Recurrent spontaneous abortion (RSA) has diverse causes, complex pathogenesis, and varied clinical manifestations, posing serious harm to patients' physical and mental health. Integrated Traditional Chinese and Western Medicine (TCM-WM) in the prevention and treatment of RSA has accumulated rich clinical experience, demonstrating distinct advantages and characteristics in eliminating causes, regulating menstruation for conception, and preventing miscarriage. With the emergence of new research findings and evidence-based medical evidence, an update and refinement of the 2023 edition of the Guidelines for the Integrated Traditional Chinese and Western Medicine Diagnosis and Treatment of Recurrent Spontaneous Abortion is necessary. Therefore, guided by key clinical issues in TCM and WM, adhering to the principles of evidence-based medicine, and objectively evaluating the evidence for integrated TCM-WM diagnosis and treatment, this guideline was formed through thorough expert deliberation, aiming to enhance the clinical diagnosis and treatment level of RSA.
Recurrent spontaneous abortion (RSA) is a common pregnancy complication, affecting approximately 1% to 5% of pregnancies in women of reproductive age. As a major unresolved issue in the field of reproductive health, RSA not only endangers the physical and mental health of patients but also imposes a heavy economic burden on families. Currently, the definition of RSA is not unified, and its diverse causes, complex pathogenesis, and varied clinical manifestations limit standardized diagnosis and treatment. Integrated TCM-WM shows distinct advantages and characteristics in eliminating causes, regulating menstruation for conception, and preventing miscarriage, especially having accumulated extensive clinical experience in the prevention and treatment of RSA. The Guidelines for the Integrated Traditional Chinese and Western Medicine Diagnosis and Treatment of Recurrent Spontaneous Abortion (2026) (hereinafter referred to as this guideline) is guided by key clinical issues in TCM and WM, adheres to evidence-based medicine principles, objectively evaluates evidence for integrated TCM-WM diagnosis and treatment of RSA, and was formed through thorough expert deliberation and extensive solicitation of opinions from experts in TCM gynecology, integrated TCM-WM obstetrics and gynecology, Western medicine obstetrics and gynecology, pharmacy, and methodology.
01 Scope
This guideline stipulates the diagnosis, syndrome differentiation, and treatment of RSA. It is applicable to the diagnosis and treatment of RSA. It is intended for use by medical staff in departments such as obstetrics and gynecology, TCM, and reproductive medicine at medical institutions of all levels.
02 Terms and Definitions
RSA refers to two or more consecutive pregnancy losses before 28 weeks of gestation with the same partner, including biochemical pregnancies (abortions occurring before the expected menstrual period). RSA falls under the category of "habitual abortion" ("Hua Tai") in Traditional Chinese Medicine. "Hua Tai" refers to the occurrence of miscarriage or premature delivery consecutively two or more times. "Miscarriage" ("Duo Tai") refers to the spontaneous loss of an embryo before 12 weeks of gestation; "premature delivery" ("Xiao Chan") refers to the spontaneous loss of a formed fetus between 12 and 28 weeks of gestation. (Expert consensus degree: 95.45%)
03 Diagnosis
The diagnosis of this disease employs a method combining disease identification and syndrome differentiation in integrated TCM-WM. First, disease and etiological diagnosis is made according to the Western medical diagnostic criteria for RSA, followed by the diagnosis of TCM syndrome patterns for RSA based on TCM syndrome standards.
3.1 Western Medical Diagnosis
3.1.1 Key Points for Clinical Diagnosis of RSA
➱ Recommendation (Expert consensus degree: 96.77%)
1) Medical History
Obtain a detailed history from both partners, including age, menstrual history, reproductive history, past medical history (including possible factors affecting pregnancy such as uterine anomalies, uterine developmental abnormalities, uterine fibroids, adenomyosis, cervical insufficiency, etc.), family history, and surgical history (paying particular attention to any history of uterine or cervical surgery). Inquire and record any unhealthy lifestyle habits (smoking, alcohol consumption, etc.) and exposure to adverse environments. Record detailed information about all past pregnancies (including number of pregnancies and outcome of each pregnancy). For past miscarriage history, record the number of miscarriages, gestational weeks, accompanying symptoms, treatment measures, and relevant test results (e.g., embryonic karyotype analysis).
2) Clinical Manifestations
Two or more consecutive pregnancy losses before 28 weeks of gestation with the same partner, including biochemical pregnancies.
3) Auxiliary Examinations
(1) Pelvic ultrasound to preliminarily assess uterine anatomy; serial ultrasound monitoring of cervical changes aids in diagnosing cervical insufficiency; for suspected uterine anatomical abnormalities, further diagnosis via 3D ultrasound, hysteroscopy, or laparoscopy.
(2) Screening for prethrombotic state (PTS), such as coagulation-related tests, antiphospholipid antibody tests, etc.
(3) Immunological tests, such as autoantibody panels, antiphospholipid antibody tests, etc.
(4) Endocrine tests, such as female endocrine hormones, thyroid function, blood glucose, etc.
(5) Karyotype analysis of peripheral blood from both partners and aborted embryonic tissue to rule out genetic causes of RSA; chromosomal microarray analysis can be combined if conditions permit.
(6) Cervical and vaginal discharge testing to rule out infectious causes of late RSA.
(7) Routine semen analysis of the male partner to rule out male factors.
3.1.2 Etiological Classification of RSA
➱ Recommendation (Expert consensus degree: 100%)
Etiologies of RSA are classified into anatomical factors, genetic factors, endocrine factors, infectious factors, PTS, immunological factors, male factors, other factors, and unexplained RSA.
3.2 Syndrome Diagnosis
3.2.1 What are the TCM syndrome patterns of RSA?
➱ Recommendation (Expert consensus degree: 77.27%)
TCM syndrome patterns in the pre-pregnancy regulation and treatment stage of RSA include Kidney Deficiency with Blood Stasis pattern, Spleen-Kidney Deficiency pattern, Kidney Qi Deficiency pattern, Qi and Blood Deficiency pattern, and Yin Deficiency with Blood Heat pattern. TCM syndrome patterns in the post-conception miscarriage prevention stage of RSA include Kidney Deficiency with Blood Stasis pattern, Spleen-Kidney Deficiency pattern, Kidney Qi Deficiency pattern, Qi and Blood Deficiency pattern, and Yin Deficiency with Blood Heat pattern.
3.2.2 How to diagnose based on key points of syndrome differentiation for RSA?
➱ Recommendations:
1) Key Points for Syndrome Differentiation of Common Patterns in the Pre-pregnancy Regulation and Treatment Stage (Expert consensus degree: 70.37%).
(1) Kidney Deficiency with Blood Stasis Pattern
Main Symptoms: Repeated pregnancies ending in miscarriage, or miscarriage occurring predictably at a certain time, soreness and weakness of the lower back and knees, dark menstrual blood with clots.
Secondary Symptoms: Dizziness, tinnitus, lower abdominal pain or stabbing pain that refuses pressure.
Tongue and Pulse: Purple-dark tongue or with ecchymosis/spots, thin white coating; deep and rough pulse.
(2) Spleen-Kidney Deficiency Pattern
Main Symptoms: Repeated pregnancies ending in miscarriage, or miscarriage occurring predictably at a certain time, soreness and weakness of the lower back and knees, lower abdominal bearing-down sensation.
Secondary Symptoms: Delayed menarche or prolonged menstrual cycle, dizziness, fatigue and weak limbs, frequent nocturia, poor appetite, loose stools.
Tongue and Pulse: Pale tongue with tooth marks, thin white coating; deep and weak pulse.
(3) Kidney Qi Deficiency Pattern
Main Symptoms: Repeated pregnancies ending in miscarriage, or miscarriage occurring predictably at a certain time, frequent nocturia.
Secondary Symptoms: Delayed menstruation, pale-dark menstrual color, dizziness, tinnitus, soreness and weakness of the lower back and knees, low libido.
Tongue and Pulse: Pale tongue, thin white coating; deep and weak pulse.
(4) Qi and Blood Deficiency Pattern
Main Symptoms: Repeated pregnancies ending in miscarriage, fatigue, pale or sallow complexion.
Secondary Symptoms: Palpitations, shortness of breath, dizziness, blurred vision.
Tongue and Pulse: Pale tongue, thin white coating; thin and weak pulse.
(5) Yin Deficiency with Blood Heat Pattern
Main Symptoms: Repeated pregnancies ending in miscarriage, or miscarriage occurring predictably at a certain time, dry mouth and throat, heat in palms and soles.
Secondary Symptoms: Scanty or heavy menses, bright red menstrual color, thick and sticky consistency, tidal fever, night sweats.
Tongue and Pulse: Red tongue with scant coating; thin and rapid pulse.
2) Key Points for Syndrome Differentiation of Common Patterns in the Post-conception Miscarriage Prevention Stage (Expert consensus degree: 86.67%).
(1) Kidney Deficiency with Blood Stasis Pattern
Main Symptoms: Small amount of vaginal bleeding after conception, or sore lower back and abdominal pain.
Secondary Symptoms: Dizziness, tinnitus, dull complexion.
Tongue and Pulse: Pale-dark tongue or with ecchymosis/spots, thin white coating; deep, thin, and slightly slippery pulse.
(2) Spleen-Kidney Deficiency Pattern
Main Symptoms: Small amount of vaginal bleeding after conception, or sore lower back and bearing-down sensation in the abdomen.
Secondary Symptoms: Dizziness, fatigue and weak limbs, frequent nocturia, poor appetite, loose stools.
Tongue and Pulse: Pale tongue with tooth marks, thin white coating; deep, thin, and slightly slippery pulse.
(3) Kidney Qi Deficiency Pattern
Main Symptoms: Small amount of vaginal bleeding after conception, soreness and weakness of the lower back and knees, frequent nocturia.
Secondary Symptoms: Possible bearing-down and distending pain in the lower abdomen, dizziness, tinnitus.
Tongue and Pulse: Pale tongue, thin white coating; deep, weak, and slippery pulse.
(4) Qi and Blood Deficiency Pattern
Main Symptoms: Small amount of vaginal bleeding after conception, fatigue, dizziness, blurred vision.
Secondary Symptoms: Pale or sallow complexion, palpitations, shortness of breath.
Tongue and Pulse: Pale tongue, thin white coating; thin, slippery, and weak pulse.
(5) Yin Deficiency with Blood Heat Pattern
Main Symptoms: Small amount of vaginal bleeding after conception, or bearing-down and distending pain in the lower back and abdomen.
Secondary Symptoms: Feverish sensation in palms, soles, and chest, dry mouth and throat, dark urine, constipation.
Tongue and Pulse: Red tongue with scant or thin yellow coating; thin, slippery, and rapid pulse.
04 Treatment
The treatment of this disease is divided into two stages: pre-pregnancy regulation/treatment and post-conception miscarriage prevention. It employs a combination of disease identification and syndrome differentiation, comprehensively utilizing integrated TCM-WM treatment methods. Combining pre-pregnancy regulation with post-conception miscarriage prevention is key to treating RSA. The pre-pregnancy stage should follow the principle of "prevention first, combining prevention and treatment," targeting the cause with appropriate treatments such as hormonal therapy, anticoagulation therapy, immunotherapy, etc. TCM treatment focuses on tonifying the kidney and spleen, supplementing qi and nourishing blood, regulating the thoroughfare and conception vessels, and preemptively correcting deficiencies. For those with irregular menstruation, regulate menstruation first. If habitual abortion is caused by other diseases, treat the other diseases first. After 3 to 6 months of regulation and treatment, eliminating causes, strengthening the body's resistance, and tonifying deficiencies, allowing the body's organs, yin-yang, qi, and blood to return to normal, and the thoroughfare and conception vessels and the uterus to properly store and discharge, and menstruation to normalize, then pregnancy can be attempted again. The post-conception stage should follow the treatment principle of treating the disease and preventing miscarriage simultaneously, immediately applying integrated TCM-WM medication for miscarriage prevention to prevent pregnancy loss. If conditions necessitate the use of blood-activating and stasis-removing herbs, or if the TCM formula contains herbs contraindicated during pregnancy or herbs that may damage liver/kidney function, they must be used under the guidance of a TCM gynecologist, strictly controlling dosage and duration. Once the condition is controlled, discontinue immediately and switch to pregnancy-safe medications for miscarriage prevention. For early RSA, miscarriage prevention should continue until 12 weeks of gestation. For late RSA, the treatment duration should exceed the timing of the previous loss by 2 weeks, and medication can be stopped for observation only when there are no signs of threatened abortion ("tai lou", "tai dong bu an"). The dosage of TCM decoctions recommended in this guideline is suggested to follow the 2020 edition of the Pharmacopoeia of the People's Republic of China. (Expert consensus degree: 93.55%)
4.1 Pre-pregnancy Regulation and Treatment
4.1.1 Treatment Based on Syndrome Differentiation
1) In the pre-pregnancy regulation and treatment stage, how effective is TCM treatment or integrated TCM-WM treatment (e.g., improving pregnancy success rate, ongoing pregnancy rate, clinical effectiveness rate, etc.)?
➱ Recommendations:
(1) Kidney Deficiency with Blood Stasis Pattern
Treatment Principle: Tonify kidney, activate blood, regulate and secure the thoroughfare and conception vessels.
Recommended Medication: Shou Tai Wan (Fetus-Longevity Pill) combined with Sheng Yu Tang (Sagely Cure Decoction) plus Danshen (Salvia) and Gancao (Licorice) combined with Enteric-Coated Aspirin Tablets. (2D)
(2) Spleen-Kidney Deficiency Pattern
Treatment Principle: Warm and tonify the spleen and kidney.
Recommended Medication: Zi Shen Yu Tai Wan (Kidney-Nourishing Fetus-Nourishing Pill) combined with Dydrogesterone Tablets. (2D)
(3) Kidney Qi Deficiency Pattern
Treatment Principle: Tonify kidney and supplement qi, regulate and secure the thoroughfare and conception vessels.
Recommended Medication: Shou Tai Wan (Fetus-Longevity Pill) combined with Low Molecular Weight Heparin Sodium Injection. (2D)
(4) Qi and Blood Deficiency Pattern
Treatment Principle: Supplement qi and nourish blood, regulate and secure the thoroughfare and conception vessels.
Recommended Medication: Ba Zhen Granules (Eight Treasure Granules). (1D)
(5) Yin Deficiency with Blood Heat Pattern
Treatment Principle: Nourish yin, clear heat, nourish blood, and regulate the thoroughfare vessel.
Recommended Medication: Zhi Bai Di Huang Wan (Anemarrhena, Phellodendron, and Rehmannia Pill). (2C)
If accompanied by tidal fever and night sweats, Da Bu Yin Wan (Great Yin-Supplementing Pill) can be used. (2Ib)
2) In the pre-pregnancy regulation and treatment stage, how to apply TCM treatment or integrated TCM-WM treatment to reduce TCM syndrome scores?
➱ Recommendations:
(1) Shou Tai Wan (Fetus-Longevity Pill) combined with Sheng Yu Tang (Sagely Cure Decoction) plus Danshen (Salvia) and Gancao (Licorice) combined with Enteric-Coated Aspirin Tablets can reduce TCM syndrome scores in RSA pre-pregnancy patients with Kidney Deficiency with Blood Stasis pattern. (2D)
(2) Zi Shen Yu Tai Wan (Kidney-Nourishing Fetus-Nourishing Pill) combined with Dydrogesterone Tablets can reduce TCM syndrome scores in RSA pre-pregnancy patients with Spleen-Kidney Deficiency pattern. (2D)
3) In the pre-pregnancy regulation and treatment stage, how safe is TCM treatment alone or integrated TCM-WM treatment?
➱ Recommendation: Zhi Bai Di Huang Wan (Anemarrhena, Phellodendron, and Rehmannia Pill) is relatively safe in treating RSA pre-pregnancy patients with Yin Deficiency with Blood Heat pattern. (2C)
4.1.2 Etiological Treatment
1) In the pre-pregnancy regulation and treatment stage, how to choose Western medical treatment for different etiologies?
➱ Recommendation (Expert consensus degree: 100%):
(1) Immunological Factors
RSA patients with autoimmune diseases require joint assessment and treatment plan formulation with rheumatology/immunology specialists. Treatment for obstetric antiphospholipid syndrome (OAPS) is low-dose aspirin (LDA) combined with low molecular weight heparin (LMWH), adding hydroxychloroquine or glucocorticoids if necessary.
(2) PTS Factors
The treatment for RSA caused by PTS is LMWH, LDA monotherapy, or combination therapy. Patients with PTS combined with positive autoantibodies or autoimmune diseases require joint management with rheumatology/immunology specialists.
(3) Genetic Factors
Genetic counseling before attempting pregnancy again. Carriers of homologous Robertsonian translocations should choose contraception, or may consider donor egg/sperm or assisted reproductive technology. Carriers of autosomal balanced translocations and non-homologous Robertsonian translocations should undergo prenatal diagnosis; if severe chromosomal abnormalities or fetal malformations are found, termination of pregnancy should be considered. Preimplantation genetic testing (PGT) can be considered before another pregnancy. For RSA patients with recurrent embryonic/fetal chromosomal abnormalities, PGT can be considered.
(4) Anatomical Factors
No effective surgical correction for unicornuate uterus. Bicornuate or arcuate uterus may be considered for selective metroplasty. Significant uterine septum can be treated with hysteroscopic septum resection. Severe intrauterine adhesions can undergo adhesiolysis. Patients with submucosal fibroids should undergo hysteroscopic myomectomy before pregnancy. Larger intramural fibroids affecting the uterine cavity shape should undergo myomectomy. Patients with previous cervical insufficiency may consider transabdominal or laparoscopic cervical cerclage before pregnancy.
(5) Endocrine Factors
For patients with hyperthyroidism before pregnancy, pregnancy should be planned after endocrine treatment controls the condition. RSA patients with hypothyroidism or subclinical hypothyroidism require thyroxine supplementation before pregnancy. Abnormal glucose metabolism due to diabetes or polycystic ovary syndrome (PCOS) can be improved through exercise, oral hypoglycemics, and insulin injections; metformin is not recommended. For hyperprolactinemia (HPRL) patients, bromocriptine treatment is recommended. Patients with luteal phase deficiency are recommended to receive progesterone treatment after ovulation.
(6) Infectious Factors
Antibiotic treatment is recommended for RSA patients with obvious symptoms of reproductive tract infection.
(7) Male Factors
It is recommended that the RSA patient's spouse correct unhealthy lifestyle habits and undergo specialized treatment if necessary.
(8) Other Factors
It is recommended that RSA patients correct unhealthy lifestyle habits and change adverse living/working environments. Provide psychological counseling for patients with psychological disorders, and pharmacological treatment if necessary.
2) In the pre-pregnancy regulation and treatment stage, how to choose TCM or integrated TCM-WM treatment for different etiologies?
➱ Recommendations:
(1) Immunological Factors
① Acupuncture combined with aspirin can improve the anti-cardiolipin antibody seroconversion rate, interferon-γ (IFN-γ), and interleukin-10 (IL-10) levels in RSA pre-pregnancy patients with Kidney Deficiency with Blood Stasis pattern. (2D)
② Dang Gui San (Chinese Angelica Powder) combined with Shou Tai Wan (Fetus-Longevity Pill) plus Dangshen (Codonopsis), Danshen (Salvia), Duzhong (Eucommia), and Zhumagen (Ramie Root) can improve the anti-β2-glycoprotein I antibody seroconversion rate in RSA pre-pregnancy patients with Spleen-Kidney Deficiency pattern. (2D)
(2) Endocrine Factors
① Zi Shen Yu Tai Wan (Kidney-Nourishing Fetus-Nourishing Pill) combined with Dydrogesterone Tablets can improve progesterone (P) levels in RSA pre-pregnancy patients with Spleen-Kidney Deficiency pattern. (2D)
② Ba Zhen Granules (Eight Treasure Granules) can improve P and prolactin levels in RSA pre-pregnancy patients with Qi and Blood Deficiency pattern. (1D)
4.2 Post-conception Miscarriage Prevention
4.2.1 Treatment Based on Syndrome Differentiation
1) In the post-conception miscarriage prevention stage, how effective is TCM treatment or integrated TCM-WM treatment (e.g., improving live birth rate, pregnancy success rate, ongoing pregnancy rate or miscarriage prevention success rate, embryo survival rate, clinical effectiveness rate, etc.)?
➱ Recommendations:
(1) Kidney Deficiency with Blood Stasis Pattern
Treatment Principle: Tonify kidney, activate blood, secure the thoroughfare vessel, and prevent miscarriage.
Recommended Medication: Shou Tai Wan (Fetus-Longevity Pill) combined with Si Wu Tang (Four-Substance Decoction) minus Chuanxiong (Ligusticum) plus Danshen (Salvia), Duzhong (Eucommia), and Gancao (Licorice) combined with Progesterone Capsules. (1B)
For those accompanied by vaginal bleeding, restless fetus, lower back/abdominal pain, fatigue, and symptoms of qi and blood deficiency, Shou Tai Wan (Fetus-Longevity Pill) combined with modified Dang Gui San (Chinese Angelica Powder) plus Low Molecular Weight Heparin can be used. (1B; Note: In the national "14th Five-Year Plan" higher education TCM textbook Chinese Materia Medica, "Chuanxiong" is a herb to be used with caution during pregnancy, so decoctions containing it should be stopped once the condition improves.)
(2) Spleen-Kidney Deficiency Pattern
Treatment Principle: Tonify kidney and spleen, secure the thoroughfare vessel, and prevent miscarriage.
Recommended Medication: Modified An Dian Er Tian Tang (Calm the Fetus and Support the Source Decoction) combined with Progesterone Injection. (2C)
Recommended Chinese Patent Medicine: Zi Shen Yu Tai Wan (Kidney-Nourishing Fetus-Nourishing Pill) combined with progestogens (Dydrogesterone, Allylestrenol, Progesterone). (1B)
(3) Kidney Qi Deficiency Pattern
Treatment Principle: Tonify kidney and supplement qi, secure the thoroughfare vessel, and prevent miscarriage.
Recommended Medication: Shou Tai Wan (Fetus-Longevity Pill) combined with Dydrogesterone Tablets. (1B)
For those accompanied by spleen-stomach weakness, fatigue, poor appetite, loose stools, use modified Shou Tai Wan (Fetus-Longevity Pill) combined with Dydrogesterone Tablets/Allylestrenol Tablets. (2C)
For those accompanied by spleen-stomach deficiency cold, spleen deficiency with poor appetite, vomiting, diarrhea, hyperemesis gravidarum, restless fetus, use Shou Tai Wan (Fetus-Longevity Pill) plus Sharen (Amomum) and Baizhu (Atractylodes macrocephala) combined with conventional Western miscarriage prevention treatment. (2C)
Recommended Chinese Patent Medicines: Yun Kang Oral Liquid combined with progestogens (Progesterone Capsules, Progesterone Injection). (1C)
Bao Tai Ling Tablets (Miscarriage Prevention Tablets) combined with Allylestrenol Tablets/Dydrogesterone Tablets. (2B). Bao Tai Ling Capsules (Miscarriage Prevention Capsules) combined with Allylestrenol Tablets/Dydrogesterone Tablets can also be used. (2C)
For those accompanied by sore/distending lower back, lower abdominal bearing-down pain, vaginal bleeding, dizziness, tinnitus, dry mouth and throat, fatigue, heat in palms and soles indicating kidney yin deficiency pattern, use Gu Shen An Tai Wan (Secure Kidney and Calm the Fetus Pill) combined with Allylestrenol Tablets/Progesterone Capsules. (2C)
Other Therapies: Acupoint application combined with conventional Western treatment. (2D)
(4) Qi and Blood Deficiency Pattern
Treatment Principle: Supplement qi and nourish blood, secure the thoroughfare vessel, and prevent miscarriage.
Recommended Medication: Tai Shan Pan Shi San (Mt. Tai Rock-Solid Powder) combined with Shou Tai Wan (Fetus-Longevity Pill) combined with Progesterone Capsules. (2D; Note: In Chinese Materia Medica, "Chuanxiong" is a herb to be used with caution during pregnancy, so decoctions containing it should be stopped once the condition improves.)
Recommended Chinese Patent Medicine: Bu Zhong Yi Qi Wan (Middle-Supplementing and Qi-Boosting Pill) combined with Dydrogesterone Tablets. (2C)
(5) Yin Deficiency with Blood Heat Pattern
Treatment Principle: Nourish yin, clear heat, nourish blood, and prevent miscarriage.
Recommended Medication: Bao Yin Jian (Yin-Preserving Decoction). (2Ib)
2) In the post-conception miscarriage prevention stage, how to apply TCM treatment or integrated TCM-WM treatment to improve TCM syndrome scores/TCM symptoms?
➱ Recommendations:
(1) Shou Tai Wan (Fetus-Longevity Pill) plus Danshen (Salvia) minus Ejiao (Donkey-Hide Gelatin) combined with Enoxaparin Sodium Injection (2D), Shou Tai Wan (Fetus-Longevity Pill) combined with modified Sheng Yu Tang (Sagely Cure Decoction) minus Chuanxiong (Ligusticum) plus Sanqi (Notoginseng) combined with Enteric-Coated Aspirin Tablets (2D), and Shou Tai Wan (Fetus-Longevity Pill) combined with Dang Gui Shao Yao San (Chinese Angelica and Peony Powder) minus Ejiao (Donkey-Hide Gelatin) and Zexie (Alisma) plus Shanyao (Dioscorea), Shanzhuyu (Cornus), Huangqi (Astragalus), and Dangshen (Codonopsis) combined with Low Molecular Weight Heparin Calcium Injection (2D) can all improve TCM syndrome scores in RSA post-conception patients with Kidney Deficiency with Blood Stasis pattern.
(2) Zi Shen Yu Tai Wan (Kidney-Nourishing Fetus-Nourishing Pill) combined with Dydrogesterone Tablets can improve TCM syndrome scores in RSA post-conception patients with Spleen-Kidney Deficiency pattern. (1B)
(3) Yun Kang Oral Liquid combined with progestogens (Progesterone Capsules, Progesterone Injection) can improve TCM syndrome scores and TCM symptoms in RSA post-conception patients with Kidney Qi Deficiency pattern. (1C)
(4) Gu Shen An Tai Wan (Secure Kidney and Calm the Fetus Pill) combined with Allylestrenol Tablets can improve TCM syndrome scores in RSA post-conception patients with Kidney Qi Deficiency pattern. (2C)
4.2.2 Etiological Treatment
1) In the post-conception miscarriage prevention stage, how to choose the method of progesterone for miscarriage prevention?
➱ Recommendation (Expert consensus degree: 100%)
RSA patients should receive miscarriage prevention treatment immediately upon confirmed pregnancy, regardless of the presence of threatened abortion ("tai lou", "tai dong bu an") signs. Based on administration route, options include oral, intramuscular injection, vaginal administration, etc., which can be combined as appropriate.
(1) Oral medication: Dydrogesterone, 20~40 mg daily, or other progesterone preparations.
(2) Intramuscular Progesterone Injection: 20 mg daily, paying attention to local skin/muscle adverse reactions.
(3) Vaginal medication: Micronized progesterone, 200~300 mg daily, or progesterone sustained-release vaginal gel, 90 mg daily. Use cautiously when vaginal bleeding is present. Use until 12-16 weeks of gestation, or 1-2 weeks beyond the gestational age of the previous miscarriage.
2) In the post-conception miscarriage prevention stage, how to choose Western medical treatment for different etiologies?
➱ Recommendation (Expert consensus degree: 100%)
(1) Immunological Factors
For OAPS patients, daily oral LDA 50~100 mg is recommended when pregnancy is planned, maintained throughout pregnancy. After confirmed pregnancy, add LMWH to the continued LDA use throughout pregnancy. LMWH dosage and duration should be individualized based on patient characteristics. Treatment for RSA with autoimmune diseases (SLE, Sjogren's syndrome, undifferentiated connective tissue disease, etc.) recommends joint management by rheumatology/immunology and obstetrics/gynecology.
(2) PTS Factors
For inherited PTS, the first-line treatment is LMWH. Administration regimen: Start from confirmed pregnancy, continue throughout pregnancy (stop 24-48 hours before delivery), resume 12-24 hours postpartum. Dosage and duration are individualized. For acquired PTS, the first-line treatment is combined LMWH and LDA. It is recommended to start medication after menstruation ends in the month of planned conception and continue throughout pregnancy.
(3) Anatomical Factors
Patients with unicornuate uterus should receive enhanced pregnancy monitoring, promptly identify and manage complications. Patients with cervical insufficiency in singleton pregnancy are recommended to undergo prophylactic cervical cerclage at 12-16 weeks gestation or emergent cerclage when ultrasound shows progressive cervical shortening. For patients unsuitable for or with poor outcomes from vaginal surgery, transabdominal or laparoscopic cervical cerclage can be considered.
(4) Endocrine Factors
Pregnancy management for RSA with endocrine factors recommends joint management with specialists. For RSA with hypothyroidism during pregnancy, levothyroxine can be used. For RSA with hyperthyroidism during pregnancy, as related medications can cause birth defects and liver damage, it is recommended to use the minimum effective dose of propylthiouracil only in the first trimester. For RSA with HPRL during pregnancy, the use of bromocriptine should be minimized. For patients with abnormal blood glucose due to diabetes or PCOS, monitoring blood glucose levels during pregnancy is recommended, managed jointly by experienced obstetricians and endocrinologists.
(5) Infectious Factors
It is recommended to perform bacterial culture of secretions and provide active treatment with sensitive antibiotics for RSA patients with obvious symptoms of reproductive tract infection.
3) In the post-conception miscarriage prevention stage, how to choose TCM or integrated TCM-WM treatment for different etiologies?
➱ Recommendations
(1) Immunological Factors
Shou Tai Wan (Fetus-Longevity Pill) combined with Low Molecular Weight Heparin can improve the antiphospholipid antibody seroconversion rate in RSA post-conception patients with Kidney Qi Deficiency pattern. (2D); Bao Tai Ling (Miscarriage Prevention) combined with Low Molecular Weight Heparin can improve IL-10, interleukin-17 (IL-17), and C-reactive protein levels in RSA post-conception patients with Kidney Qi Deficiency pattern. (2D); Tai Shan Pan Shi San (Mt. Tai Rock-Solid Powder) minus Shudihuang (Prepared Rehmannia), Danggui (Chinese Angelica), Nuomi (Glutinous Rice) plus Shengdihuang (Unprepared Rehmannia), Duzhong (Eucommia), Tusizi (Cuscuta) combined with Dydrogesterone Tablets + Heparin can improve IL-4, IFN-γ/IL-4 levels in RSA post-conception patients with Qi and Blood Deficiency pattern. (2D)
(2) PTS Factors
Modified Shou Tai Wan (Fetus-Longevity Pill) combined with Dang Gui San (Chinese Angelica Powder) plus Low Molecular Weight Heparin (1B), Shou Tai Wan (Fetus-Longevity Pill) combined with modified Sheng Yu Tang (Sagely Cure Decoction) minus Chuanxiong (Ligusticum) plus Sanqi (Notoginseng) combined with Enteric-Coated Aspirin Tablets (2D), and Shou Tai Wan (Fetus-Longevity Pill) combined with Dang Gui Shao Yao San (Chinese Angelica and Peony Powder) minus Ejiao (Donkey-Hide Gelatin) and Zexie (Alisma) plus Shanyao (Dioscorea), Shanzhuyu (Cornus), Huangqi (Astragalus), and Dangshen (Codonopsis) combined with Low Molecular Weight Heparin Calcium Injection (2D) can all improve PTS-related indicators in RSA post-conception patients with Kidney Deficiency with Blood Stasis pattern; Shou Tai Wan (Fetus-Longevity Pill) plus Danshen (Salvia) minus Ejiao (Donkey-Hide Gelatin) combined with Enoxaparin Sodium Injection can improve activated partial thromboplastin time in RSA post-conception patients with Kidney Deficiency with Blood Stasis pattern. (2D); Shou Tai Wan (Fetus-Longevity Pill) combined with Si Jun Zi Tang (Four Gentlemen Decoction) minus Fuling (Poria) plus Duzhong (Eucommia) combined with Low Molecular Weight Heparin Sodium Injection + Dydrogesterone Tablets (2D), Zi Shen Yu Tai Wan (Kidney-Nourishing Fetus-Nourishing Pill) combined with heparin drugs (Enoxaparin Sodium Injection, Low Molecular Weight Heparin Calcium Injection) (2D) can both improve PTS-related indicators in RSA post-conception patients with Spleen-Kidney Deficiency pattern; Shou Tai Wan (Fetus-Longevity Pill) combined with Enteric-Coated Aspirin Tablets + Low Molecular Weight Heparin Sodium Injection (2D), Yun Kang Granules combined with Enteric-Coated Aspirin Tablets + Low Molecular Weight Heparin Sodium Injection (2D) can both improve PTS-related indicators in RSA post-conception patients with Kidney Qi Deficiency pattern; Bao Tai Ling Capsules (Miscarriage Prevention Capsules) combined with Dydrogesterone Tablets can improve vascular endothelial growth factor levels in RSA post-conception patients with Kidney Qi Deficiency pattern. (2C); Gu Shen An Tai Wan (Secure Kidney and Calm the Fetus Pill) combined with Enteric-Coated Aspirin Tablets (2C), Gu Shen An Tai Wan (Secure Kidney and Calm the Fetus Pill) combined with Low Molecular Weight Heparin (2D), Gu Shen An Tai Wan (Secure Kidney and Calm the Fetus Pill) combined with Enteric-Coated Aspirin Tablets + Low Molecular Weight Heparin Sodium Injection (2D) can all improve PTS-related indicators in RSA post-conception patients with Kidney Yin Deficiency pattern.
(3) Endocrine Factors
Zi Shen Yu Tai Wan (Kidney-Nourishing Fetus-Nourishing Pill) combined with Dydrogesterone Tablets + Low Molecular Weight Heparin can improve human chorionic gonadotropin (hCG) levels in RSA post-conception patients with Spleen-Kidney Deficiency pattern. (2D); Bao Tai Ling Capsules (Miscarriage Prevention Capsules) combined with Allylestrenol Tablets can improve hCG, P, and estradiol levels in RSA post-conception patients with Kidney Qi Deficiency pattern. (2C)
(4) Unexplained Etiology
Shou Tai Wan (Fetus-Longevity Pill) combined with An Tai Fu Yuan Yin (Calm the Fetus and Support the Source Decoction) combined with Dydrogesterone Tablets can treat unexplained RSA post-conception patients with Kidney Deficiency with Blood Stasis pattern. (2D)
05 Prevention and Lifestyle Regulation
RSA particularly emphasizes equal importance on prevention and treatment. Pre-pregnancy regulation and treatment aim to preemptively correct deficiencies, eliminate factors causing RSA, strengthen constitution, and supplement nutrition. After conception, begin miscarriage prevention treatment early, rest in bed, avoid fatigue, abstain from sexual intercourse, increase nutrition, maintain smooth bowel movements, and ensure the treatment duration exceeds the timing of previous losses. Simultaneously, provide psychological counseling to achieve optimal outcomes.
Graphic and Text Source: 中医杂志 2026年1月第67卷第2期Joumal of Tradiional Chinese Medicine,2026,Vol.67.No.2
Responsible Editor: Lily