Habitual Miscarriage

CHAPTER 43 Habitual Miscarriage



AETIOLOGY AND PATHOLOGY 545

IDENTIFICATION OF PATTERNS AND TREATMENT 546
Kidney-Yang deficiency 546

Kidney-Yin deficiency 548

Blood-Heat 549

Spleen-Qi deficiency 550

Blood deficiency 551

Blood stasis 552

PROGNOSIS AND PREVENTION 553

WESTERN VIEW 553

‘Habitual miscarriage’ is usually defined as such after three occurrences. In Chinese medicine, miscarriage takes different names according to the time of pregnancy it occurs. If it occurs within 1 month of pregnancy, it is called an chan (image), which means ‘hidden labour’. Between 1 and 3 months, it is called duo tai (image), which means ‘falling fetus’. After 3 months it is called xiao chan (image) or ban chan (image), which mean ‘small labour’ or ‘half labour’ respectively. Habitual miscarriage is called hua tai (image) 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 image).


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:


• From the fetus: it could be due to weak Original Qi which, in turn, may be due to the parents being too old or ill while conceiving. In such cases, the fetus cannot develop normally and miscarriage results.

• From the mother: it could be due to weak body constitution, constitutionally weak Kidneys, excess sex, emotional problems, a Warm disease contracted during pregnancy, falls, accidents, emotional shocks, consumption of certain drugs or excessive lifting.

Thus the main pathologies (of the mother) are as follows:


• Kidney deficiency which can be constitutional or from overwork. This leads to the Penetrating and Directing Vessels not nourishing the fetus properly and also to Kidney-Qi not holding the fetus.

• Blood deficiency from a diet lacking in nourishment, so that the fetus is not nourished properly.

• Blood-Heat deriving from emotional problems or from a Warm disease affecting the mother.

• Blood stasis deriving from emotional problems or abdominal surgery.

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


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 being not firm, and Qi sinking. Thus, apart from the conditions of Blood-Heat or Blood stasis, the main treatment principles in habitual miscarriage are to tonify the Kidneys, nourish Blood, tonify and raise Spleen-Qi and consolidate the Directing and Penetrating Vessels.


The patterns discussed are:


• Kidney-Yang deficiency

• Kidney-Yin deficiency

• Blood-Heat

• Spleen-Qi deficiency

• Blood deficiency

• Blood stasis.


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.




Explanation


– BL-20 tonifies the Spleen: it is nearly always necessary to do this in a chronic Kidney-Yang deficiency.

– BL-23, with direct moxa cones, tonifies and warms Kidney-Yang.

– Du-4 warms the Fire of the Gate of Life.

– KI-3 tonifies the Kidneys.

– Du-20 and Ren-6 tonify and raise Qi to prevent the downwards movement of the fetus.

– ST-36 tonifies Qi in general.

– Jinggong tonifies the Kidneys and the Essence.


Herbal treatment



a Prescription



– BU SHEN GU CHONG WAN

– Tonifying the Kidneys and Consolidating the Penetrating Vessel Pill


Explanation


– Tu Si Zi, Xu Duan, Ba Ji Tian, Du Zhong and Lu Jiao Shuang tonify and warm Kidney-Yang and strengthen the Governing Vessel.

– Dang Gui, Shu Di Huang, Gou Qi Zi and E Jiao nourish Blood.

– Dang Shen, Bai Zhu and Da Zao tonify and raise Qi.

– Sha Ren resolves Dampness and counteracts the cloying nature of the tonics in the prescription.


b. Prescription



– YOU GUI WAN Variation

– Restoring the Right [Kidney] Pill Variation


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.


– Huang Qi tonifies and raises Qi to prevent the downward movement of the fetus when the woman does become pregnant.

– Fu Pen Zi is astringent and tonifies Kidney-Yang. Being astringent, it prevents loss of the fetus.

– Chi Shi Zhi is astringent and has been added for the same reason as above.


c. Prescription



– YU SHEN JIAN PI AN TAI TANG2

– Generating the Kidneys, Strengthening the Spleen and Calming the Fetus Decoction


Explanation


– Tu Si Zi, Du Zhong and Xu Duan tonify and warm Kidney-Yang, consolidate the Directing and Penetrating Vessels and calm the fetus.

– Sang Ji Sheng tonifies Liver and Kidneys and calms the fetus.

– Dang Shen, Bai Zhu and Fu Ling tonify the Spleen to hold the fetus up.

– Sheng Di Huang nourishes Yin and Blood and clears fetal Heat.

– Su Geng subdues rebellious Qi, harmonizes the Centre and calms the fetus.

– Zhu Ma Gen is astringent, it stops bleeding and calms the fetus. It is cold in energy and it clears fetal Heat.


Three Treasures remedy



– STRENGTHEN THE ROOT

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.



Case history


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):


• ST-36 Zusanli and SP-6 Sanyinjiao tonify the Spleen.

• BL-23 Shenshu and BL-20 Pishu tonify Kidney- and Spleen-Yang.

• Ren-4 Guanyuan tonifies the Kidneys, strengthens the Uterus and consolidates the Directing and Penetrating Vessels.

The prescription used (as a decoction) was a variation of Bu Zhong Yi Qi Tang Tonifying the Centre and Benefiting Qi Decoction:


• Huang Qi Radix Astragali 9 g

• Ren Shen Radix Ginseng 6 g

• Bai Zhu Rhizoma Atractylodis macrocephalae 6 g

• Dang Gui Radix Angelicae sinensis 6 g

• Chen Pi Pericarpium Citri reticulatae 3 g

• Sheng Ma Rhizoma Cimicifugae 3 g

• Chai Hu Radix Bupleuri 3 g

• Tu Si Zi Semen Cuscutae 6 g

• Du Zhong Cortex Eucommiae 4 g

• Xu Duan Radix Dipsaci 4 g

• Zhi Gan Cao Radix Glycyrrhizae preparata 3 g


Explanation

Related posts:

  1. Vaginal Itching (and Trichomonas and Candida Infections and Genital Eczema)
  2. Abdominal Pain after Childbirth
  3. Acupuncture and Herbal Treatment in Midwifery
  4. Endometriosis

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Jun 6, 2016 | Posted by in GYNECOLOGY | Comments Off on Habitual Miscarriage

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