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During labor, it is most taboo to exert force too early. The *Mai Jue* (Pulse Classic) states: "If pain is felt at midnight, delivery will surely occur by noon the next day." From this, it can be seen that delivery should occur half a day after abdominal pain begins. However, the difficulty of childbirth varies from person to person and time to time; some are naturally easy to deliver, some are naturally difficult, some are difficult first then easy, and some are easy first then difficult, with no fixed rule. If there is abdominal pain during labor but no delivery, it is not dystocia (difficult childbirth), but rather the fetus has not yet exited the womb. The mother must not be afraid; even if it takes one or two days to three or five days, there is no harm. She should calm her mind and spirit, let nature take its course, endure the pain as best she can, eat and drink, sit when she wishes, walk when she wishes, sleep when she wishes, and preserving her spirit is the priority. She must not listen to midwives urging her to exert force too early, nor should she herself seek to hasten the separation from her body, nor should bystanders speak much in fear to disturb her heart. When the time comes, delivery will happen naturally. It is like using the toilet: if not urgent, it is difficult; if urgent, it is easy. Although this logic is common, understanding it prevents disaster.

There are two reasons why midwives urge prematurely: one is due to ignorance of the timing, and the other is rushing to finish with one family to go to another, which greatly misleads major matters.

One scenario is before the proper time, when the fetus turns towards the hand, and the mother exerts force, causing the hand to emerge first; when it turns towards the foot, and the mother exerts force, the foot emerges first. Breech presentation (Heng Sheng / Dao Sheng) all result from incorrect use of force. In reality, there is no principle for hands or feet to emerge first. Therefore, if there is abdominal pain for several days without delivery, one should not panic. Nowadays, people see that delivery has not occurred after half a day and declare it dystocia, causing panic among the young and old, seeking gods and making vows. Seeing this, the parturient woman inevitably becomes worried and fearful. Once there is worry and fear, there is naturally no courage or energy, and eating becomes difficult. Not realizing that this is not dystocia but simply that the time has not arrived, she should only endure the pain and wait for the right moment. If pitying her severe pain and wanting her to deliver quickly, midwives and bystanders force her to exert effort, but since the time has not arrived, exerting force too early relates to the lives of both mother and child. Why do people not understand reason and reach such a state? At this time, the midwife should judge by intuition, and the parturient woman should examine carefully. One must not easily urge or force effort. One must wait until the umbilical abdominal pain is extreme, the waist feels heavy and painful, the eyes feel like burning fire, the anus feels urgent and protruding, amniotic fluid or blood is about to flow down, the pulse shows a Li Jing (Departing from the Channel) pattern, or is deep, fine, and slippery. Only at this point has the fetus exited the womb, and the mother should exert effort, so as not to cause mistakes. If several hours pass without seeing results, one must not act rashly out of impatience, leading to early exhaustion of spirit and energy, leaving no strength for delivery, and resulting in postpartum deficiency. Therefore, just before delivery, it is advisable to brew strong Ren Shen Tang (Ginseng Decoction) and drink it occasionally to tonify and assist.

Another scenario is exerting force too early, causing the water bag (amniotic sac) to break first. Exposed to wind, the birth canal may swell, become dry, narrow, and small, leading to difficult childbirth. This merely requires waiting a few more hours calmly, which is harmless. There are also ignorant midwives who harm people by privately puncturing the water bag with their fingers; this must be strictly guarded against.

Just before delivery, bending the body while lying down is most taboo. Even with severe abdominal pain, one should try to stand and walk around the room, or avoid standing stiffly, and definitely avoid curling the waist, to help the fetus turn and find the path. Because the mother fears pain and refuses to keep her body straight, preferring to lie curled up, the fetal movement becomes obstructed. When the fetus reaches the birth canal, it is blocked by the mother's curved waist. Turning again and being blocked again, the fetus loses strength and cannot move, inevitably leading to dystocia. People see it not moving and think the fetus is dead, but it is actually due to lack of strength, not death. At this time, even with good prescriptions and miraculous medicines, one cannot make the fetus strong and move. One must only tonify and connect the mother's Yuan Qi (Original Qi), ensure peace of mind and harmonious Qi, regulate the spirit, and restore the fetal vitality, ensuring safety. There are cases where amniotic fluid has flowed, but the fetus suddenly stops moving, lasting one or two days to three or five days. Besides regulating and tonifying Qi and Blood, one must strictly avoid fright, worry, and sudden anger. Fright scatters the spirit, worry knots the Qi, and sudden anger makes Qi unsmooth, causing Blood to move recklessly, often leading to fainting. Knowing this and regulating well ensures health.

Just before delivery, one must eat and drink, and avoid noise. Eating fills Qi and strengthens courage, preventing weakness from hunger and thirst. Avoiding noise keeps the spirit quiet and calm, preventing irritability. Quietness stores the spirit; agitation destroys it. Food should preferably be a thin rice porridge made from chicken broth and jujube rice. Chicken meat and other meats should be avoided. Being slightly hungry is best because hunger causes Qi to descend, and descending Qi speeds up delivery. Eating too much meat obstructs the Upper Jiao (Upper Burner), preventing Qi from descending, thus causing difficult childbirth. After delivery, one should also avoid overeating to prevent disease.

If there is abdominal pain during labor but not significant lower back pain, delivery is not urgent. One should be helped to stand straight and walk. If walking is impossible, lean on something to stand. Delivery has its own time, like a ripe fruit falling or a melon detaching from the vine. Do not be hasty or reckless, or you may cause harm. During pain, loosen the skirt belt slightly to give the fetus room to turn and expand in the abdomen.

During labor, people involved in mourning or defiled, nuns, widows, and unclean persons should not enter the room, as this harms delivery. Only experienced, sensible women who have given birth themselves, two or three of them, are sufficient. Superstition forbids many people knowing; having too many people makes delivery difficult. Each additional person in the room delays the process, which should also be avoided.

Delivery relies on diet. Some women cannot eat during labor, meaning their Essence and Qi are not robust, so how can they exert force? Before labor, buy 4-5 qian of Ren Shen (Ginseng Root). For those extremely deficient or with a history of syncope during delivery, use 1-2 liang. Just before delivery, decoct a cup of juice for use. When it is determined that the baby is coming, take this to greatly boost energy, far surpassing meat. Ren Shen should not be used randomly after delivery. If it is indeed a deficiency syndrome, warm herbs like Hei Gan Jiang (Blackened Ginger Rhizome) should be added. For example, after delivery, decoct 5 qian Ren Shen and 2 qian Dang Gui (Angelica Sinensis Root) in soup, mix with Tong Bian (Child's Urine), and take immediately after delivery. It tonifies all deficiencies and cures hundreds of postpartum diseases. (Zhang) commonly uses this for extremely deficient people, making the postpartum state as vigorous as pre-pregnancy.

After delivery, gradually introduce corn silk drink, as the husk Qi can descend deficient Fire. White rice porridge should be very thin, adjusting gradually is best. Within three days, avoid meat, eggs, and sticky/hard foods. On the sixth or seventh day, if the stomach is strong, small amounts of clear soup made from hen, beef, or crucian carp can be taken.

Emergency rescue methods for delivery. Hand presenting first is called Heng Sheng (Transverse Lie); foot presenting first is called Dao Sheng (Breech Presentation). It is said that hand presentation is cured by "seeking salt," which has some logic, though not fully explained. Salt is astringent and contracting. Also, salted flesh hurts; if the baby's hand gets salt, it hurts and contracts, naturally turning to descend. Hence the name "Seeking Salt." Treatment for hand/foot presenting first: urgently lay the mother supine, lightly apply salt to the baby's palm and sole, then smear with Sesame Oil (Xiang You), and gently push back. It will naturally turn and deliver normally. Do not let it stay out long, or the limbs will turn blue and injure the child, making reinsertion difficult. Do not recklessly use催产 (induction) drugs, as limb presentation cannot be treated by medicine. Do not listen to wicked women suggesting cutting off the limb; doing so would cause chaos in the abdomen and injure the mother. I have often seen dead fetuses delivered slowly without panic or force, without injuring the mother. Why does a dead fetus deliver? The human abdomen is extremely hot, digesting food inside. Even if the fetus is dead, if people are not rushed, and the mother eats and drinks calmly, the internal heat steams the fetus, softening and decomposing it, allowing it to be born without injury. The foul smell is unpleasant, showing that dead fetuses need no force, let alone live ones. I have often seen ignorant midwives lightly urging force, killing both lives. This is earnestly stated. I have also seen monster fetuses delivered naturally if people do not panic, provided the mother does not know. When the mother is critical, check face and tongue: face reflects the mother, tongue reflects the child. Blue face indicates maternal injury; blue tongue indicates fetal injury. Red face and blue tongue indicate dead fetus and living mother. Red face and red tongue indicate both are safe. Blue face and blue tongue with foaming at the mouth indicate both are hard to save. (Zhang secretly taught a formula specifically for difficult labor and dead fetus, and open pelvis bones, highly effective. Use Guang Monkey Blood, worth a coin, dissolve in wine and take, delivering immediately.)

Manual rescue techniques for delivery. If the opening is correct and the head is visible but not descending, it is likely due to the fetus turning and the umbilical cord catching its shoulder, called Ai Chan (Obstructed Labor). Treatment: lay the mother supine, gently push the fetus upward, press the shoulder with the middle finger to release the cord, wait for alignment, then exert force to push down. If the birth path is not straight and the mother forces it, the fetus may lean against the left or right leg, with the head stuck in the birth canal. Saying "the head is visible" is wrong; it is the forehead, called Pian Chan (Oblique Presentation). Treatment: lay the mother supine, gently push the fetus up, support the forehead with hand to align, then exert force to push down. If the occiput leans against the anus, and the head is visible, it is called HT Hou (Posterior Position - note: original text has typo). Treatment: wrap hand in cotton clothes, gently push the head from beside the anus to align, then exert force. Alternatively, use knees to prop the mother. These three difficulties all result from the mother lying curled and exerting force too early. These three manual methods should not be attempted lightly unless the midwife is experienced and knowledgeable.

When the baby exits, someone should hold the mother's chest with both hands, and the mother should hug her abdomen tightly to help the placenta descend. If the placenta is slow, do not panic; smoke burnt straw paper near the nose to induce expulsion. If still delayed, urgently cut the umbilical cord and wash the baby. Tie the cord with soft cloth, ensuring it is light yet secure, then cut. This cord is fragile. If the cord cannot be cut conveniently, fear blood reflux into the uterus, causing swelling and failure to descend, attacking the heart and causing injury. If the midwife is skilled, removing it by finger is convenient. For prolonged retention of placenta, one formula uses black cow dung, slightly roasted but moist, wrapped in cloth, and bound to the abdomen to induce expulsion.

For newborn suffocation/inability to cry, it is said calling the father's childhood name and patting the buttocks works. The logic is unclear, but likely there is a membrane blocking the anal opening, stifling the baby's Qi, preventing crying. Patting breaks the membrane, allowing crying. If patting doesn't work, a dexterous woman should gently pierce it with the end of a silver hairpin. If piercing is urgent and difficult, wrap warmly, do not let loose, soak the placenta in hot water (add heat in cold weather). Long-term internal heat pressure will break the membrane, allowing sound and revival.

A woman may have prolapsed intestines during delivery (Pan Chang Sheng), where intestines protrude before the baby. Treatment: urgently prepare a clean basin of warm water (hot in winter), add Sesame Oil for lubrication. Wait for baby and placenta to deliver. Mother inhales deeply to lift Qi. Midwife applies oil to hands and slowly pushes intestines back. Spraying vinegar water to startle and contract Qi might retract intestines but often causes errors and should not be used. Sometimes, after baby and placenta deliver, the bladder (Niao Bao) prolapses. Treat same as above. All these result from exerting force too early, disturbing the Five Zang organs. After reinsertion, take An Zang Tiao Bu Yao (Organ-Calming and Tonifying Medicine).

Xue Lizhai said: When feeling abdominal movement before delivery, lie supine straight. Wait for the fetus to turn downward. When pain starts, pinch the middle joint or proximal joint of the mother's middle finger. If it throbs, delivery is imminent. If water flows frequently before labor, the amniotic sac has broken, blood and fluids dried up, risking malpresentation and dystocia. If sac breaks but no delivery, use Bao Sheng Wu You San (Protect Life Fearless Powder) to stabilize blood. If blood is depleted, decoct Ba Zhen Tang (Eight Treasures Decoction) with Yi Mu Cao (Motherwort Herb) strongly and drink occasionally. Abdominal pain stopping means not yet in labor. Continuous lower back pain means approaching labor. Kidneys govern the waist, and the uterus connects to the kidneys. For any irregular pregnancy, instruct midwives to say "not yet in labor." Or if twins, say "placenta issues," fearing that fright scatters Qi and makes delivery harder. Generally, dystocia often involves depression. Wealthy families living in ease: although treatment claims regulating Qi before birth and tonifying Blood after, do not adhere rigidly. If Spleen and Stomach are weak and Qi/Blood insufficient, pre-regulate and tonify.

Dong Chan (Cold Birth): In winter, cold congeals menstrual blood, preventing descent. This is most harmful. Thus, in winter, do not remove woolens from the lower body, nor sit/lie in cold places. Ensure the room has stoves with constant warmth. Let the mother face the fire, keeping below the navel, legs, and knees warm. Heat moves Blood, making delivery easier.

Re Chan (Hot Birth): In midsummer, mothers must be neither too cool nor too hot. Overcooling increases disease. Too many people create oppressive heat, causing心烦 (Vexation), boiling Blood, and risks of Yu Mao Chong Yun (Depression/Fainting/Swooning).