Ms. Han, 35, from Zhongmu County, has experienced five consecutive pregnancies since 2004. Each pregnancy terminated around the fifth month due to fetal development arrest. Despite multiple examinations at various hospitals, no underlying issues were identified.Early this year, Ms. Han became pregnant again. Before she could celebrate, ominous signs appeared at 40 days gestation: morning chills, light bleeding, and lower abdominal heaviness. Following a friend's recommendation, she and her husband sought treatment at the Traditional Chinese Medicine Department of Zhengzhou University's Fourth Affiliated Hospital.At the time of her visit, Ms. Han experienced severe pregnancy-related symptoms including nausea and vomiting, loss of appetite, pallor, and anxiety.
Having suffered five consecutive miscarriages, Ms. Han's condition was diagnosed as recurrent miscarriage in both TCM and Western medicine. The symptoms during this pregnancy indicated a tendency toward threatened miscarriage. After consultation and pulse diagnosis, I determined her repeated miscarriages stemmed from spleen-stomach deficiency-cold affecting kidney yang.I prescribed Xiang Sha Liu Jun Zi Tang and Shou Tai Wan to strengthen her spleen and harmonize her stomach, along with herbs to tonify qi, nourish the kidneys, and stabilize the fetus. I also instructed her to rest in bed. After taking six doses of the herbs, her bleeding and dull pain subsided, and her nausea and vomiting decreased.Once the bleeding ceased, I discontinued the charred Schizonepeta and charred Rehmannia, as these herbs possess strong adsorbent properties and are highly effective for hemostasis. Subsequent prescriptions incorporated kidney-tonifying and spleen-strengthening herbs such as mulberry fruit, processed Polygonatum, Rehmannia, goji berries, white kidney beans, and cardamom. After her cold sensitivity improved, I also discontinued the black aconite.After consistently taking the herbs for over three months, Ms. Han underwent an ultrasound at five months gestation. The doctor informed her that the fetus was developing well. I then adjusted her dosage regimen. After taking the herbs for another half month, having surpassed the gestational age of her previous miscarriage, I discontinued the treatment.Recently, Ms. Han gave birth to a healthy baby boy. Traditional Chinese medicine holds that conception and embryo implantation require abundant innate kidney qi, while fetal nourishment demands sufficient qi and blood generated by the mother's acquired spleen and stomach functions. The interaction between innate kidney qi and acquired spleen qi enables normal fetal development. Hence the saying: "Early miscarriages are attributed to kidney deficiency; late miscarriages to spleen deficiency."Ms. Han's fetus developed normally during the first three months of pregnancy but showed abnormalities at five months, linked to her weakened spleen and stomach function. After the fourth month, fetal growth accelerates, demanding increasing nutrients from the mother. If the mother's spleen and stomach are deficient and cannot provide sufficient nourishment, the fetus may cease development, leading to miscarriage. Why does spleen deficiency cause late-term miscarriage? The answer lies in the spleen's dual functions.
Traditional Chinese medicine states that the spleen governs transformation and transportation. This "governance" has two primary aspects: First, it governs the transformation and transportation of water and grain essences. The generation of nutrients relies on the spleen's transformative functions. If the spleen is deficient, its transformative capacity weakens, leading to insufficient nutrient supply. This restricts fetal development, potentially causing severe fetal growth retardation or even miscarriage.Second, it governs the transformation and transportation of fluids. Excessive consumption of cold foods damages spleen yang, disrupting fluid metabolism and potentially causing polyhydramnios or oligohydramnios, which may lead to intrauterine growth abnormalities.
Additionally, TCM holds that "the spleen governs muscles," meaning the body's muscular contraction strength is linked to spleen function.As the fetus grows larger, the muscular strength required to support it must increase accordingly. If the pregnant woman has a weak constitution and deficient middle qi, she may struggle to sustain the fetus, potentially leading to symptoms of placenta previa such as bleeding, abdominal pain, and a sensation of the fetus descending. Western medicine attributes late-term miscarriages primarily to relaxation of the cervical internal os smooth muscles, a finding that aligns perfectly with the TCM theory of "the spleen governs muscles."Therefore, treatment for late-term miscarriage should focus on tonifying the kidneys while incorporating herbs that strengthen the spleen and stomach, boost qi, and nourish blood. This enhances the mother's constitution, increases the uterus's ability to retain the fetus, and supports the demands of fetal growth and development. Thus, in the formula I prescribed for Ms. Han, I emphasized Cuscuta seed (Tu Si Zi) and Codonopsis root (Dang Shen). Cuscuta seed tonifies the kidneys, while Codonopsis root strengthens the spleen.Each case of late-term miscarriage varies. If the miscarriage is related to fetal blood type incompatibility or abnormal antibody titers, herbs like Yinchen (Wormwood), Huangqin (Scutellaria), Jiu Da Huang (Wine-processed Rheum), and Sheng Gancao (Raw Licorice) can be added to the spleen-strengthening and kidney-tonifying formula to clear heat, transform dampness, and detoxify.If related to placenta previa or placental abruption, besides requiring bed rest, the formula should include Astragalus, Cimicifuga, Rubus, and charred Rehmannia to tonify qi, lift the qi, and stop bleeding. For cases with hypertension, add Gastrodia, Uncaria, Imperata, and Areca to regulate liver qi and promote diuresis.Wine-processed rhubarb improves placental blood circulation to prevent microvascular spasm and exhibits anticoagulant effects. For recurrent miscarriages with frequent nocturnal urination—typically indicating spleen-kidney yang deficiency—add Rubus chingii, Amomum villosum, Morinda officinalis, and Lindera aggregata to warm the kidneys, consolidate qi, and reduce urination.
How can women with a history of late miscarriage ensure a successful subsequent pregnancy? Here are key considerations:
1. Preconception treatment and pregnancy maintenance. Take spleen-tonifying and kidney-nourishing herbs before conception to strengthen the body. Actively treat underlying conditions like endometritis, hypertension, or menstrual disorders. After conception, maintain pregnancy beyond the previous miscarriage month.
2. Actively manage severe morning sickness during pregnancy. Intense nausea preventing food intake can deplete body fluids, leading to blood deficiency and destabilizing the fetus. Prolonged severe vomiting further damages spleen and stomach function.
3. These expectant mothers should avoid intercourse to minimize uterine contractions affecting the fetus.
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