血气荫胎，不能养肾，肾虚而腰必痛；或劳力伤肾，致动胞系，痛甚而胞系必脱；又房事不节，胞系伤而痛不止，
遂至胎堕者多矣。宜安胎为主。
肾气虚弱。青娥丸加熟地；八珍汤加杜仲、阿胶、艾、砂仁。（补十六、补五。）
气血滞而不行。缩砂饮、紫苏饮，加桔梗、香附。（散十二、散三。）
风邪所乘。此必腰痛如折。紫酒或四物汤加桑寄生、防风。（补十七、补七。）
闪挫而痛。通气散加安胎饮。（补十八、补九。）
肝火炽盛。小柴胡汤加左金丸。（和十、寒十四。）
天阴及久坐而痛。湿热也。二妙散加杜仲、米仁。（和四十四。）
腰重如带冷物，寒湿也。通气散加川断、杜仲。（补十八。）
肝脾郁结。归脾汤加柴胡，加左金丸。（补十九、寒十四。）
冲任二脉，上为乳汁，下为月水，受胎则月水应断，冲任气虚，不能固摄，血常溢下，名曰胞漏，莫作月水论，久
而不止则胎堕。非时而下为胎漏，根据期而漏号激经，尿血溺时方有，胞漏血常下而不停。
见红腰痛。六味丸合四君子汤，去甘草，加杜仲、川断、粘米。（补二、补四。）
荣血有风。荣经为风所胜，故经血动而下也，所下者本非养胎之血，若认作胎漏，服保养胎元之药，是实实矣，胎
必堕下。宜服防风丸。（散十三。）
按月出血点滴为胎漏。此因气血并虚也。宜服补中安胎饮。（补二十。）
因事而动，以至下血。二地加枳壳炭二、三分。
顿仆动胎，下血不止。安胎饮加阿胶、艾炒炭；如感寒头痛，加莲须。（补九。）
胎气内热，迫血妄行。凉胎饮。（寒十五。）
中气下陷。补中益气汤。（补六。）
脾气虚，不能摄血。归脾饮。（补十九。）
肝脾郁怒。加味归脾汤，或小柴胡汤。（补三、和十。）
肝脾风热。加味逍遥散。（补二十一。）
肝脾湿热。升阳除湿汤。（散十四。）
风入肠胃。胃风汤。（散十五。）
胎急不安，下血不止。桑寄生散。（和十二。）
因惊而气虚，虚则下陷而见血。安胎饮加人参。（补九。）
血离其位，积于胞宫，为胀为痛。四物重加当归。（补七。）
下黄汁如胶，或如豆汁。此湿热也。用升阳除湿汤，又用黄 六两、糯米五合，水五升，煎半分，作两服。（散十四。）
症气相妨，亦为漏下。行经之时，血虚而寒气乘之，血遂凝结而成症，其症不结于子宫，仍能行经成孕。既孕见血，
为之漏下，是症气为害也。宜下之，桂枝茯苓汤，然方中桃仁一味，恐妨胎，须酌用。若症在腹中，于胎无害，俟分娩
后治之为妥。（散十六。）
Qi and Blood nourish the fetus. If they fail to adequately nourish the Kidney, resulting in Kidney deficiency, the lower back will inevitably ache; or if excessive labor injures the Kidney, causing the Bao Mai (uterine ligaments) to be disturbed, severe pain may occur, and the Bao Mai may prolapse; furthermore, if sexual activity is not regulated, damaging the Bao Mai, pain will persist, often leading to miscarriage. Treatment should primarily focus on calming the fetus.
Kidney Qi Deficiency: Use Qing'e Wan (Qing'e Pill) with Shu Di Huang (Prepared Rehmannia Root); or Bazhen Tang (Eight-Treasure Decoction) with Duzhong (Eucommia Bark), Ejiao (Donkey-Hide Gelatin), Ai Ye (Mugwort Leaf), and Sharen (Amomum Fruit). (Refer to Tonification Chapter 16, Formula 5.)
Stagnation of Qi and Blood: Suo Sha Yin (Cardamom Infusion) or Zisu Yin (Perilla Leaf Infusion), with Jiegeng (Platycodon Root) and Xiangfu (Cyperus Rhizome). (Refer to Dispersing Chapter 12, Formula 3.)
Invading Wind Pathogen: This must present as lower back pain feeling like a fracture. Use Zi Jiu (Wine-processed Herb) or Siwu Tang (Four-Substance Decoction) with Sangjisheng (Taxillus Branch) and Fangfeng (Saposhnikovia Root). (Refer to Tonification Chapter 17, Formula 7.)
Pain due to Sprain or Strain: Tongqi San (Ventilation Powder) with Antai Yin (Fetus-Calming Infusion). (Refer to Tonification Chapter 18, Formula 9.)
Blazing Liver Fire: Xiaochaihu Tang (Minor Bupleurum Decoction) with Zuojin Wan (Left Metal Pill). (Refer to Harmonizing Chapter 10, Formula 14.)
Pain during cloudy weather and after prolonged sitting: This is Damp-Heat. Use Ermiao San (Two Marvels Powder) with Duzhong (Eucommia Bark) and Yiyiren (Coix Seed). (Refer to Harmonizing Chapter 44, Formula 44.)
Heavy sensation in the lower back as if carrying cold objects: This is Cold-Dampness. Use Tongqi San (Ventilation Powder) with Chuan Duan (Dipsacus Root) and Duzhong (Eucommia Bark). (Refer to Tonification Chapter 18, Formula 18.)
Liver-Spleen Stagnation: Guipi Tang (Restore the Spleen Decoction) with Chaihu (Bupleurum Root), plus Zuojin Wan (Left Metal Pill). (Refer to Tonification Chapter 19, Formula 14.)
The Chong and Ren Mai (Penetrating and Conception Vessels) transform into breast milk upwards and menstruation downwards. Upon conception, menstruation should cease. If Qi of the Chong and Ren is deficient and fails to secure and hold blood, blood frequently flows downward, termed Baolou (Uterine Leakage). Do not mistake this for normal menstruation; if it persists without stopping, it leads to miscarriage. Bleeding occurring outside the expected period is called Tailou (Fetal Leakage); bleeding that occurs according to the monthly cycle is called Jijing (Provoked Menses); hematuria appears only during urination, whereas Baolou involves continuous, unceasing vaginal bleeding.
Red discharge accompanied by lower back pain: Liuwei Wan (Six-Ingredient Pill) combined with Sijunzi Tang (Four-Gentlemen Decoction), removing Gancao (Licorice Root), adding Duzhong (Eucommia Bark), Chuan Duan (Dipsacus Root), and Nian Mi (Sticky Rice). (Refer to Tonification Chapter 2, Formula 4.)
Ying Blood Affected by Wind: When the Ying (Nutritive) Channel is overcome by Wind, menstrual blood moves and flows down. The blood discharged is originally not the blood meant to nourish the fetus. If mistaken for Tailou (Fetal Leakage) and treated with herbs that preserve and tonify the fetal origin, this constitutes a "tonifying excess" error, and the fetus will inevitably abort. It is appropriate to use Fangfeng Wan (Saposhnikovia Pill). (Refer to Dispersing Chapter 13, Formula 13.)
Monthly spotting bleeding is Tailou (Fetal Leakage): This is due to deficiency of both Qi and Blood. It is appropriate to use Buzhong Antai Yin (Middle-Tonifying Fetus-Calming Infusion). (Refer to Tonification Chapter 20, Formula 20.)
Bleeding triggered by physical exertion or events: Use Di Huang (Rehmannia Root, both raw and prepared) with Zhi Qiao Tan (Charred Aurantium Fructus) 2–3 fen.
Abdominal trauma disturbing the fetus, with incessant bleeding: Antai Yin (Fetus-Calming Infusion) with Ejiao (Donkey-Hide Gelatin) and Ai Ye (Mugwort Leaf) stir-fried to charcoal; if accompanied by cold-induced headache, add Lian Xu (Lotus Stamen). (Refer to Tonification Chapter 9, Formula 9.)
Internal Heat of Fetal Qi forcing blood to move recklessly: Liang Tai Yin (Cooling Fetus Infusion). (Refer to Cooling Chapter 15, Formula 15.)
Sinking of Middle Qi: Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction). (Refer to Tonification Chapter 6, Formula 6.)
Spleen Qi Deficiency failing to control blood: Guipi Yin (Restore the Spleen Infusion). (Refer to Tonification Chapter 19, Formula 19.)
Liver-Spleen Depression and Anger: Jiawei Guipi Tang (Modified Restore the Spleen Decoction), or Xiaochaihu Tang (Minor Bupleurum Decoction). (Refer to Tonification Chapter 3, Formula 10.)
Liver-Spleen Wind-Heat: Jiawei Xiaoyao San (Modified Free Wanderer Powder). (Refer to Tonification Chapter 21, Formula 21.)
Liver-Spleen Damp-Heat: Shengyang Chushi Tang (Raise Yang and Drain Dampness Decoction). (Refer to Dispersing Chapter 14, Formula 14.)
Wind invading the Intestines and Stomach: Weifeng Tang (Stomach-Wind Decoction). (Refer to Dispersing Chapter 15, Formula 15.)
Restless fetus with incessant bleeding: Sangjisheng San (Taxillus Powder). (Refer to Harmonizing Chapter 12, Formula 12.)
Qi deficiency due to fright, where deficiency leads to sinking and bleeding: Antai Yin (Fetus-Calming Infusion) with Renshen (Ginseng Root). (Refer to Tonification Chapter 9, Formula 9.)
Blood leaving its proper position and accumulating in the Uterus, causing distension and pain: Siwu Tang (Four-Substance Decoction) with an increased dosage of Danggui (Angelica Sinensis Root). (Refer to Tonification Chapter 7, Formula 7.)
Discharge of yellow fluid resembling gum or bean soup: This is Damp-Heat. Use Shengyang Chushi Tang (Raise Yang and Drain Dampness Decoction), and additionally use Huangbo (Phellodendron Bark) 6 liang and Nuomi (Glutinous Rice) 5 he, decocted in 5 sheng of water until half remains, divided into two doses. (Refer to Dispersing Chapter 14, Formula 14.)
Pathogenic masses (Zheng Qi) interfering with the fetus also cause leakage. During menstruation, blood deficiency allows Cold Pathogens to invade, causing blood coagulation into masses. If these masses do not form within the uterus itself, menstruation can still occur, and pregnancy is possible. Once pregnant, if bleeding occurs, it is termed leakage, caused by the interference of mass pathology. It is suitable to use purgative methods, such as Guizhi Fuling Tang (Cinnamon Twig and Poria Decoction). However, the Tao Ren (Peach Kernel) in this formula may harm the fetus, so it must be used with caution. If the mass is elsewhere in the abdomen and does not harm the fetus, it is advisable to treat it after delivery. (Refer to Dispersing Chapter 16, Formula 16.)