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*Biandan Xu Zhi* (Necessities for Childbirth) states: Near the due month, if abdominal pain occurs, sometimes appearing and sometimes ceasing, or lasting for one to two days or three to five days, with amniotic fluid already present but abdominal pain unceasing, this is called "Nongtai" (Playing Fetus), which is not the actual time of delivery. There is also a condition occurring one month before the due date, where sudden abdominal pain feels as if birth is imminent; this is called "Shitai" (Testing Fetus), which is also not the actual time of delivery. In cases of abdominal pain, whether amniotic fluid has come or not, it is generally harmless; one should simply relax the mind and wait for the proper time. If it is indeed the time for delivery, the pain will be extreme and unceasing, accompanied by heaviness and distension in the lower back, a sensation of bearing down in the anus (Gongdao Tingbing), and the flow of amniotic fluid, after which the infant will be born. This is because childbirth has its own appointed time, just as ripe fruit naturally emits fragrance and a ripe melon falls from its stem.

Shenzhai commented: The above four points outline methods for care and nursing during the臨產 period, as well as essential medicines to prepare. Regarding "Nongtai" and "Shitai," these are conditions that may occur near term; one must not panic or act rashly, lest harm be caused.

*Daquan Liang Fang* (Great Comprehensive Good Prescriptions) states: Women are primarily governed by Blood. Only when Qi flows smoothly does Blood harmonize, and only when the Fetus is secure is delivery smooth. Nowadays, wealthy families live in excessive comfort, leading to Qi stagnation and failure of the fetus to turn. Alternatively, sexual intercourse causes Essence and Blood to accumulate in the Uterus, both of which can lead to difficult labor.

Xu Shuwei stated: There are cases where delivery is delayed for several days, and催产 herbs fail to work. This is certainly because the woman went to bed too early, and fear caused Qi to knot and cease flowing. The Classics state: Fear causes Qi to sink downward; fear causes Jing (Essence) to become timid. Timidity causes the Upper Jiao to close; closure causes Qi to return; returning Qi causes Lower Jiao distension, and thus Qi fails to move. Administering Zisu Yin (Perilla Decoction) results in delivery after one dose.

Guo Jizhong stated: Difficult labor often occurs because the fetus turns, breaking the blood of the "Erzhen" (Fetal Pillow/Placental remnant), which obstructs with stale blood in the Uterus, preventing the fetus from moving freely, thus causing difficult labor. One must urgently administer Shengjin San (Winning Gold Powder) to resolve the blood stasis, making delivery easier.

Chen Wuyue stated: Difficult labor is mostly due to the fetus not being in a normal position, going to bed too early, or exerting effort excessively, causing the membranes to rupture while blood and fluids dry up, blocking the birth canal and hindering the fetus's descent. One should first administer Cisheng Rushen San (Divine-like Delivery Promoting Powder) to consolidate the Blood and Qi.

Yu Tianmin stated: Someone asked about Danxi’s view that women with difficult labor often failed to be cautious during the eighth and ninth months, leading to deficiency of Qi and Blood. What is the meaning? I replied: Pregnant women should not share a bed with their husbands. People today do not understand this principle and engage in intercourse even in the eighth or ninth month. When desire arises, Qi and Blood are consumed. The fetus relies entirely on Qi and Blood for nourishment. Once Qi and Blood are depleted, the fetal breath becomes weak. When the term is full and delivery begins, tearing through the membranes to find a path out, once the membranes rupture, amniotic fluid flows abundantly. If the fetal breath is strong, the fetus follows the fluid down easily, resulting in smooth delivery. If the fetal breath is weak, turning is slow, and it cannot follow the fluid. With the amniotic fluid dried up and foul blood blocking the birth path, the fetus has no direction, leading to transverse or breech presentation. Urgently administer delivery-promoting herbs to expel evil blood, clear the passage, and facilitate rapid delivery.

Shenzhai commented: The above five points describe the dangers of difficult labor near term. Causes of difficult labor include, prior to labor, Qi stagnation from excessive ease, Qi knotting from fear, and imprudence in sexual activity. Near labor, there is obstruction by stale blood and drying up of amniotic fluid. These essentially cover the main syndromes.