以補腎固衝法治療先兆性流產病例報告

Method for Invigorating Kidney and Consolidating Chong Vessel for Treating Threatened Abortion: A case report

先兆性流產是指懷孕20週內發生陰道出血但子宮頸未開，有時伴隨著下腹痛、腰痠、下墜感。補腎固衝法指透過填補腎中精氣，以治療衝任虛損不固的方法，在中醫婦科中主要用於腎虛所致的胎漏、胎動不安及滑胎之證，即現代醫學的先兆流產與習慣性流產。
本病例為一位34歲懷孕婦女，有原發性不孕症病史且長期慢性腹瀉，孕史G3P1E1。於胚胎植入後出現陰道出血已一週餘，診斷為先兆性流產，服用黃體素但仍持續有少量陰道出血，遂住院安胎，使用靜脈注射黃體素治療後仍有陰道出血情形，故於住院第三天會診中醫，期能止血保胎的治療經驗分享。患者經辨證為稟賦不足，脾腎氣虛，衝脈不足，胎元不固，因此以補腎健脾，固衝安胎為治則做處置，開始治療六天後陰道出血停止，八天後超音波檢查可見胎兒心跳，病人出院並持續服用中藥，順利生產。

Threatened abortion refers to vaginal bleeding occurring before 20 weeks of gestation while the cervix remains closed. It may be accompanied by lower abdominal pain, lumbosacral soreness, or a sense of pelvic heaviness. In traditional Chinese medicine (TCM), the method of ''invigorating the kidney and securing the Chong vessel'' aims to replenish kidney essence and stabilize the Chong and Ren vessels. This approach is commonly used in TCM gynecology to treat conditions such as threatened abortion, habitual miscarriage, and fetal restlessness due to kidney deficiency. This case describes a 34-year-old pregnant woman with a history of primary infertility and a pregnancy history of G3P1E1. After embryo implantation, she experienced persistent vaginal bleeding for over a week and was diagnosed with threatened abortion. Despite oral and intravenous progesterone therapy, bleeding persisted. On the third day of hospitalization, a TCM consultation was requested for adjunctive care. The patient was diagnosed with constitutional deficiency and chronic diarrhea, resulting in spleen and kidney Qi deficiency and Chong vessel instability, leading to an unstable fetus. Treatment was initiated based on the principles of tonifying the kidney and spleen, securing the Chong vessel, and calming the fetus. After six days of TCM treatment, vaginal bleeding ceased, and fetal cardiac activity was confirmed by ultrasound on the eighth day. The patient was discharged and continued TCM medication during pregnancy, eventually delivering a healthy baby.