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An Tai Ji Sheng Tang (Cushioning the Fetus and Nourishing Life Decoction, from *Fu Ren Ke* Vol. 19, for bleeding with lower back pain) Dang Gui Shao Yao Tang (Angelica Sinensis and Peony Decoction, from *Fu Ren Co* Vol. 16, for acute pain with bleeding)

Sudden vaginal bleeding during pregnancy has four main etiologies: first, it may be caused by fire-heat forcing blood to move recklessly; second, by emotional depression and anger causing qi rebellion that disturbs blood; third, by physical trauma injuring fetal qi and damaging the uterus (Baogong), leading to bleeding; fourth, by sinking of spleen and kidney qi, with failure of the Mingmen (Gate of Vitality) to secure blood, resulting in hemorrhage. These are all severe conditions involving the disturbance of blood. If not regulated promptly, miscarriage will inevitably occur. However, in treating this, one must first observe the amount of blood lost, and after the bleeding, particularly scrutinize the severity of the pathogenic factors. If fire is not yet cleared, one should still clear fire; if qi is not yet smooth, one should still regulate qi. If bleeding was triggered by pathogens, and blood deficiency follows the loss, one must rapidly focus on supporting primordial qi to prevent collapse or sinking. In these cases, some require treating the branch (symptoms), some require saving the root (constitution), and some require addressing both simultaneously. If the sequence and urgency are not understood, one may find no time to save the root while attempting to treat the branch. Therefore, careful observation is essential.

If excessive fire forces blood to move recklessly, observe the intensity of the fire. For mild fire, use Liang Tai Yin (Cool the Fetus Decoction); for slightly more severe cases, use Xi Xin Yin (Remove Firewood Decoction); for even more severe cases, use Bao Yin Jian (Protect the Yin Decoction) or Zi Qin San (Scutellaria Powder). If wind-heat in the Liver channel causes bleeding, use Fang Feng Huang Qin Wan (Saposhnikovia and Scutellaria Pill). If anger injures the Liver, causing qi rebellion and sudden violent bleeding, use Bao Yin Jian. If qi stagnation causes distension and fullness, use Si Qi Tang (Four Seven Decoction) or Er Chen Tang (Two Aged Things Decoction), possibly adding Xiong (Chuanxiong Rhizome) and Gui (Dang Gui Radix Angelicae Sinensis). If accompanied by Liver fire, use Hua Gan Jian (Transform the Liver Decoction). If trauma to fetal qi damages the uterus causing bleeding, use An Tai San (Stabilize the Fetus Powder) or Jiao Ai Tang (Colla Corii Asini and Mugwort Decoction). If blood loss is heavy, double the dose of Ren Shen (Ginseng Radix et Rhizoma). If falling from a height injures fetal qi causing bleeding, use Yi Mu Di Huang Tang (Motherwort and Rehmannia Decoction) or An Tai San. If fright causes qi deficiency and sinking, add Ren Shen. If the Spleen and Stomach are inherently weak, or if injury to the Spleen causes bleeding, use Shou Pi Jian (Nourish the Spleen Decoction) or Gui Pi Tang (Restore the Spleen Decoction). If Middle Qi sinks, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). If blood deficiency with slight heat causes spotting or hematuria, use Xu Duan Tang (Drynaria Decoction). Regarding the above various conditions of blood disturbance, if blood loss is not heavy, there is no accumulation of blood, and the fetus is not severely damaged but bleeding persists, apply cooling where appropriate, tonification where appropriate, with the primary treatment principle being to stabilize and secure the fetus. If blood has left its vessels and accumulated in the uterus, causing distension and pain, with residual blood remaining, it is impossible to retain it; to expel the blood without damaging Ying (Nutritive) qi, the most suitable method is Si Wu Tang (Four Substance Decoction) with a significantly increased dose of Dang Gui. If examination reveals that fetal qi is disturbed and retention is difficult, Wu Wu Jian (Five Material Decoction) and Jue Jin Jian (Crossing the River Decoction) are crucial remedies.

One formula: For treating sudden falls causing fetal movement, use Chuan Xiong powder (2 qian), taken with wine in two or three doses. If the fetus lives, it stabilizes; if dead, it is expelled.

Another formula: Same indication as above. Use Sha Ren (Amomi Fructus) fried with peel, ground into powder. Take 2 qian per dose, washed down with rice water. Relief occurs when abdominal warmth is felt.