Zhang Xichun on Miscarriage
Three excerpts from Yīxué zhōngzhōng cānxī lù《醫學衷中參西錄》(“Records of Medicine that Reference Western Medicine From Within the Folds of Chinese Medicine,” 1909) by Zhāng Xíchún 張錫純 (1860-1933)
On Fetal Stirring, Miscarriage, and Slippery Fetus
胎動不安流產滑胎
Note: What follows is my literal translation of some passages that Leo Lok selected as part of preparing for our upcoming course on “Nurturing Pregnancy.” In that class, which starts on March 21, we discuss the concepts and treatment introduced by Zhang Xichun in detail, and then compare them to other historical approaches as well as contemporary clinical applications in both China and the West. We hope that this blog post will entice some of you to still sign up.
On Miscarriage
Miscarriage has been a consistent disorder of women, and yet there are no formulas recorded in the formula literature that safeguard the fetus with guaranteed efficacy. Truly, when it comes to medicinals for safeguarding the fetus, we must focus on the fetus to change its basic condition and constitution. In this way we enable it to become better at absorbing the mother’s Qi to nourish itself, and thereby we avoid the risk of miscarriage. If, however, we merely supplement and support the pregnant woman, making her Qi and blood exuberant and securely contained, based on the belief that "a fetus is automatically secured when the mother is strong," this means that we have not considered the situation in its entirety. Taking this into account, based on my own clinical observations and verification, I have observed patients who miscarried numerous times even though they had a consistently strong and robust body, without even the hint of an illness. And on the other hand, there were cases where the patient had a frail body and I was worried that multiple pregnancies would exacerbate their frailty, so I wanted them to abort the fetus, and yet they did not! Based on this we know: Whether somebody miscarries or not does not solely depend on the strength or weakness of the pregnant mother’s body, but we must also observe whether the fetus is good at absorbing the mother’s Qi transformation or not.
Arguing on the basis of this, if I had to pick a single medicinal as the most effective one for treating miscarriage from among the hundreds and thousands of medicinal substances, tusizi would be it!
Shoutaiwan (“Fetal Longevity Pill”)
Shoutaiwan makes heavy use of tusizi as the ruling medicinal and uses xuduan, jisheng, and ejiao to support it. All women who are with child can slowly take one batch after the first two months of pregnancy and shall invariably avoid the disaster of miscarriage. And for patients with the greatest likelihood to miscarry, it is equally effective to take it repeatedly.
Tusizi (4 liang, stir-fried over low heat)
Sangjisheng (2 liang)
Sichuan xuduan (2 liang)
Genuine Ejiao (2 liang)
Crush the first three ingredients above finely and then mix with rehydrated ejiao into pills 1 fen in weight (dry weight). Take 20 pills per dose, chasing them down with boiled water, 2 doses a day. For cases with Qi vacuity, add 2 liang of renshen. For cases with major Qi collapse, add 3 liang of fresh huangqi. For cases with reduced appetite, add 2 liang of stir-fried baizhu. For patients who are cool, add 2 liang of stir-fried buguzhi, and for patients who are hot, add 2 liang of sheng dihuang.
Regarding the fetus in the mother’s abdomen, ultimately if it is good at absorbing the mother’s Qi transformation, then naturally there will no worries about miscarriage. Moreover, both male and female reproduction rely on the kidney organ’s function of “forceful action.” Tusizi has a great ability to supplement the kidney and hence is naturally able to shelter the fetus due to the kidney’s exuberance. Sangjisheng is able to nourish blood and strengthen the sinews and bones, and has a great ability to make the Qi of the fetus strong and robust. Hence the Shennong bencaojing records it as being able to calm the fetus. Xuduan is also a kidney-supplementing medicinal. Ejiao is produced from boiled donkey hide and is excellent for submersing the blood vessels, for moistening Yin and for supplementing the kidney. Hence the Shennong bencaojing also records its ability to calm the fetus. Now in regard to cases with Qi vacuity, add renshen to supplement the Qi. And for the collapse of Major Qi, add the huangqi to raise and supplement Major Qi. When thirst and appetite are reduced, add baizhu to strengthen and supplement the spleen and stomach. For cool patients, add buguzhi to assist the yang inside the kidney (buguzhi excels at safeguarding the fetus, as Chen Xiuyuan has discussed in detail). And for hot patients, add sheng dihuang to moisten the yin inside the kidney. If you carefully calibrate the appropriateness at the moment of diagnosis, there is no way that the use of this formula will not be effective.
This formula is a method to consider for prevention, not a rescue remedy for emergencies. If the fetal Qi is already stirring, possibly to the point of bleeding, we have other formulas to rescue critical conditions.
A Case Study Using a Rescue Remedy
I once treated a young woman who had miscarried in the fifth or sixth month of her first pregnancy. Afterwards, she was once again with child, in the sixth or seventh month, when she suddenly experienced fetal stirring and bleeding. I urgently gave her 2 liang each of fresh huangqi and dihuang, and 1 liang each of baizhu, shanzhuyu (pitted), longgu (calcined), and muli (calcined). After decocting this in 1 large bowl of water, I made her quaff it, and the Qi of the fetus consequently was calmed. I reduced the amount of medicinals by half and made her take another preparation. Afterwards she gave birth to one son who was strong and robust, with no faults.
