薛氏曰∶交骨不开，产门不闭，皆由元气素弱，胎前失于调摄，以致血气不能运达而然
也。交骨不开，阴气虚也，用加味芎归汤、补中益气汤；产门不闭，气血虚也，用十全大补汤。
地官李孟卿，娶三十五岁女为继室，妊娠，虑其产难，索加味芎归汤四帖备用，至期
果产门不开，止服一帖，顿然分娩。
上舍费怀德之室，产门不开，两日未生，服前药一剂，实时而产，上舍传此方，用之者
无有不验。
一妇人分娩最易，至四十妊娠，下血甚多，产门不开，与前汤一剂，又以无忧散斤许
煎熟，时时饮之，以助其血而产。
准绳云∶产难子死腹中者，多因惊动太早，或触犯禁忌，致令产难，胞浆已破，无血养
胎，枯涸而死故也。须验产母舌，若青黑，其胎死矣，当下之。
大法寒者，热以行之；热者，凉以行之；燥者，滑以润之；危急者，毒药下之。
一稳婆之女，勤苦负重，妊娠腹中阴冷重坠，口中甚秽，余意其胎必死，令视其舌，果青
黑，与朴硝半两许服之，随下秽水而愈。（其有用攻击之药而无益者，以产母之本气竭而神
不使也，宜补之）
一妇胎死，服朴硝而下秽水，肢体倦怠，气息奄奄，用四君为主，佐以四物、姜、桂调补
而愈。（愚意虚剧者，朴硝同补剂下之，何如）
Xue said: Failure of the pubic symphysis to separate (narrowing of the birth canal due to insufficient separation of the pubic symphysis during delivery) and failure of the vaginal orifice to close after delivery are both caused by a constitutionally weak Yuan Qi (Original Qi), improper care during pregnancy, resulting in the inability of Blood and Qi to circulate and reach their destinations.
Failure of the pubic symphysis to separate is due to deficiency of Yin Qi; use Jiawei Xiong Gui Tang (Modified Ligusticum and Angelica Decoction) and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). Failure of the vaginal orifice to close is due to deficiency of both Qi and Blood; use Shiquan Dabu Tang (Ten Substance Great Tonifying Decoction).
Li Mengqing, an official titled Diguan, married a thirty-five-year-old woman as his second wife. During her pregnancy, fearing difficult labor, he requested four doses of Jiawei Xiong Gui Tang for backup. When the time came, she indeed experienced failure of the vaginal orifice to open. After taking only one dose, she delivered immediately.
The wife of She Fei Huaide experienced failure of the vaginal orifice to open and had not given birth after two days. After taking one dose of the aforementioned medicine, she delivered promptly. She transmitted this prescription, and all who used it found it effective.
A certain woman had previously delivered easily, but at forty years old, during a pregnancy, she suffered from heavy bleeding and failure of the vaginal orifice to open. She was given one dose of the aforementioned decoction, and additionally, about one jin of Wuyou San (Worry-Free Powder) was decocted and taken frequently to tonify Blood and facilitate delivery.
Zhunsheng states: Difficult labor with the fetus dead in the uterus is mostly due to premature agitation or violating taboos, leading to difficult labor. Once the amniotic sac has ruptured, there is no Blood to nourish the fetus, causing it to die from dryness and exhaustion. One must examine the mother's tongue; if it is cyanotic and black, the fetus is dead, and purgative treatment should be employed.
The general principle is: For cold patterns, use hot-natured herbs to promote circulation; for heat patterns, use cool-natured herbs to promote circulation; for dryness patterns, use slippery/lubricating herbs to moisten; for critical emergencies, use potent/toxic drugs to purge.
The daughter of a midwife, burdened with hard labor and heavy loads, felt coldness and heavy bearing down in her abdomen during pregnancy, with a very foul odor in her mouth. I suspected the fetus must be dead and asked her to check her tongue; it was indeed cyanotic and black. I administered approximately half liang of Xiaofanshi (Natrii Sulfas) orally. She subsequently discharged foul fluid and recovered. (Note: In some cases, using attacking/purgative herbs yields no benefit because the mother's fundamental Qi is exhausted and Shen [Spirit] cannot direct the action; such cases require tonification.)
Another woman whose fetus had died took Xiaofanshi (Natrii Sulfas) and discharged foul fluid. Her limbs were listless, and her breath was faint and dying. She was treated primarily with Six Gentlemen Decoction (Sijunzi Tang), assisted by Four Substances Decoction (Siwu Tang), Ginger, and Cinnamon Twig to tonify and regulate, and she recovered. (My opinion is that for patients with extreme deficiency, combining Natrii Sulfas with tonifying formulas before purging might be advisable.)