妊娠胎动不安者，由冲任经虚，受胎不实也。有饮酒房事过度、损动不安；有忤触伤仆而动不安；有怒气伤肝、或
郁结不舒，触动血脉不安；有过服暖药并犯禁之药动而不安；有因母病而胎动者，但治母病其胎自安；有因胎不坚固动
及母病者，但当安胎，其母自愈。若面赤、舌青，是儿死也；面青、舌赤，是母死也；唇、口、面、舌俱青，吐沫者，
是子母俱死。然胎动与胎漏，皆有下血，胎动则腹痛，胎漏无腹痛。胎动宜调气，胎漏宜清热。然子宫久虚，多令坠胎，
其危同于风烛，非正产可比，急以杜仲丸预服，以保胎元。
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，子与母气尚通呼吸，若子死腹中，胞脏气寒，
胎血凝 ，气不升降。古方多以行血顺气药及硝石、水银、 砂之类。但其胎已死，则躯形已冷，血凝气聚，复以至寒
之药下之，不惟无益，而害母命者多矣，不知古人立方深于用意。盖子死之故，因有二端，用药寒温各存至理，有妊娠
胎漏血尽子死者；有坠堕颠仆内伤子死者；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，胎受邪热毒瓦斯，内外交攻，因致胎死留于胞脏。古人深虑胎受毒
气必然胀大，故用朴硝、水银、 砂之药，不惟使胎不胀，又能使胎形化烂，再副以行血、顺气之药，死胎即下。此
古人立方之至意也。
凡脉三阳俱盛，名曰双躯。若少阴微紧者（谓督脉），血即凝浊，经养不周，胎即偏夭，其一独死，其一独生，不
去其死，害母失胎，千金神造散主之。是方 治双胎，一胎生、一胎死者，用蟹爪以去其死，阿胶以安其生，甘草和药
性，立方之心意深远矣。
人之胃气壮实，冲任荣和，则胎得其所，如鱼处深涧，自然和畅。若气血虚弱，无以滋养，其胎终不能成宜下之，
以免其祸。然胎伤宜下、而下法最宜谨慎。如胎死腹中，心先 舌青、腹冷、口秽的确，方可用下，也必先固妊妇本元，
补气养血而后下之。如遇有不安，未能详审，遂用峻厉攻伐，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。若欲下之，朴硝断不可少。
妊娠期间出现胎动不安，是由于冲脉和任脉虚弱，导致受孕不稳固。有的因为饮酒或房事过度，损伤并扰动胎气而致不安；有的因受到撞击、跌仆损伤而导致胎动不安；有的因愤怒伤肝，或者情绪郁结不畅，触动血脉而导致胎动不安；有的因过量服用温热药物以及触犯禁忌的药物而导致胎动不安；有的因为母亲患病而导致胎动，此时只需治疗母亲的疾病，胎儿自然安定；有的因为胎儿本身不坚固而动摇，进而引发母亲生病，此时只需安胎，母亲的身体自然会痊愈。如果孕妇面色红赤、舌质青紫，这是胎儿死亡的表现；如果面色青紫、舌质红赤，这是母亲死亡的表现；如果嘴唇、口唇、面部、舌质全部发青，且呕吐涎沫的，这是母子俱死的表现。然而，胎动与胎漏（妊娠期阴道少量出血），都有下血的症状，但胎动伴有腹痛，胎漏则没有腹痛。胎动适宜调理气机，胎漏适宜清热凉血。然而子宫长期虚弱，多会导致堕胎，其危险程度如同风中残烛，不能与正常分娩相比，应紧急预先服用杜仲丸，以保护胎元。
胎盘未排出，其危急程度在于胎儿尚未出生之时。胎儿死于腹中，其危险程度超过胎盘尚未排出的情况。大概是因为胎盘未排出时，胎儿与母体的气息尚相通连，若胎儿死于腹中，胞宫脏腑之气寒冷，胎血凝结，气机不能升降。古方多使用行血顺气的药物以及硝石、水银、硇砂之类的药物。但是胎儿已经死亡，则躯形已经冰冷，血液凝结，气机聚滞，再用极寒的药物来攻下，不仅无益，反而大多会伤害母亲的生命，这是因为不了解古人立方的深意。胎儿死亡的原因，主要有两种情况，用药的寒温各有其至理：有因妊娠胎漏，失血过多导致胎儿死亡的；有因坠跌颠仆造成内伤导致胎儿死亡的；有因久病导致胎萎不长最终胎儿死亡的。对于前两种情况，服用附子汤三剂，使胞宫脏腑温暖，使凝结的血液流动。因为附子能破除寒气，此处使用温药的意思在于此。有因伤寒、热病、温疟等疾病，胎儿受到邪热毒气的侵袭，内外交攻，导致胎儿死亡留在胞宫中。古人深深考虑到胎儿受毒气必然胀大，所以使用朴硝、水银、硇砂等药物，不仅能使胎儿不胀大，还能使胎儿形体化烂，再配合行血、顺气的药物，死胎即可排出。这是古人立方的深意所在。
凡是寸关尺三部脉象都盛大，名叫双胎（怀双胞胎）。如果少阴脉微紧（指督脉），血液就会凝浊，经血供养不周全，胎儿就会偏夭折，其中一个单独死亡，另一个单独存活，如果不去除那个死的，会危害母亲并失去存活的胎儿，由千金神造散主治。这个方子治疗双胎，一胎生、一胎死的情况，用蟹爪来去除死胎，用阿胶来安养活胎，甘草调和药性，立方的心意深远啊。
人的胃气壮实，冲任二脉气血调和，那么胎儿就能得到适宜的滋养，如同鱼处在深涧之中，自然和谐舒畅。如果气血虚弱，无法滋养胎儿，胎儿最终不能成形，应当采用下法，以避免祸患。然而，胎伤需要下法时，下法最需谨慎。比如胎儿死于腹中，必须确认心先冷、舌青、腹部冷、口臭等症状确实存在，才可以采用下法，但也必须先固护孕妇的本元，补气养血之后才能下之。如果遇到胎动不安，未能详细审察，就使用峻烈攻伐的药物，难免不测之祸。这要诀中说“顺其自然”四个字，最为精妙。薛立斋也说：“胎儿果然不能安住的，才可以讨论下法。”谨慎啊，谨慎啊，前贤的告诫非常深刻。如果想要下胎，朴硝是绝对不可少的。
Pregnancy with restless fetus (Tai Dong Bu An) arises from deficiency of the Chong and Ren meridians, resulting in unstable conception. Some cases are caused by excessive alcohol consumption or sexual intercourse, damaging and disturbing the fetal qi; some by physical trauma such as collisions or falls; some by anger injuring the Liver, or emotional depression causing blood vessel disturbance; some by overconsumption of warming herbs or forbidden substances; some due to maternal illness, where treating the mother's illness naturally stabilizes the fetus; and some due to an inherently weak fetus affecting the mother, where stabilizing the fetus naturally cures the mother. If the face is red and the tongue is cyanotic, it indicates fetal death; if the face is cyanotic and the tongue is red, it indicates maternal death; if lips, mouth, face, and tongue are all cyanotic accompanied by frothy vomiting, it indicates death of both mother and fetus. However, both restless fetus (Tai Dong) and threatened miscarriage with bleeding (Tai Lou) involve vaginal bleeding, but restless fetus is accompanied by abdominal pain, whereas threatened miscarriage with bleeding is not. Restless fetus should be treated by regulating Qi, while threatened miscarriage with bleeding should be treated by clearing heat. However, long-term uterine deficiency often leads to abortion, a danger comparable to a candle in the wind, distinct from normal delivery. Emergency pre-administration of Duzhong Wan (Eucommia Bark Pill) is required to preserve the fetal origin.
If the placenta remains undelivered, the situation is critical before birth. Fetal death in utero is more dangerous than retained placenta. When the placenta is undelivered, the fetus and mother still share respiratory connection. In fetal death, the uterine qi becomes cold, fetal blood coagulates, and Qi fails to ascend and descend. Ancient formulas often used blood-moving and Qi-regulating herbs along with minerals like Niter (Xiaoshi), Mercury (Shuiyin), and Rock Salt (Naosha). However, since the dead fetus is already cold with coagulated blood and stagnant Qi, using extreme cold purgatives is not only ineffective but often fatal to the mother, failing to grasp the profound intent of ancient prescriptions. There are two main causes for fetal death, each requiring specific thermal properties: death due to hemorrhage from threatened miscarriage; death due to internal injury from falls; or death due to wasting from chronic illness. For these, administering Fuzi Tang (Aconite Decoction) three times warms the uterus and mobilizes coagulated blood, utilizing Aconite's ability to break cold stagnation. Conversely, in cases of Typhoid fever, Heat diseases, or Warm Malaria where toxic heat invades the fetus, causing fetal death and retention, ancients feared fetal distension. Thus, they used Glauber's Salt (Puxiao), Mercury, and Rock Salt to prevent distension and rot the fetal tissue, assisted by blood-moving and Qi-regulating herbs to expel the dead fetus. This reflects the profound intent of ancient formulations.
When the pulse at all three positions (Cun, Guan, Chi) is vigorous, it is called "Shuang Qu" (Twin Pregnancy). If the Shaoyin pulse (referring to the Du Mai) is slightly tight, blood becomes turbid and nourishment is insufficient, leading to the demise of one twin while the other survives. Failure to remove the deceased twin harms the mother and endangers the survivor, treated by Qianjin Shenzao San. This formula treats twin pregnancies where one is alive and one dead, using Crab Claw (Xiezhua) to expel the dead fetus, Donkey-hide Gelatin (Ejiao) to stabilize the live fetus, and Licorice Root (Gancao) to harmonize the formula, demonstrating profound prescriptive wisdom.
When gastric Qi is robust and Chong and Ren meridians are harmonious, the fetus thrives like a fish in a deep stream. If Qi and Blood are deficient, the fetus cannot develop properly, necessitating expulsion to prevent disaster. However, expulsion methods must be used with extreme caution. For fetal death in utero, one must confirm symptoms such as cold heart, cyanotic tongue, cold abdomen, and foul breath before proceeding. Crucially, the pregnant woman's original Qi must first be fortified by tonifying Qi and nourishing Blood before any purgative action. Blindly using harsh purgatives without thorough examination invites unpredictable disasters. The key principle is "following nature," as stated by Xue Lizhai: only consider expulsion if the fetus truly cannot be sustained. Caution is paramount. If expulsion is necessary, Glauber's Salt (Puxiao) is indispensable.