bubble_chart Concept

Threatened abortion refers to the sensation of fetal movement descending, abdominal pain, soreness in the lower back, or slight vaginal bleeding during pregnancy. If the pain in the lower abdomen and soreness in the lower back worsen, and vaginal bleeding increases, it may lead to "early abortion," "late abortion," or "intrauterine fetal death." Therefore, threatened abortion is often a precursor to early abortion and late abortion.

bubble_chart Pattern Analysis

1. Qi Deficiency︰Pregnancy with a sensation of fetal movement descending, abdominal distension and fullness, soreness in the waist, occasional slight vaginal bleeding with pale color and thin texture, or discharge of yellowish fluid, {|###|}pallid complexion{|###|}, mental fatigue, shortness of breath and reluctance to speak, fear of cold, {|###|}pale tongue{|###|} with thin white coating, floating and slippery but weak pulse or deep and weak pulse. It must be accompanied by {|###|}pallid complexion{|###|}, shortness of breath and reluctance to speak, fear of cold, pale tongue, weak pulse, etc. The treatment should focus on {|###|}tonifying the kidney to calm the fetus{|###|}, supplemented by nourishing blood, using the modified Original-Qi Lifting Decoction.
2. Blood Deficiency︰Pregnancy with lower back soreness, abdominal distension and fullness, or a subjective feeling of threatened abortion, heavy pressure and sagging, occasional vaginal bleeding, complexion shallow yellow, dizziness and palpitations, mental fatigue and lack of strength, dry skin, tongue texture pale red, thin or no coating, pulse thin and rapid. It must also include dizziness and palpitations, complexion shallow yellow, dry skin, pulse thin and weak, etc. Treatment should focus on nourishing blood and tonifying qi, supplemented by tonifying the kidney to calm the fetus. The prescription used is Fetus Decoction. Gezhi Yulun states: "Yang spreads and yin transforms, thus pregnancy is achieved. Deficiency and damage of qi and blood, insufficient nourishment, lead to spontaneous abortion." Clinically, cases of threatened abortion due to dual deficiency of qi and blood are also relatively common. Treatment should focus on tonifying qi and nourishing blood to calm the fetus. The prescription used is Tocolysis Decoction.
3. Kidney Deficiency︰Pregnancy with lower abdominal sagging, distension or pain, lumbago, vaginal bleeding, dizziness, tinnitus, weakness in both legs, frequent urination or incontinence, pale tongue texture with thin white coating, deep and thin weak pulse. Mostly due to innate weakness, congenital deficiency, or excessive sexual activity depleting kidney qi, or repeated miscarriages damaging the lower origin, leading to instability of the Chong and Ren meridians and fetal movement descending. The key points of differentiation are lumbago and weakness in both legs. Fuke Yuchi states: "Pregnancy lumbago is most critical, as the fetus is connected to the waist, hence severe waist pain and soreness indicate the fetus is about to detach from the kidney, signaling imminent delivery." However, kidney deficiency threatened abortion can be further differentiated into yin deficiency and yang deficiency. For kidney yin deficiency, there should be signs of yin deficiency with internal heat, such as flushed complexion, tidal fever and night sweats, feverish sensation in palms and soles, dry mouth without desire to drink, red and dry tongue, thin and rapid pulse, etc. Treatment should focus on nourishing yin and blood to calm the fetus, using modified Neibu Wan combined with Fetus-Preserving Pill. For kidney yang deficiency, there should be signs of weakened primordial yang, such as cold limbs, dusty complexion, frequent urination or incontinence, pale tongue texture, deep and thin pulse, especially weak in both chi positions, etc. Treatment should focus on strengthening the kidney to soothe the fetus, using the tonifying the kidney to calm fetus decoction.
4. Blood Heat︰During the third to fifth month of pregnancy, there is occasional vaginal bleeding with bright red blood, soreness in the lower back, a dragging pain in the lower abdomen, dry mouth and throat, thirst with a preference for cold drinks, scanty dark urine, constipation, a red tongue with thin, yellow, and dry coating, and a slippery, rapid, and forceful pulse. This is often due to an inherently exuberant yang constitution, where blood gathers in the uterus to nourish the fetus, causing yang qi to become even more hyperactive. The exuberant yang generates heat, which disturbs the Sea of Blood and damages the fetal origin, or pathogenic heat invades during pregnancy, disturbing the Chong and Ren meridians, leading to threatened abortion. The key diagnostic points include: distending pain in the lower abdomen, soreness and discomfort in the lower back, dry mouth and throat, and bright red bleeding. The treatment principle is to clear heat, cool the blood, and calm the fetus, using Yin-Preserving Decoction.
5. Qi Depression︰During pregnancy, there is backache, fetal movement, dull abdominal pain, and dark red vaginal bleeding. The patient experiences low spirits, irritability, hypochondriac distending pain, belching, poor appetite, a red tongue with thin yellow coating, and a wiry-slippery pulse. This is often caused by anger damaging the liver after conception, leading to liver qi stagnation and threatened abortion. The key diagnostic points include symptoms of liver depression pattern, such as low spirits, irritability, hypochondriac distending pain, belching, poor appetite, and a wiry-slippery pulse. The treatment principle is to soothe the liver and regulate qi to calm the fetus, using Shunqi Yinzi (Qi-Regulating Decoction).
6. External Injury︰During pregnancy, sudden fetal movement with a sinking sensation, aching pain in the waist, abdominal distension and fullness or pain, vaginal bleeding with bright red blood, mental fatigue and lack of strength, normal tongue texture, and a slippery yet weak pulse. This is often caused by falls, sprains, collisions, or carrying heavy loads over long distances, which injure the Chong and Ren meridians, leading to disordered qi and blood, inability to support and nourish the fetus, resulting in sudden threatened abortion, sore waist, abdominal pain, and vaginal bleeding. Treatment should focus on supporting qi and nourishing blood to calm the fetus. The recommended formulas are Sage Cure Decoction combined with Fetus-Preserving Pill, or Finger Citron Powder can also be used.

Threatened abortion, vaginal bleeding during pregnancy, and abdominal pain during pregnancy are closely related. If abdominal pain during pregnancy is accompanied by lower back pain and vaginal bleeding, or if vaginal bleeding during pregnancy is accompanied by lower abdominal pain and lower back pain, these conditions are considered threatened abortion. Therefore, abdominal pain during pregnancy and vaginal bleeding during pregnancy are mild forms of threatened abortion, while threatened abortion itself is a severe form of both abdominal pain during pregnancy and vaginal bleeding during pregnancy.

bubble_chart Documentation

1. Nyuke Zhengzhi Zhunsheng．Prenatal Section: "In the eighth or ninth month of pregnancy, threatened abortion, severe pain in the heart and abdomen, a bluish complexion, cold sweating, and a faint breath, these are caused by overexertion damaging the uterine environment, and should be urgently treated."Uncaria Decoctionis the main treatment.
2. Jingyue Quanshu．Women's Regulations: "Fetal qi disease with cold and instability, its symptoms may include acid regurgitation, nausea and bloating, a preference for heat and aversion to cold, cold diarrhea, a deep and thin pulse, or the complete absence of fire pattern with threatened abortion, all belong to yang deficiency cold pattern. Simply warming the interior will naturally stabilize the fetus. It is appropriate to use warming stomach fluid retention, Liyin Decoction, and similar formulas with modifications as the main treatment. It is also necessary to consider the usual visceral qi, observe its condition, and adjust the treatment accordingly."