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Pregnancy in women is like a hen incubating an egg; the chick, inside the shell, pecks its way out naturally when ready to hatch. Similarly, the fetus, within the amniotic sac, breaks through the membranes on its own at the time of birth. Cases of difficult or prolonged labor are mostly due to the amniotic sac being too thick or the fetus being too large. If pregnant women avoid excessive leisure, over-nourishment, and sexual indulgence, the amniotic sac will not be overly thick, nor will the fetus become excessively large, making delivery easier and benefiting future offspring.

Women's health is primarily based on blood; only when Qi flows smoothly does blood harmonize, and only when the fetus is secure is delivery smooth. Nowadays, wealthy families often indulge in excessive comfort, leading to Qi stagnation and fetal immobility, or engage in frequent intercourse, causing essence and blood to accumulate in the uterus, all resulting in dystocia (difficult childbirth). The Shenghua Tang (Blood-Generating Decoction) is indicated.

In cases where labor has dragged on for days without delivery despite taking parturition-inducing medicines, it is likely because the woman went to bed too early, and fear caused Qi to knot and cease moving. The Classic states: "Fear causes Qi to sink, and fear makes essence timid." Timidity leads to closure of the Upper Jiao (Upper Burner), which causes Qi to return, leading to distension in the Lower Jiao (Lower Burner) and cessation of Qi movement. It is appropriate to warm and tonify Qi and Blood, strengthening the body's vital energy to promote movement.

If the amniotic fluid breaks prematurely with excessive leakage, causing the fetus to dry out and fail to descend, first administer Siwu Tang (Four Substances Decoction) combined with Sijunzi Tang (Four Gentlemen Decoction) to tonify Qi and Blood. Then, decoct a strong scallion water for the midwife to wash the vaginal opening, ensuring the free flow of Qi up and down. Apply sesame butter and talcum powder to the vulva, followed by administering the Cui Sheng Bao Chan Wan Quan Tang (Ten Thousand Complete Parturition-Inducing and Protection Decoction).

Dystocia may result from maternal excess Qi and a large fetus, or from maternal deficiency Qi and depleted Blood. These are all due to poor daily regulation or engaging in intercourse during the seventh or eighth month of pregnancy, causing turbid stagnation that prevents natural delivery. The general principle is to soothe Qi and harmonize Blood. In cases of dried amniotic fluid preventing descent, moisten and lubricate. For obstruction by stagnant blood, expel stasis. If premature pushing dries the amniotic waters, use Hua Tai San (Slippery Fetus Powder) and Shen Ying San (Miraculous Response Powder), administered in large doses continuously, allowing the delivery to proceed as naturally as fish in water.

Treatment methods for dystocia include opening and lubricating the uterus, regulating Qi up and down, or nourishing Qi and Blood, adapting to circumstances. If the fetus is dead in the womb, purgative methods are necessary; use Pingwei San (Stomach-Ping Powder) with Mangxiao (Natrii Sulfas) to purge turbid fluids. If limbs are fatigued, urgently tonify with Sijunzi Tang and Siwu Tang plus Ginger and Cinnamon. It is better to remove Chuanxiong and add Niuxi (Achyranthes Root), Honghua (Safflower), and Yimucao (Motherwort Herb) for superior effect.

Xue Lizhai stated: The three syndromes of unopened pubic symphysis (Jiao Gu), non-closing vaginal introitus, and uterine prolapse are all caused by inherent weakness of Yuan Qi (Original Qi) and lack of prenatal regulation, leading to inability of Qi and Blood to function. Unopened pubic symphysis indicates Yin Blood deficiency; use Foshou San (Buddha's Hand Powder) with Fa Hui (Hair Ash) and Gui Ban (Tartar Testudinis). Non-closing vaginal introitus indicates Qi and Blood deficiency; use Shiquan Dabu Tang (Ten Thousand Great Tonifying Decoction) with Wuweizi (Schisandra Fruit) to astringe. Uterine prolapse requires Bu Zhong Yi Qi Tang (Center-Supplementing and Qi-Boosting Decoction) with Vinegar-fried Baishao (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 Bu Zhong Tang with Banxia (Pinellia Tuber) and Fuling (Poria) to strengthen the Spleen, restoring Yuan Qi so diseases heal themselves; strictly avoid cold-cooling agents. He further stated: Unopened pubic symphysis is due to Yin Qi deficiency. The turtle is the ultimate Yin entity, and its shell's interlocking structure helps separate bones, hence its use. There is also Kaigu Gao (Bone-Opening Paste): 1 liang of Ming Ru Xiang (Frankincense), finely ground on the fifth day of the fifth lunar month, formed into pills the size of a soybean with pig blood, coated with Zhusha (Cinnabar), taken with Jiawei Foshou San. Shan Yangxian said: If these three syndromes appear postpartum, generally administer Shenghua Tang; for unopened pubic symphysis, add one Gui Ban. Shenghua Tang consists of Chuanxiong, Danggui, Taoren (Peach Kernel), 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. The *Yi Shu* states: For unopened pubic symphysis at labor, drinking Zimu Zhi Tang (Catalpa Branch Decoction) will naturally open it. (Zimu, commonly known as 'one leaf one thorn', has straight-growing branches with a thorn emerging under each leaf.)

"Pan Chang Sheng" (Intestine Prolapse at Birth) occurs due to maternal Qi and Blood deficiency causing downward prolapse. Treatment requires tonifying Qi and Blood combined with lifting herbs, so the intestine retracts naturally. Use a large dose of Renshen (Ginseng), Danggui, Chuanxiong, and Shengma (Cimicifuga Rhizome). Some suggest spraying vinegar water on the face to startle and chill the woman, causing Qi to rise and the intestine to retract. However, startling scatters Qi, and chilling congeals Blood, making retraction harder and causing disease. It is better to blow Zaojiao Mo (Gleditsia Sinensis Powder) into the nose; the resulting sneeze naturally lifts the tissue upward.

The term "Sheng" (Birth/Generation) refers to administering drugs only when the fetal head reaches the vaginal introitus during labor. If labor is prolonged and the mother is exhausted, drugs should be given to boost Qi and Blood to facilitate rapid delivery. General principles: Slippery herbs unblock stagnation, bitter herbs drive away obstruction, warm herbs regulate the meridians, and aromatic herbs open orifices and expel blood. If amniotic fluid breaks early with Qi stagnation and Blood dryness, tonify Essence and Blood to promote movement. However, if the woman has weak Qi and no strength, or is exhausted after a long labor and cannot push the fetus out, Ren Shen (Ginseng) must be doubled. This herb can treat transverse lie and breech presentation, serving as the primary drug for inducing labor and protecting life.