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Spontaneous abortion (Xiao Chan) is caused by deficiency and damage to Yuan Qi (Original Qi), which fails to nourish the fetus, leading to natural miscarriage. Ancients compared it to: when branches wither, fruits fall; when vines shrivel, flowers drop. However, sometimes labor and anger cause emotional injury, triggering internal fire, which can also induce miscarriage. This is like wind shaking trees or people breaking branches. Fire has the nature to consume things, which is the natural law of creation. Those who explain it as cold wind damaging the Zi Zang (uterus) have not grasped the essence of the disease. Generally, spontaneous abortion belongs to deficiency or heat patterns. Treatment should be based on the severity of the condition. Thus, full-term delivery is like a mature chestnut where the shell opens naturally, causing no harm to either mother or fetus. Half-term delivery (spontaneous abortion) is like harvesting new chestnuts by chopping, shattering the shell, damaging the membrane, before obtaining the kernel. This is because the fetal organs are damaged, and the placental connections are broken, after which the fetus falls. Therefore, post-spontaneous abortion requires ten times the care of normal delivery. The general principle is to tonify blood, generate flesh, nourish organs, generate fresh blood, and remove stasis. There are some people who act recklessly, behave immorally, or have too many children and grow weary of raising them, often using herbal poisons to abort. This often leads to retained dead blood failing to discharge, rushing up to the heart causing oppression and confusion, alternating wheezing and sweating, resulting in death. Urgent rescue with detoxifying and blood-moving herbs is required. Bai Bian Dou San (White Hyacinth Bean Powder) is suitable. If a pregnant woman conceives and inevitably miscarries during the 3rd, 5th, or 7th lunar months (Yang months), one should clear internal heat before the expected time of miscarriage. Qin Shu Tang (Scutellaria and Atractylodes Decoction) and An Tai Wan (Fetus-Stabilizing Pills) are suitable. If Qi is insufficient, preventive supplementation is suitable, such as Ba Zhen Tang (Eight Treasure Decoction). *Ming Yi Za Zhu* states: Spontaneous abortions mostly occur in the 3rd, 5th, and 7th months. If a miscarriage occurs in the first three months, the next pregnancy will likely miscarry at the same time. Therefore, after a previous spontaneous abortion, one should take more medicine to nourish Qi and Blood and secure the fetal origin to replenish deficiency. In the next pregnancy, starting from two and a half months, take several doses of heat-clearing and fetus-stabilizing medicine to prevent miscarriage at three months. At four and a half months, take several more doses to prevent miscarriage past five months. At six and a half months, take several more doses to prevent miscarriage at seven months. At nine months, take several doses of Da Sheng San (Reaching Life Powder) to ensure safety. Suitable formulas include Qian Jin Bao Tai Wan (Thousand Gold Fetus-Preserving Pills), Jin Gui Dang Gui San (Golden Cabinet Angelica Powder), Xiong Gui Bu Zhong Tang (Ligusticum and Angelica Tonifying Middle Decoction), Wu Wei An Tai Wan (Five-Ingredient Fetus-Stabilizing Pills), An Rong Tang (Peaceful Nourishment Decoction), and He Tong Tang (Harmonizing Pain Decoction). Who says spontaneous abortion can be ignored? All diseases following spontaneous abortion should be referred to postpartum conditions.

Regarding pulse diagnosis: *Mai Jue* (Pulse Classic) states: For half-term miscarriage with dripping bleeding, Ge Mai (Leather Pulse) is indicated. Weakness indicates blood exhaustion, immediately showing danger. *Mai Jing* (Pulse Canon) states: Yin pulses floating and tight indicate Jian Jia (abdominal masses) and abdominal pain, leading to half-term miscarriage and fetal expulsion.

Shen Jin'ao's commentary: What *Mai Jue* and *Mai Jing* describe are all cases of miscarriage due to internal causes. If caused by falls, trauma, or accidental ingestion of toxic drugs, these rules do not apply.

Miscarriage: Chen Ziming said: Pregnant women with lower back pain are prone to miscarriage. Also, if pregnant women under term experience pain resembling labor, or difficulty delivering at term, or suffer from Zi Fan (pregnancy-related restlessness/irritability), using only Zhi Mu (Anemarrhena Rhizome) made into honey pills taken with rice soup is effective. Alternatively, Pu Huang (Pollen Typhae) powder mixed with water, taken in small amounts, is also effective. Zhu Zhenheng said: A Mrs. Jia always miscarried around the third month of pregnancy. Her pulse was large and powerless on the left hand, and choppy upon heavy pressure, indicating blood deficiency. Since she was young, he only tonified Middle Qi so that blood would naturally nourish. It was early summer, so he instructed her to take Huang Qin (Scutellaria Root) powder with strong decoction of Bai Zhu (Atractylodes Macrocephala Rhizome). After taking 30-40 doses, she was preserved and recovered. Wang Lun said: For those with multiple miscarriages and severe damage to the fetal origin, medication must be taken in large quantities and for a long time to retain the fetus. Use Si Wu Tang (Four Substances Decoction) plus Ren Shen (Ginseng Radix), Bai Zhu, Chen Pi (Citrus Reticulata Pericarpium), Fu Ling (Poria), Gan Cao (Licorice Root), Ai Ye (Artemisia Argyi Folium), E Jiao (Donkey-hide Gelatin), and Tiao Qin (Scutellaria Root). For Qi deficiency, add Sha Ren (Amomum Fruit) and Xiang Fu (Cyperus Rhizome). For phlegm, add Ban Xia Qu (Pinellia Fermented Paste) in small amounts. Huang Qin is the holy medicine for stabilizing the fetus because it clears heat. It is especially suitable in summer. Nourishing the fetus relies entirely on the Spleen and Stomach, so Bai Zhu tonifies the Spleen and is the chief herb for stabilizing the fetus. If fetal unrest is caused by Qi stagnation and anger, use Chuan Xiong (Ligusticum Chuanxiong Rhizome), Chen Pi, Gan Cao, Fu Ling, adding more Sha Ren, and a little Mu Xiang (Aucklandiae Radix) to move Qi. Wang Kentang said: Mr. Yuan Liaofan stated that conception changes every seven days in the womb, transforming mutually, each having generative relationships. Now, women miscarrying mostly do so in the 3rd, 5th, and 7th months, rarely in the 2nd, 4th, and 6th. Zang organs are Yin and Fu organs are Yang. The 3rd month belongs to the Heart, the 5th to the Spleen, and the 7th to the Lung, corresponding to the pulses of the Five Zang organs. Yin is easily deficient, hence frequent miscarriage. Only at one month do people not know there is a pregnancy, attributing it to infertility, not knowing it is conception followed by immediate miscarriage. The first month belongs to the Liver. Anger causes miscarriage; washing the lower body frequently opens the orifices and causes miscarriage. Once miscarried, the Liver pulse is injured, leading to future miscarriages. Most childless people actually miscarry at one month, they are not completely infertile. Therefore, after initial intercourse, one must rest carefully, avoid sexual intercourse to disturb the uterus, avoid anger, avoid fatigue, avoid vigorous movement, avoid bathing, and take medicine to nourish the Liver and calm Qi, then the fetus can be secured. Wan Quan said: Frequent miscarriages are due to men being lustful and indulgent, women having excessive sexual desire, and liking spicy and hot foods, violently damaging the Chong and Ren meridians. Diet differs between rich food and coarse food, and desires differ in quantity. Some women have a pregnancy but seem not to, experiencing phlegm-Qi pain and fever. Doctors ignorant of medical principles do not know that the fetus should be nourished and the disease attacked, but recklessly use attacking and consuming methods, which is wrong. Thus, nourishing the fetus relies on Blood, protecting the fetus relies on Qi. Some women have too many spontaneous abortions and want to preserve health in middle age, trying medicines, but if desires are not extinguished, combined with rebellious Qi damaging the Chong and Ren meridians, death may result. Also, if the Spleen and Stomach are damaged, the fetus easily miscarries. Cold and heat mixed lead to fetal phlegm. Moreover, eating too much sour damages the Liver, bitter damages the Heart, sweet damages the Spleen, pungent damages the Lung, salty damages the Kidney. Depending on food, the Zang Qi is damaged. Not only does the fetus easily miscarry, but even if it doesn't, the child suffers many illnesses. Joy damages the Heart, scattering Qi; anger damages the Liver, causing Qi to rise; worry damages the Spleen, causing Qi to stagnate; sorrow damages the Lung, causing Qi to knot; fear damages the Kidney, causing Qi to sink. When maternal Qi is damaged, fetal Qi responds. Maternal damage makes the fetus prone to miscarriage; fetal damage leads to disharmony of Zang Qi, resulting in blindness, deafness, muteness, dementia, epilepsy, etc. Also, if walking, standing, sitting, or lying down for too long during pregnancy, muscles, bones, and skin are damaged. The fetus in the womb connects Qi with the mother, so both are injured. Sleeping places need protection to prevent pathogenic invasion. Avoid dangerous places to prevent falls. Zhang Jiebin said: Miscarriage is due to Qi deficiency failing to hold firm, or Blood deficiency failing to irrigate properly. Those good at preserving the fetus focus on Blood. For deficiency, Tai Yuan Yin (Fetal Origin Decoction) is primary, followed by Shao Yao Xiong Gui Tang (Peony, Ligusticum, and Angelica Decoction), then Tai Shan Pan Shi San (Mount Tai Porphyry Powder), and Qian Jin Bao Yun Wan (Thousand Gold Pregnancy-Preserving Pills), all achieving miraculous results. Additionally, fetal heat moves Blood, and moved Blood unsettles the fetus, so miscarriage due to internal heat is often due to deficiency. For Spleen Qi deficiency with Blood heat, use Si Sheng San (Four Sacred Powders); for Liver-Kidney deficiency with Blood heat, use Liang Tai Yin (Cooling Fetus Decoction); for Liver-Spleen deficiency with Blood heat, use Gu Tai Jian (Fetus-Securing Decoction). For other symptoms causing fetal unrest, treat according to the Stabilizing Fetus section. Chen Shize said: Spontaneous abortion is not a normal delivery symptom but can be treated as a prenatal condition. Since Qi and Blood are greatly damaged in spontaneous abortion, urgent tonification prevents future metrorrhagia and metrostaxis during subsequent pregnancies. Use Ren Shen, Dang Gui (Angelica Sinensis Radix), Bai Zhu, each 5 qian; Fu Ling 3 qian; Shu Di Huang (Prepared Rehmannia Root) 1 liang; Du Zhong (Eucommia Bark) 2 qian; Pao Jiang (Roasted Ginger) 0.5 qian. This formula is a holy prescription for tonifying Qi and Blood. Fetal movement downward damages the Dai Mai (Girdle Vessel). Tonifying Qi and Blood allows the damaged Dai Mai to regenerate, preventing further damage in future conceptions. Wu Zhiwang said: Delivery before term with incomplete fetal Qi is called Ban Chan (half-term delivery), commonly known as Xiao Chan. It is caused by Chong and Ren Qi deficiency in the pregnant woman, failing to nourish the fetus, leading to insecure fetal Qi, or falls causing Qi and Blood damage and agitation, or febrile diseases like Wen Nue (warm malaria) causing half-term delivery. Black God Powder (Hei Shen San) is contraindicated to avoid aggravating heat and causing other diseases. Yu Zhu San (Jade Candle Powder) and He Jing Tang (Harmonizing Meridian Decoction) are suitable. Xue said: Spontaneous abortion is more serious than normal delivery, but many die due to negligence. Treatment should tonify Body Qi, generate fresh Blood, and remove stasis. If pain and labor urge appear before term, use Xiong Gui Bu Zhong Tang with doubled Zhi Mu to stop it. If bleeding continues after delivery, use Ren Shen Huang Qi Tang (Ginseng and Astragalus Decoction). If heart and abdominal pain occur after delivery, use Dang Gui Chuan Xiong Tang (Angelica and Ligusticum Decoction). For weak fetal Qi causing spontaneous abortion, use Ba Zhen Tang. For fever due to excessive blood loss, use Sheng Yu Tang (Sage Saving Decoction). For unceasing sweating, urgently use Du Shen Tang (Single Ginseng Decoction). For fever, irritability, muscle twitching, and tendon tremors, use Ba Zhen Tang. For extreme thirst, red face, and surging yet empty pulse, use Dang Gui Bu Xue Tang (Angelica Tonifying Blood Decoction). For body heat, red face, and deep yet faint pulse, use Si Jun Zi Tang (Four Gentlemen Decoction) plus Ginger and Aconite. Dong Yuan said: Fever during the day and quiet at night indicates Yang Qi flourishing in the Yang aspect. Quiet during the day and fever at night indicates Yang Qi sinking into the Yin aspect. Fever day and night indicates excess Yang without Yin, requiring vigorous tonification of Yin. Wang Taipu said: Severe cold unresponsive to heat therapy indicates lack of Fire. Heat coming and going, appearing by day and hiding by night, occurring seasonally, indicates lack of Fire. Severe heat unresponsive to cold therapy indicates lack of Water. Heat moving and stopping, suddenly coming and going, intermittently active and still, indicates lack of Water. For Yang Qi flourishing, use Si Wu Er Lian Tang (Four Substances and Two Coptis Decoction). For Yang Qi sinking into Yin, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment Qi Decoction). For excess Yang without Yin, use Si Wu Tang. For lack of Fire, use Ba Wei Wan (Eight-Ingredient Pill). For lack of Water, use Liu Wei Wan (Six-Ingredient Pill).