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[Mai Jue] The pulse of a woman about to give birth leaves the regular channel (referring to significant changes in pulse quality, such as from deep to floating), manifesting as deep, fine, and slippery; this pulse is also called "Li Jing" (Leaving the Regular Channel). If abdominal pain is felt at midnight, it should be known that delivery will definitely occur at noon the next day.

The *Mai Jing* (Pulse Classic) states: Regarding "Li Jing," the pulse is floating; if accompanied by abdominal pain radiating to the lower back and spine, this indicates imminent delivery. However, merely having a Li Jing pulse does not guarantee immediate delivery. It further states: If the pulse is Li Jing and pain is felt at midnight, birth will occur at midday. "Jing" means constant or regular. "Li Jing" refers to the pulse leaving its usual position. For example, if yesterday the pregnant woman's left wrist pulse was deep and solid (indicative of a male fetus), and today it has become floating, this represents a departure from her usual pulse pattern and differs from yesterday's. Combined with abdominal pain, one knows that delivery is impending. Tong Zhenzi cited the *Nan Jing* (Classic of Difficult Issues), defining "one breath three beats" as Li Jing, to explain this. Li Fan further cited the *Nan Jing*, defining "one breath one beat" as Li Jing, to explain the deep, fine, and slippery pulse; both interpretations are incorrect. The *Nan Jing* states that although both deficient (Sun) and excessive (Zhi) pulses may be termed Li Jing, their pulse principles differ. Moreover, the *Mai Jing* explicitly states that the Li Jing pulse is floating and does not cite the *Nan Jing* to support the *Mai Jue*. Because the *Mai Jue* mentions a floating pulse and adds deep, fine, and slippery qualities under the name Li Jing, it is likely because previous methods for diagnosing fetal sex sometimes showed a large floating pulse for females. If only a floating pulse were defined as Li Jing, how would one distinguish Li Jing from the normal large floating pulse seen in female pregnancies? Therefore, deep, fine, and slippery qualities were added to show that Li Jing is a departure from the usual large floating pulse, specifically relative to the usual slippery pulse. The *Sheng Hui Fang* states: If abdominal pain begins at Zi hour (midnight), delivery will surely occur at Wu hour (noon). This is because Zi and Wu hours are opposite, spanning half a day. Tong Zhenzi stated that "pain at midnight, birth at noon" is perhaps not entirely accurate. He also said: Abdominal pain without lumbar pain indicates labor has not started. Severe abdominal pain combined with severe lumbar pain indicates imminent delivery. This is because the Kidneys govern the lower back, and the uterus is connected to the Kidneys. Palpating the Chi (Cun Cun) pulse, if it becomes urgent, like cutting a rope or rolling beads, delivery is imminent. Delivery varies in difficulty, and pain varies in intensity; how can it be fixed at half a day? One must apply flexible methods.) A heavy body, fever, and frequent chills, blackish-blue sublingual veins, a tongue that curls backward with a cold palate indicate fetal death; if the fetus is in this state within the abdomen, the mother will also die. A red face and cyanotic tongue require careful examination; it is difficult for the mother to survive while the fetus dies. If lips and mouth are cyanotic with frothing, both mother and child will die, requiring desperate measures. A cyanotic face, red tongue, and frequent frothing indicate maternal death with fetal survival. If you do not believe this, verify it; the wisdom of sages is not false. (*Mai Nan Zhi* writes cyanotic face and red tongue. Generally, the face reflects the mother, and the tongue reflects the fetus. Since it says the fetus survives, the red tongue is correct. If the tongue were cyanotic, it would contradict the earlier sign of red face/cyanotic tongue indicating maternal survival/fetal death. If the fetus presents first, it may survive; if not, both perish. From "heavy body..." onwards, pulse diagnosis is not used; instead, external signs are consulted to determine maternal and fetal life or death, because the labor pulse is unpredictable, and one should rely on observing complexion.)

Yang Zijian's *Ten Types of Labor*:
1. **Zheng Chan** (Normal Labor): When a woman carries a fetus for ten months, she suddenly experiences paroxysmal lower abdominal and lumbar pain. Subsequently, the fetal Qi descends abruptly. Pain reaches the navel and abdomen intensely, followed by heavy lumbar pain, rectal protrusion (tenesmus), rupture of membranes, and bleeding, after which the infant is born. This is called Normal Labor.

2. **Shang Chan** (Injured/False Labor): Human birth is determined by Yin and Yang timing and cannot be altered prematurely. If a woman experiences sudden umbilical and abdominal pain resembling labor more than a month before term, but then nothing happens, this is called "Shi Yue" (Testing Month), not true labor. However, for all parturients, before true labor signs appear, no one should hold their waist, and the parturient must not strain uselessly. When a woman is about to deliver, if her abdomen hurts but the fetus is not yet in position, and the midwife encourages her to strain randomly, the fetus may shift incorrectly, becoming transverse or inverted, unable to deliver normally. This results from improper straining by the mother. Straining should only begin when the fetus is in position and approaching the cervix, pushing once to deliver. Straining too early before true labor signs, or taking drugs indiscriminately, is like pulling shoots to help them grow—harmful and useless. This is called Injured Labor.

[Lou] The method above to prevent Injured Labor is crucial and must not be neglected. If ten months are not complete, and there is labor-like pain that comes and goes or is mild, it is called "Nong Tong" (Playing Pain), not true labor. Severe abdominal pain without severe lumbar pain is not true labor. High fetal position not descended is not true labor. No rectal protrusion is not true labor. Ruptured membranes and no blood loss is not true labor. Blood and fluid discharge without abdominal pain is not true labor. If there are no signs of true labor, allow the woman to walk and endure patiently. If she cannot walk, let her sit leaning on something or lie down quietly. Administer one or two doses of An Tai (Fetus-Calming) medicine; stop once comfort is achieved. Do not recklessly administer Cu Chan (Labor-Inducing) drugs, causing panic and fear which damages her spirit. Ensure the parturient remains calm and composed, and have the midwife explain the situation. If she feels stifled, take one spoonful of white honey mixed with fresh water. Do not strain wildly, exhausting the mother first. Only when the fetus presses against the cervix, lumbar pain is extreme, eyes feel fiery, and rectum protrudes, is it true labor; only then strain and take labor-inducing drugs. My family member experienced severe lumbar and abdominal pain resembling labor more than a month before term, peaking until Si hour (9-11 AM) when it eased slightly. This lasted over ten days. Finding no solution, I reviewed this text and prescribed An Tai medicine with Ginseng and Atractylodes for several doses, supplemented with meat broth. She recovered and remained pain-free, delivering a boy twenty days later. Had we strained or used inducing drugs then, she would have faced immediate danger.

3. **Cui Chan** (Induced Labor): Refers to when a woman is ready to deliver, membranes rupture, blood flows, severe paroxysmal abdominal pain occurs, and signs of true labor (lumbar heaviness, rectal protrusion) are present, but the fetus has not yet been born. Medication can be administered to accelerate delivery. If several days pass, the mother is exhausted, and true labor signs are clear but the fetus struggles to emerge, medication can boost the mother's Zheng Qi (Upright Qi) to facilitate rapid delivery. This is Induced Labor.

4. **Dong Chan** (Cold Labor): In winter, cold weather causes menstrual blood to coagulate, preventing fetal descent. This is highly dangerous. In winter deliveries, the lower body must not be exposed to cold; cotton clothes should remain on. Avoid sitting or lying in cold places. Keep the room warm with fire. Have the mother face away from the heat source towards warmth, keeping the area below the navel and knees warm. Warmth promotes blood flow, facilitating easier delivery. This is Cold Labor.

[Xue] Jing's wife had difficult labor in early winter, damaging Yuan Qi (Primal Qi); the baby was stillborn. We burned an oil-paper wick through the umbilical cord, using its heat to warm the infant. Shortly after, the infant made sounds. This child never suffered from food stagnation or diarrhea, proving the efficacy of this method.

5. **Re Chan** (Hot Labor): In midsummer, mothers must maintain appropriate warmth and coolness. Do not excessively seek coolness, damaging fetal Qi. Also, avoid crowding with many people generating heat, which causes maternal blood to boil, leading to fever, headache, flushed face, dizziness like drunkenness, and unconsciousness. This is Hot Labor. (If summer is cool or rainy, do not seek excessive coolness, lest serious illness arise.)

6. **Heng Chan** (Transverse Lie): The fetus presents hand or arm first. This is caused by the mother straining improperly or too early. With the fetus malpositioned, forceful straining causes transverse presentation. The mother should lie supine. The attendant should gently push the presenting limb upward toward the body, massaging the shoulder with the middle finger to correct alignment, or pulling the ear. The mother must remain supine while the fetus is gently pushed up and corrected. Once aligned, administer a cup of labor-inducing decoction, then strain to deliver. This is Transverse Lie.

7. **Dao Chan** (Breech Presentation): Due to insufficient fetal Qi and weak pelvic floor, combined with premature straining, the fetus fails to turn and presents feet first. The mother should lie supine. The attendant should push the feet back up. The mother must exert zero effort and remain calm to allow natural repositioning.

**She Tuo San** (Snake Molt Powder): Treats pregnant women near term who refuse to move, curling in bed enduring pain, causing the fetus to be unable to turn, resulting in foot-first presentation (Ni Sheng). Without prompt rescue, both mother and child die.
Ingredients: One snake molt (Wu She Tui), fourteen cicada molts (Chan Tui), one handful of hair cinder (Xue Yu, preferably fetal hair).
Process: Calcine all ingredients to ash, retain nature, grind into powder. Divide into two doses. Mix with warm wine and consume continuously. Have the mother lie supine for a moment. Alternatively, prick the sole of the fetal foot 3-5 times with a small silk needle, apply a little salt to the puncture site. Delivery will proceed smoothly, saving both. Another method: Apply salt to the soles of the feet, scratch with fingernails, and rub salt on the mother's abdomen. Another method: Use the middle finger to collect soot from the bottom of a pot, draw cross marks on the soles of the feet; delivery proceeds smoothly. Another method: Write the father's name on the soles of the feet; delivery proceeds smoothly. For transverse presentation where the fetus cannot exit, take Che Qian Zi (Plantago Seed) powder, mix with wine, take 2 qian bi. Another method: Tu Si Zi (Cuscuta Seed) powder, mix with wine, take 1 qian bi; rice water is also acceptable. Another method: Bai Cao Shuang (Soil Soot) and Xiang Bai Zhi (Angelica Dahurica), equal parts not roasted. Mix with child's urine and good vinegar (1 he each) into a paste. Take immersed in boiling water. Severe cases resolve in two doses. If transverse/breech difficult labor with dead fetus in utero: First, stir-fry one large measure of black beans. Cook with water and heavy urine (repeatedly urinated water), drink. Miraculous effect. Another method: Boil 0.5 jin of Ai Ye (Mugwort Leaf) in 4 sheng of wine, reduce to 1 sheng, drink. Another method: Dang Gui (Angelica Sinensis) powder, taken with wine (1 cun bi); Zi Su Tang (Perilla Decoction) is also acceptable.

8. **Pian Chan** (Asymmetrical Presentation): The fetus is not upright. Forceful straining causes the head to press against the left or right thigh. The head emerges but is stuck on one side. The mother should lie supine. The attendant should gently push the fetus upward, manually correcting the head to ensure the vertex is centered. Then the mother strains to deliver. If the occiput presses against the anus, exposing only the forehead: The attendant, wearing warmed cotton-wrapped hands, should gently push the head from outside the anus to correct alignment, then the mother strains. This is Asymmetrical Presentation.

9. **Ai Chan** (Obstructed Labor): The fetus is in position, presenting the vertex, but cannot descend. This is often due to the fetus turning, causing the amniotic sac/belt to catch on the shoulder, blocking the vertex. The mother should lie supine. The attendant should gently push the fetus up, slowly guiding the hand, pressing the shoulder with the middle finger to dislodge the sac. Wait until the fetus is straight and smooth, then the mother strains to deliver. This is Obstructed Labor.

For the four methods above (Transverse, Breech, Asymmetrical, Obstructed), if the attendant is not highly skilled, do not attempt these manipulations, lest ignorance cause harm. Note: Breech births often result in healthy infants delivered feet-first without sequelae; manual correction is not always necessary. Regarding Obstructed Labor, sometimes the sac wraps around the vertex, but the head exits naturally past the perineum. Attendants may manually clear the sac over the head. Sometimes the sac wraps once around the vertex, and the fetus and placenta descend together naturally. These are harmless; do not insert hands to remove the sac unnecessarily.

10. **Zuo Chan** (Sitting Labor): As birth approaches, the mother sits for a long time due to fatigue. The chair/cushion obstructs the birth canal. Tie a handkerchief high up. Let the mother hold it, bend her legs, and sit in a semi-upright position to aid delivery. This is not sitting on an object. This is Sitting Labor.

11. **Pan Chang Chan** (Prolapsed Intestine Labor): The mother's intestine prolapses before the fetus is born. Lady Gong, wife of Zhao Duyun, always experienced rectal prolapse before delivery, causing great distress postpartum as the intestine did not retract. Doctors could not treat it. While in Jianchang, she learned a method from a midwife: Mix half a cup of vinegar with seven parts fresh water. Apply to the mother's face. Each time the intestine retracts slightly, repeat three times until fully retracted. This is an excellent method.

Note: Ancient formulas for this condition used 49 castor bean kernels, ground and applied to the crown of the mother's head to retract the intestine, then washed off immediately. If the intestine is dry, moisten slightly with knife-sharpening water. Internally, drink magnetite decoction to retract. Magnetite must be verified effective by Yin-Yang practitioners. Using cold water on the face may cause fright and Qi dispersion.

[Dan] Postpartum intestinal prolapse: Heat 5 jin of sesame oil, pour into a basin. When warm, sit in the oil basin for about one mealtime. Blow powdered Gleditsia sinensis (Zao Jiao) into the nose to induce sneezing, which instantly retracts the intestine. Excellent. (*Dou Men*)

[Dai] Rhizoma Pinelliae (Ban Xia) powder insufflated into the nose retracts the intestine.

Another method: Dip a large paper wick in sesame oil, light it, blow out, and smoke the mother's nose with the fumes; the intestine retracts.

Another method: Place the prolapsed intestine in a clean lacquerware vessel. Immerse in concentrated Scutellaria baicalensis (Huang Qin) decoction; the intestine retracts.

[Xue] At the onset of labor, feeling internal movement, lie supine upright. Wait for the fetus to turn downward and pain to begin. Test the middle joint or proximal phalanx of the mother's middle finger for pulsation. Only then prepare for delivery; birth will follow. If one does not lie supine initially to wait for fetal rotation, or if waters break frequently before labor starts, the membranes have ruptured, fluids dried up, risking malpresentation and dystocia. If membranes rupture but delivery fails, Bao Sheng Wu You San (Preserve Life and Peace of Mind Powder) stabilizes blood, allowing natural birth. If blood is depleted, use Ba Zhen Tang (Eight Treasures Decoction) 1 jin, plus 0.5 jin Motherwort (Yi Mu Cao), decoct in several bowls of water, drink intermittently; some survive. Generally, abdominal pain alone in pregnancy indicates pre-labor. Severe pain extending to the lower back indicates imminent labor, as Kidneys govern the back and connect to the uterus. Pregnant women should hire compassionate, experienced midwives in advance, building rapport. Inform them beforehand. If complications arise, tell the mother it is just pre-labor. If twins, say the placenta hasn't descended. Fear disperses Qi, making birth harder. My family experience confirms that difficult labor often affects depressed, idle, wealthy families. Treatment theories suggest clearing Qi before birth and tonifying blood after, but do not adhere rigidly. If Spleen/Stomach are weak and Qi/Blood insufficient, tonify in advance; otherwise, labor difficulties are inevitable. In case of difficult labor or extreme cold, slowly burn the umbilical cord with a thick oil-paper wick. Even if the infant is dead, warmth entering the abdomen may revive them. Never cut with a knife.