Wen | Doctor ChiEdit | the Taihu Lake CarpRecurrent miscarriage refers to the loss of the fetus before 28 weeks of pregnancy due to two or more consecutive spontaneous abortions.The probability of recurrent miscarriage in women of childbearing age is about 1% to 5%, and the rate of embryo loss after re pregnancy in patients who have had more than three consecutive natural abortions is 73% to 84%

Wen | Doctor Chi

Edit | the Taihu Lake Carp

Recurrent miscarriage refers to the loss of the fetus before 28 weeks of pregnancy due to two or more consecutive spontaneous abortions.

The probability of recurrent miscarriage in women of childbearing age is about 1% to 5%, and the rate of embryo loss after re pregnancy in patients who have had more than three consecutive natural abortions is 73% to 84%.

About 30% to 40% of recurrent miscarriages have unknown causes, known as unexplained recurrent miscarriage (URSA), also known as autoimmune recurrent miscarriage.

At present, it is believed that its pathogenesis is related to the imbalance of maternal and fetal Immune tolerance, and there is no unified standard treatment plan in clinical practice.URSA belongs to the category of "slippery abortion", "multiple abortions" and "multiple pregnancies and abortions" in Traditional Chinese medicine.

Chen Ziming clearly proposed the concept of "multiple abortions" in his book "The Great Recipes for Women",If a person suffers from deficiency of qi and blood, and their organs are afflicted by wind and cold, then their qi and blood are insufficient, so they cannot raise a fetus, so they have multiple abortions.

Ye Tianshi first named "miscarriage" as the name of the disease. In "Ye's Treatment of Women's Diseases - Abortion", "miscarriage occurred in three months of pregnancy, six or seven months of pregnancy, and repeated miscarriage due to lack of qi and blood.".

Kidney tonifying and blood nourishing method

The kidney stores essence and is responsible for reproduction. The cellular veins originate from the kidney, and the growth and development of embryos depend on the abundance of kidney essence,According to the "Western Records of Medical Zhongshen", "Both male and female reproduction relies on the strengthening of kidney qi, and a strong kidney can naturally nourish the fetus.

According to the book "Women's Medicine Classic", "A woman's kidney is connected to the fetus. If her kidney qi is depleted, she cannot retain the fetus's vitality." The kidney is connected to the cellular vessels. If her kidney qi is depleted, she will have insufficient energy and energy, and the fetus will lose its nourishment, which can lead to slippery fetuses and even repeated pregnancies and abortions.

The "Lingshu Five Tones and Five Flavors" states that "in the birth of women today, there is more than qi and less than blood, and with its number, blood is shed,Clarifying that deficiency of qi and blood can also lead to slippery fetuses.

The "Treatise on the Origin and Etiology of Various Diseases" states that "if a person suffers from deficiency of blood and qi, and their organs are inhabited by wind and cold, then their blood and qi are insufficient, so they cannot maintain their fetuses, resulting in multiple abortions." It is explicitly pointed out that deficiency of blood and qi leads to unstable fetuses.

The Complete Book of Ye Tian's Scholars and Women's Science points out that "there are people who are pregnant repeatedly and fall repeatedly, and they are called slippery fetuses due to insufficient blood", pointing out the pathogenic factor of insufficient blood.

Zhang Jingyue believed that "fetal qi in pregnancy is based on blood gas", and whether the fetus grows normally depends on blood gas.

In the "Complete Book of Jingyue", it is said: "Any fetus with unstable pregnancy is nothing but a disease of qi and blood damage. If it is due to deficiency of qi, it will not be able to lift and absorb properly, and if it is due to deficiency of blood, it will not be irrigated properly, resulting in frequent miscarriage

Modern doctors believe that the main causes of this disease are kidney deficiency, qi and blood deficiency, spleen and kidney deficiency, while in reality, it is blood heat and blood stasis.Therefore, the treatment of this disease should be based on tonifying the kidney and nourishing blood, supplemented by strengthening the spleen, clearing heat, and resolving blood stasis.

The correlation between kidney deficiency and blood deficiency and immune imbalance

Kidney stores essence, refines marrow, and marrow nourishes bone. Bone marrow affects the production and maturation of immune cells in the body.

Human immune cells come from hematopoietic stem cells in the bone marrow, which is the site for the production, differentiation, and maturation of immune activated cells and plays an important role in the immune response.

The pluripotent stem cells in bone marrow can differentiate into two Cell lineage, and then further develop into T cells, B cells and innate immune cells, so kidney deficiency is closely related to immune cells.

The regulation of the human immune system is similar to the balance of yin and yang in traditional Chinese medicine. The kidney stores essence and is also the foundation of reproduction. Kidney deficiency leads to an imbalance of yin and yang in the kidney, so it is closely related to immune recurrent miscarriage.

Blood is an important material foundation for maintaining human life and mental activities. The maintenance of human immune function also depends on sufficient qi and blood in the body. The normal interaction of immune organs, immune cells, and immune molecules all depends on the nutrition of blood.

Therefore, qi and blood deficiency can lead to reproductive immune dysfunction, tonifying qi and blood can improve the blood supply to the uterus and placenta, promote reproductive immune function remodeling, promote embryonic development, and prevent recurrent miscarriage.

If the kidney is deficient and the essence is deficient, and the qi and blood are insufficient, the maternal immune system will be imbalanced, resulting in unstable fetal strength and "repeated pregnancy and miscarriage".Therefore, the "repeated pregnancy and abortion" caused by insufficient kidney qi and deficiency of qi and blood are similar to URSA caused by immune imbalance in Western medicine.

Kidney tonifying and blood nourishing method

Modern medical research shows that traditional Chinese medicine has a good regulatory effect on recurrent abortion caused by immune factors. Traditional Chinese medicine can promote the Immune tolerance of the maternal fetal interface by intervening in different targets of embryonic and maternal immunity.

Thus exerting its therapeutic effect on URSA.Traditional Chinese medicine believes that the occurrence of this disease is mainly due to kidney deficiency, fetal loss, deficiency of qi and blood, loss of fetal vitality, and often accompanied by pathological factors such as blood stasis and heat.

The treatment should regulate the spleen and kidney qi and blood to consolidate the foundation, and also treat blood stasis and heat clearing. Traditional Chinese medicine has achieved good results in using its own advantages in syndrome differentiation and classification treatment.

The "Fetal Birth Heart Law" states: "The ability of a fetus to grow and thrive depends entirely on the spleen and soil of the mother transmitting qi to the child. Therefore, although the growth and development of the fetus are mainly related to the kidneys and liver, the growth and nourishment are related to the spleen and soil

The causes of URSA patients are nothing more than kidney deficiency, inability to conceive the fetus, blood deficiency, inability to nourish the fetus, and the kidney being the innate origin, the fetus being the origin, the spleen being the acquired origin, the source of qi and blood biochemistry, and the maintenance of the fetus.

Kidney deficiency inevitably leads to the loss of spleen nourishment, and treatment should focus on tonifying the kidney and nourishing blood, while also taking into account spleen strengthening. Traditional Chinese medicine believes that spleen and kidney deficiency correspond to immune dysfunction.

According to Fu Qing's "Pregnancy", "The spleen is acquired, the kidney is innate, and the non innate qi of the spleen cannot be transformed, and the non acquired qi of the kidney cannot be generated. If the kidney is replenished without the spleen, then why does the essence of the kidney suddenly arise? It is to replenish the acquired spleen,That's why it helps to nourish the congenital kidney. The spleen and kidneys that have been replenished for two days are the same as the qi and blood that solidifies the fetus. The spleen and kidneys are not evenly replenished

It can be seen that tonifying the kidney is essential for strengthening the spleen, and the two complement each other. The treatment of recurrent miscarriage requires not only tonifying the kidneys and replenishing essence, but also strengthening the spleen and nourishing blood. Clinical studies have shown that traditional Chinese medicine for tonifying the kidney and strengthening the spleen can regulate immune cytokines.

Qu Xiaohui et al. showed significant therapeutic effects in the treatment of recurrent miscarriage with self-designed tonifying the kidney, nourishing the blood, and calming the fetus decoction, correcting the pathological shift in serum Th1/Th2 cytokine balance.

Professor Zhang Qin used the method of tonifying the kidney, strengthening the spleen, and promoting blood circulation to treat recurrent miscarriage caused by immune disorders, based on the combination of Cistanche Tuzi Wan and Siwu Tang, and achieved good clinical results.

The Kidney Tonifying and Spleen Strengthening Formula can improve the clinical symptoms of patients with autoimmune recurrent miscarriage, increase the success rate of pregnancy, and have a significant effect.

Zishen Yutai Pill combined with Dydrogesterone, which has the functions of invigorating the spleen and kidney, supplementing qi and promoting vitality, and nourishing blood and tranquilizing fetus, can regulate the balance of Th1/Th2 cytokines in URSA patients, induce the production of Th2 cytokines, and enhance its dominant role.

Diao Xinli randomly divided 100 cases of URSA patients into two groups, 50 cases in each group. The control group took Dydrogesterone and vitamin E. On this basis, the observation group added Zishen Yutai Pill, which has the effect of tonifying the kidney, nourishing the blood, supplementing the qi, strengthening the spleen and tranquilizing the fetus.

The results showed that the observed group showed a more significant decrease in Th1 related cytokines compared to the control group, and a more significant increase in Th2 related cytokines compared to the control group. Moreover, the total effective rate and success rate of fetal protection in the observed group were higher than those in the control group.

There was a statistically significant difference between the two groups of traditional Chinese medicine syndrome scores before and after treatment, and the observation group was able to better improve the clinical symptoms of patients compared to the control group.

The combination of Mount Taishan Panshi Powder and Dydrogesterone, which can invigorate the kidney, invigorate the qi, strengthen the spleen and nourish the blood, can regulate cytokines in URSA patients, maintain pregnancy in a normal state, and do not increase adverse reactions.

Tonifying the Kidney, Nourishing Blood, and Resolving Blood Stasis

The patient suffers from repeated pregnancies and miscarriages, which depletes the essence and qi. Qi deficiency leads to obstruction of blood flow in the cells, and blood stasis remains in the cells. This prevents the production of new blood, leading to insufficient yin blood and loss of nourishment in the fetus. It can be seen that blood stasis is also an important reason for recurrent miscarriage.

According to the book "Correcting Mistakes in the Medical Forest," it is often said that those who repeatedly injure multiple fetuses do not know that there is blood stasis occupying the uterus first, and blood neither enters the fetus nor nourishes the fetus, resulting in miscarriage

Blood stasis blocks the uterus, causing the imbalance of Chong Ren, hindering the circulation of Qi and blood, and causing the fetus to lose nourishment from the essence and blood, resulting in a lack of nutrients in the fetus and ultimately leading to miscarriage.

Modern research shows that hypercoagulable state and placental embolism caused by autoimmune abnormalities are one of the causes of recurrent miscarriage.

It can inhibit the production of inflammatory related immune factors IL-17 and Th17 cells, maintain the balance of maternal immune microenvironment, induce maternal and fetal Immune tolerance, and then improve the pregnancy outcome of pregnant rats with recurrent abortion.

Kidney tonifying and blood activating combined with active immunotherapy can improve the Immune tolerance of URSA patients, regulate the balance of Th1/Th2, and significantly improve the survival rate of the fetus.

Zhu's Kidney Tonifying and Blood Activating Formula can effectively reduce the serum levels of IL-2 and IL-4 in patients with recurrent miscarriage, increase IL-10 levels, maintain immune balance at the maternal fetal interface, increase patient survival rate, and improve pregnancy outcomes.

Pan Yongmei randomly divided 76 cases of URSA into two groups. The control group was given Dydrogesterone. On this basis, the treatment group was added with Kidney Tonifying and Blood Activating Therapy combined with acupoint application.

After treatment, the Th17/CD4+and Th17/Treg levels in the treatment group were lower than those in the control group, while Treg/CD4+levels were higher than those in the control group, with statistically significant differences.It can be seen that the method of tonifying the kidney and promoting blood circulation can achieve the effect of protecting the fetus by regulating the maternal and fetal immune microenvironment.

Traditional Chinese medicine advocates for the treatment of slippery fetuses by "pre cultivating its damage". Feng Xiaoling et al. used the formula of tonifying the kidney and promoting blood circulation to improve the serum levels of pp14, IL-17, and IL-23 in non pregnant URSA patients, making them close to normal, promoting embryo implantation and maintaining normal pregnancy, and preventing miscarriage after pregnancy.

Regulate Th1/Th2 immune balance, enhance maternal and fetal protective immune function, and thereby improve pregnancy success rate.

Shen Gui Yang Yuan Fang has the effects of tonifying the kidney and essence, supplementing qi and blood, removing blood stasis and generating new blood. Combined with Dydrogesterone Tablets to treat URSA can improve the efficacy and improve the live birth rate of newborns.

Yishen Zhuangmu Tang has the functions of promoting blood circulation and resolving stasis, nourishing blood and nourishing yin, and tonifying the kidney and fixing the fetus. It can improve the patient's immune level and reduce the level of inflammatory factors.

Research has shown that the expression of IL-21R in the decidua of URSA patients is significantly higher than that of the normal pregnancy group, while the expression of IL-27R in the decidua of URSA patients is lower than that of the normal pregnancy group.

The tonifying kidney and promoting blood circulation formula can reduce the level of IL-21 and increase the level of IL-27 in the peripheral blood of URSA patients, thereby improving the maternal fetal immune microenvironment and the homeostasis of decidual tissue.

The above research indicates that the combination of tonifying the kidney and nourishing blood and resolving blood stasis method can regulate the patient's immune function, maintain maternal fetal immune balance, and have good therapeutic effects on URSA caused by immune imbalance.

Traditional Chinese medicine believes that insufficient kidney essence and deficiency of qi and blood are the main pathological basis of URSA. Clinical studies have shown that the combination of tonifying the kidney and nourishing blood, strengthening the spleen, clearing heat, and promoting blood circulation methods are used to treat URSA.

It can promote the balance of maternal fetal immune regulation, improve clinical symptoms of patients, and increase pregnancy rate and live birth rate. However, there are still some problems in clinical research on the differentiation and treatment of URSA using traditional Chinese medicine.

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