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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.