abstracted & translated by
Bob Flaws, L.Ac.

Strictly speaking, biochemical pregnancy refers to the very early period of pregnancy where pregnancy is confirmed by serum and/or urine analysis but not yet by ultrasound. It is called a biochemical pregnancy because pregnancy can only be established by biochemical means. However, this term has also come to mean a pregnancy that stops growing before it is large enough to be seen on ultrasound. In other words, it has come to mean a very early miscarriage. Because of the increased use of assisted reproductive technologies (ART) and all the testing that goes along with that, more and more women are finding out they are pregnant at a very early stage. Since these women are being treated for infertility in the first place, they and their doctors are usually very concerned about spontaneous abortions or what are more commonly called miscarriages. This concern is even more acute in those women who have already had one or more miscarriages during their long ordeal to conceive and successfully give birth to a child.

One of the traditional strong points of Chinese medicine has been its teachings on preventive medicine. Unfortunately, not much of the modern literature on the preventive use of Chinese medicine has been translated into English. Most assuredly, the topic of “treating when there is no disease” is a common one in contemporary Chinese medical journals where it is referred to as zhi wei bing, ??? . One example of such an article is by Li Jian et al. titled “An Introduction to Director He Gui-ying’s Experiences in the Preventive Treatment of Occult Pregnancy with Chinese & Western Medicine.” This article appeared on pages 20-21 of issue 4, 2009 of Fu Jian Zhong Yi Yao (Fujian Chinese Medicine & Pharmacology). Dr. He is the Director of the Fuzhou Municipal Chinese Medical Hospital with 39 years of clinical experience in gynecology. In addition, Dr. He was a student of the famous Fujian Chinese doctor Sun Hao-ming. Because I know of nothing else published in English on the Chinese medical treatment of biochemical pregnancy and because many Westerners are unaware that there even is a contemporary Chinese literature on preventive treatment, I would like to summarize Director He’s main Chinese medical points.

Disease mechanisms:  

Director He believes that the disease mechanisms of biochemical pregnancy, meaning spontaneous abortion during very early pregnancy, are mostly “kidney qi vacuity not securing of the chong and ren with the fetus thus losing its ligation (or that which ties it to the mother’s body).” In Chinese medicine it is said, “A woman’s kidneys ligate to the fetus” and “The uterine vessels ligate to the kidneys.” The kidneys are the root of the five viscera and the root of the source qi, and they govern reproduction. The kidney vessel connects with the chong, ren, and governing vessels and all these mutually connect with the uterus. The chong is the sea of blood, while the ren governs the uterus and fetus. If the kidney qi is exuberant, then the fetus has somewhere to tie to. If the yin essence is full and exuberant, this leads to the fetus having a source of nourishment. Conversely, if the kidneys are vacuous, then the opposite of all this is true.

Diagnosis:

Director He uses Western medicine to diagnose this condition, meaning a combination of basal body temperature (BBT) charting and serum beta-hCG. Basically, in most cases of biochemical pregnancy,  hCG levels rise only slightly rather than double every few days as they should. Menstruation may be delayed by seven days or more or there may be a slight amount of blood from the vaginal tract. If there is a history of habitual miscarriage, Director He simply prescribes one packet of Chinese medicinals per day as soon as the woman knows she is pregnant until the women is no longer likely to miscarry (i.e., 10-12 weeks).

Preventive treatment:

Director He preventively treats biochemical pregnancy with a combination of Western and Chinese medicines. Since women in the West diagnosed with biochemical pregnancy are typically undergoing ART, I assume that the Western medical part of their treatment will be handled by their Western fertility specialist. Basically, Director He uses a combination of Chinese herbs with intramuscular or orally administered supplemental progesterone. This treatment is stopped after the woman has been pregnant for 10 weeks. The Chinese medical treatment principles Director He bases treatment on are to supplement the kidneys and fortify the spleen, bank and supplement the chong and ren. For this, Director He uses various modifications of Shou Tai Wan (Long-life Fetus Pill). This is a commonly used formula for threatened miscarriage in Chinese gynecology. The standard formula consists of:

Tu Si Zi (Semen Cuscutae)
Xu Duan (Radix Dipsaci)
Du Zhong (Cortex Eucommiae)
Sang Ji Sheng (Herba Taxilli)
Gou Qi Zi (Fructus Lycii)
Dang Shen (Radix Codonopsis)
Huang Qi (Radix Astragali)
Bai Zhu (Rhizoma Atractylodis Macrocephalae)
Sha Ren (Fructus Amomi)

Modifications:

If there is simultaneous blood heat, Director He adds Huang Qin (Radix Scutellariae), Zhu Ma Gen (Radix Boehmeriae), and Wu Dou (literally “Chicken Bean;” otherwise unidentifiable; may be a typographical error).

If there is simultaneous abdominal pain, Director He adds uncooked Bai Shao (Radix Alba Paeoniae), stir-fried Bai Shao (Radix Alba Paeoniae), uncooked Gan Cao (Radix Glycyrrhizae), and uncooked Gan Cao (Radix Glycyrrhizae).

If there is simultaneous breast distention, Director He add Chai Hu (Radix Bupleuri) and Zhi Ke (Fructus Aurantii).

For simultaneous blood vacuity, Director He adds Dang Gui (Radix Angelicae Sinensis), Bai Shao (Radix Alba Paeoniae), and Shu Di Huang (cooked Radix Rehmanniae).

For vaginal tract bleeding, Director He adds Mo Han Lian (Herba Ecliptae) and Shan Zhu Yu (Fructus Corni).

Formula analysis:

Within this formula, Tu Si Zi, Sang Ji Sheng, Du Zhong, Xu Duan, and Gou Qi Zi supplement the kidneys and boost the qi, secure pregnancy and quiet the fetus in order to treat the root of this condition. These are assisted by Dang Shen, Huang Qi, and Bai Zhu which supplement the kidney qi and boost the spleen and stomach, thus providing a source for the engenderment and transformation of qi and blood. These medicinals address the latter heaven root so it can supplement and nourish the former heaven. Sha Ren rectifies the qi and quiets the fetus. When all these medicinals are used together, they supplement the kidneys and fortify the spleen, bank and supplement the chong and ren. Director He believes that this formula promotes the function of the corpus luteum in its secretion of progesterone as well as improves the endometrial lining and increases the strength of immunity. Thus it addresses luteal phase defect, submucosal myomas, immune factors, and other unknown etiologies which may cause biochemical pregnancy in the sense of a very early miscarriage.

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