Ideas of combining Chinese and Western medicine to prevent and treat recurrent spontaneous abortion

  The clinical manifestations of recurrent spontaneous miscarriage are similar to those of slippery fetus in Chinese medicine. Most of them advocate tonifying kidney energy, clearing heat and calming the fetus, activating blood and calming the fetus before and after pregnancy, combined with Western medicine treatment of etiology, with special emphasis on post-pregnancy treatment. In the treatment of this disease, based on the pathology of Western medicine and the main pathogenesis of deficiency of positive qi and disturbance of evil qi, the author often adopts a combination of Chinese and Western medicine to prevent and treat the disease in three stages: pre-conception, pregnancy and post-conception, and obtain satisfactory results.  According to Chinese medicine, recurrent spontaneous abortion is mostly due to the weakness of congenital endowment, deficiency of spleen and kidney, lack of fullness of punching and fetal intake, or deficiency of essence and blood, deficiency of yin and fire, fire disturbing egg withering or fetal pearl not being born. With the intervention of modern family planning methods and changes in people’s lifestyle, the etiology of recurrent spontaneous abortion has become increasingly complex, mostly due to injuries caused by gold blades, drugs, diet, environment and emotions. Injuries caused by the golden edge are mainly due to unmarried pregnancy, or unwanted pregnancy after marriage and repeated abortions or induced abortions. Injuries caused by gold blades make the blood of the Punching Vessel leave the meridian and become stagnant, so that the stagnant blood does not go away and the new blood does not come into being. Injuries caused by diet, mostly due to eating thick food or spicy and cold food after miscarriage or induction of labor, which may cause phlegm, dampness, heat, fire, cold and other injuries to the ramus, and the fetus does not become a pearl; injuries caused by the environment, mostly due to industrial exhaust, automobile exhaust, plastic, food additives and pesticides, which may cause damage to the paternal and maternal fetus, or fetal damage; injuries caused by emotion, mostly due to panic about slippery fetus, which may cause dysregulation of the seven emotions and also injure the ramus and cause the fetus to become unsolidified. The fetus is not solid. In conclusion, if the zongren is injured by gold, drugs, diet, environment and emotion, cold, dampness, heat, fire, food, phlegm, poison, gas stagnation and blood stasis will become voodoo and obstruct the development of the fetus, or cause the zongren to lose its strength and cause repeated spontaneous abortions. The clinical manifestations are mostly fetal pearls that are not born. In one case, only biochemical pregnancy can be diagnosed by B-ultrasound, so called neglected pregnancy. In one case, early pregnancy has been diagnosed by B ultrasound, but only the gestational sac is visible and no fetal bud is developed, which is smaller than the gestational month.  Western medical tests should be performed to find out the cause, such as hysteroscopy and hysterosalpingogram to exclude anatomical factors; examination of paternal and maternal chromosomes to exclude genetic factors; examination of mycoplasma, chlamydia, toxoplasma, rubella virus, cytomegalovirus and herpes simplex virus to exclude infectious factors; examination of lactogen, mid-luteal progesterone and thyroid function to exclude endocrine factors; examination of antisperm antibodies, antiendometrial antibodies, anti Anti-seminal antibody, anti-endometrial antibody, anti-phospholipid antibody, blood group antibody, anti-embryonic antibody and closed antibody should be checked to rule out immune factors, and other related causes should be investigated. After the cause of the disease is identified, timely treatment should be provided to prevent and eliminate the disease in its infancy.  Based on the above understanding of the etiology of Chinese medicine, the pathogenesis of this disease is the deficiency of the righteousness and the ambush of the evil. Therefore, in principle, the treatment should be internal nourishment of the right qi, the right qi is sufficient, then the evil can not be played, slippery fetus before pregnancy should be careful diet, living in moderation, restraint in sexual intercourse, strengthen the exercise, so that the kidney qi is sufficient, punching the full, yin and Yang coordination, system fetus powerful. As the “Jin Kui Essentials” said: “more not to break the king’s law, animal calamity, room do not make exhausted lack of food and drink, and not to leave the body has decay, the disease is no reason to enter its couples”, so as to prevent disease in the future. The secondary caution of the evil, remove the evil cold, damp, heat, fire, food, phlegm, poison, gas stagnation, blood stasis, etc.. The common clinical diagnosis and classification are spleen and kidney yang deficiency treated by tonifying the kidney, strengthening the spleen and benefiting the qi, the formula is Shou Fetus Pill with Si Jun Zi Tang; kidney deficiency and blood deficiency treated by tonifying the kidney, filling the essence and nourishing the blood, the formula is Shou Fetus Pill with Si Wu Tang; kidney deficiency and blood heat treated by nourishing the kidney, nourishing the yin and clearing the heat, the formula is Shou Fetus Pill with Bao Yin Decoction; kidney deficiency and blood stasis treated by tonifying the kidney, consolidating the kidney and activating the blood, the formula is Shou Fetus Pill with Dan Shen; kidney deficiency and damp heat treated by tonifying the kidney, dipping the damp and clearing the heat, the formula is Shou Fetus Pill with Yin Chen Artemisia Tang. The treatment focuses on both tonifying the Chong Ren and eliminating the volatile evil, which is the source of safe fetus, and eliminating the volatile evil so that the seed will be free of worry and the fetus will be safe and solid.  After the above prevention and treatment, this is the time when the positive Qi is full of evil Qi and external evil is not easily disturbed, so we should strike while the iron is hot to promote conception. At this stage, the quality of gametes and the development of endometrium are the prerequisites for smooth embryo implantation and normal growth and development. If the gametes are abnormal, such as follicle development disorder or low quality sperm, or if the endometrium is poorly developed due to lack of sperm and blood, or poor blood flow, such as endometrium thinness, thickness and abnormal morphology, they become potential causes of recurrent spontaneous abortion, so the disease should be suppressed and regulated according to the menstrual cycle. Chinese medicine is the main treatment, supplemented by Western medicine. During the follicular development period, the method of warming the kidneys and benefiting the essence, regulating the liver and strengthening the spleen is often used to harmonize yin and yang and improve the quality of eggs or sperm, while during the ovulation period, blood and qi are activated to promote ovulation and the overflow of essence and diarrhea.  After ovulation, TCM focuses on warming the kidneys, strengthening the spleen, astringent essence and activating blood to improve luteal function, promote fertilized egg cleavage, prevent embryonic chromosomal abnormalities, and improve endometrial microcirculation. At the same time, if the progesterone or basal body temperature is monitored at the mid-luteal phase, if it indicates that the luteal function is still insufficient, natural progesterone will be given to improve the luteal function together with Chinese herbal medicine. If the positive antiphospholipid antibodies turn negative after treatment, it is also necessary to prevent the reversion of the positive antibodies.  The embryo is already in bed during this period and it is the time when the fetus grows. Due to the influence of pregnancy physiology, the qi and blood go down to nourish the fetus, and the punching of the fetus is on the high side, so the yin and yang qi and blood are biased and easily disturbed by evil. If the kidney yang is deficient, the blood loses warmth and stasis will remain if the blood is slow to move or does not work; if the kidney yin is deficient and heat burns the blood, the blood will be astringent and stasis will remain, so activating the blood and removing stasis is the standard of prevention. The use of warming the kidney and invigorating the blood or nourishing the kidney and clearing heat to invigorate the blood and calm the fetus to eliminate the triggering factors, life conditioning, such as careful eating spicy, fatty and cold products, living and living, cautious of sexual intercourse to avoid the triggering factors, by this treatment most of the mother safe fetal solid. Otherwise, the fetus will be damaged, such as vaginal bleeding or fetal leakage with lower abdominal pain and fetal movement, while the ultrasound shows that the fetus has a fetal bud and heart, and then the ultrasound shows that the embryo has stopped developing and the fetal heart has disappeared. If the phenomenon of pre-eclampsia (fetal leakage or fetal movement) occurs again, it should be treated as early as possible, so as not to wait and see, and to prevent further development of the disease. This stage of treatment should be stopped only in 3.5 months of pregnancy, so that the placenta has been established and a defense barrier is formed for the fetus.  4.Conclusion Although the etiology of recurrent spontaneous abortion is complex, great progress has been made in the research of Chinese medicine and western medicine treatment. The academic idea of “prevention before illness and prevention after illness” runs through the three treatment stages of pre-conception prevention and control, conception assistance and post-conception fetal preservation in Chinese and Western medicine, and the three stages are continuous and related, interdependent and mutually enriching, without obvious boundaries. It is important for the success of recurrent spontaneous abortion (miscarriage) treatment to standardize the combined Chinese and Western medicine treatment ideas in the pre-conception prevention and treatment, conception assistance and fetal preservation stages.