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20. When Qi and Blood are abundant, the fetus is naturally secure; when the Chong and Ren meridians are deficient, the root of the fetus is damaged. Sudden anger or excessive sexual activity damages the Liver and Kidney; diseases interfering with pregnancy or physical trauma also cause harm. Fetal expulsion at five months, when the fetus has formed, is called spontaneous abortion (Xiao Chan); before formation, it is called miscarriage (Duo Tai). If spontaneous abortions occur repeatedly at term without obvious cause, one must be cautious, as this is often due to the simmering of desire fire.

[Note] If a pregnant woman has sufficient Qi and Blood and a robust physique, the fetal Qi will be stable. If the Chong and Ren meridians are deficient, the fetus cannot become solid. Alternatively, sudden anger may damage the Liver, and sexual fatigue may damage the Kidney, leading to unstable fetal Qi and predisposing to fetal restlessness. Or, after conception, contracting other illnesses may interfere with fetal Qi, causing fetal instability. Or, physical trauma such as bumps, falls from heights, etc., may injure the fetus, leading to miscarriage. However, there is a distinction between Xiao Chan (spontaneous abortion) and Duo Tai (miscarriage): those occurring in the fifth or seventh month, where the fetus has taken shape, are called Xiao Chan; those occurring in the third month, where the fetus has not yet taken shape, are called Duo Tai. The aforementioned cases of Xiao Chan and Duo Tai all have specific causes. If a woman miscaries spontaneously in the third, fifth, or seventh month without reason, and this recurs upon subsequent pregnancies, repeatedly losing the fetus, it is termed Slippery Fetus (Hua Tai). This is mostly due to excessive sexual activity and the simmering of desire fire, which makes the fetus insecure; thus, caution is essential.

Jiawei Shengyu Decoction, Jiawei Foshou Powder, Shisheng San, Jiawei Xiongqiong Tang, Yimu Wan.

21. For fetal injury with abdominal pain but no bleeding, use Shengyu Decoction plus Du Zhong, Xu Duan, and Sha Ren. For bleeding with abdominal pain, use Foshou Powder plus E Jiao, Ai Ye, Du Zhong, Xu Duan, Bai Zhu, and Huang Qin. For fetal threat due to maternal illness, use Shisheng San (Ten Holy Powder), derived from Shiquan Dabu Decoction by removing Fu Ling and Rou Gui, praised for its efficacy. For fetal threat due to physical trauma, use Xiongqiong Tang mixed with Yimu Wan. For fetal restlessness due to sudden anger or fatigue damaging the Liver and Kidney, Xiaoyao San combined with Dihuang Tang is excellent.

[Note] In pregnancy, if the fetus is injured and there is abdominal pain without bleeding, it is appropriate to use Shengyu Decoction added with Du Zhong, Xu Duan, and Sha Ren to calm the fetus. If there is bleeding accompanied by abdominal pain, it is appropriate to use Foshou Powder added with E Jiao, Qi Ai, Du Zhong, Xu Duan, Bai Zhu, and Tiao Qin to calm the fetus. If the fetus is threatened due to maternal illness, it is appropriate to use Shisheng San, which is Shiquan Dabu Decoction minus Fu Ling and Rou Gui, plus Xu Duan and Sha Ren. If the fetus is threatened due to physical trauma, it is appropriate to take Xiongqiong Tang harmonized with Yimu Wan. Xiongqiong Tang consists of Chuan Xiong and Dang Gui. If fetal restlessness is caused by sudden anger or sexual fatigue damaging the Liver and Kidney, it is appropriate to treat with Xiaoyao San and Dihuang Tang.

The formulas for Shengyu Decoction, Foshou Powder, Xiaoyao San, and Dihuang Tang are all found in the first volume of this book.