小产重于大产。盖大产如粟熟自脱。小产如生采。破其皮壳。断其根蒂。岂不重于大产
但
人轻忽致死者多矣。治法。宜补形气。生新血。去瘀血。若未足月。痛而欲产。芎归补中汤
倍加知母止之。若产而血不止。人参黄 汤补之。若产而心腹痛。当归川芎汤主之。胎
气
弱而小产者。八珍汤固之。若出血过多而发热。圣愈汤。汗不止。急用独参汤。发热烦躁。
肉筋惕。八珍汤。大渴面赤。脉洪而虚。当归补血汤。即黄 一两。当归三钱是也。身热
面赤。脉沉而微。四君姜附。东垣云。昼发热而夜安静。是阳气自旺于阳分也。昼安静而夜
发热。是阳气下陷于阴分也。如昼夜俱发热者。是重阳无阴也。当峻补其阴。王太仆云。如
大寒而甚。热之不热。是无火也。热来复去。昼见夜伏。夜发昼止。时节而动。是无火也。
如大热而甚。寒之不寒。是无水也。热动复止。倏忽往来。时动时止。是无水也。若阳气自
旺者。补中益气汤。阳气陷于阴者。四物二连汤。即四物汤。加胡连、川连是也。重阳无阴
者。四物汤。无火者。八味丸。无水者。六味丸。一论小产气虚。血下不止。宜
人参黄 汤
人参 黄 （蜜炒） 当归 白术（去芦炒） 白芍（酒炒） 艾叶（醋炒各一钱） 阿胶（炒
二钱） 上锉一剂。水煎温服。
一论小产气血虚。宜芎归补中汤。（方见妊娠）
一论小产后。瘀血心腹疼痛。或发热恶寒。
当归川芎汤
当归 川芎 白芍（炒） 熟地黄 元胡索 桃仁 红花 香附 青皮 泽兰 牡丹皮
上水煎。入童便好酒。各半杯。同服。如小产腹痛。以手按腹愈痛。此是瘀血为患。宜
用
此药。或失笑散消之。若按之反不痛。此是血虚。宜用四物加参、苓、术、甘。若痛而作呕
此是胃虚。宜用六君子。若痛而泻。此是脾虚。宜用六君子送二神丸。
一妊娠五月。服剪红丸而坠。腹中胀痛。服破血之剂益甚。以手按之益痛。余曰。此峻
药重
伤。脾胃受患。用八珍汤。倍人参、黄 。加半夏、乳香、没药。二剂而痛止。数剂而全愈
一妇人年二十余。疫疾堕胎。时刻服清肺解表。喘急不寐。请治。余以为脾土虚。不能
生肺
金。药损益甚。先与补中益气加茯苓、半夏、五味、炮姜。四剂渐愈。往视之。又与八珍加
五味。及十全大补汤撤消。
一小产下血不止。气虚之甚也。以补中益气汤。去升柴。加白芍、川芎、香附、砂仁、
艾叶、阿胶。
小产（妊娠不足月而流产）比大产（足月分娩）的危害更重。因为大产就像谷物成熟后自然脱落，而小产则如同生摘果实，破坏了果皮果壳，切断了根茎蒂柄，这难道不比大产更严重吗？
然而，人们往往轻视它，导致死亡的情况很多。治疗原则应当是：补益形体与元气，生成新血，祛除瘀血。如果未满月就出现腹痛并想要生产，应使用芎归补中汤，并加倍加入知母以制止早产；如果产后出血不止，用人参黄芪汤来补益；如果产后心腹部疼痛，以当归川芎汤为主治方剂。如果是胎气虚弱而导致小产的，用八珍汤来固摄调理。如果因出血过多而出现发热，用圣愈汤；如果汗出不止，紧急情况下使用独参汤；如果出现发热烦躁、肌肉跳动筋脉抽搐，用八珍汤；如果极度口渴、面色红赤、脉象洪大而按之空虚，用当归补血汤，即由一两黄芪和三钱当归组成。如果身体发热、面色红赤、脉象沉微，用四君子汤加干姜、附子。李东垣说：白天发热而夜间安静，这是阳气在阳分旺盛的表现；白天安静而夜间发热，这是阳气下陷于阴分的表现。如果昼夜都发热，这是重阳无阴的状态，应当峻补其阴。王太仆说：如果非常寒冷且严重，用热药治疗却不回暖，这是无火（命门火衰）；如果热象来时又消失，白天显现夜间潜伏，夜间发作白天停止，随季节或时间而动，这也是无火。如果非常炎热且严重，用寒药治疗却退不了热，这是无水（肾阴亏虚）；如果热象躁动后又停止，忽来忽去，时而活动时而静止，这也是无水。如果是阳气自旺的，用补中益气汤；如果是阳气陷于阴分的，用四物二连汤，即四物汤加上胡黄连、黄连。如果是重阳无阴的，用四物汤；如果是无火的，用八味丸；如果是无水的，用六味丸。
以下论述小产气虚，血液下注不止，宜用人参黄芪汤：人参、黄芪（蜜炒）、当归、白术（去芦头并炒）、白芍（酒炒）、艾叶（醋炒），各一钱；阿胶（炒）二钱。以上药材锉碎为一剂，加水煎煮，温服。
以下论述小产后，因瘀血导致心腹疼痛，或伴有发热恶寒，用当归川芎汤：当归、川芎、白芍（炒）、熟地黄、元胡索、桃仁、红花、香附、青皮、泽兰、牡丹皮。以上用水煎煮，加入童便和好酒各半杯，混合同服。如果小产后腹痛，用手按压腹部疼痛加剧，这是瘀血为患，适宜用此药，或者用失笑散消散瘀血。如果按压反而不痛，这是血虚，适宜用四物汤加人参、茯苓、白术、甘草。如果疼痛伴随呕吐，这是胃虚，适宜用六君子汤。如果疼痛伴随腹泻，这是脾虚，适宜用六君子汤送服二神丸。
有一位孕妇在妊娠五个月时，服用剪红丸导致堕胎，腹中胀痛，服用破血药物后症状更加严重，用手按压疼痛加剧。我说：这是峻烈药物重伤脾胃所致。使用八珍汤，加倍人参、黄芪，加入半夏、乳香、没药，服用两剂后疼痛停止，数剂后完全痊愈。
有一位二十多岁的妇人，因疫疾导致堕胎，时刻服用清肺解表药物，导致喘急无法入睡，请求治疗。我认为这是脾土虚弱，不能生养肺金，药物反而使病情加重。先给予补中益气汤加茯苓、半夏、五味子、炮姜，服用四剂后逐渐好转。我去探望时，发现她又服用八珍汤加五味子，以及十全大补汤进行撤消治疗（此处指误治或过度治疗后的调整）。
Xiaochan (spontaneous abortion before term) is more severe than Dachan (full-term delivery). This is because Dachan is like grain ripening and falling off naturally, whereas Xiaochan is like picking fruit while unripe, breaking the skin and shell, and severing the root and stem. Is this not more severe than full-term delivery?
However, many people neglect it, leading to death. The treatment principle should be: tonify the body and Qi, generate new blood, and remove blood stasis. If labor pain occurs and delivery seems imminent before the full month, use Xionggui Buzhong Tang (Cnidium and Angelica Decoction to Supplement the Middle), doubling the dosage of Zhi Mu (Anemarrhenae Rhizoma) to stop premature labor. If bleeding continues after delivery, use Renshen Huangqi Tang (Ginseng and Astragalus Decoction) to tonify. If heart and abdominal pain occur after delivery, Danggui Chuanxiong Tang (Angelica and Ligusticum Decoction) is the primary formula. If Xiaochan is caused by weak fetal Qi, use Bazhen Tang (Eight-Tonics Decoction) to consolidate. If fever arises due to excessive blood loss, use Shengyu Tang (Sage Renewal Decoction). If sweating does not stop, urgently use Dushen Tang (Single Ginseng Decoction). If there is fever with irritability, muscle twitching, and tendon tremors, use Bazhen Tang (Eight-Tonics Decoction). If there is extreme thirst, red face, and a surging yet empty pulse, use Danggui Buxue Tang (Angelica Tonifying Blood Decoction), which consists of one liang of Huangqi (Astragali Radix) and three qian of Danggui (Angelicae Sinensis Radix). If there is body heat, red face, and a deep, faint pulse, use Sijunzi Tang (Four Gentlemen Decoction) plus Ganjiang (Zingiberis Rhizoma Recens) and Fuzi (Aconiti Lateralis Radix Praeparata). Li Dongyuan stated: Fever during the day and quietness at night indicates Yang Qi flourishing in the Yang aspect; quietness during the day and fever at night indicates Yang Qi sinking into the Yin aspect. If fever persists both day and night, this is "Double Yang without Yin," requiring vigorous tonification of Yin. Wang Taipu stated: If there is severe cold that does not warm up despite hot treatment, this is "No Fire" (deficiency of Mingmen Fire); if heat comes and goes, appearing by day and hiding by night, erupting at night and stopping by day, moving with seasons or time, this is also "No Fire." If there is extreme heat that does not cool down despite cold treatment, this is "No Water" (kidney Yin deficiency); if heat flares up and subsides, coming suddenly and going suddenly, acting intermittently, this is also "No Water." For cases of self-flourishing Yang Qi, use Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi). For cases where Yang Qi sinks into Yin, use Siwu Erlian Tang (Four Substances Decoction with Two Coptises), which is Siwu Tang (Four Substances Decoction) added with Hulián (Coptidis Rhizoma var. chinense) and Chuánlián (Coptidis Rhizoma). For Double Yang without Yin, use Siwu Tang (Four Substances Decoction). For No Fire, use Bawei Wan (Eight-Ingredient Pill). For No Water, use Liuwei Wan (Six-Ingredient Pill).
The following discusses Qi deficiency in Xiaochan with continuous downward bleeding, suitable for Renshen Huangqi Tang: Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix, honey-fried), Danggui (Angelicae Sinensis Radix), Baizhu (Atractylodis Macrocephalae Rhizoma, de-gutted and fried), Baishao (Paeoniae Radix Alba, wine-fried), Aiye (Artemisiae Argyi Folium, vinegar-fried), each 1 qian; Ejiao (Asini Corii Colla, fried) 2 qian. These are cut into pieces for one dose, decocted in water, and taken warm.
The following discusses Qi and Blood deficiency after Xiaochan, suitable for Xionggui Buzhong Tang. (See Pregnancy section for formula details.)
The following discusses heart and abdominal pain due to blood stasis after Xiaochan, possibly accompanied by fever and aversion to cold, treated with Danggui Chuanxiong Tang: Danggui (Angelicae Sinensis Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Baishao (Paeoniae Radix Alba, fried), Shudihuang (Rehmanniae Radix Preparata), Yuanhusuo (Corydalis Rhizoma), Taoren (Persicae Semen), Honghua (Carthami Flos), Xiangfu (Cyperi Rhizoma), Qingpi (Citri Reticulatae Pericarpium Viride), Zelan (Lycopersici Herba), Mudanpi (Moutan Cortex). Decoct in water, add Tongbian (Child's Urine) and Haojiu (Good Wine), half cup each, and take together. If abdominal pain after Xiaochan worsens upon pressure, this is caused by blood stasis, and this medicine is appropriate, or use Shixiao San (Pain-Stopping Powder) to dissipate it. If pressure causes no pain, this is Blood deficiency, suitable for Siwu Tang (Four Substances Decoction) added with Renshen (Ginseng Radix et Rhizoma), Fuling (Poria), Baizhu (Atractylodis Macrocephalae Rhizoma), and Gancao (Glycyrrhizae Radix et Rhizoma). If pain is accompanied by vomiting, this is Stomach deficiency, suitable for Liujunzi Tang (Six-Gentlemen Decoction). If pain is accompanied by diarrhea, this is Spleen deficiency, suitable for taking Liujunzi Tang (Six-Gentlemen Decoction) with Ershen Wan (Two Deities Pill).
A pregnant woman at five months took Jianhong Wan (Red-Cutting Pill) and suffered miscarriage, experiencing abdominal distension and pain. Taking blood-breaking agents worsened the condition, and pressure increased pain. I said: This is injury from harsh medicines damaging the Spleen and Stomach. Use Bazhen Tang (Eight-Tonics Decoction), doubling Renshen (Ginseng Radix et Rhizoma) and Huangqi (Astragali Radix), adding Banxia (Pinelliae Rhizoma), Ruxiang (Olibanum), and Moyao (Myrrha). After two doses, pain stopped; after several doses, full recovery was achieved.
A woman in her twenties suffered miscarriage due to epidemic disease. She continuously took Lung-clearing and exterior-releasing medicines, resulting in panting, urgency, and insomnia. Upon request for treatment, I believed this was Spleen Earth deficiency failing to generate Lung Metal, and the medicines aggravated the condition. First, administer Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi) added with Fuling (Poria), Banxia (Pinelliae Rhizoma), Wuweizi (Schisandrae Chinensis Fructus), and Paojiang (Zingiberis Rhizoma Preparatum). After four doses, she gradually improved. Upon visiting, I found she had also taken Bazhen Tang (Eight-Tonics Decoction) added with Wuweizi (Schisandrae Chinensis Fructus), as well as Shiquan Dabu Tang (Ten-Ingredient Great Tonifying Decoction) for withdrawal management.
One case of continuous bleeding after Xiaochan indicates extreme Qi deficiency. Use Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi), removing Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix), adding Baishao (Paeoniae Radix Alba), Chuanxiong (Ligustici Chuanxiong Rhizoma), Xiangfu (Cyperi Rhizoma), Sharen (Amomi Fructus Rotundus), Aiye (Artemisiae Argyi Folium), and Ejiao (Asini Corii Colla).