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When fetal movement and insecurity occur during pregnancy, it is due to the deficiency of the Chong and Ren meridians (meridians regulating menstruation and gestation), resulting in an unstable conception. Some cases arise from excessive drinking or sexual intercourse, damaging the body and causing fetal movement; some from fright, trauma, or falls leading to fetal movement; some from anger injuring the Liver or emotional stagnation disturbing the blood vessels and causing fetal movement; some from overconsumption of warm-natured herbs or violation of dietary/behavioral taboos causing fetal movement; some are caused by maternal illness, in which case treating the mother's illness will naturally stabilize the fetus; others result from an inherently weak fetus whose movement subsequently affects the mother, in which case stabilizing the fetus will naturally cure the mother. If the face is red and the tongue is cyanotic, this indicates fetal death; if the face is cyanotic and the tongue is red, this indicates maternal death; if the lips, mouth, face, and tongue are all cyanotic accompanied by vomiting of froth, this indicates death of both mother and child. However, both fetal movement (Tai Dong) and threatened miscarriage with bleeding (Tai Lou) involve vaginal bleeding, but fetal movement is accompanied by abdominal pain, whereas threatened miscarriage with bleeding is not. Fetal movement is suitable for regulating Qi, while threatened miscarriage with bleeding is suitable for clearing heat. If the uterus has been deficient for a long time, it often leads to abortion, a danger comparable to a candle in the wind, not comparable to normal delivery; one should urgently take Duzhong Wan (Eucommia Decoction) in advance to protect the fetal origin.

The retention of the placenta is critical, though less so than before birth. Fetal death in utero is more critical than placental retention. When the placenta is retained, the fetus and mother still share respiratory connection; however, if the fetus dies in utero, the uterine qi becomes cold, fetal blood coagulates, and Qi fails to ascend and descend. Ancient formulas often used blood-invigorating and Qi-smoothing herbs along with Niter (Xiaoshi), Mercury (Shuiyin), and Ammonium Chloride (Naosha). But since the fetus is already dead, its body is cold, blood is coagulated, and Qi is stagnant, using extremely cold purgatives is not only ineffective but often fatal to the mother. This reveals the profound intent behind ancient formula creation. There are two main causes of fetal death, each requiring specific thermal properties: death due to hemorrhage from threatened miscarriage exhausting blood; death due to internal injury from falls or trauma; death due to fetal atrophy from chronic illness. Administering Fuzi Tang (Aconite Decoction) three times warms the uterus and mobilizes coagulated blood. Aconite can break cold and induce abortion; here, warm herbs are used for this purpose. In cases of Cold Damage, febrile diseases, or warm malaria where the fetus is attacked by pathogenic heat and toxins internally and externally, leading to fetal death retained in the uterus, ancients feared the fetus would swell due to toxic gas. Thus, they used Mirabilite (Puxiao), Mercury, and Ammonium Chloride to prevent swelling and rot the fetal form, assisted by blood-invigorating and Qi-smoothing herbs to expel the dead fetus. This represents the ultimate intent of ancient formula design.

When the pulse at the Cun, Guan, and Chi positions on both hands is vigorous, it is called twin pregnancy. If the Shaoyin pulse (referring to the Du meridian) is slightly tight, blood becomes turbid and coagulated, nourishment is insufficient, and one fetus may die prematurely while the other survives. If the dead fetus is not expelled, it harms the mother and endangers the live fetus; this is treated with Qianjin Shenzao San (Thousand Gold Divine Creation Powder). This formula treats twins where one is alive and one is dead: using Crab Claw (Xiezhua) to remove the dead fetus, Donkey-hide Gelatin (Ejiao) to secure the live fetus, and Licorice (Gancao) to harmonize the properties, showing profound intent in its formulation.

If a person's Stomach Qi is robust and the Chong and Ren meridians have harmonious Ying and Wei, the fetus resides comfortably, like a fish in a deep ravine, naturally smooth. If Qi and Blood are deficient and unable to nourish, the fetus cannot develop properly, and expulsion may be necessary to avoid disaster. However, when expulsion is indicated for fetal injury, the purgative method must be applied with extreme caution. Only when fetal death in utero is confirmed by heart pain, cyanotic tongue, cold abdomen, and foul breath should purgatives be used. One must first consolidate the pregnant woman's Yuan Qi, tonify Qi and nourish Blood, and then purge. If fetal insecurity is present without thorough examination, and harsh attacking drugs are used, unpredictable disasters may ensue. The essential principle "following nature" is most excellent. Lizhai also stated: only when the fetus truly cannot be preserved should expulsion be considered. Be cautious, be cautious; the warnings of former sages are profound. If expulsion is desired, Mirabilite (Puxiao) is indispensable.