《圣济总录》曰∶胞衣未下，急于胎之未生。子死腹中，危于胎之未下。盖胞衣未下，子与母气通其呼吸。
若子死腹中，胞脏气寒，胎血凝冱，气不升降，古方多以行血顺气药，及硝石、水银、 砂之类。若胎已死，躯
形已冷，血凝气聚，复以至寒之药下之，不唯无益，而害母命者多矣。古人用药，深于用意。子死之理有二端，
用药寒温，各从其宜。有妊娠胎漏，血尽子死者。坠堕颠仆，有内伤子死者，有久病胎萎子死者。以附子汤进
三服，使胞脏温暖，凝血流动。盖附子能破寒气、堕胎，此用温药之意也。有因伤寒热病温疟之类，胎受邪热毒
气，内外交攻，因致胎死，留于胞脏。古人虑胎受毒瓦斯必胀大，故用朴硝、水银、 砂之药。不唯使胎不长，
又能使胎化烂，副以行血顺气之药，死胎即下也。
陈良甫曰∶人之胃气壮实，冲任荣和，则胎得其所，如鱼处渊。若气血虚弱，无以滋养，其胎终不能成，宜
下之，以免其祸。
《证治要诀》曰∶有胎漏不止，欲因其势，遂下之，唯佛手散。可安即安，不可安即下，顺其自然。医者
检方，用牛膝一两，酒煎服。谓牛膝补下部药，用之何害？服之未下，又进桂香散，血遂暴下如决，煎独参汤未
成而卒。或问，牛膝补药而能堕胎，何也？曰∶生则宣而熟者补。故破血之与填精，如箭锋相射，岂独牛膝哉。
鹿角亦堕胎破血，煎为白胶则安胎止血。因其熟而信其生，此之谓粗工，着以为世戒。
慎斋按∶以上三条，序胎伤用下，恐有误下之戒也。妊娠胎伤宜下，下法最宜谨，不可轻议。如胎死腹中，
必先验舌青、腹冷、口秽的确，方可用下，亦必先固妊妇本元，补气养血，而后下之。若偶有不安，未能详审，
遽用峻厉攻伐，岂能免不测之祸，此《要诀》云顺其自然四字最妙。立斋亦云，胎果不能安者，方可议下，慎
之慎之，前贤之垂戒深矣。
《圣济总录》说：胞衣（胎盘）不下，比胎儿未出生时更为紧急。胎儿死于腹中，比胎盘未娩出时更加危险。这是因为胎盘未下时，胎儿与母体的气息通过呼吸相互连通。
如果胎儿死于腹中，子宫脏腑之气寒冷，胎血凝结冰冻，气机不能升降，古方多用行血顺气的药物，以及硝石、水银、硇砂之类的药。如果胎儿已经死亡，躯体已经变冷，血液凝固，气机郁结，再用极寒的药物来攻下，不仅没有益处，反而害死母亲的情况很多了。古人用药，深究其用意。胎儿死亡的机理有两种情况，用药的寒温，各自遵循适宜的原则。有因妊娠期间胎漏（阴道出血），血尽导致胎儿死亡的。有因坠跌仆倒，内伤导致胎儿死亡的，有因久病导致胎萎不长进而胎儿死亡的。用附子汤进服三剂，使子宫脏腑温暖，凝血流动。因为附子能破除寒气、堕胎，这是使用温药的道理。有因伤寒、热病、温疟之类的疾病，胎儿受到邪热毒气的侵袭，内外交攻，因此导致胎儿死亡，滞留于子宫脏腑。古人担心胎儿受毒气必然胀大，所以使用朴硝、水银、硇砂这类药物。不仅能使胎儿停止生长，还能使胎儿腐烂化烂，配合行血顺气的药物，死胎就能排出。
陈良甫说：人的胃气壮实，冲脉任脉气血调和，那么胎儿就有安身之所，就像鱼处在深渊一样。如果气血虚弱，无法滋养，胎儿最终不能成形，应当采用下法，以避免祸患。
《证治要诀》说：有胎漏不止的情况，想要顺应其势，于是采用下法，只用佛手散。可以安胎就安胎，不可以安胎就下胎，顺其自然。医生检查药方，用牛膝一两，酒煎后服用。说牛膝是补下部虚损的药物，用它有什么害处？服用后死胎未下，又进服桂香散，血液突然大量流出如决堤一般，独参汤还没煎好人就死了。有人问，牛膝是补药却能堕胎，为什么呢？回答说：生品具有宣通作用，熟品具有补益作用。所以破血与填精，如同箭锋相对相射，难道只有牛膝是这样吗？鹿角也能堕胎破血，煎煮成白胶（阿胶）则能安胎止血。因为熟品而相信其生品的功效，这叫做粗疏的医生，以此作为世人的警戒。
慎斋按语：以上三条，叙述了胎伤后使用下法，恐怕是有误用下法的戒律警示。妊娠胎伤宜用下法，下法最需谨慎，不可轻易议论。如胎儿死于腹中，必须先确验舌质青紫、腹部发冷、口中有秽臭气，方可使用下法，也必先固护孕妇的本元，补气养血，然后才下胎。如果偶然出现不安，未能详细审察，就急于使用峻烈攻伐的药物，怎么能避免不测之祸呢？《证治要诀》说的“顺其自然”四个字最妙。立斋也说，胎儿果然不能安胎的，才可以讨论下法，谨慎啊谨慎，前贤的垂诫很深了。
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.