《圣济总录》云∶胞衣不下，急于胎之未生；子死腹中，危于胎之未下。盖胎儿未下，子与母气，通
其呼吸。若子死腹中，胞脏气寒，胎血凝冱，气升不降。古方多用行血、顺气药，及硝石、水银、 砂
之类。然胎已死，躯形已冷，血凝气聚，复以至寒之药下之，不惟无益，而害母命也多矣。古人用药，深
于用意。子死之理有二端，用药寒温、各从其宜。如娠妇胎漏，血尽子死者；有坠堕颠扑，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。盖以附子能破寒气堕胎故也。若因伤寒热
证、温疟之类，胎受热毒而死，留于胞中不下者。古人虑其胎受热毒，势必胀大难出，故用朴硝、水银、
砂之类，不惟使胎不胀，且能使胎化烂，副以行血顺气之药，使胎即下也。
热病胎死腹中，新汲水浓煮红花汁，和童便热饮，立效。（见《本章经疏》）
妊病去胎，大麦芽一升，蜜一升，服之即下。（见《千金方》）
齐仲甫曰∶堕胎后血出不止∶一则因热而行；一则气虚不能敛。泻血多者，必烦闷而死。或因风冷堕
胎，血结不出，抢上攻心，烦闷而死，当温经逐寒、其血自行。若血淋漓不止，是冲任气虚，不能约制故
也，宜胶艾汤加伏龙肝散。
王孟英按∶有无故堕胎而恶露全无者，此血虚不能荣养，如果之未熟而落。血既素亏，不可拘常例而
再妄行其瘀也。
问∶何以知胎死？曰∶面赤舌青，母活子死；面青舌赤，子活母死；面舌俱青，子母俱死。死胎坠胀
瘀痛，亦与常产不同。
王孟英按∶吴鞠通云∶死胎不下，不可拘执成方而悉用通法。催生亦然。当求其不下之故，参以临时
所现之脉证若何，补偏救弊，而胎自下也。余谓诸病皆尔，不特下死胎也。又《寓意草》有用泻白散加芩、
桔以下死胎之案。可见人无一定之病，病非一法可治，药无一定之用，随机应变，贵乎用得其当也。
王孟英按∶许裕卿诊邵涵贞室，娠十七月不产，不敢执意凭脉，问诸情况，果孕非病，但云孕五月以后
不动，心窃讶之。为主丹参一味，今日服七钱。两旬胎下，已死而枯。其胎之死，料在五月不动时。经年
在腹不腐而枯，如果实在树，败者必腐，但亦有不腐者，则枯胎之理可推也。余谓此由结胎之后，生气不
旺，未能长养，萎于胞中，又名僵胎。亦有不足月而自下者，并有不能破胞而自落者，余见过数人矣。若
胎已长成，则岂能死于腹中而不为大患，至年余而始下哉？惜许君言之未详也。丹参长于行血，专用能下
死胎，凡胎前皆宜慎用。世人谓其功兼四物，以之安胎，因而反速其堕，而人不知之，余见亦多矣。
《圣济总录》记载：胞衣不下（胎盘滞留），其紧迫程度超过胎儿未出生时；子死腹中（胎儿在子宫内死亡），其危险程度超过胎儿未娩出时。这是因为胎儿尚未娩出，子体与母体的气息通过呼吸相互连通。如果胎儿死于腹中，胞宫脏气寒冷，胎血凝结冻结，导致气机上升而不能下降。古方多使用行血、顺气的药物，以及硝石、水银、硇砂之类的药材。然而，既然胎儿已经死亡，躯体形状已经变冷，血液凝滞、气机聚结，再用极寒的药物来攻下，不仅没有益处，反而大多会损害母亲的生命。古人用药，深究其中的用意。胎儿死亡的机理主要有两个方面，用药的寒温属性，应各自顺应病情适宜的原则。例如：孕妇胎漏（妊娠期间阴道少量出血），因失血过多导致胎儿死亡的；有因坠跌撞击，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：此时服用附子汤三剂，使胞宫温暖，凝血流动。这是因为附子能够破除寒气并促使堕胎的缘故。如果是由于伤寒热证、温疟之类疾病，胎儿受热毒而死，滞留于胞宫中不能排出的情况。古人担心胎儿受热毒，势必胀大难以产出，所以使用朴硝、水银、硇砂之类的药物，不仅能使胎儿不胀大，而且能使胎儿腐烂化开，辅以行血顺气的药物，使胎儿立即排出。
热病导致胎死腹中，用新汲水浓煮红花汁，混合童便（儿童尿液）热饮，立刻见效。（见《本草经疏》）
妊娠疾病需要去胎，大麦芽一升，蜂蜜一升，服用后即能排出。（见《千金方》）
齐仲甫说：堕胎后出血不止：一种是因为热邪导致血行妄动；另一种是气虚不能收敛止血。泻血过多者，必然因烦闷而死。或者因为风冷导致堕胎，血液凝结不出，逆气上冲攻心，导致烦闷而死，应当温经散寒，血液自然运行。如果血液淋漓不止，这是冲任二脉气虚，不能约束控制血液的缘故，适宜使用胶艾汤加伏龙肝散。
王孟英按语：有无故堕胎而恶露全无的情况，这是血虚不能荣养，就像果实未成熟就掉落一样。血液既然素来亏虚，不可拘泥于常规案例而再次妄用化瘀之法。
问：如何知道胎儿已死？答：面部红润舌色青紫，是母活子死；面部青紫舌色红润，是子活母死；面部和舌头都青紫，是母子俱死。死胎坠落时的胀痛瘀痛，也与正常分娩不同。
王孟英按语：吴鞠通说：死胎不下，不可拘泥执守成方而全部使用通利之法。催生也是如此。应当探求胎儿不能产下的原因，参考当时呈现的脉象和症状，纠正偏差补救弊端，那么胎儿自然就能排出。我认为各种疾病都是如此，不仅仅是处理死胎。另外，《寓意草》中有使用泻白散加黄芩、桔梗以下死胎的案例。可见人没有固定不变的病，病也不是一种方法可以治疗的，药也没有固定的用途，随机应变，贵在运用得当。
王孟英按语：许裕卿诊治邵涵贞的妻子，怀孕十七个月未能生产，不敢仅凭脉象断定，询问具体情况，果然不是病态，只是说怀孕五个月后胎动停止，心中暗自惊讶。主方只用丹参一味药，今日服用七钱。二十天后胎儿排出，已经死亡且干枯。推测胎儿之死，应在五月胎动停止之时。胎儿在腹中一年不腐烂而干枯，就像果实挂在树上，败坏的必然腐烂，但也有不腐烂的，那么枯胎的道理就可以推知了。我认为这是由于结胎之后，生气不旺盛，未能生长养育，萎缩于胞宫中，又名僵胎。也有不足月而自行排出的，还有不能破胞而自行落下的，我见过好几例了。如果胎儿已经长成，怎么能死于腹中而不造成大患，直到一年多以后才排出呢？可惜许君讲述得不详细。丹参擅长于行血，专用它能下死胎，凡是产前都应慎用。世人说它的功效兼有四物汤的作用，用它来安胎，因而反而加速了流产，而人们并不知道这一点，我也见过很多例子了。
*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.