We all wish that clinic were as simple as giving "this for this and that for that." We wish there would be a protocol that would work every time for some diseases. However, we learn through experience that the only method that works reliably is diagnosing our patient as best we can at each visit and applying a method that matches the presenting pattern.
In this essay, Lúo Yuánkǎi challenges the tendency to simply through Huang Qin and Bai Zhu on women who are threatening miscarriage based on truisms. He writes, "If you give herbs, and the fetus can't be calmed and drops, this is considered to be beyond the capabilities of the herbs and is regarded with equanimity. Is this actually so? In my experience, I can't agree without giving it serious thought." He disagrees with writing off a miscarriage as inevitable if Huang Qin and Bai Zhu don't work.
Lúo Yuánkǎi affirms the importance of Huang Qin and Bai Zhu for protecting the fetus, analyzing their function in the classical formula Dang Gui San that includes them. At the same time, he shares a compelling story from Qing dynasty scholar Chén Xiūyuán that illustrates how giving herbs for an illness without diagnosing can lead to repeated disasters (five miscarriages!)
I am publishing this translation of the article in preparation for my White Pine Circle presentation on Bai Zhu.
Enjoy!
An Informal Discussion on "Huáng Qín and Bái Zhú for Dropping Fetus, By Lúo Yuánkǎi."
胎动不安乃妊娠常见病症，其原因很多，安胎之法，必 须辨证施治，方能奏效，固执一方一法，实难达到预期的效 果。自金元以来，朱丹溪提出所谓：“黄芩白术乃安胎圣药” 之说，对后世影响很大，至今仍有人持此二味作为安胎必用 之药者，胎或能安，则更坚信不疑；如果服药后胎不能安而 坠堕，则认为已尽了医药之能事而安之若素。事实是否这样 呢？根据个人经验，对此说不能苟同。
Restless fetus is a common disease pattern in pregnant women. There are many causes. To apply methods to calm the fetus, one must differentiate the pattern to treat and get to an effective formula. Achieving results will be difficult if you cling to one formula or method. Zhū Dānxī, from the Jīn-Yúan dynasty, put forward the saying that "Huang Qin and Bai Zhu are dropping fetus herbs." This influenced later dynasties tremendously. Until today, there are still those who consider these two herbs obligatory to use to calm the fetus. When the fetus calmed, they then had no doubt. If you give herbs, and the fetus can't be calmed and drops, this is considered to be beyond the capabilities of the herbs and is regarded with equanimity. Is this actually so? In my experience, I can't agree without giving it serious thought.
《丹溪心法·金匮当归散论》说：＂妇人有孕则碍脾，运 化迟而生湿，湿而生热，古人用白术黄芩为安胎之圣药，盖 白术补脾燥湿，黄芩清热故也。况妊娠赖血培养，此方有当 归川笃芍药，以保血尤为备也，服此药则易产，所生男女兼 无胎毒，则瘦疹亦稀，无病易育，而聪明智慧不假言矣。”
In the Dānxī Xīn Fǎ: Treatise on the Jīn Guì's Dang Gui San: "When a pregnant woman has uterine obstruction, the movement and transformation are hesitant, and this generates dampness. This dampness generates heat. The ancients used Bai Zhu and Huang Qin as the sage herbs to calm the fetus because Bai Zhu supplements the spleen and dries dampness while Huang Qin clears heat. Moreover, a pregnant woman relies on blood for growth and nourishment. This formula has Dang Gui, Chuan Xiong, and Bai Shao to guard the blood fully. Taking these herbs leads to an easy birth of a son or daughter without a fetal toxin, making smallpox rare. Children without disease are easy to educate as they are very intelligent and not tentative in their speech."
本来，张仲景的《金匮要略·妇人妊娠病脉证井治》只说： “妇人妊娠，宜常服当归散主之。“当归散原方是： “当归、 黄芩、芍药、川穹各一斤，白术半斤。右五味，忤为散，酒 饭服方寸匕，日再服。妊娠常服，即易产，胎无疾苦，产后 百病，悉主之。
Originally, Zhāng Zhòngjǐng's Jīn Guì Yào Luè chapter on the pulse, pattern, and treatment of women in pregnancy says, "When a woman is pregnant, it is appropriate to regularly take Dang Gui San to manage [the pregnancy]. "The original formula is "one Jin of Dang Gui, Chuan Xiong, Huang Qin, Shao Yao, and a half Jin of Bai Zhu. Pound these herbs into powder and take with a square-inch spoon in wine twice a day. When a pregnant woman takes this regularly, there will be an easy birth with a fetus without disease. It rules the 100 postpartum diseases."
“清代医学家尤在泾于《金匮心典》注释说： ＂妊娠之后，最虑湿热伤动胎气，故千芍归芍养血之中，用 白术除湿，黄芩除热。丹溪称黄芩白术为安胎圣药，夫芩术 非能安胎者，去湿热而胎自安耳。”
In his book, Jin Gui Xin Dian, the Qing dynasty medical scholar Yóu Zàijīng explained, "After a woman becomes pregnant, damp-heat is the most likely issue to damage the fetus. Therefore, Chuang Xiong, Dang Gui, and Shao Yao nourish the blood, Bai Zhu dispels dampness, and Huang Qin dispels heat. Dān Xī named Huang Qin and Bai Zhu as sage herbs to calm the fetus. These herbs do not calm the fetus. By expelling damp heat, you will spontaneously calm the fetus."
《医宗金鉴》注释云： ＂妊娠无病，不须服药，若其人瘦而有热，恐耗血伤胎，宜 常服此以安之。”
The Yi Zong Jin Jian explains, "When a pregnant woman is without disease, she need not take herbs. If she is frail and has heat, there is a concern that the consumption of blood will damage the fetus. It is appropriate to give this to calm."
这两家解释，似较允当。原张仲景
并无突出黄芩白术为安胎主药之意，且白术只占其余四味药 之半量，并非当归散之主药可知。但朱丹溪又说：＂条芩白 术乃安胎圣药，俗以黄芩为寒而不用，反谓温热药能养胎， 殊不知胎孕宜清热养血，使血循经而不妄行，乃能养胎。”
These two similar explanations are fair. In Zhāng Zhongjing's original text, no concept stresses Huang Qin and Bai Zhu as ruling herbs for calming the fetus. In addition, the dose of Bai Zhu is half that of the other herbs in the formula. They are not principal herbs in Dang Gui San. Nevertheless, Zhū Dānxī said, "Tiao Qin [Huang Qin] and Bai Zhu are the sage herbs for calming the fetus. Convention takes Huang Qin as a cold herb and hence does not use it and, on the contrary, says that it is warm, hot herbs that nourish the fetus. Few know that it is appropriate to clear heat and nourish blood for the fetus and pregnancy to make the blood flow in the channels and prevent it from moving recklessly, and only then can there be nourishment for the fetus.
他的立论，自有其一方面的道理。但他解释当归散时，却谓 “古人用白术黄芩为安胎圣药”，未免歪曲古人意，而妄下断 语。从学术态度来说，实在不够严肃。
His position has one rational point of view. However, when he explains Dang Gui San, he says, "The ancients use Huang Qin and Bai Zhu as calm the fetus herbs," which truly misrepresents the ideas of the ancients and is an absurd statement. From an academic approach point of view, it is not a serious matter.
查孙思邈的《备急千 金要方·妇人方》以至宋代著名医学家陈自明的《妇人良方 大全》等较朱丹溪为早的妇产科典籍，均未有“黄芩白术为 安胎圣药”之说，朱丹溪却以“古人”二字冠之，亦不过托 古以自重而已。
Sūn Sìmiǎo's Bèi Jí Qiān Jīn Yào Fāng up to the Sòng dynasty medical scholar Chén ZìMíng's Fù Rén Líang Fāng Dà Quán were written earlier than Zhū Dānxī's books on gynecology and obstetrics. When examining the books from this period, none of them say that Huang Qin and Bai Zhu are "sage herbs to calm the fetus." Zhū Dānxī just put these two words, "the ancients," only to exploit the ancients to make himself important, and that's all.
至谓“所生男女兼无胎毒，则疮疹亦稀，无 病易育”，亦属浮词。后更渭”而聪明智慧不假言矣”则更 属唯心之论。
He even said these unfounded remarks, "Taking these herbs leads to an easy birth of son or daughter that is born without a fetal toxin which makes smallpox rare. Children without disease are easy to educate." He says, "They will be very intelligent and not tentative in their speech." This makes his treatise even more idealistic.
清代医学家陈修园《女科要旨》讲了一个故事，兹抄录 如下：“余内子每得胎三月必坠，遵丹溪法，用药连坠五次， 后余赴省应试，内子胎适三个月，漏红欲坠，先慈延族伯延 义，以四物汤加鹿角胶、补骨脂、杜仲、续断各二钱，一服 而安，令每旬一次，余归已六个月矣。阅其方大为一骇，叹 曰：补骨脂《本草》载其坠胎，又合鹿角胶、杜仲之温，川 笃之行以助之，竟能如此之效，设余在家，势必力争，又以 黄芩、白术坠之矣。此后凡遇胎漏欲坠之症，不敢专主凉 血。
The Qing dynasty scholar Chén Xiūyuán told a story in his Nǔ Kē Yào Zhǐ, which I've shared below:
"My wife miscarried at three months with each pregnancy. I complied with Dānxī's methods, and, using his suggested herbs, she suffered five miscarriages in succession. Later, when my wife was three months pregnant, I had to leave to take an exam. She dripped blood and threatened miscarriage, so she first sent for her deceased mother's elder brother. She was given Si Wu Tang with two qian each of Lu Jiao Jiao, Bu Gu Zhi, Du Zhong, and Xuan Duan. After one dose, the fetus was calmed. She was told to retake this every ten days. I returned when she was already six months pregnant. I saw the formula and was greatly shocked. Sighing, he said that, in the Běn Cáo, Bu Gu Zhi treats dropping fetus and that it can also be combined with the warm Lu Jiao Jiao and Du Zhong and the moving Chuan Xiong to help. It was effective. If I had been at home, I would have put up a fight about dropping the Huang Qin and Bai Zhu. After this, when I encounter fetal dripping, on the point of dropping, I do not arbitrarily cool the blood.
“陈修园是以崇古著名的医家，食古不化，亦身受其害， 以后，在事实面前得到一次深刻的教训，才有所醒悟，后来 订出一条“新定所以载丸” （人参、白术、杜仲、桑寄生， 云笭、枣肉为丸，米汤送服）以治胎动不安。
Chén Xiūyuán is a revered and respected skilled doctor of ancient times, accepted [Dānxī's] half-baked ideas and also had personal experience of the adverse effects. It was only after he came face to face with the profound moral lesson that he had an awakening. Afterward, he put forward the one line, "Xīn Dìng Suǒ Yǐ Zài Wán" (Ren Shen, Bai Zhu, Du Zhong, Sang Ji Sheng, Yun Ling, Zao Rou, given as a pill or decoction) to treat restless fetus.
对于朱丹溪之论点，张景岳在《妇人规》已提异议。他 说：“凡妊娠胎气不安者，证本非一，治亦不同，盖胎气不 漫谈“黄芩白术乃安胎圣药”之说 安，必有所因，或虚，或实，或寒，或热，皆能为胎气之 病，去其所病，便是安胎之法，故安胎之方，不可执，亦不 可泥其月数，但当随证随经，因其病而药之，乃为至善，若 谓白术、黄芩乃安胎之圣药，执而用之，鲜不误矣。
Regarding Zhū Dānxī's arguments, in his Fù Rén Guī, Zhāng Jǐngyuè put forward his objection. He said, "There is not one cause for the restlessness of fetal Qi in pregnancy. The treatments are also not the same. One should not speak informally about fetal Qi. Huang Qin and Bai Zhu are the sage herbs for calming the fetus and dropping the fetus." There are causes of fetal Qi illness, such as deficiency, excess, cold, or heat. To dispel the illness, even if you are using a method to calm the fetus and hence using a calm-the-fetus formula, you can't be rigid or vague about the stage of pregnancy. Only by following the pattern and the classics and giving herbs according to the cause of the disease will there be reliable success. If, in this context, you say that Bai Zhu and Huang Qin are the sage herbs for calming the fetus and use them, you will rarely be mistaken.
”他更 详细解释说： “治热用黄芩，寒则不宜也；非惟寒者不宜， 即平气者亦不宜。盖凡今之胎妇，气实者少，气虚者多，气 虚则阳虚，而再用黄芩，有即受其损而病者，有用时虽或未 觉，而阴损胎元，暗残母气，以致产妇羸困，或儿多脾病 者，多由乎此，奈今人不能察理，但以｀圣药＇二字，认为 胎家必用之药，无论人之阴阳强弱，凡属安胎，无不用之， 其害盖不少矣。至若白术虽善安胎，然或用之不善，此其性 躁而气闭，故凡阴虚者非可独用，气滞者亦当权宜。“张景 岳这个论点切中时弊，较为正确，现在重温一下，颇有必 要。
He went on to give a detailed explanation. "When treating heat, use Huang Qin. It is not suitable when there is cold. Not only is it unsuitable for cold, it is also not appropriate in a balanced situation. If Huang Qin is used in every case where there is very little excess and abundant deficiency, this Qi deficiency leads to Yang deficiency, and if one uses Huang Qin, there will be damage and disease. While using it, although it does not show, this can also covertly damage the fetal source and secretly damage the mother's Qi, putting her in a poor condition for birth. The child may have a lot of spleen illness and much more! How can modern practitioners not observe this? Instead, these two words, "Sage Herbs," make them think this must be used for the fetal palace. They don't consider if the person's Yin and Yang are diminished. Do not use for every type of calming the fetus because the harm is not minimal. As for Bai Zhu, although it is good at calming the fetus and not bad to use, its nature is drying, and its Qi blocks. This means you must not use it rashly when there is a Yin deficiency. One should also determine its proper place with Qi stasis." In this sharp criticism of the status quo, Zhāng Jǐngyuè is correct. It is necessary to review this below:
我认为，妊娠妇女如身体有所不适，应随证随人，按其 虚实寒热加以调治，而避免使用犯胎药。如早期妊娠而有少 量阴道流血、腰酸腹痛、下坠感等先兆流产证候，则必须进 行安胎，按固肾补气、止血养血为主的原则治理。
I think that if a pregnant woman's body is ill-disposed, one should rely on the pattern and the person and give recuperative treatment according to deficiency, excess, cold, and heat. One should avoid using herbs that will violate the fetus. Suppose there are signs of threatened miscarriage in early pregnancy, like vaginal bleeding with lower back soreness, low back pain, and dropping down feeling. In that case, one must progress to calming the fetus, using the principles of consolidating the fetus, supplementing Qi, stopping bleeding, and nourishing the blood.
经云： "胞脉系于肾＂，肾以载胎，血以养胎。早期先兆流产，除身 体虚弱，胚胎先天发育不良及跌仆挫损伤冲任等外，主要由 千肾脾亏损，伤及冲任，以致不能系胞载胎及摄血养胎，其 诱因多由于妊娠三月内不能节制房事及劳力过度所致。
The classic says, "The Bao Mai is tethered to the kidneys." The kidneys carry the fetus, and the blood nourishes the fetus. In early-stage threatened miscarriage, except for poor health, fetal maldevelopment, or damage to the Chong and Ren due to falling or accidents, the primary cause is kidney and spleen depletion and damage to the Chong and Ren. This leads to an inability to tether the uterus to carry the fetus and a failure to absorb blood and nourish the fetus. The causes are often the pregnant woman having sexual intercourse in the third month and arduous work.
故 《傅青主女科》对导致“小产”的几种原因，首重行房不慎， 治法提出以固肾补气摄血安胎为主。临床常用的方药可选用 《医学衷中参西录》的寿胎丸（冤丝子、阿胶、续断、桑寄 生）合四君子汤加减化栽。寿胎丸以冤丝子为主，《中国药 学大辞典》谓其能“补肝肾，生精髓，用作强壮收敛药”。
Therefore, regarding the types of original causes of small birth, Fù Qīngzhǔ's Gynecology first names incautious sexual intercourse. The treatment method principal he puts forward is to consolidate the kidneys, supplement Qi, absorb blood, and calm the fetus. The herbs he uses are from the Yī Xuè Zhōng Cān Xī Lù’s Shòu Tāi Wán. This uses the herbs Tu Si Zi, Sang Ji Sheng, E Jiao, and Xu Duan combined with Si Jun Zi Tang and modified. The primary herb in Shòu Tāi Wán is Tu Si Zi. China's Great Dictionary of the Pharmacopia says this herb can "supplement the liver and kidneys and generate essence and marrow and is used to strengthen receiving."
《圣惠方》谓其可治难产。我个人经验，冤丝子是固肾安胎 的主药，补而不燥，是补益肝肾的理想药物，而且药价便 宜，药源不缺。桑寄生是固肾养血安胎止漏之品，兼有强腰 壮骨之功。续断温补肝肾，暖子宫，止胎漏，强筋骨。阿胶 有滋肾安胎、养血止血的作用。本方具有滋养肝肾、止血安 胎的功效。
The Shèng Huì Fāng says this [Shòu Tāi Wán ]can treat difficult birth. In my clinical experience, Tu Si Zi is a primary herb to consolidate the kidneys and calm the fetus. It supplements but is not drying. It is the ideal herb to supplement and boost the liver and kidneys. It is also relatively inexpensive. Sang Ji Sheng consolidates the kidneys, nourishes the blood, calms the fetus, and stops the dripping of blood. Together, these two strengthen the back and invigorate the bones. Xu Duan warms and supplements the liver and kidneys, warms the uterus, stops fetal dripping, and strengthens the tendons and bones. E Jiao enriches the kidneys, calms the fetus, nourishes blood, and stops bleeding. This formula, as a whole, enriches and nourishes the liver and kidneys, stops bleeding, and calms the fetus.
四君子汤补气健脾，在本方的基础上，可加人首 乌、熟地以滋肾养血，少量春砂仁以化气安胎，并防止阿 胶、冤丝子、熟地的滋滞。我用此方治疗多例先兆流产和习 惯性流产之有先兆症状者，均能奏效。当然，如果流血过 多、时间过长，或胎元不正、胎萎不长，甚至已成不可避免 流产者，则当别论。
Si Jun Zi Tang supplements Qi and fortifies the spleen. Upon the foundation of this formula, one can add Ren Shou Wu and Shu Di Huang to enrich the kidneys and nourish blood. A small amount of spring Sha Ren transforms Qi and calms the fetus. It helps guard against the enriching stasis of Shu Di Huang, E Jiao, and Tu Si Zi. I have used this formula to treat many cases with early signs of threatened miscarriage and habitual miscarriage with signs of threatened miscarriage. It is effective for both of these. Indeed, suppose there is profuse bleeding for a prolonged period. In that case, the fetal source is not correct, or there is fetal atrophy and poor fetal development that is already to the point of unavoidable miscarriage; this should be differentiated.
“黄芩、白术乃安胎圣药”之说，应该重新评价，以免 误人。
The saying that "Huang Qin and Bai Zhu are the sage herbs to calm the fetus" should be evaluated anew to avoid mistakes.
1 Kǎi, Lúo Yuán. China’S 100 Years of 100 Famous Doctor’s Clinical Experience Book Series: Luo Yuan Kai. China's Chinese Medicine Publishing House, 2001. pp. 213. Originally published in the New Chinese Medicine, January, 1977.
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