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Vaginal bleeding during pregnancy refers to occasional slight bleeding from the vagina, or continuous spotting, or intermittent bleeding during the first half of pregnancy. If the bleeding does not stop, it can often lead to early abortion or late abortion. Bencao Gangmu states: "If the bleeding does not stop, the blood will be exhausted and the fetus will die." Therefore, paying attention to the diagnosis and treatment of vaginal bleeding during pregnancy is key to preventing late abortion.

This condition has various names in classical medical texts. Jingui Yaolue refers to it as "pregnancy bleeding," "Complete Collection of Gynecology" refers to it as "vaginal bleeding during pregnancy," Furen Liangfang calls it "vaginal bleeding during pregnancy," Taiping Shenghui Fang refers to it as "vaginal bleeding during pregnancy," and Bencao Gangmu calls it "fistula disease of the fetus."

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1. Qi Deficiency︰In early pregnancy, there is occasional vaginal bleeding with small amounts of non-fresh blood or yellowish discharge, a pale complexion, fatigue, aversion to cold, shortness of breath, soreness in the lower back, abdominal distension and fullness with a bearing-down sensation, a pale tongue with possible tooth marks, thin white coating, and a slippery pulse. This is often due to constitutional weakness, inherent spleen and stomach deficiency, insufficient middle qi, or illness during pregnancy that damages healthy qi, leading to qi deficiency and sinking. As a result, the blood that nourishes the fetus loses its foundation, and the Chong and Ren meridians fail to retain it, causing vaginal bleeding during pregnancy. The bleeding is typically scant, with non-fresh blood or yellowish discharge, accompanied by a pale complexion, fatigue, aversion to cold, abdominal distension and fullness with a bearing-down sensation, a pale tongue, and a weak pulse.
2. Blood Deficiency︰pregnancy vaginal bleeding during pregnancy with scanty and pale discharge, pale yellow complexion, dizziness and blurred vision, palpitation and insomnia, dry stool, pale red tongue texture with thin yellow or no coating, thready rapid and slippery pulse. Mostly due to constitutional blood deficiency, or severe morning sickness during pregnancy leading to spleen and stomach impairment, insufficient production of blood, resulting in inadequate nourishment of the fetus and insecurity of the thoroughfare and conception vessels, thus causing vaginal bleeding during pregnancy. The key points of pattern identification are: must present with pale yellow complexion, dizziness and blurred vision, palpitation and insomnia, pale red tongue texture, thready slippery and rapid pulse, and other symptoms of blood deficiency failing to nourish. As for treatment, for qi deficiency, it is appropriate to tonify the middle and replenish qi, lift the sinking and calm the fetus, commonly using Middle-Tonifying Qi-Replenishing Decoction, or Original-Qi Lifting Decoction plus Donkey-hide Gelatin and Mugwort; for blood deficiency, it is appropriate to nourish blood to calm the fetus, using Fetus Decoction or Donkey-hide Gelatin and Artemisia Decoction.
3. Kidney Deficiency︰Vaginal bleeding during pregnancy, with scanty and pale discharge, aching pain in the lower back and spine, weak legs, dizziness, tinnitus, frequent urination. Pale tongue with white and slippery coating, slippery or deep weak pulse, especially weak in both chi positions. Mostly due to congenital weakness, insufficient innate endowment, kidney qi deficiency, and insecurity of the thoroughfare and conception vessels, leading to vaginal bleeding during pregnancy. However, it can also result from excessive sexual activity, injuring kidney qi, causing insecurity of the thoroughfare and conception vessels, leading first to fistula disease and then miscarriage. The key diagnostic points include: aching pain in the lower back and spine, weak legs, dizziness, tinnitus, and a thin weak pulse in the chi position. Treatment should focus on tonifying the kidney to calm the fetus, with the modified Fetus-Preserving Pill as the main remedy.
4. Blood Heat︰In the first half of pregnancy, there is intermittent vaginal bleeding with bright red blood, flushed face and red lips, restlessness and insomnia, dry stool, scanty dark urine, a red tongue with yellow and dry coating, and a rapid and slippery pulse. This belongs to an excess pattern, often due to constitutional yang exuberance, where blood nourishes the fetus during pregnancy, leading to further exuberance of yang qi, or the mother suffering from warm-heat diseases, with pathogenic heat internally damaging the fetal origin. As stated in Jingyue Quanshu·Furen Gui: "When fetal qi is diseased due to heat and slightly unsettled, the symptoms must include much restlessness and heat, or thirst, or dryness, or upper and lower body disharmony, or fistula disease with bloody and red urine, or six pulse conditions being slippery and rapid, etc." Treatment should focus on clearing heat, nourishing blood, stopping fistula disease, and calming the fetus. Yin-Preserving Decoction with charred Platycladus orientalis is commonly used.
5. Deficiency Heat︰Vaginal bleeding during pregnancy with intermittent flow, dizziness, blurred vision, palpitations, insomnia, dry mouth and throat with little desire to drink, flushed cheeks, afternoon fever, burning palms, red tongue without coating, thin and rapid pulse (especially thin at both chi positions). This is a deficiency pattern, often caused by kidney yin deficiency leading to internal heat from yang deficiency. The key diagnostic points include: dizziness, blurred vision, palpitations, insomnia, dry mouth and throat with little desire to drink, afternoon tidal fever, burning palms, red tongue without coating, and thin, rapid pulse. Treatment should focus on enriching yin and clearing heat, stopping bleeding, and calming the fetus. The commonly used formula is Donkey-hide Gelatin Rehmannia Decoction. If accompanied by bitter taste in the mouth, dry throat, chest tightness, hypochondriac distension, irritability, and a wiry, rapid, and slippery pulse, the heat is caused by liver depression transforming into fire. Treatment should aim to soothe the liver, relieve depression, clear heat, and stop bleeding, using Peony and Gardenia Peripatetic Powder.
6. External Injury︰Constitutional weakness, vaginal bleeding during pregnancy with symptoms such as lower back soreness, weak legs, or a sagging sensation in the lower abdomen, mental fatigue and lack of strength, a pale tongue with normal coating, and a slippery yet weak pulse. This condition is often caused by falls, collisions, impacts, sprains, or excessive fatigue, leading to injury of fetal qi and resulting in vaginal bleeding during pregnancy. For such cases of vaginal bleeding during pregnancy, a detailed medical history can clarify the cause, followed by a comprehensive analysis of the pulse and complexion, making diagnosis straightforward. Treatment should focus on replenishing qi, nourishing blood, and calming the fetus to stop bleeding. The recommended formulas are Sage Cure Decoction combined with Fetus-Preserving Pill.

Vaginal bleeding during pregnancy is a condition primarily caused by the instability of the Chong and Ren meridians, which fail to regulate menstrual blood, leading to the discharge of blood due to retardation of the fetus. The causes include qi deficiency, blood deficiency, kidney deficiency, blood heat, deficiency heat, and trauma. In clinical differentiation, it is essential to thoroughly examine the disease cause and carefully distinguish the pulse and symptoms. It should also be differentiated from menstruation during pregnancy. Menstruation during pregnancy, also known as "pregnancy menstruation," "menstruation during pregnancy," or "pregnancy menstruation," is characterized by the continuation of menstruation during the initial stage of pregnancy, albeit with a reduced flow. The clinical features include normal diet and mental state, with the six pulse conditions being smooth, large, and disease-free. This condition does not significantly harm the pregnant woman or the fetus and is considered an abnormal physiological phenomenon that typically resolves by the fourth or fifth month of pregnancy without the need for medication. In contrast, vaginal bleeding during pregnancy involves irregular bleeding and is often accompanied by systemic symptoms, making it prone to early or late abortion and thus should not be overlooked.

Vaginal bleeding during pregnancy is also different from threatened abortion. Yixue Rumen states: "Abdominal pain accompanied by bleeding indicates threatened abortion; bleeding without pain indicates vaginal bleeding during pregnancy. This is the distinction between the two."

bubble_chart Documentation

1. Jingui Yaolue．"Diseases of Pregnancy: Pulse, Symptoms, and Treatment": "If a woman has a long-standing abdominal mass disease, and her menstruation has ceased for less than three months, yet she suffers from continuous discharge due to fistula disease, and fetal movement is felt above the navel, this is due to the harm caused by the abdominal mass. If fetal movement is felt in the sixth month of pregnancy, and there was smooth menstruation in the previous three months, it indicates a normal pregnancy. If there is bleeding, it suggests a three-month cessation of menstruation with blood stasis. The reason for the continuous bleeding is that the condition has not been resolved. The mass should be treated, and Cinnamon Twig and Poria Pill should be prescribed.
2. 《Annotations on Furen Liangfang．Diseases of Pregnancy》: "Bleeding during pregnancy, accompanied by fever, thirst, poor appetite, and physical fatigue, is due to spleen qi deficiency being overwhelmed by liver fire. Use Si Jun Zi Tang with Bupleurum and Gardenia."
3. Zhangshi Yitong．Women's Section: "Vaginal bleeding during pregnancy, yellow discharge, or discharge resembling bean juice, if due to dampness-heat in the liver and spleen, use Sheng Yang Chu Shi Tang; if due to wind-heat in the liver and spleen, add Peripatetic Powder; if due to stagnation in the liver and spleen, add Returning to Spleen Decoction; ... if due to wind-heat in the liver meridian, take Saposhnikovia Root and Skullcap Root in pill form; if wind enters the stomach and intestines, use Stomach-Wind Decoction."
4. Also: "Sudden discharge of water indicates that the fetus will be lost. If the discharge is gradual, use kidney-tonifying and fetus-calming herbs."