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Regulation and Care

When pregnancy nears the due date, one should calm the mind and eliminate worries, walk frequently, and avoid excessive sleep, overeating, or drinking too much sweet wine. During labor, there should be no noise or clamor in the room. If amniotic fluid (shuǐ jiāng) is seen and lower back pain is severe, it indicates that the fetus has shifted from its normal position (tāi yǐ lí jīng), and only then can medication be used to induce labor and prepare for delivery. (*Furen Liangfang*)

Protection

In winter, when the weather is cold, the mother's menstrual blood may congeal upon exposure to cold, making it difficult for the fetus to be born. Therefore, for winter deliveries, the lower body must not be stripped of cotton clothing, nor should the mother sit or lie in cold places; a stove should be placed in the room, with the mother's back facing the fire, keeping the waist, abdomen, legs, and knees warm. Blood flows smoothly when warmed, facilitating easier birth. ○ In summer deliveries, temperature regulation must be appropriate; one must not indulge in cooling measures to the detriment of fetal qi. The room should not be crowded, as excessive heat may cause maternal restlessness, boiling blood heat, leading to risks of depression, dizziness, and fainting. (Yang Zijian)

Labor Signs

There are ten types of labor signs: 1. Normal labor (zhèng chǎn); 2. Sitting labor (zuò chǎn); 3. Lying labor (wò chǎn); 4. Transverse presentation (héng chǎn); 5. Breech presentation (nì chǎn); 6. Oblique presentation (piān chǎn); 7. Obstructed labor (ài chǎn); 8. Prolapsed intestine (pán cháng chǎn); 9. Heat labor (rè chǎn); 10. Cold labor (dòng chǎn). (*Furen Liangfang*)

True Words on Labor: 1. Sleep; 2. Endure pain; 3. Delay pushing. ○ When a pregnant woman nears her due date, intermittent abdominal pain is called "playing fetus" (nòng tāi) and is not a sign of true labor. Abdominal pain without significant lower back pain is not a sign of true labor. A fetus positioned high and not descended is not a sign of true labor. Absence of rectal pressure/urgency is not a sign of true labor. Unruptured membranes and no bleeding are not signs of true labor. Vaginal discharge of fluid and blood without abdominal pain is not a sign of true labor. At this stage, the mother should be supported to walk and rest, enduring patiently, and should not rush to bed for delivery. (*Dasheng Bian*)

When labor is imminent, and internal fetal movement is felt, the mother should lie supine with her body straight, waiting for the fetus to turn downward. Pinching the middle finger of the mother; if the middle joint throbs, true labor has begun, and delivery is imminent. (Xue Lizhai)

Timing of Pushing

One must wait until umbilical and abdominal pain is extreme, lower back feels heavy and painful, eyes feel like burning, rectum feels urgent/protruding, amniotic fluid and blood flow down together, and the pulse shows the "Li Jing" (departing from the channel) pattern. Only at this point, when the fetus has exited the sac, should the mother push. (*Fengshi Jinnang*)

Some ask: Defecation requires effort; why does childbirth not require effort? One must understand that feces are inert matter requiring human force to expel; whereas the fetus moves itself. Not only is effort unnecessary, but premature pushing is strictly forbidden. The fetus sits upright in the womb and turns head-down during birth. The uterine space is narrow, and external help is difficult; one must allow it to turn slowly, forcing its way to the cervix, head down, feet up, emerging inverted. If the fetus has not turned and the mother pushes prematurely, feet may emerge first, colloquially called "Feet Treading on Lotus." If turning is incomplete and pushing occurs, the fetus may lie transversely with a hand emerging first, called "Seeking Salt Birth." Even if turning downward is achieved but alignment is poor, premature pushing may cause the head to lodge against the leg bone, preventing delivery. These complications arise from pushing before the proper time. However, complete lack of effort is also incorrect; pushing should last only about the time it takes to drink a cup of tea. Just as defecation cannot occur before reaching the anus regardless of effort, so too with childbirth. ○ If the fetus exhausts its strength and cannot descend, the mother should sleep quietly, allowing the fetus to rest in the womb as well; natural birth will follow. When the fetus descends, if the mother sits or stands, the fetus remains inverted, which cannot be sustained. If the mother lies down, the fetus aligns accordingly, causing no harm. Some worry: What if suffocation occurs? Answer: It survived ten months in the womb without suffocating; how could it suffocate in a moment? ○ If premature pushing causes transverse or breech presentation, immediately have the mother sleep, administer a large dose of Jiawei Xionggui Tang, gently push the protruding limbs back inside, and let her sleep another night for natural delivery. (*Dasheng Bian*)

Midwife (Wěnpó)

The midwife must be selected for maturity, steadiness, and honesty, and instructed beforehand. Upon labor, she must remain calm and composed, avoiding coercive methods. I have seen midwives who are hurried and impatient, fearing mistakes, who forcibly test remedies, pull, pinch, and force the fetus down, often resulting in malpresentation (limbs emerging before the head) or transverse/breech positions, causing significant harm. If contractions are not tight, she should not intervene. For cases of irregular breathing or twins not yet delivered, only steady comfort should be provided; the mother must not be informed, as shock disperses qi, making birth harder. Also, beware of deceitful women who feign distress or exaggerate minor issues to display skill or seek reward, causing maternal panic and greater harm. (*Jingyue Quanshu*)

Inducing Labor

When the fetal essence is complete and the month is full, birth occurs naturally according to its term; it cannot be forced. "Inducing labor" merely means assisting qi and blood to facilitate guidance. Only at the onset of labor should Tuohua Jian or Huatai Jian be used. If prolonged labor leads to maternal exhaustion, Huatai Jian is suitable to boost qi and blood. For qi deficiency and weakness hindering expulsion, Dushen Tang is necessary to supplement strength. These are key methods for inducing labor. If used before the due date, agents that move qi and blood are akin to picking flower buds or pulling up seedlings to help them grow—both futile and harmful. (*Jingyue Quanshu*)

General Principles of Induction: Use slippery substances to unblock stagnation; bitter substances to drive out obstruction; aromatic substances to open orifices and move blood; regulate qi for qi stagnation; nourish blood if membranes rupture early and blood is dry. (*Nuke Daquan*)

Prepared Medicines

- Huarui Shi San (Coral Fossil Powder): Treats lochia entering the placenta, causing distension and retention, or upward attack of lochia.
- Foshou San (Buddha's Hand Powder): Treats various conditions of blood deficiency.
- Jiawei Xionggui Tang with Gui Ban (Tortoise Shell): Treats failure of the pubic symphysis to open (Jiaogu Bukai).
- Castor seeds applied to the sole of the foot: Treats retained placenta.
- Shixiao San: Treats lochia-related abdominal pain.
- Butter mixed with Talcum powder applied to the vulva: A sacred remedy for lubricating the birth canal.
- Qinghun San: Treats blood syncope (Xue Yun).
- Pingwei San with Xiao Ming (Mirabilite): Dissolves dead fetus.
These are essential medicines for labor and should be prepared. For qi and blood deficiency, Bazhen Tang or Shiquan Tang should be used. (*Furen Liangfang*)

Medication During Labor

Question: Is taking medicine during labor beneficial without harm?
Answer: How can it be without harm? Consider Shutu Er Wan combined with Huisheng Dan, commonly used by laypeople. Shutu Er Wan typically uses aromatic and penetrating herbs. During labor, all vessels open, and qi and blood are already deficient; these drugs further deplete them. After birth, the aromatic properties linger, causing much damage. They also open pores, inviting wind pathogens, leading to unspeakable disasters. Huisheng Dan uses Dahuang (Rhubarb) and Honghua (Safflower) as chief ingredients, mostly draining and breaking agents; using them on depleted blood causes endless trouble.
Question: Then are there no usable medicines?
Answer: Yes. Only Jiawei Xionggui Tang and Foshou San are sufficient. Childbirth relies entirely on abundant blood. With sufficient blood, like a boat with water, movement is assured. Both formulas use large doses of Chuanxiong and Danggui to remove old blood and generate new blood quickly. Their ingredients are available everywhere, truly beneficial without harm. It is lamentable that people seek novelty and strangeness. (*Dasheng Bian*)

Seven Causes of Difficult Labor

1. **Ease/Laziness**: Pregnancy requires blood to nourish and qi to protect. Constant movement ensures circulation and fetal activity. Prolonged sitting or lying causes qi stagnation and blood stasis, making the fetus sluggish and causing difficult labor. Laboring women in fields often give birth easily after sudden pain, illustrating this.
2. **Over-nourishment**: Fetal size relates to the mother's diet. Excessive consumption of rich, greasy foods leads to a large fetus and difficult labor. Women eating coarse food often deliver easily.
3. **Sexual Desire**: Ancient texts advise pregnant women to live separately from husbands to prohibit sexual desire, as it is most dangerous. The fetus relies on qi and blood; stillness preserves spirit. Sexual arousal consumes qi and blood, stirring fire and boiling blood. Before three months, it risks miscarriage; after three months, it causes thickened membranes (difficult birth) or fetal leakage (leading to weak, short-lived infants prone to sores and pox). Unlike horses, cattle, dogs, and pigs, which abstain from mating after conception, humans often fail to restrain themselves, especially with excess.
4. **Worry and Doubt**: Despite eager desires for children, precautions are often lax. Divination and prayer cause constant fear and anxiety, weakening qi and causing difficult labor.
5. **Timidity/Weakness**: Young women giving birth for the first time may have weak spirit and qi, with an unopened cervix. Bending and twisting hinders delivery. Middle-aged women with many births may suffer from qi and blood deficiency, making birth difficult.
6. **Panic/Haste**: Foolish midwives, failing to distinguish true labor from false labor, urge pushing upon seeing pain. The mother, lacking direction, complies, leading to transverse/breech presentations and injury to mother and child.
7. **Exhaustion**: Premature pushing before the fetus exits depletes the mother's strength. By the time the fetus is ready to exit, the mother is exhausted, and the birth canal is dry, causing difficult labor. Immediately administer Buchong Cuisheng Tang or Baochan Wanquan Tang. (*Fengshi Jinnang*)

Selected Case

Danxi stated: The theory of Shoutai Yin (Emaciating Fetus Decoction) in medical texts was created for Princess Huyang. My cousin suffered from difficult labor. Observing her obese physique and diligence in needlework, I pondered for ten days and realized: This is opposite to Princess Huyang's case.

Those well-nourished likely have excess qi; reducing it brings balance, facilitating birth. This obese woman likely has qi deficiency and immobility from sitting; thus, tonifying maternal qi will strengthen the fetus and ease birth. Prescribed Zisu Yin with qi-tonifying herbs from the 5th to 6th month of pregnancy. After several doses, she delivered a son swiftly. Note: While both cases involve difficult labor, one is excess and the other deficiency. The qi-tonifying formula was inspired by the emaciating decoction, showing that one must not read rigidly. (*Wu Yi Huijiang*)

Three Life-Saving Methods

1. **Obstructed Labor (Ai Chan)**: Cervix is open, fetal head is visible but not descending because the umbilical cord is around the shoulder. Method: Have the mother lie supine, gently push the fetus upward, press the shoulder with the middle finger to free the cord, wait for alignment, then push down.
2. **Oblique Presentation (Pian Chan)**: Birth path is misaligned due to premature pushing, causing the fetus to lean against the leg. The head appears to be the vertex but is actually the forehead. Method: Have the mother lie supine, gently push the fetus up, correct the head position, then push down.
3. **Occiput Posterior (Cheng Hou)**: The back of the fetal head presses against the rectum, exposing the forehead. Method: Wrap hand in cotton cloth, gently push the fetal head from the side of the rectum to correct position, then push down. Alternatively, use the knee to support the mother. These difficulties arise from bending the waist while lying and pushing too early. These techniques require experienced and careful midwives. (*Fengshi Jinnang*)

Premature Rupture of Membranes

If membranes rupture early with excessive amniotic fluid, causing the fetus to dry and not descend, first administer Siwu Tang to nourish blood. Then wash the vulva with strong scallion soup to ensure smooth qi flow, and apply butter mixed with talcum powder to the vulva. (*Nuke Daquan*)

Premature rupture before labor has two causes: 1. Weak constitution and unstable membranes ruptured by fetal movement (Qi and Blood deficiency). 2. Premature sitting on the birthing mat and excessive effort rupturing membranes before the fetus turns (Trauma from movement). Besides Siwu Tang, Bazhen Tang, and scallion wash, boiling Huangqi (Astragalus), Chuanxiong, and Danggui in large quantities to fill the room with vapor, which the mother inhales, is also effective. (*Jingyue Quanshu*)

Failure of Pubic Symphysis to Open (Jiaogu Bukai)

Caused by Yin blood deficiency. Use Jiawei Xionggui Tang. Tortoise belongs to extreme Yin; its shell interlocks, symbolizing the need to separate the bones. Hence, it is used. (*Xue Shi Yi An*)

Prolapsed Intestine (Pan Chang Sheng)

Caused by chronic qi deficiency and excessive straining during labor, causing qi and blood to sink, dragging the intestine out with the fetus. Once it happens, it may recur. If one waits for natural ripening, such anomalies would not occur. (*Dasheng Bian*)

If the intestine protrudes before the baby and does not retract, place it in a clean lacquerware container and soak in concentrated Huangqi (Astragalus) decoction to retract it. Another method: Grind 49 castor seeds and apply to the crown of the mother's head; once the intestine retracts, wash off immediately. (Zhang Jingyue)

Prolapsed intestine results from qi and blood deficiency leading to sinking. Tonify qi and blood with ascending agents. Large doses of Renshen (Ginseng), Huangqi (Astragalus), Chuanxiong, and Danggui with Shengma (Cimicifuga) are primary. Spraying vinegar water on the face to startle and chill the woman raises qi and retracts the intestine. However, shock disperses qi and cold coagulates blood, making retraction harder and risking other diseases. It is safer to blow Saponaria officinalis powder (Zao Jiao Mo) into the nose to induce sneezing, which naturally lifts qi. (Li Taisu)

Seeking Salt Birth (Mi Yan Sheng)

Hand presenting first is transverse presentation (Heng Sheng); feet first is breech presentation (Dao Sheng). Traditionally, hand presentation is called "Seeking Salt Birth." There is logic here: Salt causes contraction and pain. Applying salt to the hand causes pain and shrinking, prompting the fetus to turn and descend naturally. Method: If hands/feet present, have the mother lie supine, lightly apply salt to the palms/soles, then smear with sesame oil, and gently push back. Do not leave them exposed long, as they become stiff and hard to replace, endangering the fetus. Do not use indiscriminate induction drugs, as limb presentation is not treated by medicine. Never listen to malicious advice to cut the limb; cutting causes chaos in the womb and endangers the mother.

Retained Placenta (Baoyi Bu Xia)

Two causes: 1. Lochia enters the placenta, causing distension and retention. 2. Yuan Qi deficiency fails to expel it. If lochia causes distension/pain, use Duoming Dan or Shixiao San to resolve blood stasis; delay is fatal. If qi deficiency causes non-painful retention, use Baochan Wuyou San to tonify and secure yuan qi; or apply one liang of castor seed paste to the sole of the foot; wash off after delivery. Another method: Insert the woman's own hair into the throat to induce vomiting, raising qi and dispersing blood, softening the placenta for natural expulsion. This method is very effective for a condition often fatal. (*Jingyue Quanshu*)

Ancient formulas use Huarui Shi San, but mineral drugs may not suit those with weak spleen/stomach. Better to choose Shenghua Tang or Wanquan Tang. Alternatively, Foshou San with Honghua, Yimucao, Xiangfu, Shanzha, Chenpi, and Niuxi, decocted and taken with infant urine, is excellent. (*Fengshi Jinnang*)

Retained placenta is always due to premature labor. During birth, joints open; robust women close in days, weak ones in a month. Forcing delivery before opening causes the bony ring to close quickly after the fetus exits, trapping the placenta. Do not panic with random drugs. Tie the umbilical cord with coarse hemp rope, double-fold it, tie again, weigh it down, then cut. After 3-5 days, the placenta shrinks and falls naturally. Verified repeatedly. (*Dasheng Bian*)

Pulse Diagnosis

For a woman about to give birth, the pulse departs from the channel (Li Jing), appearing deep, fine, and slippery. Pain begins at midnight, and birth is certain by noon the next day. (*Maijue*)

*Nan Jing* states: Three pulses per breath is Li Jing, indicating Yang adding to Yin; one pulse per breath is also Li Jing, indicating Yin adding to Yang. Fetal movement internally causes pulse disorder externally, indicating impending birth. ○ Deep, fine, and slippery is the kidney pulse shape. Since the kidney governs the uterus, this pulse also indicates impending birth. (*Taichan Mishu*)

Saying the pulse is Li Jing, or deep/fine/slippery, or scattered/rootless, are not absolute. "Li" means different; "Jing" means normal. A pulse different from normal is Li Jing. Different from the patient's usual pulse or the average person's usual pulse is acceptable. (*Yican*)