I. Overview of diseases
Habitual abortion is more than three consecutive spontaneous abortions, and each abortion often occurs in the same pregnancy month. Chinese medicine is called "slippery tire". The causes of habitual abortion are mostly luteal insufficiency, hypothyroidism, congenital uterine malformation, abnormal uterine development, intrauterine adhesions, uterine fibroids, chromosomal abnormalities, autoimmune and so on.
Habitual late abortion is often caused by cervical relaxation. Most of them are caused by curettage or cervical dilatation, and a few may belong to congenital dysplasia. After the second trimester of pregnancy, due to the increase of amniotic fluid, the fetus grows up and the intrauterine pressure increases, and the fetal sac can protrude from the cervix. When the intrauterine pressure rises to a certain extent, it will break the membrane and abort, so there are often no conscious symptoms before abortion.
abstract
Where the pregnancy is less than 20 weeks and the fetal weight is less than 500 grams, it is called abortion. Habitual abortion refers to those who have occurred more than three times in a row. The main clinical symptoms are vaginal bleeding and paroxysmal abdominal pain. The causes of habitual abortion are complex, and modern western medicine still lacks ideal treatment methods.
Habitual abortion is called "slippery fetus" in Chinese medicine. Most of them are caused by deficiency of kidney qi and unstable chong and ren, and advocate the methods of prevention and treatment before onset, tonifying kidney and spleen, benefiting qi and nourishing blood.
In ancient books and documents, such as Acupuncture and Moxibustion Self-defeating Classic, Analogy Classic, Shenjiu and other medical books, there are records about acupuncture and moxibustion treatment of this disease. There are few reports about modern acupuncture treatment of habitual abortion. In 1960s, progesterone was injected into Zusanli to prevent habitual abortion and threatened abortion [1]. In recent years, some scholars have tried to prevent and treat habitual abortion with acupuncture according to Xu Zhicai's theory that the fetus belongs to the twelve meridians in the Northern Song Dynasty, which was reproduced in The Outline of Yin Ji. After more than 65,438+00 years of observation, they have achieved initial success [2]. At present, acupuncture is the prevention, and acupuncture prevention is carried out in the month when patients are prone to abortion after pregnancy; First, it is used for treatment. When there are symptoms of threatened abortion during pregnancy, the corresponding acupoints should be selected for treatment according to the month of pregnancy. Of course, in general, acupuncture is still in the exploratory treatment stage for this disease. Because habitual abortion is one of the most intractable diseases in modern times, it is attached here for readers' reference.
treat cordially
Human acupuncture (1)
(1) acupoint selection
Key points: Divide into 2 groups. 1, Zhongji, Regression, Leaky Valley, Zusanli; 2, curved bones, uterus, ground machine, Sanyinjiao.
Matching points: Neiguan.
(2) treatment
Two groups of points, pregnant < 5 months, the first group of acupuncture; If the pregnancy is more than or equal to 5 months, the second group of points should be acupuncture. Those with severe abdominal pain should add Neiguan point. Acupoints in the lower abdomen should be supplemented by acupuncture after getting angry; Reinforce and reduce acupoints of lower limbs. Leave the needle 15 ~ 30 minutes. Every day 1 time, 15 times is a course of treatment.
(3) Evaluation of curative effect
Seven cases were treated by the above method, including 4 cases of habitual abortion (1 ~ 3 fetal abortion), all of which were successful. Follow-up of 5 cases, all full-term delivery [2].
Body Acupuncture Therapy (Ⅱ)
(1) acupoint selection
Key points: Divide into 9 groups. 1, Taichong, Ququan; 2. Yanglingquan, with veins; 3. Shenmen and Shaohai; 4. Yangtang and branch ditch; 5. Bell spring and ground handling machine; 6. Zusanli and Shu Tian; 7. Ikezawa and Taiyuan; 8. Quchi and armpit; 9. Taixi and Shiguan.
(2) treatment
The above nine groups of acupoints refer to choosing different groups of acupoints according to different months in the months when pregnancy or abortion occurs frequently. For example, 1 month has frequent pregnancy or abortion, and taking 1 group has frequent pregnancy or abortion in February, taking two groups, and so on. In terms of prevention and treatment, the specific methods are: preventive acupuncture, which is selected according to the frequent months of abortion, and every other day 1 time,1time is one course of treatment and three courses of treatment. Therapeutic acupuncture, when there are symptoms of threatened abortion in pregnancy, choose acupoints corresponding to the month of pregnancy once every other day, regardless of the course of treatment, stop treatment when the symptoms are relieved and continue to observe. All the above methods are supplemented, and the needle is kept for 30 minutes.
(3) Evaluation of curative effect
558 cases were treated by the above method, and the effective rate was 86.0 ~ 93.4%. This law also shows that the theory that pregnant women are forbidden to take injections is not necessarily reliable [2].
Warm acupuncture
(1) acupoint selection
Key points: Baihui.
Matching points: Zusanli, Waiguan, Middle, Sanyinjiao, Xue Hai and Guanyuan.
(2) treatment
The main points must be selected, and the matching points should be selected alternately as appropriate. A silver copper needle, about 20 in thickness, pierces Baihui point forward and twists. After the needle is used up, leave the needle, put a moxa stick at the end of the needle, and light it and heat it. Each needle is about 3 inches long. Zusanli, Waiguan, Sanyinjiao, Xue Hai, Guanyuan and other points were all stabbed directly, and the lifting and inserting technique was used. After the air is exhausted, the acupoints between rows are pricked obliquely upward, and the stimulation is strengthened.
(3) Evaluation of curative effect
This method * * * treated 4 1 case, among which 27 cases were delivered at 30-40 weeks, the baby's weight was 2600-3800 g, 4 cases were premature at 3 1 ~ 33 weeks, and 10 cases were ineffective [3].
Main references
Zhang Lirong. 558 cases of habitual abortion treated by acupuncture. Selected Papers on Acupuncture (Chinese Acupuncture Society), 1987: 84, Beijing.
[2] Wen. Acupuncture can protect the fetus. Journal of traditional chinese medicine, Zhejiang1989,24 (12): 558.
[3] Yu Rong. Warm acupuncture treatment of habitual abortion 4 1 case. Shaanxi Traditional Chinese Medicine1993; (6):273。
Second, the main points of self-diagnosis
Generally speaking, women who have habitual abortion should first rule out non-immune reasons before preparing for another pregnancy, because endocrine dysfunction can be regulated by drugs, some chromosome abnormalities can not be solved by current medicine, and problems such as abnormal uterine morphology and intrauterine adhesions need to be solved by surgery. If the above tests are normal, it is necessary to consider the examination of immune-related factors. About 80% of habitual abortion in clinic is related to immune abnormality. That is to say, during pregnancy, the woman has an immune response to the man, which leads to the failure of the embryo to survive in the mother, leading to abortion. The classification of immune etiology must be correct in order to choose a more effective treatment scheme. It is very important for patients to wait patiently and cooperate with the examination. If the immune examination is started without full recovery after abortion, all the indicators have not reached a stable state and cannot reflect the real situation.
The clinical significance of speed reading of habitual abortion examination mainly includes endocrine factors, basal body temperature, blood estrogen, progesterone, prolactin and other infectious factors, reproductive factors such as leucorrhea, Toxoplasma gondii, mycoplasma, chlamydia, cytomegalovirus, herpes simplex virus and rubella virus, genetic factors such as hysteroscopy, chromosome karyotype analysis of couples, immune factors, zona pellucida antibody, phospholipid antibody, ABO blood group antibody, blocking antibody and blocking antibody anti-idiotypic antibody.
Note: The above examination was conducted after the man's semen was abnormal.
Immune etiology can be divided into three categories.
The immunization program is very complicated. Many patients complain that they can't read the test results. Some people simply think that "positive" antibody index is not good, and "negative" means no problem, which is far from simple. Here, we can only choose two more important examinations for brief analysis, and listen to the doctor's face-to-face explanation for more detailed situations.
Lack of Blocking Antibody-the Main Cause of Habitual Abortion
Blocking antibody is a mixed antibody, which exists in the serum of normal pregnant women, but it can not be detected in 80%~90% women with habitual abortion. During pregnancy, the mother can produce sensitized T cells, which can destroy embryonic cells, but the killing function of sensitized T cells can be inhibited by blocking antibodies. However, due to the lack of this antibody, there are uninhibited cytotoxic cells in patients with habitual abortion, which directly act on the embryo or indirectly damage the fetus or placenta by releasing inflammatory mediators, thus leading to abortion.
Anticardiolipin antibody-an indicator of pregnancy again
For patients with habitual abortion, it is suggested to do anticardiolipin antibody test and immune related examination to determine whether it is suitable for pregnancy. If the anticardiolipin antibody is negative, the patient can get pregnant; If anticardiolipin antibody is positive, it indicates that anticardiolipin syndrome may exist, which may lead to repeated abortion or stillbirth due to repeated episodes of hypercoagulability, thrombosis and thrombocytopenia.
Clinically, immune abortion can be divided into three categories according to the etiology, and the treatment methods are also different.
Diagnosis and treatment of immune abortion: low maternal-fetal immune recognition type: mainly manifested as blocking antibody deficiency, spouse leukocyte active immunotherapy, intravenous immunoglobulin passive immunotherapy, maternal-fetal immune recognition type including autoimmune abnormalities (such as zona pellucida antibody, phospholipid antibody positive, etc. ) and allogeneic immune abnormality (maternal-fetal ABO blood group incompatibility), immunosuppressants are the main types of maternal-fetal immune recognition disorder, on the one hand, the lack of blocking antibodies, on the other hand, the abnormal increase of immune damage. The treatment is very difficult, and the scheme remains to be explored.
According to the definition of this disease, a diagnosis can naturally be made. Clinical manifestations include bleeding, lower abdominal pain, back pain and fetal discharge.
Third, treatment suggestions
Prevention first, before conception, both men and women should go to the hospital for careful examination, including genital examination and necessary examination. If possible, you can do chromosome examination. If you can find the cause, you can treat it according to the cause. Pregnant women should also be treated differently according to the doctor's instructions.
Traditional Chinese medicine believes that this disease is mostly caused by deficiency of kidney qi and unstable chong and ren, so it is advisable to tonify kidney and spleen, replenish qi and nourish blood, and regulate before pregnancy. The specific prescription can be Bushen Guchong Pill. Take 6- 10g each time, three times a day, and stop using during menstruation. Taking 2 months as a course of treatment, you can take 1-3 courses of treatment.
For habitual abortion in the third trimester of pregnancy caused by loose cervix, the cervix is usually sutured at 16-22 weeks of pregnancy to maintain pregnancy until the third trimester or even full term.
Fourth, matters needing attention
1. Pregnant women should not be angry, worried or afraid after abortion, and their husbands should appease them more, but don't have sex in a short time.
2. Go to the hospital for examination, follow the doctor's advice, and don't use drugs indiscriminately.
3. When pregnant again, it is necessary to prohibit heavy physical labor, especially to avoid holding your breath, lifting heavy objects, and forcibly defecating, so that the intra-abdominal pressure increases and abortion occurs; Avoid big temperature and big tonic; It is forbidden to contact with X-rays, ultrasound and radioisotopes in the first trimester, and it is absolutely forbidden to check the abdomen with such equipment to prevent fetal malformation and miscarriage.
4. Pregnant women should try to avoid activities in epidemic areas such as influenza, typhoid fever and pneumonia, and do not go to crowded public places to reduce the chance of infection; Don't smoke actively or passively; No contact with pets; Don't inhale gas.
( 1)
Syndrome Differentiation: Yin deficiency and blood heat, excess fire, stagnation of liver and spleen.
Treatment: clearing liver and softening liver, regulating qi and fixing fetus.
Fang Ming Gu Taijian
Comprises 8 grams of Scutellaria baicalensis Georgi, 4-8 grams of Atractylodes macrocephala, 6 grams of Chinese angelica, 6 grams of white peony root, 6 grams of donkey-hide gelatin, 4 grams of dried tangerine peel and 2 grams of Amomum villosum.
Usage: decoct with water, 1 dose, twice a day.
Source "Jing Yue Quan Shu" Volume 51.
(2)
Syndrome differentiation of deficiency of spleen and kidney.
Treating qi and strengthening spleen, tonifying kidney and preventing miscarriage.
Fangming Bushen Guchong Decoction.
Is prepared from Semen Cuscutae 15g, Rubus Rubus 15g, Eucommia ulmoides Oliv. 15g, Radix Dipsaci 15g, Herba Taxilli 15g, Radix Rehmanniae Preparata 15g, Radix Paeoniae Alba 15g, and Colla Corii Asini 60.
Decoct with water and take it from the critical period of abortion until the end of the critical period.
Source: China Medical Journal.
(3)
Syndrome differentiation of deficiency of both qi and blood.
Treatment: Yiqi Gutai.
Wu Tang.
Comprises 40 grams of astragalus root, 40 grams of Ligusticum wallichii, 60 grams of fried licorice root and 20 grams of Evodia rutaecarpa.
Usage: at the end, 8 grams each time, taken with warm wine.
Source: Health Collection Volume 18.