庞安常治一妇将产。七日而子不下。百治不效。庞视之。令其家人以汤温其腰腹。自为
上下拊摩。孕得觉肠胃微痛。呻吟间生一男子。其家惊喜。而莫知所以。庞曰。儿已出胞。
而一手误执母肠。不能复脱。故非符药所能为。吾隔腹扪儿手所在。针其虎口。痛即缩手。
所以遽生。无他术也。取儿视之。右手虎口。针痕存焉。
一妇累日产不下。服催生药不效。庞曰。此必坐草太早。心下怀惧。气结而不行。非不
顺也。素问云。恐则气下。盖恐则精神怯。怯则上焦闭。闭则气逆。逆则下焦胀。气乃不行
矣。以紫苏饮一服便产。如妇人六七月子悬者。用此亦往往有效。
震按苏文忠公有与庞公尺牍。讲杨子云太元经罔真蒙酋冥之义而云。安常博极群书。善
穷物理。常为仆思之。其推重如此。观此二案。益信名不虚传。
丹溪曰。世之难产者。往往见于郁闷安佚之人。富贵奉养之家。若贫贱辛苦者无有也。
方书只有瘦胎饮一论。而其方为湖阳公主作也。实非极至之言。何者。见用此方。其难自若
予族妹苦于难产。后遇孕则触而去之。予甚悯焉。视其形肥。而勤于女工。构思旬日。悟
曰。此正与湖阳公主相反。彼奉养之人。其气必实。耗其气使和平。故易产。今形肥知其气
虚。久坐知其不运。而其气愈弱。且久坐则胞胎亦随母气不运。当补其母之气。则儿健而易
产。令其有孕至五六个月。以紫苏饮加补气药。与十数帖。因得男而甚快。后遂以此方。随
人之形色性禀。参以时令加减。与之无不应者。因名其方曰。大达生散。
震按读古人书而能反其道以合乎理。固非高明之士不能。盖自达生散出。而后世之孕育
者。母子安全无算。丹溪之造福宏矣。
石山治一妇。常患横生逆产。七八胎矣。子皆不育。汪诊脉皆细濡颇弦。曰。此气血两
虚兼热也。或曰。气血有余。方成妊娠。气血既亏。安能胎耶。汪曰。观其形长瘦。而脉细
濡。属于气血两虚。色青脉弦。属于肝火时炽。而两尺浮滑。似血虚为轻。而气虚为重也。
宜以补阴丸。除陈皮。倍加香附、参、 。蜜丸服之。常令接续。逾年。临产果顺而育一子
震按保胎易产之道。此为正理。盖母虚则无力。儿在腹中。不能运转其身。以致横生倒
产。若临月多服人参。母气既旺。其产自顺。乃屡试屡验者。
陈良甫治一妇。有孕七个月。远归。忽然胎上冲心而痛。坐卧不安。两医治之不效。遂
言胎已死矣。已用蓖麻子研烂。加麝香调。贴脐中以下之。甚危急。陈诊视两尺脉绝。他脉
平和。陈问医作何证治之。答曰。死胎也。陈曰。何以知之。曰。两尺脉沉绝。陈曰误矣。
此子悬也。若在胎死。却有辨处。面赤舌青。子死母活。面青舌赤。母死子活。唇口俱青。
母子俱死。今面不赤。舌不青。其子未死。是胎上迫心。宜紫苏饮治之。至十帖。而胎乃近
下矣。
震按两尺脉绝。易认作子死腹中。若非陈氏辨法。宁不误杀两命。
滑伯仁治一妇人产难。七日而不乳。且食甚少。伯仁视之。乃以凉粥一盂。擂碎枫叶煎
汤
调啖之。旋乳。或诘其理。滑曰。此妇食甚少。未有无谷气而能生者。夫枫叶先生先落。后
生后落。故以作汤饮也。
吴茭山治一妇产难。三日不下。服破血行经之药。俱罔效。吴制一方。以车前为君。冬
葵子为臣。白芷、枳壳为佐使。已服午产。众医异之。吴曰。本草谓催生以此为君。毛诗采
莒以防难产。
魏云。车前以鲜者为妙。
刘复真遇府判女。产不利。已死。刘以红花浓煎。扶女于凳上。以绵帛蘸汤遏之。连以
浇帛上。以器盛水。又暖又淋。久而苏醒。遂生男子。盖遇严冬。血冷凝滞不行。温则产。
见亦神矣。
一医宿客店。值店妇数日不产。下体已冷。无药。甚窘。以椒、橙叶、茱萸等煎汤。可
下手。则和脐腹人门处皆淋洗之。气温血行。遂产。
震按催生之方甚多。或效或不效。总无定局。要在用得恰好。如此数则。聊示机括。若
能学后案孙公之思路。方是巨灵神开山手也。
一妇人分娩最易。至四十妊娠。下血甚多。产门不开。与加味芎归汤一剂。又用无忧散
斤许。一剂煎熟。时时饮之。以助其血。而产。
孙东宿曰。侄元素内人。季夏难产。叩其状。曰。产已及户。不能下。用力则胸膈间有
物上冲。痛不可忍。予思少顷。曰。此必双胎。胞已分而一上一下也。及户者在下欲产。在
上者以用力而上冲。惟上冲胸膈。故痛也。热亦险矣。奈产科诸书。俱未论及何法以处。因
详思其治法。必安上而下始用力产也。即取益元散一两。以紫苏汤送下。取紫苏安胎下气。
滑石滑以利窍。亦催生之良品也。饮药入腹而胸膈痛止。不超时。产二女。母亦无恙。
庞安常治疗一位即将分娩的妇人。过了七天胎儿仍未能娩出，各种治疗方法都无效。庞安常诊察后，让她的家人用热水温敷她的腰腹部，并亲自用手在她的腹部上下抚摸按摩。孕妇感觉到肠胃有轻微疼痛，在呻吟声中生下一个男婴。她的家人既惊喜又困惑，不知道其中的原因。庞安常说：“胎儿已经出了胞衣，但有一只手误抓住了母亲的肠子，无法自行松开，所以不是药物所能解决的。我在隔着腹壁摸到胎儿手的位置后，针刺了它的‘虎口’穴（合谷穴），疼痛使胎儿缩回了手，因此迅速分娩，没有其他办法。”取出婴儿查看，右手虎口处确实留有针痕。
另一位妇人连续多天分娩不下，服用催生药也无效。庞安常说：“这一定是因为坐草（临产准备）太早，心中怀有恐惧，导致气机郁结而不能运行。这并不是胎位不正。《素问》说：‘恐则气下。’大概是因为恐惧导致精神怯弱，怯弱则上焦闭塞，闭塞则气机逆乱，逆乱则下焦胀满，气便不能运行了。”于是给予紫苏饮，一服药后就顺利分娩。对于怀孕六七个月出现“子悬”症状的妇人，使用此方也往往有效。
俞震按语：苏东坡曾给庞安常写信，讨论扬雄《太玄经》中“罔、真、蒙、酋、冥”的含义，并称赞道：“庞安常博览群书，善于探究事物的原理，常常让我思考他的见解。”他如此推崇庞安常。看了这两个医案，更加相信庞安常的名声不是虚传的。
朱丹溪说：世间的难产者，往往出现在心情郁闷、生活安逸的人身上，即富贵奉养之家；而贫贱辛苦劳作的人反而没有这种情况。医书中只有“瘦胎饮”这一种论述，但该方是为湖阳公主制定的，实际上并非极致的理论。为什么呢？因为见到有人使用该方，难产情况依然如故。我的族妹深受难产之苦，后来每次怀孕就设法终止妊娠，我很怜悯她。观察她形体肥胖，但勤于女工（手工劳动）。我构思了十天，领悟道：“这正好与湖阳公主的情况相反。那些奉养之人，体内气必实，消耗其气使其平和，所以容易分娩。现在她形体肥胖可知其气虚，久坐可知其气机不运，且气更虚弱。而且久坐会导致胞胎也随着母体的气机而不运转。应当补益母亲的气，那么胎儿健壮就容易分娩。”让她在怀孕五六个月时，服用加了补气药的紫苏饮，共十几帖，因而顺利生下男孩且非常愉快。此后便以此方为基础，根据每个人的形体、性格禀赋，参酌时令进行加减，使用无不奏效。因此将此方命名为“大达生散”。
俞震按语：读古人的书却能反其道而行而合乎道理，本来就不是高明之士不能做到的。自从大达生散问世后，后世孕育的妇女，母子安全无数。朱丹溪造福社会可谓宏大。
汪石山治疗一位妇人，经常发生横生逆产（胎位不正导致的难产），已有七八个胎儿，但都未能存活。汪石山诊脉发现脉象细濡且略带弦象，说：“这是气血两虚兼有内热。”有人问：“气血有余才能形成妊娠，气血既然亏损，怎么能怀胎呢？”汪石山说：“看她的形体长而瘦，脉象细濡，属于气血两虚；面色青、脉弦，属于肝火时常炽盛。两尺脉浮滑，显示血虚较轻，而气虚较重。”适宜使用补阴丸，去掉陈皮，加倍加入香附、人参、白术，制成蜜丸服用，要求连续不断服用。过了一年，临产时果然顺产下一子。
俞震按语：保胎易产的道理，这才是正理。因为母亲虚弱则无力，胎儿在腹中，不能转动身体，以致横生倒产。如果在临产前多服人参，母气旺盛，分娩就会顺利，这是屡试屡验的方法。
陈良甫治疗一位妇人，怀孕七个月，从远方归来，忽然感觉胎气上冲心脏而疼痛，坐卧不安。两位医生治疗无效，于是说胎儿已经死了。已经用了蓖麻子研烂，加麝香调匀，贴敷在脐下以促使堕胎，情况十分危急。陈良甫诊察发现两尺脉绝（摸不到），其他脉象平和。陈良甫询问医生将其诊断为何证，回答说：“是死胎。”陈良甫说：“怎么知道的？”回答说：“两尺脉沉绝。”陈良甫说：“错了。这是‘子悬’病。如果是胎死，却有辨别之处：面赤舌青，是子死母活；面青舌赤，是母死子活；唇口俱青，是母子俱死。现在面色不赤，舌不青，说明胎儿未死。这是胎气上迫于心，适宜用紫苏饮治疗。”服用十帖后，胎气才下行。
俞震按语：两尺脉绝，容易误认为是子死腹中。如果不是陈氏的辨证方法，岂不误杀两条性命。
滑伯仁治疗一位妇人难产，七天了还不泌乳，且进食很少。滑伯仁诊察后，给她一碗凉粥，将枫叶捣碎煎汤，调和后让她饮用。随即开始泌乳。有人追问其中的道理，滑伯仁说：“这位妇人吃得很少，没有谷气是不可能产生乳汁的。枫叶是先开花结果后落叶，还是先落叶后结果？这里取意枫叶先生先落，后生后落（意指顺应自然生长规律或取其特定药理意象，原文意指利用枫叶特性），所以用它煎汤饮用。”
吴茭山治疗一位妇人难产，三天胎儿未下，服用破血行经的药物都无效。吴茭山制定一方，以车前子为君药，冬葵子为臣药，白芷、枳壳为佐使药。病人服药后中午就分娩了。众医生对此感到奇怪。吴茭山说：“《本草》记载催生以此类药为君药，《诗经·采莒》中提到以防难产。”
魏云补充说：车前子以新鲜的为佳。
刘复真遇到府判的女儿，生产不利，已经死亡。刘复真用红花浓煎，扶起女子坐在凳子上，用绵帛蘸取药汤擦拭身体，连续用器皿盛水，又暖又淋洗。久而久之，女子苏醒过来，遂生下一名男婴。这是因为正值严冬，血液因寒冷凝结停滞不行，温暖则血液流通从而分娩，见识也很神奇。
一位医生寄宿在客店，恰逢店主妇人数日不产，下身已冷，无药可用，十分窘迫。他用花椒、橙叶、吴茱萸等煎汤，待温度合适时，和着在脐部、腹部及产门处淋洗。气温血行，于是顺利分娩。
俞震按语：催生的方剂很多，有的有效有的无效，总没有定局。关键在于用得恰到好处。像这几个案例，姑且展示其机巧。如果能学习后面孙东宿公的思路，那才是巨灵神开山般的手腕。
一位妇人以往分娩最容易，到了四十岁妊娠，下血量很多，产门不开。给予加味芎归汤一剂，又用无忧散一斤许，一剂煎熟，时时饮用，以助其血，从而分娩。
孙东宿说：侄元素的内人，季夏时节难产。询问病情，她说：“产程已到门口（指宫口开全或胎儿下降至产道），但不能娩出。用力时胸膈间有物上冲，痛不可忍。”我思考片刻，说：“这一定是双胎，胞衣已分开，一个在上一个在下。‘已户’者在下面欲产，在上面者因用力而上冲。正因为上冲胸膈，所以疼痛。这也算危险了。无奈产科诸书，均未论及如何处理此法。于是详细思考治法，必须安定上方，下方才能用力分娩。”于是取益元散一两，用紫苏汤送服。取紫苏安胎下气，滑石滑利窍道，也是催生的良品。服药入腹后胸膈痛止，不超过一小时，生下两个女儿，母亲也无恙。
Pang Anchang treated a woman who was about to give birth. Seven days passed, yet the child remained undelivered, and all treatments proved ineffective. Pang examined her and instructed her family to warm her waist and abdomen with hot water, while he personally performed upper and lower massage on her abdomen. The pregnant woman felt slight pain in her intestines and stomach, and amidst groaning, she delivered a male infant. Her family was both surprised and delighted but did not know the reason. Pang said, "The fetus has already exited the amniotic sac, but one hand mistakenly grasped the mother's intestine and could not release it. Therefore, this cannot be resolved by medicine alone. I palpated the location of the fetal hand through the abdominal wall and acupunctured its 'tiger mouth' (Hegu, LI4). The pain caused the hand to retract, which is why delivery occurred rapidly. There is no other technique." Upon examining the infant, needle marks were indeed found on the right tiger mouth area.
Another woman had been unable to deliver for several consecutive days, and parturition-inducing medicines were ineffective. Pang said, "This must be due to preparing for labor too early, causing fear in the heart, leading to qi stagnation and failure to move. This is not malposition. As stated in *Suwen*: 'Fear causes qi to sink.' Generally, fear makes the spirit timid; timidity causes closure of the Upper Jiao; closure leads to qi rebellion; rebellion causes distension in the Lower Jiao, so qi fails to move." He then administered Zisu Yin (Perilla Decoction), and after one dose, she delivered smoothly. For women experiencing "Zixuan" (Fetal Distension) at six or seven months of pregnancy, this formula is also often effective.
Yu Zhen commented: Su Dongpo once wrote to Pang Anchang discussing the meanings of "Wang, Zhen, Meng, Qiu, Ming" from Yang Xiong's *Tai Xuan Jing*, praising him by saying, "Anchang reads extensively and excels at exploring the principles of things; his insights often make me ponder." Such high regard for Pang Anchang. Observing these two cases further confirms that his reputation is well-deserved.
Zhu Danxi said: Difficult labors in the world often occur among people who are depressed and live in leisure, specifically those from wealthy families enjoying luxurious lifestyles; they are rarely seen among the poor and hardworking. Medical texts only discuss "Shoutai Yin" (Fat-Reducing Decoction), but this formula was created for Princess Huyang and does not represent the ultimate theory. Why? Because seeing its use, difficult labors persisted. My clan sister suffered greatly from difficult labor and would terminate pregnancies whenever she conceived, which deeply pitied me. Observing her obese physique but diligence in female crafts, I pondered for ten days and realized: "This is exactly opposite to Princess Huyang's case. Those living in luxury likely have excess qi; consuming their qi to bring it to balance facilitates easy delivery. Now, her obesity indicates qi deficiency, and prolonged sitting indicates stagnant qi movement, making qi even weaker. Furthermore, prolonged sitting causes the uterus to follow the mother's stagnant qi. We should tonify the mother's qi, so the fetus becomes robust and delivery is easy." She was prescribed Zisu Yin supplemented with qi-tonifying herbs during the fifth to sixth month of pregnancy, taking over ten doses, resulting in a smooth delivery of a son with great relief. Thereafter, based on this formula, adjusting according to each person's physique and constitution, and considering seasonal changes, it proved universally effective. Thus, the formula was named "Da Dasheng San" (Great Delivery Powder).
Yu Zhen commented: Reading ancient texts and reversing their approach while adhering to reason is something only superior scholars can do. Since the emergence of Da Dasheng San, countless mothers and infants have enjoyed safety. Zhu Danxi's contribution to society was immense.
Wang Shishan treated a woman who frequently experienced transverse or breech presentations, having had seven or eight pregnancies, none of which survived. Wang diagnosed the pulse as fine, soggy, and slightly wiry, stating, "This is a combination of dual deficiency of qi and blood with internal heat." Someone asked, "Only when qi and blood are sufficient can pregnancy form; if qi and blood are deficient, how can one conceive?" Wang replied, "Her tall and thin physique with fine and soggy pulses indicates dual deficiency of qi and blood; her bluish complexion and wiry pulse indicate frequent flaring of Liver Fire. The floating and slippery pulses at the Cunkou position suggest blood deficiency is mild, while qi deficiency is severe." It is suitable to use Buyin Wan (Tonify Yin Pill), removing Chenpi (Tangerine Peel), doubling the dosage of Xiangfu (Cyperus Rhizome), Renshen (Ginseng), and Baizhu (Atractylodes Macrocephala Rhizome), formed into honey pills, taken continuously. After more than a year, she finally delivered a son smoothly at term.
Yu Zhen commented: The principle of preserving pregnancy and facilitating easy delivery presented here is correct. Because maternal weakness results in lack of strength, the fetus within the abdomen cannot rotate its body, leading to transverse or inverted presentations. If ginseng is taken frequently before term, maternal qi becomes vigorous, ensuring smooth delivery. This has been verified repeatedly.
Chen Liangfu treated a woman at seven months of pregnancy who returned from a long journey and suddenly experienced fetal qi rushing up to the heart causing pain, restlessness in sitting and lying down. Two physicians failed to treat her and declared the fetus dead. Castor bean paste mixed with musk had already been applied below the navel to induce abortion, creating a critical situation. Chen examined her and found the pulses at the Chi position (Kidney position) absent, while other pulses were peaceful. Chen asked the physicians what diagnosis they had made. They answered, "Dead fetus." Chen asked, "How do you know?" They replied, "The Chi pulses are deep and absent." Chen said, "Incorrect. This is 'Zixuan' (Fetal Distension). If the fetus were dead, there would be distinguishing signs: red face and blue tongue indicate dead fetus and living mother; blue face and red tongue indicate dead mother and living fetus; blue lips and mouth indicate death of both. Currently, the face is not red, and the tongue is not blue, indicating the fetus is alive. This is fetal qi pressing against the heart, suitable for treatment with Zisu Yin." After ten doses, the fetal qi descended.
Yu Zhen commented: Absent Chi pulses are easily mistaken for a dead fetus in the womb. Without Chen's diagnostic method, how could one avoid mistakenly killing two lives?
Hua Borén treated a woman with difficult labor who had not lactated for seven days and ate very little. Hua examined her and provided a bowl of cool porridge, grinding maple leaves to decoct in water, mixing them together for her to drink. Lactation resumed shortly. When questioned about the rationale, Hua said, "This woman eats very little; without grain qi, lactation is impossible. Maple leaves shed leaves after bearing fruit/flowers (implying a specific natural order or property), hence using them in decoction."
Wu Jiaoshan treated a woman with difficult labor where the fetus had not descended for three days. Blood-breaking and menstruation-promoting medicines were ineffective. Wu formulated a prescription with Cheqianzi (Plantago Seed) as the sovereign herb, Dongkuizi (Malva Seed) as the minister herb, and Baizhi (Angelica Dahurica Root) and Zhike (Bitter Orange Fruit) as assistant and envoy herbs. The patient delivered at noon after taking the medicine. Other physicians were astonished. Wu explained, "*Bencao* states these herbs are sovereign for inducing labor; *Shijing* mentions preventing difficult labor."
Wei Yun added: Fresh Cheqianzi is superior.
Liu Fuzhen encountered the daughter of a Prefectural Judge who died due to obstructed labor. Liu boiled Honghua (Safflower) strongly, supported the woman on a stool, dipped cotton cloth in the decoction, and wiped her body, continuously pouring warm water over the cloth. After a long time, she revived and subsequently delivered a male infant. This was because it was severe winter, causing blood to congeal and stagnate; warmth promoted circulation and delivery. His insight was miraculous.
A doctor staying at an inn found the innkeeper's wife unable to deliver for several days, with cold lower extremities and no medicine available, leaving him in distress. He decocted Sichuan pepper, orange leaves, and Evodia fruit. When the temperature was suitable, he washed her umbilical area, abdomen, and perineum with the liquid. The warmth promoted qi and blood flow, resulting in successful delivery.
Yu Zhen commented: There are many parturition-inducing formulas, some effective, others not, with no fixed outcome. The key lies in precise application. These few cases merely demonstrate flexibility. Only by learning the thought process of Sun Dongsu in the following case can one achieve the skill of a giant god splitting mountains.
A woman who previously delivered easily faced excessive bleeding and an unopened cervix during her fortieth pregnancy. One dose of Jiawei Xionggui Tang (Modified Ligusticum and Angelica Decoction) was given, along with a large amount of Wuyou San (Carefree Powder), decocted and sipped frequently to nourish blood and facilitate delivery.
Sun Dongsu said: My nephew Yuansu's wife suffered from difficult labor in midsummer. Inquiring about her condition, she said, "Delivery has reached the threshold [cervix fully dilated/fetus low], but cannot descend. Straining causes a sensation of something rushing up in the chest and diaphragm, unbearable pain." I pondered for a moment and said, "This must be twins. The sacs have separated, one above and one below. The lower one wants to deliver, while the upper one rushes upward due to straining. Because it presses against the chest and diaphragm, there is pain. This is dangerous. Unfortunately, obstetric texts do not discuss methods for this. After careful consideration of treatment, I realized we must calm the upper part so the lower part can exert force effectively." I took Yiyuan San (Yi Yi Yuan San / Talc and Coix Seed Powder), one tael, administered with Zisu Tang (Perilla Decoction). Perilla calms the fetus and directs qi downward; Talc lubricates orifices. Both are excellent for inducing labor. After the medicine entered the stomach, chest pain ceased. Within less than an hour, twin daughters were born, and the mother was unharmed.