妊娠漏极，如同月水，胞干胎死，母亦难保，其调治之方，已详论于胎漏门中，兹不重论。
妊娠吐血，凡七情内伤，六淫外感，皆足致失血之患。一主火热者，以气血壅
养胎元，或有所感，则气逆而火上乘，心烦满闷，血随而溢，甚者或致堕胎。但火
有虚实之分，实火清热养血，虚火滋阴补水，则血安胎固。若泛用行血清血之剂，胎必堕而祸不旋踵矣。
如肝经怒火，加味逍遥散。膏粱积热，加味清胃散。郁结伤脾，加味归脾汤。肺经有火，黄芩清肺饮。
因气郁滞，紫苏饮。气不摄血，补中益气去升麻，加煨葛根。肾经虚火，冬味地黄汤。
鼻衄不止，东垣凉膈散，加当归、生地各一钱，茅花一大团。生姜引。
咳嗽咳血，宜凉血地黄汤。《医通》云∶咳嗽咯衄，胎前皆不宜见，如面赤声哑不治。又云∶凡咯
吐血，多致堕胎，胎赖血养，不宜漏溢，宜紫苏饮加条芩。
尿血，乃热乘血分，流渗于脬，故令尿血，自尿门而下，若胎漏则自人门下血可辨，宜四物加山栀、
发灰，或阿胶、熟地、麦冬、五味之类。如怒动肝火，小柴胡加山栀。脾气下陷及劳动脾火，补中益气
加茯苓、车前。若浓味积热，加味清胃散。若肝脾血热，加味逍遥散。
肠风脏毒下血者，平胃散去苍术，加槐角、防风、当归、乌梅治之。
加味清胃散 治胃中蕴热，斑疹，口舌生疮，齿龈腐烂出血。
生地（四钱） 丹皮（五钱） 当归 川连（酒蒸） 连翘（去心。各三钱） 升麻 生草（各一钱五分）
为散，分三服，水煎去滓，冲犀角磨汁三四分，入药服之。
黄芩清肺饮 治渴而小便不利。
栀子（炒黑） 黄芩
各等分，煎服。予谓此方乃治杂证发渴而小便不利，妙在热服探吐以提，则肺气立清。然胎前血证，
探吐之法似非所宜。若服而不吐，不特绵延不能刻应，纵或小瘥，其苦寒之性留薄于内，大伤氤氲之气，
治胎前之证者，得不为之预虑乎？
冬味地黄汤（附丸方。）
熟地（四钱） 山药（二钱，炒） 山萸（一钱，古方分两加倍） 丹皮 茯苓 泽泻（各七分）
麦冬（一钱或钱半） 五味子（十粒）
水煎服。此方药味十倍之，炼蜜丸，即名冬味地黄丸，又名八仙长寿丸。
凉血地黄汤 治妊娠咳嗽吐血、咳血。
生地（三钱） 麦冬（去心） 当归（酒洗。各二钱） 黄芩（一钱五分） 紫菀 知母（盐水炒
）白术（土炒） 天冬（去心。各一钱） 犀角（八分） 陈皮 甘草（各四分）
水煎服。有喘加栝蒌仁一钱。
加味逍遥散（见本卷子悬门，附逍遥散下。） 加味归脾汤（见本卷胎漏小产门，附
归脾汤下。） 紫苏饮 四物汤（俱见本卷安胎门。） 补中益气汤 东垣凉膈散
小柴胡汤 平胃散（俱见本卷诸痛门。）
妊娠期间出现阴道出血量极大，如同月经来潮，若胞宫干枯、胎儿死亡，母亲也难以保全。其调理治疗的方剂，已在“胎漏”章节中详细论述，此处不再重复讨论。
妊娠期间吐血，凡是七情（喜、怒、忧、思、悲、恐、惊）内伤，或六淫（风、寒、暑、湿、燥、火）外感，都足以导致失血的祸患。其中主要病机为火热者，因气血壅盛以滋养胎元，若有所感触，则气机上逆而火邪上冲，导致心烦意乱、胸脘满闷，血液随之溢出，严重时甚至会导致堕胎。但火邪有虚实之分，实火需清热养血，虚火需滋阴补水，如此则血能安宁、胎元稳固。如果泛用行气活血、破血之剂，胎儿必然坠落，灾祸随即而至。
如属肝经怒火所致，可用加味逍遥散（在逍遥散基础上加减）。膏粱厚味积热所致，可用加味清胃散。郁结损伤脾气所致，可用加味归脾汤。肺经有火所致，可用黄芩清肺饮。因气机郁滞所致，可用紫苏饮。气虚不能摄血所致，可用补中益气汤去掉升麻，加入煨葛根。肾经虚火所致，可用冬味地黄汤。
鼻衄（鼻出血）不止，可用东垣凉膈散，加入当归、生地各一钱，茅花一大团。用生姜作为药引。
咳嗽咳血，宜用凉血地黄汤。《医宗金鉴·医学入门》云：咳嗽咯血或鼻衄，在妊娠期间都不应该见到，如果出现面色赤红、声音嘶哑，则属不治之症。又说：凡是大口咯吐鲜血，多会导致堕胎，因为胎儿依赖血液滋养，不宜血液漏溢，宜用紫苏饮加条芩（黄芩）。
尿血，乃热邪侵入血分，流渗于膀胱，所以导致尿血，血液从尿道排出；若是胎漏，则血液从阴道排出，二者可以辨别。治疗宜用四物汤加山栀、发灰，或者阿胶、熟地、麦冬、五味子之类。如属怒气触动肝火，可用小柴胡汤加山栀。脾气下陷及劳累导致的脾火，可用补中益气汤加茯苓、车前子。若属浓味食物积热，可用加味清胃散。若属肝脾血热，可用加味逍遥散。
肠风脏毒引起的下血，可用平胃散去苍术，加槐角、防风、当归、乌梅治疗。
加味清胃散：治疗胃中蕴热，斑疹，口舌生疮，齿龈腐烂出血。
处方：生地（四钱）、丹皮（五钱）、当归、川连（酒蒸）、连翘（去心，各三钱）、升麻、生草（各一钱五分）。
制法用法：研为散剂，分三次服用，水煎去渣，冲入犀角磨成的汁三四分，混合后服用。
黄芩清肺饮：治疗口渴且小便不利。
处方：栀子（炒黑）、黄芩，各等分。
制法用法：煎服。我认为此方是治疗杂病引起的口渴和小便不利，妙处在于热服并探吐以提举气机，则肺气立刻清利。然而对于妊娠期间的血证，探吐之法似乎并不适宜。如果服药后不呕吐，不仅病情拖延不能即刻见效，即使稍微好转，其苦寒之性滞留体内，会严重损伤人体氤氲的生气，治疗妊娠疾病的人，能不预先考虑这一点吗？
冬味地黄汤（附丸方）：
处方：熟地（四钱）、山药（二钱，炒）、山萸肉（一钱，古方分量加倍）、丹皮、茯苓、泽泻（各七分）、麦冬（一钱或钱半）、五味子（十粒）。
制法用法：水煎服。此方药物剂量增加十倍，炼蜜为丸，即名为冬味地黄丸，又名八仙长寿丸。
凉血地黄汤：治疗妊娠咳嗽吐血、咳血。
处方：生地（三钱）、麦冬（去心）、当归（酒洗，各二钱）、黄芩（一钱五分）、紫菀、知母（盐水炒）、白术（土炒）、天冬（去心，各一钱）、犀角（八分）、陈皮、甘草（各四分）。
制法用法：水煎服。若有气喘，加栝蒌仁一钱。
加味逍遥散（见本卷悬门，附逍遥散下）。加味归脾汤（见本卷胎漏小产门，附归脾汤下）。紫苏饮、四物汤（均见本卷安胎门）。补中益气汤、东垣凉膈散、小柴胡汤、平胃散（均见本卷诸痛门）。
During pregnancy, if vaginal bleeding is extremely heavy, resembling menstruation, and the uterus becomes dry with fetal death, the mother's life may also be endangered. The methods for regulation and treatment have been detailed in the section on "Fetal Leakage" (Tai Lou), so they are not repeated here.
Hematemesis during pregnancy can be caused by internal injury from the Seven Emotions (Qing Zhi: joy, anger, worry, thought, sadness, fear, fright) or external contraction of the Six Excesses (Liu Yin: wind, cold, summer-heat, dampness, dryness, fire). Both are sufficient to cause hemorrhage. The primary pathogenesis involves Heat-Fire. When Qi and Blood are congested to nourish the Fetal Origin (Tai Yuan), any disturbance causes Qi to rebel and Fire to ascend. This leads to mental restlessness, chest and epigastric fullness, and blood overflowing. In severe cases, it may result in miscarriage. However, Fire has deficiency and excess patterns. For Excess Fire, clear heat and nourish blood; for Deficiency Fire, nourish Yin and replenish water. Thus, blood will stabilize and the fetus will remain secure. If one indiscriminately uses formulas that move Qi and invigorate/break blood, the fetus will inevitably abort, and disaster will follow immediately.
If caused by Fire from Liver Meridian anger, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). If caused by accumulation of heat from rich foods, use Jiawei Qingwei San (Modified Stomach-Clearing Powder). If caused by constraint injuring Spleen Qi, use Jiawei Guipi Tang (Modified Restore the Spleen Decoction). If caused by Fire in the Lung Meridian, use Huangqin Qingfei Yin (Scutellaria Lung-Clearing Drink). If caused by Qi stagnation, use Zisu Yin (Perilla Drink). If caused by Qi failing to control blood, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) removing Shengma (Cimicifugae Rhizoma) and adding Wei Gegen (Prepared Puerariae Radix). If caused by Deficiency Fire in the Kidney Meridian, use Dongwei Dihuang Tang (Dongwei Rehmannia Decoction).
For persistent epistaxis (nosebleed), use Dongyuan Liangge San (Dongyuan Cooling Chest Powder) added with Danggui (Angelicae Sinensis Radix) and Shengdi (Rehmanniae Radix) each 1 qian, and a large tuft of Maohua (Menthae Haplocalycis Herba). Use Shengjiang (Zingiberis Rhizoma Recens) as an herb guide.
For coughing up blood, Liangxue Dihuang Tang (Cooling Blood Rehmannia Decoction) is appropriate. *Yitong* states: Coughing with hemoptysis or epistaxis should not occur during pregnancy; if accompanied by red face and hoarseness, it is incurable. It further states: Massive hemoptysis often leads to miscarriage because the fetus relies on blood for nourishment and blood leakage is unfavorable. One should use Zisu Yin added with Tiaoqin (Huangqin/Coptidis Rhizoma).
Hematuria occurs when Heat enters the Blood level and infiltrates the Bladder (Pao), causing blood to exit via the urethra. This differs from fetal leakage, where blood exits via the vagina. Treatment should use Siwu Tang (Four Substances Decoction) added with Shanzhi (Gardeniae Fructus) and Fahui (Hair Ash), or Ejiao (Asini Corii Colla), Shudi (Prepared Rehmanniae Radix), Maidong (Ophiopogonis Radix), and Wuweizi (Schisandrae Fructus). If caused by anger stirring Liver Fire, use Xiao Chaihu Tang (Minor Bupleurum Decoction) added with Shanzhi. If caused by Spleen Qi sinking or labor-induced Spleen Fire, use Buzhong Yiqi Tang added with Fuling (Poria) and Cheqian (Plantaginis Semen). If caused by accumulation of heat from rich flavors, use Jiawei Qingwei San. If caused by Liver-Spleen Blood Heat, use Jiawei Xiaoyao San.
For lower gastrointestinal bleeding due to Intestinal Wind (Changfeng) or Visceral Toxin (Zangdu), use Pingwei San (Peace the Stomach Powder) removing Cangzhu (Atractylodis Rhizoma), added with Huaijiao (Stemonae Radix - *Note: Text says Huaijiao which usually refers to Sophorae Fructus/槐角 in this context despite literal translation difference, but strictly translating text*), Fangfeng (Saposhnikoviae Radix), Danggui, and Wumei (Mume Fructus).
**Jiawei Qingwei San**: Treats heat accumulation in the Stomach, macules and rashes, mouth and tongue ulcers, and bleeding from rotting gums.
Ingredients: Shengdi (4 qian), Danpi (5 qian), Danggui, Chuanlian (steamed with wine), Lianqiao (core removed, each 3 qian), Shengma, Shengcao (each 1.5 qian).
Preparation: Grind into powder, divide into three doses. Decoct in water, remove dregs, mix with Xijiao (Rhinocerotis Cornu) juice (3-4 fen), and take orally.
**Huangqin Qingfei Yin**: Treats thirst with difficulty in urination.
Ingredients: Zhizi (charred black), Huangqin, equal parts.
Preparation: Decoct and take. I believe this formula treats thirst and urinary difficulty in miscellaneous diseases. Its efficacy lies in taking it hot to induce vomiting, thereby lifting Qi and clearing the Lungs immediately. However, for hemorrhagic conditions during pregnancy, inducing vomiting seems inappropriate. If vomiting does not occur, the condition drags on without immediate effect. Even if slightly improved, the bitter-cold nature remains internally, severely damaging the vital Qi (Yinyun Qi). Those treating pregnancy disorders must consider this precaution.
**Dongwei Dihuang Tang** (Attached Pill Formula):
Ingredients: Shudi (4 qian), Shanyao (2 qian, stir-fried), Shanyuzi (1 qian, ancient dosage doubled), Danpi, Fuling, Zexie (each 0.7 qian), Maidong (1 or 1.5 qian), Wuweizi (10 berries).
Preparation: Decoct in water and take. If the dosage of these herbs is increased tenfold and formed into pills with refined honey, it is named Dongwei Dihuang Wan (Dongwei Rehmannia Pill), also known as Baxian Changshou Wan (Eight Immortals Longevity Pill).
**Liangxue Dihuang Tang**: Treats coughing and hematemesis/hemoptysis during pregnancy.
Ingredients: Shengdi (3 qian), Maidong (core removed), Danggui (washed with wine, each 2 qian), Huangqin (1.5 qian), Ziwan, Zhimu (stir-fried with salt water), Baizhu (soil-stir-fried), Tiantong (core removed, each 1 qian), Xijiao (0.8 qian), Chenpi, Gancao (each 0.4 qian).
Preparation: Decoct in water and take. If wheezing is present, add Gualouren (Trichosanthis Semen) 1 qian.
**Jiawei Xiaoyao San** (See Suspended Section in this volume, attached under Xiaoyao San). **Jiawei Guipi Tang** (See Fetal Leakage and Miscarriage Section in this volume, attached under Guipi Tang). **Zisu Yin**, **Siwu Tang** (Both see Fetal Security Section in this volume). **Buzhong Yiqi Tang**, **Dongyuan Liangge San**, **Xiao Chaihu Tang**, **Pingwei San** (All see Pain Syndromes Section in this volume).