During pregnancy, intermittent vaginal bleeding without abdominal pain and lumbago is known as "vaginal bleeding during pregnancy," while that with lumbago or bearing-down sensation in the lower abdomen is known as "excessive fetal movement." Both of them are a sign of threatened abortion.

Etiology and Pathogenesis

The dysfunction of the Chong and Ren meridians and failure to nourish the fetus are the main causes of these disorders, which may be induced by the deficiency of qi and blood, kidney-deficiency, blood-heat, trauma, etc.

Diagnosis and Differential Diagnosis

These disorders may be differentiated from the following conditions:

A. Abortion: Gradually increasing amount of vaginal bleeding and lumbago occurring in the first trimester of pregnancy ending in a discharge of embryonic tissues.

B. Regular menstruation during pregnancy: Menstruation occurring regularly without interference to the growth of the fetus and stopping spontaneously as the fetus grows.

C. Hematuria during pregnancy: Bleeding occurring only during urination and by spontaneous dripping.

D. Molar pregnancy: Amenorrhea, enlarged abdomen, vomiting, paroxysmal abdominal pain but without fetal movement, discharge of cysts resembling a bunch of grapes, or even menorrhagia.

Syndrome Differentiation and Treatment

The general body condition, the past history including any traumatic accidents and emotional factors should be noted. The therapy for preventing miscarriage should be adopted as the chief measure, and that of strengthening the kidneys, regulating qi, nourishing blood and clearing away heat should be employed according to different situations. The pregnancy may be maintained after the vaginal bleeding is controlled and abdominal pain relieved. When the vaginal bleeding becomes more serious, lumbago and abdominal pain aggravated and abortion becomes inevitable, the therapy for abortion should be employed.

Syndrome Differentiation

A. Kidney-deficiency syndrome

Manifestations: Bleeding from the vagina during pregnancy with scanty dull discharge, lumbago and bearing-down pain in the abdomen, dizziness, tinnitus, frequent urination, nocturia or even incontinence of urine, pale tongue with white coating, deep and smooth pulse and weak Chi pulse; a history of habitual abortion may be present.

Therapeutic principles: Strengthen the kidneys, benefit qi, and prevent miscarriage.

Prescription: The Modified Bolus for Strengthening the Fetus

Semen Cuscutae 15 g
Ramulus Taxalli 15 g
Radix Dipsaci (fried) 10 g
Colla Corii Asini 10 g

Remarks: For cases with discharge of fresh blood, add Radix Boehmeriae (10 g). For cases with discharge of dull-colored blood, add Receptaculum Nelumbinis Carbonisatus (10 g). For cases with marked lumbago, add Cortex Eucommiae (15 g) and Rhizoma Dioscoreae (15 g). For cases with profuse bleeding, add Herba Agrimoniae (15 g) and Herba Ecliptae (15 g). For cases with frequent urination or even incontinence of urine, add Fructus Alpiniae Oxyphyllae (10 g), Ootheca Mantidis (15 g) and Fructus Corni (10 g).

B. Qi and blood deficiency syndrome

Manifestations: Bleeding from the vagina during pregnancy with scanty, thin and reddish discharge, lumbago, bearing-down sensation or pain over the abdomen, fatigue, pale complexion, palpitations, shortness of breath, pale tongue with thin, white coating and thready and smooth pulse.

Therapeutic principles: Nourish blood, tonify qi, strengthen the kidneys, and prevent miscarriage.

Prescription: The Modified Decoction for Invigorating Fetus-Qi

Radix Ginseng 10 g
Cortex Eucommiae 15 g
Radix Paeoniae Alba 10 g
Radix Rehmanniae Praeparata 15 g
Rhizoma Atractylodis Macrocephalae 12 g
Pericarpium Citri Reticulatae 10 g
Radix Glycyrrhizae Praeparata 6 g
Radix Astragali 15 g
Colla Corii Asini (dissolved in water and taken separately) 10 g

Remarks: For cases with profuse vaginal bleeding, add Folium Artemisiae Argyi Carbonisatus (3 g) and Herba Agrimoniae (15 g). For cases with severe abdominal pain, increase the dosage of Paeoniae Alba and Glycyrrhizae. For cases with impairment of the liver and spleen due to over-thinking and grief, add Flos Rosae Chinensis (10 g) to disperse the stagnated liver-qi and alleviate mental depression. For cases with poor appetite, loose stool and white and greasy tongue coating due to the dysfunction of the spleen, add Fructus Amomi (6 g) and Rhizoma Dioscoreae (fried, 15 g).

C. Blood-heat syndrome

Manifestations: Bright red discharge from the vagina during pregnancy, bearing-down pain over the lumbus and abdomen, restlessness, feverish sensation over palms and soles, dryness of mouth and throat, hectic fever, oliguria with yellow urine, constipation, red tongue with yellow and dry coating and smooth and rapid pulse.

Therapeutic principles: Tonify yin, clear away heat, nourish blood, and prevent miscarriage.

Prescription: The Modified Decoction for Promoting Yin

Radix Rehmanniae 15 g
Radix Rehmanniae Praeparata 15 g
Radix Dipsaci (fried) 10 g
Rhizoma Dioscoreae 15 g
Radix Scutellariae 10 g
Radix Paeoniae Alba 15 g
Radix Boehmeriae 10 g
Radix Scrophulariae 15 g
Fructus Gardeniae 10 g
Fructus Trichosanthis 20 g
Radix Ophiopogonis 10 g

Remarks: For cases with profuse bleeding, add Herba Ecliptae (15 g) and Colla Corii Asini (10 g, dissolved in the decoction) to tonify yin, cool blood and prevent miscarriage. For cases with anorexia and abdominal distention, add Fructus Amomi (6 g) to regulate qi circulation, prevent miscarriage and protect the stomach from impairment by cold-natured drugs. For cases with lumbago, add Cortex Eucommiae (10 g) to tonify the kidneys, strengthen the lumbus and prevent miscarriage.

D. Fetal injury by trauma

Manifestations: Vaginal bleeding, lumbago, distending pain in the lower abdomen after trauma during pregnancy, normal tongue and smooth and weak pulse.

Therapeutic principles: Tonify qi, nourish blood, and prevent miscarriage.

Prescription: The Modification of Taishan Rock Powder

Radix Codonopsis Pilosulae 15 g
Radix Astragali 12 g
Rhizoma Atractylodis Macrocephalae 12 g
Radix Angelicae Sinensis 10 g
Radix Paeoniae Alba 10 g
Radix Rehmanniae Praeparata 15 g
Fructus Amomi 6 g
Radix Dipsaci (fried) 10 g
Ramulus Taxalli 15 g
Radix Glycyrrhizae Praeparata 6 g

Remarks: For cases with profuse bleeding and marked fetal movement, add Radix Boehmeriae (10 g), Colla Corii Asini (10 g) and omit Angelicae Sinensis to nourish blood and arrest bleeding. For cases with blood stasis, add Radix Rubiae Carbonisatus (10 g), Os Sepiellae seu Sepiae (15 g) and Herba Cephalanoploris (fried, 10 g) to cool blood, eliminate blood stasis and stop bleeding. For those cases accompanied by stagnation of qi and blood, add Rhizoma Cyperi Praeparata (10 g) and Caulis Perillae (10 g) to regulate qi circulation and prevent miscarriage. For cases with severe lumbago, add Cortex Eucommiae (15 g) and Semen Cuscutae (15 g) to invigorate the kidneys and prevent miscarriage.

Copyright 1995 Hopkins Technology