凡产妇胎未顺而胞先破者，其因有二∶盖一有母质薄弱，胞衣不固，因儿转动，随触而
破者，此气血之虚也；一有儿身未转，以坐草太早，用力太过，而胞先破者，此举动之伤也
。若胞破久而水血干，产路涩则儿难下，宜急用大料四物汤，或五物煎、脱花煎、滑胎煎、
五福饮、当归汤之类，助其气血，并浓煎葱汤熏洗产户，使其暖而气达，则自当顺下。若持
久力乏，血已耗涸，则甚危矣。当用八珍汤料一斤，益母草四两，水数碗煎熟，不时饮之，
亦有得生者。或以黄 、芎、归数斤，以大釜煎，药气氤氲满室，使产母口鼻俱受其气，亦
良法也。大抵产难之证，多患于郁闷、安佚、富贵之家，治法虽云胎前清气，产后补血，然
不可拘泥。若脾胃不健，气血不充，必当预为调补；不然，临产必多患难。
一、产难经日不下，别无危证者，宜用脱花煎催之，极妥极妙。
一医宿客店，治店妇临产数日不生，下体俱冷，无药甚窘，令取椒、橙叶、茱萸，共煎
汤一盆，令产妇以小凳坐盆内熏洗，良久，小腹皆暖，气温血行，遂产。
一方∶以紫苏煎汤熏洗。大抵遇严寒时月，产久伤冷，气血必凝，此熏洗之法，亦要法
也。外以淋汤，内以羊肉汤，必效。
一方∶令产妇以自己发梢含于口中，令其恶心作呕，即下。亦治胞衣不出。
凡是产妇胎儿尚未转正而胞衣先破裂的情况，其原因主要有两种：一种是母亲体质虚弱，胞衣不坚固，因胎儿转动，触动即破裂的，这是气血虚弱的表现；另一种是胎儿身体尚未转动，因为过早坐草（上产床），用力过度，导致胞衣先破裂的，这是动作不当造成的损伤。如果胞衣破裂时间较长，羊水血液干涸，产道干涩，则胎儿难以娩出，应当立即使用大剂量的四物汤，或者五物煎、脱花煎、滑胎煎、五福饮、当归汤等方剂，以补益气血，并浓煎葱汤熏洗产门，使其温暖且气机通达，那么胎儿自然会顺利下行。如果拖延日久，体力耗尽，血液已经枯竭，那就非常危险了。此时应当使用八珍汤料一斤，益母草四两，加水数碗煎熟，不时饮用，也有能够存活的案例。或者用黄芪、川芎、当归数斤，用大锅煎煮，药气弥漫满屋，让产妇口鼻都吸入药气，这也是很好的方法。大抵来说，难产这种情况，多发生在忧郁、安逸、富贵的人家，治疗方法虽然常说产前清利气机，产后补血，但是不可拘泥不变。如果脾胃功能不强健，气血不充足，必定应当预先进行调补；否则，临产时必然多有困难。
其一，难产经过几天仍不下，没有其他危急症状的，适宜使用脱花煎来催产，极为稳妥巧妙。
有一位医生在客栈投宿，治疗客栈妇女临产几天生不下来，下身全部冰冷，没有药物非常窘迫，便让人取花椒、橙叶、吴茱萸，共同煎成一盆汤，让产妇坐在小凳子上对着盆内熏洗，过了很久，小腹都暖和了，气温血行，于是分娩。
另一个方子：用紫苏煎汤熏洗。大抵遇到严寒时节，产程久损伤寒气，气血必定凝滞，这种熏洗的方法，也是重要的方法。外部淋洗热汤，内部服用羊肉汤，必定有效。
另一个方子：让产妇将自己头发梢含在口中，使其恶心呕吐，胎儿就会下来。也能治疗胞衣不下。
In cases where the membranes rupture before the fetus is in a proper position for delivery, there are two main causes: First, the mother’s constitution is weak, and the fetal membranes are not secure; due to fetal movement, they rupture upon contact. This is due to deficiency of Qi and Blood (Qi and Blood). Second, the fetus has not yet turned, but because the woman assumed the birthing position too early and exerted excessive force, the membranes rupture prematurely. This is due to injury from improper physical exertion. If the membranes have been ruptured for a long time and the amniotic fluid and blood have dried up, causing the birth canal to become dry and obstructed, the fetus will be difficult to deliver. In such cases, one should immediately administer large doses of Siwu Tang (Four Substances Decoction), or Wuwu Jian (Five-Ingredient Decoction), Tuohua Jian (Decoction for Expelling the Fetus), Shuitai Jian (Decoction for Lubricating the Fetus), Wufu Yin (Five Blessings Drink), Danggui Tang (Angelica Decoction), and similar formulas to tonify Qi and Blood. Additionally, decoct green onion water strongly to fumigate and wash the vulva, so that warmth reaches the area and Qi circulates freely, allowing the fetus to descend naturally. If the condition persists until strength is exhausted and blood is depleted, the situation becomes critical. One should then use one jin (approx. 500g) of Bazhen Tang (Eight-Treasure Decoction) ingredients, along with four liang (approx. 125g) of Yimucao (Leonurus japonicus Herba), decocted in several bowls of water, and drink it intermittently; survival is possible. Alternatively, use several jin of Huangqi (Astragali Radix), Xiong (Ligustici Chuanxiong Rhizoma), and Danggui (Angelicae Sinensis Radix), decocted in a large cauldron, so that the medicinal vapor fills the room, allowing the parturient woman to inhale the aroma through her mouth and nose. This is also an excellent method. Generally, dystocia often affects those who are prone to depression, lead sedentary lives, or belong to wealthy families. Although treatment principles generally suggest clearing Qi during pregnancy and tonifying Blood after delivery, these rules should not be applied rigidly. If the Spleen and Stomach are weak and Qi and Blood are insufficient, preventive regulation and tonification are necessary; otherwise, difficulties during labor are inevitable.
First, in cases of dystocia lasting several days without other critical symptoms, Tuohua Jian (Decoction for Expelling the Fetus) is suitable for inducing labor, which is extremely safe and effective.
A physician staying at an inn treated a shopkeeper’s wife who had been in labor for several days without delivering. Her lower body was cold, and she lacked medicine, creating a desperate situation. The physician instructed taking Sichuan pepper (Zanthoxyli Pericarpium), orange leaves, and Evodia fruit (Evodiae Fructus), decocting them together in a basin of water. The patient sat on a small stool over the basin to fumigate and wash herself. After some time, her lower abdomen became warm, Qi temperature rose, and Blood circulation improved, resulting in delivery.
Another prescription: Use Perilla leaf (Perillae Folium) decoction for fumigation and washing. Generally, during severe cold months, prolonged labor damages the body with cold, causing Qi and Blood to coagulate. Therefore, this fumigation and washing method is also essential. External application of hot water infusion, combined with internal consumption of mutton soup, is certain to be effective.
Another prescription: Have the parturient woman hold the tip of her own hair in her mouth to induce nausea and vomiting, which facilitates delivery. This method also treats retained placenta (retained fetal membranes).