[Difficulty in Delivery with Feet or Hands Presenting First (58)]

During childbirth, there are cases where the feet present first and the fetus cannot be delivered, as well as cases where the hands present first and the fetus cannot be delivered. People consider this to be a critical condition of transverse or breech presentation. However, who would know that this is actually due to deficiency of both Qi and Blood? If the mother's Qi and Blood are sufficient, the fetal position will be normal; if the mother's Qi and Blood are deficient, the fetal position will be abnormal. A normal position makes delivery easy, while an abnormal position leads to dystocia. Since Qi and Blood are deficient, the mother's body must be weak, and consequently, the fetus within the uterus must also be weak. The fetus, lacking strength, is unable to turn its head downward, which is why the feet or hands present first. At this time, one should immediately prick the fetus's hands and feet with needles. The pain will cause the fetus to retract. Immediately administer Zhuan Tian Tang (Turning Heaven Decoction) to correct the fetal position.

Prescription: Ren Shen (Ginseng Radix et Rhizoma, 2 liang), Dang Gui (Angelicae Sinensis Radix, 2 liang, washed with wine), Chuan Xiong (Ligusticum Chuanxiong Rhizoma, 1 liang), Chuan Niu Xi (Cyathulae Radix, 3 qian), Sheng Ma (Cimicifugae Rhizoma, 4 fen), Fu Zi (Aconiti Lateralis Radix Praeparata, 1 fen, processed).
Decoct in water and take orally. After one dose, the fetus turns; after two more doses, natural delivery occurs. The brilliance of this formula lies in using Ren Shen to tonify deficient Qi, and Chuan Xiong and Dang Gui to tonify deficient Blood—a principle everyone understands. However, the simultaneous use of Sheng Ma, Niu Xi, and Fu Zi may not be recognized by all. Because the fetus's body is tilted, lifting force is required for the head to turn easily; yet, to descend the body, descending guidance is necessary for the body to lower easily. Using Sheng Ma and Niu Xi together, along with Fu Zi, aims to ensure the medicinal power reaches all meridians unimpeded, allowing Qi and Blood to circulate rapidly to induce labor.

Marginal Note: If after three doses, pricking the fetus's hands and feet still fails to make it turn, prick the He Gu acupoint (Hegu, LI4) of the mother, and the fetus will be delivered. Under no circumstances should one manually probe for the fetus, as this endangers both mother and child. Take heed!

Verse:
When feet or hands present first, birth is hard to achieve,
Due to Qi and Blood failing to fill and nourish.
Prick the infant's limbs so pain causes retraction,
Then tonify Qi and Blood to save the newborn.
Zhuan Tian Tang contains Ginseng, Angelica, and Ligusticum,
Combined with Cyathula, Cimicifuga, and Prepared Aconite.
One dose turns the infant's body,
Two doses bring the baby into the world.

[Difficulty in Delivery due to Rebellious Qi (59)]

Some women experience several days of labor without delivering the fetus. Medications intended to induce labor prove ineffective. People attribute this to the inability of the Jiao Gu (pubic symphysis) to open. However, who would know that this is actually caused by rebellious and stagnant Qi? While failure of the pubic symphysis to open is indeed a cause of dystocia, it only applies when the fetal head has reached the birth canal but cannot descend. In such cases, formulas that open the bones are appropriate. If the fetal head has not yet reached the birth canal, the issue is rebellious Qi preventing the fetal body from turning, not the opening of the pubic symphysis. Forcing the pubic symphysis open at this stage would widen the birth canal prematurely; since the fetal head has not turned downward, this would lead to severe complications. Therefore, the birth canal must never be opened lightly. Generally, during labor, it is crucial to avoid getting onto the birthing bed too early. If the fetus has not yet turned, sudden delivery is difficult. Getting on the bed too early causes the mother to see the fetus lingering without emerging, leading to fear. Fear weakens the Spirit, causing Qi to sink rather than rise. When Qi does not rise, the Upper Jiao becomes obstructed, leading to rebellious Qi. Once the upper Qi rebels, distension occurs in the upper Jiao, making Qi movement even more difficult. Qi stagnates between the upper and lower parts. If one merely tries to induce labor without regulating Qi, the Qi rebellion worsens, and the fetus becomes more trapped. The treatment method is simply to regulate Qi; the fetus will naturally turn and descend.

Prescription: Shu Qi San (Soothing Qi Powder).
Ren Shen (Ginseng Radix et Rhizoma, 1 liang), Dang Gui (Angelicae Sinensis Radix, 1 liang, washed with wine), Chuan Xiong (Ligusticum Chuanxiong Rhizoma, 5 qian), Bai Shao (Paeoniae Radix Alba, 5 qian, stir-fried with wine), Zi Su Geng (Perillae Caulis, 3 qian), Niu Xi (Cyathulae Radix, 2 qian), Chen Pi (Citri Reticulatae Pericarpium, 1 qian), Chai Hu (Bupleuri Radix, 8 fen), Cong Bai (Allii Fistulosi Bulbus, 7 cun).
Decoct in water and take orally. After one dose, the rebellious Qi is regulated, and the fetus is delivered. This formula regulates Qi while simultaneously tonifying it. Rebellious Qi stems from Qi deficiency; Qi deficiency predisposes one to fear. Tonifying Qi stabilizes fear, and once fear is stabilized, the rebellious Qi resolves unknowingly. Why bother with the unnecessary act of forcing the pubic symphysis open?

Marginal Note: Three days before delivery, there is usually a mild abdominal pain known as "false labor" or "trial pain." At this time, do not get on the birthing bed. Prepare all items for wrapping the baby. Do not call the midwife too early. After three days, if severe abdominal pain begins, then call the midwife. Do not let the mother see the midwife initially; have her sit quietly in another room and avoid loud talking. The midwife's role is to catch the baby gently to prevent injury upon landing, not because she possesses magical methods. If the mother sees the midwife immediately, the midwife may talk nonsense and encourage pushing too early, leading to dystocia and various complications. Be extremely cautious!

Verse:
Why does delivery fail for several days?
Getting on the bed too early is the root cause.
The fetus lingers, frightening the mother,
Fear causes Qi rebellion, hindering rotation.
Shu Qi San uses Ligusticum, Ginseng, Angelica, and Perilla Stem.
White Peony, Cyathula, Tangerine Peel, and Bupleurum,
Decocted with Scallion White to induce birth.