妇人孕子如鸡覆卵相似，雏在卵壳中临出雏乃自家破卵壳而出。儿在胞胎中临生，
乃儿自吮开胞衣而生，其有艰难延久者，多为胞衣太浓，胎气肥大故也。如孕子者，勿
过安逸，勿浓奉养，勿多淫欲，自然胞衣不浓，胎气不肥，产自不难，且于子嗣有益。
妇人以血为主，惟气顺则血和，胎安则产顺，今富贵之家，过于安逸，以致气滞而
胎不转，过多交合，使精血聚于胞中，皆致难产也，生化汤主之。
有产累日不下，服催生药不验，此必坐草太早，心惧而气结不行也。《经》云∶恐
则气下，恐则精怯，怯则上焦闭，闭则气还，还则下焦胀气乃不行，宜温补气血，壮而行之。
胞浆先破，恶水来多，胎干不得下，先与四物，佐以四君，补养气血，次煎浓葱
汤，令稳婆洗产户，使气上下通畅，更用酥油、滑石涂产门，次服催生保产万全汤。
难产有因母气盛；胎肥而难产者，有因母气弱血枯而难产者，悉是平时不善调摄，
或七八月而犯房室，致污浊凝滞，不得顺生，大法以顺气和血为主。如浆干不下者，
滋润为主。污血阻滞者，逐瘀为主。加坐草用力太早，胞水干者，滑胎散、神应散，连
进大剂，如鱼得水自顺矣。
难产治法，或开滑子宫，或通调上下之气，或滋养气血，当随机应变，若胎死腹
中，惟有下法，平胃散加朴硝以下秽水。如肢体倦怠，急以四君、四物加姜桂调补之，
更宜去川芎加牛膝、红花、益母尤妙。
立斋曰∶交骨不开，产门不闭，子宫不
收三证，皆由元气素弱，胎前缺于调理，致气血不能运用而然。交骨不开者，阴血虚
也，佛手散加发灰、龟板。产门不闭者，气血虚也，十全大补汤，加五味子收之。子宫
不闭者，补中益气，加醋炒白芍、五味。如初产肿胀痛而不闭者，加味逍遥散。若肿既
消而不闭者，补中汤加半夏、茯苓以健脾，使元气复而诸疾自愈，切忌寒凉之剂。又
曰∶交骨不开者，阴气虚也，龟为至阴，板则交错相解，故用之。又有开骨膏、明乳香
一两，五月五日研细，猪血为丸，如鸡豆大，朱砂为衣，加味佛手散送下。单养贤
曰∶产后见此三证，总服生化汤，如交骨不开，加龟板一枚，生化汤者，芎、归、桃
仁、黑姜、炙草，善化恶血，骤生新血而得名，为产后圣药。《经疏》云∶临产交骨不
开，惟浓者梓木枝汤饮之自开。（梓木俗名一叶一刺，其木枝干直上，每一叶下必发一刺者是也。）
盘肠生是母气血虚弱，因而下脱，当用补气血之药，兼以升提，则肠自收，大剂参
归芎加升麻主之。有以醋水喷面，使妇人惊寒，则气提而肠缩，恐惊则气散，寒则血
凝，愈难收而致病矣。不若皂角末吹鼻，嚏作自上也。
生者，言欲产时，儿头至产门，方服药催之。或经日久，产母困倦难生，宜服
药以助血气，令儿速生也。大法滑以通滞涩，苦以驱逐闭塞，温以调幔诸经，香以开
窍逐血，胞浆先破，气滞血干者，滋补精血以行之，然妇人气弱无力，或日久困倦，而
不能送子出产门者，须倍服人参，此药能兼治横生、倒产，催生保生之第一药也。
妇人怀孕的情况就像鸡孵蛋一样，雏鸟在蛋壳中，临近出壳时，是自己啄破蛋壳出来的。胎儿在胞胎中，临产时，也是胎儿自己吮开胞衣而生出来。那些有难产、拖延时间久的情况，大多是因为胞衣太厚，胎气过于肥大所致。如果像孵蛋一样，不要过分安逸，不要过度进补营养，不要纵欲，自然胞衣就不会太厚，胎气不会过于肥大，生产就不困难，而且对子嗣也有益处。
妇女以血为本，只有气机顺畅则血液调和，胎元安稳则生产顺利。如今富贵人家，过分安逸，导致气机阻滞而胎位不转；过多房事，使精血聚积于胞宫，都导致难产，用生化汤主治。
有的产妇劳累多日胎儿不下，服用催生药无效，这一定是坐草（上产床待产）太早，心中恐惧导致气结而不行。《内经》说：恐则气下，恐则精怯，怯则上焦闭塞，闭塞则气还，气还则下焦胀满，气机不行，适宜温补气血，壮盛后推动运行。
如果胞浆先破，羊水来多，胎儿干燥不得下行，先用四物汤，佐以四君子汤，补养气血，然后煎浓葱汤，让稳婆清洗产户，使气上下通畅，再用酥油、滑石涂抹产门，接着服用催生保产万全汤。
难产有的因为母体气盛、胎肥而导致难产，有的因为母体气弱、血枯而导致难产，这都是平时不善调养，或在七八个月时犯房事，导致污浊凝滞，不能顺产，大法以顺气和血为主。如羊水干涸胎儿不下的，以滋润为主。污血阻滞的，以逐瘀为主。加上坐草用力太早，胞水干的，用滑胎散、神应散，连续进服大剂量，如鱼得水自然顺产。
难产治法，或开滑子宫，或通调上下之气，或滋养气血，应当随机应变。如果胎死腹中，惟有下法，用平胃散加朴硝以下除秽浊之水。如肢体倦怠，急用四君子汤、四物汤加生姜、肉桂调补，更宜去掉川芎，加牛膝、红花、益母草尤其好。
薛立斋说：交骨不开、产门不闭、子宫不收这三证，都是由元气素来虚弱，胎前缺乏调理，导致气血不能运用所致。交骨不开者，是阴血虚，用佛手散加发灰、龟板。产门不闭者，是气血虚，用十全大补汤，加五味子收敛。子宫不收者，补中益气，加醋炒白芍、五味子。如果是初产肿胀痛而不闭的，用加味逍遥散。如果肿既消而不闭的，用补中汤加半夏、茯苓以健脾，使元气恢复而诸疾自愈，切忌寒凉之剂。又说：交骨不开者，是阴气虚，龟为至阴之物，板则交错相解，所以用它。又有开骨膏，明乳香一两，五月五日研细，猪血为丸，如鸡豆大，朱砂为衣，加味佛手散送下。单养贤说：产后见此三证，总服生化汤，如交骨不开，加龟板一枚。生化汤由川芎、当归、桃仁、黑姜、炙甘草组成，善于化恶血，骤生新血而得名，为产后圣药。《经疏》说：临产交骨不开，只喝浓梓木枝汤自开。（梓木俗名一叶一刺，其木枝干直上，每一叶下必发一刺者是也。）
盘肠生是因为母体气血虚弱，因而下脱，当用补气血的药，兼以升提，则肠自收，大剂量参、归、芎加升麻主治。有用醋水喷脸，使妇人惊寒，则气提而肠缩，但恐惊则气散，寒则血凝，更难收回而致病。不如皂角末吹鼻，喷嚏作自上也。
“生”字，指欲产时，儿头至产门，才服药催之。或经日久，产母困倦难生，宜服药以助血气，令儿速生也。大法滑以通滞涩，苦以驱逐闭塞，温以调幔诸经，香以开窍逐血，胞浆先破，气滞血干者，滋补精血以行之，然妇人气弱无力，或日久困倦，而不能送子出产门者，须倍服人参，此药能兼治横生、倒产，催生保生之第一药也。
The condition of a woman's pregnancy is similar to a hen incubating an egg; the chick, inside the shell, breaks out of the shell itself when it is about to hatch. Similarly, when a fetus is in the amniotic sac and near birth, it sucks open the placenta and membranes to be born. Cases of difficult or prolonged labor are mostly due to the placenta and membranes being too thick, or the fetal Qi being overly robust and large. Just as with incubation, one should not be overly sedentary, avoid excessive nourishment, and abstain from excessive sexual desire. Naturally, the placenta and membranes will not be too thick, the fetal Qi will not be overly robust, labor will not be difficult, and this is beneficial for offspring.
Women take blood as their foundation; only when Qi flows smoothly does blood harmonize, and only when the fetus is secure is delivery smooth. Nowadays, wealthy families live in excessive comfort, leading to Qi stagnation and failure of the fetus to descend; excessive intercourse causes essence and blood to accumulate in the uterus, all resulting in dystocia. Shenghua Tang (Decoction for Generating Blood) is the primary formula.
In cases where labor has been prolonged for days without delivery, and parturifacient medicines have failed, this is likely due to getting into bed for labor too early, causing fear that knots the Qi and prevents its movement. The *Classic* states: "Fear causes Qi to sink; fear causes essence to become weak; weakness causes the Upper Jiao to close; closure causes Qi to return; return causes distension in the Lower Jiao, and Qi fails to move." In such cases, it is appropriate to warm and tonify Qi and Blood, strengthening them to promote movement.
If the amniotic fluid breaks first and there is excessive discharge, leaving the fetus dry and unable to descend, first administer Siwu Tang (Four Substances Decoction), assisted by Sijunzi Tang (Four Gentlemen Decoction), to tonify and nourish Qi and Blood. Then, decoct a strong scallion water for the midwife to wash the vaginal opening, ensuring the Qi moves freely up and down. Apply butter and talc powder to the perineum, followed by administering Cuisheng Baochan Wanquan Tang (Decoction for Safe Delivery and Protection).
Dystocia may result from the mother having excess Qi and a large fetus, or from the mother having deficient Qi and depleted Blood. All these stem from poor daily regulation, or engaging in intercourse during the seventh or eighth month, causing turbidity and stagnation that prevent natural delivery. The general principle is to regulate Qi and harmonize Blood. If the amniotic fluid is dry and the fetus cannot descend, focus on moistening. If blocked by stagnant blood, focus on expelling stasis. If caused by pushing too early in labor and drying of the amniotic fluid, use Huatai San (Slippery Fetus Powder) and Shenying San (Miraculous Response Powder), administered in large doses continuously; the fetus will deliver smoothly like a fish in water.
Treatment methods for dystocia include lubricating the uterus, regulating the Qi of the upper and lower body, or nourishing Qi and Blood, adapting to the situation. If the fetus is dead in the womb, only purgative methods apply, using Pingwei San (Peaceful Stomach Powder) plus Poxiao (Mirabilite) to purge turbid fluids. If the limbs are fatigued, urgently use Sijunzi Tang and Siwu Tang with Shengjiang (Fresh Ginger) and Rougui (Cinnamon Bark) to tonify and regulate. It is better to remove Chuanxiong and add Niuxi (Achyranthes Root), Honghua (Safflower), and Yimucao (Motherwort Herb) for optimal effect.
Xue Lizhai stated: The three conditions of unopened pubic symphysis (Jiaogu), non-closing vulva (Chanmen), and non-retracting uterus (Zigong) are all due to inherent deficiency of Yuan Qi and lack of regulation during pregnancy, resulting in the inability of Qi and Blood to function. Unopened pubic symphysis indicates Yin Blood deficiency; use Foshou San (Buddha's Hand Powder) with Fazhui (Hair Ash) and Guiban (Tortoise Shell). Non-closing vulva indicates Qi and Blood deficiency; use Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction) with Wuweizi (Schisandra Berry) to astringe. Non-retracting uterus requires Bu Zhong Yi Qi (Tonify the Middle and Augment the Qi), with Chao Baishao (Vinegar-fried White Peony Root) and Wuweizi. For initial swelling and pain with non-closure, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). If swelling subsides but closure fails, use Buzhong Tang with Banxia (Pinellia Tuber) and Fuling (Poria) to strengthen the Spleen, allowing Yuan Qi to recover and diseases to heal spontaneously; strictly avoid cold-natured formulas. He also said: Unopened pubic symphysis indicates Yin Qi deficiency. The turtle is the ultimate Yin entity, and its shell interlocks and separates, hence its use. There is also Kaigu Gao (Bone-Opening Ointment): 1 liang of Ming Ru Xiang (Frankincense), finely ground on the fifth day of the fifth lunar month, formed into pills with pig blood the size of a soybean, coated with Zhusha (Cinnabar), taken with Jiawei Foshou San. Shan Yangxian stated: If these three conditions appear postpartum, generally use Shenghua Tang. For unopened pubic symphysis, add one piece of Guiban. Shenghua Tang consists of Chuanxiong, Danggui, Taoren, Heijiang (Charred Ginger), and Zhi Gancao (Honey-fried Licorice); it is named for its ability to transform evil blood and rapidly generate new blood, making it the sacred medicine for postpartum care. *Jingshu* states: For unopened pubic symphysis at labor, drinking a strong decoction of Zimuzhi (Catalpa Branch) will cause it to open naturally. (Zimu is commonly known as "one leaf, one thorn"; its branches grow straight up, and each leaf has a thorn beneath it.)
"Placenta prolapse" (Panchang Sheng) occurs because the mother's Qi and Blood are weak, causing the intestine to descend. It should be treated with herbs that tonify Qi and Blood and promote ascending, which will naturally retract the intestine. A large dose of Renshen (Ginseng), Danggui, Chuanxiong, plus Shengma (Cimicifuga Rhizome) is indicated. Some use vinegar-water sprayed on the face to startle and chill the woman, causing Qi to rise and the intestine to contract. However, startling scatters Qi, and chilling coagulates Blood, making retraction harder and causing disease. It is better to blow Zaojiao Mo (Gleditsia Sinensis Powder) into the nose to induce sneezing, which naturally lifts the Qi.
"Sheng" refers to administering drugs for induction only when the fetal head reaches the vaginal opening. If labor has been prolonged and the mother is exhausted and unable to deliver, medicines should be given to assist Qi and Blood, enabling rapid delivery. The general principles are: slippery substances to unblock stagnation, bitter substances to drive away obstruction, warm substances to regulate the meridians, and aromatic substances to open orifices and expel blood. If the amniotic fluid breaks first and Qi stagnates with dry Blood, tonify and nouressence and Blood to promote movement. However, if the woman has weak Qi and no strength, or is exhausted from prolonged labor and cannot push the baby out, Ren Shen (Ginseng) must be doubled in dosage. This herb can also treat breech presentation and transverse lie, making it the number one drug for inducing labor and protecting life.