Syndrome differentiation and treatment

Heterotopic pregnancy mainly manifests as the sthenia syndrome of blood stasis in the lower abdomen. So the therapeutic principle is activating blood and resolving stasis. Clinically it is divided into syndrome of blood loss due to qi asthenia, stagnation and stasis syndrome and blood stasis syndrome. It can be treated with blood transfusion and fluid infusion according to the development of the pathological conditions. Treatment should be monitored carefully in light of the complications when operation is not resorted to. The most commonly encountered complication is sthenia syndrome of fu organs, the manifestations of which are constipation, abdominal distension, epigastric discomfort, unpressable abdominal pain and reduction or disappearance of borborygmus. Sthenia syndrome of fu organs is either heat-sthenia or cold-sthenia or mixture of cold and heat.

Syndrome of blood loss due to qi asthenia

Main symptoms: Rupture of oviducal pregnancy or abortion of oviducal pregnancy, pale complexion, cold limbs, lowering of blood pressure, unpressable lower abdominal pain, light-colored tongue with thin and white fur, deep, thin and indistinct pulse.

Therapeutic methods: Restoring yang and arresting prostration or loss, activating blood and resolving stasis.

Prescription and drugs: Modified Shenfu Tang combined with Huoluo Xiaoling Dan composed of 9g of prepared slice of Fuzi (Radix Aconiti Praeparata ), 6g of Hongshen (Radix Ginseng Destillata ) ( to be decocted separately), 5g of roasted Gancao (Radix Glycyrrhizae), 3g of roasted Guizhi (Ramulus Cinnamomi), 10g of Fuling ( Poria ), 10g of Mudanpi ( Cortex Moutan Radicis), 10g of Danshen (Radix Salviae Miltiorrhizae), 10g of Chishaoyao (Radix Paeoniae Rubra), 6g of roasted Ruxiang (Olibanum) and 6g of roasted Moyao (Myrrha).

Modification: For constipation and abdominal distension as well as yellow and greasy tongue fur, 6g of crude Daihuang (Radix et Rhizoma Rhei) (to be decocted later), 9g of Xuanmingfen (Natrii Sulfas Exsiccatus) (to be mixed in boiled water for oral taking) and 9g of Zhishi ( Fructus Aurantii Immaturus) are added; for complication with cold and heat with yellow, white, greasy and thick tongue fur, 6g of crude Dahuang (Radix et Rhizoma Rhei) (to be decocted later), 9g of Xuanmingfen (Natrii Sulfas Exsiccatus ) (to be mixed in boiled water for oral taking) and 3g of Rougui (Cortex Cinnamomi) (to be decocted later) are added.

Syndrome of stagnation and stasis

Main symptoms: Abortion and rupture of oviducal pregnancy, mild interior hemorrhage, stable blood pressure, unpressable distending pain in the lower abdomen,tenderness and rebound pain, slight vaginal bleeding and thin and slow pulse.

Therapeutic methods: Activating blood and resolving stasis, regulating qi and stopping pain.

Prescript ion and drugs: Modified Gongwaiyun No. 1 (No. 1 prescription for heterotopic pregnancy) composed of 15g of Danshen (Radix Salviae Miltiorrhizae), 10g of Chishaoyao ( Radix Paeoniae Rubra ), 9g of Taoren (Semen Persicae), 10g of Chuanniuxi (Radix Cyathulae), 3g of Wugong ( Scolopendra ), lOg of Wulingzhi (Faeces Trogopterorum ) and 9g of prepared Xiangfu ( Rhizoma Cyperi ) .
Modification: For massive hemorrhage, 0.5g of Yunnan White Powder (for oral taking) or 3g of Shensanqi (Radix Notoginseng) powder (to be taken orally) are added, twice or three times a day.

Syndorme of blood stasis

Main symptoms: Hematoma and mass in the abdomen, gradual alleviation of abdominal pain, prolapsing sensation and distension in the lower abdomen or desire for defecation, stoppage of vaginal bleeding and thin and unsmooth pulse.

Therapeutic methods: Breaking stasis and eliminating abdominal mass.

Prescription and drugs: Modified Gongwaiyun No.2 (No. 2 prescription for heterotopic pregnancy) composed of 12g of Danshen (Radix Salviae Miltiorrhizae),10g of Chishaoyao (Radix Paeoniae Rubra ), 6g of Ruxiang ( Olibanum ), 6g of Moyao ( Myrrha ), 9g of Taoren ( Semen Persicae ), 10g of Sanleng ( Rhizoma Sparganii), 10g of Ezhu (Rhizoma Curcumae) and 6g of Zhechong (Eupolyphaga seu Steleophaga ).

Modification: For infection,  15g of Jinyinhua (Flos Lonicerae), lOg of Lianqiao (Fructus Forsythiae ), 30g of Hongteng (Caulis Sargentodoxae) and 30g of Baijiangcao (Herba Patriniae) are added; for constipation, 6 - 9g of crude Dahuang (Radix et Rhizoma Rhei) or 9g of Fanxieye (Folium Sennae) are added.

Other therapeutic methods

Chinese patent drugs

1) Dahuang Zhochong Pill: 1 pill each time and twice a day, applicable to the treatment of heterotopic pregnancy.

2) Shixiao Powder: 6- 9g each time and once or twice a day (mixed with vinegar or millet wine for oral taking), applicable to the treatment of heterotopic pregnancy without rupture or old heterotopic pregnancy.

3) Huazheng Huisheng Bolus: 6g each time and twice a day, applicable to the treatment of heterotopic pregnancy without rupture or old heterotopic pregnancy.

Empirical and folk recipes

1) Huoluo Xiaoling Bolus composed of 9 - 15g of Danshen ,( Radix Salviae Miltiorrhizae ), 6 - 9g of Chishaoyao ( Radix Paeoniae Rubra ), 3 - 6g of Ruxiang (Olibanum), 3- 6g of Moya0 (Myrrha) and 6- 9g of Taoren (Semen Persicae). These herbs are decocted for oral taking, applicable to the treatment of heterotopic pregnancy without rupture due to blood stasis.

2) Enriched Huoluo Xiaoling Bolus composed of 15g of Danshen (Radix Salviae Miltiorrhizae), 12g of Chishaoyao (Radix Paeoniae Rubra ), 6g of Ruxiang ( Olibanum), 6g of Moyao (Myrrha), 6g of Sanleng (Rhizoma Sparganii ) , 6g of Ezhu ( Rhizoma Curcumae ) , 30g of Niuxi (Radix Achyranthis Bidentatae), 9g of Taoren (Semen Persicae ), 18g of Dongkuizi (Semen Malvae ), 2 Wugong ( Scolopendra ) and 10g of Zhechong ( Eupolyphaga seu Steleophaga). These ingredients are decocted for oral taking, applicable to the treatment of beterotopic pregnancy without rupture due to blood stasis.

3) 3- 6g of Hongshen (Radix Ginseng Destil