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A woman, three to four days after delivery, has the fetus reaching the birth canal, but the pubic symphysis (Jiaogu) fails to open, preventing the fetus from descending. The fetus dies while the mother remains alive. If medicines that open the bones prove ineffective, there is a risk of death.

Fortunately, she does not die precisely because the fetus has died and the placenta has descended, separating mother and child. The mother's Qi has already retracted and has not yet reached the point where both mother and child's Qi are simultaneously exhausted. Treatment should focus solely on saving the mother, without concern for the fetus. However, a dead fetus lodged in the birth canal blocks the exit, posing a danger of maternal death. One should employ a method of pushing it out by nourishing Blood to generate Water (Kidney essence), and tonifying Qi to generate Blood, thereby making both Qi and Blood abundant so that the dead fetus can be expelled and the mother's life preserved. If one merely uses downward-draining formulas to force expulsion, the dead fetus may not descend, while the mother's Qi will collapse first; this is not a sound rescue method. I (Fu Shan) have personally witnessed such cases and often used Jiumu Dan (Mother-Saving Decoction) to save many lives. Therefore, I record this.

Ren Shen (Ginseng Radix) (1 liang), Dang Gui (Angelicae Sinensis Radix) (2 liang, washed with wine), Chuan Xiong (Ligustici Chuanxiong Rhizoma) (1 liang), Yi Mu Cao (Leonuri Herba) (1 liang), Chi Shi Zhi (Halloysit Rubrum) (1 qian), Jing Jie Sui (Schizonepetae Spica, stir-fried until black) (3 qian).
Decoct in water and take orally. After one dose, the dead fetus will be expelled. This formula uses Chuan Xiong and Dang Gui to nourish Blood, and Ren Shen to tonify Qi. When Qi and Blood are abundant, they ascend above and descend below; Qi provides propulsion and Blood provides transport. Moreover, Yi Mu Cao is adept at expelling dead fetuses, and Chi Shi Zhi can eliminate stasis. Naturally, they will surge out without any obstruction.

Commentary: The formula is exquisite and should not be arbitrarily modified.

Rhyme:
When the fetus dies in the birth canal, delivery is difficult;
Taking bone-opening herbs is futile.
Greatly tonifying Qi and Blood is the wondrous method,
It can expel the dead fetus and ensure the mother's safety.
In Jiumu Dan, Dang Gui comes first,
Followed by Ren Shen, Chuan Xiong, and Yi Mu Cao.
With blackened Jing Jie Sui and Chi Shi Zhi,
One dose expels the fetus and ensures peace.

A woman, six to seven days after delivery, has her amniotic sac ruptured, yet the fetus does not descend. People assume this is due to dystocia, but who would suspect that the fetus has already died in the abdomen? A fetus dying near the birth canal is easy to identify, whereas one dying inside the abdomen is hard to recognize. Generally, if the fetus has reached the edge of the birth canal and is still alive, its head can extend and retract; if dead, it remains motionless. Even if pushed by hand, it will stay as before. If alive, gently pulling its hair will cause it to retreat inward; thus, it is said to be easy to identify. How, then, can one know if the fetus is dead inside the abdomen? There are indeed ways to discern this. In cases where the fetus dies in the abdomen but the mother can be saved, the mother's face will lack a coal-black hue, indicating that although the fetus is dead, the mother retains vitality. Conversely, if the mother is difficult to save, her face will exhibit a smoky, soot-like appearance, indicating that both fetus and mother lack vital energy. Using this to distinguish between life and death is absolutely accurate. Once it is known that the fetus is dead in the abdomen, using medicine to forcibly expel it is dangerous; using harsh, purgative methods is also dangerous. By the sixth or seventh day of labor, the mother's Qi is severely depleted and cannot withstand harsh treatments. Forcing the expulsion of the dead fetus with harsh methods risks immediate maternal death upon fetal expulsion. One must continue to tonify the mother, making her Qi and Blood abundant, so that the dead fetus will naturally descend.

Use Liao'er San (Fetus-Curing Powder).
Ren Shen (Ginseng Radix) (1 liang), Dang Gui (Angelicae Sinensis Radix) (2 liang, washed with wine), Chuan Niu Xi (Cyathulae Radix) (5 qian), Ru Xiang (Olibanum) (2 qian), Gui Jiu (Podophylli Peltati Rhizoma et Radix) (3 qian, ground, water-washed).
Decoct in water and take orally. After one dose, the dead fetus will be expelled and the mother will survive. Normally, during birth, the fetus must first turn its head. This is often due to the mother's deficiency of Qi and Blood, which prevents the fetus from turning downward. Laypeople use parturition-inducing drugs, which deplete the fetus's Qi and Blood, causing stagnation and leading to death in the abdomen; this is effectively murder by incompetent physicians. Therefore, for dystocia, parturition-inducing drugs must absolutely not be used. Instead, one should tonify Qi and Blood to strengthen the mother; the proper way to preserve the infant's life is endless. This formula saves the mother affected by fetal death by greatly tonifying Qi and Blood, addressing the root cause. Who would know that treating the root is itself a form of inducing labor?

Commentary: It is ingenious not to use Hou Po (Magnoliae Officinalis Cortex) for expelling dead fetuses. There was once a case of a puerpera with a black face and cyan tongue who recovered fully (mother and child) using Qi-tonifying, Blood-nourishing, and Blood-invigorating herbs; this was a rare fortune among ten thousand cases.

Rhyme:
Identifying a fetus dead in the abdomen is difficult;
A coal-black face indicates critical danger.
If the face lacks a smoky hue,
Know that while the fetus is dead, the mother can be safe.
In Liao'er San, Ren Shen and Dang Gui are superior,
Accompanied by Niu Xi, Gui Jiu, and Ru Xiang.
When the fetus is dead, tonify Qi and Blood;
Do not recklessly administer parturition-inducing drugs.