小产者，言非大产，在四五六月之间而堕者，所谓半产是也。若二三月，人像未全，还是血
块。苟有所伤而堕者，非曰堕胎，三者皆属根蒂不固，冲任经虚，须分是火是寒治之。有火
者清之，白术、黄芩之属，而益以养血也。寒者温之，胶艾、桂附之属，而加六味。然桂附
辛热，尚宜酌用，切勿轻投，实者清之，虚者补之，尤当顾脾胃以生新血。盖胃为水谷之海
，脾为万物之母，人身之有脾胃，犹万物之有土也。有土乃生金，金生水，水生木，木生
火，故培土而五行有相生之妙，扶脾胃而五脏有递受之益，在孕妇永保无虞，何有堕胎小产
之虞哉?
宋遂真先生曰∶前哲云，初受胎而即堕者，肝血虚也。胎以血为本，肝脏虚则生发之机困，
如春初多冷，草木不芽可知也。治宜益肝血，胎斯固矣。二月堕者亦然。实者反是。三月堕
者，心血虚也。胎以血为根本，心脏虚则长茂之气消。如夏初天气暴寒，而花果不实可知也
。治宜养心补血，胎斯固矣。四月堕者亦然。五六七八月而堕者，责在气血之并虚也。盖气
为血之卫，血为气之配，气不能卫血则血无所统，血不能配气则气无所归。儿在母腹中，所
赖母之气血充和耳，苟有所伤，安所赖乎?是以调气先必养血，盖血尤须补气，养血而血不
生，补血之源，肾水是也。补气而气不足，补气之根，命门火也。故五六月间而有堕胎者，
六味去丹皮加人参、麦冬、杜仲、续断为要药。寒痛者加附子少许，百无一失也。有胎乱动
而不休者，胎热也，不可用燥热之剂。此外胎动者，或因冲任经虚，或因七情六欲，或因过
服热药，须各审清病源而治之，如四五月间，心中昏闷，四肢沉重，不能移动，恶闻谷食，
喜吞酸味，胎动不安，安胎饮主之，或紫苏饮加半夏、茯苓、枳壳。
小产，是指并非足月生产，而是在怀孕四、五、六月之间发生流产的情况，也就是所谓的“半产”。如果是怀孕二、三个月时流产，此时胎儿尚未完全成形，排出的物质仍像血块一样。如果是因为受到损伤而导致流产的，这不叫堕胎（指故意或外力导致的早期流产），这三种情况（小产、早期血块样流产、堕胎）都属于根基不固、冲脉和任脉虚弱所致，治疗时必须分辨是火邪还是寒邪所致。对于有火邪的，采用清热的方法，使用白术、黄芩这类药物，并辅以养血药；对于有寒邪的，采用温补的方法，使用阿胶、艾叶、肉桂、附子这类药物，并加入六味地黄丸加减。然而肉桂、附子辛热燥烈，应当斟酌使用，切勿轻易投用。实证者宜清泻，虚证者宜补益，尤其应当顾护脾胃以化生新血。因为胃是水谷之海，脾是万物之母，人身拥有脾胃，就像万物拥有土地一样。有了土地才能生出金，金生水，水生木，木生火，所以培补脾胃则五行具有相生之妙，扶持脾胃则五脏能得到递相受益的好处，在孕妇身上若能永远保持这种状态而无虞，哪里还会有堕胎或小产的忧患呢？
宋遂真先生说：前代哲人曾说，受孕之初即发生流产的，是肝血虚损所致。胎儿以血为根本，肝脏虚损则生发之机受困，就像初春寒冷多时，草木不能发芽一样，这是显而易见的。治疗应当补益肝血，胎儿就能稳固了。怀孕两个月流产的情况也是如此。实证则相反。怀孕三个月流产的，是心血虚损所致。胎儿以血为根本，心脏虚损则长养茂盛之气消退。就像初夏天气突然变寒，花果就不能结果一样，这也是显而易见的。治疗应当滋养心脏、补益血液，胎儿就能稳固了。怀孕四个月流产的情况也是如此。怀孕五、六、七、八个月流产的，责任在于气血同时虚损。因为气是血的护卫，血是气的配偶，气不能护卫血则血无所统摄，血不能配合气则气无所归属。婴儿在母腹中，所依赖的是母亲的气血充盛调和，如果有所损伤，还能依赖什么呢？因此调理气必须先养血，而养血又必须补气，养血的源头在于肾水。补气而气不足，补气的根本在于命门之火。所以在五、六个月间发生堕胎的，以六味地黄丸去掉丹皮，加入人参、麦冬、杜仲、续断作为要药。如果有寒痛症状，加少许附子，几乎百无一失。如果有胎动不安且持续不止的，是胎热所致，不可使用燥热性质的药剂。此外导致胎动的，可能是因为冲任经脉虚弱，可能是因为七情六欲失调，可能是因为过服热性药物，必须分别审清病源而进行治疗。例如在四、五月间，出现心中昏闷、四肢沉重、不能移动、厌恶闻谷物食物的气味、喜欢吞咽酸味、胎动不安等症状，主方用安胎饮，或者紫苏饮加半夏、茯苓、枳壳。
Xiao chan (spontaneous abortion in the mid-trimester) refers to miscarriage occurring between the fourth and sixth months of pregnancy, rather than at full term; this is also known as ban chan (half-birth). If miscarriage occurs in the second or third month, when the fetus is not yet fully formed, the expelled material resembles a blood clot. If miscarriage results from injury, it is termed tuo tai (induced or traumatic early miscarriage); these three conditions—xiao chan, early expulsion resembling blood clots, and tuo tai—all stem from an unstable root and deficiency of the Chong and Ren meridians. Treatment must distinguish whether the cause is fire or cold. For cases involving fire, clear the heat using herbs such as Baizhu (Atractylodis Macrocephalae Rhizoma) and Huangqin (Scutellariae Radix), supplemented by blood-nourishing agents. For cases involving cold, warm the interior using herbs such as Ejiao (Colla Corii Asini) and Aiyè (Artemisiae Argyi Folium), along with Guizhi (Cinnamomi Ramulus) and Fuzi (Aconiti Lateralis Radix Praeparata), combined with Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). However, since Guizhi and Fuzi are acrid and hot, they should be used with caution and never administered lightly. Excess patterns require clearing, while deficiency patterns require tonifying; particular attention must be paid to protecting the Spleen and Stomach to generate fresh blood. The Stomach is the sea of water and grain, and the Spleen is the mother of all things; just as all things rely on earth, the human body relies on the Spleen and Stomach. Earth generates Metal, Metal generates Water, Water generates Wood, and Wood generates Fire. Therefore, fortifying the Earth element facilitates the mutual generation of the Five Phases, and supporting the Spleen and Stomach brings sequential benefits to the Five Zang organs. If pregnant women can maintain this state without worry, there would be no risk of tuo tai or xiao chan.
Mr. Song Suizhen stated: Ancient sages said that miscarriage immediately after conception is due to Liver Blood deficiency. The fetus is rooted in blood; if the Liver is deficient, its generating mechanism is hindered, much like how grass and trees fail to sprout in the early spring when cold prevails. Treatment should focus on nourishing Liver Blood to stabilize the fetus. The same applies to miscarriage in the second month. Excess patterns present oppositely. Miscarriage in the third month is due to Heart Blood deficiency. Since the fetus is rooted in blood, Heart deficiency leads to a decline in the qi of growth and flourishing, similar to how flowers and fruits fail to set when sudden cold strikes in early summer. Treatment should nourish the Heart and tonify blood to stabilize the fetus. This also applies to miscarriage in the fourth month. Miscarriage in the fifth, sixth, seventh, or eighth months is attributed to simultaneous deficiency of Qi and Blood. Qi acts as the guard of Blood, and Blood is the companion of Qi; if Qi cannot guard Blood, Blood has no control; if Blood cannot accompany Qi, Qi has no return. The fetus in the womb relies on the mother’s abundant and harmonious Qi and Blood. If injured, what reliance remains? Therefore, regulating Qi requires first nourishing Blood, and nourishing Blood requires tonifying Qi. The source of Blood is Kidney Water; if Blood fails to generate, one must address this source. The root of Qi is Mingmen Fire; if Qi is insufficient, one must strengthen this root. Thus, for miscarriage occurring between the fifth and sixth months, the essential prescription is Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) modified by removing Mudanpi (Moutan Cortex) and adding Renshen (Ginseng Radix et Rhizoma), Maidong (Ophiopogonis Radix), Duzhong (Eucommiae Cortex), and Xuduan (Dipsaci Radix). If cold pain is present, add a small amount of Fuzi (Aconiti Lateralis Radix Praeparata), which yields nearly perfect results. If fetal movement is restless and unceasing, it indicates fetal heat; dry and hot formulas must not be used. Other causes of fetal movement include deficiency of the Chong and Ren meridians, emotional disturbances (Seven Emotions and Six Desires), or excessive consumption of hot medicines. One must carefully identify the pathogenesis and treat accordingly. For example, during the fourth or fifth month, if symptoms include mental confusion, heaviness of the four limbs, immobility, aversion to the smell of food, craving for sour tastes, and restless fetus, the primary formula is Antai Yin (Fetus-Stabilizing Decoction), or Zisu Yin (Perilla Decoction) modified with Banxia (Pinelliae Rhizoma), Fuling (Poria), and Zhike (Aurantii Fructus Immaturus).