血下如同月水来。漏极胞干生杀胎。亦损妊母须忧虑。争遣神丹救得回。
通真子曰。此只论漏胎候也。夫胎之漏。或食动胎之物。或因热毒之气侵损。或因入房劳损。
损轻则漏轻。损重则漏重。但漏血尽则死。然安胎有二法。因母病而动胎。但治母疾。其胎自安。
若胎有不坚。致动。母因以病。但治胎。则母自安。
心腹急痛面目青。冷汗气绝命必倾。血下不止胎冲上。四肢冷闷定伤身。
堕胎倒仆或举重。致胎死在腹中居。已损未出血不止。冲心闷痛母魂孤。
伤寒头痛连百节。气急冲心溺如血。上生斑点赤黑时。壮热不止致胎灭。呕吐不止心烦热。腰
背俱强脑痛裂。六七日来热腹中。小便不通大便结。
见此证必损胎。而妊母亦或致死。治法详见活人书。
产后因得热病临。脉细四肢暖者生。脉大忽然肢逆冷。须知其死莫留停。
脉盛身热。得之伤寒。产后热病。脉必洪大。难便。以脉大为死证。必遵内经、仲景诸书。
根据法汗下。若脉不为汗衰而仍大。是为阴阳交。乃可断死。汗后脉静乃可断生。岂可以病在表里。
未行治法。遽以脉细为生。四肢冷暖。当参以病证。或阳厥而厥。或作汗而厥。今脉诀所歌。胶柱
刻舟之论。
欲产之妇脉离经。沉细而滑也同名。夜半觉痛应分诞。来日日午定知生。
脉经曰。离经其脉浮。设腹痛引腰脊。为欲生也。但离经者不产也。又云其脉离经。夜半觉。
日中则生也。
经者常也。谓离其常处为离经。假如妊妇昨日见左沉实为男之脉。今日或脉浮。是离其寻常之脉。而
异于平日。又且腹痛。是知将诞也。通真子引难经一呼三至曰离经为解。李 范又引难经一呼一至
曰离经以解沉细而滑。皆非也。难经言损至二脉。虽同名离经。其脉与理则不同。且脉经明言离经。
其脉浮也。不曾引援难经之文。今脉诀因其言脉浮又添沉细而滑。同名离经。盖以前所诊男女脉。
或云浮大为女。若只脉浮为离经。若平常见浮大为女之脉。何以辨离经。故又增沉细而滑。以见离
浮大之常经为沉滑也。圣惠方云。夜半子时觉腹痛。来日午时必定生产。谓子午相冲。正半日时数也。
通真子曰夜半痛。日午生。此言恐未为的。又曰腹痛而腰不痛者未产也。若腹痛连腰痛甚者即产。所
以然者肾候于腰。胞系于肾。故也。诊其尺脉。转急如切绳转珠者。即产也。生产有难易。痛来有紧慢。
安可定半日。当断以活法。
身重体热寒又频。舌下之脉黑复青。及舌上冷子当死。腹中须遣母归冥。面赤舌青细寻看。母活子
死定应难。唇口俱青沫又出。母子俱死总高KT 。面青舌〔青〕（赤）沫出频。母死子活定知真。不信若
能看应验。寻之贤哲不虚陈。
脉指南作面青舌赤。盖面以候母。舌以候子。今云子活。合以舌赤为是。若云舌青。则与前面赤舌青。
母活子死之候相反。若胎先下。其子得活。如未下。子母俱亡。自身重体热寒又频至此。并不用脉。
只以外候参决子母生死。盖以临产脉不可考。但当以察色而知之。
阴道出血如同月经来潮。若漏血极度严重导致胞宫干枯，则母子皆危；若损伤较轻，虽需忧虑，但若能及时使用神丹等药物救治，尚可挽回。
通真子说：这里只讨论胎漏的证候。胎儿不固而漏血，可能是因为食用了动胎的食物，或因热毒之气侵袭损伤，或因房事劳损所致。损伤轻则漏血少，损伤重则漏血多。只要漏血不止耗尽阴血就会死亡。然而安胎有两种方法：如果是母亲生病而动胎，只需治疗母亲的疾病，胎儿自然安定；如果是胎元不坚固导致动摇，进而使母亲患病，只需安胎，母亲自然安康。
心腹突然剧痛，面目发青，冷汗出、气息微弱似绝，生命必将倾覆。下血不止且胎气上冲，四肢冰冷闷乱，必定伤身。
因堕胎跌倒或举重物，导致死胎留在腹中。若已受损且出血不止，瘀血上冲心胸引起闷痛，会导致母亲魂魄离散（死亡）。
伤寒头痛牵连全身关节，气急上冲心胸，小便如血，身上出现赤黑色斑点，高热不退导致胎儿死亡。呕吐不止，心烦发热，腰背强直，头痛欲裂。发病六七日后，腹部发热，小便不通，大便干结。见到这些症状必然损伤胎儿，孕妇也可能因此致死。治疗方法详见《活人书》。
产后因患热病而来就诊，脉象细弱但四肢温暖者生；脉象盛大却突然四肢逆冷者，须知其必死，不可延误。脉盛身热，得自伤寒。产后患热病，脉象必洪大，难以判断生死。因为脉大为死证，必须遵循《内经》、张仲景等书籍，根据法则进行发汗或攻下治疗。如果发汗后脉象不减弱反而仍然盛大，这是阴阳交争的死证，可以断定为死；发汗后脉象平静，才可以断定为生。怎么能仅仅因为病在表里，尚未进行治疗，就匆忙以脉细为生呢？四肢冷暖，应当参考具体病证，或是阳厥导致的四肢厥冷，或是作汗时出现的厥冷。现在的《脉诀》歌诀，是拘泥固执、不知变通的言论。
将要生产的妇女，脉象离经（异常），若是沉细而滑，也称作离经。半夜感到疼痛，应分秒必争准备分娩；次日中午必定生产。
《脉经》说：离经之脉浮。如果腹痛牵引腰脊，是即将生产的征兆。但所谓“离经”是指脉象离开常位，并非指不产。又说脉象离经，半夜感觉异常，日中时分就会生产。
“经”就是常的意思，谓离开其常处称为离经。假如孕妇昨天诊得左脉沉实，是怀男胎的脉象；今天脉象变为浮，这就是离开了寻常的脉象，异于平日，再加上腹痛，就知道将要分娩了。通真子引用《难经》中“一呼三至”解释为离经；李范又引用《难经》中“一呼一至”解释离经以对应沉细而滑的脉象，都不正确。《难经》所言的损脉和至脉，虽然都同名离经，但其脉理不同。而且《脉经》明确说离经之脉是浮脉，并没有引用《难经》的文字。现在的《脉诀》因为它提到脉浮，又添加了沉细而滑，统称为离经。大概是之前诊断男女胎的脉象，有的云浮大为女胎，如果只凭脉浮作为离经的标准，那么平时常见浮大为女胎的脉象，如何辨别是否为离经呢？所以又增加沉细而滑，以显示离开浮大的常经表现为沉滑。《圣惠方》说：半夜子时感到腹痛，来日午时必定生产，这是因为子午相冲，正好是半日的时间。通真子说半夜痛、日午生，这话恐怕不够确切。又说腹痛而腰不痛的未生产，如果腹痛连腰痛严重的即生产。之所以这样，是因为肾主腰部，胞宫系于肾。诊察尺脉，转动急促如同切绳转珠的感觉，就是即将生产。生产有难易之分，疼痛有紧慢之别，怎么可以断定一定是半天呢？应当用灵活的方法来判断。
身体沉重，发热恶寒频繁，舌下脉络黑且青，以及舌上冷，胎儿当死；腹中情况危急，母亲也将归入冥界（死亡）。面赤舌青，仔细查看，母亲存活胎儿死亡，定应如此。嘴唇口唇俱青，流出泡沫，母子俱死，总归是高KT（此处疑为衍文或错字，意指结局悲惨/死亡）。面青舌赤，泡沫频出，母亲死胎儿活，确定无疑。如果不信，若能验证，寻找贤哲之言，并非虚设。
《脉指南》作面青舌赤。大概面部用来候察母亲，舌头用来候察胎儿。现在说胎儿存活，应当以舌赤为准。如果说舌青，则与前面提到的面赤舌青、母活子死的征候相反。如果胎儿先产出，胎儿得以存活；如未产出，母子俱亡。从“身重体热寒又频”至此，并不依赖脉诊，只以外在征候参决母子生死。大概是因为临产时的脉象难以考究，只应当通过观察面色来知晓。
Vaginal bleeding occurs like the onset of menstruation. If the leakage is extreme, causing the uterus to dry up, both mother and fetus face death; if the damage is mild, although concern is warranted, timely administration of divine elixirs (Shen Dan) can still save them.
Tongzhenzi states: This section only discusses the syndrome of fetal leakage (Tai Lou). Fetal leakage may be caused by consuming foods that disturb the fetus, invasion by heat-toxin qi, or exhaustion from sexual intercourse. Mild damage results in light leakage; severe damage results in heavy leakage. Once the leaked blood is exhausted, death ensues. However, there are two methods for stabilizing the fetus: if the mother's illness disturbs the fetus, treat the mother's disease, and the fetus will naturally stabilize; if the fetus is unstable and causes disturbance, thereby making the mother ill, treat the fetus, and the mother will naturally recover.
Sudden severe pain in the heart and abdomen, bluish-green complexion, cold sweat, and fainting breath indicate impending death. Continuous bleeding with fetal qi rushing upward, accompanied by cold and stifling limbs, inevitably damages the body.
Falling due to threatened abortion or lifting heavy weights may cause a dead fetus to remain in the abdomen. If damaged and bleeding does not stop, blood stasis rushes to the heart causing stifling pain, leading to the loss of the mother's soul (death).
Typhoid fever (Shang Han) headache extending to all joints, rapid breathing rushing to the heart, hematuria (urine like blood), appearance of red-black macules on the body, and persistent high fever lead to fetal death. Persistent vomiting, vexation, and heat, stiffness of the waist and back, and splitting headache. After six or seven days, abdominal heat, urinary retention, and constipation. Witnessing these symptoms必然 injures the fetus, and the pregnant woman may also die. Treatment methods are detailed in *Huoren Shu* (The Book That Revives People).
Postpartum heat disease presents with fine pulse and warm limbs indicates survival; large pulse with sudden cold extremities indicates death, do not delay. Pulse fullness and body heat, acquired from typhoid fever. Postpartum heat disease typically presents with a洪大 (Hong Da, surging-large) pulse, making diagnosis difficult. Because a large pulse is a sign of death, one must follow the *Neijing* (Inner Canon) and Zhang Zhongjing's works, applying sweating or purging therapies according to principles. If the pulse remains large after sweating, it is Yin-Yang Jiao (Yin-Yang Intertwining/Crossing), indicating death; if the pulse becomes calm after sweating, it indicates life. How can one hastily judge survival based solely on a fine pulse before treatment, merely because the disease is in the exterior or interior? Extremity warmth or coldness should be assessed alongside symptoms, such as Yang Jue (Yang Reversal) causing cold limbs or cold limbs during sweating. The song in the current *Mai Jue* (Pulse Classic) is rigid and inflexible dogma.
For a woman about to give birth, the pulse deviates from the regular pattern (Li Jing). A deep, thin, and slippery pulse is also named Li Jing. Pain felt at midnight suggests delivery soon; delivery is certain by noon the next day.
*Mai Jing* (Pulse Classic) says: Li Jing pulse is floating. If abdominal pain radiates to the lower back and spine, it indicates imminent delivery. But "Li Jing" means the pulse has left its normal position, not that delivery won't happen. It also says if the pulse is Li Jing, feeling abnormal at midnight, delivery occurs at midday.
"Jing" means regular. Leaving its regular position is called Li Jing. For example, if a pregnant woman had a deep and solid left pulse yesterday (indicating a male fetus), but today the pulse is floating, this deviates from her usual pulse. Combined with abdominal pain, delivery is imminent. Tongzhenzi cites *Nan Jing* stating "three beats per exhalation" as Li Jing; Li Fan cites *Nan Jing* stating "one beat per exhalation" to explain the deep-thin-slippery pulse. Both are incorrect. *Nan Jing* discusses Sun (damaged) and Zhi (excessive) pulses, both named Li Jing, but their pulse theories differ. *Mai Jing* explicitly states Li Jing pulse is floating, without citing *Nan Jing*. The current *Mai Jue*, noting the floating pulse, adds deep-thin-slippery, calling them all Li Jing. Perhaps previously, diagnosing fetal gender showed floating-large for female; if only floating is Li Jing, how to distinguish from the common floating-large female pulse? Thus, deep-thin-slippery is added to show deviation from the regular floating-large to deep-slippery. *Shenghui Fang* states: Abdominal pain starting at Zi hour (midnight) leads to delivery at Wu hour (noon), as Zi and Wu oppose each other, spanning half a day. Tongzhenzi says midnight pain, noon delivery, which is likely inaccurate. He also says abdominal pain without lower back pain means not yet delivered; severe abdominal pain with lower back pain means delivery. This is because the Kidney governs the waist, and the uterus is connected to the Kidney. Palpating the Chi (Cun-Chi) pulse, if it turns urgent like cutting a rope or rolling pearls, delivery is imminent. Delivery varies in difficulty, and pain varies in intensity; how can one fix it to half a day? One must use flexible judgment.
Heavy body, fever with frequent chills, black and blue sublingual veins, and cold tongue indicate fetal death; the mother will also perish. Red face and blue tongue, carefully examined, indicate mother survives, fetus dies. Blue lips and mouth with froth indicate both mother and fetus die. Blue face and red tongue with frequent froth indicate mother dies, fetus survives. If you doubt this, verify it; the words of sages are not in vain.
*Mai Nan Zhi* describes blue face and red tongue. Generally, the face reflects the mother, and the tongue reflects the fetus. Now saying the fetus survives, the tongue should be red. If the tongue is blue, it contradicts the earlier sign of red face/blue tongue where mother lives and fetus dies. If the fetus is born first, it survives; if not, both perish. From "heavy body, fever, frequent chills" onwards, pulse diagnosis is not used; only external signs determine maternal-fetal survival. Since intrapartum pulses are hard to assess, one should rely on observing complexion.