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1. Normal Delivery (Zhengchan): When a woman's pregnancy reaches ten months, she suddenly experiences paroxysmal pain in the lower back and abdomen. Subsequently, the fetal Qi descends rapidly. The pain intensifies in the umbilical and abdominal regions, extending to severe heaviness and pain in the waist, with a sensation of prolapse in the anal region (Gudao). This is followed by the rupture of membranes and bleeding, after which the infant is born. This is called Normal Delivery.

2. Injurious Delivery (Shangchan): If a woman experiences sudden pain in the umbilical and abdominal regions before the full month of pregnancy, resembling the onset of labor, but the symptoms subside without delivery, this is called "Trial Month" (Shiyue) and is not normal delivery. However, for any parturient who has not yet shown signs of normal delivery, one must not allow others to hold her waist, nor should the mother move or exert force randomly. If the fetus has not yet assumed a proper position and merely shifts, instructing the mother to exert force blindly may cause the fetus to dislocate, turning sideways or upside down, preventing normal birth. Such outcomes are due to improper exertion by the mother. One should wait until the fetus is in a proper position and approaches the birth canal before instructing the mother to exert force once to facilitate delivery. *Note: The text defines the scenario resulting from improper effort as Shangchan.*

3. Induced Delivery (Cui Chan): When a pregnant woman desires to deliver, and membranes have ruptured with bleeding, indicating signs of normal delivery, but no birth occurs without medication, one may administer parturifacient drugs to test their effect. If several days pass without delivery, causing the mother to become fatigued and exhausted, medication can be given to support the mother's Healthy Qi (Zheng Qi) and accelerate birth. This is called Induced Delivery.

4. Frozen Delivery (Dong Chan): This occurs in winter when coldness causes the mother's menstrual blood (lochia) to coagulate, hindering the birth of the infant. This is highly detrimental. For births occurring in winter, the lower body must not be exposed to cold; cotton garments should not be removed, and sitting or lying in cold places must be avoided. The room should be heated with fire to maintain warmth. The mother should face away from the heat source towards the fire, ensuring the area below the navel, legs, and knees remains warm. Heat promotes blood circulation, facilitating easier birth. This is called Frozen Delivery.

5. Hot Delivery (Re Chan): During summer, when heat is intense, the parturient must maintain appropriate temperature balance. She should not excessively seek coolness, which could damage Fetal Qi. Furthermore, the delivery room should not be overcrowded, as excessive heat may oppress the mother, causing blood to boil, leading to fever, headache, flushed face, drowsiness resembling intoxication, or even loss of consciousness. This is called Hot Delivery.

6. Transverse Presentation (Heng Chan): The fetus presents first with a hand or arm. This results from improper or premature exertion by the mother while the fetus is not yet aligned. Forceful pushing causes the fetus to lie transversely, preventing birth. The mother should lie supine. The attendant should gently guide the fetus, first pushing the limb upward into a vertical position, then gradually adjusting the body. Using the middle finger, rub the shoulder and push upwards to correct the position, or pull the ear to align it. The mother must remain supine to facilitate correction. Once the fetus is aligned, administer a cup of induced delivery decoction. Only then should the mother exert force to deliver the infant. This is called Transverse Presentation.

7. Breech Presentation (Dao Chan): Due to insufficient Fetal Qi and laxity of the cervix ("key"), premature exertion prevents the fetus from rotating, causing the feet to present first. The mother should lie supine. The midwife should gently push the feet back inside. The mother must not exert any force, nor should she be frightened; she must be comforted to allow the fetus to naturally assume a correct position. This is called Breech Presentation.

8. Oblique Presentation (Pian Chan): The fetus is misaligned, and forceful pushing causes the head to tilt against the left or right thigh, presenting obliquely and preventing birth. The mother should lie supine. The attendant should gently push the fetus upward and manually correct the head's position. Using a cloth warmed by heating, the attendant should place it near the anus and gently push the head into alignment. Then, the mother should exert force to deliver the infant. This is called Oblique Presentation.

9. Impeded Delivery (Ai Chan): The fetus is aligned and the vertex presents, but cannot be delivered. This is often caused by the umbilical cord wrapping around the shoulder during fetal rotation, trapping the vertex. The mother should lie supine. The attendant should gently push upward, guiding the hand to press below the shoulder and dislodge the cord. Wait until the fetus is fully aligned, then instruct the mother to exert force for delivery. This is called Impeded Delivery.

Commentary: For transverse, breech, oblique, and impeded presentations, these methods require skilled midwives. Unskilled application may harm life. Currently, many breech births occur naturally with the feet presenting first, known as "Lotus Stepping Birth," with no adverse effects on mother or child; thus, manual reduction of feet is not always necessary. For impeded delivery, if the cord wraps the vertex but the head emerges, the midwife can simply dislodge the cord over the head. If the cord encircles the vertex and the infant and placenta descend together, forcing them back into the birth canal may cause errors.

10. Sitting Delivery (Zuo Chan): This refers to a method where, upon imminent delivery, a towel is hung high. The mother holds onto it, bends her knees, and sits lightly to facilitate birth. It does not mean sitting on an object. This is called Sitting Delivery.

Historical Case: Lady Gong, wife of Zhao Duyun, suffered from "Intestine Prolapse Birth" (Panchang Sheng), where the large intestine prolapsed before and after delivery, causing great distress. Physicians could not cure it. While in Jianchang, a effective method was found: Mix half a cup of vinegar with seven parts fresh cold water. Spray this mixture on the mother's face. With each uterine contraction, spray three times. Upon completion of contractions, the intestine retracts. This is an effective method.

For postpartum intestinal prolapse: Boil five jin (approx. 2.5 kg) of sesame oil, pour into a basin, and let it cool to a warm temperature. Sit on the basin for about half an hour. Then, blow powdered Gleditsia sinensis (Zaojiao) into the nose to induce sneezing, which immediately retracts the intestine. (*Doumen Fang*) Another method: Use Pinellia ternata (Banxia) powder insufflated into the nose to retract the intestine. Alternatively, dip a paper wick in sesame oil, light it, extinguish it, and use the smoke to fumigate the mother's nose, which also retracts the intestine.

Danxi stated: During pregnancy, avoid stagnation; after delivery, avoid deficiency. Postpartum, all exterior-releasing methods (such as sweating) are contraindicated. Bai Shao (Radix Paeoniae Alba) should not be used early postpartum because its sour and cold nature suppresses the ascending and generating Qi. Generally, postpartum women should not overeat to prevent food stagnation. Within the first month, do not force oneself out of bed. Avoid excessive talking, laughing, fright, worry, sadness, anger, prolonged sitting or standing, and needlework. Failure to observe these may lead to "Chuilao" (postpartum consumptive disease) after the month ends. Greasy meats and fish should be avoided. Intercourse should only resume after one hundred days; otherwise, various diseases may arise. Women suffering from wind pathogens or coldness in the lower abdomen often do so due to early resumption of sexual activity.

Question: Since new mothers suffer from blood deficiency and potential lochia retention, is Hei Shen San (Black Divine Powder) an essential medicine?

Answer: The Earth element generates all things; this is the natural order. After childbirth, blood deficiency and lochia retention are not necessarily complete, nor is organ coldness guaranteed. Why use medicine? Proper care in diet and lifestyle prevents illness. If there is indeed lochia retention, weakness, and cold, a few doses of medicine are simple and effective. For other conditions, identify the cause and meridian involvement, and prescribe accordingly. Do not indiscriminately mix herbs. Those with irritable temperaments, thin bodies, and frequent anger should avoid ginger and cinnamon in summer due to the prevailing fire climate. Protective measures involving rich foods are unreasonable. Meat broths may ignite fire in the Yin meridians, leading to internal injury. As previously advised, avoid mutton and chicken broths and tonics like Dang Gui Wan or Si Shun Li Zhong Wan, which are too hot. If organs are not cold, they cannot tolerate such heat. When the abdomen feels empty after birth, cravings for eggs may arise, but eggs are hard to digest and may cause illness. It is common for healthy mothers to recover better by avoiding Hei Shen Dan, meat, and eggs, instead consuming white porridge, dried vegetables, and small amounts of salted fish for half a month, which nourishes Stomach Qi and prevents disease. Wealthy, indulgent women who suddenly develop headaches, chest fullness, phlegm, dry mouth, or irregular menstruation often suffer from Yang excess and Yin deficiency. Natural Qi and Blood are balanced; such disorders arise from misconceptions and improper practices.