宫外孕从实质上说肯定不是有瘀血的存在，但为什么用活血化瘀的方法能够达到治愈的目的呢?这是有理论根据的。从本病的发病情况来看：①痛有定位，疼痛的部位都有少腹；②疼痛都相当剧烈，而且兼有刺痛拒按之表现；③疼痛的时间都在月经过期不来或来而淋沥不畅时。
从以上特点可以看出，宫外孕符合少腹血瘀证之辨证特点，故施以活血祛瘀可以治之。
针对宫外孕患者的主症——经停后月余前后，少腹部疼痛拒按，甚则休克，阴道出血等，李老确定了祛瘀消癥止痛的治法，选用活络效灵丹加味为主，处方为丹参、归尾、生乳香、生没药、怀牛膝、苏木、桃仁。因当时当归药源奇缺，改为赤芍。乳香、没药二药不但流通经络之气血，诸凡脏腑中有气血凝滞，二药皆能流通之。乳没最宜生用，若炒用之则其流通之力顿减。但生者易致呕吐，而呕吐可使腹内压增高，从而加重出血，故去“生”字。后因一些患者仍然不能接受乳没之异味而致呕吐，故去乳没。经临床反复验证，最后形成由丹参、赤芍、桃仁组成的治疗宫外孕破损的主方，即宫外孕Ⅰ号方。但临床实践也证实，在病人能够接受乳没的前提下。不去乳没效果会更好。
宫外孕破损后，可以引起急性大量内出血，同时又有少量不规则阴道出血淋沥不断，此时应活血还是止血?中医理论认为，血在正常情况下，周流不息地循行于脉中，灌溉五脏六腑，濡养四肢百骸，一旦由于某种原因造成血液离经妄行而出现崩漏等出血证，此时若止血过急，易致留瘀，单纯固涩止血，每因固涩留瘀，故止血应治本，因血瘀而致血液离经妄行者，应以活血祛瘀为主，切勿一味着眼于止血，故有“见血休止血”之说。总之，必须做到审因论治，才能提高疗效。临床实践也证实，应用炭类止血，可导致病人腹腔内血液过早凝固，形成较大而硬的血肿包块，难以吸收，子宫内膜难以剥脱，阴道出血也不易停止；反之，以活血祛瘀的治则始终贯穿于治疗宫外孕病人的整个过程中，则腹腔内血液凝成的血肿包块常较软且易于吸收，效果比较好。至于阴道出血，等到子宫蜕膜完全排出，子宮内膜修复，血肿包块消失，出血自然会停止。
辨证论治疗兼证
宫外孕从病的性质上说是一种实证。但患宫外孕的患者有乎素兼寒者，有兼热者，有兼肝气郁滞者，有兼盆腔炎者，还有兼脾胃虚弱、食欲不振者，也有兼肠结核、经常泄泻者，此外还有临时感冒、食滞或继发黄疸者，甚而有的引起内部同时出血形成严重的休克状态等，种种情况，不一而足。而中医的治法也不是一方一药，而是从全面考虑，辨证施治的。如何辨证施治?简明地说，也就是根据《内经》“虚则补之，实则泻之，寒者温之，热者清之”、“先治新病，后治旧病”、“急则治标，缓则治本”等理论，结合患者的客观实际灵活运用。下面就几种常见的宫外孕兼夹证论述如下： 一、腑实证 腑实证是宫外孕患者最多见的兼证，同时也是最重要的兼证，其临床表现为大便秘结，腹胀，胃脘不适，腹痛拒按等。病人兼腑实证，则腹痛加剧，不能安静休息，多次恶心呕吐可导致再出血，出现或加重休克。同时，由于胃肠功能障碍，营养不能及时补给，药物也不能很好地吸收利用。所以，及时解决腑实证很重要，也是治疗本病取得良效的关键。李老认为，此时必须用攻下法，由于病人有兼肠胃积滞寒性、热性及寒热错杂性的不同，治疗方法也各异。
(一)寒性祛瘀止痛之方
主治：宫外孕开始腹痛兼喜冷便秘之证。
药品：
赤芍 归尾 桃仁 芒硝 大黄(醋炒) 怀牛膝 元胡 香附 灵脂 蒲黄 麝香(后入) 没药
制法：共研细末，水泛为丸，绿豆大。
服法：每服9克，开水送下，每日1～2次。
或可结合应用大承气汤：大黄、芒硝各3～7．5克，枳实、厚朴各3～9克。大黄后下，芒硝分2包冲服。
(二)热性祛瘀止痛之方
主治：宫外孕开始腹痛兼喜热便秘之证。
药品：
赤芍 归尾 桃仁 芒硝 大黄(醋炒) 怀牛膝 元胡 香附 灵脂 官桂 麝香 小茴 没药
制法：共为细末，水泛为丸，绿豆大。
服法：每服9克，开水送下，每日1～2次。
本方用大黄、芒硝等佐以较多量的温热药，下腹凉者加官桂，全身冷者加肉桂。
也可用《金匮要略》“九痛丸”：炮附子9克，高丽参、干姜、吴茱萸、狼毒(醋炒)、巴豆霜各3克。上药共研细末，炼蜜为丸，如豌豆大。用量可根据病人体质和病情决定，一次可服3～10丸，热开水送下，也可溶于热水中，通过胃肠减压管注入，然后停止胃肠减压2小时。
(三)寒热夹杂者用方
可用大黄、芒硝，佐以适量官桂或肉桂即可。
注意事项：宫外孕破损后有过大量内出血的病人，其身体情况与一般急腹症病人不同，特别是休克型病人，内出血较多，有虚脱现象者，用攻下药时不可过量。为了免伤正气，攻下药应中病即止，不可久用，兼用枳实、厚朴等破气药时更应注意。一般病人可连用两次攻下药，如效果不著，亦不可再用，应改服主方，隔1～2日后，再重复用1～2次，多可奏效。 二、气虚证 症见倦怠乏力，气短懒言，纳呆等。可于主方中加入党参6～9克。 三、气虚欲脱证 常见于休克型。应立即输液、给氧、输血补充血液循环量，配合中药积极抢救，同时给予宫外孕Ⅰ号方和攻下药内服，早期治疗或预防腑实证的发生。
常用处方：
丹参15克 赤芍15克 桃仁9克 枳实6～9克 厚朴6～9克 元胡9克 归尾9克
根据病人寒、热或寒热夹杂情况给攻下药疏通胃肠。血压不升或不稳定，虚脱征象严重者，加生脉散，即关东参9一15克，麦冬15克，五味子15克。或加独参汤，即关东参9—15克，另煎频服。四肢厥逆者加附子6—9克。大汗淋漓不止者加山萸肉15—30克。
应用人参可大补元气以固脱，益气以止血，扶正以祛邪，补虚以止痛，但由于宫外孕病人以实证为本，如虚证不重者，不必一律使用，如过用或滥用，常易引起腹胀中满，腹痛增剧，病情加重。
附案：
案一 季某，24岁。病历号：300。1965年12月9日20时入院。
当时已停经40天，阴道出血]天多．突发性剧烈腹痛5个多小时，昏厥2次，伴呕吐、出冷汗等。人院前1小时测血压为60／0毫米汞柱。入院时血压测不到，脉微欲绝，四肢、鼻尖发凉，腹微隆起，有轻度肌紧张与明显压痛、反跳痛，尤以胃脘部与左下腹部明显，两侧腹腋前线以下均为浊音，肠鸣音较弱。未叩移动浊音，亦未内诊。诊断为子宫外孕(左侧输卵管妊娠破裂)休克型。 具体治疗方法： 1．输液，输血，吸氧。 2．关东参9克，捣碎冲服。
3．丹参15克，赤芍6克，半夏6克，元胡6克，桃仁6克，附子3克，水煎服。
4．九痛丸6粒，热开水送下。
按：本案患者为少腹血瘀之实证，兼有急性血虚气脱之虚证、寒证与腑实证。治宜祛瘀活血，助阳扶正，同时用温下法疏通胃肠。方用附子大辛大热，回阳救逆，丹参、赤芍、元胡、桃仁祛瘀活血，半夏燥湿化痰，同时热水送服九种心痛丸，以预防腑实证的发生。
12月10日：零时以前血压波动于70—90／40—50毫米汞柱，以后血压维持在90—100／50—70毫米汞柱以上，稍平稳，脉渐有力。腹胀尤以胃脘部明显，液乎面未发现上升，肠鸣音仍较弱，未排气，无排便。作胃肠减压，并给予中药：
东参15克 丹参15克 赤芍7。5克 元胡6克 桃仁6克 大黄(后下)4．5克 芒硝(冲服)3克 枳实6克厚朴6克 肉桂9克
水煎服，以继续活血祛瘀补气并疏通胃肠。
按：患者血压渐趋平稳，以少腹血瘀证兼气虚、腑实证为主。治宜活血祛瘀补气并疏通胃肠。方中东参大补元气，丹参、赤芍、元胡、桃仁活血化瘀，大黄、芒硝、枳实、厚朴为大承气汤，可泻下通便，疏通胃肠，肉桂辛甘热，能温补命门之火，且温中有通，寒凝瘀滞之疼痛最为相宜。
12月11日：病人一般情况好，血压平稳，脉有力。昨日自胃管灌注中药并配合炒大葱腹部热敷之后，肠蠕动增强并有排气。今日用50％甘油灌肠后又有排便。腹痛腹胀渐好转。超声波探测显示腹腔内有液体平面。腹腔穿刺抽出6毫升不凝血，与末梢血对照有显著差异，镜检有花边状红细胞。化验检查：血红蛋白5．2克，尿胆素与胆红质均阴性，尿胆原可疑，黄疸指数2。停药。
12月12日：一般情况好，不活动时无腹痛，有饥饿感．阴道出血量很少。脉有力，舌苔薄白，腹部稍胀，有轻度压痛与反跳痛，移动性浊音阳性。服宫外孕工号方加当归9克，陈皮6克。
12月14日：自觉左下腹部轻痛。检查：巩膜稍黄，腹部压痛和反跳痛不明显，移动性浊音阳性。内诊检查：外阴、阴道、宫颈无异常发现，宫体前位，正常大小，活动，无压痛，附件右侧可对合，左侧近宫体处可触及5厘米×6厘米大小扁包块，很软，有漂浮感，无压痛。化验检查：尿妊娠试验：原尿阴性，尿浓缩试验阳性。服宫外孕工号方。
12月18日：无不适感，昨日已下床活动。尿深茶色，巩膜皮肤黄染明显，腹部移动性浊音阳性。内诊检查：附件左侧可触及3厘米×5厘米×3厘米大小包块，软，可活动，无压痛。化验检查：肝功能正常。黄疸指数等因溶血不能作。服宫外孕Ⅱ号方加茵陈15克。
按：患者病情稳定，以腹腔血肿包块为主症，治宜攻坚消积，方用宫外孕Ⅱ号方。因患者巩膜皮肤黄染，加茵陈以除湿退黄。
12月22日：皮肤巩膜黄染渐轻，脉有力，腹部移动性浊音消失。
12月25日：黄疸已消退，黄疸指数6。血红蛋白10．3克。内诊检查：宫体左上方可触及3厘米×4厘米×6厘米大小软包块。继续服宫外孕Ⅱ号方至包块消失。
1966年4月14日随访病人，无不适，月经规律。内诊检查：宫体前位，正常大小，活动，无压痛，附件双侧可对合，无压痛。
案： 赵某。26岁。病历号：34。
主因停经5个多月，腹痛、阴道出血1个多月，2天来加剧，于1961年5月1日入院。1960年11月开始闭经，1961年2月5日结婚，3月24日开始有少量不规则阴道出 血伴轻度腹痛，4月29日有数次发作性较剧烈的腹痛，5月1日腹痛加剧，伴眼黑及出冷汙。体格检查：血压55／30毫米汞柱，脉搏80次／分，细弱，腹部压痛，以下腹部明显，移动性浊音阳性．内诊检查：后穹隆饱满，宫颈有举痛，宫体前位，大小正常，活动，有压痛，附件双侧不易对合，有液体存在感和压痛。血红蛋白9克。
入院后给予输液、输血(200毫升)、吸氧等抢救措施，血压维持在70／50毫米汞柱以上。3小时后，血压稳定于90／70毫米汞柱。服宫外孕工号方加减。4天后移动性浊音消失。第5天查血红蛋白5．6克。8天后再次腹痛，血压一度下降。17天后内诊检查附件右侧可触及不具体包块，大小欠清。继续服宫外孕Ⅰ号方加减至包块完全消失。
出院后于1963年1月10日在我科足月顺产一男孩，母子均好。同年6月12日因右下腹痛12小时，诊断为急性阑尾炎，在我院外科手术。打开腹腔后无血液积存，肠管等也无粘连，右侧输卵管稍增粗，有轻微粘连，极易分离，壶腹部有米粒大小之瘢痕，左侧输卵管正常。
根据临床体会，李老认为，宫外孕单纯者，治疗期短而容易，有兼证者，治疗期长而较难。特别是兼虚之证者，治疗时间最久，因为该证是虚中夹实，既不能充分使用补药，又不能充分使用攻药。但关于兼证治疗的规律和关键已经有了初步的把握。此外，患者本人或家属如果强调使用手术治疗时我们绝不可勉强。
补虚消积治包块
宫外孕患者未破损或破损后腹腔内血液形成血肿包块，应以攻坚消积为治，经临床筛选，确立了由丹参、赤芍、桃仁、三棱、莪术组成的宫外孕Ⅱ号方，但包块型患者常兼虚证，且攻坚药久用易伤正气，临床又有寒热之不同，为此，李老立三方以应不同之需：
一、寒性补虚消积之方
主治：宫外孕善后包块兼喜冷之证。
药品：
水蛭30克 生口芪75克 三棱15克 莪术15克 当归45克 知母18克 生桃仁24克 麝香(另研，后人)0．3克
制法：除麝香另研外，先将诸药共研细末，人麝香和匀，炼蜜为丸，梧子大。
服法：每服3～4．5克，早晚空心开水送下。
二、热性补虚消积之方
主治：宫外孕善后包块兼喜热之证。
药品：
水蛭30克 生口芪30克 三棱15克 莪术15克 当归45克 肉桂18克 桃仁24克 麝香(另研，后入)0．3克
制法：除麝香外，先将诸药共研细末，人麝香和匀，炼蜜为丸，梧子大。
服法：每服3～4．5克，早晚空心开水送下。 三、平性补虚消积之方 主治：宫外孕善后包块体虚者。 药品： 水蛭30克 生口芪75克 三棱15克 莪术15克 当归45克 人参30克 生桃仁24克 麝香(另研，后入)O．3克
Ectopic pregnancy, in essence, does not inherently involve the presence of blood stasis. However, why can the method of invigorating blood and resolving stasis achieve a cure? This is based on theoretical grounds.
From the perspective of the disease's onset: ① The pain has a fixed location, specifically in the lower abdomen (Shaofu); ② The pain is quite severe, accompanied by stabbing sensations and aversion to pressure; ③ The timing of the pain coincides with delayed menstruation or irregular, scanty menstrual flow.
Based on these characteristics, ectopic pregnancy aligns with the syndrome differentiation of Lower Abdomen Blood Stasis Syndrome (a condition caused by blood stagnation in the lower abdomen). Therefore, treatment with methods to invigorate blood and dispel stasis is appropriate.
Addressing the main symptoms of ectopic pregnancy patients—amenorrhea for over a month followed by lower abdominal pain with aversion to pressure, potentially leading to shock, and vaginal bleeding—Dr. Li established the therapeutic principle of dispelling stasis, dissipating masses, and relieving pain. He selected Huoluo Xiaoling Dan (Vessel-Activating Efficacy and Spirit-Rescuing Decoction) with modifications as the primary prescription, consisting of Danshen (Salviae Miltiorrhizae Radix et Rhizoma), Guiwei (Angelicae Sinensis Radix Caulis), Raw Rush Xiang (Boswelliae Resina), Raw Mo Yao (Myrrhae Resina), Huainiuxi (Achyranthis Bidentatae Radix), Sumu (Pterocarpus Santalinus Lignum), and Taoren (Persicae Semen). Due to the severe shortage of Danggui at the time, it was replaced with Chishao (Paeoniae Radix Rubra). Rush Xiang and Mo Yao not only circulate Qi and blood in the meridians but also resolve Qi and blood stagnation in all organs and viscera. These two herbs are best used raw; if stir-fried, their circulating power diminishes significantly. However, raw usage may easily induce vomiting, which increases intra-abdominal pressure and exacerbates bleeding, so the term "raw" was removed. Later, because some patients still vomited due to the peculiar taste of Rush Xiang and Mo Yao, these herbs were omitted. After repeated clinical verification, the main formula for treating ruptured ectopic pregnancy, composed of Danshen, Chishao, and Taoren, was formed, known as Ectopic Pregnancy Formula No. 1. However, clinical practice has also confirmed that if patients can tolerate Rush Xiang and Mo Yao, retaining them yields better results.
After rupture of an ectopic pregnancy, acute massive internal hemorrhage can occur, accompanied by continuous, irregular, scanty vaginal bleeding. At this point, should one invigorate blood or stop bleeding? Traditional Chinese Medicine theory holds that under normal conditions, blood flows continuously within the vessels, irrigating the Zang-Fu organs and nourishing the limbs and bones. Once, for various reasons, blood leaves the vessels and bleeds abnormally, causing syndromes such as metrorrhagia, if hemostasis is applied too hastily, it tends to leave residual stasis. Purely using astringent hemostatic methods often leads to stasis retention due to astringency. Therefore, hemostasis should address the root cause. For bleeding caused by blood stasis forcing blood out of the vessels, the primary approach should be invigorating blood and resolving stasis, rather than solely focusing on stopping bleeding. Hence, there is the saying, "When seeing blood, do not immediately stop it." In summary, only by determining the treatment based on the etiology can efficacy be improved. Clinical practice has also confirmed that using carbonized herbs for hemostasis can cause premature coagulation of blood in the abdominal cavity, forming large, hard hematoma masses that are difficult to absorb, preventing endometrial shedding and making vaginal bleeding difficult to stop. Conversely, maintaining the principle of invigorating blood and resolving stasis throughout the treatment of ectopic pregnancy patients results in softer hematoma masses from coagulated blood in the abdominal cavity, which are easier to absorb and yield better effects. As for vaginal bleeding, once the uterine decidua is completely expelled, the endometrium repairs itself, and the hematoma mass disappears, the bleeding will naturally cease.
Syndrome Differentiation and Treatment of Accompanying Syndromes
In terms of nature, ectopic pregnancy is a excess syndrome. However, patients with ectopic pregnancy may have underlying cold syndromes, heat syndromes, Liver Qi stagnation, pelvic inflammatory disease, Spleen and Stomach deficiency with poor appetite, intestinal tuberculosis with frequent diarrhea, temporary common cold, food stagnation, secondary jaundice, or even simultaneous internal bleeding leading to severe shock. There are countless variations. TCM treatment is not a single formula or herb but considers the whole picture, applying syndrome differentiation and treatment. How to differentiate and treat? Simply put, it involves flexibly applying theories from the *Neijing* (Classic of Internal Medicine): "Tonify deficiency, drain excess, warm cold, clear heat," "Treat new diseases first, old diseases later," and "In emergencies, treat the branch/symptoms; in stable conditions, treat the root/cause," combined with the patient's objective reality. The following discusses several common accompanying syndromes of ectopic pregnancy:
I. Fu Organ Excess Syndrome
Fu organ excess syndrome is the most common and important accompanying syndrome in ectopic pregnancy patients. Its clinical manifestations include constipation, abdominal distension, epigastric discomfort, and lower abdominal pain with aversion to pressure. When patients have this accompanying syndrome, abdominal pain intensifies, preventing rest. Frequent nausea and vomiting can lead to re-bleeding, appearing or worsening shock. Simultaneously, gastrointestinal dysfunction prevents timely nutritional supplementation and hinders drug absorption. Therefore, promptly resolving Fu organ excess syndrome is crucial and key to achieving good results. Dr. Li believes that purgative methods must be used at this time. Depending on whether the accompanying gastrointestinal stagnation is cold, heat, or mixed cold and heat, the treatment methods vary.
(1) Cold-Type Formula for Invigorating Blood, Resolving Stasis, and Relieving Pain
Indications: Early-stage ectopic pregnancy abdominal pain accompanied by preference for cold and constipation.
Ingredients: Chishao, Guiwei, Taoren, Mangxiao (Natrii Sulfas), Dahuang (Stir-fried with vinegar), Huainiuxi, Yuanhu, Xiangfu, Lingzhi (Pistacis Resina), Puhuang (Typhae Pollen), Shexiang (Moschus, added later), Moyao.
Preparation: Grind into fine powder, make pills with water, size of mung beans.
Dosage: Take 9 grams each time, washed down with boiled water, 1–2 times daily.
Alternatively, combine with Dachengqi Tang (Major Order the Qi Decoction): Dahuang and Mangxiao 3–7.5 grams each, Zhishi (Aurantii Fructus Immaturus) and Houpo (Magnoliae Officinalis Cortex) 3–9 grams each. Add Dahuang later; dissolve Mangxiao in two portions and take orally.
(2) Heat-Type Formula for Invigorating Blood, Resolving Stasis, and Relieving Pain
Indications: Early-stage ectopic pregnancy abdominal pain accompanied by preference for heat and constipation. (Note: The text describes using warming herbs with purgatives, likely addressing specific cold-heat complex presentations despite the label).
Ingredients: Chishao, Guiwei, Taoren, Mangxiao, Dahuang (Stir-fried with vinegar), Huainiuxi, Yuanhu, Xiangfu, Lingzhi, Guigui (Cinnamomi Ramulus), Shexiang, Xiaohui (Foeniculi Fructus), Moyao.
Preparation: Grind into fine powder, make pills with water, size of mung beans.
Dosage: Take 9 grams each time, washed down with boiled water, 1–2 times daily.
This formula uses Dahuang and Mangxiao assisted by a relatively large amount of warming herbs. Add Guigui for cold lower abdomen, or Rougui (Cinnamomi Cortex) for general coldness.
Alternatively, use *Jin Gui Yao Lue*'s Jiutong Wan (Nine-Pain Pill): Paofuzi (Prepared Aconiti Lateralis Radix Praeparata) 9g, Gaolishen (Ginseng Radix), Ganjiang (Zingiberis Rhizoma), Wuzhuyu (Evodiae Fructus), Langdu (Stellerae Radix, stir-fried with vinegar), Badoushuang (Crotonis Semen Extractum) each 3g. Grind into fine powder, make pills with refined honey, size of pea. Dosage depends on constitution and condition, 3–10 pills per dose, taken with hot boiled water, or dissolved in hot water and injected via nasogastric tube, then stop gastric decompression for 2 hours.
(3) Formula for Mixed Cold and Heat
Use Dahuang and Mangxiao, assisted by appropriate amounts of Guigui or Rougui.
Precautions: Patients with ectopic pregnancy who have experienced massive internal hemorrhage differ from typical acute abdomen patients, especially those in shock with significant internal bleeding and collapse. Purgatives should not be overdosed. To avoid damaging healthy Qi, purgatives should be stopped once the condition improves and not used long-term. Special attention is needed when combining with Qi-breaking herbs like Zhishi and Houpo. Generally, patients can take purgatives twice consecutively. If ineffective, do not continue; switch back to the main formula. After 1–2 days, repeat purgatives 1–2 times, which often proves effective.
II. Qi Deficiency Syndrome
Symptoms include fatigue, shortness of breath, reluctance to speak, and poor appetite. Add Dangshen (Codonopsis Radix) 6–9 grams to the main formula.
III. Qi Deficiency with Impending Collapse Syndrome
Common in shock-type cases. Immediate intravenous fluids, oxygen, and blood transfusion to replenish blood volume are required, combined with active rescue using TCM. Administer Ectopic Pregnancy Formula No. 1 and purgatives orally to treat early or prevent Fu organ excess syndrome.
Common Prescription: Danshen 15g, Chishao 15g, Taoren 9g, Zhishi 6–9g, Houpo 6–9g, Yuanhu 9g, Guiwei 9g.
Administer purgatives to unblock the gastrointestinal tract based on cold, heat, or mixed patterns. If blood pressure does not rise or is unstable, with severe signs of collapse, add Shengmai San (Generate the Pulse Powder): Guandongshen (Panax Ginseng Radix) 9–15g, Maidong (Ophiopogonis Radix) 15g, Wuweizi (Schisandrae Chinensis Fructus) 15g. Or add Dushen Tang (Single Ginseng Decoction): Guandongshen 9–15g, decocted separately and taken frequently. For cold extremities, add Fuzi (Aconiti Lateralis Radix Praeparata) 6–9g. For profuse sweating, add Shanzhuyu (Corni Fructus) 15–30g.
Using Renshen (Ginseng) greatly tonifies Yuan Qi to secure collapse, benefits Qi to stop bleeding, supports Zheng Qi to expel pathogenic factors, and tonifies deficiency to relieve pain. However, since ectopic pregnancy is fundamentally an excess syndrome, if deficiency is not severe, it need not be used universally. Overuse or misuse often causes abdominal fullness, worsened abdominal pain, and aggravated condition.
Attached Cases:
Case 1: Ji, Female, 24 years old. Medical Record No. 300. Admitted December 9, 1965, at 20:00.
Menstruation had been absent for 40 days. Vaginal bleeding for over 1 day. Sudden severe abdominal pain for over 5 hours. Fainted twice, accompanied by vomiting and cold sweats. Blood pressure measured 60/0 mmHg one hour before admission. Upon admission, blood pressure was unmeasurable, pulse was faint and nearly imperceptible, extremities and nose tip were cold. Abdomen slightly distended, mild muscle tension, obvious tenderness and rebound tenderness, especially in the epigastrium and left lower quadrant. Dullness below the anterior axillary line on both sides. Bowel sounds weak. No shifting dullness elicited. No pelvic exam performed. Diagnosis: Ectopic Pregnancy (Left Tubal Pregnancy Rupture) Shock Type.
Specific Treatment Methods:
1. Intravenous fluids, blood transfusion, oxygen inhalation.
2. Guandongshen 9g, crushed and taken orally.
3. Danshen 15g, Chishao 6g, Banxia (Pinelliae Rhizoma) 6g, Yuanhu 6g, Taoren 6g, Fuzi 3g. Decoct and take orally.
4. Jiutong Wan 6 pills, taken with hot boiled water.
Commentary: This patient presents with an excess syndrome of Lower Abdomen Blood Stasis, complicated by acute Blood Deficiency and Qi Collapse (deficiency syndrome), Cold syndrome, and Fu Organ Excess syndrome. Treatment should focus on invigorating blood, resolving stasis, assisting Yang, supporting Zheng Qi, and simultaneously using Warm Purgation to unblock the gastrointestinal tract. The formula uses Fuzi, extremely acrid and hot, to restore Yang and rescue from collapse. Danshen, Chishao, Yuanhu, and Taoren invigorate blood and resolve stasis. Banxia dries dampness and transforms phlegm. Hot water is used to administer Jiutong Wan to prevent the occurrence of Fu organ excess syndrome.
December 10: Before midnight, blood pressure fluctuated between 70–90/40–50 mmHg. Afterwards, maintained above 90–100/50–70 mmHg, slightly stabilized, pulse gradually strengthened. Abdominal distension, especially in the epigastrium, remained prominent. Fluid level did not rise. Bowel sounds still weak. No flatus or defecation. Gastrointestinal decompression performed. TCM administered:
Guandongshen 15g, Danshen 15g, Chishao 7.5g, Yuanhu 6g, Taoren 6g, Dahuang (added later) 4.5g, Mangxiao (dissolved) 3g, Zhishi 6g, Houpo 6g, Rougui 9g.
Decoct and take orally to continue invigorating blood, resolving stasis, tonifying Qi, and unblocking the gastrointestinal tract.
Commentary: Patient's blood pressure is gradually stabilizing. Main syndrome is Lower Abdomen Blood Stasis complicated by Qi Deficiency and Fu Organ Excess. Treatment focuses on invigorating blood, resolving stasis, tonifying Qi, and unblocking the gastrointestinal tract. Guandongshen greatly tonifies Yuan Qi. Danshen, Chishao, Yuanhu, and Taoren invigorate blood and resolve stasis. Dahuang, Mangxiao, Zhishi, and Houpo constitute Dachengqi Tang, which purges and unblocks the bowels and gastrointestinal tract. Rougui is acrid, sweet, and hot, warming the Mingmen Fire, promoting circulation within warmth, making it suitable for pain caused by cold coagulation and blood stasis.
December 11: Patient's general condition is good, blood pressure stable, pulse strong. Following infusion of TCM via gastric tube and abdominal hot compress with stir-fried green onions yesterday, bowel peristalsis increased and flatus passed. Today, after enema with 50% glycerin, defecation occurred. Abdominal pain and distension gradually improved. Ultrasound showed fluid levels in the abdominal cavity. Abdominal paracentesis yielded 6ml of non-clotting blood, significantly different from peripheral blood; microscopy showed lace-like red blood cells. Lab tests: Hemoglobin 5.2g, Urobilinogen and Bilirubin negative, Urobilinogen questionable, Jaundice Index 2. Stop medication.
December 12: General condition good. No abdominal pain when inactive, feeling hungry. Scanty vaginal bleeding. Pulse strong, tongue coating thin white. Abdomen slightly distended, mild tenderness and rebound tenderness, shifting dullness positive. Take Ectopic Pregnancy Formula No. 1 plus Danggui 9g, Chenpi (Citri Reticulatae Pericarpium) 6g.
December 14: Mild pain in left lower abdomen. Examination: Sclera slightly yellow. Abdominal tenderness and rebound tenderness not obvious. Shifting dullness positive. Pelvic exam: Vulva, vagina, cervix normal. Uterus anteverted, normal size, mobile, no tenderness. Right adnexa reducible. Left adnexa near uterus palpable 5cm x 6cm flat mass, very soft, floating sensation, no tenderness. Lab tests: Urine pregnancy test: Original urine negative, concentrated urine positive. Take Ectopic Pregnancy Formula No. 1.
December 18: No discomfort, ambulating yesterday. Urine dark tea-colored. Sclera and skin jaundice obvious. Abdominal shifting dullness positive. Pelvic exam: Left adnexa palpable 3cm x 5cm x 3cm mass, soft, mobile, no tenderness. Lab tests: Liver function normal. Jaundice index etc. cannot be done due to hemolysis. Take Ectopic Pregnancy Formula No. 2 plus Yinchen (Artemisiae Scopariae Herba) 15g.
Commentary: Patient's condition is stable. Main symptom is intra-abdominal hematoma mass. Treatment focuses on attacking hardness and dissipating accumulation, using Ectopic Pregnancy Formula No. 2. Due to scleral and cutaneous jaundice, Yinchen is added to drain dampness and reduce jaundice.
December 22: Cutaneous and scleral jaundice gradually lightening. Pulse strong. Abdominal shifting dullness disappeared.
December 25: Jaundice resolved. Jaundice Index 6. Hemoglobin 10.3g. Pelvic exam: Soft mass 3cm x 4cm x 6cm palpable upper left of uterus. Continue taking Ectopic Pregnancy Formula No. 2 until mass disappears.
Follow-up April 14, 1966: No discomfort, regular menstruation. Pelvic exam: Uterus anteverted, normal size, mobile, no tenderness. Both adnexae reducible, no tenderness.
Case 2: Zhao, Female, 26 years old. Medical Record No. 34.
Main complaint: Amenorrhea for over 5 months, abdominal pain and vaginal bleeding for over 1 month, aggravated for 2 days. Admitted May 1, 1961. Menstrual cessation started November 1960. Married February 5, 1961. Irregular scanty vaginal bleeding with mild abdominal pain started March 24, 1961. Several episodes of severe abdominal pain on April 29. Abdominal pain aggravated on May 1, accompanied by blurred vision and cold sweats. Physical examination: Blood pressure 55/30 mmHg, pulse 80 bpm, thready and weak. Abdominal tenderness, obvious in lower abdomen. Shifting dullness positive. Pelvic exam: Posterior fornix full. Cervical motion tenderness present. Uterus anteverted, normal size, mobile, tender. Both adnexae not reducible, sense of fluid and tenderness present. Hemoglobin 9g.
Upon admission, resuscitation measures including IV fluids, blood transfusion (200ml), and oxygen were given. Blood pressure maintained above 70/50 mmHg. After 3 hours, blood pressure stabilized at 90/70 mmHg. Take modified Ectopic Pregnancy Formula No. 1. Shifting dullness disappeared after 4 days. On day 5, Hemoglobin was 5.6g. Abdominal pain recurred after 8 days, blood pressure dropped temporarily. After 17 days, pelvic exam revealed indistinct mass in right adnexa. Continue modified Ectopic Pregnancy Formula No. 1 until mass completely disappears.
Delivered a healthy boy vaginally at term on January 10, 1963. Mother and child well. On June 12 same year, diagnosed with acute appendicitis due to right lower quadrant pain for 12 hours, underwent surgery. Upon opening the abdominal cavity, no blood accumulation, no adhesions of intestines, right fallopian tube slightly thickened with mild adhesions easily separable, scar the size of a grain of rice in ampulla, left fallopian tube normal.
Based on clinical experience, Dr. Li believes that simple ectopic pregnancy has a short treatment period and is easy to treat. Cases with accompanying syndromes have longer treatment periods and are more difficult. Especially cases with deficiency, where treatment takes the longest, as they are deficiency mixed with excess, preventing full use of tonics or purgatives. However, preliminary grasp of the laws and keys for treating accompanying syndromes has been achieved. Furthermore, if the patient or family insists on surgical treatment, we must not force it.
Tonifying Deficiency and Dissipating Accumulation to Treat Masses
For ectopic pregnancy patients without rupture or with hematoma formation in the abdominal cavity after rupture, the treatment should focus on attacking hardness and dissipating accumulation. Through clinical screening, Ectopic Pregnancy Formula No. 2, composed of Danshen, Chishao, Taoren, Sanleng (Sparganii Rhizoma), and Ezhu (Curcumae Rhizoma), was established. However, mass-type patients often have accompanying deficiency syndromes, and long-term use of attacking drugs easily damages healthy Qi. Clinically, there are also differences in cold and heat. Therefore, Dr. Li established three formulas to meet different needs:
1. Cold-Type Formula for Tonifying Deficiency and Dissipating Accumulation
Indications: Post-ectopic pregnancy mass accompanied by preference for cold.
Ingredients: Shui zhi (Hirudo) 30g, Shengkouqi (Astragali Radix) 75g, Sanleng 15g, Ezhu 15g, Danggui 45g, Zhimu (Anemarrhenae Rhizoma) 18g, Shengtaoren 24g, Shexiang (Moschus, separately ground, added later) 0.3g.
Preparation: Besides grinding Shexiang separately, grind other herbs into fine powder, mix with Shexiang, make pills with refined honey, size of mulberry seeds.
Dosage: Take 3–4.5 grams each time, morning and evening on an empty stomach with boiled water.
2. Heat-Type Formula for Tonifying Deficiency and Dissipating Accumulation
Indications: Post-ectopic pregnancy mass accompanied by preference for heat.
Ingredients: Shui zhi 30g, Shengkouqi 30g, Sanleng 15g, Ezhu 15g, Danggui 45g, Rougui 18g, Taoren 24g, Shexiang (separately ground, added later) 0.3g.
Preparation: Besides Shexiang, grind other herbs into fine powder, mix with Shexiang, make pills with refined honey, size of mulberry seeds.
Dosage: Take 3–4.5 grams each time, morning and evening on an empty stomach with boiled water.
3. Neutral-Type Formula for Tonifying Deficiency and Dissipating Accumulation
Indications: Post-ectopic pregnancy mass in patients with deficiency.
Ingredients: Shui zhi 30g, Shengkouqi 75g, Sanleng 15g, Ezhu 15g, Danggui 45g, Renshen 30g, Shengtaoren 24g, Shexiang (separately ground, added later) 0.3g.