（激经 胞阻 湿胞）
【歌】下血腹痛名胞阻，胶艾芎归最有灵，非时卒下为胞漏，月事根据期号激经，尿血溺时常有血，漏胞血去不
曾停，更有肝风荣实症，防风丸服与黄芩。
【论】胎漏者，由冲任脉虚，不能约制手太阳、少阴之经血也。怀妊之人经水不行者，壅之以养胎，蓄之以
为乳也。若冲任气虚则胞内泄不能制其经血，故月水时下，亦名胞漏血，则尽人毙矣，此虚症也。
张仲景曰∶妇人宿有症病，经断未及三月而得漏下不止，胎动在脐上者，为症痼害。妊娠六月动者，前三月
经水利时胎也。下血者，后断三月胚也。所以血不止者，其症不去故也，此宿病也。娄全善曰∶妊娠经来不多，
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，此缓症也。《百问》曰∶胎息未实，劳力
触犯，或食毒物，或房劳惊恐，致令子宫虚滑，经血淋
沥，败血凑心，子母难保，此急症也。《产集》曰∶肝经有风，荣经既为风所胜，则所下者，非养胎之血，作漏胎
治则误，宜防风黄芩丸，此实症也。《金匮要略》曰∶妊娠下血，腹中痛者，为胞疽，芎归胶艾汤。《千金方》
曰∶妊娠下血不止，名曰漏胞，胞干便死，宜用生地黄八两，以清酒三升，煮减半，绞去滓服。《脉经》曰∶妇人
经水下但为微少，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，则清阳明∶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，
阴滑血盛，滑则多实，立经养成，所以月见阴，见阳。精汁凝，胞散，散者损坠，设复阳盛双妊二胎，今阳不足，
故令激经也。曾有妊娠月信不断而胎不损，产科熊宗古曰∶妇人血盛气衰，其体必肥，是以月信来而胎不损，若
作漏胎治，则胎必坠，若不作漏胎治，则胎未必坠，诚有旨也。
【方】
胶艾四物汤
当归 川芎 生地 白芍 阿胶 艾叶
防风黄芩丸
防风（一两） 黄芩（醋炙黑两）
末之酒糊丸米饮下三钱。
止漏散
干生地（四两） 炮姜灰（二两）
为末空心米汤调服，二钱服。
备金散
香附（醋炒黑） 当归 五灵脂（炒黑）
为末米汤调服二钱，加炒黑荆芥，醋炒地榆尤妙。
【歌诀】
下血且伴有腹痛的称为胞阻，胶艾芎归汤（即芎归胶艾汤）最为灵验；非经期突然出血的称为胞漏；月经按时来潮的称为激经。尿血是指排尿时经常有血液流出；漏胞则是指出血量持续不停。此外还有肝风与营分实热的证候，服用防风丸配合黄芩即可。
【论述】
胎漏这一病症，是由于冲脉和任脉虚弱，不能制约手太阳小肠经和手少阴心经的经血所致。怀孕后，月经停止，这是为了壅聚气血以滋养胎儿，蓄积气血以备产后化乳。如果冲任二脉气虚，则胞宫内部失固，无法控制经血，因此月经会时下，这也称为胞漏。若出血不止，会导致母子俱亡，这属于虚证。
张仲景说：妇女原本就有癥瘕积聚的病，停经不到三个月就出现漏下不止，且胎动感觉在脐上的，这是癥瘕病对妊娠造成了危害。妊娠六个月时胎动的，是因为前三个月月经通畅时受孕的。如果停经三个月后出现下血，那是胚胎形成的时期。之所以血止不住，是因为癥瘕不去除的缘故，这是宿疾引起的。
娄全善说：妊娠期间月经量不多，饮食和精神状态如常，六脉和缓滑大而无病象的，这是血盛有余的表现。胎儿长大自然能吸收这些多余的血，月经就不会再来了，这属于缓症。
《百问》说：胎儿气息未实，因劳累用力触犯，或食用有毒食物，或房事劳损惊恐，导致子宫虚滑，经血淋漓不尽，败血上凑于心，母子都难以保全，这属于急症。
《产集》说：肝经有风邪，营分既被风邪所胜，那么流出的血就不是滋养胎儿的血了，按漏胎治疗就会误诊，适宜使用防风黄芩丸，这属于实证。
《金匮要略》说：妊娠期间下血，腹中疼痛的，称为胞疽，用芎归胶艾汤治疗。
《千金方》说：妊娠期间下血不止，称为漏胞，胞宫干枯则胎儿死亡，适宜用生地黄八两，以清酒三升，煮至减半，滤去药渣服用。
《脉经》说：妇女月经水仅略微减少，医生切脉反而说有身孕。后来证实确实如此，那么脉象像什么呢？如何辨别呢？医生说：寸口脉阴阳两部都平和，营卫调和，重按脉搏滑利，轻取浮取，则反映阳明经气清肃，少阴经血盛，各符合经脉常规。身体反而恶寒战栗，不想饮食，头痛心烦，恶心欲吐，呼气微快，吸气不惊慌，阳气多而气溢，阴脉滑利血盛，滑脉主多实，利于经血养成，所以月经来潮见阴脉，平时见阳脉。精汁凝结，胞宫散开，散开者易致损伤坠落，假如阳气过盛怀双胎，如今阳气不足，所以导致激经。曾有妊娠期间月经不断但胎儿未受损的情况，产科医生熊宗古说：妇人血盛气衰，其体质必定肥胖，因此月经来潮而胎儿未损，如果当作漏胎治疗，则胎儿必坠；如果不当作漏胎治疗，则胎儿未必坠落，这话很有深意。
【方剂】
防风黄芩丸
防风（一两）、黄芩（醋炙黑，一两）
研为细末，用酒糊做成丸剂，米饮送服三钱。
[Jijing (Menstruation during Pregnancy), Baozu (Fetal Obstruction), Shibao (Dampness in the Uterus)]
【Verse】
Bleeding accompanied by abdominal pain is called Baozu (Fetal Obstruction); Xiong Gui Jiao Ai Tang (Cinnamon Twig, Angelica, and Donkey-Hide Gelatin Decoction) is most effective. Sudden bleeding outside of the expected menstrual period is called Baolou (Fetal Leakage). Menstruation occurring on schedule during pregnancy is called Jijing (Menstruation during Pregnancy). Hematuria refers to blood appearing frequently during urination. Lou Bao indicates continuous bleeding without cessation. Additionally, there are syndromes of Liver Wind and Excess Heat in the Ying (Nutritive) Level; treating these with Fang Feng Wan (Saposhnikovia Pill) combined with Huang Qin (Scutellaria) is appropriate.
【Discussion】
The condition known as Tailou (Fetal Leakage) arises from deficiency in the Chong (Penetrating) and Ren (Conception) vessels, which fail to restrain the blood of the Hand-Taiyang Small Intestine and Hand-Shaoyin Heart meridians. During pregnancy, menstruation ceases because blood and Qi are gathered to nourish the fetus and stored to transform into milk postpartum. If the Qi of the Chong and Ren vessels is deficient, the interior of the Bao (Uterus) becomes unstable and cannot control the menstrual blood, causing it to flow intermittently; this is also named Baolou. If bleeding continues unchecked, it leads to the death of both mother and child; this is a Deficiency syndrome.
Zhang Zhongjing stated: "If a woman has an existing mass disease (Zheng Bing), and before three months of amenorrhea she experiences continuous leakage bleeding, with fetal movement felt above the umbilicus, this is due to an entrenched mass harming the pregnancy." Fetal movement at six months of gestation indicates conception occurred when the menstrual flow was regular in the preceding three months. Bleeding after three months of amenorrhea relates to the embryo stage. The reason the bleeding does not stop is that the mass remains; this is caused by a pre-existing disease.
Lou Quanshan said: "If during pregnancy the menstrual flow is scanty, but diet and spirit remain normal, and the six pulses are harmonious, slippery, and large without pathological signs, this indicates abundant blood and excess. As the fetus grows, it will consume this excess, and menstruation will cease naturally; this is a Slow/Chronic syndrome."
The *Baiwen* states: "If the fetal Qi is not yet solid, and one suffers from physical exertion or trauma, consumes toxic substances, or experiences sexual exhaustion and fright, the uterus becomes deficient and slippery, leading to dripping menstrual blood. Stagnant blood rises to the heart, endangering both mother and child; this is an Urgent syndrome."
The *Chanji* states: "If there is Wind in the Liver Meridian, and the Ying (Nutritive) level is overcome by Wind, the discharged blood is not that which nourishes the fetus. Treating this as Fetal Leakage would be a mistake; instead, Fang Feng Huang Qin Wan (Saposhnikovia and Scutellaria Pill) should be used. This is an Excess syndrome."
The *Jingui Yaolue* states: "In pregnancy, if there is bleeding accompanied by abdominal pain, it is called Baoju (Fetal Abscess/Ulcer), treated with Xiong Gui Jiao Ai Tang."
The *Qianjin Fang* states: "Continuous bleeding during pregnancy is called Lou Bao. If the Bao dries up, the fetus dies. Use eight taels of Sheng Di Huang (Rehmanniae Radix) boiled in three sheng of clear wine until reduced by half, strain, and take."
The *Maiejing* states: "When a woman's menstrual flow is merely slightly reduced, the physician's pulse diagnosis may indicate pregnancy. Upon confirmation, what does the pulse resemble? How to distinguish it? The physician says: The Cun Kou (Radial) pulse is balanced in Yin and Yang aspects, with harmonious Ying and Wei. Pressing reveals a slippery quality; floating reveals clarity reflecting the Yangming channel, while Shaoyin shows abundant blood, conforming to meridian laws. The body may feel chills, appetite is lost, headache and mental confusion occur, nausea and retching arise. Exhalation is slightly rapid, inhalation is calm. Yang Qi is abundant and overflowing; Yin pulse is slippery indicating blood abundance. Slippery pulses indicate Excess, facilitating the formation of menses. Thus, menstruation appears under Yin conditions, while Yang conditions prevail normally. Essence and fluid coagulate, the Bao scatters; scattering leads to damage or miscarriage. If Yang is excessive, twins may result. Now, with insufficient Yang, Jijing (Menstruation during Pregnancy) occurs."
It has been recorded that some women experience uninterrupted menstruation during pregnancy without harming the fetus. Obstetrician Xiong Zonggu said: "When a woman has abundant blood and deficient Qi, her physique is likely robust. Thus, menstruation occurs without harming the fetus. If treated as Fetal Leakage, the fetus will certainly abort; if not treated as such, the fetus may not abort. This insight is profound."
【Formulas】
Jiao Si Wu Tang (Gelatin Four Substances Decoction)
Dang Gui (Angelicae Sinensis Radix), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Sheng Di Huang (Rehmanniae Radix), Bai Shao (Paeoniae Radix Alba), E Jiao (Colla Corii Asini), Ai Ye (Artemisiae Argyi Folium).
Fang Feng Huang Qin Wan (Saposhnikovia and Scutellaria Pill)
Fang Feng (Saposhnikoviae Radix) [1 liang], Huang Qin (Scutellariae Radix) [1 liang, stir-fried with vinegar until black].
Grind into powder, bind with wine paste to form pills, take 3 qian with rice broth.
Zhi Lou San (Stop Leakage Powder)
Gan Sheng Di Huang (Dried Rehmanniae Radix) [4 liang], Pao Jiang Hui (Charred Ginger Ash) [2 liang].
Grind into powder, mix with rice broth and take 2 qian on an empty stomach.
Bei Jin San (Prepare Gold Powder)
Xiang Fu (Cyperi Rhizoma, stir-fried with vinegar until black), Dang Gui (Angelicae Sinensis Radix), Wu Ling Zhi (Trogopterori Faex, stir-fried until black).
Grind into powder, mix with rice broth and take 2 qian. Adding Jing Jie (Schizonepetae Spica, stir-fried until black) and Di Yu (Sanguisorbae Radix, stir-fried with vinegar) is especially effective.