is inferred. Generally, during pregnancy, if menstruation is scanty but diet and spirit remain normal, and all six pulse positions are gentle, slippery, and large without signs of disease, it indicates abundant Blood. As the fetus grows and requires nourishment, menstruation naturally ceases.
[Daquan Liangfang] "Leaking Fetus" (Lou Tai) in pregnancy refers to vaginal bleeding occurring monthly during gestation. This results from deficiency of the Chong and Ren vessels, failing to control the blood of the Hand-Taiyang Small Intestine and Hand-Shaoyin Heart meridians. The Chong and Ren vessels are the sea of meridians, originating in the uterus. They correspond to the Hand-Taiyang Small Intestine and Hand-Shaoyin Heart meridians, which are exterior-interior pairs. Upward they transform into milk, downward into menstrual blood. In pregnancy, menstruation stops because blood is congested to nourish the fetus and stored as milk. If Chong and Ren Qi is deficient, the uterus leaks and cannot control menstrual blood, causing monthly bleeding, also called "Uterus Leakage" (Bao Lou). If blood is exhausted, death ensues. Other causes include overexertion, emotional imbalance, consumption of cold/raw foods, or exposure to wind-cold, leading to fetal agitation. If the mother has chronic illness, cold-wind invades the Zang organ (uterus), disrupting Qi and Blood and unsettling the fetus, causing bleeding. Physician Xiong Zonggu stated that women with abundant Blood and deficient Qi tend to be obese. After conception, if menstruation continues without disturbing the fetus, it should not be treated as Leaking Fetus; treating it as such may cause miscarriage. Non-treatment may preserve the fetus. Chao Yuanfang noted that amenorrhea without other symptoms indicates pregnancy, as blood is stored for the fetus and milk. If menstruation continues during pregnancy, it is not necessarily due to Blood excess. If Wind affects the Ying meridian, blood moves freely due to Wind dominance. The flowing blood is not that meant for nourishing the fetus. Treating this as Leaking Fetus with tonifying herbs constitutes "reinforcing excess and depleting deficiency," likely leading to miscarriage. If the physician understands Wind in the Ying meridian, treating only with Wind-dispelling herbs may stop bleeding, or no treatment may suffice. However, if the fetus is inherently unstable due to sexual indiscretion, leading to leakage and then miscarriage, it must be treated as Leaking Fetus. Careful differentiation is essential.
[Danxi] Causes of fetal leakage include Qi deficiency, Blood deficiency, and Blood heat.
[Xue Ji] For the above conditions: If caused by Wind-Heat, use Fangfeng Huangqin Wan. If caused by Blood Heat, use Jiawei Xiaoyao San. If caused by Blood Deficiency, use Erhuang San. If due to excessive blood loss, use Bazhen Tang; if ineffective, use Buzhong Yiqi Tang. If caused by Liver Fire, use Chaihu Shanzhi San. If caused by Spleen Fire, use Jiawei Guipi Tang. If bleeding and pain occur due to emotional stress, use Bazhen Tang plus Ejiao and Shu Ai. If due to Spleen-Stomach weakness, use Buzhong Yiqi Tang plus Wuweizi. If due to Spleen-Stomach sinking, increase Shengma and Chaihu in the previous formula. If afternoon fever and internal heat occur, use Xiaoyao San. For sudden bleeding in pregnancy due to anger, use Xiao Chaihu Tang. Due to Wind-Heat, use Yiwu Fangfeng Wan. Due to Blood Heat, use Yiwu Ziqing Wan. Due to Spleen Qi deficiency, use Liu Junzi Tang. Due to Middle Qi sinking, use Buzhong Yiqi Tang. If bleeding occurs despite abundant Qi and Blood, it is because the fetus consumes little; medication is unnecessary. One patient took cooling Blood herbs, worsening bleeding, fatigue, and poor appetite, indicating Spleen Qi deficiency failing to control Blood; cured with Buzhong Yiqi Tang. Later, anger caused chills/fever and continued bleeding, indicating hyperactive Liver Fire boiling Blood; stopped with Jiawei Xiaoyao San, stabilized with Buzhong Yiqi Tang. Another patient had bleeding, fever, thirst, fatigue, attributed to Spleen Qi deficiency oppressed by Liver Fire; treated with Sijunzi Tang plus Chaihu and Zhizi. After stopping, recurrence due to anger was treated with Liujunzi Tang plus Chaihu, Zhizi, and Shengma. A sixth-month pregnant patient had bleeding upon anger, chills/fever, headache, hypochondriac distension, abdominal pain, vomiting, and poor appetite. Headache/chills indicated Liver Fire rising; distension/pain indicated stagnant Liver Qi; vomiting/poor appetite indicated Liver overacting on Spleen-Stomach; urinary bleeding indicated Liver Qi/Fire/Blood heat. Cured with Xiao Chaihu Tang plus Shaoyao, Chao Hei Zhizi, Fuling, and Baizhu. Another sixth-month patient with fatigue, poor appetite, and exertion-induced bleeding was cured with Liujunzi Tang plus Danggui, Shudihuang, Chaihu, and Shengma. Jiang Yingsu treated Secretary Wang's wife at three months' gestation with progressive lower back/abdominal pain, continuous leakage, Qi surging, and distension. Pulses were wiry and rapid, normally deep and fine. Anger stirred Liver Fire, combining with Ministerial Fire to generate internal heat. The pregnancy pulse was not slippery, not yet deviating from the norm, so preservation was possible. Prescribed Huangqin, Baizhu, Zhike, Xiangfu, Fuling, Ejiao, Baishao, Danggui, and Chenpi, decocted with Lu Jiao Shuang (Deer Horn Powder) quenched in wine (1 qian). Yi Qing Wan was taken once for pain relief; several doses restored health. Zhang Zhongjing stated: Women with uterine masses (Zheng) may have continuous bleeding after missed periods of less than three months, with fetal movement above the umbilicus, indicating a mass complication. Fetal movement at six months corresponds to regular menstruation before conception. Bleeding after three months of amenorrhea is due to the mass. To stop bleeding, the mass must be resolved using Guizhi Fuling Wan.
Guizhi Fuling Wan Formula
Guizhi, Fuling, Mudanpi (remove heart), Taoren (remove skin/apiculus, roast), Shaoyao (equal parts).
Grind five ingredients into powder, mix with refined honey to form pills size of rabbit feces. Take one pill before meals daily; if ineffective, increase to three pills.
For continuous fetal bleeding: Burn dried peaches fallen from peach trees, mix with water, and take. (Bencao states: Taonuo breaks Blood stasis and treats Fuliang and accumulated Qi.)
Yubai Pi San
Treats uterine leakage in pregnancy with fear of difficult labor; suitable for regular use.
Yubai pi, Kuigen, Qumai (2 qian each), Dama Ren (shelled), Mutong (1 qian each), Niuxi (de-rooted, wine-soaked, roasted, 1.5 qian).
Decoct one dose in two zhong of water to one zhong; take anytime.
[Daquan Fang] Treats abdominal pain and intermittent bleeding in the third/fourth month of pregnancy.
Xuduan (2 liang), Aye, Danggui, Dihuang (6 liang each), Zhuru, Ejiao, Jisu (1 liang each).
Decoct in one sheng of water to obtain six he; take twice on an empty stomach.
[Guangji Fang] Stabilizes the fetus. Treats fetal disease with leakage and abdominal pain.
Danggui, Chuanxiong, Ejiao (roasted), Renshen (1 liang each), Dazao (20 pieces).
Cut ingredients, boil in three sheng water and four sheng wine to obtain two and a half sheng. Divide into three doses. One dose every five days; frequent administration of three to four doses is safe.
Jisheng Rusheng Tang
Treats fetal agitation with abdominal pain or leaking fetus.
Liyu pi, Danggui (wine-soaked), Shudihuang (wine-steamed), Baishao, Ejiao (fried with clam powder), Chuanxiong, Xuduan (wine-soaked), Gancao (roasted, equal parts). Some versions add Ganjiang and Zhuru.
Cinchonaize, take 4 qian per dose with one lamp of water, a little Zhumgen, and five slices of ginger. Decoct and take warm. [Jisheng Fang] contains Xuduan but lacks Ganjiang and Zhuru.
Sangjisheng San
Treats fetal leakage with erratic menstrual flow and persistent dripping.
Sangjisheng, Danggui (remove radix, wine-soaked), Chuanxiong, Chuanxuduan (wine-soaked), Ejiao (fried with gecko powder), Xiangfu (roasted, remove hairs), Fushen (remove wood), Baizhu (1 qian each), Renshen, Gancao (roasted, 0.5 qian each).
One dose, decoct in two zhong water with five slices of ginger to one zhong. Take anytime.
Zhengshi Renshen San
Treats leaking fetus with敗血 (decayed blood) rushing to the heart, leading to dry fetus and critical condition of mother and child.
Renshen, Huangqi (roasted), Ejiao (fried, 5 qian each), Zhuru, Muxiang, Gancao (roasted), Fuzi (processed, 0.5 qian each), Chuanxiong, Chenpi, Zhumgen (2.5 qian each), Shengjiang (3 qian, roasted black).
Cinchonaize, take 4 qian with 37 grains of glutinous rice, decoct in water, and take hot. Avoid cold/raw foods, chicken, duck, fish, and wheat.
Meishi treats fetal agitation with bleeding and severe abdominal pain, uncertain survival. This decoction ensures safety if alive, expulsion if dead. It is the Childbirth Foshou San (see Major Principles of Obstetrics), consisting of Chuanxiong and Danggui in equal parts powdered.
For unexplained sudden continuous bleeding in pregnancy: Take 3 liang of Ejiao, roast, powder, and decoct in one and a half sheng of wine until dissolved. Take once for cure.
Luoshi Lisheng San
Treats continuous bleeding in pregnancy.
Three chicken livers, cooked in one sheng of wine. Consume together; highly effective.
Erhuang San
Treats fetal leakage.
Shengdihuang and Shudihuang (equal parts, cut). Decoct in three zhan of water until half-dry, strain, and take.
For fetal leakage bleeding:
Ejiao (2 liang), powdered. Shengdihuang (8 liang), juiced. Mix with three sheng of clear wine, strain, and divide into three doses.
For continuous fetal leakage bleeding where the fetus dries and dies, urgent treatment is required:
Shengdihuang juice (1 sheng), aged wine (5 he).
Simmer together for three to five boils. Take warm, divided into three doses, until bleeding stops.
Dihuang Tang
Treats erratic menstrual flow and persistent epistaxis.
Shengdihuang (juiced with wine, 0.5 liang), Bohe (3 qian), Gancao (1 qian).
Powder the two ingredients, mix with fresh well-water and Dihuang juice, take after meals.
[Xuyi Jian Fang] Treats leaking blood.
Ye Zhum gen (2 liang, cut and stir-fried; cultivated is acceptable), Jinyinhua (approx. 1 liang each).
One dose. Add wine/water appropriately, simmer until half evaporated, take warm. For traumatic fetal agitation threatening leakage: Roast Shenren pi until hot, powder (2 qian), take with wine or salt water.
Baoming Zhike Tang
Treats uterine leakage and bleeding due to specific triggers.
Zhike, Huangqin (0.5 liang each), Baizhu (1 liang).
Coarse powder, take 7 qian per dose with one lamp of water, simmer to 70%, take before meals.
Ziqing Wan
Treats Liver meridian heat causing erratic bleeding.
Fine Huangqin strips, roasted and powdered. Take 1 qian per dose, mixed with hot wine quenched from a red-hot hammer weight. Not suitable for Spleen-Stomach deficiency.
Fangfeng Wan
Treats Liver meridian wind causing blood to scatter and fail to return to vessels.
Fangfeng powdered. Take 1 qian per dose, mixed with plain boiled water.
Fangfeng Huangqin Wan
Treats Liver meridian Wind-Heat causing metrorrhagia, hematochezia, or melena.
Chao Huangqin (charred) and Fangfeng in equal parts, powdered, bound with wine paste into pills size of wutong seeds. Take 30-50 pills with rice drink or warm wine, far from meals or before meals.
Zhang Zhongjing stated: Women with chronic uterine masses (Zheng) may experience continuous bleeding after missing periods for less than three months, with fetal movement above the umbilicus, indicating a mass complication. Fetal movement at six months corresponds to regular menstruation prior to conception. Bleeding after three months of amenorrhea is due to the mass. The reason bleeding persists is that the mass remains. The mass must be expelled using Guizhi Fuling Wan.
Guizhi Fuling Wan Formula
Guizhi, Fuling, Mudanpi (remove heart), Taoren (remove skin/apiculus, roast), Shaoyao (equal parts).
Grind five ingredients, mix with refined honey to form pills size of rabbit feces. Take one pill before meals daily; if ineffective, increase to three pills.
For continuous fetal bleeding: Burn dried peaches from peach trees, mix with water, and take. Cure. (Bencao states: Taonuo breaks Blood stasis and treats Fuliang and accumulated Qi.)
Yubai Pi San
Treats uterine leakage in pregnancy with fear of dystocia; suitable for regular use.
Yubai pi, Kuigen, Qumai (2 qian each), Dama Ren (shelled), Mutong (1 qian each), Niuxi (de-rooted, wine-soaked, roasted, 1.5 qian).
One dose, decoct in two zhong of water to one zhong. Take anytime.