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Jiaogu Bu Kai (failure of the pubic symphysis to open) is caused by a deficiency of Yin blood. In some cases, pregnancy occurs at a young age when Yin Qi is insufficient; insufficiency of Yin leads to an inability of Yang Qi to penetrate, thus preventing opening. In other cases, marriage occurs at an older age when meridians and collaterals have fully matured; or there is a weakness of Yuan Qi (Original Qi) with improper regulation before delivery; all these conditions can present this syndrome. Use Shen Bian Fo Shou San (Ginseng and Child's Urine Hand-Holding Powder) to tonify and open it, or Shi Quan Da Bu Tang (Ten Significant Tonifying Decoction) may also be used. The ancient method uses Jia Wei Xiong Gui Tang (Modified Ligusticum and Angelica Decoction), but it is often seen that those who take this medicine suffer from stagnant evil blood, which instead becomes incurable. Only by adding large doses of Ren Shen (Ginseng Root) and Tong Bian (Child's Urine) to the Xiong Gui formula, assisting Qi and Blood, can the attacking force of opening and closing be achieved immediately. Symptoms include teeth grinding and fainting; urgently irrigate with hot urine, otherwise it will be too late. If Yuan Qi is not deficient, only Fo Shou San taken with urine is needed, and Ren Shen need not be used. Some use Kai Gu Gao (Bone-Opening Paste), delivered with a decoction of Shen Bian Fo Shou San; I believe this is inferior to using Jia Wei Shen Zuo Yin (Modified Artemisia and Quercus Decoction) to open Jiaogu with miraculous effect. I once treated a woman surnamed Peng during her first delivery; after many days the fetus had not descended, and Jiaogu remained closed. She took Shen Zuo Yin and other parturition-inducing medicines without effect. Then three qian of Ren Shen were decocted and administered, and the fetus was delivered immediately.

Shen Bian Fo Shou San: Treats failure of Jiaogu to open during labor, with verification as if by divine spirit. Dang Gui (Angelica Sinensis Root) 3 qian, Chuan Xiong (Ligusticum Chuanxiong Rhizome) 1 qian, Ren Shen (Ginseng Root) 3–5 qian (increase to 1 liang if excessive blood loss); decoct in water, add half a zhan of Tong Bian (Child's Urine) just before administration, and drink slowly. For those with robust constitution and excess Qi, only Tong Bian needs to be added, and Ren Shen may be omitted.

Kai Gu Gao: Treats failure of Jiaogu to open (i.e., the parturition-inducing formula Ru Zhu Dan; that formula treats difficult labor generally, while this one specifically opens Jiaogu). Ming Ru Xiang (Boswellia Resin) 1 liang, May...

Jia Wei Shen Zuo Yin: Opens Jiaogu with miraculous effect; see the parturition-inducing formulas in this volume.

Whenever the placenta has not been expelled, it is more urgent than the fetus not having been born yet. When the fetus dies in the womb, it is more urgent than the placenta not being expelled. This is because when the placenta has not been expelled, the fetus and mother still breathe together through Qi exchange. If the fetus dies in the womb, the body becomes cold, the uterine Qi becomes cold, fetal blood coagulates and freezes, and Qi fails to ascend and descend. To expel a dead fetus, if extremely cold medicines are used, not only is there no benefit, but many harm the mother's life. Therefore, ancients used Fu Zi Tang (Aconite Decoction) to warm the uterus and make coagulated blood flow, because Fu Zi (Aconite Lateral Root) can break cold Qi and induce abortion. There are also cases where, due to contracting Shang Han (Cold Damage), Re Bing (Heat Disease), or Wen Nue (Warm Malaria), the fetus is attacked by pathogenic heat and toxic vapors from inside and outside, resulting in fetal death retained in the uterus. Ancients deeply feared that fetal exposure to toxic vapors would cause distension, so they used Po Xiao (Mirabilite), Shui Yin (Quicksilver), and Niao Sha (Sal Ammoniac) medicines. Not only do these prevent fetal distension, but they also rot the fetal form. Assisted by medicines that move Blood and smooth Qi, the dead fetus is expelled. This is the intent behind the ancient prescriptions; later generations followed this intent and imitated them, hence the creation of Li Hou Xia Tai San (Standby Fetus-Expelling Powder). However, the ingredients are mostly harsh and possess the ability to rot flesh. Even for robust rural women, I dare not lightly use them, let alone for frail noble ladies! Moreover, I have frequently observed that when people do not panic regarding a dead fetus, it can be slowly delivered without harming the mother. What is the reason? Generally... protecting the waist from below, injury to the fetus leads to death; syndromes etc., those suitable for taking... Yin and Du Mai (Conception and Governor Vessels) micro... Qian Jin Shen... Jian Yi Dan... fall, mouth... blood and then... failed to examine... Li Hou Xia Tai San: Treats breech or transverse presentation, dryness of the Blood Sea, or retained dead fetus, with life hanging in the balance. Pi Xiao (Mirabilite) 1 qian, for younger/stronger individuals 1.5 qian; for weaker individuals taking large Fu Zi (Aconite Lateral Root), add 3–5 fen (simmered, skin removed); strong individuals do not use it; in cold weather, also add 3–5 fen of Fu Zi (simmered, skin removed)...

Wu Jin San (named Hei Shen San in Ju Fang, Rou Gui San in Ling Yuan): Treats difficult labor, or fetal death in the womb due to heat disease, or due to falling, jumping from heights, sexual activity causing convulsions, premature excitement during labor, violating taboos, or menstruation preceding delivery with exhausted lochia, leading to dried fetus, fetal death, cold body unable to exit. Shu Di Huang (Prepared Rehmannia Root) (roasted in wine), Pu Huang (Typha Pollen), Dang Gui (Angelica Sinensis Root), Jiao Zhi Gui (Cinnamon Bark from Cochinchina), Bai Shao (White Peony Root), Jun Jiang (Prepared Ginger)... six... fetus... add good Hua Shi (Talcum) powder half liang, Kui Zi (Abutilon Seed) 50 grains crushed, Huang Zuo Ye (Quercus Leaf) 7–8 fen, Cong Bai (Scallion White) 2 cun, decoct in flowing water and mix with powder. Hua Shi promotes urination, Zuo Ye moves Qi and expels Blood, Cong Bai unblocks Yang Qi; when Qi is abundant and Blood flows, delivery occurs.

Checking Hei Shen San in Ju Fang, it lacks Bai Cao Shuang (Burnt Grass Ash), uses Tong Bian (Child's Urine) and Wine mixed equally to take 2 qian. Hei Shen San in Liang Fang contains Pao Fu Zi (Prepared Aconite Lateral Root) half liang, lacks Pu Huang. Hei Shen San in Jian Yi Fang uses only Bai Cao Shuang, and there is another Hei Shen San with added Ru Xiang (Boswellia Resin), Mo Yao (Myrrh), and Xue Jie (Dragon's Blood). Gang Mu uses 1 jin of Shu Di Huang and half a jin of Sheng Jiang (Fresh Ginger), stir-fried dry into powder, taken with Wu Mei Tang (Mume Decoction) 2 qian, for treating postpartum mass pain Hei Shen San. All have records distinguishing various formulas named Hei Shen San.

Tuo Hua Jian: For those about to deliver, taking this medicine first is best for inducing labor. It is also excellent for prolonged difficult labor or retained dead fetus. Dang Gui (Angelica Sinensis Root) 7–8 qian or 1 liang, Rou Gui Xin (Cinnamon Twig Heart) 1–2 qian or 3 qian, Chuan Xiong (Ligusticum Chuanxiong Rhizome) and Niu Xi (Achyranthes Root) each 2 qian, Che Qian Zi (Plantago Seed) 1.5 qian, Hong Hua (Safflower) 1 qian (this ingredient may be omitted for induction); decoct 2 zhong of water to 0.8 zhong, take hot. Drinking several cups of wine after taking it is also excellent. If the fetus is dead in the womb or hard and stagnant, adding 1–2 qian of Po Xiao (Mirabilite) causes expulsion. If Qi deficiency is severe, add Ren Shen (Ginseng Root) accordingly. If Yin deficiency, add Shu Di Huang (Prepared Rehmannia Root) 3–5 qian.

Xiang Gui San (also known as Gui Xiang San, attached to Jiu Ku San): Treats retained dead fetus in the womb, simple and most effective. Gui Xin (Cinnamon Heart) 3 qian, She Xiang (Musk) 3 fen... fetal aggression...

Niu Xi Wan: Expels dead fetus. Du Niu Xi (Cyathula Root) 3 liang, Zi Jin Teng (Pueraria Lobata Stem, i.e., Zi Mu Xiang), Shu Kui Gen (Malva Root) each 7 qian, Rou Gui (Cinnamon Bark) 2 qian, Dang Gui (Angelica Sinensis Root) 4...

Hu Po Wan: Treats women of any age, various diseases before and after delivery, thirty-six types of illnesses, seven hernias, eight masses, stabbing pain in heart and abdomen, sudden stroke paralysis, hemiplegia, eight wind disorders, twelve bi syndromes, swelling and pain in hands and feet, breast nodules and toxic swellings, fetal disturbance and injury causing unrest, retained dead fetus. Hu Po (Amber), Zhu Sha (Cinnabar) (each separately ground), Chen Xiang (Aquilaria Wood), E Jiao (Donkey-hide Gelatin) (fried into beads), Fu Zi (Processed Aconite Lateral Root), Chuan Xiong (Ligusticum Chuanxiong Rhizome), Rou Gui (Cinnamon Bark), Wu Wei Zi (Schisandra Berry), Shi Hu (Dendrobium Stem) each... medicine each one... Ru Xiang (Boswellia Resin)... guide.

After women take five to ten doses, doubling daily food intake, the merits cannot be fully described; users should feel it themselves.

Xin Fa Xia Tai Fang (a variation of Ping Gu San, safer than Ping Wei San): Best for treating retained dead fetus; sometimes half a dose is used. Dang Gui (Angelica Sinensis Root) 1 liang, Nong Po (Magnolia Bark) 3 qian, Chen Pi (Citrus Reticulata Peel) 2 qian, decoct with one zhong of wine and one zhong of water to one zhong, add Po Xiao (Mirabilite) 1 or 2 qian, boil ten more times, strain, and take warm. The dead fetus will naturally be expelled or dissolve into water. Using Tuo Hua Jian alone is even better; see formula above. Or using Fo Shou San (Hand-Holding Powder) mixed with wine is also excellent.

Qian Jin Shen Zao San: If a pregnant woman carries twins, one dead and one alive, taking this ensures the living one is safe and the dead one is expelled. Xie Zhua (Crab Claw) 1 sheng, E Jiao (Donkey-hide Gelatin) 2 liang, Gan Cao (Licorice Root) 2 qian. First decoct Xie Zhua and Gan Cao in flowing water, remove dregs, dissolve E Jiao, and take. If blood coagulation prevents expulsion, add Gui Xin (Cinnamon Heart) 3 qian. This formula uses Crab Claws to remove the dead, Donkey-hide Gelatin to protect the living, and Licorice to harmonize the medicinal properties.

Fu Lei Duan Ji Fang: For weak persons wishing to expel a fetus, use this. Ren Shen (Ginseng Root), Fen Cao (Licorice Root), Chuan Xiong (Ligusticum Chuanxiong Rhizome), Rou Gui (Cinnamon Bark), Gan Jiang (Dried Ginger), Tao Ren (Peach Seed), Huang Qin (Scutellaria Root), Xie Zhua (Crab Claw), equal parts. Take 1 liang per dose, decoct 2 zhong of water to 0.8 zhong, take on an empty stomach; if no movement, take again.

Xian Chuan Bao Ming Dan (also known as An Rang Wan, Duo Ming Dan): For pregnant women with continuous bleeding, miscarriage bleeding, or fetal death in the womb... medicine... black... pellet...

Guan Gui San: Treats postpartum red face and blue tongue indicating fetal death with maternal survival. Or blue face and red tongue with froth indicating maternal death with fetal survival. Or blue-black lips and tongue with froth indicating both mother and fetus death. This formula expels dead fetuses with miraculous effect. Guan Gui (Cinnamon Bark) 5 qian (skin removed), Dan Pi (Moutan Cortex), Chuan Xiong (Ligusticum Chuanxiong Rhizome), Kui Zi (Abutilon Seed) each 1.5 qian, grind into powder, mix with Scallion White decoction and take 3 qian.

Hei Shen San: For excessive bleeding during labor where the fetus is wrapped in blood causing difficult labor, it is advisable to sacrifice the fetus to save the mother. Breech/transverse presentation, fetal death in the womb, retained placenta, blood confusing the heart orifices, dizziness, blurred vision,败血 (failed blood) scattering due to deficiency, limb edema, thirst, dry tongue, alternating chills and fever, irritability, mania, confused speech resembling madness; or drinking cold liquids within the month causing failed blood coagulation, difficult defecation, urinary retention; or blood flowing into the Small Intestine causing hematuria; or lochia not finished, mistakenly eating sour foods causing astringency leading to metrorrhagia; or lung failure, black breath from nose; or failed blood rushing to the heart causing throat tightness and rapid breathing; or blood stagnating in Spleen and Stomach causing abdominal distension, fullness, vomiting resembling inversion of the stomach. Taking this yields miraculous effects. Dang Gui (Angelica Sinensis Root), Shu Di Huang (Prepared Rehmannia Root), Bai Shao (White Peony Root), (stir-fried) Rou Gui (Cinnamon Bark), Zhi... mix with warm wine and take.

Chicken Compress Method for Dead Fetus: One black chicken, plucked and finely chopped, decocted in 2–3 sheng of water. When the liquid is hand-warm, dip silk cloth and rub the abdomen; the fetus will naturally be expelled.

Single Formula for Expelling Fetus: Cow dung as needed, stir-fried until very hot, add half a zhan of vinegar, wrap in green cloth, compress above and below the mother's umbilicus; immediate expulsion.

Qian Jin Yu Pi Tang: Treats fetal death in the womb, or mother ill and wishing to expel fetus. A handful of Elm bark, boil the white inner bark into juice and take; it will naturally be expelled.

Hun Dan: Treats various childbirth syndromes, dead fetus and evil blood, retained placenta, breech/transverse presentation. Clears heat and nourishes Blood before delivery; eliminates stale matter and generates new matter after delivery. Ye Tian Ma (Wild Gastrodia Rhizome, also known as Yi Mu Cao/HMotherwort, flowers and leaves harvested in April-May and dried in shade) half jin, Chi Shao (Red Peony Root) 6 qian, Dang Gui (Angelica Sinensis Root) 7 qian, Mu Xiang (Aucklandia Root) 5 qian, grind into... adjust...