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*Shengji Zonglu* records: Retained placenta (retention of the placenta after delivery) is more urgent than the state before fetal birth; fetal death in utero (fetal demise within the uterus) is more critical than the state before fetal expulsion. This is because, while the fetus has not yet been expelled, the qi and respiration of the offspring and the mother are connected. If the fetus dies in the womb, the qi of the uterus becomes cold, fetal blood coagulates and freezes, causing qi to ascend but not descend. Ancient formulas often used herbs that promote blood circulation and regulate qi, as well as minerals such as Niter (Natrii Sulfas), Mercury (Hydrargyrum), and Realgar (Realgar). However, since the fetus is already dead and the body has cooled, with blood coagulated and qi gathered, using extremely cold-natured drugs to purge does not only fail to help but often harms the mother's life. The ancients' use of medicine was deeply considered. There are two main mechanisms for fetal death, and the cold or warm nature of the medication should be chosen according to what is appropriate. For example: In cases of threatened miscarriage with bleeding (threatened abortion with vaginal bleeding) where the fetus dies due to excessive blood loss; or cases where the fetus dies due to internal injury from falls or blows; or cases where the fetus dies due to prolonged illness causing fetal atrophy: Administering Fuzi Tang (Aconite Decoction) three doses warms the uterus and liquefies the coagulated blood. This is because Fuzi (Radix Aconiti Lateralis Preparata) can break up cold qi and induce abortion. In cases where the fetus dies due to heat toxins from conditions like Cold Damage with heat syndromes or Warm Malaria, and remains retained in the uterus: The ancients feared that heat toxins would cause the fetus to swell and become difficult to expel, so they used Puxiao (Natrii Sulfas), Mercury, and Realgar. These not only prevent swelling but also decompose the fetus into a liquid state, assisted by herbs that promote blood circulation and regulate qi, ensuring immediate expulsion.

For fetal death in utero caused by febrile diseases, decoct Honghua (Carthami Flos) thickly in fresh water, mix with Tongbian (Uterine Urine/Child's Urine), and drink hot; this yields immediate results. (See *Bencao Jing Shu*)

To terminate pregnancy due to gestational disease, take one sheng of Dayamai (Hordei Fructus Germinatus) and one sheng of Honey; it will be expelled immediately. (See *Qianjin Fang*)

Qi Zhongfu stated: After induced abortion, if bleeding does not stop: One reason is that heat causes blood to move recklessly; another is that qi deficiency fails to consolidate and hold blood. Excessive hemorrhage leads to death from restlessness and suffocation. Alternatively, if wind-cold causes abortion, blood may coagulate and fail to exit, with rebellious qi attacking the heart, leading to death from restlessness and suffocation; in such cases, one should warm the meridians and drive out cold, allowing blood to flow naturally. If blood drips continuously without stopping, this is due to qi deficiency in the Chong and Ren vessels, failing to constrain the blood; Jiao'ai Tang (Donkey-Hide Gelatin and Mugwort Decoction) added with Fulonggan (Caulis Longan Arillatus/Fired Earth) powder is suitable.

Wang Mengying's commentary: There are cases of spontaneous abortion without obvious cause where lochia is completely absent; this is due to blood deficiency failing to nourish, similar to fruit falling before ripening. Since blood is chronically deficient, one must not rigidly adhere to standard protocols and recklessly apply methods to resolve stasis.

Question: How does one know the fetus is dead? Answer: A ruddy face with a cyan tongue indicates the mother is alive and the fetus is dead; a cyan face with a ruddy tongue indicates the fetus is alive and the mother is dead; a cyan face and tongue indicate both mother and fetus are dead. The distending pain and blood stasis associated with the expulsion of a dead fetus differ from normal labor.

Wang Mengying's commentary: Wu Jutong said: When a dead fetus is retained, one cannot rigidly stick to established formulas and indiscriminately use purgative methods. The same applies to inducing labor. One must seek the cause of the retention, reference the presenting pulse and symptoms at that time, correct deviations and remedy deficiencies, and the fetus will naturally be expelled. I believe this applies to all diseases, not just the expulsion of dead fetuses. Furthermore, *Yuyi Cao* contains a case where Xiebai San (White Rhizoma Smilacis Decoction) added with Huangqin (Scutellariae Radix) and Jiegeng (Platycodonis Radix) was used to expel a dead fetus. This shows that humans do not have fixed diseases, diseases cannot be treated by a single method, and medicines do not have fixed uses; adapting to changes is crucial, and the key lies in appropriate application.

Wang Mengying's commentary: Xu Yuqing diagnosed the wife of Shao Hanzhen, who had not delivered after seventeen months of pregnancy. Not daring to rely solely on pulse diagnosis, he asked about her condition. It turned out she was pregnant, not ill, but reported that fetal movement had ceased after five months, which surprised him. He prescribed Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma) alone, seven qian per day. Twenty days later, the fetus was expelled, dead and desiccated. It is speculated that the fetus died when movement stopped at five months. The fetus remained in the abdomen for a year without rotting but became dry, much like fruit hanging on a tree; rotten ones decay, but some do not, thus the principle of a desiccated fetus can be inferred. I consider this to be due to weak vital qi after conception, failing to grow and nourish, resulting in atrophy within the uterus, also known as a "stiff fetus" (Jiang Tai). Some are expelled spontaneously before term, and some fall without rupturing the membranes; I have seen several such cases. If the fetus were fully developed, how could it die in the uterus without causing major harm and remain there for over a year before being expelled? It is a pity that Master Xu did not explain this in detail. Dan Shen excels at promoting blood circulation and is specifically effective in expelling dead fetuses; it should be used with caution during pregnancy. The world claims its efficacy combines that of Siwu Tang (Four Substances Decoction), and using it to calm the fetus ironically accelerates miscarriage, a fact many people are unaware of; I have witnessed this frequently.