Zhang Zhongjing’s approach to gynaecological haemorrhage was characteristic of his thinking throughout the Jin Kui Yao Lue: identify the precise constitutional root driving the bleeding, then address it with a formula that treats both root and branch simultaneously, without sacrificing one for the other. For the pattern of Chong-Ren vessel deficiency with Blood deficiency and Cold tendency — the pattern he described as causing metrostaxis, persistent post-partum bleeding, gestational bleeding, and foetal obstruction with abdominal pain — the formula is Jiao Ai Tang (Ass-hide Gelatin and Mugwort Decoction), also called Xiong Gui Jiao Ai Tang. Seven herbs that nourish Blood, warm the channels, stop bleeding, and calm the foetus simultaneously; and because Blood deficiency often involves Qi stagnation from insufficient Blood to circulate, the formula includes Chuan Xiong to keep the Blood-nourishing herbs from producing stagnation. The result is one of classical TCM’s most complete single-formula solutions for the Blood-deficient, Cold-tendency gynaecological patient.

I. Classical Source and Historical Development

Jiao Ai Tang first appears in Jin Kui Yao Lue · Gynaecological Pregnancy Disease: "Women with metrostaxis; or persistent bleeding after incomplete miscarriage; or gestational bleeding; or if pregnant, with abdominal pain — this is foetal obstruction (bao zu); Jiao Ai Tang governs." The formula’s original administration included clear wine mixed with the decoction water — wine’s pungent-warm nature assists the formula in warming the channels, promoting Qi-Blood movement, and dispersing Cold.

Subsequent dynasties extended and refined the formula. Tang Dynasty Wai Tai Mi Yao preserved only the core E Jiao and Ai Ye for pregnancy-related foetal damage and abdominal pain. Qian Jin Yi Fang added Gan Jiang for trauma-related internal bleeding. Song Dynasty San Yin Ji Yi Bing Zheng Fang Lun changed Gan Di Huang (dry rehmannia) to Shu Di Huang (processed rehmannia) and added Huang Qi, intensifying the Blood-supplementing-Qi-supplementing combination for foetal restlessness. Ming Dynasty Yi Xue Ru Men named it “Jiao Ai Si Wu Tang,” making explicit its relationship to Si Wu Tang. Qing Dynasty master You Yi (Jin Kui Yao Lue Xin Dian): "For metrostaxis and gestational bleeding not stopping, all from Chong-Ren vessel deficiency with Yin unable to consolidate — Jiao Ai Tang alone can supplement and consolidate them." Fu Qingzhu: "Jiao Ai Tang is the sacred formula for foetal calming and metrostaxis; for Blood deficiency: increase the Gui and Di doses; for severe Cold: double the Ai Ye dose." Li Ke (National TCM Master): “This formula is the cornerstone of Chong-Ren consolidation; less Yang deficiency but more Blood deficiency compared to Huang Tu Tang; less Qi descent but more Cold congealment compared to Gu Chong Tang.”

II. Seven-Herb Composition and Formula Analysis

Modern clinical reference doses: Dang Gui 9g · Chuan Xiong 6g · Bai Shao 12g · Gan Di Huang 12g · E Jiao 6g (dissolve separately) · Ai Ye 9g · Zhi Gan Cao 6g. Classical: “Chuan Xiong, E Jiao, and Gan Cao each 2 liang; Ai Ye and Dang Gui each 3 liang; Bai Shao and Gan Di Huang each 4 liang.” Administration: traditionally decocted in water plus clear wine; E Jiao dissolved separately into the strained liquid. Modern: water decoction; E Jiao melted separately and stirred in; moderate yellow wine may be added for pronounced Cold presentations.

Chief herbs — E Jiao and Ai Ye:

• E Jiao (Ass-hide Gelatin) 6g (dissolve separately): sweet, neutral; enters Heart, Liver, Kidney. Nourishes Yin and supplements Blood, stops bleeding and calms the foetus. The Shen Nong Ben Cao Jing records it for “internal Heart-abdomen collapse, calming the foetus.” E Jiao is the formula’s Yin-Blood replenishment agent: it simultaneously fills the depleted Blood substrate driving the haemorrhage and arrests the bleeding itself. Dissolve separately into the strained decoction — never boil with other herbs, which causes charring and destroys its collagen-based active compounds. Recommended source: Shandong Donge E Jiao is considered the highest quality.
• Ai Ye (Mugwort leaf) 9g: bitter-pungent, warm; enters Liver, Spleen, Kidney. Warms the channels and scatters Cold, stops bleeding and calms the foetus. Ming Yi Bie Lu: “stops lower bleeding.” Ai Ye directly enters the Uterine channel, warming Uterine Yang, relieving Uterine Cold cramping, and arresting Cold-type haemorrhage. Charcoal-processed Ai Ye (Ai Ye Tan) intensifies haemostatic action — use when stopping bleeding is the priority; plain Ai Ye retains more warming-channel action — use when relieving pain and warming the Uterus is equally important. Paired with E Jiao: one moistens and nourishes (E Jiao, cool), one warms and moves (Ai Ye, warm) — yi run yi wen, yi bu yi gu (moisten and warm, supplement and consolidate). This is the formula’s core dyadic mechanism.

Deputy herbs — Si Wu Tang base (Dang Gui, Chuan Xiong, Bai Shao, Gan Di Huang):
These four herbs constitute the formula’s Blood-nourishing foundation — the classical Si Wu Tang, the core nourishing-Blood combination in all of Chinese medicine. Without adequate Blood substrate, E Jiao and Ai Ye cannot sustain their haemostatic and warming effects.

• Dang Gui 9g: sweet-pungent, warm; nourishes Blood and harmonises Blood, warms the channels and relieves pain. The primary Blood-supplementing herb; also has gentle Blood-activating properties, so it “supplements while moving” — avoiding the stagnation that purely cloying tonics produce. The formula’s largest non-chief dose reflects its importance.
• Chuan Xiong 6g: pungent, warm; “Qi-mover within the Blood”; activates Blood and moves Qi, expels Wind and relieves pain. Its role here is to prevent the Blood-nourishing herbs from creating stagnation — the formula’s built-in “anti-clogging” mechanism. It also directly reaches the Uterine channel and unblocks Chong Mai circulation.
• Bai Shao 12g (largest dose in the formula): sweet-bitter, slightly cold; consolidates Yin and nourishes Blood, soothes Liver and relieves cramping, moderates urgency. Its high dose reflects its dual role: primary Blood-Yin nourishment alongside Gan Di Huang, and relief of the “foetal obstruction” abdominal cramping through its “relieve urgency-cramping” action. Also moderates Ai Ye’s warmth and Chuan Xiong’s pungent dispersal, keeping the formula from being over-warming.
• Gan Di Huang 12g (equal highest dose): sweet-bitter, cold; nourishes Yin, cools Blood, generates fluids. Cools Blood-Heat (which may accompany the deficiency pattern and worsen bleeding), replenishes the Yin-Blood depleted by haemorrhage. The formula specifies Gan (dry) Di Huang rather than the processed (Shu) form because Gan Di Huang has active Blood-cooling and Heat-clearing properties that Shu Di lacks; however, when Blood deficiency (without Heat) predominates, substituting Shu Di Huang amplifies the Blood-supplementing effect.

Assistant/Envoy — Zhi Gan Cao 6g: supplements Qi and warms the Middle; harmonises all herbs; moderates Ai Ye’s pungent-warming nature and Di Huang’s cloying-cold tendency; protects Spleen-Stomach from the formula’s cold and rich herbs. Embodies the TCM principle that Spleen-Stomach is the source of Blood generation — protecting it ensures the formula’s haemostatic and Blood-building effects can be sustained.

Three-characteristic formula design:
① Warm and nourish combined, not cold: Si Wu Tang nourishes Blood-Yin; Ai Ye warms the Uterine channel; E Jiao bridges both. Blood deficiency easily generates Cold (insufficient Blood fails to warm); the formula addresses both the deficiency and the consequent Cold without the extremes of either pure warming or pure cooling
② Supplement with movement — stop bleeding without leaving Stasis: E Jiao, Di Huang, and Bai Shao supplement and consolidate; Chuan Xiong and Dang Gui move and activate. This prevents the classical complication of pure stop-bleeding leading to Blood Stasis retention
③ Root and branch simultaneously: Si Wu Tang restores the depleted Blood substrate (root); E Jiao and Ai Ye arrest the haemorrhage (branch); Zhi Gan Cao sustains Spleen-Stomach Blood generation (long-term root)

III. Pattern Identification and Clinical Applications

Core pattern: Chong-Ren vessel deficiency, Blood deficiency with Cold tendency, Blood failing to consolidate
Bleeding signs: pale-red, thin-consistency blood without clots; metrostaxis (chronic or acute), post-partum bleeding not resolving, gestational spotting. Cold signs: cold lower abdominal pain relieved by warmth and pressure, cold limbs, pale sallow complexion. Deficiency signs: dizziness, fatigue, lower back soreness. Tongue: pale with white coating. Pulse: thin-weak or deep-slow. Foetal obstruction: lower abdominal pain in pregnancy accompanying spotting.

1. Gynaecological haemorrhage (primary indication): dysfunctional uterine bleeding (metrostaxis, menorrhagia, intermenstrual spotting); post-partum lochia not stopping; post-miscarriage bleeding persistent — all in Cold-deficiency pattern. Modifications: Qi deficiency (breathlessness, fatigue, profuse bleeding) → add Huang Qi 15g, Dang Shen 12g; charcoal-process Ai Ye to intensify haemostasis; Case (Liu Duzhou verification): 40-year-old woman, metrostaxis 1+ month, pale red thin blood, pale complexion, dizziness, cold lower abdomen, pale tongue, deep weak pulse — Jiao Ai Tang plus Mai Dong 20g, Tai Zi Shen 18g, Ai Ye Tan 10g; bleeding markedly reduced at second visit; resolved after 7 further doses; maintained with Gui Pi Tang.

2. Threatened miscarriage and recurrent miscarriage: the formula’s classical indication. Pregnancy spotting with cold lower abdominal pain, lower back aching, fatigue — Chong-Ren deficiency with Uterine Cold failing to nourish the foetus. Modifications: add Du Zhong 12g, Sang Ji Sheng 12g, Xu Duan 10g (strengthen Kidney and calm foetus); Qi deficiency → add Ren Shen 9g; classical case: pregnancy at 4 months, unprovoked pale-red spotting; given Jiao Ai Tang plus Xu Duan, Ren Shen; bleeding stopped after 3 doses; foetus secure after 5 doses.

3. Dysmenorrhoea (Cold-type): cold lower abdominal pain relieved by warmth and pressure; pale-red scanty menses. Modifications: add Xiao Hui Xiang 6g, Rou Gui 6g (intensify Uterine warming).

4. Other applications: thrombocytopaenic purpura (Cold-deficiency type: skin petechiae with pale complexion, cold limbs, fatigue) → combine with Dang Gui Bu Xue Tang; anaemia post-partum → add Ren Shen; Cold-type gastrointestinal bleeding with Blood-deficiency signs.

Common clinical modifications:

• Qi deficiency prominent (breathlessness, profuse bleeding, fatigue): add Huang Qi 15g, Dang Shen 12g; or Ren Shen 9g for severe deficiency
• Kidney deficiency (lower back soreness, frequent urination, history of recurrent miscarriage): add Du Zhong 12g, Sang Ji Sheng 12g, Xu Duan 10g, Tu Si Zi 10g
• Haemostasis priority (heavy ongoing bleeding): charcoal-process Ai Ye (Ai Ye Tan); add Xian He Cao 15g, Zong Lu Tan 9g
• Concurrent Yin-deficiency Heat (oral bitterness, hot palms): reduce Ai Ye; add Mai Dong 12g, Xuan Shen 10g; use Gan Di Huang rather than Shu Di
• Blood-Heat with bright red blood (do not use standard Jiao Ai Tang): contraindicated; pattern does not match

IV. Usage, Dosage, and Safety

Preparation: decoct all herbs except E Jiao; melt E Jiao separately (in a small amount of warm water or the strained decoction liquid over low heat); stir into the strained liquid before serving. Never boil E Jiao with other herbs. Yellow wine (Huang Jiu) may be added during decoction for pronounced Cold presentations — its pungent-warm quality amplifies the warming-channel and Blood-moving effects. Take warm, 2–3 times daily. Patent forms: Hai Tian Jiao Ai Tang and Nong Ben Fang Xiong Gui Jiao Ai Tang.

Contraindications: Blood-Heat haemorrhage (bright red, thick blood, warm sensation, thirst, red tongue, yellow coating) — this pattern is the opposite of the formula’s target and will worsen; Blood-Stasis haemorrhage (dark red blood with clots, abdominal pain that is fixed and refuses pressure) — this pattern requires Blood-Stasis resolution first; infants and young children — E Jiao and Di Huang may cause digestive distress; known allergy to any component. Pregnant women using Jiao Ai Tang must be under TCM practitioner supervision; Chuan Xiong and Ai Ye in large doses could potentially affect foetal development.

Drug form notes: E Jiao dose should generally not exceed 10g without practitioner guidance (risk of digestive heaviness); Ai Ye generally not exceed 10g; Chuan Xiong generally not exceed 9g (high doses may cause dizziness or excessive Blood-moving). Do not stop abruptly once symptoms improve — continue for 1–3 further doses to consolidate results; then transition to Gui Pi Tang or similar formula for ongoing Blood-building maintenance.

Dietary support: avoid cold-raw, spicy-fried foods; favour red dates, longan, yam, lotus seed, lamb soup (warming Blood-building); avoid vigorous activity and heavy lifting during active haemorrhage; adequate rest; avoid emotional agitation (which aggravates haemorrhage via Liver-Qi disruption).