Key Learning Points
What causes miscarriage?
Miscarriage happens quite often, sometimes without the mother noticing. In contrast, if the baby is much desired, a miscarriage can be physically and emotionally crippling.
Why does it happen? What causes miscarriage?
This site tries to explain health issues from the point of view of Chinese medicine. If you’re only interested in how Western medicine explains it, we think you’ll be missing some key insights, but anyway, away you go! (You could look at the British NHS site, for a start.)
Over many thousands of years miscarriage happened in Asian countries too. Their doctors gave it considerable thought.
The remarks below apply mainly when the problem lies with the mother. If the problem is mainly with the foetus, treatment with Chinese medicine (acupuncture etc), may be less successful.
In Chinese medicine it happens because there is either
A lot hinges on those words ‘excess’ and ‘deficiency’. (For more on this important distinction see our page on ‘excess or deficient’.)
Excess can occur because of Heat or blockage or accident.
Deficiency occurs because of insufficient Qi and/or Blood or because of inadequate inherited ‘knowhow’.
Heat is the most common excess factor. The heat is commonly found in the Blood (Blood Heat), making a healthy pregnancy impossible, due to ‘over-cooking’ the foetus. Being yang, the result leads to early miscarriage. (Yang factors work with more facility when yin hasn’t fully developed. To understand this fundamental idea better, read our page on yin and yang.)
Early signs of Blood Heat include thirst, anxiety, sometimes even panics, and the mother feels hotter than usual. Other signs of this excess include insomnia, inability to relax, restlessness and irritability. Physically there may be mild vaginal bleeding, sometimes nosebleed or bleeding gums, and a history of heavy periods.
Sometimes the skin shows heat too, in the form of dermatitis and itching, even boils.
Her tongue is, typically, red. Its covering may be yellow.
Her pulse is fast.
For more, click on Blood Heat.
Heat can manifest in other ways too as the mother’s body tries to externalise the problem. One way a woman’s body may have tried, before pregnancy, to clear Heat is through producing heavy or early periods, in its attempt to push out the heat with the blood. Although she will have felt better overall after these periods, she may also have felt tired.
Another way is one you’ve probably experienced yourself in a small way! Ever eaten something that disagreed with you, giving you the ‘shits’?
What happens when you get the shits?! Quite apart from the painful or uncomfortable sensations in your lower abdomen, you get frequent and insistent urging to defecate: to poo! You’ll also be tired – all your energy has been invested into producing the heat.
And that heat emerges, forcefully, gracelessly, noisily and offensively – meaning that the odour reeks! … and ‘splatters’!
By the way, if you get this when on holiday, our advice is to let your body do its business. Avoid medication which aims to inhibit the problem – modern medicine has quite an armoury of drugs that suppress these urgings, their heat and smell!
But, for your health, it’s better outside than inside. In the past, we’ve seen quite a few people develop other symptoms of Heat after suppressing this hot form of diarrhoea. For one thing, the problem can move into your Blood, causing Blood-Heat, already mentioned above. To find out more, read our page on Suppression.
This Heat in your gut is mainly in your lower abdomen, exactly where the foetus is trying to grow. In very hot weather, most people experience lassitude – tiredness. Surround the foetus with Heat and it won’t grow so efficiently, potentially becoming what causes miscarriage.
If you are trying to get pregnant and think you have Heat, please try to clear it before you get pregnant. Chinese medicine has many ways to treat it, including acupuncture and herbs.
This is another cause of miscarriage. We all get Liver qi stagnation from time to time: it’s part of life. But usually, we resolve it fairly easily.
However, some people live in impossible situations. Perhaps they are repeatedly forced to do something they hate or are given unrealistic targets to meet. Or maybe they work or live with people who make life miserable for them, yet parting is not an option. Or perhaps they have to participate in activities that make them grind their teeth with frustration or distaste.
Sometimes the food they eat can make it worse, but usually the emotional dilemma comes first.
Qi stagnation has been a boon for alert and enterprising manufacturers! They persuade us to spend fortunes on foods that frequently make the condition worse (think of alcohol, coffee, sweets, crisps and meals full of carbohydrates) or on trying to identify foods that cause the symptoms.
They get – usually – digestive problems, ranging from unusual or uncomfortable bowel movements, which can take many forms ranging from diarrhoea through loose stools to constipation: if constipated their faeces often look like small round pebbles – like rabbit or sheep stools! IBS is common.
At the same time your abdomen feels (and may actually be) swollen, distended, bursting – as if full of gas, which it could be.
Because having a healthy working colon is so important for health and energy, when the colon isn’t working as it should you feel unhealthy and tired.
By the way, with Liver Qi stagnation, there’s usually an effect on your chest too. Here your chest includes your breathing, though you may not notice this in comparison with your abdominal discomfort. But your breathing may be inhibited, making you more susceptible to coughs and colds.
And for a woman, the chest area includes her breasts where a woman often feels this uncomfortable distending feeling before her periods.
For much more on Liver Qi stagnation, what it is, what it feels like and what to do about it, click on Liver Qi stagnation.
The problem with Liver Qi stagnation for a pregnant mother is that it produces the need for Heat and Movement. The Heat we’ve described above – it can be a cause of miscarriage. Movement is noticeable in changes in behavior (restlessness, irritability, moodiness) and bowel movements, as well as in movements of the foetus – exactly the wrong type of movement – that leads to miscarriage.
Acupuncturists treat Liver Qi stagnation every day, typically very successfully, and usually much faster than with Chinese herbal medicine. However, if its cause is emotional, and usually the cause IS emotional, then the underlying problem must be addressed, or the syndrome will recur.
Your Liver Qi stagnation usually benefits from advice on nutrition and lifestyle.
What’s ‘advice on lifestyle‘, you ask?!
Well, you won’t like it, so pretty much any advice you get that you don’t like is probably to do with your lifestyle!
You’ll regard it as interfering and impertinent and you may find yourself disliking whoever gives you the advice.
And they probably give it at their peril, unless you’re paying for it of course, when the person paid may rapidly become an irrelevance! (But if their advice is good, perhaps you should take notice of it!)
I should stress that in a mild form, the kind which most of us experience regularly, caused by life’s little frustrations, Liver Qi stagnation is not a major cause of miscarriage.
However, when it becomes a major factor, or if it combines with other factors, then it can cause miscarriage.
Trauma can take many forms, physical and emotional. An emotional shock can lead to miscarriage in mothers who are susceptible..
Normally, the shock comes in the form of accidents, falls, major bruising, fractures and so on. If miscarriage follows, it may not occur immediately, so may be difficult to link directly to the trauma.
About to miscarry, the mother will probably notice pain in her abdomen, unusual movements there, backache and some bleeding from her vagina. Her tongue and pulse may be unchanged. But she should seek urgent help or treatment. The problem is that trauma often leads to a syndrome called Blood Stasis, where her blood stops flowing properly. (Look up Blood Stasis here.)
If the mother’s Blood stops flowing as it should, or is very upset in how it flows, for the foetus this can be a crisis. When the body finds the foetus is unable to flourish, it can lead to what causes miscarriage.
The above are the main ‘excess’ causes of miscarriage.
Now we come to the causes that arise from ‘deficiency’.
Qi deficiency is one of the main causes of miscarriage. It’s usually easy to diagnose and easy to treat – though not always, and that’s because it can be quite deep-seated, meaning the mother’s body has enough energy and resources to get pregnant but not enough to hold the foetus in place and nourish it – see Blood deficiency, next below.
What does qi deficiency mean? Well … tiredness, fatigue, exhaustion. It means you are dragged down by other factors or ill-health, pain or chronic disease. It means you have to bestir yourself to do anything. Sometimes you are so tired you don’t know you are weary.
There’s a mental component too. You feel hopeless, despondent, indifferent.
There are various kinds of Qi deficiency – too many to put here or the page would be too long, but you can read more about them here.
The problem is that Qi deficiency leads to Spleen qi deficiency (or may be caused by it). Your Spleen energy does a huge range of things in your body, but one of its main functions is to hold things in place.
As we grow older, it becomes less effective, which leads to the paunch you see on elderly people and the varicose veins on their legs: things just aren’t held in place. Also, with Spleen deficiency, appetite reduces, you get abdominal distension and a tendency to worry about anything.
A deficiency of Qi, especially of the Spleen Qi, can result in miscarriage.
Apart from treatment (acupuncture and Chinese herbal prescriptions can both make a powerful difference) you may need advice on nutrition.
How foods affect your health and energy has been a fruitful study for Chinese medicine for thousands of years and it has insights not yet understood by Western nutritionists.
Studying the effect of individual foods is part of this.
For example, which foods are warming and energising, and which are cooling and steadying? You may need less of the latter and more of the former – but get advice! Most acupuncturists have studied it and want to help you.
There’s another factor. If you have Liver Qi stagnation (see above) you may also run out of energy. There are times when clearing your Liver Qi stagnation is enough, but if you’ve had it for a long time, your levels of Qi and your ability to make it may have decreased.
The other problem with Qi deficiency is that it often leads on to Blood deficiency – see next.
This won’t happen if you just feel tired one day, perhaps from lack of sleep or overdoing it. But it may happen if you never get refreshing sleep and always overdo it, leading to Qi deficiency then Blood deficiency, together becoming what causes miscarriage.
Usually, Qi deficiency precedes Blood deficiency so you have time to do something about it.
Although anaemia, as understood by Western medicine, and Blood deficiency, as described by Chinese medicine, have many similarities, the Chinese term means a lot more than iron-deficiency.
To make sense of this please read our page on Blood.
There are various kinds of Blood deficiency in Chinese medicine, explained on that page. Finding out which affects you makes a huge difference to how we treat it.
In other words, identifying your particular kind of Blood deficiency will help your acupuncturist or herbalist give you the treatment that leads most quickly to improvement – which you’ll notice as feeling better and more ‘together’.
That’s because, as explained on that page, Blood is the basis of a healthy personality and vitality.
It needs your healthy Blood to grow.
Blood deficiency, especially if caused by or associated with Qi deficiency, can become what causes miscarriage.
As you might expect, Blood deficiency gives dizziness, poor or blurred vision, worse from standing up too fast. In the woman’s history there will have been a history of either no menstrual bleeding (amenorrhoea), or very limited ‘scanty’ bleeding, and the blood would have been pale.
Blood deficiency means distal parts aren’t nourished, so you get numb or tingly fingers or toes.
Because, in Chinese medicine, Blood is where personality resides, when Blood is deficient, the woman’s personality will be easily unsettled by events or criticism, her sleep poor (difficulty staying asleep) she’ll often seem or feel in low spirits and be restless and anxious, and since Blood carries fluids, she’ll get dry skin and hair. Her tongue will be pale and look thin, her pulse ‘uneven’ and ‘fine’.
With Qi and Blood deficiency, your pulse will be weak and uneven, and your tongue pale.
However, usually this deficiency takes time to manifest so doesn’t happen early in pregnancy when miscarriage is more likely to happen from more yang-like factors, like Heat, Qi stagnation or trauma.
Young, healthy women seldom have this. But age and disease, and the many burdens of life can lead to Kidney deficiency. It comes in two forms (Kidney yang deficiency and Kidney yin deficiency). You can have both kinds together but one of them will take precedence.
They share many characteristics, but in other areas are quite different, with different causes.
These shared symptoms include:
Usually, people with Kidney yang deficiency feel cold and have poor digestion.
You’ll like warmth and warm foods. What you drink passes through you fast and is colourless or only slightly coloured, and frequent. You may have oedema – water retention – in your legs – worse by the evening.
You probably aren’t a thirsty person, and may have cold hands.
How do you acquire Kidney Yang deficiency?
Well, anything that wears you down could do it, including chronic disease, exhausting yourself physically too often, and getting chilled too much or too often.
There’s much more on our page on Kidney Yang deficiency.
Now, what about Kidney Yin deficiency?
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Kidney yin deficiency symptoms don’t often include feeling cold. It does happen, but mostly with yin deficiency you feel warm.
Yin deficiency means a lack of fluids which means dryness and ongoing thirstiness or mouth and throat dryness. You like a little fluid to moisten things. You may lose fluids during sleep through perspiration, even when it’s not hot. Urine is dark and scanty. Good sleep is rare: you wake up too often, and can’t settle.
How do you get Kidney yin deficiency? Usually through loss of fluids, for example from sweat during a high fever or diarrhoea, or from blood loss from surgery or accident.
Overwork (mental overwork, as in working all the time or too often without respite) is a frequent cause.
Over-stimulation from drugs (notably caffeine) can produce it if taken too often.
Read more about it at Kidney Yin deficiency.
What are the signs you might notice that suggest Kidney deficiency may be about to lead to miscarriage? Look for the symptoms mentioned above under either Kidney Yin or Kidney Yang deficiency, together with vaginal bleeding, exhaustion and backache.
The syndromes listed above may also bring about habitual miscarriage.
Habitual early miscarriages, ie occurring within the first three months, are often from Blood Heat or from either Kidney yang or yin deficiency.
Common to both Kidney Yin and Yang forms of deficiency are dizziness, backache and tinnitus, but while Kidney yang deficiency comes with coldness, tiredness and frequent pale or colourless urine; Kidney yin deficiency has more dryness in the mucus membranes in mouth and throat, less frequent and darker urine, and night sweats. A history of infertility is more likely with kidney yin deficiency.
After three months, habitual miscarriages are slightly more likely to be caused by Spleen qi deficiency, Blood deficiency (as described above) or Blood stasis (see below).
Blood stasis is a bit like an internal bruise.
With Blood-stasis the flow of healthy, new, blood is retarded so the foetus doesn’t get the nourishment it needs. This ‘bruise’ inside blocks blood flow leading to a history of periods which come with sharp, stabbing, deep, colicky type pains.
There may be internal lumps, fibroids or tumours which stay in one position, are easily palpable and hurt when pressed.
Since blood isn’t flowing properly, some symptoms resemble those of Blood deficiency, like dryness of tissues, skin and hair, and poor circulation, with numb or tingling extremities.
Like Blood deficiency, you may get coldness of hands and feet, but unlike Blood deficiency, your tongue is more likely to be dark and purple, and your pulse described as ‘wiry’.
There is a saying in Chinese medicine, that miscarriage is more serious for a woman’s body than childbirth.
Why? Because miscarriage causes, or at least comes with, heavy blood loss. This seriously depletes the woman and it may take her a long time to recover fully.
She also feels the effect of the loss emotionally partly as a result of its spiritual effect and partly as a result of its physical impact.
Serious blood loss causes restlessness, inability to settle, the tendency to worry, pallor and potentially Kidney deficiency, with backache, tinnitus, forgetfulness and anxiety.
Carefully performed, an abortion usually causes less blood loss. But it’s still a major shock to the system, forcing the body to do something it’s not designed for, so miscarriage, abortion and childbirth may each cause Blood stasis. That causes depression.
So if, arising after miscarriage, abortion or childbirth, you see an acupuncturist for low spirits and tiredness, then probably he or she will need to treat you for Blood stasis, Qi and Blood deficiency – and check you for Heat.
If you seek help for habitual early miscarriage, then add in Kidney deficiency for treatment.
Theory says it’s best to deal with ‘excess’ factors first so probably he’d look at any Blood Heat or Blood stasis first.
Don’t know! It depends on the most prominent syndrome and the intensity of your symptoms.
If you’ve followed me so far, you’ll realise that while some women don’t even notice an early miscarriage, certainly at a later stage it can be both a shock and immensely draining, physically and emotionally.
Shock disturbs the Shen, the spirit, an important topic in Chinese medicine. (Read more under Shen-Mind.)
The Shen is based in your Blood, which grounds it. I suspect many gender identity issues arise because the individual’s Shen is not properly rooted in the Blood.
Often after a miscarriage, the women can feel as if her womanhood has been upset.
To bring her spirits and body back to equilibrium we must
NB Usually, after the shock of miscarriage, it is best not to get pregnant again immediately. Your body needs time to recover.
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