妊妇生产之际，有脚先下而儿不得下者，有手先下而儿不得下者，人以为横生倒生，至危之症也，谁知是气血
两虚之故乎！产母之气血足，则胎必顺，产母之气血亏，则胎必逆；顺则易生，逆则难产。气血既亏，母身必弱，
子在胞中，亦必弱；胎弱无力，欲转头向下而不能，此胎之所以有脚手先下者也。当是之时，急用针刺儿之手足，
则儿必痛而缩入。急用转天汤以救顺之。
人参（二两） 当归（二两，酒洗） 川芎（一两） 川牛膝（三钱） 升麻（四分） 附子（一分，制）
水煎服。一剂而儿转身矣，再二剂自然顺生。此方之妙，用人参以补气之亏；用芎归以补血之亏，人人皆知其
义。若用升麻又用牛膝、附子，恐人未识其妙也。盖儿已身斜，非用提挈则头不易转，然转其身非用下行则身不易
降。升麻、牛膝并用，而又用附子者，欲其无经不达，使气血迅速以催生也。
眉批∶若服三剂后，以针刺儿手足仍不转身，以针刺产妇合骨穴，儿即下。万不可用手探取，以致子母俱危，
戒之！
歌括∶脚手先下难产生，原因气血两不盈。
针儿手脚痛缩入，再补气血救孩婴。
转天参归和川芎，牛膝升麻附子同。
一剂儿身即顺转，二剂婴儿即降生。
妇人有生产数日而胎不下者，服催生之药，皆不见效，人以为交骨之难开也，谁知是气逆不行而然乎！夫交
骨不开，固是难产，然儿头到产门而不能下者，方是交骨不开之故，自当用开骨之剂。若儿头尚未到产门，乃气逆
不行，儿身难转，非交骨不开之故也。若开其交骨，则儿门大开，儿头未转而向下，必致变症非常，是儿门万万不
可轻开也。大凡生产之时，切忌坐草太早。若儿未转头，原难骤生，乃早于坐草，产妇见儿许久不下，未免心怀恐
惧，恐则神怯，怯则气下而不能升，气既不升，则上焦闭塞，而气乃逆矣；上气既逆，而上焦必胀满，而气益难
行，气沮滞于上下之间，不利气而徒催生，则气愈逆而胎愈闭矣。治法但利其气，儿自转身而下矣。
方用舒气散。
人参（一两） 当归（一两，酒洗） 川芎（五钱） 白芍（五钱，酒炒） 紫苏梗（三钱） 牛膝（二钱） 陈
皮（一钱） 柴胡（八分） 葱白（七寸）
水煎服。一剂而逆气转，儿即下矣。此方利气而实补气，盖气逆由于气虚，气虚易于恐惧，补其气而恐惧自
定，恐惧定而气逆者将莫知其何以定也，何必开交骨之多事乎哉！
眉批∶凡临产三日前，必先腹疼一小次，名曰试痛。此时万勿坐草临盆，但将包儿诸物预备现成，不可早叫
稳婆来。过三日后，腹若大痛，方叫稳婆来，不可令产妇见面，暂让别室静坐，不可高言。盖稳婆名曰收生，使其两手
接收，不欲儿堕地受伤，非稳婆别有妙法也。若稳婆来时，即令产妇见面，彼必胡言乱语，用力太早，必致难产，百变
丛生，戒之慎之！
歌括∶难产数日主何缘，坐草大早是根源。
儿久不生产母惧，惧则气逆难转旋。
舒气散中用川芎，人参当归紫苏梗。
白芍牛膝陈紫胡，煎入葱白催儿生。
[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.