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Wang Shuhe said: When a woman's menstruation flows but is scanty, and the physician palpates the pulse yet incorrectly diagnoses pregnancy, which later proves true, what does this pulse resemble? It is described as follows: The cunkou (inch position) pulse shows both yin and yang aspects as peaceful, with Ying (Nutrient) and Wei (Defensive) qi harmonized. (Shen's note: When the yin and yang aspects of the cunkou pulse are peaceful, it naturally indicates harmony between Ying and Wei.) Pressing deeply reveals a slippery quality, while light palpation feels floating and light. (Shen's note: Deep pressing examines the yin aspect; slipperiness indicates excess. Light palpation examines the yang aspect; lightness indicates deficiency. I consider this to be the meaning of "yin pulsating distinct from yang".) The Maiyang (Yangming) and Shaoyin meridians follow their regular methods. (Shen's note: The Chong vessel belongs to Yangming and governs blood; the Ren vessel belongs to Shaoyin and governs essence. Following regular methods implies no damage to essence or blood, indicating pregnancy without miscarriage.) The body may experience chills (chattering teeth), anorexia, headache, mental confusion, and vomiting. (Shen's note: These symptoms correspond to the Classic's statement "disease in the body but no abnormal pulse," signifying pregnancy.) Exhalation is weak and rapid, while inhalation is calm and unstartled. Yang excess leads to qi overflowing outward; yin slipperiness leads to vigorous qi. Slippery pulses often indicate excess; the nourishment of the six meridians allows menstruation to appear. (Shen's note: Rapid exhalation and calm inhalation suggest yang qi overflowing externally. If internal yang is deficient and yin pulses are slippery, internal yin blood is abundant, causing menstruation. The phrase "nourishment of the six meridians" is unclear and requires further verification.) When yin encounters yang essence, fluids coagulate and disperse within the uterus; dispersion damages the fetus. (Shen's note: If yin is deficient and yang essence invades, the uterine cavity scatters, leading to miscarriage. However, if the uterus scatters, the pulse would be scattered rather than slippery. Since the pulse is slippery, there is no cause for alarm.) If yang is excessively strong, it may indicate twins; currently, due to insufficient yang, this condition is termed "Ji Jing" (provoked menstruation). (Shen's note: If both yin and yang were excessive, it would be twins. Now, qi is insufficient while blood is abundant, not twins, but provoked menstruation.)

Textual variants: "Menstruation flows" is written as "Menstruation comes monthly" in Zhou's edition. "But scanty" is written as "merely slightly scanty." "Pregnancy, vomiting, what resemblance?" has four additional characters "how to distinguish them?" in Zhou's edition. "Pressing then slippery" lacks the character "then" in Zhou's edition. "Does not desire food" has the character "drink" added in Zhou's edition. "Vomiting" is written as "vomiting, retching, desiring to vomit." "Exhaling then weak" is written as "exhaling is weak and rapid." "Inhaling without startle" is written as "inhaling without startle." "Dispersion damages fetus" is written as "dispersion causes miscarriage."

The *Chanru Ji* states: Pregnant women whose menstruation continues without damaging the fetus asked obstetrician Xiong Zonggu. He replied: This woman has abundant blood and deficient qi, and her physique must be fat. After pregnancy, menstruation frequently occurs, yet the fetus remains undisturbed. If treated as threatened abortion (Lou Tai), the fetus will surely miscarry; if not treated as threatened abortion, the fetus may not miscarry. Zonggu's words are indeed insightful. However, it is not always due to abundant blood. If wind pathogen affects the Ying meridian, menstrual blood tends to move recklessly due to wind dominance. The discharged blood is not that which nourishes the fetus; treating it as threatened abortion with tonifying herbs constitutes a double-evil error (tonifying excess), making miscarriage inevitable. Knowing it is wind, using a single wind-dispelling herb can stop menstruation, and even without medication, the fetus remains safe. There are cases where the fetus was inherently unstable due to sexual indiscretion, presenting spotting before miscarriage; these must be treated as threatened abortion and require careful examination!

Shen Yaofeng stated: Menstruation during pregnancy differs from threatened abortion. Menstruation arrives on schedule and is necessarily scanty; such individuals have abundant blood, deficient qi, and robust physiques. Threatened abortion may be caused by wind pathogen invasion or sexual indiscretion; bleeding may not be periodic, and the physique need not be robust. Furthermore, causes of threatened abortion extend beyond wind and sex, including blood heat and liver fire syndromes; one must not fail to differentiate via pulse and symptom analysis. Wind entering the vessels causes pulses that fluctuate between large and small, sometimes protruding. The aforementioned single wind-dispelling herb refers to Juqing Gubai San. (Shen's note: Also known as Huatuo Yufeng San. Scutellaria barbata [Jingjie] lightly stir-fried into powder, taken 3 qian per dose, mixed with wine infused with black soybeans.) Blood heat syndromes manifest as five-palm heat, treated with cooling blood herbs like Huangqin (Scutellariae Radix) and Ejiao (Donkey-hide Gelatin). Liver fire moving internally presents with wiry and rapid pulses, accompanied by abdominal distension and pain, treated with Jiawei Xiaoyao San. Sexual exhaustion syndromes present with deficient pulses, suitable for Renshen (Ginseng Radix); if deficient and rapid, Liuwei Dihuang Wan is appropriate.

Yu Tianmin said: Someone asked about pregnant women who menstruate monthly while the fetus grows normally; those who bleed heavily at three to five months without miscarriage; those delivering on time; or those delivering months late. What is the rationale? Monthly menstruation with normal fetal growth is called "Sheng Tai" (Abundant Fetus). The woman's qi and blood are abundant, leaving surplus blood after nourishing the fetus. Heavy bleeding several months into pregnancy is called "Lou Tai" (Leaking Fetus): external events disturb the fetus, agitating the Chong vessel, causing blood discharge without injuring the uterus. However, blood loss during pregnancy depletes qi and blood even if the fetus doesn't miscarry, often delaying delivery. I have seen deliveries at twelve to thirteen, seventeen to eighteen, or twenty-four to twenty-five months; these are all due to insufficient qi and blood, hindering embryo growth. For those past ten months without delivery, substantial tonification of qi and blood is necessary to prevent delivery complications.

Li Shi stated: Lou Tai bleeding exits from the lower vagina; Hematuria bleeding exits from the urethra.

Xiao Gengliu said: Lou Tai bleeding occurs frequently without fixed timing; hematuria occurs only during urination, not otherwise.

Shen Yaofeng said: For hematuria, Xiaoji Yinzi is excellent.

Wang Mengying commented: After repeated bleeding episodes during pregnancy, qi and blood are depleted, leading to delayed deliveries up to thirty to forty months. Some claim vaginal discharge during pregnancy predicts female birth, which is entirely incorrect. Wu Yunxiang's fifth daughter-in-law suffered from leukorrhea since youth, worsening after marriage, followed by irregular menstruation. Physicians attributed it to leukorrhea, prescribing warming and astringent herbs ineffectively. I diagnosed her pulse as very slippery and rapid, predicting pregnancy, and cured her by clearing fetal heat. She delivered a son on time.