或先漏去血而脏燥, 或子脏宿挟疹病，或始觉腹痛，先惊动秽血早下，致子道干涩，产妇力疲，皆令
产难。其横生、逆产，皆因用力太早，儿转身未竟故也。若秽露尽而胎横燥，子不得出，必死于腹。下胎
之方，不过瞿麦、车前之属。润燥者牛稣，白蜜。又古方下死胎而用寒热药，盖有意焉。或因漏血尽子
死，或 扑内伤子死，或久病胎萎子死。若此类脏腑气寒，胎血凝聚，湮于死子，气不升降，所以难产，宜
附子汤温其内，仍热熨覆脐腹腰胁于外，使恶血渐动，盖附子皆破寒堕胎，故胎必下；或热病温疟之类，
胎受热毒，内外攻逼，因致产难，宜承气汤。产难有五不
治∶一、腹底不觉疼；二、抱着脚，足垂 无力；三、病未退，遍身不暖；四脏腑泄吐清涎及沫不止；
五、项筋展舒无力∶皆不治。死胎血凝，腹必胀大，宜硝石、水银、KT 砂，三药性味不惟使胎化烂，
辅以行血顺气，必下矣！
膏粱之妇，多食肥美而生内热，则肾之阴水不足以养胎而胎萎弱，运动不健，所以阴虚阳盛，而气不
降则胎不下；又或安逸久坐久卧皆伤其气，则气衰血滞，因此，母之气虚不能送胎，胎气弱不能番转，故
胎亦难下；悲忧离情，气必郁结，血随气行，气郁血必滞，故亦难也。下胎之药，必分气结与气血弱而治
余每于膏粱、安逸之妇，将产时无他症者，必用参、术、芎、归、甘草、芍药、黄芩、大腹皮。气虚甚
者服此，使子母气健。及期，加益母草，与一二服，不生余症。忧悲气结气郁甚者，加枳壳、砂仁、香附。
大抵使子母气血健运，不惟使胎速下，且使产后无虚损病也。又有脾胃中气不足，气血二海、冲任之脉不得
禀水谷气，致难产者，得参、术补气血药以助之，则水谷荣卫之气流行，而产自易矣！岂独守难产之病，
概与下胎之药而已哉！
有的产妇在分娩前出现阴道漏血，导致胞宫（子宫）干燥；有的产妇的胞宫原本就夹杂有疹病（指体内潜伏的热毒或皮肤病邪）；有的刚开始感到腹痛，随即惊恐不安，导致污浊之血提前排出，致使产道干涩，产妇体力疲惫，这些情况都会导致难产。至于胎儿横位、逆位出生，都是因为用力过早，胎儿转身尚未完成所致。如果污浊恶露排尽而胎体横置且干燥，胎儿无法产出，必然死于腹中。此时下胎的方药，不过是用瞿麦、车前子之类的药物。润燥的药物则是牛酥（牛乳制成的酥油）、白蜜。另外，古方中下死胎会使用寒热性质的药物，这其中是有深意的。或者因为漏血过多导致胎儿死亡，或者因跌扑内伤导致胎儿死亡，或者因久病导致胎萎不长进而胎儿死亡。如果是这类情况，脏腑之气寒冷，胎血凝聚，阻塞于死胎之上，气机不能升降，所以导致难产，适宜用附子汤温补内部，同时在外部用热敷熨烫覆盖脐部、腹部、腰部和胁部，使恶血逐渐活动起来，因为附子具有破除寒气、堕胎的作用，所以胎必能下行；或者是热病、温疟之类疾病，胎儿受热毒侵袭，内外攻逼，因而导致难产，适宜用承气汤。
难产有五种情况属于不治之症：第一，腹部底部感觉不到疼痛；第二，双手抱住脚，足下垂且无力；第三，病症未退，全身不温暖；第四，脏腑功能失调，呕吐清涎及泡沫不止；第五，颈部筋脉舒展无力：以上五种情况都难以治愈。死胎与血液凝结，腹部必然胀大，适宜使用硝石、水银、硇砂这三种药物，这三味药的性味不仅能将胎化烂，辅以行血顺气的功效，胎一定能下来！
食用膏粱厚味的妇女，多吃肥甘美味之物而生内热，则肾中的阴水不足以滋养胎儿而导致胎萎弱，运动不健全，因此阴虚阳盛，气机不降则胎不下；又或者因为安逸久坐、久卧都损伤了气，导致气衰血滞，因此，母亲的气虚不能推送胎儿，胎气虚弱不能翻转，所以胎儿也难以产出；悲伤忧愁离散之情，气必然郁结，血随气而行，气郁则血必滞，所以也难产。下胎的药物，必须区分是气结还是气血虚弱来进行治疗。我每当遇到吃膏粱厚味、生活安逸的妇女，在临产时没有其他症状的，必定用人参、白术、川芎、当归、甘草、芍药、黄芩、大腹皮。气虚严重的服用此方，使母子之气强健。到了预产期，加入益母草，服一两次，就不会产生其他后遗症。对于忧悲气结、气郁严重的，加入枳壳、砂仁、香附。大抵上使母子气血健运，不仅能使胎儿快速产出，而且能使产后没有虚损性疾病。又有脾胃中气不足，气血二海（冲脉、任脉）、冲任之脉得不到水谷精微之气的禀赋，导致难产的，得到人参、白术等补气血的药物来辅助，那么水谷荣卫之气流行，生产就容易了！哪里只是死守难产这一种病，一概给予下胎的药物就可以了呢！
Some parturients experience vaginal bleeding prior to labor, leading to dryness of the Zang organs (specifically the uterus); some have latent pathogenic factors such as rashes (referring to internal heat toxins or skin-related pathogens) in the Zi Zang (uterus); some initially feel abdominal pain, followed by fright and premature discharge of turbid blood, causing the birth canal to become dry and slippery, and the mother to become exhausted; all these conditions lead to dystocia. Transverse presentation and breech presentation are both caused by exerting force too early, before the fetus has completed turning. If the lochia is exhausted while the fetus remains transverse and dry, the fetus cannot be delivered and will inevitably die in the abdomen. The formulas for expelling the fetus in such cases mainly consist of herbs like Epimedii Herba (Qumai) and Plantaginis Semen (Cheqian). To moisten dryness, beef su (Niusu, clarified butter from cow's milk) and white honey (Baimi) are used. Furthermore, ancient formulas for expelling dead fetuses employ both cold and hot medicines, implying a specific therapeutic intent. This may occur when excessive bleeding leads to fetal death, or when trauma causes fetal death, or when prolonged illness results in fetal atrophy and subsequent death. In such cases, if the Qi of the Zang-Fu organs is cold, causing fetal blood to coagulate and obstruct the dead fetus, preventing the ascent and descent of Qi, thus resulting in dystocia, it is appropriate to use Fuzi Tang (Aconite Decoction) to warm the interior, while simultaneously applying external heat compresses to the umbilicus, abdomen, waist, and hypochondrium to gradually activate the stasis. Since Aconiti Lateralis Radix Preparata (Fuzi) breaks cold and induces abortion, the fetus will be expelled. Alternatively, in cases of febrile diseases or warm malaria where the fetus is affected by heat toxicity, with internal and external attacks causing dystocia, Chengqi Tang (Gut-Draining Decoction) is indicated.
There are five types of dystocia that are considered untreatable: 1. No pain felt at the base of the abdomen; 2. Holding the feet with drooping, powerless legs; 3. The disease persists, and the whole body is not warm; 4. Continuous vomiting of clear saliva and foam due to Zang-Fu dysfunction; 5. Flaccidity and weakness of the neck tendons. All these conditions are untreatable. When a dead fetus and blood coagulate, the abdomen must be distended. It is appropriate to use Natrii Sulfas (Xiaoshi), Hydrargyrum (Shuiyin), and Ammonium Chloridum (Naosha). The nature and flavor of these three drugs not only decompose the fetus but, assisted by their ability to move blood and regulate Qi, will ensure expulsion.
Women who consume rich and fatty foods often develop internal heat. Consequently, the Yin water of the Kidney is insufficient to nourish the fetus, leading to fetal atrophy and weak movement. Thus, Yin deficiency with Yang hyperactivity occurs, and if Qi does not descend, the fetus cannot be delivered. Additionally, excessive leisure, prolonged sitting, or lying down can damage Qi, leading to Qi deficiency and blood stagnation. Therefore, the mother's deficient Qi cannot push the fetus, and the weak fetal Qi cannot turn, making delivery difficult. Sadness, grief, and emotional distress cause Qi stagnation. Since Blood follows Qi, Qi stagnation leads to Blood stasis, also resulting in difficulty. Medicines for expelling the fetus must differentiate between Qi stagnation and Qi-Blood deficiency for treatment. Whenever I encounter women accustomed to rich diets and sedentary lifestyles who have no other symptoms during labor, I invariably use Ginseng Radix et Rhizoma (Renshen), Atractylodis Macrocephalae Rhizoma (Baizhu), Ligusticum Chuanxiong Rhizoma (Chuanxiong), Angelicae Sinensis Radix (Danggui), Glycyrrhizae Radix et Rhizoma (Gancao), Paeoniae Radix Alba (Baishao), Scutellariae Radix (Huangqin), and Arecae Pericarpium (Dafupi). For those with severe Qi deficiency, this formula strengthens the Qi of both mother and child. At term, adding Leonurus Japonicus Herba (Yimucao) and administering one or two doses prevents other sequelae. For those with severe sadness, grief, Qi stagnation, or depression, add Aurantii Fructus (Zhike), Amomi Fructus Rotundus (Sharen), and Cyperi Rhizoma (Xiangfu). Generally, ensuring the smooth circulation of Qi and Blood in both mother and fetus not only facilitates rapid delivery but also prevents postpartum deficiency syndromes. Furthermore, if insufficiency of Middle Qi in the Spleen and Stomach prevents the Chong and Ren meridians (which govern Qi and Blood) from receiving the essence of food and drink, leading to dystocia, supplementation with Qi- and Blood-tonifying herbs like Renshen and Baizhu promotes the flow of Ying and Wei Qi derived from food and drink, making delivery easier. Is it merely about adhering rigidly to the pathology of dystocia and indiscriminately using abortifacient drugs?