典藏书目

When the fetal qi is injured and disturbed during pregnancy, causes such as falls or blows, anger, weakness, fatigue, erroneous intake of medicines or foods, and imprudent sexual intercourse can all lead to this condition. If the fetal movement is caused by the mother's illness, one should only treat the mother; if the mother's illness is caused by fetal restlessness, one should only stabilize the fetus. In mild cases characterized by restlessness or slight bleeding, if the condition is not severe, immediate stabilization measures should be taken using methods for stabilizing the fetus or sudden bleeding mentioned earlier. If there is abdominal pain with heavy bleeding, soreness and heaviness in the lower back, indicating that the fetus cannot be retained, Juejin Jian (Decoction for Crossing the River) or Wuwu Jian (Decoction of Five Ingredients) are the most appropriate choices to assist blood flow and induce expulsion, which is very suitable. If the condition is severe, presenting with a blue tongue, red face, distension, vomiting, or cold qi rushing upward, the fetus has died. If the face is blue, foam is vomited, and the tongue is red, the mother has died. If the face, tongue, lips, and corners of the mouth are all blue, and foam issues from the mouth, both mother and fetus have died. If the fetus has died, it must be removed quickly to save the mother. For those with deficiency of qi and blood, Juejin Jian is best. If there is no response and distension/pain rushes upward with urgent heat, immediately use Pingwei San (Regulate the Stomach Powder), one liang, decocted with half wine and half water, adding Poxiao (Natrii Sulfas) five qian, taken hot; or use one liang of Poxiao mixed with urine from an uncircumcised child, then the dead fetus will be expelled. After expulsion, tonify according to the syndrome. If there is no urgency or distension, simply use Juejin Jian added with Poxiao, and the dead fetus will naturally pass.

1. Whenever qi and blood are weak and unable to nourish the fetus, or if the mother has a minor illness such that the fetus is unlikely to survive, it is better to induce abortion to avoid other complications. Guixin San (Cinnamon Heart Powder) or Xia Tai Duan Ju Fang (Short and Rapid Formula for Expelling the Fetus) are suitable.

The fetus grows through yang generating and yin nourishing; when qi moves, blood follows, and when Ying and Wei (nutritive and defensive qi) are harmonious, delivery occurs at term. If the mechanism of nourishment is interrupted even slightly, the source and branches will not connect, and the fetus will not be secure. This is like planting: if fluids do not reach, branches wither and fruits fall, vines collapse and flowers drop. As stated in the *Suwen: Chapter on the Five Regular Policies*: "Rooted within, it is called Shen Ji (Spirit Mechanism); when Shen departs, the mechanism ceases. Rooted without, it is called Qi Li (Qi Establishment); when Qi stops, transformation ends." This refers precisely to this situation. Frequent miscarriages during pregnancy are invariably due to damage to qi and vessels. Causes of this damage include innate constitutional weakness, decline in age and strength, exhaustion of essence and vitality due to worry, anger, labor, and hardship, and secret loss of vital qi due to imprudent sexual activity. Additionally, falls, dietary errors, etc., can all injure qi and vessels. It is rare for the fetus to remain unharmed after qi and vessel injury unless the congenital constitution is extremely solid; this is not seen in ordinary people. Furthermore, throughout the ten months of pregnancy, different meridians govern nourishment at different times. Therefore, frequent spontaneous abortions often occur around three, five, and seven months, and subsequent abortions tend to recur at these specific times. This is because a previous injury to a specific meridian makes it vulnerable when that meridian becomes active again, leading to failure. Moreover, the Kidney connects to the Bao Palace (uterus), and the waist is the mansion of the Kidney. Thus, pregnant women are most prone to lower back pain; severe pain leads to abortion, so prevention is essential. Therefore, anyone fearing abortion must examine the cause of injury and exercise extreme caution. In treating habitual abortion, one must investigate the source of fetal nourishment and preemptively tonify deficiencies; this is the essence of fetal protection. Waiting until the last moment may be too late. Unstable pregnancy is essentially a disease of qi and blood injury. Qi deficiency leads to insecure holding, and blood deficiency leads to inadequate irrigation, often resulting in miscarriage. Therefore, experts in fetal protection focus on blood deficiency, primarily using Taiyuan Yin (Fetal Origin Decoction) with modifications. Next is Shaoyao Xiong Gui Tang (Peony, Ligusticum, and Angelica Decoction), followed by Taishan Panshi San (Mount Tai Porphyry Powder) or Baoyun Wan (Pregnancy Protection Pills) from *Qianjin Fang*, all of which possess miraculous effects and should be used judiciously. Additionally, fetal heat causes blood to move recklessly, making the fetus unstable; thus, abortions due to internal heat and deficiency are common. For Spleen qi deficiency with blood heat, Six Saints Powder (Sisheng San) is suitable; for Liver-Kidney deficiency with blood heat, Liangtai Yin (Cooling Fetus Decoction) is suitable; for Liver-Spleen deficiency with blood heat, Gutai Jian (Stabilizing Fetus Decoction) is suitable. Additionally, Li Zhongzi's method: for blood deficiency with blood heat causing frequent miscarriages, besides tonifying, during early summer, instruct the patient to take Huangqin Mo (Scutellaria Powder) two qian with strongly decocted Baizhu Tang (Atractylodes Macrocephala Decoction) for dozens of doses, ensuring survival, which is also a worthy method. For other syndromes causing fetal instability, treatment should be adjusted according to the section on stabilizing the fetus.