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In women, spontaneous abortion (miscarriage occurring between 12 and 28 weeks of gestation) often happens at three, five, or seven months of pregnancy. Excluding cases caused by falls or physical trauma, if a miscarriage occurred at the third month previously, it is likely to recur at the same time in the next pregnancy.

This is because damage was sustained at that specific time previously, so the reaction inevitably occurs when that period arrives, taking advantage of the body's deficiency. For women who have experienced spontaneous abortion, it is necessary to take numerous doses of herbs that nourish Qi and Blood and secure the fetal root after delivery, to replenish their deficiency and loss. In subsequent pregnancies, starting from two and a half months, administer more than ten doses of fetal-securing prescriptions to prevent miscarriage at three months; at four and a half months, take another eight or nine doses to prevent miscarriage at five months; at six and a half months, take more doses to prevent miscarriage at seven months; and within the ninth month, take more than ten doses of Danxi Dasheng San (a fetal-securing formula by Zhu Danxi) to ensure safety. For those who have suffered multiple consecutive miscarriages with severe damage to the fetal root, medication should be taken for a longer duration and in greater quantity, which can help retain the fetus. The prescription uses Siwu Tang (Four Substances Decoction) added with Baizhu (Atractylodis Macrocephalae Rhizoma), Renshen (Ginseng Radix et Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Fuling (Poria), Gancao (Glycyrrhizae Radix et Rhizoma), Ejiao (Colla Corii Asini), Aye (Folium Artemisiae Argyi), and Huangqin (Scutellariae Radix). If there is significant Qi deficiency, add Xiangfu (Cyperi Rhizoma) and Suosha (Amomi Fructus Rotundus); if there is phlegm-dampness, add Jiangzhi Banxia (Pinelliae Rhizoma Preparatum with Ginger). Regulating pregnancy lies in clearing heat and nourishing blood. Tiaoshi Huangqin (high-quality Scutellariae Radix) is the sacred herb for securing the fetus because it clears heat, making it suitable for increased use during summer months. Nourishing the fetus relies entirely on the Spleen and Stomach, similar to a bell suspended from a beam; if the beam is soft, the bell sinks, and if it breaks, the bell falls. Therefore, Baizhu tonifies the Spleen and serves as the chief herb for securing the fetus. If emotional anger causes fetal unrest, use Chuanxiong (Ligustici Chuanxiong Rhizoma), Chenpi, Fuling, Gancao, with increased Suosha and a small amount of Muxiang (Aucklandiae Radix) to move Qi.

My commentary: Spontaneous abortion is more severe than term delivery. Term delivery is like a ripe melon falling naturally or a ripe chestnut detaching from its shell, whereas spontaneous abortion is like picking an unripe fruit forcibly and severing its stem; is this not more severe than term delivery? However, many people die due to negligence and overlooking this condition. The treatment method should involve tonifying the form and Qi, generating new blood, and removing stasis. If labor pains occur before full term, use Xionggui Buzhong Tang (Chuanxiong and Danggui Tonify Middle Decoction) with doubled Zhimu (Anemarrhenae Rhizoma) to stop premature labor; if bleeding continues after delivery, use Renshen Huangqi Tang (Ginseng and Astragalus Decoction) to tonify; if heart and abdominal pain occur after delivery, use Danggui Chuanxiong Tang (Danggui and Chuanxiong Decoction) as the primary treatment; for spontaneous abortion due to weak fetal Qi, use Bazhen Tang (Eight Treasures Decoction) to secure it; if fever occurs due to excessive bleeding, use Shengyu Tang (Sage Renewal Decoction); if sweating does not stop, urgently use Dushen Tang (Single Ginseng Decoction); for fever with restlessness, muscle twitching, and tendon tremors, use Bazhen Tang; for extreme thirst and red face with a flooding yet empty pulse, use Danggui Buxue Tang (Danggui Tonify Blood Decoction); for body heat and red face with a deep, thin, and faint pulse, use Sijunzi Tang (Four Gentlemen Decoction) added with Shengjiang (Zingiberis Rhizoma Recens) and Fuzi (Aconiti Lateralis Radix Preparata).

One woman, at six months of pregnancy, would bleed every time she became angry, accompanied by alternating chills and fever, headache, distension in the hypochondrium, abdominal pain, poor appetite, and vomiting. I reasoned that the alternating chills and fever and headache were due to Liver Fire rushing upward; the hypochondriac distension and abdominal pain were due to stagnant Liver Qi; the poor appetite and vomiting were due to Liver Qi invading and insulting the Spleen and Stomach; and the blood in urine was due to Liver Fire flowing downward. She was cured using Xiaochaihu Tang (Minor Bupleurum Decoction) added with Shaoyao (Paeoniae Radix), Chaohei Zhizi (Gardeniae Fructus Preparated with Stir-frying until Black), Fuling, and Baizhu.

Another woman, at six months of pregnancy, presented with physical fatigue, reduced appetite and desire for food, hematochezia after exertion, and restless fetus. She was cured using Liujunzi Tang (Six Gentlemen Decoction) added with Shengdihuang (Rehmanniae Radix), Shudihuang (Rehmanniae Radix Preparata), Shengma (Cimicifugae Rhizoma), and Chaihu (Bupleuri Radix).

Yet another woman, whenever she reached three or four months of pregnancy, experienced abdominal pain threatening miscarriage. I diagnosed this as "painful fetus" (fetal unrest caused by pain) and treated her with Danggui (Angelicae Sinensis Radix) 2 qian and Shudihuang 3 qian, resulting in a cure.