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The *Shengji Zonglu* states: Retained placenta (placenta) is more urgent than the fetus being unborn. Fetal death in utero is more critical than the failure of the placenta to be expelled. This is because when the placenta is retained, the fetus and mother are connected through respiration.
If the fetus dies in the uterus, the qi of the uterine organs becomes cold, fetal blood coagulates and freezes, and the movement of qi fails to ascend or descend. Ancient prescriptions often used herbs that promote blood circulation and regulate qi, as well as minerals such as Niter (Natrii Sulfas), Mercury (Hydrargyrum), and Sal Ammoniac (Sal Ammoniacum). If the fetus has already died and the body has become cold, with blood coagulated and qi stagnant, using extremely cold-potent drugs to purge will not only be ineffective but also frequently endanger the mother's life. The ancients' use of medicine demonstrated profound intentionality. There are two mechanisms for fetal death; the choice between cold and warm medicines should follow appropriateness. In cases where prolonged uterine bleeding (fetal leakage) leads to blood exhaustion and fetal death, or where internal injury from falls and trauma causes fetal death, or where chronic illness leads to fetal atrophy and subsequent death, one may administer Fuzi Tang (Aconite Decoction) three times to warm the uterine organs and liquefy the coagulated blood. This utilizes the warming property of Aconiti Lateralis Radix Preparata (Fuzi, Prepared Lateral Root of Aconitum carmichaelii), which can dispel cold and induce abortion, illustrating the rationale for using warm medicines. In cases where exogenous febrile diseases such as Cold Damage (Shanghan), heat diseases, or warm malaria expose the fetus to pathogenic heat and toxic qi, causing internal and external assault leading to fetal death and retention in the uterus, the ancients feared that toxin accumulation would cause fetal distension. Thus, they used Mirabilite (Natrii Sulfas), Mercury, and Sal Ammoniac. These not only halt fetal growth but also decompose the fetus into putrid matter. Combined with herbs that invigorate blood and regulate qi, the dead fetus is expelled.

Chen Liangfu stated: When a person's Stomach Qi is robust and the Chong and Ren meridians are harmonious, the fetus finds its proper place, like a fish in an abyss. If Qi and Blood are deficient and unable to nourish, the fetus cannot develop properly, and purgative methods should be employed to prevent disaster.

The *Zhengzhi Yaojue* states: In cases of persistent uterine bleeding, one may follow the natural trend and employ purgation, using only Foshou San (Buddha's Hand Powder). If the fetus can be preserved, preserve it; if not, expel it, following nature. A physician examined the prescription and prescribed one liang of Achyranthis Bidentatae Radix (Niuxi, Root of Achyranthes bidentata) decocted in wine, reasoning that Niuxi tonifies the lower body, so what harm could it do? After administration, the dead fetus was not expelled. Subsequently, Guixiang San (Cinnamon and Amber Powder) was given, causing sudden profuse hemorrhage like a bursting dam. Before the Dushen Tang (Single Ginseng Decoction) could be prepared, the patient died. Someone asked: Niuxi is a tonic, yet it induces abortion. Why? The answer is: Raw forms promote dispersion, while cooked forms tonify. Therefore, blood-breaking and essence-filling actions are contradictory, like opposing arrowheads. Is this unique to Niuxi? Cervus Cornu (Deer Antler) also breaks blood and induces abortion, but when processed into Ejiao (Donkey-hide Gelatin), it calms the fetus and stops bleeding. Mistaking the properties of the cooked form for the raw form characterizes a crude practitioner; this serves as a warning for future generations.
Shenzhai commented: The above three passages discuss the use of purgatives after fetal injury, cautioning against erroneous purgation. While purgation may be indicated for fetal injury during pregnancy, the method must be applied with extreme caution and not discussed lightly. For fetal death in utero, one must first confirm signs such as a bluish tongue, cold abdomen, and foul breath before employing purgation. Furthermore, the pregnant woman's root vitality must first be secured by tonifying Qi and nourishing Blood, followed by expulsion. If there is occasional discomfort without thorough examination, hastily using harsh attacking drugs cannot avoid unpredictable disasters. The phrase "following nature" in the *Zhengzhi Yaojue* is most excellent. Lizhai also stated that purgation may only be considered if the fetus truly cannot be preserved. Exercise utmost caution; the warnings of former sages are profound.