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Zhu Danxi stated: In some women, after menstruation has ceased for three months, the chi pulse (pulse at the wrist position corresponding to the kidneys and lower jiao) may be choppy or weak. If the woman presents with no other symptoms, it indicates insufficiency of the true qi in the uterus. Consequently, yang fails to transform and yin fails to differentiate; although essence and blood have coagulated, they ultimately fail to form a fetus. At delivery, what is expelled are blood clots or the gestational sac. Only when the pulse is full and vigorous will the fetus not miscarry.

Wang Haizang stated: Miscarriage is invariably caused by deficiency and damage of qi and blood, which fail to nourish the fetal origin. It may also result from excessive emotional stimulation, triggering internal fire that consumes substances and causes miscarriage; or from overexertion, irregular diet, disturbing the fetus; or from excessive sexual activity, agitating the fetus; or from physical labor, falls, or sprains, injuring the fetus; or from extreme anger or grief, damaging the blood of the heart and liver. However, spontaneous abortion (small birth) is more severe than term delivery because it involves damage to the uterine organ and decay of the placental membranes. Treatment should primarily focus on tonifying deficiency, generating flesh, nourishing visceral qi, generating new blood, and eliminating stasis. Patients with a history of habitual miscarriage should be treated according to their specific patterns.

Wang Jiezhai stated: Female miscarriages often occur during the third, fifth, or seventh months of pregnancy. Excluding traumatic injury, if a previous miscarriage occurred at three months, the next one will likely occur at the same time. Therefore, after delivery, one must take ample formulas to nourish qi and blood to consolidate the fetal origin and replenish deficiency. Nourishing the fetus relies entirely on the spleen and stomach, akin to a vessel hanging from a beam; if the beam is soft, the vessel sinks; if it breaks, the vessel falls. Thus, Atractylodis Macrocephalae Rhizoma (Baizhu, 白术) is a crucial herb for strengthening the spleen and calming the fetus. If the cause is qi stagnation, add more Amomum Fructus (Sharen, 砂仁), and assist slightly with Aucklandiae Radix (Muxiang, 木香) to move qi.

Shenzhai commented: The above ten items describe conditions preceding miscarriage during pregnancy. Pregnancy loss can be caused by external pathogenic factors and trauma, deficiency of qi and blood, or disturbance of fire due to exertion and sexual activity; the preceding texts have already covered the essential pathogenesis. Regarding methods to preserve the fetus, Wang Jiezhai’s discussion emphasizes nourishing the spleen and stomach as the root. The formula Bao Tai Wan (Fetus-Preserving Pill) from *Qianjin Fang* is considered the most excellent, comprising Atractylodis Macrocephalae Rhizoma (Baizhu, 白术), Scutellariae Radix (Huangqin, 黄芩), Rehmanniae Radix Praeparata (Shudihuang, 熟地), Angelicae Sinensis Radix (Danggui, 当归), Eucommiae Cortex (Duzhong, 杜仲), Dipsaci Radix (Xuduan, 续断), Asini Corii Colla (Ejiao, 阿胶), Cyperi Rhizoma (Xiangfu, 香附), Leonuri Herba (Yimucao, 益母), Chuanxiong Rhizoma (Chuanxiong, 川芎), Tangerine Peel (Chenpi, 陈皮), Amomum Fructus (Sharen, 砂仁), and Mugwort Leaf (Aiyè, 艾叶), made into pills with date paste. Zhao Yangkui grasped its essence by adding Eucommiae Cortex (Duzhong, 杜仲), Dipsaci Radix (Xuduan, 续断), Asini Corii Colla (Ejiao, 阿胶), and Schisandrae Fructus (Wuweizi, 五味) to Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia). This urgently nourishes kidney water to consolidate the fetal origin. Since the fetus is anchored by the kidney, robust kidney qi ensures the fetus remains secure. This illustrates the profound principle that tonifying the kidney is superior to tonifying the spleen in this context.