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The *Daquan* (Complete Good Prescriptions) states: If the amniotic sac ruptures first and excessive fluid is lost, causing the fetus to dry out and fail to descend, one should first administer Siwu Tang (Four Substances Decoction) to tonify qi and blood. Next, decoct a strong scallion soup for the midwife to wash the vulva, ensuring the free flow of qi between the upper and lower body. Additionally, apply clarified butter and talcum powder to the vaginal opening, followed by administering Shenmiao Rusha Dan (Miraculous Musk and Nitre Pill) or Kuizi Rusheng San (Hibiscus Seed Like-Sage Powder).

*Nuke Zhengzong* (Orthodox Principles of Gynecology) states: Dystocia may occur due to the mother having abundant qi and blood resulting in an oversized fetus, or due to the mother having weak qi and dry, viscous blood causing dystocia. These conditions usually arise from poor daily care or sexual intercourse during the seventh or eighth month of pregnancy, leading to the stagnation of turbid pathogens and preventing smooth delivery. The general principle is to regulate qi and harmonize blood. In cases where amniotic fluid is depleted and the fetus does not descend, moistening is the primary approach. In cases of blood stasis obstruction, expelling stasis is the primary approach. If labor was attempted too early, depleting the amniotic fluid, Huatai San (Slippery Fetus Powder) and Shenying San (Divine Response Powder) should be administered in large doses continuously; the fetus will then deliver as naturally as a fish returning to water.

Chen Liangfu states: In dystocia with fetal death in utero, it is often caused by premature agitation or violation of taboos, leading to difficult labor. Once the amniotic sac has ruptured, the lack of blood nourishment causes the fetus to wither and die. One must examine the mother's tongue; if the tongue is cyanotic or black, the fetus is dead, and purgative methods should be used to expel it using Pingwei San (Calm the Stomach Powder) added with Poxiao (Niter).

Xue Lizhai states: If the fetus is dead and Poxiao (Niter) is taken, resulting in the expulsion of turbid fluids accompanied by limb fatigue and faint breath, one should urgently use Sijunzi Tang (Four Gentlemen Decoction) as the main formula, assisted by Siwu Tang (Four Substances Decoction), adding Shengjiang (Fresh Ginger) and Rougui (Cinnamon Bark) to regulate and tonify.

Shenzhen’s commentary: The above three points outline the general principles for treating dystocia. Treatment methods for dystocia include lubricating the uterus, unblocking the qi of the upper and lower body, or nourishing qi and blood, depending on the specific situation. If the fetus is dead in the uterus, only purgative methods are applicable. After expulsion, it is crucial to follow Xue Lizhai’s advice, which must not be overlooked.

Xue Lizhai states: All three conditions—failure of the pubic symphysis to open, failure of the vaginal introitus to close, and uterine prolapse—are caused by inherent weakness of primal qi and lack of regulation during pregnancy, resulting in the inability of qi and blood to circulate. Failure of the pubic symphysis to open is due to deficiency of yin blood; treat with Foshou San (Buddha's Hand Powder) added with Guiban (Tortoise Shell). Failure of the vaginal introitus to close is due to deficiency of qi and blood; treat with Shiquan Dabu Tang (Ten Thousand Benefits Great Tonifying Decoction) added with Wuweizi (Schisandra Berry) to astringe. Uterine prolapse is treated with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Cu Chao Baishao (Vinegar-processed White Peony Root) and Wuweizi (Schisandra Berry). For primiparas with swelling and pain but no closure, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). If liver qi has dissipated but closure still fails, use Buzhong Tang (Tonify the Middle Decoction) added with Banxia (Pinellia Tuber) and Fuling (Poria) to strengthen the spleen, allowing primal qi to recover and diseases to heal spontaneously. Cold-natured agents must be strictly avoided. He further states: Failure of the pubic symphysis to open is due to deficiency of yin qi. The turtle belongs to the extreme yin category, and its shell has interlocking properties that facilitate separation, hence its use. There is also Kaigu Gao (Bone-Opening Ointment): take 1 liang of Ming Ru Xiang (Frankincense) on the fifth day of the fifth lunar month, grind into fine powder, form pills with pig blood the size of a broad bean, coat with Zhusha (Cinnabar), and swallow with Jiawei Foshou San (Modified Buddha's Hand Powder).

Dan Yangxian states: When these three syndromes appear postpartum, always administer Shenghua Tang (Generate the New Decoction). If there is failure of the pubic symphysis to open, add one piece of Guiban (Tortoise Shell).