难产之由不一端，胎前安逸过贪眠，惊恐气怯用力早，胞破血壅血浆干。
【注】妊娠难产之由，非只一端。或胎前喜安逸不耐劳碌，或过贪眠睡，皆令气滞难
产；或临产惊恐气怯，或用力太早，则产母困乏难产；或胞伤血出，血壅产路，或胞浆
破早，浆血干枯，皆足以致难产。临证之工不可不审也。
胞衣不下因初产，用力劳乏风冷凝，下血过多产路涩，血入胞衣腹胀疼，急服夺命没竭散，勿使冲
心喘满生。谕令稳婆随胎取，休惊产母莫教闻。
【注】产妇胞衣下不者，或因初产用力困乏，风冷相干致血瘀凝；或因下血过多，血
枯产路干涩；或血入胞衣，胀满疼痛，皆能使胞衣不下。均当急用夺命散，即没药、血
竭二味为散也。免致上攻心胸，胀满喘急，为害不小。且宜谕令稳婆随胎取下，莫使产母
闻之，恐被惊则愈难下也。
产门不闭由不足，初产因伤必肿疼。不足十全大补治，甘草汤洗肿伤平。
【注】凡产后玉门不闭者，多由气血不足所致。亦有因初产伤重者，必肿而疼也。气
血不足者，用十全大补汤治之；因伤肿痛者，浓煎甘草汤洗之，其肿伤自平。
十全大补汤（方见首卷）
清魂散
产后血晕恶露少，面唇色赤是停瘀；恶露去多唇面白，乃属血脱不须疑。虚用清魂荆芥穗，人参芎
草泽兰随；腹疼停瘀佛手散，醋漆熏法总相宜。
【注】产后血晕，有因恶露去少，内有停瘀上攻迷晕者，面唇必赤色；有因去血过多，
血脱而晕者，面唇必色白。血弱者宜用清魂散，即荆芥穗、人参、川芎、甘草，泽兰叶
也。若停瘀腹痛者，用佛手散。二者俱宜频烧干漆及用火烧铁钉淬醋，不时熏之。
佛手散（方见首卷）
The causes of dystocia are not limited to one aspect; they may result from excessive comfort and oversleeping during pregnancy, fright leading to qi deficiency and timidity, or premature exertion causing rupture of the amniotic sac, blood stasis, and drying up of plasma.
[Note] The causes of dystocia during pregnancy are not singular. Some cases arise because the pregnant woman prefers comfort and cannot endure labor, or sleeps excessively, all of which lead to qi stagnation and difficult delivery. Others occur due to fright and qi deficiency at the time of labor, or premature pushing, resulting in maternal exhaustion and difficulty in delivery. Still others result from injury to the amniotic sac with bleeding, blood stasis obstructing the birth canal, or premature rupture of membranes with drying up of fluids and blood, all of which can cause dystocia. Clinicians must carefully examine these conditions.
Retained placenta is often seen in primiparas, caused by exhaustion from excessive pushing combined with cold-wind invasion coagulating blood, or excessive postpartum hemorrhage leading to a dry and rough birth canal, or blood entering the placenta causing abdominal distension and pain. In such cases, immediately administer Duoming Shejie San (Life-Rescuing Myrrh and Dragon's Blood Powder), preventing the pathogenic factors from rushing to the heart and chest, which could cause asthma and fullness leading to death. Instruct the midwife to remove the placenta immediately after the fetus is delivered, avoiding startling the mother or letting her hear about the procedure.
[Note] Retained placenta may be due to fatigue and weakness from excessive pushing during first-time labor, where cold-wind interferes causing blood stasis and coagulation; or due to excessive blood loss leading to blood depletion and a dry, rough birth canal; or blood entering the placenta causing distension and pain, all of which prevent the placenta from being expelled. One should urgently use Duoming San, composed of Myrrha (Myrrh) and Draconis Sanguis (Dragon's Blood) ground into powder. This prevents the pathogen from attacking the heart and chest, causing distension and急促 breathing, which poses significant harm. It is advisable to instruct the midwife to remove the placenta immediately following fetal expulsion, ensuring the mother does not hear about it, as fear may hinder its expulsion.
Vulvar laxity (failure of the vaginal opening to close) is primarily due to insufficiency; in primiparas, it is necessarily accompanied by swelling and pain due to injury. Insufficiency is treated with Shiquan Dabu Tang (Ten Substance Great Tonifying Decoction), while swelling and injury are treated by washing with Gancao Tang (Licorice Decoction).
[Note] Postpartum failure of the Yumen (vaginal opening) to close is mostly caused by qi and blood deficiency. In some cases, severe injury during first-time labor inevitably leads to swelling and pain. For qi and blood deficiency, treat with Shiquan Dabu Tang (Ten Substance Great Tonifying Decoction); for swelling and pain due to injury, wash with concentrated Gancao Tang (Licorice Decoction), and the swelling and injury will naturally subside.
Shiquan Dabu Tang (Formula see Volume 1)
Qinghun San
Postpartum syncope with scant lochia indicates retained blood stasis, characterized by red face and lips; profuse lochia loss with pale lips indicates blood collapse, without doubt. For deficiency patterns, use Qinghun San, composed of Jingjie Sui (Schizonepeta Spike), Renshen (Ginseng), Chuanxiong (Ligusticum Rhizome), Gancao (Licorice Root), and Zelan Ye (Eupatorium Leaf). For abdominal pain due to retained stasis, use Foshou San (Buddha's Hand Powder), and fumigation with vinegar and dried lacquer is generally suitable.
[Note] Postpartum syncope can be caused by scant lochia with internal retained stasis rushing upward causing coma and dizziness, where the face and lips appear red; or by excessive blood loss leading to blood collapse and fainting, where the face and lips appear white. For blood deficiency, Qinghun San is appropriate, composed of Schizonepeta Spike (Jingjie Sui), Ginseng (Renshen), Ligusticum Rhizome (Chuanxiong), Licorice Root (Gancao), and Eupatorium Leaf (Zelan Ye). If there is retained stasis with abdominal pain, use Foshou San (Buddha's Hand Powder). Both conditions are suitable for frequent fumigation using burnt dried lacquer and iron nails heated in fire and quenched in vinegar.
Foshou San (Formula see Volume 1)