Library

There are many obstetric books circulating in the world. *Qianjin Fang* (Essential Prescriptions Worth a Thousand Gold), *Waitai Miyao* (Secret Essentials of the Outer Cabinet), *Huiwang Chanbao*, as well as works by Masters Ma, Wang, and Cui all contain obstetric treatises. Chao Yuanfang has *Weisheng Baoji* (Health Treasure Collection) and *Zimu Bilu* (Secret Records of Mother and Child), among others. Although they are comprehensive, it is not easy to test them one by one in emergencies. Only Li Shisheng, in his preface to Guo Jizhong's *Chanke Jingyan Baoqing Ji* (Collection of Experienced and Auspicious Obstetric Prescriptions), mentions twenty-one discussions and eighteen formulas, which have proven quite effective. However, the discussions therein are not entirely appropriate. Therefore, I have briefly organized and analyzed the formulas below for the reference of knowledgeable practitioners, not out of a desire to argue.

The first discussion states: What is the situation where a fetus dies in the womb due to febrile disease? The answer is: This occurs because the mother suffers from a febrile disease. After six or seven days, the zang-fu organs become extremely hot, scorching and boiling the fetus, leading to its death. Since the fetus is dead, the cold prevents it from expelling itself naturally. One should administer Heishen San (Black Divine Powder) to warm the fetal qi; once the fetal qi warms up after a moment, it will be expelled naturally. How can one know if the fetus has died? Observe the color of the parturient woman's tongue; if it is cyanotic, this is the sign.

Ingredients: Guixin (Cinnamomi Ramulus), Danggui (Angelicae Sinensis Radix), Shaoyao (Paeoniae Radix), Gancao (Glycyrrhizae Radix et Rhizoma, roasted), Shengdihuang (Rehmanniae Radix, raw and dried), Ganjiang (Zingiberis Rhizoma, prepared), Heidou (Sojae Semen Nigrum, stir-fried and peeled, 2 liang), Fuzi (Aconiti Lateralis Radix Praeparata, prepared, peeled, without skin and umbilicus, 0.5 liang).
Grind the above ingredients into powder. Take 2 qian per dose, mixed with warm wine on an empty stomach. Another method: omit Fuzi and use Puhuang (Typhae Pollen) instead.

Commentary: Pregnancy is referred to as "double body" (zhongshen), with two lives dependent on it. Improper management can damage the fetus, not only due to heat scorching. It may also result from sudden falls or fright, exposure to wind-cold during outings, or pre-existing zhengjia jiju (pathological accumulations and masses), which most frequently harm the fetus. Observing a cyanotic tongue indicates fetal death. The *Yangtai Lun* (Treatise on Nurturing the Fetus) states: "If the face is cyanotic and the tongue red, the mother dies but the child lives; if the lips are cyanotic and saliva is vomited, both mother and child perish." In cases of twin pregnancies, where one fetus dies and the other lives, the signs are particularly difficult to discern. Unless changes are observed at the time of delivery, it is hard to predict in advance; thus, one must prepare by studying this thoroughly. However, using Heishen San to warm the fetus is inferior to supporting the parturient woman, rectifying her qi, and preventing deficiency and exhaustion, so that the fetus is expelled naturally. Cuisheng Tang (Parturition-Promoting Decoction) is superior to Heishen San.
Cuisheng Tang: Treats fetal death in the womb, or parturient weakness and exhaustion, causing dryness and涩ness of the birth canal. (Formula see section on Difficult Labor).

The second discussion states: What is the situation of difficult labor? The answer is: There is a formed mass on the side of the fetus, called Erzhen (Fetal Pillow). When the fetus is about to be born, the Erzhen ruptures, and stagnant blood wraps around the fetus, causing difficult labor. Administer Shengjin San (Golden Victory Powder) to expel the stagnant blood, and natural delivery will occur. This also treats breech presentation (nixsheng) and transverse lie (hengsheng).