《金匮要略》曰∶妇人宿有 病，经断未及三月，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，胎也。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。
徐忠可曰∶妇人行经时，遇冷则血留而为症。 者，有形可征。然 病女人恒有，或
不在子宫，则行经受胎，经断即是孕矣。未及三月，将三月也。既孕而见血，谓之漏下。未及三月，漏下不止，
则养胎之血伤，故胎动。假使胎在脐下，则直欲落矣。今在脐上，是每月凑集之新血，因 气相妨而为漏下，
实非胎病，故曰 痼害。痼者，宿疾也。害者，累之也。至六月胎动，此宜动之时，但较前三月，经水利时，
胎动下血，则已断血，三月不行，复血不止，是前之漏下，新血去而 反坚牢不去，故须下之为安。药用桂枝
茯苓汤者，桂、芍，一阴一阳，茯苓、丹皮，一气一血，调其寒温，扶其正气；桃仁破恶血，消 瘕，不嫌伤
胎者，有病病当之也。且 之初，必因于寒，桂能化气，消其本寒。 之成，必挟湿热为窠囊，茯苓清湿气，
丹皮清血热，芍药敛肝血而扶脾，使能统血，养正即所以去邪也。
《产孕集》曰∶有妊妇月信不绝，而胎不损，向产科熊宗古，答曰∶妇人血盛气衰，其人必肥。既娠后，
月信常来而胎不动。若便以漏胎治之，则胎必堕。若不作漏胎治，其胎未必堕。今推宗古之言，诚有旨也。巢
氏云∶妇人经闭不利，别无所苦，是谓有子。以经血蓄之养胎，壅为乳汁也。有子后，蓄以养胎矣，岂可复散
动耶。所以然者，有妊而月信每至，亦未必因血盛也。妇人荣经有风，则经血喜动，以风胜故也。荣经既为风
所胜，则所下者，非养胎之血。若作漏胎治，必服保养补胎药，胎本不损，强以药滋之，是实实也，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。然亦有胎本不固，因房室不
节，先漏而后堕者，须作漏胎治，又不可不审也。
按∶肝经有风，致血得风而流散不归经，以一味防风丸。若肝经有热，致血妄行，条芩炒焦为末，酒下。
《金匮要略》说：妇女素有癥病（腹内结块，固定不移，痛有定处），月经停止不到三个月，阴道漏下出血不止，胎动感觉在肚脐上方的，这是癥病为害。如果妊娠六个月时胎动，而前三个月月经通畅正常，那是正常的胎动。如果有阴道出血，说明月经已经停止三个月了。之所以出血不止，是因为癥块没有消除的缘故。应当攻下癥块，用桂枝茯苓丸主治。
徐忠可说：妇女在行经期间，遇到寒冷则血液停滞形成癥块。癥块是有形之物可以验证的。然而癥病女人常常患有，有的不在子宫，那么行经期间受孕，月经停止就是怀孕的标志。不到三个月，是指接近三个月的时候。既然怀孕后出现出血，称为漏下。不到三个月，漏下不止，就会损伤养胎之血，所以胎动。假如胎位在肚脐下方，就直接要堕落了。现在在肚脐上方，是每月汇聚的新血，因为癥气相妨碍而导致漏下，实际上不是胎有病，所以说是癥病为害。痼，是宿疾。害，是累及。到了六个月胎动，这是应该胎动的时期，只是与前三个月月经通畅时相比，胎动伴随下血，此时月经已断绝三个月，却又再次出血不止，这是之前的漏下，新血流失而癥块反而坚固不去，所以必须攻下癥块才能安宁。药用桂枝茯苓汤的原因在于：桂枝、芍药，一阴一阳；茯苓、丹皮，一气一血，调和寒温，扶持正气；桃仁破除恶血，消除癥瘕，不担心伤胎，是因为有病则病受之。而且癥之初起，必然因于寒，桂枝能化气，消除本寒。癥的形成，必然挟带湿热成为巢穴，茯苓清除湿气，丹皮清除血热，芍药收敛肝血并扶持脾气，使脾能统摄血液，扶助正气即是为了祛除邪气。
《产孕集》说：有孕妇月经一直不断，但胎儿不受损，曾向产科医生熊宗古请教，他回答说：妇女血盛气衰，其人一定肥胖。怀孕之后，月经常来而胎儿不动。如果就把这种情况当作漏胎治疗，那么胎儿必定会流产。如果不当作漏胎治疗，胎儿未必会流产。如今推究熊宗古的话，确实很有深意。巢元方说：妇女月经闭止不通利，没有其他痛苦，这叫做怀孕。因为经血蓄积用来养胎，壅滞转化为乳汁。有了孩子后，经血蓄积用来养胎了，怎么可以再散动呢？之所以这样，有妊娠而月经每月到来，也未必是因为血盛。妇女营经受风，则经血喜欢流动，因为风性善行数变的缘故。营经既然被风所胜，那么流下的血，就不是养胎的血。如果当作漏胎治疗，必然服用保养补胎的药，胎儿本来没有受损，强行用药滋补它，这就是“实实”（实证用补法，导致邪气更盛），其胎儿最终流产也是应该的。如果医生知道营经有风的道理，专门用一味药治风，月经自然可以停止，或者不服药，胎儿也无恙。然而也有胎儿本来不稳固，因为房事不节制，先漏下而后流产的，必须当作漏胎治疗，又不可不仔细审察。
The *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) states: If a woman has a pre-existing *zheng* mass (a fixed abdominal mass with definite location and pain), and her menstruation stops for less than three months, yet she suffers from continuous vaginal bleeding, and the fetal movement is felt above the umbilicus, this indicates that the *zheng* mass is causing harm. If fetal movement occurs at six months of pregnancy, and the menstruation was smooth and regular during the first three months, it is a normal fetus. If there is bleeding, it means the menstruation has stopped for three months. The reason the bleeding does not stop is that the *zheng* mass has not been eliminated. One should purge the *zheng* mass, and Guizhi Fuling Wan (Cinnamon Twig and Poria Pill) is the primary prescription.
Xu Zhongke said: When a woman is menstruating, if she encounters cold, blood stagnates to form a *zheng* mass. A *zheng* mass is tangible and verifiable. However, women often have *zheng* diseases; if they are not in the uterus, conception can occur during menstruation, and the cessation of menstruation signifies pregnancy. "Less than three months" refers to approaching the third month. Once pregnant, if bleeding appears, it is called "leaking down." If bleeding continues without stopping before three months, it damages the blood nourishing the fetus, causing fetal movement. If the fetus were below the umbilicus, it would be on the verge of miscarriage. Now, since it is above the umbilicus, the new blood gathered monthly is obstructed by the *zheng* qi, leading to leaking down. This is actually not a disease of the fetus, hence it is called "harm by an entrenched condition." "Guo" (entrenched) refers to a chronic disease; "hai" (harm) refers to its detrimental effect. By the sixth month, fetal movement is expected. Comparing this to the period when menstruation was smooth in the first three months, although the fetus moves and bleeds, and menstruation has ceased for three months, the continued bleeding indicates that previous leaking has depleted new blood, while the *zheng* mass remains firm and unremoved. Therefore, purging it is necessary for peace. The rationale for using Guizhi Fuling Tang (Cinnamon Twig and Poria Decoction) is as follows: Guizhi (Cinnamon Twig) and Baishao (White Peony Root) represent Yin and Yang; Fuling (Poria) and Mudanpi (Moutan Cortex) represent Qi and Blood. They harmonize cold and heat and support healthy Qi. Taoren (Peach Seed) breaks down bad blood and eliminates *zhijia* (masses), without fear of harming the fetus, because the disease bears the brunt of the treatment. Furthermore, the initial formation of *zheng* is due to cold; Guizhi transforms Qi and dispels the root cold. The formation of *zheng* involves damp-heat forming a nest; Fuling clears dampness, Mudanpi clears blood heat, and Shaoyao (Peony Root) astringes Liver Blood and supports Spleen Qi, enabling the Spleen to control blood. Supporting healthy Qi is the way to eliminate pathogenic factors.
The *Chan Yun Ji* (Collection of Obstetrics and Pregnancy) states: There are cases where a pregnant woman's menstruation continues without damaging the fetus. When asked about this, obstetrician Xiong Zonggu replied: Women with abundant Blood and deficient Qi tend to be obese. After conception, menstruation may continue while the fetus remains stable. If treated as "leaking fetus," the fetus will likely miscarry. If not treated as such, the fetus may not miscarry. Analyzing Xiong Zonggu's words reveals profound meaning. Chao Yuanfang stated: If a woman's menstruation is irregular or absent, with no other discomfort, it indicates pregnancy. Menstrual blood is stored to nourish the fetus and transforms into milk. Once pregnant, blood is stored for nourishment; why should it flow again? The reason is that even if menstruation occurs during pregnancy, it is not necessarily due to abundant Blood. If a woman's Ying (Nutritive) Channel is affected by Wind, menstrual blood tends to flow due to the nature of Wind. Since the Ying Channel is dominated by Wind, the discharged blood is not the blood nourishing the fetus. If treated as leaking fetus, one would administer tonifying and stabilizing medicines. Since the fetus is not damaged, forcing nourishment upon it constitutes "reinforcing excess," making miscarriage inevitable. If a physician understands the principle of Wind in the Ying Channel, treating only the Wind with a single herb can stop menstruation, or even without medication, the fetus remains safe. However, there are cases where the fetus is inherently unstable, and due to excessive sexual activity, leakage precedes miscarriage; these must be treated as leaking fetus, requiring careful differentiation.
Note: If Wind in the Liver Channel causes blood to scatter and fail to return to the vessels, use Fangfeng Wan (Saposhnikovia Pill). If Heat in the Liver Channel causes reckless blood flow, use fried Tiaohuangqin (Scutellariae Radix) ground into powder, taken with wine.