Threatened Miscarriage

General

Clinical Manifestations	The treatment of gestational leakage and threatened abortion focuses on calming the fetus. In some cases, the fetal condition induces disorder in the mother; in other cases, maternal disorder induces the fetal condition. In the latter case, treat the maternal disorder in order to calm the fetus. In general, in addition to the use of herbal medicine, it is important to prescribe adequate and proper rest, release of emotional stress, proper diet and cessation of sexual activity. Proper diet requires avoidance of strong-flavored or spicy foods and stopping smoking and all alcohol. If there is any constipation, diarrhea, cough, nausea or vomiting, it should be treated. Furthermore, it is important to avoid unnecessary gynecological examination. In some cases, threatened abortion may be averted; in other cases, it may not be. If the abdominal pain becomes increasingly more severe and the bleeding persists for over a week or worsens, or the fetus dies, then the appropriate action may actually be to induce abortion in order to preserve maternal health. The treatment of habitual abortion begins prior to conception and aims at the restoration of parental health. When conception has occurred, continue to calm the fetus until past the point of previous miscarriage.
Treatment Principle
Herb Formulas	To Stabilize the womb: Gu Chong Tang Gu Jing Wan Zhen Ling Dan Wan Dai Tang Yi Huang Tang For prevention without Heat or Cold signs: Tai Yuan Yin modified For abdominal pain and cramping and muscle spasms in the calve: Shao Yao Gan Cao Tang
Points	Unstable position of the fetus or breech presentation: First session: PC-6, ST-36, Ear: Shenmen: Disperse for 25-30 minutes Second session: PC-6, SP-4, Ear: Shenmen: Disperse for 25-30 minutes Third, fourth and fifth sessions : UB-67, Ear: Uterus: manipulate 3-4 times during the session (may use electroacupuncture for 5-10 minutes)

Spleen Qi Deficiency

Clinical Manifestations	Threatened miscarriage Pale-red to normal Blood color Thin and watery Blood with clots Irregular menstruation Sallow complexion Fatigue Anorexia Four limbs feel tired and heavy Abdominal and epigastric distention after eating Maybe acid regurgitation or vomiting Loose stools Shortness of breath May be much Blood due to Spleen Not Governing Blood May be little Blood due to Spleen Qi Sinking The Blood is pale-red in color and watery An empty feeling in the lower abdomen Spleen Not Governing Blood: Shortness of breath Dizziness Palpitations Functional Uterine Bleeding Purpura Epistaxis Hemafecia Hematuria Menorrhagia Metrorrhagia Spleen Qi Sinking: Prolapse of one or more organs T: Pale and flabby - may have teethmarks C: White P: Even, forceless and deficient
Treatment Principle	Nourish the Middle Jiao Qi Keep the Blood in the Chong and Ren channels
Herb Formulas	Bu Zhong Yi Qi Tang
Points

Spleen Not Governing The Blood

Clinical Manifestations	Abdominal pain Uterine bleeding (metrorrhagia) Excessive menstruation Menstruation with constant spotting Postpartum bleeding Bleeding during pregnancy The Blood is pale and thin without clots Weakness Sore lower back Post abortion bleeding Dull complexion Weakness and pain of the legs Light red, unelevated and indistinct eruptions T: Pale C: Thin and white or Whitish and moist P: Thready and weak
Treatment Principle	Nourish and warm the Blood Stop bleeding Regulate menstruation Calm the fetus Prevent miscarriage
Herb Formulas	Jiao Ai Tang
Points	SP-1, SP-3, SP-10, UB-17, UB-20, ST-36, other points are selected according to signs and symptoms

Spleen And Kidney Deficiency

Clinical Manifestations	A scanty amount of vaginal tract bleeding after having stopped menstruating Pale red Blood Low back and knee soreness and weakness Insidious pain in the lower abdomen Torpid intake Nausea Loose stools Frequent urination T: Pale C: Thin and white P: Fine and slippery
Treatment Principle	Tonify the Spleen and Kidneys
Herb Formulas	An Tai Yin #3 modified Dang Gui Shao Yao San
Points

Qi Stagnation In The Liver Channel Blocking The Descending Function Of Blood To The Lower Jiao

Clinical Manifestations	A sensation of fullness, distention and pain in the chest which is improved with massage Cough Prefers warm drinks P: Wiry and large
Treatment Principle	Unblock Yang Expand the chest Dredge Stasis Transform clumps
Herb Formulas	Xuan Fu Hua Tang
Points

Kidney Deficiency

Clinical Manifestations	Threatened miscarriage There may be a history of habitual abortion During pregnancy, slow uterine bleeding of dusky pale and thin blood Low back sore and weak Aches and weakness in the waist and knees May be a history of several abortions or miscarriages Dizziness Tinnitus Polyuria Nocturia Incontinence Fatigue T: Pale C: White P: Deep and slippery; in the Chi position it is feeble or Weak and deep
Treatment Principle	Tonify the Kidneys Prevent miscarriage
Herb Formulas	An Tai Yin An Tai Yin #2 Threatened Miscarriage #1
Points

Kidney Yang Deficiency

Clinical Manifestations	Lumbago: low back feels cold, weak and aching Feeling chilled Aversion to Cold Cold limbs General debility Pale face Urinary frequency with abundant, clear urine or Oliguria with edema Maybe nocturia Lassitude Withdrawn, subdued behavior Knees feel cold and aching Dizziness Tinnitus Impotence Spermatorrhea Premature ejaculation Low libido Female infertility ("uterus cold and infertile") Maybe anorexia Maybe loose stools Maybe chronic diarrhea or "cock crow" diarrhea T: Pale and swollen C: Thin and white P: Deep and thready - maybe slow
Treatment Principle	Warm and Reinforce Kidney Yang
Herb Formulas	Jin Gui Shen Qi Wan (Ba Wei Di Huang Wan)
Points	Moxa or moxa needle DU-4, KI-3, REN-4, UB-23 For chronic diarrhea, rectal prolapse and Vanquished Yang: + moxa DU-20, REN-8 For Kidney Yang Deficiency impotence: moxa or moxa needle DU-4, DU-20, KI-3, REN-4, UB-23 For Kidney Yang Deficiency (Cock Crow) Diarrhea: moxa or moxa needle DU-20, KI-3, REN-4, UB-23

Kidney Yin Deficiency With Blood Heat

Clinical Manifestations	Continuous menstruation or Uterine bleeding that alternates between spotting and gushing The Blood is very red, thick and sticky and may contain dark-purple clots A sensation of Heat and irritability in the chest Menstruation may be delayed Dry mouth Leukorrhea Dysuria Abdominal pain Dark urine Red urine Red face Difficulty defecating T: Red C: Normal or Yellow P: Wiry or Wiry and rapid or Tight and rapid or Slippery and rapid
Treatment Principle	Enrich Yin Clear Heat Clear Deficiency Heat Stop bleeding Stabilize the Menses
Herb Formulas	Bao Yin Jian An Tai Yin #2 Gu Jing Wan
Points	REN-4, REN-6, SP-1, SP-8, KI-2, KI-10, UB-23, DU-4 With night sweating: HT-6 Sedate, KI-7 Tonify or Even With insomnia: KI-6, UB-62 Sedate

Kidney Yin And Yang Deficiency

Clinical Manifestations	There may be a history of habitual abortion. During pregnancy, slow uterine bleeding of dusky pale and thin Blood Lower back soreness and distention Aches and weakness in the waist and knees A sensation of collapse in the lower abdomen Vaginal bleeding during pregnancy Dizziness Tinnitus Polyuria Nocturia Frequent urination to the point of incontinence T: Pale C: White or Slippery and white P: Deep and slippery, feeble in the chi position or Deep and frail at the rear position
Treatment Principle	Strengthen and stabilize the Kidneys Calm the fetus Augment Qi
Herb Formulas	Shou Tai Wan An Tai Yin #2 With Blood Deficiency: Bu Shen Si Wu Tang
Points

Kidney And Liver Yin Deficiency

Clinical Manifestations	Facial complexion pale and sallow Both cheeks slightly red Dizziness Dry eyes Blurred vision Spots before the eyes Numbness of limbs Flaccid paralysis (Wei syndrome), weakness Tinnitus Deafness Forgetfulness Low back and knees sore and painful Throat dry and painful Five sole Heat Low-grade fever Night sweats Irritability Insomnia Stools difficult to pass Constipation Men: Spermatorrhea Women: Irregular menses or Scanty menses or Amenorrhea Vaginal discharge T: Red C: None P: Thready and rapid
Treatment Principle	Nourish and Reinforce the Liver and Kidneys
Herb Formulas	Er Zhi Wan
Points	KI-3, LIV-3, SP-6, UB-18, UB-23

Qi And Blood Stagnation

Clinical Manifestations	A history of pelvic or uterine mass or of trauma Fetal unrest Aches in the waist Abdominal pain Vaginal bleeding T: Dusky C: Normal The pulse is slippery and forceless.
Treatment Principle	Regulate Qi and Blood Calm the fetus
Herb Formulas	Sheng Yu Tang modified For patients with pelvic or uterine mass: Gui Zhi Fu Ling Wan(use prior to conception to invigorate the Blood and eliminate the mass)
Points

Qi And Blood Deficiency

Clinical Manifestations	A history of pelvic or uterine mass or of trauma Threatened abortion during the first trimester, with slight uterine bleeding of light-colored and thin Blood Fetal unrest Low back soreness Aches and weakness in the waist and knees Lower abdominal insidious pain Abdominal distention with vague pain There may be a history of habitual abortion A sensation of downward sagging A lusterless, pallid facial complexion Essence spirit withering Heart palpitations Shortness of breath Lassitude Weak limbs Fatigue Pale face Shortness of breath T: Pale or Dusky C: Thin and white P: Empty and slippery or Thready, slippery and forceless or Weak
Treatment Principle	Augment Qi Generate Blood Strengthen the Kidney Calm the fetus
Herb Formulas	Tai Shan Pan Shi Tang Bao Chan Wu You Fang Ju Yuan Jian Tai Yuan Yin An Tai Yin #3 modified Ba Zhen Tang (use prior to conception and during pregnancy) Si Wu Tang Sheng Yu Tang Threatened Miscarriage #2 For patients with pelvic or uterine mass: Gui Zhi Fu Ling Wan (use prior to conception to mobilize blood and eliminate mass) For Spleen Deficiency: Qian Jin Bao Tai Wan For Kidney Deficiency: Liu Wei Di Huang Wan modified
Points	SP-6, REN-4, REN-6, ST-36, UB-17, UB-20, UB-23

Qi , Blood And Yang Deficiency

Clinical Manifestations	Fatigue Anorexia Dizziness Pale face Weak voice Reluctance to speak Sweating with little or no exertion Dizziness Palpitations Insomnia Dry skin Dry hair Poor memory Paleness Scanty periods Chills Cold limbs Inability to get warm Loose stools Profuse clear urine Spontaneous sweating Lassitude T: Pale C: White or Thin, white and dry P: Slow, deep and weak or Empty or Thready and rapid or Weak
Treatment Principle	Tonify Qi and Blood Strengthen the Spleen Tonify Yang
Herb Formulas	Ren Shen Dang Shao San
Points

Blood Stagnation

Clinical Manifestations	Infertility Irregular and painful periods or Delayed menstruation with decreased menses or Dysmenorrhea The menses may become dark purple in color and contain many clots May be abdominal pain with guarding Pain in the lower abdomen Irritability Manic behavior Frequent abdominal pain Mental restlessness T: Purple or Pale with purple dots C: Normal P: Wiry or Choppy or Thin and wiry or Taut and thready
Treatment Principle	Invigorate the Blood Promote Qi circulation Dispel Stasis Regulate menstruation Promote conception Pacify the Liver and the Chong channel Nourish the uterus
Herb Formulas	Zhe Cong Yin
Points

Blood Stagnation Due To Blood Deficiency

Clinical Manifestations	Abdominal pain in women Dizziness Blurred vision Pale, lusterless complexion Pale nails Pale lips Generalized muscle tension Irregular menstruation with little flow Amenorrhea Periumbilical pain Lower abdominal pain Vertigo Tinnitus Blurred vision Insomnia Spotting of pale Blood Postpartum uterine bleeding Maybe five sole Heat Delayed menstruation Palpitations Dizziness Dry skin Maybe leukorrhea Maybe fever Firm, painful abdomen Sporadic fever and chills Dysmenorrhea Breast distention and pain before and during menses Menorrhagia Hard abdominal masses with recurrent pain Unstable fetus with bleeding Chills and fever T: Pale C: Normal P: Thready and wiry or Thready and choppy
Treatment Principle	Nourish the Blood Invigorate the Blood Dispel Stasis
Herb Formulas	Si Wu Tang Jian Wei
Points

Blood Stagnation Due To Cold

Clinical Manifestations	Mild persistent uterine bleeding Irregular menstruation (either early or late) Prolonged menstruation Skipped period Metrorrhagia Extended or continuous menstrual flow Pain Lower abdominal distention Lower abdominal Cold Lower abdominal pain Infertility Dry lips Dry mouth Spermatorrhea Pale complexion Leukorrhea Amenorrhea Bleeding between periods Low grade fever at dusk Irritability Five Sole Heat No desire to drink Distending breast pain Low back coldness and pain Loose stools Cold limbs Aversion to Cold T: Purple with petechiae P: Thready and choppy
Treatment Principle	Warm the menses Regulate menstruation Dispel Cold Warm the channels Nourish the Blood Dispel Blood Stasis
Herb Formulas	Wen Jing Tang
Points

Blood Heat

Clinical Manifestations	Occurs early in pregnancy Threatened abortion with with scanty vaginal bleeding that is bright red or Lower abdominal pain with fetal unrest Agitation Mental restlessness Insomnia A feeling of Heat Five Sole Heat Dry mouth and throat Thirst Constipation Dark urine T: Red C: Yellow and dry coating P: Taut and slippery or Slippery and rapid or Rapid and overflowing
Treatment Principle	Nourish Yin Cool Heat Generate Blood Calm the fetus
Herb Formulas	Bao Yin Jian modified Threatened Miscarriage #3 For Deficiency Heat: Bao Yin Jian For Excess Heat: Qing Re Gu Jing Tang modified
Points	REN-6, SP-8, SP-10, LI-11 With Liver Qi Stagnation: + LIV-2, LIV-3, SJ-5, GB-34 With Damp-Heat: REN-6, SP-1, SP-6, SP-9, LIV-5

Blood Deficiency

Clinical Manifestations	A history of miscarriage or threatened miscarriage Fatigue Anorexia Restless fetus General weakness Light red Blood Constant lower abdominal pain Insomnia A pale or sallow complexion Lassitude Palpitations Ptosis of the viscera Dizziness T: Pale C: Slippery or Thin and white P: Slippery and forceless or Deep and weak
Treatment Principle	Nourish the Blood
Herb Formulas	Dang Gui San modified Tai Shan Pan Shi San Jiao Ai Tang An Tai Yin #3 For Spleen Deficiency: Qian Jin Bao Tai Wan For Kidney Deficiency: Liu Wei Di Huang Wan modified
Points

Blood And Yin Deficiency

Clinical Manifestations	Threatened miscarriage Tidal fever Unstable pregnancy Postpartum weakness Sore back Hysteria Thirst History of habitual miscarriage Difficult labor Postpartum anemia Abdominal pain Dryness T: Pale red C: Little of None P: Thready or Thready and rapid
Treatment Principle	Dispel Heat Stabilize the fetus Nourish the Blood Strengthen the Spleen Prevent gynecological problems
Herb Formulas	Dang Gui San
Points

Yin Deficiency

Clinical Manifestations	Vaginal tract bleeding after having stopped menstruating The amount of Blood is sometimes excessive and sometimes scanty The Blood is fresh red Low back soreness Lower abdominal distention and pain Heart vexation Insomnia A dry mouth Desire to drink Dry, bound stools T: Red C: Thin and yellow P; Slippery and rapid
Treatment Principle
Herb Formulas	An Tai Yi #3 modified
Points

Phlegm And Blood Stagnation

Clinical Manifestations	Mild, persistent uterine bleeding of purple and black blood during pregnancy Abdominal pain that is worse with pressure Abdominal spasms and tension Immobile masses in the lower abdomen with pain and tenderness Amenorrhea with distention and pain Dysmenorrhea Headache Sinus congestion Constipation Excess weight in the pelvis Lower back ache Irregular menstruation Nervousness Fatigue Fetal instability Skin eruptions Scanty menstrual flow Scaly, dry skin Retention of lochia Headache Shoulder stiffness Vertigo Cold low body and feet Flushed face Protruding abdomen T: Dark purple or with echymoses or petechiae or pale with purplish spots C: White P: Choppy or Tense and deep and slow
Treatment Principle	Invigorate Blood Transform Blood Stasis Soften lumps Reduces fixed abdominal pain
Herb Formulas	Gui Zhi Fu Ling Wan
Points

Deficiency Cold Of The Chong And Ren Channels

Clinical Manifestations	Threatened miscarriage Habitual miscarriage Afternoon fever Five sole heat Dry mouth Thirst Cold abdominal pain Infertility Dysmenorrhea Uterine bleeding Chronic pelvic inflammation Menopause
Treatment Principle	Warms the vessels Comforts the Womb Nourishes and invigorates the Blood
Herb Formulas	Wen Jing Tang Zhen Ling Dan
Points

Trauma

Clinical Manifestations	Threatened miscarriage after trauma Vaginal bleeding Soreness of the waist Dragging distention in the abdomen T: Normal C: White P: Slippery and weak
Treatment Principle	Tonify Qi Nourish the Blood Prevent miscarriage
Herb Formulas	Sheng Yu Tang  modified
Points