Library

During labor, one must absolutely not panic or act in haste.
If the pregnancy has reached full term (ten months), with sufficient Qi and blood, and the fetus is robust, sudden abdominal pain, or merely lower back pain, will lead to delivery shortly thereafter; why rush to induce? This is the natural joy of spontaneous delivery. Taking single-ingredient Motherwort Paste (Yimu Gao) can prevent postpartum complications.
In the interim, for those with weak constitutions and impatient temperaments, abdominal pain that comes and goes is called "playing pain" (Nong Tong); if amniotic fluid drips sparingly, it is called "trial water" (Shi Shui).
Even if both the umbilical and abdominal areas are painful, and the cervix is dilated (Lu Ding), but there is no lower back pain, do not be alarmed. Strictly forbid the midwife from rubbing or massaging the mother's abdomen.
One must wait until the due date has arrived, abdominal pains become frequent and dense, after the waters have broken, accompanied by lower back pain, and a sensation of fire in the eyes, before getting into bed for delivery (Zuo Cao); only when the fetal head is straight, aligned, and approaching the birth canal, should one exert force to push.
If getting into bed too early and exerting excessive force leads to maternal exhaustion and delayed labor, then use labor-inducing medicines at that point.
All difficult labors are often caused by indulgence in sexual activity during pregnancy, as well as pampering and complete lack of exercise; or by the stagnation caused by raw, cold, hard foods; or by narrow pelvises (Ai Shi Nv Zi) where the pubic symphysis does not open; or by an excessively large abdomen with unexpelled amniotic fluid; or by bystanders startling the mother during labor.
Fear causes essence and Qi to weaken; weakness of essence and Qi causes closure of the Upper Jiao; closure leads to Qi rebounding, causing distension in the Lower Jiao and obstruction of the birth canal. In such cases, Perilla Decoction (Zisu Yin) is most effective.
For excess Qi patterns, use Fetus-Thinning Powder of Zhi Gan (Shoutai Zhigan San); for deficient Qi patterns, use Da Sheng San.

Invigorating blood and calming the fetus applies when membranes have not yet ruptured;
If there is abdominal pain but membranes have not ruptured, only Gu Xiong Gui Tang should be used to invigorate blood circulation; or if membranes have ruptured but pain is slight, though present but not dense, An Tai Yin or Da Sheng San should be used to secure the fetal origin.
One must absolutely not lightly use harsh medicines, which would merely drain the water passages, damaging fetal Qi and making delivery even more difficult.
The mother should also be allowed to sleep and eat as she pleases, provided she does not overeat or oversleep.

If membranes have been ruptured for a long time and delivery remains difficult:
Excessive loss of amniotic fluid leads to dryness and stickiness of the blood; Gu Heishen San must be used. For blood deficiency, Gu Xiong Gui Tang is used to administer Gu Heishen San, named Xiong Gui Heishen San; for Qi deficiency, Si Junzi Tang is used, named Si Jun Heishen San. For transverse or breech presentations, add 1 li of Moschus (She Xiang) per dose.
At this time, it is like a boat stranded on sand; flow must surge before passage is possible.
After taking these medicines, externally apply two jin of scallions, mashed and spread on the lower abdomen. Use one dou of sand from a rapid stream, heated in a wok, wrapped in cloth, placed over the scallions, and gently kneaded.

Slippery and rapid delivery requires appropriate timing.
Induction should only occur when the cervix is fully dilated and the position is correct, yet delivery remains delayed, possibly due to external obstruction by wind, cold, heat, or cold.
In summer hot deliveries, Qi dissipates and blood boils; use Wu Ling San plus seeds of Abutilon (Kuizi), or San Tui Liu Yi San.
In winter cold deliveries, blood stagnates; keep the room warm, and use Cui Sheng Wu Ji San.
For dry water passages preventing descent, or after excessive use of astringent Heishen medicines, use equal parts of refined sesame oil and white honey, mixed with juice boiled from pig liver; or take seven qian of Liu Yi San plus five qian of Kuizi powder, taken hot in two qian doses.
For prolonged difficult labor with dried fluids, or exposure to foul qi causing mental restlessness and oppression, use Rabbit Brain Pill (Tunao Wan). For lower back pain and irritability, use two qian each of Ginseng Radix (Renshen) and Frankincense (Ruxiang), plus five fen of Cinnabar (Chensha), powdered, mixed with egg white and ginger juice, taken cold.
The above describes methods for difficult normal deliveries; below are methods for transverse, breech, and lateral obstructions.

Transverse presentation with hand protruding, or breech with feet protruding, should be slowly pushed back by the midwife;
Transverse presentation means the hand appears first. The cause is that the fetal body had not turned during abdominal pain, and the mother's premature pushing forced it sideways.
The mother should lie flat on her back calmly. The midwife should gently and slowly push the fetus slightly upward, gradually using the middle finger to massage the shoulder upwards, and pull the ear to align it.
Take Xiong Gui Heishen San to consolidate and generate blood; only when the fetal body is straight and facing the birth canal, take powder of Donkey-hide Gelatin (Ejiao), Talcum (Huashi), and Abutilon seeds (Kuizi), mixed with warm wine and honey, then exert force to push down.
Breech presentation means the feet appear first. This is due to maternal Qi deficiency and laxity of the pelvic joints, combined with premature pushing.
The mother should lie flat on her back calmly. The midwife should slowly push the feet back in, without any alarm.
Take Xiong Gui Heishen San to consolidate and invigorate blood, waiting for the fetus to naturally align.
If delivery is delayed for a long time, the midwife should gently push the feet to one side to straighten them, allowing the fetal head to gradually descend on that side; take more Chuanxiong and Angelica sinensis medicines, until the fetal body turns and the birth canal is aligned, then take San Tui San mixed, and exert force to push down.

Sitting presentation with buttocks protruding, assisted by holding onto a high strap;
Sitting presentation means the buttocks appear first. Tie a towel securely at a high place for the mother to hold; take blood-consolidating medicines, bend the legs gently for a long time, and the fetus will deliver smoothly.

Face pressed against the top of the head to rescue prolapsed intestines (Pan Chang);
"Prolapsed intestines" refers to the small intestine protruding first. Quickly soak an old cloth in hot water, cover the intestine, do not bandage it; externally, mix half a cup of vinegar with seven-tenths of a bowl of fresh water, apply to the mother's face. Each application induces one contraction; three applications induce three contractions, until fully retracted.
Apply Ru Sheng Gao to the center of the mother's crown; wipe off any residue from the intestine. Internally, take tonifying medicines including Chuanxiong, Danggui, Renshen, etc., plus Cimicifugae Rhizoma (Shengma) and Saposhnikoviae Radix (Fangfeng) to lift, ensuring successful retraction.
If dried out by wind for a long time and unable to retract, use a little whetstone water, warmed over fire to moisten the intestine, then drink one cup of decoction made from high-quality Magnetite (Cishi); the intestine will retract spontaneously.

Obstructed delivery due to fetal shoulder caught by umbilical cord;
Obstruction occurs when the fetal body turns and the umbilical cord catches the shoulder; although the vertex may be visible, delivery cannot proceed.
The mother should lie on her back. The midwife should gently push the fetus upward, slowly guide the hand, use the middle finger to support the fetal head, release the umbilical cord, take blood-consolidating medicines, and wait for the fetal body to align before exerting force to push down.

Forehead protruding laterally, leg and buttock drooping;
Lateral presentation occurs when the fetus is turning, and the mother's forceful pushing causes the fetal head to droop to the left leg, suddenly to the right leg, exposing either the left or right frontal angle, with the head tilted to one side.
Take more Xiong Gui Heishen San; have the mother lie on her back, the midwife gently pushes the fetus up, aligns the head with the hand towards the birth canal, then exerts force to push down.
If the occipital bone is drooping into the anus, causing only the forehead to show, the midwife should warm cotton clothing and gently press outside the anus to push the fetal head up and align it; after taking labor-inducing medicine, the mother should exert force to push down. This requires the midwife's skillful and gentle touch.

Injured delivery, sudden eye rolling and jaw locking;
If harsh labor-inducing medicines are mistakenly used during labor, damaging maternal Qi and blood, urgently use methods to calm the fetus and delay delivery until another month.
Some may deliver after one, two, four, or five years, all due to panic and premature pushing, or because the placenta/blood stasis broke prematurely when the fetus wanted to be born, trapping the fetus in bad blood. Use one liang of fermented soybeans (Yan Chi), wrapped in green cloth, charred but not burnt, mixed with one qian of Moschus (She Xiang), powdered, quenched in wine with a red-hot hammer, and taken in one cup. In emergencies, grind Jingmo ink with fresh water and take it; the ink wraps around the fetus as it exits; or Chuanxiong, Danggui, Motherwort (Yimucao), and Abutilon heart can all expel stasis to clear the birth path.
If during labor, sudden eye rolling, jaw locking, and foaming occur, use Pili Dan.
For women with narrow pelvises and non-opening pubic symphysis causing difficult labor, use Turtle Shell Powder (Gu Ke San) or Gu Xiong Gui Tang. Commonly use Wuyou San, Laisu San, and Tunao Wan.

Dead fetus, mother's tongue becomes unusually black;
External signs include blue-black fingernails, distension, anorexia, and extreme halitosis. Use Pingwei San plus five qian of Mirabilite (Piaoxiao), decocted in water and wine; the dead fetus will transform into bloody fluid and pass.
For constipation and excess pulse, use Dahuang Beijii Wan, or powder of Deer Antler (Lujiao) mixed with Scallion and Forsythia decoction.
For lethargy and faint pulse, use Yangzheng Dan, taken with strong Frankincense decoction, 120 pills.
For dry blood or cold patterns, take Gu Guixiang Wan with Siwu Tang.
For Qi deficiency, use Cui Sheng Wuji San plus 1 li of Moschus.
For twins where one is dead and one alive, use one cup of crab claws, two liang of Licorice Root (Gancao), and ten cups of east-flowing water, decocted to three cups, strained, mixed with three liang of Ejiao, taken in two or three doses. This can save the living fetus and expel the dead one. Commonly use Pili Dan and Duoming Wan. Externally apply Ru Sheng Gao to the soles of the feet, continue taking labor-inducing medicines, and blow Tongguan San into the nose for immediate expulsion.

Retained placenta due to blood distension; trust ancient formulas for resolving stasis and harmonizing Qi.
This is all due to premature pushing; after delivery, the mother cannot exert further force to expel the placenta. After staying in too long, external cold attacks, causing blood stagnation and placental distension, preventing expulsion. Full abdomen pressing on the chest, panting, and pain indicate danger. Urgently tie a small object to the umbilical cord to hang it, then cut it; otherwise, the placenta may rise to encircle the heart, causing death.
Ensure the mother remains calm; do not blindly trust the midwife to manually manipulate. Internally, take Niuxi Tang or Cui Sheng Wuji San, or take powder of true Dragon's Blood (Xuejie) mixed with wine.
For severe cases, use Duoming Dan; externally apply Ru Sheng Gao to the soles of the feet. For severe fainting and critical condition, use Bawei Heishen San or Heilong Dan.