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Xue Lizhai treated a woman who, after a miscarriage, suffered from coma and confusion, along with intermittent expectoration of phlegm. She had self-administered blood-nourishing and phlegm-resolving agents, which worsened her condition, leading to unconsciousness, spontaneous sweating, convulsions, and profuse salivation. Her family mistook this for wind-stroke (Zhong Feng) and intended to use wind-dispelling and phlegm-resolving formulas. Xue said, "This is caused by deficiency-cold of the Spleen Qi." He prescribed Shiquan Dabu Tang (Complete Great Tonifying Decoction) with processed ginger (Pao Jiang). After more than twenty doses, she recovered quickly.

Another woman in her twenties suffered a miscarriage due to malaria (Yi Ji) and coughing. Having taken lung-clearing and exterior-releasing medicines, she developed wheezing, urgency of breath, and insomnia. Xue diagnosed that the Spleen Earth was deficient and failed to generate Lung Metal, meaning the previous medications aggravated the condition. He first prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Poria (Fu Ling), Pinellia (Ban Xia), Schisandra (Wu Wei Zi), and processed ginger. After four doses, she gradually improved. Subsequently, she took Bazhen Tang (Eight Treasures Decoction) with Schisandra, and finally recovered completely with Shiquan Dabu Tang.

Gong Zicai treated a woman who invariably miscarried at three months of pregnancy but refused medication. He advised her to boil soups from old hens aged four or five years, adding red-shelled small yellow millet to make porridge. After just a few servings, her fetus stabilized, and she delivered a healthy boy at full term.

Mrs. Zhu, wife of Fang Jie'an, experienced repeated difficult labors. Seeking medical help, she requested an abortifacient formula, which proved ineffective. She then sought advice from Zheng Shi. Zheng said, "If the abortifacient fails to expel the fetus, it indicates the fetus is precious/stable; you should now take fetal-securing medicines." One day, while strolling in the fields, Fang saw a Daoist priest carrying a bamboo basket sitting under a bridge. Upon conversation, he found the priest's aura profound and invited him home for a meal. When asked about the contents of the basket, the priest replied, "These are miraculous pills to heal patients." He then imparted a formula named Huisheng Jiuchan Dan (Life-Restoring and Labor-Saving Pill) and encouraged its widespread distribution. During Mrs. Zhu's confinement month, taking one pill daily ensured a smooth delivery. She subsequently gave birth to two sons: the eldest, Peng, courtesy name Jiaoting; and the second, Feng, courtesy name Gaiting. Later, one became a Gongzhan (Imperial Tutor/Advisor) and the other a Censor (Yushi). (From *Zhangshi Zhiyan*.)

Xue Lizhai treated another woman suffering from reproductive issues. At three months of pregnancy, she ingested a mixture of flour and rice wine intended to induce abortion. Although the fetus was expelled, she suffered continuous bleeding, vomiting, and inability to retain any food or medicine. Her six pulses were minute and nearly imperceptible. Xue determined that the toxic substance had damaged Stomach Qi, leaving it too weak to receive nourishment. He administered Ren Shen (Ginseng Root) 2 qian and Gan Cao (Licorice Root) 5 fen, decocted in water and given slowly. The vomiting ceased. She was then regulated with Bazhen Tang and stabilized.

He also treated a pregnant woman who, after taking the aforementioned abortifacient, presented with chest and abdominal distension and incessant vomiting. She was soothed by drinking Mung Bean and Licorice Decoction (Lvdou Gancao Tang).

A woman miscarried at three months, followed by fever, spontaneous sweating, and weakness in the four limbs. Xue stated, "This is due to Qi and Blood deficiency failing to nourish the fetus, causing the miscarriage. Post-miscarriage, the deficiency increases; Yin deficiency causes fever, and Yang deficiency causes spontaneous sweating." He used Shiquan Dabu Tang minus Gui Zhi (Cinnamon Twig), adding Wu Wei Zi (Schisandra Berry), resulting in recovery.

Wu Qiao treated the wife of Cheng Yingzhao, who was chronically ill. Her menstruation had stopped for three months, and she suddenly exhibited slight vaginal bleeding. Various physicians assumed it was blood stasis and forcefully attempted to purge it. This resulted in massive lochia discharge, profuse whole-body sweating, and near-death collapse before she revived. The patient was extremely deficient, yet doctors administered heavy tonics. She then developed upward-gazing eyes, opisthotonos (back arching), convulsions, and coma, with a towel placed over her head as she awaited death. Wu Qiao palpated the pulse, finding it deviated from the normal pregnancy pulse but remained unbroken upon pressure. He said, "This is a pregnancy pulse." Mistaking it for blood stasis and forcing purgation caused excessive bleeding. The fetus detached from the meridian and attempted to descend, leading to blood exhaustion and stagnation. Without Yin-blood to anchor it, Yang Qi floated upward. The expelled fetus allowed Yang to rebel upward and strike the Heart, causing upward gazing, opisthotonos, convulsions, and coma. According to medical principles, death was not inevitable. He prescribed Shuntai San (Fetus-Pacifying Powder). Initially, administration was difficult, but halfway through, the medicinal action took effect, and she fell into a deep sleep. Other physicians looked at Wu Qiao and said, "She has died." Wu Qiao replied, "The medicine hit the disease site, hence the sleep. Wait and see." Soon, she groaned and complained of headache. Others thought it was residual heat and predicted death by midnight. Wu Qiao said, "At midnight, Yang Qi generates, and recovery should follow." As time passed, she relaxed slightly and woke up refreshed in the morning. Suddenly, she collapsed on the bed. Terrified, the other physicians said, "Truly dead." Wu Qiao explained, "The fetus wanted to descend, but blood was nearly exhausted, causing obstruction. I will now use Shuntai San to expel it." A large blood clot, size of a cupped hand, was expelled. The physicians, awed, admitted, "We indeed thought it was blood stasis, and it turned out to be so." Wu Qiao calmly responded, "It was not stasis, but the fetus." He ordered water to wash the mass; it was purple outside and white inside, possessing human form. The patient gradually stabilized, and the other physicians submitted. (From *Taihan Ji*.)

Xu Lingtai commented: In gynecology, the two most critical aspects are miscarriage and dystocia (difficult labor). Those treating miscarriage often rely solely on tonification, while those treating dystocia focus exclusively on purgation; both approaches are incorrect. The causes of premature birth (half-birth/miscarriage) vary. Cases due to deficiency and slipping account for only 10-20%, whereas cases due to internal heat account for 80-90%. The fetus relies on blood for nourishment; thus, after conception, menstruation ceases because the blood of the Chong and Ren meridians is absorbed by the fetus, leaving no surplus to flow downward. If blood is insufficient, the fetus withers and miscarries. The reason for insufficiency lies in internal fire and excess heat, where Yang is vigorous and Yin is deficient. Therefore, ancient fetal-nourishing formulas primarily use Huang Qin (Scutellaria Root). Furthermore, blood generation depends on the Spleen and Stomach. The *Classic of Internal Medicine* states that Ying and Wei pathways value grain intake; thus, Bai Zhu (Atractylodes Macrocephala Rhizome) is used to assist. However, modern practitioners often indiscriminately use Ren Shen (Ginseng) and Huang Qi (Astragalus Root) to boost Qi. Shu Di Huang (Prepared Rehmannia Root) can cloy the Stomach. Excess Qi leads to excess fire, and Stomach dampness impairs transformation. Consequently, the source of bio-transformation declines, and blood becomes even scarcer. Regarding childbirth, it is a natural process of Heaven and Earth's creation and inherently carries no danger; dangerous outcomes occur in less than 1 in 1,000 cases. Adversities arise from improper human management. The key lies with the parturient: she must not exert force early. The fetus must rotate before descending; early exertion causes the fetus to drop prematurely, making rotation difficult, leading to malpresentations like transverse or breech births. Moreover, exertion causes amniotic fluid to rush out, leaving the fetus dry and stuck, hindering delivery. This ignorance exists not only among families but also among midwives. Regarding medication, specific formulas exist for conditions such as non-opening of the pubic symphysis (Jiao Gu) or failure of fetal rotation. Treatments may involve moistening, descending, warming, or cooling, depending on symptoms. The general principle is to nourish Blood, as sufficient Blood resolves various symptoms. Conversely, robust women prone to easy labor sometimes suffer sudden death. After massive hemorrhage, the Chong and Ren meridians are empty, and vessels are fragile. Healthy women may underestimate this, moving lightly or exerting themselves heavily, potentially rupturing the Chong Mai (Penetrating Vessel), leading to Qi collapse and blood flooding, causing instant death. Particularly, raising hands above the head is forbidden. I have witnessed many such deaths. Laypeople find this strange, but it is common logic. Families involved in childbirth must understand this.