”Summary of clinical application experience of “Antifetus Tang
1.Drug composition and addition and subtraction.
Antifetus Tang is composed of Xi Dang, Sheng Qi, Fructus Parviflorus, Cornu Cervi Pantotrichum, Atractylodes Macrocephalae, Su Stem, Pericarpium Citri Reticulatae, Jujube, Ramie Root and other drugs. For thirst, disturbed heart, restless sleep at night, red tongue, add gardenia, scutellaria, lotus heart, etc.; for constipation, add 15g of cuscuta; for small amount of vaginal bleeding without abdominal pain and lumbago, add 20g of yam, 20g of lotus seeds to strengthen the spleen and fix the fetus, 10g of aconite to nourish blood and stop bleeding, nourish yin and moisten dryness; for abdominal pain, add 10g of white peony; if bleeding is accompanied by abdominal distension, because “qi carries the fetus”, it is advisable to tonify qi to calm the fetus. If bleeding is accompanied by lumbar pain, the kidney is deficient and cannot fix the fetus, so the kidney should be tonified to calm the fetus. “The heart is the main determinant of the mind, the kidney is the main determinant of the essence, so the mind is tranquil, the heart and kidney can help each other to fix the fetus, it is advisable to calm the mind and calm the fetus. It is advisable to calm the heart and tranquilize the fetus. It can be chosen from hooked vine and jujube seeds [1].
2. Analysis of formula meaning.
Xi Dang tonifies the middle and benefits the qi, strengthens the spleen and benefits the lung, which can tonify both the qi and blood, and also has the effect of tonifying the qi and generating fluid, which strengthens the spleen to quickly generate fluid and blood to help the membrane carry the fetus and fix the fetus, and is the ruling herb. Huang Qi is sweet and warm, warms the middle and strengthens the spleen, benefits the qi and helps the west party to strengthen the spleen to take in the fetus, to carry the fetus and to carry the fetus as the subject herb. Atractylodes macrocephala strengthens the spleen, enhances qi, dries dampness and induces diuresis, stops sweating, and calms the fetus. Yam is sweet in taste and flat in nature, enters the lung, spleen, and kidney meridians, tonifies the spleen and stomach, and benefits the lung and kidney. Su stems are pungent and warm. Regulates Qi, relieves pain, and calms the fetus. Used for stuffiness in the chest and diaphragm, pain in the stomach and epigastrium, belching and vomiting, and fetal restlessness. Chen Pi is pungent, bitter and warm, pungent can awaken the spleen, bitter can strengthen the spleen, warm can nourish the spleen, with the function of regulating Qi and lowering rebellion, regulating the middle and opening the stomach, drying dampness and resolving phlegm, together with Western Party Astragalus to strengthen the spleen, benefit Qi and calm the fetus. Mulberry, its taste is bitter and sweet, its gas is calm, not cold and not hot, can nourish the blood and calm the fetus, tonifying the kidney and fixing the fetus. The herb “seeking truth” cloud its: “for the kidney to nourish the blood important agent”. In the Treatise on the Nature of Medicinal Herbs, it is said to “strengthen the fetus and is used to treat bleeding in pregnancy. Ramie root is sweet in taste and cool in nature, and it can not only stop bleeding but also clear heat and calm the fetus, so it has been regarded as an important medicine to calm the fetus. It has been used in many cases for fetal heat disturbance and fetal leakage of blood. In the “Compilation of Medical Sciences”: “After two or three months of pregnancy, the phase of fire becomes more intense, the blood becomes more hot, and the fetus is more restless. Ramie root sweet and salty into the heart, can spread its light, but not for the depression of heat, this good medicine for the fetus.” Cornus officinalis is sour, astringent, slightly warm. It belongs to the liver and kidney. Beneficial to the liver and kidney, astringent essence to fix the abscission. The three medicines are used to help strengthen the spleen to nourish the kidney and fix the fetus. Jujube is sweet, warm, enters the spleen and stomach meridians, tonifies the middle, nourishes the blood and calms the mind, and is the medicine to induce menstruation.
3. Clinical application and experience.
3.1 This formula is mostly used for the prevention and treatment of pregnancy followed by lower abdominal and lumbosacral soreness, small amount of vaginal bleeding, and other pre-term abortions such as fetal leakage and fetal movement.
3.2 In recent years, with the development of assisted reproduction technology represented by IVF-ET, it has become a major component of the field of reproductive medicine and an important means of clinical treatment of infertility. At present, the international pregnancy rate of IVF-ET is still around 30-40%. There are many reasons for failure to conceive, among which poor endometrial receptivity leading to obstructed implantation is one of the most difficult problems. It can minimize the loss of granulosa cells due to aspiration of follicles and reduce the number of granulosa corpus luteum cells, which affects the production of corpus luteum, and increase the level of progesterone and HCG to accelerate the growth of endometrium and synchronize it with the development of implanted embryos as much as possible to improve the embryo implantation rate[3] . After the pregnancy is confirmed (continue) to take the medication until the fetal heart rate is seen on ultrasound, stop the medication as appropriate. Do not use cold, hot, nourishing, greasy, or lightly oozing products, and avoid spicy and dissipative substances that hinder fetal development[1] .
3.3 Patients with polycystic ovary syndrome who come to the clinic with the aim of pregnancy can also be treated with this formula after ovulation (luteal phase) [4]. In addition, this formula can be applied after ovulation in all types of infertility patients who have fertility requirements in the same month to help the membranes to grow and nourish, which can not only avoid injury to the fetus due to misdiagnosis and mistreatment during early and early pregnancy, but also lay a good foundation for the fertilization of the fertilized egg, which can help regulate the menstruation and calm the fetus at the same time.
3.4 Antifetal soup is based on strengthening the spleen, tonifying the kidney and calming the fetus as the main treatment method. Strengthening the spleen helps the membranes to take in the fetus, carry the fetus and nourish the fetus. Before the embryo is in the womb, cultivating the earth is the foundation of antifetus; after the embryo is in the womb, because the kidney is the main organ of the fetus, so it is clear that after pregnancy, the spleen and kidney are tonified together, which is the key to antifetus.
According to the teacher, the spermatozoa depend on the endometrium to take in, hold, carry and nourish them before they can further develop into embryos and grow into fetuses, leading to full-term delivery. The endometrium has the characteristics of biochemical, carrying and nourishing properties of the earth, so to help the endometrium take in, hold and carry the fetus, we must start by strengthening the spleen. A strong spleen is a source of biochemical energy and blood, so that the endometrium of the fetus can be filled with blood, which is conducive to the fertilization of the egg and its further growth and development. As Fu Shan, a famous doctor of the Qing Dynasty, said, “The spleen unifies the blood and the lungs are responsible for the gas, the fetus is not shaded by the blood and not born by the gas. If the spleen is healthy, the blood will be strong and the fetus will be shaded, and if the lung is clear, the qi will be strong and the fetus will be born. Therefore, the fetus soup to the West Party, Astragalus as the ruling drug. In addition, the Kidney harbors essence and is the master of reproduction. The Punch is the sea of blood and the Ren is the master of twins. If the kidney is damaged, then the spleen and kidney are not consolidated and cannot hold the fetal element, which leads to fetal movement, fetal leakage and even slippage. In addition, the heart is the sovereign organ, and if the sovereign is clear, the 12 officials are not in danger. Physiologically, the heart and kidneys help each other, the heart is the master of the blood vessels, the heart is the master of the mind, “the heart is the master of fixing the mind, the kidneys are the master of hiding the essence” and “the cellular vein is tied to the heart”. The heart and mind are tranquil. The heart and kidneys are in harmony in order to fix the fetus. Patients with preeclampsia or habitual miscarriage are often mentally stressed, so the treatment from the heart is also an important part of TCM treatment to preserve the fetus [5]. In addition to using lotus heart, dendrobium, hooked vine, date palm, Fu Shen and dragon tooth to nourish the mind and calm the fetus, the clinical evidence also pays attention to psychological guidance and treatment of the patient.
3.5 Based on the “luteal support therapy” after fertilized egg transplantation in Western medicine and the successful experience of preserving the fetus for the patients, Ms. Wang has proposed the theory of “moving the fetus forward”.
In the short term after IVF transplantation, it is not possible to determine whether the fertilized egg has been fertilized. If we wait until the diagnosis of pregnancy is clear, or even if there is a pre-eclampsia miscarriage, we will definitely miss a good opportunity. Therefore, our teacher proposed the theory of “moving the fetus forward”, and once transplanted, we immediately applied prophylactic treatment with antifetal soup to help the membranes to grow and nourish in order to take in and carry the fetus, and asked the patient to be hospitalized, so that even if there was one percent of hope, we would do our best to strive for a successful pregnancy for the patient. Secondly, in patients with fertility requirements, after ovulation or in the late menstrual period, without a clear diagnosis of pregnancy, we should not rashly activate the blood to regulate menstruation; instead of waiting for the result, we should take the initiative to regulate it. Firstly, even if there is no pregnancy in this cycle, the endometrium can be nourished and the menstruation can come on time; secondly, if there is a pregnancy, it can be used to calm the fetus, which can be called “the best of both worlds”. When pregnancy is not confirmed, go to the sour astringent dogwood to avoid affecting the onset of menstruation. After pregnancy is confirmed, if there is a small amount of vaginal bleeding, increase the dosage of yam and lotus seeds to strengthen the spleen and benefit the qi in order to benefit the qi to take in the fetus and stop the bleeding; add peony to nourish the blood and soften the liver to ease the pain in the lower abdomen.
In addition, although Zhu Danxi cloud “Scutellaria baicalensis and Atractylodes macrocephala are wonderful medicines to calm the fetus”, but Scutellaria baicalensis is a product to clear heat and disperse knots, if there is no heat and should not be used, even if the heat is obvious dosage should not be too large. In addition, the modern pharmacological study of Eucommia has toxic side effects that cause malformation of animal embryos, clinical application should also be cautious.
3.6 Combined application of three methods for better therapeutic effect
The ear points are based on the pelvis, heart, spleen, and kidney. It acts to strengthen the spleen, tonify the kidneys, calm the heart and mind, and induce the downward movement of medicine. The dietary therapy uses carrot, dendrobium, yam, lotus meat and big bone in appropriate amounts to make soup to supplement the herbs to calm the fetus.
In a word, You’s Fertility Soup is ingeniously conceived to strengthen the spleen and help the membrane to take in the fetus, to carry the fetus, and to nourish the kidneys and strengthen the fetus; the clinical application highlights the double meaning of “flexibility” and “safety”; it opens a new chapter for the application of TCM in the field of modern reproductive medicine!
4.Examples of cases.
Zhou, female, 33 years old, was first diagnosed on January 26, 2010.
The patient had in vitro fertilization-embryo transfer due to polycystic ovary syndrome and weak sperm of her husband for 3 years, but the two transfers were unsuccessful. Therefore, she requested to undergo in vitro fertilization-embryo transfer again after herbal treatment.
She usually has regular menstruation 7-8d/28-35d, Lmp: 2010.1.25-present, low volume bright red with blood clots, vague abdominal pain before menstruation, bilateral breast swelling, lower abdominal pain during menstruation, headache, back swelling, lumbosacral pain before and after menstruation (since IVF-ET), nasal function, poor night sleep and dreaminess, urinary bowel movement, purple-red tongue with teeth marks, thin white fur, smooth pulse. In June 2007, she became pregnant naturally after herbal treatment and saw redness in the third month of pregnancy and miscarried spontaneously. After the miscarriage, she was treated with Chinese medicine in a hospital and diagnosed as “secondary infertility (liver-depression and kidney-deficiency type)”.
Treatment history: In the first three months after the diagnosis, the patient was treated according to the IVF-ET TCM adjuvant therapy program before the week, her mental outlook improved, her follicles were full and could be expelled in time, her endometrial thickness was appropriate and her typing was grade A. In September of the same year, the patient went to Western Hospital for IVF-ET treatment for the third time. On the day of transplantation, the patient was given An Fetus Soup with reduction, mainly consisting of 15g of Dang Ginseng, 15g of Astragali, 10g of Atractylodes Macrocephala, 10g of Siberian Stem, 10g of Ramie Root, 10g of Cornus Officinalis, 15g of Yam, 5g of Lotus Heart, 10g of Dendrobium and 10g of Dendrobium, to nourish the kidney essence and help the membranes to grow and nourish, and to increase the progesterone and HCG levels to accelerate the growth and nourishment of the endometrium and synchronize it with the development of the implanted embryo as far as possible. The herbs were administered for 10 times.
On November 9, the hospital tested positive for urine pregnancy test and ordered her to be hospitalized for observation and treatment, followed by the addition and subtraction of An Fertilization Tang, one dose of which was taken twice a day. Half a month later, ultrasound showed intrauterine pregnancy with good embryonic development, and the patient had no significant discomfort and was discharged from the hospital for observation. The fetus was developing well and the patient had no significant discomfort.