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Zhang Xugu treated a woman surnamed Chen, who was under thirty years old and had been pregnant for six months. Her abdomen was distended up to her chest, she could not eat, her stool was dry and difficult to pass, and her urination was obstructed. She experienced pulling pain in her left hip and lower abdomen as sharp as needle pricks, unable to sleep day or night even while sitting. The physician prescribed the Wuling San (Five-Ingredient Powder with Poria) formula. Upon examination, Zhang found the left pulse wiry and strong, especially at the Guan position, while the right Guan pulse was wiry and stagnant. He stated: "In cases of warm pathogenic factors, the pulse is typically soggy and fine. The current pulse presentation indicates blood deficiency with Liver Qi invading the Spleen and Stomach." Because of the urinary obstruction, it was mistakenly diagnosed as dampness pathogen. However, the Classics state that the Liver governs enuresis and strangury; this is strangury caused by constrained Liver Fire. Wind and fire agitating internally caused the stabbing pain in the hip. If diuretic herbs were used, they would damage body fluids, worsening the dryness and potentially leading to convulsions and syncope. Therefore, he heavily utilized Sheng Di Huang (Rehmanniae Radix Recens) as the sovereign herb, assisted by Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba), Huang Qin (Scutellariae Radix), Zi Su (Perillae Folium), and Sheng Gan Cao Gao (Glycyrrhizae Radix et Rhizoma cum Melle prepared tip), along with Hou Po (Magnoliae Officinalis Cortex) and Mu Xiang (Aucklandiae Radix). After two doses, the pulse became slightly harmonious, and distension slightly decreased. Urination remained difficult with persistent stabbing pain, so Huang Bo (Phellodendri Cortex) and Che Qian (Plantaginis Semen) were added. After two more doses, urination flowed freely, and the pain disappeared. Huang Bo and Zi Su were then removed, and after two additional doses, chest fullness resolved and appetite improved, though abdominal distension did not completely vanish. On the third night, a loud sound occurred in her sleep, followed by the expulsion of a dead fetus, flooding the bed with fluid. It was then realized that water had accumulated in the uterus, and the fetus had long been macerated to death. Diuretic drugs cannot drain water from the uterus but instead consume Yin, inevitably leading to convulsions and death. Disease manifestations are often beyond ordinary reasoning. At the same time, Zhang's niece suffered from a similar condition; treatment with diuretics led to convulsions. She was further misdiagnosed as having cold invasion and given one dose of Fuzi Lizhong Tang (Aconite Decoction to Regulate the Middle), resulting in the separation of Yin and Yang. Zhang administered large doses of Yin-nourishing and Yang-retaining medicines urgently day and night, but failed to save her, and she died three days later.

Xu Yuqing treated the wife of Shao Hanzhen, who had been pregnant for seventeen months without delivery. Relying solely on the pulse was deemed unreliable, so Xu inquired about her condition. It was confirmed as pregnancy rather than disease, but she reported no fetal movement since the fifth month. Xu suspected something unusual and prescribed Dan Shen (Salviae Miltiorrhizae Radix) alone, instructing her to take seven qian daily. Over twenty days later, a dead and shriveled fetus was expelled. The death of the fetus likely occurred when movement ceased at five months; remaining in the womb for thirteen months, it did not rot but dried up. Just as rotten wood rots while some decaying matter dries up, the principle of fetal demise can be inferred. (Xiong notes: This occurs because after conception, the vital energy is weak, failing to nourish the fetus, causing it to wither in the uterus, also known as 'stiff fetus'. I have treated several such cases. If the fetus were fully formed, how could it die in the womb without causing major complications? I regret that Mr. Xu did not explain this in detail, hence my addition.)

Zhang Luyu treated the wife of Ma Yunsheng, who had been pregnant for thirteen months without delivery, presenting with a slightly knotted pulse. He prescribed Shiquan Dabu Tang (Decoction for Complete Great Tonification). After taking over twenty doses, the fetus was expelled, appearing shriveled and white. Although the treatment differed, the result—fetal desiccation—was the same.

Yu Jiayan treated the wife of Gu Yiye. In midsummer, at five months of pregnancy, she experienced occasional vaginal bleeding. A physician, noting the illness had lasted a month, used E Jiao (Colla Corii Asini) to tentatively secure the fetus. However, she developed body swelling and qi distension, with rebellious blood rushing upward, accumulating between the epiglottis and thoracic diaphragm. Food intake caused painful contact, making defecation extremely difficult; slight urgency resulted in vomiting, resembling esophageal obstruction. Several physicians attributed this to fetal pressure pushing upward. By autumn, at eight months of pregnancy, her condition reached its peak, with breathing nearly ceasing. Examination revealed no obvious external symptoms, but the Chi position pulse was faint, choppy, and difficult to palpate, while the Lung pulse was excessively surging. Her wheezing sounded like dragging a saw, and her arms were blue-purple, swollen, and shiny like bruised skin. He exclaimed: "Such a critical condition, why was it not consulted earlier?" However, he did not speak plainly to avoid causing panic, instead prescribing gentle medicine to open the upper blockage and unblock the lower closure. When Gu insisted on a diagnosis, Zhang explained: "The upper blockage is indicated by the surging Lung pulse combined with epiglottal congestion, suggesting lung abscess; the lower closure is indicated by the faint, choppy Chi pulse combined with bluish-swollen skin, indicating the fetus has been dead for a long time." The prescription was Xie Bai San (Drain White Powder) modified with bitter Huang Qin and Jie Geng to open the blockage, avoiding harsh purgatives like Xiao Shi (Natrii Sulfas) and Da Huang (Rhei Radix et Rhizoma). After one large dose, abdominal cramping occurred as if in labor. Asked if she was delivering, Zhang replied: "Lung Qi opens and descends; after prolonged rejection, foul matter should exit. Why mention labor?" Another dose reduced swelling and calmed the rebellious Qi, expelling several dou of white, pus-like discharge containing the putrid fetus. For over ten days, only white turbid discharge continued without blood, indicating the fetus had decomposed in the abdomen for nearly a hundred days, with placental blood and the fetus turning into pus. The patient's chest opened immediately, allowing her to eat porridge continuously with clear mental state. Although the putrid fetus was expelled, foul qi filled the body, and the bluish swelling remained; although the chest felt wide, Lung Qi obstruction causing chills, fever, and cough persisted. Treatment focused primarily on clearing the Lung, resulting in recovery within ten days. (Thus, before lung abscess forms, it is caused by turbid qi attacking upward.)

Li Zhai treated the daughter of a midwife, who worked hard carrying heavy loads. During pregnancy, she felt heavy descending pressure in the lower abdomen and had very foul breath. Suspecting fetal death, he examined her tongue, which was indeed blue-black. He prescribed Ban Liang of Piao Xiao (Natrii Sulfas) for her to take, after which foul water was discharged, and she recovered (This case is recorded in *Ji Yin Gang Mu* as an Xue case).

Another woman with a dead fetus took Piao Xiao and discharged foul water. She presented with limb fatigue and faint respiration. Treatment centered on Si Jun Zi Tang (Four Gentlemen Decoction), assisted by Si Wu Tang (Four Substances Decoction), Sheng Jiang (Zingiberis Rhizoma Recens), and Rou Gui (Cinnamomi Cortex), tonifying and regulating until she recovered. (Xiong notes: Large tonics should not be administered immediately, as it may retain turbid pathogens and cause other complications.)

The wife of General Li fell severely ill. Hua Tuo was summoned to examine her pulse and said: "Pregnancy injury with retained fetus." The general replied: "I recently injured my pregnancy, but the fetus has already passed." Hua Tuo said: "Palpating the pulse, the fetus has not passed." The general disagreed. Hua Tuo left. The woman improved slightly, but after a hundred days, symptoms recurred, and she called Hua Tuo again. He said: "This pulse confirms pregnancy. Previously, you should have delivered twins. One child was born first, losing much blood; the second child was not delivered. The mother was unaware, others did not notice, and no assistance was provided, so the second child could not be born. The fetus died, blood vessels did not return to normal, and the corpse dried against the mother's spine, causing severe back pain. Now, combining decoction and acupuncture will ensure the dead fetus is expelled." After treatment, pain intensified as if in labor. Hua Tuo said: "This dead fetus has been shriveled for a long time and cannot exit spontaneously; someone should manually retrieve it." Indeed, a dead male infant was retrieved, complete with hands and feet, black and about a chi long. Such were Hua Tuo's extraordinary skills (Recorded in *Records of the Three Kingdoms*).

Chen Douyan treated a woman who miscarried at four months. Afterward, she presented with swelling, fever, asthma, a surging pulse, red face, and blue-black mouth, nose, and tongue. Chen stated: "A surging pulse indicates the fetus has not yet passed; a red face indicates excessive Heart Fire drying out; blue-black mouth, nose, and tongue indicate Liver Qi exhaustion and fetal death." He used She Tui (Mantis Ootheca) decoction to mix Ping Wei San (Regulate the Stomach Powder), adding Mang Xiao (Natrii Sulfas) and Gui Wei (Angelicae Sinensis Radix tail). The dead fetus was expelled, and she stabilized.

The Lady of the Chancellor of Ganling was pregnant for six months, suffering from abdominal pain and restlessness. Hua Tuo examined her pulse and said: "The fetus is dead." He induced delivery, and a male fetus was expelled, curing her (Recorded in *Records of the Three Kingdoms*).

Chen Liangfu treated Du Shi, the daughter-in-law of Zhai Jue, who could not deliver. Midwives and spiritual interventions were ineffective. Upon examination, he said: "Pulse diagnosis is unreliable before delivery; one must observe complexion." He lifted the curtain and lit candles to examine her. Her face was red, and her tongue was blue. With these colors, he knew the fetus was dead, but the mother was safe. When asked how he knew, he answered: "Red face and blue tongue clearly indicate fetal death with maternal survival." He personally prepared three pills of Zhi Bao Dan (Treasure Treasure Pill) for her to take, and the fetus was expelled immediately. This demonstrates the speed of ancient prescriptions (Recorded in *Good Prescriptions*).