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Pregnancy with restless fetus (Tai Dong Bu An) arises from deficiency of the Chong and Ren meridians, resulting in unstable conception. Some cases are caused by excessive alcohol consumption or sexual intercourse, damaging and disturbing the fetal qi; some by physical trauma such as collisions or falls; some by anger injuring the Liver, or emotional depression causing blood vessel disturbance; some by overconsumption of warming herbs or forbidden substances; some due to maternal illness, where treating the mother's illness naturally stabilizes the fetus; and some due to an inherently weak fetus affecting the mother, where stabilizing the fetus naturally cures the mother. If the face is red and the tongue is cyanotic, it indicates fetal death; if the face is cyanotic and the tongue is red, it indicates maternal death; if lips, mouth, face, and tongue are all cyanotic accompanied by frothy vomiting, it indicates death of both mother and fetus. However, both restless fetus (Tai Dong) and threatened miscarriage with bleeding (Tai Lou) involve vaginal bleeding, but restless fetus is accompanied by abdominal pain, whereas threatened miscarriage with bleeding is not. Restless fetus should be treated by regulating Qi, while threatened miscarriage with bleeding should be treated by clearing heat. However, long-term uterine deficiency often leads to abortion, a danger comparable to a candle in the wind, distinct from normal delivery. Emergency pre-administration of Duzhong Wan (Eucommia Bark Pill) is required to preserve the fetal origin.

If the placenta remains undelivered, the situation is critical before birth. Fetal death in utero is more dangerous than retained placenta. When the placenta is undelivered, the fetus and mother still share respiratory connection. In fetal death, the uterine qi becomes cold, fetal blood coagulates, and Qi fails to ascend and descend. Ancient formulas often used blood-moving and Qi-regulating herbs along with minerals like Niter (Xiaoshi), Mercury (Shuiyin), and Rock Salt (Naosha). However, since the dead fetus is already cold with coagulated blood and stagnant Qi, using extreme cold purgatives is not only ineffective but often fatal to the mother, failing to grasp the profound intent of ancient prescriptions. There are two main causes for fetal death, each requiring specific thermal properties: death due to hemorrhage from threatened miscarriage; death due to internal injury from falls; or death due to wasting from chronic illness. For these, administering Fuzi Tang (Aconite Decoction) three times warms the uterus and mobilizes coagulated blood, utilizing Aconite's ability to break cold stagnation. Conversely, in cases of Typhoid fever, Heat diseases, or Warm Malaria where toxic heat invades the fetus, causing fetal death and retention, ancients feared fetal distension. Thus, they used Glauber's Salt (Puxiao), Mercury, and Rock Salt to prevent distension and rot the fetal tissue, assisted by blood-moving and Qi-regulating herbs to expel the dead fetus. This reflects the profound intent of ancient formulations.

When the pulse at all three positions (Cun, Guan, Chi) is vigorous, it is called "Shuang Qu" (Twin Pregnancy). If the Shaoyin pulse (referring to the Du Mai) is slightly tight, blood becomes turbid and nourishment is insufficient, leading to the demise of one twin while the other survives. Failure to remove the deceased twin harms the mother and endangers the survivor, treated by Qianjin Shenzao San. This formula treats twin pregnancies where one is alive and one dead, using Crab Claw (Xiezhua) to expel the dead fetus, Donkey-hide Gelatin (Ejiao) to stabilize the live fetus, and Licorice Root (Gancao) to harmonize the formula, demonstrating profound prescriptive wisdom.

When gastric Qi is robust and Chong and Ren meridians are harmonious, the fetus thrives like a fish in a deep stream. If Qi and Blood are deficient, the fetus cannot develop properly, necessitating expulsion to prevent disaster. However, expulsion methods must be used with extreme caution. For fetal death in utero, one must confirm symptoms such as cold heart, cyanotic tongue, cold abdomen, and foul breath before proceeding. Crucially, the pregnant woman's original Qi must first be fortified by tonifying Qi and nourishing Blood before any purgative action. Blindly using harsh purgatives without thorough examination invites unpredictable disasters. The key principle is "following nature," as stated by Xue Lizhai: only consider expulsion if the fetus truly cannot be sustained. Caution is paramount. If expulsion is necessary, Glauber's Salt (Puxiao) is indispensable.