〔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 is scanty, and the physician, upon palpating the pulse, predicts pregnancy, which is later confirmed, what kind of pulse is this? How can it be distinguished? The physician says: The cun-kou (radial artery) pulse shows yin and yang in balance, with Ying (Nutritive) 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 their respective normal patterns. The body may feel chilly and aversion to wind, there is lack of appetite, headache, mental restlessness, nausea, retching, or desire to vomit. Exhalation is slightly rapid, inhalation is calm without palpitations. Yang Qi is abundant and overflowing, Yin pulse is slippery indicating vigorous Qi and Blood. A slippery pulse indicates excess Blood; since menstrual flow is scanty, pregnancy is suspected. Generally, during pregnancy, if menstrual flow is slight but diet and spirit remain normal, and the six positions of the pulse are harmonious, slippery, and large without signs of disease, it indicates abundant Blood. Once the fetus grows sufficiently to draw nourishment, menstruation ceases naturally.
[The Great Compendium on Women's Diseases] "Leaking Fetus" (Lou Tai) refers to vaginal bleeding occurring intermittently during pregnancy. This is caused by deficiency of the Chong and Ren vessels, which fail to restrain the blood of the Hand-Taiyang Small Intestine and Hand-Shaoyin Heart meridians. The Chong and Ren vessels are the sea of the meridians, originating in the uterus. They correspond to the Hand-Taiyang Small Intestine meridian and the Hand-Shaoyin Heart meridian, which are exterior-interior pairs. Upward they transform into milk, downward into menstruation. In pregnancy, menstruation stops because the blood is congested to nourish the fetus and stored to become milk. If Chong and Ren Qi are deficient, the uterus leaks and cannot control menstrual blood, causing intermittent bleeding, also called "Uterine Leakage." If blood is exhausted, death ensues. Other causes include overexertion, emotional imbalance (anger, joy, worry, sadness), consumption of raw/cold foods, or exposure to wind-cold, leading to fetal agitation. If the mother has chronic illness, cold-wind invades the uterus, disrupting Qi and Blood, unsettling the fetus, and causing bleeding. Physician Xiong Zonggu stated that women with abundant Blood and deficient Qi are often obese. After conception, if menstruation continues without disturbing the fetus, it should not be treated as leaking fetus, for doing so may cause miscarriage. If not treated as such, the fetus may remain safe. Chao Yuanfang noted that amenorrhea without other symptoms indicates pregnancy, as blood is stored to nourish the fetus and form milk. Once pregnant, blood is stored for the fetus and should not disperse. However, some women experience monthly bleeding during pregnancy, not necessarily due to abundant Blood. If Wind affects the Ying meridian, blood may move freely due to Wind dominance. Since this blood is not intended for nourishing the fetus, treating it as leaking fetus with tonifying herbs may harm the fetus ("making excess more excess and deficiency more deficient"). If the physician understands Wind in the Ying meridian, treating only the Wind may stop bleeding, or no treatment may suffice. However, if the fetus is inherently unstable due to sexual indiscretion, leading to leakage then miscarriage, it must be treated as leaking fetus. Careful differentiation is essential.
[Zhu Danxi] Causes of fetal leakage include Qi deficiency, Blood deficiency, and Blood heat.
[Xue Ji] For the above conditions: If due to Wind-Heat, use Fangfeng Huangqin Wan. If due to Blood Heat, use Jiawei Xiaoyao San. If due to Blood Deficiency, use Erhuang San. If due to excessive blood loss, use Bazhen Tang; if ineffective, use Buzhong Yiqi Tang. If due to Liver Fire, use Chaihu Shanzhi San. If due to Spleen Fire, use Jiaweigui Pi Tang. If due to emotional stress causing bleeding and pain, 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 or internal heat occurs, 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 Ziqin Wan. Due to Spleen Qi deficiency, use Liujunzi Tang. Due to Central Qi sinking, use Buzhong Yiqi Tang. If abundant Qi and Blood lead to bleeding, it is because the fetus draws little nourishment; no medicine is needed. One patient took cooling Blood herbs, worsening bleeding, fatigue, and poor appetite, indicating Spleen Qi deficiency failing to contain Blood; cured with Buzhong Yiqi Tang. Later, anger caused chills/fever and continued bleeding, indicating Liver Fire boiling Blood; stopped with Jiawei Xiaoyao San, stabilized with Buzhong Yiqi Tang. Another patient had bleeding, fever, thirst, fatigue, indicating 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 after 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, charred 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 a patient at three months pregnant with progressive lower back/abdominal pain, continuous leakage, Qi rushing, and distension. Pulses were wiry and rapid; normally deep and fine. Anger stirred Liver Fire, mixing with Minister Fire causing internal heat. Pregnancy pulse was not slippery, not yet at the stage of miscarriage, so preservation was possible. Prescribed Huangqin, Baizhu, Zhike, Xiangfu, Fuling, Ejiao, Baishao, Danggui, Chenpi, decocted with Lu Jiao Shuang (deer horn powder) quenched in wine. Also administered Yiqing Wan once for pain relief; recovered after several doses. Zhang Zhongjing stated: Women may have leakage, post-miscarriage bleeding, or pregnancy bleeding. If pregnancy abdominal pain occurs, it is Bao Zu (womb obstruction), treated with Xiong Gui Jiao Ai Tang.
*Daquan Fang* treats abdominal pain and intermittent bleeding in the 3rd-4th month of pregnancy.
Duanxuan (2 liang), Aiyè, Danggui, Dihuang (6 liang each), Zhuru, Ejiao, Jisu (1 liang each).
Decoct 1 sheng water to 6 he. Take twice on an empty stomach.
*Guangji Fang* for calming the fetus. Fetal disease with leakage and abdominal pain.
Danggui, Chuanxiong, Ejiao (roasted), Renshen (1 liang each), Dazao (20 pieces).
Chop, decoct in 3 sheng water and 4 sheng wine to 2.5 sheng. Divide into 3 doses. One dose every 5 days; frequent administration of 3-4 doses is safe.
Jisheng Rusheng Tang treats fetal agitation with abdominal pain or leaking fetus.
Liyupi, Danggui (soaked in wine), Shudihuang (steamed in wine), Baishao, Ejiao (stir-fried with clam powder), Chuanxiong, Duanxuan (soaked in wine), Gancao (roasted, equal parts). Alternative formulas include Ganjiang and Zhuru.
Crush, take 4 qian per dose with 1 cup water, a little Zhumgen, and 5 slices of ginger. Decoct and take warm. *Jisheng Fang* contains Duanxuan but lacks Ganjiang and Zhuru.
Sangjisheng San treats fetal leakage with abnormal uterine bleeding and persistent dripping.
Sangjisheng, Danggui (de-rooted, wine-soaked), Chuanxiong, Chuan Duanxuan (wine-soaked), Ejiao (stir-fried with gecko powder), Xiangfuzi (roasted, de-hairy), Fushen (de-wood), Baizhu (1 qian each), Renshen, Gancao (roasted, 0.5 qian each).
One dose, decoct 2 zhong water with 5 slices of ginger to 1 zhong. Take anytime.
Zhengshi Renshen San treats leaking fetus with stale blood converging on the heart, leading to fetal drying and danger to mother and child.
Renshen, Huangqi (roasted), Ejiao (stir-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).
Crush, take 4 qian with 37 grains of glutinous rice, decoct in water, take hot. Avoid raw/cold foods, chicken, duck, fish, and wheat.
Meishi treats fetal agitation with bleeding and abdominal pain, uncertain outcome. This decoction saves life if viable, expels if dead. It is the same as Caisheng Foshou San (see Major Principles of Obstetrics), which is Chuanxiong and Danggui in equal parts powdered.
For sudden unexplained continuous bleeding in pregnancy: Take 3 liang of Ejiao, roast, powder, decoct in 1.5 sheng wine until dissolved. One dose cures.
Luoshi Lisheng San treats continuous bleeding in pregnancy.
Boil 3 chicken livers in 1 sheng wine, eat together. Highly effective.
Erhuang San treats fetal leakage.
Shengdihuang, Shudihuang (equal parts, chopped). Decoct 3 zhan water until half dry, strain, and drink.
Treats fetal leakage bleeding.
Ejiao (2 liang, powdered), Shengdihuang (8 liang, juiced). Mix juice with 3 sheng clear wine, strain, divide into 3 doses.
Treats persistent fetal leakage bleeding; if fetus dries, it dies, so treat urgently.
Shengdihuang juice (1 sheng), aged wine (5 he).
Decoct together for 3-5 boils, take warm in 3 doses. Stop when bleeding ceases.
Dihuang Tang treats abnormal uterine bleeding 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.
*Xuyijian Fang* treats leaking blood.
Ye Zhumgen (2 liang, chopped and stir-fried; cultivated is acceptable), Jinyinhua (approx. 1 liang each).
One dose. Decoct in water/wine mixture until half evaporates, take warm. For traumatic fetal agitation threatening leakage: Roast sha ren pi until hot, powder (2 qian), take with wine or salt water.
Baoming Zhike Tang treats women's fetal leakage and bleeding due to specific triggers.
Zhike, Huangqin (0.5 liang each), Baizhu (1 liang).
Coarse powder, take 7 qian per dose with 1 cup water, decoct to 0.7 cup, take before meals.
Ziqin Wan treats Liver Meridian Heat causing erratic bleeding.
Stir-fry thin Huangqin strips to powder, 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 the vessels.
Powder Fangfeng, take 1 qian per dose with plain boiled water.
Fangfeng Huangqin Wan treats Liver Meridian Wind-Heat causing metrorrhagia, hematochezia, or melena.
Stir-fry Huangqin until scorched, mix with equal parts Fangfeng, powder, bind with wine paste into pills the size of paulownia seeds. Take 30-50 pills with rice drink or warm wine, far from meals or before meals.
Zhang Zhongjing said: If a woman has a fixed mass (Zheng), and menstruation stops for less than three months but continuous leakage occurs, with fetal movement felt above the umbilicus, it is due to a entrenched pathogenic factor. If fetal movement occurs at six months, it corresponds to the time when menstruation was regular before pregnancy. Bleeding after stopping for three months indicates the Zheng remains. The reason bleeding persists is that the Zheng has not been removed. The Zheng should be purged using Guizhi Fuling Wan.
Guizhi Fuling Wan Formula
Guizhi, Fuling, Mudan (de-heart), Taoren (de-skin/hilt, roasted), Shaoyao (equal parts).
Powder the five ingredients, mix with refined honey to make pills the size of rabbit droppings. Take one pill before meals daily. If ineffective, increase to three pills.
To treat persistent fetal bleeding: Burn dried peons remaining on peach trees to ash, mix with water, and take. Cures. (*Bencao* states: Tao Nu breaks Blood and treats Fu Liang and accumulated Qi.)
Yubai Pi San treats fetal leakage in pregnancy to prevent difficult labor; suitable for regular use.
Yubai pi, Kuigen, Qumai (2 qian each), Damaren (shelled), Mutong (1 qian each), Niuxi (de-root, wine-soaked, roasted, 1.5 qian).
One dose, decoct 2 zhong water to 1 zhong. Take anytime.