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(Note: Bleeding resembling menstruation during pregnancy)

*Maijing* (Pulse Classic) records: When a woman has vaginal bleeding after conception, but the flow is scanty, and the physician palpates the pulse, stating that she is pregnant, which is later confirmed. What does this pulse resemble, and how can it be distinguished? The Master said: The Cun and Kou positions of both Yin and Yang are peaceful; Ying and Wei Qi are harmonious. Pressing reveals a slippery quality, while light palpation feels floating and gentle. The Maiyang and Shaoyin pulses conform to standard methods. The body may feel chilly, there is loss of appetite, headache, mental restlessness, nausea with desire to vomit, rapid exhalation, and unlabored inhalation. Excess Yang causes Qi overflow; Yin slipperiness indicates abundant Qi and Blood. This should be considered as an abundance of Blood. A slippery pulse indicates excess Blood. With the nourishment of the Six Channels, menstruation appears. If Yin encounters Yang essence, the fluid coagulates and the fetus disperses; if dispersed, it leads to damage or abortion. If Yang becomes excessive, twin pregnancies may occur. Now, due to insufficient Yang, this results in "Ji Jing" (provoked menstruation). (A slippery pulse governs excess Blood; since menstruation is scanty now, we know it is pregnancy.) Generally, when there is slight bleeding during pregnancy, but diet and spirit remain normal, and the six pulses are harmonious, slippery, and large without disease signs, it indicates excess Blood and Qi. As the fetus grows, it consumes the blood, and bleeding will cease naturally.

*Daquan Liangfang* (Great Comprehensive Good Prescriptions) records: The condition known as "Lou Tai" (leaking fetus) refers to vaginal bleeding occurring monthly during pregnancy for several months. This is caused by deficiency of the Chong and Ren vessels, which fail to constrain the blood of the Hand-Taiyang (Small Intestine) and Hand-Shaoyin (Heart) meridians. The Chong and Ren vessels are the sea of meridians, originating from the Bao Gong (uterus). The Hand-Taiyang meridian belongs to the Small Intestine, and the Hand-Shaoyin meridian belongs to the Heart. These two meridians are exterior-interior pairs; upwards they transform into milk, downwards into menstrual water. In pregnant women, menstruation stops because blood is congested to nourish the fetus and stored to become milk. If Chong and Ren Qi are deficient, the interior of the uterus leaks, failing to control menstrual blood, hence monthly bleeding occurs. This is also called "Bao Lou Xue" (uterine leaking blood); if the blood is exhausted, death ensues. Other causes include labor, emotional imbalance (joy, anger, worry, sadness), consumption of raw/cold foods, or exposure to wind-cold, leading to fetal movement. If the mother has chronic diseases, the Zang Fu of the fetus is invaded by wind-cold, causing Qi and Blood to lose regulation, making the fetus unstable and resulting in bleeding. (This describes three types of Lou Tai: Chong-Ren deficiency implies emptiness of the Blood Sea; Seven Emotions, diet, and stomach cold imply external/internal pathogens; chronic diseases imply Qi and Blood failing to nourish.)

Once, a pregnant woman had continuous menstruation without fetal loss. She asked Obstetrician Xiong Zonggu. He replied: If a woman has abundant Blood and deficient Qi, she is likely obese. After conception, menstruation may continue without disturbing the fetus. If observed late, it might be mistaken for Lou Tai. Treating it as Lou Tai would cause abortion. Not treating it as Lou Tai means the fetus likely won't abort. Analyzing Xiong's words reveals profound meaning. Chao Yuanfang stated: If a woman has amenorrhea without other discomfort, it indicates pregnancy, as blood is stored to nourish the fetus and transform into milk. Once pregnant, blood is stored for the fetus; how could it scatter? Therefore, monthly bleeding during pregnancy is not necessarily due to Blood excess. If one claims the Ying Meridian has Wind, causing blood to move freely, this is plausible. (Using Wind herbs to treat Lou Tai lifts Liver Qi, preventing blood leakage and stabilizing the fetus, not just dispelling Wind.) Since the Ying Meridian is overcome by Wind, the flowing blood is not that meant to nourish the fetus; thus, it can be distinguished. Treating it as Lou Tai requires tonifying herbs, which might not harm the fetus. Forcing tonification is "reinforcing excess and depleting deficiency," leading to inevitable abortion. If a doctor understands the Wind in Ying Meridian theory, using a single herb to treat Wind can stop menstruation, or even without medication, the fetus remains safe. However, if the fetus is inherently unstable due to sexual indiscretion, leading to bleeding then abortion, it must be treated as Lou Tai. This requires careful examination.

Fang Shi said: Both Fetal Movement and Fetal Leaking involve bleeding, but Fetal Movement includes abdominal pain, whereas Fetal Leaking does not. Thus, Fetal Movement requires moving Qi, while Fetal Leaking requires clearing Heat. (Analysis is precise.)

Li Shi said: Hematuria bleeds from the urethra; Lou Tai bleeds from the vagina. Pregnancy hematuria is mostly due to Bladder Heat; use Si Wu Tang with Shan Zhi and Fa Hui. Single Ku Cai Yin is also effective. For Summerheat, use Yi Yuan San with Sheng Ma decocted. For slight deficiency, use Jiao Ai Si Wu Tang. For chronic cases, use Long Gu (1 qian) and Pu Huang (5 qian) powdered, taken with wine.

*Maijing* states: In the 6th or 7th month of pregnancy, sudden profuse watery bleeding indicates uterine tilt and abortion. This is premature rupture of the amniotic sac ("Gu Jiang"). (Premature rupture leads to abortion, indicating dual deficiency of Qi and Blood.)

Xue Shi said: Lou Tai may discharge yellow fluid or bean-jelly-like substance. If due to Liver-Spleen Damp-Heat, use Sheng Yang Chu Shi Tang. For Blood Flooding due to Liver-Spleen Wind-Heat, use Jia Wei Xiao Yao San. For Liver-Spleen Stagnation and Anger, use Jia Wei Gui Pi Tang. For Spleen-Stomach Qi Deficiency, use Qian Shi Bai Zhu San. For Sinking Spleen Qi, use Bu Zhong Yi Qi Tang. For Liver Meridian Wind-Heat, use Fang Feng Huang Qin Wan. For Wind invading Stomach-Intestines, use Wei Qi Tang.

**Jia Jian Jiao Ai Tang**: Effective for Fetal Movement and Leaking.
E Jiao (fried to pearls), Dang Gui, Chuan Xiong, Bai Shao Yao (fried), Di Yu (each 1 qian), Ai Ye (fried), Gan Cao (each 0.5 qian).
Decoct one dose, take warm on an empty stomach. If bleeding is heavy due to Qi stagnation, Blood rebellion, or Fire agitation, add fried Huang Qin, fried Xiang Fu, and fried Sha Ren. For miscarriage at 4-5 months or threatened abortion at 6-7 months, remove Ai Ye and Di Yu from the above formula, add Bai Zhu, Huang Qin, Fu Ling, Shu Di Huang, and Xu Duan. If Qi is excessive, add Xiang Fu and Sha Ren. If Qi is deficient, add Ren Shen and Huang Qi. For multiple miscarriages, take Qian Jin Zi Su Yin early after conception, along with previous modifications. Alternate between decoctions and pills to prevent further miscarriage.

**An Tai Yin**: For sudden lower back pain and continuous bleeding during pregnancy.
Dang Gui, Chuan Xiong, Bai Shao Yao (fried), Shu Di Huang, E Jiao (fried), Ai Ye, Huang Qi (each 1 qian), Gan Cao (roasted), Di Yu (each 0.5 qian).
Decoct one dose with Ginger and Jujube, take orally.

**Da Quan Fang**: For abdominal pain and intermittent bleeding in the 3rd-4th month of pregnancy.
Dang Gui, Shu Di Huang, Ai Ye (each 6 liang), Xu Duan (2 liang), E Jiao, Ji Su, Zhu Ru (each 1 liang).
Decoct with 1 sheng of water to obtain 7 he, take twice on an empty stomach.

**Ru Sheng Tang**: For Fetal Movement with abdominal pain or Fetal Leaking.
Li Yu Pi (usage is unique), Dang Gui (soaked in wine), Bai Shao Yao, Shu Di Huang (steamed in wine), Chuan Xiong, Chuan Xu Duan (soaked in wine), E Jiao (fried with Ge Fen to pearls), Gan Cao (roasted, equal parts).
Chop, take 4 qian per dose, add some Zhu Gen and 5 slices of Ginger, decoct with water, take warm.

**An Tai Dang Gui Tang**: For palpitations due to movement, fetal instability, lower abdominal pain radiating to the waist, and bleeding.
Dang Gui, Chuan Xiong, E Jiao (fried), Ren Shen (each 1 liang), Da Zao (12 pieces), Ai Ye (1 bundle).
Alternative formula has Gan Cao, no Ren Shen or Da Zao.
Decoct with 3 sheng of water and 3 sheng of wine down to 3 sheng, melt E Jiao into it, divide into three doses.

**Zhi Ke Tang**: For Fetal Leaking bleeding and bleeding triggered by events.
Zhi Ke (pulp removed, bran-fried), Huang Qin (each 0.5 liang), Bai Zhu (1 liang). (Bai Zhu is the sovereign herb; avoiding blood-tonics is another method.)
Chop, decoct with water, take warm before meals. Alternative adds Sheng Di Huang and a little wine.

**Dang Gui Ji Sheng Tang**: For Fetal Leaking and non-menstrual bleeding.
Dang Gui, Chuan Xiong, Ai Ye, Bai Zhu (each 1 qian), Ren Shen, Sang Ji Sheng, Xu Duan, Shu Di Huang (each 2 qian).
Decoct with water, take warm on an empty stomach.

**Er Huang San**: For Fetal Leaking bleeding.
Sheng Di Huang, Shu Di Huang (equal parts).
Powder finely, take 2 qian per dose, mixed with Bai Zhu and Zhi Ke decoction before meals, or decoct directly.
(Using Bai Zhu and Zhi Ke decoction to mix with Di Huang powder shows superior insight.)

**E Jiao San**: For sudden unexplained bleeding during pregnancy.
E Jiao (fried with Ge Fen to pearls, 2 liang, powdered), Sheng Di Huang (0.5 jin, juice pressed).
Mix with 3 sheng of clear wine, warm, divide into three doses.

**Alternative Formula**: For persistent Fetal Leaking bleeding; dryness of the uterus leads to death, so treat urgently.
Sheng Di Huang Juice (1 sheng), Chen Jiu (aged wine, 5 he).
Boil together for 3-5 boils, take warm in three doses, until bleeding stops.

**Yu Bai Pi San**: For Fetal Leaking blood loss, to prevent difficult labor, suitable for regular use.
Yu Bai Pi, Kui Gen, Da Ma Ren, Qu Mai (each 2 qian), Mu Tong (1 qian), Niu Xi (wine-soaked, roasted, 1.5 qian).
Chop, decoct with water, take warm.

**Alternative Formula**: For sudden profuse bleeding (several sheng) and fetal restlessness. (Suitable for fetal dryness; contraindicated in Spleen deficiency with loose stools.)
Yu Bai Pi (3 liang), Shu Di Huang (4 liang), Dang Gui, Sheng Jiang (each 2 liang), Kui Zi (1 sheng, not used in *Zhou Hou Fang*).
Chop, decoct with 5 sheng of water to obtain 2.5 sheng, divide into three doses. Repeat if ineffective.

**Zi Qin San**: For Liver Meridian Heat causing reckless bleeding.
Fine Huang Qin strips fried and powdered, take 1 qian per dose, mixed with wine quenched with a red-hot weight, take warm. Contraindicated in Spleen-Stomach deficiency.

**Fang Feng Wan**: For Liver Meridian Wind causing blood to scatter and fail to return to the vessels.
Fang Feng powdered, take 1 qian per dose, mixed with plain boiled water.

**Fang Feng Huang Qin Wan**: For Liver Meridian Wind-Heat causing flooding, hematochezia, and hematuria.
Huang Qin (charred), Fang Feng (equal parts).
Powder, make pills with wine paste, size of wutong seeds. Take 30-50 pills per dose, with rice drink or warm wine, before or after meals.
The above three formulas treat Liver Meridian Wind-Heat.

**Gui Zhi Fu Ling Wan**: Zhang Zhongjing said: Women with existing masses (Zheng), who have missed their period for less than three months but experience continuous spotting, with fetal movement above the umbilicus, have a Zheng mass harming the fetus. If fetal movement occurs at six months, and periods were normal for the first three months, it is a normal fetus. Spotting after three months of amenorrhea indicates a Zheng mass. The reason for continuous bleeding is the persistence of the Zheng mass. It should be expelled using Gui Zhi Fu Ling Wan. (Lou Shi said: Fetal movement usually occurs at the umbilicus; movement above suggests a Zheng mass.)
Gui Zhi, Fu Ling, Mu Dan Pi, Tao Ren (skin and tip removed, fried), Shao Yao (equal parts).
Powder the five ingredients, make pills with refined honey, size of rabbit droppings. Take one pill before meals daily; increase to three pills if ineffective.

**Ben Shi Fang**: For persistent Fetal Leaking bleeding.
Burn dried peaches that remained on peach trees to ash, mix with water and take until cured. *Ben Cao* states: Tao Nu breaks blood stasis and treats Fu Liang Qi accumulation.
The above two formulas are blood-breaking agents for treating Zheng masses.

**Da Quan Fang**: For sudden discharge of yellow glue-like or bean-jelly-like fluid, or Fetal Movement with abdominal pain.
Huang Qi (fried, 6 liang), Mi Nan (5 he).
Decoct with 7 sheng of water to obtain 2 sheng, divide into four doses.

**Yin Zhu Jiu**: For discharge of yellow fluid or red-bean-like substance during pregnancy.
Zhu Gen (black skin removed, sliced, 2 liang), Silver (5 liang, or silver jewelry). (Yellow/red indicates Heat, so Zhu Gen cools; discharge of yellow/red indicates Liver Qi dispersion, so Silver suppresses it heavily.)
Decoct with one large cup of water and wine, take orally.
The above two formulas treat symptoms of yellow-red bean-jelly discharge.