章虚谷治陈姓妇，年未三十，怀妊已六月，腹满及胸，饮食不进，大便艰燥，小便不利，左胯间与小腹掣
痛如锥刺，日夜坐不能寐，医用五苓散方。章诊之，左脉弦强，关尤甚，右关弦滞，曰∶凡温邪脉必濡细，今
脉象如是，乃血少肝气犯脾胃也。彼以小便不利，故认为湿邪，不知经云肝主遗溺癃闭，此肝火郁结之癃闭
也。风火煽动，故胯间刺痛。若用利水药，反伤津液，其燥愈甚，必致痉厥之变矣。乃重用大生地为君，佐以
当归、白芍、黄芩、紫苏、生甘草梢，加浓朴、木香等，服两剂脉稍和，满略减。惟小便仍涩，犹有刺痛，于
前方加黄柏、车前，服两剂，小便畅行，其痛若失。乃去黄柏、紫苏，又服两剂，胸宽食进，惟腹满不能全消。
至第三夜，忽于睡梦中震响一声，落下死胎一个，满床皆水，始悟水在胞中，其胎早经泡死。利水之药，断不
能泄胞中之水，反耗其阴，必致痉厥而死。病情变幻，有非常理所能测者。同时，章侄女亦患此症，为医用利
水药而致痉厥。又妄认为中寒，用附子理中汤一剂，乃至阴阳脱离。章用大剂滋阴摄阳之药，昼夜急进，竟不
能救，延三日而卒。
许裕卿治邵涵贞内子，孕十七月不产，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，令日服七钱，两旬余胎下已死而枯。其胎之死，料在五月不动时，经十三月在腹，不腐
而枯，如果实在树，败者必腐，亦有不腐者则枯，胎之理可推也。（雄按∶此由结胎之后，生气不旺，
未能长养，萎于胞中，又名僵胎。余治过数人矣。若胎已长成，岂能死于腹中，而不为大患哉？惜许君言之未
详也，故及之。）
张路玉治马云生妇，孕十三月不产，脉来微结。为处十全大补汤，服至二十余剂而下，胎枯色白。治虽异，
而胎枯则一也。
喻嘉言治顾季掖乃室，仲夏时孕已五月，偶尔下血。医以病经一月，用阿胶勉固其胎，又身肿气胀，血逆
上奔，结聚于会厌胸膈间，饮食才入，触之痛楚，转下甚难，稍急即呕出，全似噎症。数更医皆谓胎气上逼。
延至秋，计孕已八月，病已造极中之极，呼吸将绝。诊之，不云病状，其脉尺部微涩难推，独肺部洪大无伦，
其喘声如曳锯，其手臂青紫肿亮如殴伤色，乃骇曰∶似此凶症，何不早商？然不必明言，以滋惊恐，姑以善药
投之，通其下闭上壅可也。季掖必求病名，曰∶上壅者，以肺脉之洪大，合于会厌之结塞，知其肺当生痈也；
下闭者，以尺脉之微涩，合于肉色之青肿，知其胎已久坏也。善药者，泻白散加芩、桔之苦以开之，不用硝黄
等厉药也。服一大剂，腹即努痛如欲产状。问欲产乎？曰∶肺气开而下行，多时闭拒，恶秽得出可也，奚产之
云。再进一剂，身肿稍退，上气稍平，下白污如脓者数斗，裹朽胎而出。旬余尚去白污，并无点血相间，可知
胎朽腹中，已近百日，荫胎之血和胎俱化为脓也。病患当时胸膈即开，连连进粥，神思清爽。然朽胎虽去，而
秽气充斥，周身为青肿者未去也；胸膈虽宽，而肺气壅遏，为寒热咳嗽者未除也。乃一以清肺为主，旬余获痊。
（然则肺痈未成，乃秽浊之气上攻而然耳。）
立斋治一稳婆之女，勤苦负重，妊娠腹中阴气重坠，口中甚秽。意其胎必死，令视其舌果青黑。与朴硝半
两许服之，随下秽水而愈（《济阴纲目》是薛案。）
一妇胎死，服朴硝而下秽水，肢体倦怠，气息淹淹，用四君子为主，佐以四物、姜、桂，调补而愈。（雄按∶
未可即投大补，恐秽浊逗遛，反生他变也。）
李将军妻病甚，呼华佗视脉，曰∶伤娠而胎不去。将军言∶间实伤娠，胎已去矣。佗曰∶按脉胎未去也。
将军以为不然。佗舍去，妇稍小瘥，百余日复动，更呼佗。佗曰∶此脉故是有胎，前当生两儿，一儿先出，血
出甚多，后儿不及生，母不自觉，旁人亦不寤，不复迎，遂不得生。胎死，血脉不复归，必燥着母脊，故使多
脊痛。今与汤并针一处，此死胎必出。汤针既加，痛急如欲生者。佗曰∶此死胎久枯，不能自出，宜使人探之。
果得一死男，手足完具，黑长可尺许。佗之绝技，凡此类也。（《三国志》。）
陈斗岩治一妇，孕四月而堕，堕后肿胀发热，气喘，脉洪盛，面赤，口鼻舌青黑。陈曰∶脉洪盛者，胎未
堕也；面赤者，心火盛而且干也；口鼻舌青黑，肝气绝而胎死也。以蛇蜕煎汤调平胃散，加芒硝、归尾服之，
下死胎而安。
甘陵相夫人有妊六月，腹痛不安。华佗视脉曰∶胎已死矣。使下之，果下男形即愈。（《三国志》。）
陈良甫治 宅厥媳孺人杜氏，生产不下，坐婆魂童救疗皆无效。召诊之，曰∶产前脉不可考，但当察色而
知之。遂揭帐明烛以察之，其面色赤，舌色青。如此色者，知胎已死，母却无忧矣。或问曰∶何以知之？答曰∶
面赤舌青，子死母活明矣。躬自合至宝丹三粒服之，胎即落矣。此以见古人处方神速。（《良方》。）
章虚谷诊治陈姓妇人，年龄不到三十岁，怀孕已有六个月，腹部胀满波及胸部，饮食无法进用，大便干结难解，小便不通畅，左侧胯部与小腹牵引疼痛如锥刺一般，日夜坐着都无法入睡。医生使用了五苓散方剂。章虚谷诊察后认为：左脉弦而强劲，关脉尤其明显；右关脉弦而滞涩。他说：“凡是温邪致病，脉象必然濡细，如今脉象如此，这是血少导致肝气侵犯脾胃所致。”患者因为小便不利，所以被误认为是湿邪，却不知道《内经》记载“肝主遗溺癃闭”，这是肝火郁结导致的癃闭。风火煽动，所以胯间出现刺痛。如果利水药，反而伤津液，其燥愈甚，必致痉厥之变矣。于是重用大生地为君药，佐以当归、白芍、黄芩、紫苏、生甘草梢，加浓朴、木香等，服用两剂后脉象稍和缓，胀满略微减轻。只是小便仍然涩滞，仍有刺痛，于前方加黄柏、车前，服用两剂，小便畅行，疼痛消失。于是去黄柏、紫苏，又服两剂，胸宽食进，惟腹满不能全消。至第三夜，忽于睡梦中震响一声，落下死胎一个，满床皆水，始悟水在胞中，其胎早经泡死。利水之药，断不能泄胞中之水，反耗其阴，必致痉厥而死。病情变幻，有非常理所能测者。同时，章侄女亦患此症，为医用利水药而致痉厥。又妄认为中寒，用附子理中汤一剂，乃至阴阳脱离。章用大剂滋阴摄阳之药，昼夜急进，竟不能救，延三日而卒。
许裕卿诊治邵涵贞的妻子，怀孕十七个月不生产，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，令日服七钱，两旬余胎下已死而枯。其胎之死，料在五月不动时，经十三月在腹，不腐而枯，如果实在树，败者必腐，亦有不腐者则枯，胎之理可推也。（雄按∶此由结胎之后，生气不旺，未能长养，萎于胞中，又名僵胎。余治过数人矣。若胎已长成，岂能死于腹中，而不为大患哉？惜许君言之未详也，故及之。）
张路玉诊治马云生的妻子，怀孕十三个月不生产，脉来微结。为处十全大补汤，服至二十余剂而下，胎枯色白。治虽异，而胎枯则一也。
喻嘉言诊治顾季掖的妻子，仲夏时怀孕已五月，偶尔下血。医以病经一月，用阿胶勉固其胎，又身肿气胀，血逆上奔，结聚于会厌胸膈间，饮食才入，触之痛楚，转下甚难，稍急即呕出，全似噎症。数更医皆谓胎气上逼。延至秋，计孕已八月，病已造极中之极，呼吸将绝。诊之，不云病状，其脉尺部微涩难推，独肺部洪大无伦，其喘声如曳锯，其手臂青紫肿亮如殴伤色，乃骇曰∶似此凶症，何不早商？然不必明言，以滋惊恐，姑以善药投之，通其下闭上壅可也。季掖必求病名，曰∶上壅者，以肺脉之洪大，合于会厌之结塞，知其肺当生痈也；下闭者，以尺脉之微涩，合于肉色之青肿，知其胎已久坏也。善药者，泻白散加芩、桔之苦以开之，不用硝黄等厉药也。服一大剂，腹即努痛如欲产状。问欲产乎？曰∶肺气开而下行，多时闭拒，恶秽得出可也，奚产之云。再进一剂，身肿稍退，上气稍平，下白污如脓者数斗，裹朽胎而出。旬余尚去白污，并无点血相间，可知胎朽腹中，已近百日，荫胎之血和胎俱化为脓也。病患当时胸膈即开，连连进粥，神思清爽。然朽胎虽去，而秽气充斥，周身为青肿者未去也；胸膈虽宽，而肺气壅遏，为寒热咳嗽者未除也。乃一以清肺为主，旬余获痊。（然则肺痈未成，乃秽浊之气上攻而然耳。）
立斋诊治一位稳婆的女儿，勤苦负重，妊娠腹中阴气重坠，口中甚秽。意其胎必死，令视其舌果青黑。与朴硝半两许服之，随下秽水而愈（《济阴纲目》是薛案。）
一妇胎死，服朴硝而下秽水，肢体倦怠，气息淹淹，用四君子为主，佐以四物、姜、桂，调补而愈。（雄按∶未可即投大补，恐秽浊逗遛，反生他变也。）
李将军的妻子病得很重，叫华佗诊脉，说：伤娠而胎不去。将军言：间实伤娠，胎已去矣。佗曰：按脉胎未去也。将军以为不然。佗舍去，妇稍小瘥，百余日复动，更呼佗。佗曰：此脉故是有胎，前当生两儿，一儿先出，血出甚多，后儿不及生，母不自觉，旁人亦不寤，不复迎，遂不得生。胎死，血脉不复归，必燥着母脊，故使多脊痛。今与汤并针一处，此死胎必出。汤针既加，痛急如欲生者。佗曰：此死胎久枯，不能自出，宜使人探之。果得一死男，手足完具，黑长可尺许。佗之绝技，凡此类也。（《三国志》。）
陈斗岩诊治一妇人，怀孕四月而堕，堕后肿胀发热，气喘，脉洪盛，面赤，口鼻舌青黑。陈曰：脉洪盛者，胎未堕也；面赤者，心火盛而且干也；口鼻舌青黑，肝气绝而胎死也。以蛇蜕煎汤调平胃散，加芒硝、归尾服之，下死胎而安。
甘陵相夫人有妊六月，腹痛不安。华佗视脉曰：胎已死矣。使下之，果下男形即愈。（《三国志》。）
陈良甫诊治宅厥媳孺人杜氏，生产不下，坐婆魂童救疗皆无效。召诊之，曰：产前脉不可考，但当察色而知之。遂揭帐明烛以察之，其面色赤，舌色青。如此色者，知胎已死，母却无忧矣。或问曰：何以知之？答曰：面赤舌青，子死母活明矣。躬自合至宝丹三粒服之，胎即落矣。此以见古人处方神速。（《良方》。）
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*).