Dr. Zhu Xiao-nan’s case on Fetus Failing to Develop

Dr. Zhu Xiao-nan was born in 1901 and spent much of his life working as a Doctor of Chinese medicine, focusing on gynecology and obstetrics.

I decided to translate and post this particular case because it is informative from a practical treatment perspective but also from a medical anthropological perspective.  It seems that, in 1961, when this patient came to Dr. Zhu, there was no ultrasound, amniocentesis or blood tests to determine the well-being of the fetus.  In fact, in the introduction to the text from which this case is published, it states that Dr. Zhu considers women’s pathology to be “invisible”, making it very important to “interrogate thoroughly, make precise diagnoses so that the herbs are used with bull’s eye accuracy”.  For me, it is interesting to consider what would have happened in this patient’s case today.  My guess is that the outcome may not have been so positive.

Dr. Zhu uses his own methods for determining whether the fetus is alive or not. It is clear from his discussion here that this method involves the following:

• Checking the pulse:  If the pulse is still slippery, there is a chance the fetus might be living.
• Observing the tongue: If the tongue is not dark, there is a chance the fetus is still living.
• Asking about the temperature of the abdomen: A cold feeling may indicate an expired fetus while a lack of this feeling may indicate that the fetus is still living.
• Smelling the patient’s breath: a foul smelling breath may indicate an expired fetus. If there is a lack of foul breath the fetus may still be alive.

Dr. Zhu also used what he called the differentiate the fetus method (Fen Tai Fa,分胎 法) to treat this patient so that, if the fetus had expired, the baby would come out and if the fetus was still alive it would be saved.

Finally, it is very interesting to see that, because this patient’s pregnancy got such a slow start, the woman went past dates, giving birth at 11 months!  It is clear from Dr. Zhu’s discussion that this is not unheard of.

Dr. Zhu’s case: from Selections from Zhu Xiao-Nan’s Experience in Gynecology (Zhu Xiao-Nan Fu Ke Jing Yan Xuan 朱小南妇科经验选) published by PMPH in Beijing)

Ms. Xu was 27, married and an office worker.

Ms. Xu’s menstruation had been regular.  In December of 1961 she missed her menstruation.  In March she was 3 months pregnant and she suddenly developed acute appendicitis.  She when into the hospital and had surgery to remove her appendix.  After this, her fetus was not developing well and her abdomen was not growing larger.  At five months she stopped feeling the movement of the fetus and her abdomen stopped growing.  Another hospital diagnosed fetal expiration but after a long period, the baby had not come out.

On May 21, 1962.  She was feeling chest oppression and loss of appetite.  Her spirit was not flourishing, she had abdominal pain in the front and continuous dirty leucorrhea.  Was the baby dead or not?  Her pulse was weak, soft and slightly slippery.  Her tongue was pale with and thin sticky moss and was not dark.  Her appetite was not good and she burped but there was no bad taste.  She had lower abdominal labor pains but there was no bearing down distended feeling. There was not verification as to whether the fetus was doomed or not.  There was a slim chance of survival so it was still suitable to rush to save it.  I used the Fen Tai method,分胎 法, to treat so that the critically ill fetus can either live or, if it is already dead, it can come out.  I gave her 2 packages of the following formula. (grams/day)

On May 24 she returned.  After giving her the above formula, the abdominal pain had stopped and the dirty leucorrhea had lessened.  There had been a change for the better.  She was aware that her abdomen had grown.  Her pulse was thin and slippery and the tongue moss was slightly white.  There was hope for the fetus.  Although it was still alive, it was still not out of danger.  I still needed to help the fetus recuperate.  Otherwise things could easily change.

There was a turn for the better.  This calmed the woman.  After 8 packages the baby grew and the mother already felt movement.

Next visit: the patient was now 6 months pregnant.  She began to have some dripping of blood that was scanty.  She had a backache and lower abdominal distended feeling, frequent urination.  Her pulse was slippery and rapid with thin yellow moss.  I instructed her to go home and rest in bed.  I advised her that, after taking the herbs, the bleeding should stop.  Otherwise this may be early labor.  Because her pulse was still slippery, for now I calmed the fetus.

After two packages of the herbs, the bleeding stopped.  Occassionally she had back soreness and abdominal pain.  I continued with the with modifications to consolidate.  I gave her 10 packages.  Although she was now 8 months pregnant, her abdomen was the size of about a 6 mont pregnancy.  However, there was fetal movement.  Because it was summer, she ate some bad food and suddenly had diarrhea and then began to bleed.  She hurried to the hospital for treatment.

July 23.  During the visit the patient was very worried.  She had abdominal pain, diarrhea, bleeding, back soreness and feared that this was a premature birth.  However, her pulse was still slippery and her tongue moss was thin and slippery.  She needed to stay calm and rest.

I gave her 4 packages of the above formula and the bleeding stopped, as did the diarrhea.  There was still back soreness, urinary frequency and lower abdominal drooping.  There were not a lot of fetal movements.  I gave her recuperative herbs.

After 10 packages of herbs, during October, past the expected date of birth by many days, she gave birth.  The mother and child were well.  At a follow up several years later, the child had developed well and was in good health.

Discussion: The fetus failing to grow is called “fetal depletion illness”.  Chen Ziming in his Fu Ren Liang Fang (Miraculous Formulas for Women) has this to say “When the pregnant woman does not develop this can be due to an old illness or another imbalance that causes the Zang and Fu to weaken and the Qi and blood to be depleted”.  The result is that the fetus does not develop.  In the clinic, the etiology is that the natural endowment of the mother is weak so it is difficult for her to nourish the fetus.  It may also be that after pregnancy there is a trauma or irregular sexual relations, which can cause fetal dripping.  Afterwards the bleeding may stop but the Qi and blood are already deficiency and the mothers belly does not resume growing and the baby stops moving.  When this is chronic, it is easy for the baby to die in the belly.  It may be there for a long time without coming out or be a late term miscarriage.  However, if the pulse is still slippery, the tongue is not dark (qing), there is no icy feeling in the lower belly or foul smell coming from the mouth, there is a chance that the baby will survive.  It is appropriate to vigorously treat.

In this case of fetus failing to develop, the patient was 4 months pregnant when she had surgery for appendicitis.  The damaged her Qi and blood as well as the fetus.  The fetus stopped developing.  It had to be determined whether the fetus was still alive or if it had died in the belly. However, if the pulse is still slippery, the tongue is not dark (qing), there is no icy feeling in the lower belly or foul smell coming from the mouth, there is a chance that the baby will survive.  It is appropriate to vigorously treat.

After the herbs the symptoms changed for the better and the abdomen increased in size.  The fetus had received an injury and the body became weaker but this changed and it started to grow.  At 6 months she began to bleed but after treatment the bleeding stopped.  A month later, after eating some bad food, she developed abdominal pain and diarrhea and the baby received a shock.  Soon she began to bleed and she became worried about a premature birth but she pulled through.  She had a successful birth.

When treating this pathology it is appropriate to fortify the Spleen and Stomach as the source of transformation and generation.  One should vigorously supplement Qi and blood and enrich and nourish the fetus.  Afterwards it is appropriate to consolidate the Kidney and calm the fetus.   One should guard against the heavy dropping down and a “small birth”.  After using the above formulas, one is often able to help the fetus flourish and continue to grow.  Because of this, when you see acute cases like this, never give up the chance to save the baby.  When health has been restored, most often there will be a birth at the normal time.  A small number of women will exceed their dates even by several months.