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Zhu Danxi stated: When Yang exerts and Yin transforms, conception occurs. If Qi and Blood are deficient and insufficient to nourish the fetus, spontaneous abortion will happen naturally. Alternatively, labor or anger may injure the emotions, causing internal Fire to move, which can also lead to miscarriage. Tracing back to the root cause, it is all due to Heat-Fire consuming substances, following the natural laws of creation. *The Source of Diseases* attributes miscarriage to Wind-Cold injuring the uterus, which fails to grasp the true nature of the disease. I observed a woman surnamed Jia who, whenever pregnant, would inevitably miscarry around the third month. Her pulse was large and powerless on the left hand, and choppy upon heavy pressure, indicating Blood deficiency. Since she was young, I only tonified Middle Qi, allowing Blood to become abundant naturally. At that time, it was early summer. I instructed her to decoct Baizhu Tang (using only Baizhu to tonify Middle Qi, as Ying Qi originates from the Middle Jiao, and Earth generates all things), taking one qian of Huangqin powder with it. After taking thirty to forty doses, she successfully carried the pregnancy to term. Reflecting on this, miscarriages caused by internal Heat and deficiency are more common in principle. One must distinguish the severity of Heat and Deficiency. Generally, at three months of pregnancy, the Ministerial Fire is active, making miscarriage prone; otherwise, why are Huangqin, Shu Ai (Shu Ai is warm-natured and may assist Ministerial Fire, so it might not be suitable if there is actual Heat), and Ejiao considered excellent herbs for stabilizing the fetus? Physicians who cherish life should not underestimate this.

A woman in her thirties experienced amenorrhea or incomplete fetal development followed by inevitable miscarriage. Observing her irritable temperament, dark complexion, and robust Qi, this indicated excessive Ministerial Fire, which failed to generate Qi and transform the fetus, instead consuming Qi and damaging Essence. Therefore, during the second month after missed menses, she was prescribed Huangqin, Baizhu, Danggui, and Gancao. She took them until the end of the third month, then stopped medication, and subsequently gave birth to a son.

Another woman had a choppy or weak and faint Chi pulse three months after missed menses, yet had no other symptoms. This indicated incomplete True Qi in the uterus, resulting in Yang failing to exert and Yin failing to transform. Although Jing and Blood condensed, they could not form a fetus. During delivery, blood clots or placental membranes were expelled.

A woman’s abdomen gradually enlarged like pregnancy. At ten months, she sought medicine for easy delivery. Her spirit and color showed extreme exhaustion, making medication difficult. Not long after, she delivered half a bucket of white worms. This was due to severe deficiency of Yuan Qi; although Jing and Blood condensed, they could not form a fetus but turned into foul and putrid matter. Accumulated over time, Dampness transformed into Heat, and Damp-Heat generated worms. This follows logical principles, requiring the full ten months of Qi movement to expel the material. It was ultimately an ill omen; the woman died within a month. Damp-Heat generating worms is like stagnant, filthy ditches where various insects breed after long accumulation without flow.

Wang Shishan treated a thin, yellowish-white woman in her thirties with an irritable temperament who suffered recurrent miscarriages, having experienced seven or eight such incidents. Her pulses were soft and powerless; the Chi positions were floating and weak, unresponsive to pressing. He stated that frequent miscarriages had severely depleted Qi and Blood, leaving the fetus without nourishment, hence the frequent losses. It is like water drying up causing crops to wither, or soil eroding causing trees to fall. Moreover, the third and fifth months correspond to the activation of Shaoyang Fire. Combined with her irritable nature triggering it, miscarriages often occurred in the third, fifth, and seventh months. He prescribed Da Bu Yin Tang, removing Guizhi and adding Huangbai and Huangqin, decocted and taken orally. The remaining herbs were powdered and made into honey pills for maintenance. After six months of treatment, the fetus stabilized, and she gave birth to two sons.

Qian Zhongyang treated a pregnant woman whose physician predicted imminent miscarriage. Qian said: "During pregnancy, the five Zang organs transmit nourishment. Usually, after sixty days, adjustments are made monthly, supplementing specifically according to the month. Why would miscarriage occur?" Subsequently, both mother and child were preserved.

Chen Douyan treated a woman who miscarried at four months. Ten days later, her abdomen swelled, she had fever, asthma, a surging pulse, red face, and blue-black tongue, mouth, and nose. Chen diagnosed: A surging pulse indicates the fetus is still alive; a red face signifies excess Heart Fire and dried Blood; a blue tongue and black mouth/nose indicate Liver Qi exhaustion and fetal death. Everyone believed the fetus had been dead for a long time. Upon re-examination, the signs remained the same. He used Shed Snake Decoction to administer Pingwei San plus Mangxiao and double the amount of Guiwei. After ingestion, borborygmus sounded like thunder, and intermittent lower abdominal pain occurred, followed by the expulsion of a dead fetus, and the illness resolved.

Cheng Renfu treated a woman nearing forty, constitutionally weak, who induced abortion herself. Within five days, her abdomen distended like a drum up to the epigastrium, accompanied by vomiting and inability to eat. Tonics were ineffective. Her six pulses were weak and faint; she complained of unbearable distension. This was distension caused by Spleen Qi injury. However, in emergencies, treat the branch first. Adhering strictly to Danxi’s method might be too slow. He used Taoren Chengqi Tang added with Zhishi and Houpo, doubling Mangxiao and Dahuang. Taking one-quarter dose resulted in vomiting one-third of the content. The next morning, bowel movement was still obstructed. Given the urgency, he administered Hu Po Wan (Amber Pill) three qian. By Shen hour, there was a massive bowel movement, distension decreased, but she felt fatigued, limbs were weak, taste was lost, and fever persisted. He then prescribed Renshen, [missing character, likely Huangqi], Danggui, Baishao, Zhaxie, Baizhu, and Chenpi. After eight doses, she recovered.

Jiang Yingsu treated Wang Hao’s wife, aged thirty-one, who feared childbirth and mistakenly took abortifacient drugs, resulting in profuse bleeding like a metrorrhagia. Over ten days, she had intermittent abdominal pain and occasional epistaxis. Various medicines failed. Her six pulses were rapid and slightly wiry, indicating rebellious Flow of Fire in the Jueyin channel. He prescribed Siwu Tang with Shengdihuang replacing Shudihuang, adding Ejiao, Chao Hei Shanzhi, and Puhuang. One dose cured her.

Xue Shi stated: Generally, treatment methods require examining which meridian nourishes the fetus in a specific month and prescribing accordingly.

Xiong Lao Buzhong Tang treats pregnancy with Qi and Blood deficiency, unable to protect and nourish, leading to miscarriage after several months, termed semi-miscarriage. (Often seen in women who lose the fetus before ten months; taking this formula ensures safety.)

Chuanxiong, Wuweizi, Ejiao (stir-fried with clam powder), Ganjiang (charred, each 1 qian), Huangqi (deprived of roots, honey-fried), Danggui (soaked in wine), Baishao, Baizhu (each 1.5 qian), Renshen, Duzhong (peeled), Muxiang (not exposed to fire), Gancao (roasted, each 0.5 qian).

Take as one dose, decoct with two sheng of water to one sheng, take at any time.

Ejiao Tang treats recurrent miscarriage in pregnancy with unbearable colic in the lower abdomen.

Ejiao (roasted dry), Shu Dihuang (baked), Aye (lightly stir-fried), Chuanxiong, Danggui (cut and baked), Duzhong (scraped coarse bark, roasted, sliced), Baizhu (each 1 liang).

Crush ingredients. Take 4 qian per dose, with three dates, decoct in water, take warm before meals.

Qianjin Baotai Wan treats women who miscarry at three months after conception. Although Qi and Blood are insufficient, the Chong Mai is injured. The Chong Mai corresponds to the Stomach Meridian of Yangming, which supplies the fetus. At this stage, one must regulate diet, abstain from sexual desire, and avoid anger to prevent premature birth. Taking this formula can preserve the pregnancy. (Although the Pericardium Meridian nourishes the fetus at three months, actually all twelve meridians receive Qi from Yangming. Yangming belongs to Chong; thus, injury to Chong leads to miscarriage. This formula is very stable.)

Baizhu (soil-stir-fried), Shu Dihuang (stir-fried with ginger juice), Duzhong (stir-fried with ginger juice, each 4 liang), Danggui (washed with wine), Xuduan (washed with wine), Ejiao (stir-fried with clam powder), Xiangfu Mi (four-process processed), Yimucao, Tiaoqin (stir-fried, each 2 liang), Chenpi, Chuanxiong, Aye (vinegar-roasted, each 1 liang), Sharen (stir-fried, 5 qian).

Grind into fine powder, mix with jujube paste to make pills the size of paulownia seeds. Take 100 pills per dose with rice soup on an empty stomach.

Duzhong Wan treats fetal restlessness and threat of miscarriage in the third or second month of pregnancy. Preventive use is recommended.

Duzhong (scrape coarse bark, stir-fry with ginger juice, remove fibers).

Grind into powder, mix with jujube paste to make pills the size of paulownia seeds. Take 70 pills per dose with rice drink. (The fetus is tied to the Kidney, so Duzhong is used to tonify the Kidney. If fetal restlessness is mentioned, it may differ due to Spleen deficiency, Qi deficiency, Blood deficiency, Cold, or Heat. Medication should be tailored to the disease, not applied rigidly.)

Shanfan Fang treats pregnancy with repeated non-viable conceptions, cold or heat, the source of hundred diseases.

Huangqi, Renshen, Baizhu, Gancao, Chuanxiong, Dihuang, Wuzhuyu (equal parts).

One prescription includes Danggui and Ganjiang.

Grind into powder. Take 2 qian with warm wine on an empty stomach. Avoid Brassica vegetables, peaches, plums, sparrow meat, and vinegar items.

Lou Shi stated: According to Danxi’s discussion, these cases involve deficiency-Heat without Cold. I temporarily preserve this formula for the rare case where it applies among hundreds. (This remark deserves careful consideration.)