CHAPTER 43 Habitual Miscarriage
), which means ‘hidden labour’. Between 1 and 3 months, it is called duo tai (
), which means ‘falling fetus’. After 3 months it is called xiao chan (
) or ban chan (
), which mean ‘small labour’ or ‘half labour’ respectively. Habitual miscarriage is called hua tai (
) which means ‘slippery fetus’.It is important to remember that, according to the experience of Chinese medicine, a miscarriage is as draining to a woman’s energy as labour. Indeed, there is a saying that proclaims ‘a miscarriage is more serious than labour’ (xiao chan chong yu da chan 
).
This chapter will deal only with the treatment of habitual miscarriage, i.e. the treatment of the woman when she is not pregnant. The treatment for threatened miscarriage or an actual miscarriage was outlined in Chapter 31.
Aetiology and pathology
The most common underlying cause is a deficiency of the Kidneys; other concurrent factors may be a deficiency of the Spleen, the Penetrating and Directing Vessels (Chong and Ren Mai) being not firm, and Qi sinking. The aetiological factors should be distinguished as due to the fetus or the mother:
Thus the main pathologies (of the mother) are as follows:
In the first 3 months of pregnancy, miscarriage manifests with abdominal pain, sore back and vaginal bleeding which increases steadily with large clots. If miscarriage occurs after 3 months, the vaginal bleeding is heavier and the abdominal pain is severe.
Identification of patterns and treatment
To treat the underlying cause of habitual miscarriage, it is best if the woman does not try to get pregnant for at least 6 months, and preferably for a year. Persuading the woman of this is important, and may sometimes be difficult as women who have been infertile for many years are, understandably, anxious to try to conceive as soon as possible. Another reason to dissuade a woman from trying to conceive during the course of treatment is that some of the herbal decoctions used might contain herbs that are contraindicated in pregnancy.
It is important to have a clear idea in mind of the aim of our treatment for habitual miscarriage: we treat the woman when she is not pregnant by addressing the underlying condition which is causing her to miscarry. The approach is therefore quite different from that adopted in threatened miscarriage when the main emphasis of the treatment is on ‘calming the fetus’ and avoiding any herb that is contraindicated in pregnancy. It is important to stress this as some books, including Chinese ones, say that the approach to treatment of habitual miscarriage is the same as that for threatened miscarriage, a view with which I personally disagree. For example, the text Chinese Medicine Gynaecology says: “In treating a woman suffering from habitual miscarriage, one must protect the fetus and the treatment may be based on that for threatened miscarriage.”1
Kidney-Yang deficiency
Clinical manifestations
A history of miscarriages early in the pregnancy, lower backache, depression, feeling cold, cold feet, frequent, pale urination, a history of infertility. Tongue: Pale. Pulse: Deep, Weak.
Treatment principle
Tonify and warm the Kidneys, warm the Uterus, consolidate the Penetrating and Directing Vessels.
Acupuncture
BL-20 Pishu, BL-23 Shenshu, Du-20 Baihui, Ren-6 Qihai, Du-4 Mingmen, KI-3 Taixi, ST-36 Zusanli, Jinggong (half cun lateral to BL-52 Zhishi). All with reinforcing method and moxa.
Herbal treatment
a Prescription
b. Prescription
Explanation
The formula You Gui Wan, already explained, tonifies and warms Kidney-Yang. Rou Gui has been removed to make it less hot and Dang Gui has been removed so as not to invigorate Blood.
c. Prescription
Three Treasures remedy
This remedy is a variation of the formula You Gui Wan Restoring the Right [Kidney] Pill and it tonifies Kidney-Yang and strengthens the Governing, Directing and Penetrating Vessels. The tongue presentation appropriate to this remedy is a Pale and wet body.
A 40-year-old woman had had a child 6 years previously but she had suffered four miscarriages since then. These four miscarriages all occurred in the first trimester, at 3, 9 (twice) and 12 weeks of pregnancy. She also complained of lower backache, frequent urination, nocturia, a bearing-down feeling in the lower abdomen and tiredness. Her periods were regular, painless but heavier since her miscarriages. Her tongue was Pale and her pulse was Deep, Weak and especially so on both Rear positions.
Diagnosis
This is a very clear case of Spleen and Kidney-Yang deficiency. The occurrence of the miscarriages in the first trimester often points to a Kidney deficiency and this is confirmed by the backache, the frequent urination, the nocturia, the Pale tongue and the Deep and Weak pulse on both Kidney positions. Besides this, there is also a deficiency and sinking of Spleen-Qi causing the tiredness, the bearing-down feeling and the heavy period.
Treatment principle
This patient was treated with both acupuncture and herbal medicine. The main points used were chosen from the following (all with reinforcing method):
The prescription used (as a decoction) was a variation of Bu Zhong Yi Qi Tang Tonifying the Centre and Benefiting Qi Decoction:
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