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Xiao chan (spontaneous abortion in the mid-trimester) refers to miscarriage occurring between the fourth and sixth months of pregnancy, rather than at full term; this is also known as ban chan (half-birth). If miscarriage occurs in the second or third month, when the fetus is not yet fully formed, the expelled material resembles a blood clot. If miscarriage results from injury, it is termed tuo tai (induced or traumatic early miscarriage); these three conditions—xiao chan, early expulsion resembling blood clots, and tuo tai—all stem from an unstable root and deficiency of the Chong and Ren meridians. Treatment must distinguish whether the cause is fire or cold. For cases involving fire, clear the heat using herbs such as Baizhu (Atractylodis Macrocephalae Rhizoma) and Huangqin (Scutellariae Radix), supplemented by blood-nourishing agents. For cases involving cold, warm the interior using herbs such as Ejiao (Colla Corii Asini) and Aiyè (Artemisiae Argyi Folium), along with Guizhi (Cinnamomi Ramulus) and Fuzi (Aconiti Lateralis Radix Praeparata), combined with Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). However, since Guizhi and Fuzi are acrid and hot, they should be used with caution and never administered lightly. Excess patterns require clearing, while deficiency patterns require tonifying; particular attention must be paid to protecting the Spleen and Stomach to generate fresh blood. The Stomach is the sea of water and grain, and the Spleen is the mother of all things; just as all things rely on earth, the human body relies on the Spleen and Stomach. Earth generates Metal, Metal generates Water, Water generates Wood, and Wood generates Fire. Therefore, fortifying the Earth element facilitates the mutual generation of the Five Phases, and supporting the Spleen and Stomach brings sequential benefits to the Five Zang organs. If pregnant women can maintain this state without worry, there would be no risk of tuo tai or xiao chan.

Mr. Song Suizhen stated: Ancient sages said that miscarriage immediately after conception is due to Liver Blood deficiency. The fetus is rooted in blood; if the Liver is deficient, its generating mechanism is hindered, much like how grass and trees fail to sprout in the early spring when cold prevails. Treatment should focus on nourishing Liver Blood to stabilize the fetus. The same applies to miscarriage in the second month. Excess patterns present oppositely. Miscarriage in the third month is due to Heart Blood deficiency. Since the fetus is rooted in blood, Heart deficiency leads to a decline in the qi of growth and flourishing, similar to how flowers and fruits fail to set when sudden cold strikes in early summer. Treatment should nourish the Heart and tonify blood to stabilize the fetus. This also applies to miscarriage in the fourth month. Miscarriage in the fifth, sixth, seventh, or eighth months is attributed to simultaneous deficiency of Qi and Blood. Qi acts as the guard of Blood, and Blood is the companion of Qi; if Qi cannot guard Blood, Blood has no control; if Blood cannot accompany Qi, Qi has no return. The fetus in the womb relies on the mother’s abundant and harmonious Qi and Blood. If injured, what reliance remains? Therefore, regulating Qi requires first nourishing Blood, and nourishing Blood requires tonifying Qi. The source of Blood is Kidney Water; if Blood fails to generate, one must address this source. The root of Qi is Mingmen Fire; if Qi is insufficient, one must strengthen this root. Thus, for miscarriage occurring between the fifth and sixth months, the essential prescription is Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) modified by removing Mudanpi (Moutan Cortex) and adding Renshen (Ginseng Radix et Rhizoma), Maidong (Ophiopogonis Radix), Duzhong (Eucommiae Cortex), and Xuduan (Dipsaci Radix). If cold pain is present, add a small amount of Fuzi (Aconiti Lateralis Radix Praeparata), which yields nearly perfect results. If fetal movement is restless and unceasing, it indicates fetal heat; dry and hot formulas must not be used. Other causes of fetal movement include deficiency of the Chong and Ren meridians, emotional disturbances (Seven Emotions and Six Desires), or excessive consumption of hot medicines. One must carefully identify the pathogenesis and treat accordingly. For example, during the fourth or fifth month, if symptoms include mental confusion, heaviness of the four limbs, immobility, aversion to the smell of food, craving for sour tastes, and restless fetus, the primary formula is Antai Yin (Fetus-Stabilizing Decoction), or Zisu Yin (Perilla Decoction) modified with Banxia (Pinelliae Rhizoma), Fuling (Poria), and Zhike (Aurantii Fructus Immaturus).