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[Background Information]
Book: Pediatric Essentials (Erke Yaolue)
Chapter: Section 4 · Treatment of Emergencies
Category: Gynecology and Pediatrics

[Translation]

After birth, infants often experience various acute emergencies that can be unexpected. Although the causes may vary, treatment must be prompt; otherwise, any delay may result in untreatable conditions. The following details the causes and rescue methods for various emergencies.

I. Failure to Cry After Birth
Infants usually cry immediately upon exiting the birth canal, hence birth is described as "crying while falling to the ground." Infants who do not cry after birth are considered to be in a state of "apparent death" (Jiasi). The causes differ and require careful differentiation.

(1) The most common cause is dystocia (difficult labor), where the fetus is trapped in the birth canal for an extended period. This leads to obstruction of Qi and respiration, resulting in silence and a lifeless appearance upon delivery. In this case, the midwife should gently pat the infant's back to promote the expansion of Lung Qi, which will induce crying.

(2) In cases of severe dystocia requiring prolonged surgical intervention by a physician, the infant may have suffered from prolonged asphyxia. Patting the back may not immediately elicit a cry. The rescuer should lift the infant's legs, suspend the infant upside down, and gently swing them. If ineffective, artificial respiration should be employed.

(3) If the failure to cry is due to maternal exhaustion damaging fetal Qi during labor, or due to cold weather, the umbilical cord should not be cut immediately. The "Moxibustion on Umbilical Cord" method should be used: wrap the infant in cotton wool, hold them close to the mother's body (about one cun away), tie the umbilical cord tightly with ramie fiber, and ignite a large paper strip dipped in sesame oil. Smoke the area around the umbilical cord to allow warmth to enter the navel and disperse cold. Once the infant cries and Qi returns, the cord can be cut. Alternatively, moxa (Ai Ye) from Qicheng can be applied to the umbilical cord.

(4) Another cause for failure to cry is a membrane blocking the throat. Immediate inspection is required. If such a membrane exists, it should be punctured with a clean silver needle or broken with a finger. The foul blood should be wiped away with silk to prevent swallowing. Applying Jingmo (Beijing Ink) to the area can restore voice and enable sucking.

(5) Failure to cry may also result from a membrane closing the anus, obstructing Qi flow. Puncturing this membrane with a silver needle will allow the infant to cry.

Even if these measures successfully induce crying, careful nursing is essential. The infant should not be allowed to sleep for long periods to prevent recurrence of Qi obstruction.

II. Failure to Suckle After Birth
Infants naturally seek milk by puckering their lips. Refusal to suckle indicates illness. Causes include mouth sores (Koushang) or umbilical wind (Qifeng), detailed in subsequent chapters. For other causes:
1. Accumulation of blood stasis and filth in the abdomen presents with abdominal distension and shortness of breath. Treat with purgatives such as Dahuang (Rhei Radix et Rhizoma), Qianniu (Pharbitidis Semen), and Binglang (Arecae Semen).
2. Cold invasion during gestation or after birth presents with a cyan-white complexion. Treat with warming agents such as Shengjiang (Zingiberis Rhizoma), Ganjiang (Zingiberis Rhizoma Exsiccatus), Baizhu (Atractylodis Macrocephalae Rhizoma), Sharen (Amomi Fructus), Muxiang (Aucklandiae Radix), and Chenpi (Citri Reticulatae Pericarpium) to warm the middle, dispel cold, regulate the Stomach, and move Qi.
Diagnosis and prescription must consider the pulse and tongue coating.

III. Eyes Not Opening
Failure of the eyes to open after birth may be due to fetal toxin accumulation with Heat in the Liver, or invasion of filth into the eyes at birth. Treat by fumigating and washing with a decoction of Xiongdan (Ursi Fel) and Huanglian (Coptidis Rhizoma). Alternatively, administer a decoction of Shengdi (Rehmanniae Radix), Chishao (Paeoniae Radix Rubra), Danggui (Angelicae Sinensis Radix), and Qingxiangzi (Celosiae Semen). Topical cooling eye drops may also be used. Care must be taken to protect the delicate eyes to prevent blindness.

IV. Obstruction of Urine and Feces
For infants with obstipation and urinary retention accompanied by severe abdominal distension, immediate suction therapy (Xiza) should be performed on seven points: anterior chest, posterior back, below the umbilicus, palms of both hands, and soles of both feet. Perform five to seven sucks per point until redness appears. This promotes Qi circulation and relieves obstruction. Internally, administer Qingfen (Calomelas) 0.5 fen mixed with honey slowly. (Note: Qingfen is toxic and should be used with extreme caution). Check for anal atresia and treat mechanically if necessary.
For mild cases of dual obstruction, use Dahuang, Qianniu, Cheqiancao (Plantaginis Herba), Gancao (Glycyrrhizae Radix et Rhizoma), and Mutong (Akebiae Caulis). For severe cases, use a small amount of Badou (Crotonis Fructus) for constipation, or apply Tianluo (Cipangidae Shell) mixed with Shexiang (Moschus) juice to the lower abdomen for urinary retention.
If the abdomen is severely distended, feeding is impossible, and the infant groans, prognosis is poor.
For isolated urinary retention, use Congru Tang (Scallion Milk Decoction): crush 3-4 cun of Baicong (Allii Fistulosi Bulbus), mix with human milk, and feed. Alternatively, apply heated Yanpanyan (Halitum) to the umbilicus. If the lower abdomen is distended, pricking the area to release a few drops of purple blood can relieve retention.
For isolated fecal obstruction, Sanhuang Tang (Three Yellows Decoction) with added Dahuang is effective.

V. Persistent Vomiting
Persistent vomiting after birth has several causes:
1. Retention of filth in the abdomen causing vomiting, often with abdominal distension and constipation: Use Mugua Wan (Papaya Pill).
2. Exogenous Cold invading the Stomach, characterized by curved-back crying and continuous spitting of foam: Use Xiangsu Yin (Costus and Perilla Drink).
3. Heat inherited from gestation, characterized by yellow-red face, warm extremities, and yellow saliva: Use Erchen Tang (Two Aged Substances Decoction) plus Huanglian (Coptidis Rhizoma).
4. Cold inherited from gestation, characterized by cyan-white face, cold extremities, and white foam: Use Lizhong Tang (Regulate the Middle Decoction).
5. Continuous regurgitation of milk due to overfeeding and impaired digestion: Use Jiao Maiya (Scorched Hordei Fructus Germinatus) 3 qian, Juhong (Exocarpium Citri Grandis) 1 qian, and Dingxiang (Caryophylli Flos) 0.3 fen decocted together.

VI. Absence of Skin
Infants born without skin, showing only red flesh, may result from the mother living in high buildings without contact with Earth Qi during pregnancy. Apply finely ground pure yellow earth (Huangtu) in a soft silk bag, gently dusting the body 3-4 times daily until skin regenerates. Pearl powder (Zhenzhu Mo) or rice flour can also be used.
If accompanied by heat and redness due to excessive maternal Fire, apply Shigao (Gypsum Fibrosum) powder.
If caused by hereditary syphilis from parents, presenting as widespread red erosion without skin, treat internally with Huanji Xiaodu San (Muscle-Replacing Detoxification Powder) and externally with Huangbai (Phellodendri Cortex) and Shigao powder.

VII. Generalized Blisters
Infants born with blisters resembling fish bubbles or crystal, leaking fluid when ruptured, suffer from Damp-Toxin in the skin. Apply extremely fine, roasted Mituosen (Litharge) powder dry to the lesions. Internally, administer Suhe Xiang Wan (Styrax Pill).

VIII. Toad Plague (Hamu Wenyi)
Infants presenting with sudden crystal-like transparency and swelling of the chest and abdomen, revealing internal organs visually, suffer from "Toad Plague." Treat by using six large toads (Xiahama). Tie the four legs, rub the toad's belly on the affected transparent areas several times, then place the toad on the infant's umbilicus. Repeat with subsequent toads until all six are used. The disease should resolve. Caution: Toad eyes contain ChanSu (Bufonis Venenum); cover the eyes with silk to prevent spraying. Release the toads into the wild after use.

IX. Retraction of Scrotum into Abdomen
Within days of birth, if the scrotum retracts into the abdomen with incessant crying, it is due to Cold. Apply a powder of Liuhuang (Sulfur) and Wuzhuyu (Evodiae Fructus), each 5 qian, mixed with crushed garlic to the lower abdomen. Then, apply heated Chuangzi (Cnidii Fructus) wrapped in cloth to the umbilicus to reduce the retraction.

X. Swollen Scrotum
For swollen, pendulous scrotum that does not retract, apply Zisu (Perillae Folium) powder. If wet, apply dry powder; if dry, mix with Sesame Oil (Shizi You) for application. This is effective even if the skin is ulcerated and the testicle threatens to fall.

Appendix Formulas

(1) Mugua Wan (Papaya Pill)
Indications: Persistent vomiting in children.
Ingredients: Mugua (Chaenomelis Fructus), Shexiang (Moschus), Nifen (Calomelas/Qingfen), Muxiang (Aucklandiae Radix), Binglang (Arecae Semen) in equal parts.
Preparation: Grind to fine powder, bind with wheat paste into pills the size of millet seeds. Dosage: 1-2 pills, washed down with Licorice water, administered frequently.

(2) Xiangsu Yin (Costus and Perilla Drink)
Indications: Vomiting and diarrhea in children.
Ingredients: Huoxiang (Agastaches Herba), Ziye (Perillae Folium), Zhimhoupo (Magnoliae Officinalis Cortex processed), Chenpi (Citri Reticulatae Pericarpium), Zhiqiao (Aurantii Fructus), Fuling (Poria), Weimuxiang (Aucklandiae Radix processed), Zhigancao (Glycyrrhizae Radix et Rhizoma processed) in equal parts.
Preparation: Use Shengjiang (Zingiberis Rhizoma) as a guide, decoct in water.

(3) Erchen Tang (Two Aged Substances Decoction)
Indications: Cold-dampness and phlegm-turbidity in the Stomach.
Ingredients: Chenpi (Citri Reticulatae Pericarpium - peel removed, vinegar-fried for hypochondriac pain, honey-processed for dry cough), Banxia (Pinelliae Rhizoma - ginger-juice processed, bamboo-juice processed for hot-phlegm, vinegar-processed for morning sickness), Fuling (Poria - 2 qian each, decocted with Guizhi wine for fluid retention and palpitations), Zhigancao (Glycyrrhizae Radix et Rhizoma processed - 1 qian, sandalwood-juice processed for fullness), Shengjiang (Zingiberis Rhizoma - 7 slices, honey-processed for rebellious Qi and phlegm-knots). Alternative: Add one Wumei (Mume Fructus) meat, fried until charred for diarrhea/dysentery.

(4) Lizhong Tang (Regulate the Middle Decoction)
Indications: Deficiency-cold of Middle Jiao Spleen and Stomach, failure of transformation and transportation, vomiting, diarrhea, anorexia, chest bi/stuffiness, abdominal pain with phlegm, Taiyin syndrome from Cold damage, spontaneous diarrhea without thirst, cold cholera with vomiting/diarrhea, cold limbs, spontaneous sweating with deficient pulse, hematochezia/dysentery, stomach injury with hematemesis, deficiency-cold in pregnant women.
Ingredients: Renshen (Ginseng Radix), Zhigancao (Glycyrrhizae Radix et Rhizoma processed), Baizhu (Atractylodis Macrocephalae Rhizoma) 3 qian each, Ganjiang (Zingiberis Rhizoma Exsiccatus) 1 qian.
Preparation: Decoct in clear water.

(5) Huanji Xiaodu San (Muscle-Replacing Detoxification Powder)
Indications: Seasonal sores, Syphilis (Yangmei Chuang), early stage or ulcerated.
Ingredients: Bibo (Dioscoreae Hypoglaucae Rhizoma) 5 qian, Danggui (Angelicae Sinensis Radix), Baizhi (Angelicae Dahuricae Radix), Zaojiaoci (Gleditsiae Spina), Yiyiren (Coicis Semen) 1 qian each, Baixianpi (Dictamni Cortex), Mugua (Chaenomelis Fructus - avoid iron), Mutong (Akebiae Caulis), Jinyinhua (Lonicerae Japonicae Flos) 0.7 fen each, Gancao (Glycyrrhizae Radix et Rhizoma), Lianqiao (Forsythiae Fructus), Fangfeng (Saposhnikoviae Radix) 0.5 fen each, Fuling (Poria), Shaoyao (Paeoniae Radix Alba) 1 qian each, Huangqi (Astragali Radix) 2 qian, Chuanxiong (Ligustici Chuanxiong Rhizoma), Shengdi (Rehmanniae Radix) 0.8 fen each.
Preparation: Divide into 2-3 doses, decoct in clear water.

(6) Suhe Xiang Wan (Styrax Pill)
Indications: Chuan Shi (Consumption/TB), Gu Zheng (Bone-steaming Fever), Gui Zhu (Ghost Tumor), Fei Wei (Flaccid Lung), Zhu Wu (Infectious Pestilence), Fox/Ghost Evil Spirits, Jing Xian (Convulsions/Epilepsy), Zhong Feng (Wind Stroke), Tan Jue (Phlegm Syncope), Sudden Heart/Abdominal Pain, Coma/Collapse, Cold Syndrome with Qi Closure, Cold Cholera, Malaria, Acute Dysentery, Blood Stasis/Amenorrhea in Women, Infantile Convulsions/Vomiting Milk, Carbuncles/Masses.
Ingredients: Suhe Xiang You (Styrax Liquid Resin - white is best, mixed with Anxi Jiang, 5 qian), Dingxiang (Caryophylli Flos), Anxi Xiang (Styrax - separate powder, decoct in unfermented wine to make paste, remove sediment), Qingmuxiang (Aucklandiae Radix), Baitanxiang (Santalum Album Wood), Chenxiang (Aquilariae Lignum Resinatum - grind separately very fine), Bibo (Piperis Longi Fructus), Xiangfuzi (Cyperi Rhizoma - stir-fry to remove hairs), Heliele (Myristicae Semen - roast for pulp), Wuxijiaoxie (Rhinocerotis Cornu - slice, grind separately very fine), Zhusha (Cinnabar - grind separately with water, half used as coating, 1 liang each), Xunluxiang (Olibanum - grind separately), Longnao (Borneolum Syntheticum - grind separately, 5 qian each), Shexiang (Moschus - grind separately, avoid fire, 7.5 qian). Alternative formula: Add Baizhu, remove Baitanxiang, Bibo, Heliele.
Preparation: Mix Anxi Xiang paste and refined white honey into pills the size of Euryale Seed (Qianshi), weighing about 8 fen. Coat with Zhusha, seal in wax shell. Dosage: One pill per administration.