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(Support, Injury to Fetus, Dry Womb, Dystocia, Obstetric Complications, Palpation, Lying-in Posture, Labor Induction, Dietary Taboos, Preparation Methods, Method for Expelling Dead Fetus, Retained Placenta, Failure of Pubic Symphysis Separation, Vaginal Orifice Incompetence, Uterine Prolapse)

**Support**: During the ninth month of pregnancy, it is advisable to take Dasheng San (Birth-Ready Powder) for several doses. For those who are obese with robust Qi, use Zhiqiao (Bitter Orange Peel, *Citri Reticulatae Pericarpium*) two liang, Xiangfu (Cyperus Rhizome, *Cyper Rotundii Rhizoma*) and Gancao (Licorice Root, *Glycyrrhizae Radix et Rhizoma*) one liang each, ground into powder, taken with boiling water, two qian per dose, morning and evening. For those with excess Blood and dark complexion, use Zhiqiao (Bitter Orange Peel, *Citri Reticulatae Pericarpium*) two liang and Danggui (Angelica Sinensis Root, *Angelicae Sinensis Radix*) one liang, ground into powder, mixed with refined honey to form pills, taken on an empty stomach with wine, fifty pills per dose. However, for those with deficient Yuan Qi (Primal Qi), only large doses of Zisu Yin (Perilla Decoction) can boost their Qi, ensuring smooth delivery. If the previous remedies are mistakenly used, they will consume Qi, often leading to dystocia.

**Injury to Fetus**: Near term, if amniotic fluid has not ruptured but bleeding occurs first, this indicates injury to the fetus, not labor. Large doses of Baoyuan Tang (Protect the Origin Decoction) added with Danggui (Angelica Sinensis Root, *Angelicae Sinensis Radix*) and Tongbian (Child's Urine) are most effective. If movement near labor has injured the fetus and fever ensues, the condition is critical; double the Ren Shen (Ginseng Root, *Panacis Ginseng Radix*) in Zisu Yin (Perilla Decoction).

**Dry Womb**: During labor, if amniotic fluid and lochia have completely drained, causing the fetus to become dry and stuck, difficult to deliver. Remove Bai Zhu (Atractylodes Macrocephala Rhizome, *Atractylodis Macrocephalae Rhizoma*) from Dasheng San (Birth-Ready Powder) and double the Ren Shen (Ginseng Root, *Panacis Ginseng Radix*). If the membranes have ruptured for a long time and blood is depleted, with Yuan Qi (Primal Qi) exhausted and fatigued, urgently use high-quality Ren Shen (Ginseng Root, *Panacis Ginseng Radix*) approximately one liang and Danggui (Angelica Sinensis Root, *Angelicae Sinensis Radix*) two qian, decocted and drunk. After finishing, decoct again to assist Qi and Blood, which is most effective. Abandoning this method to use various gas-consuming labor-inducing drugs will yield no results.

**Dystocia**: Dystocia refers to prolonged abdominal pain without delivery. If lochia is scanty, prolonged pain is not harmful because the amniotic fluid has not ruptured; natural delivery will occur when the fluid flows. Severe lower back pain indicates imminent labor, as the Kidney governs the waist and the fetus is connected to the Kidney. If amniotic fluid ruptures first and lochia drains, but delivery does not occur after days, nourish Qi and Blood. Do not use blood-breaking or Qi-consuming drugs. Urgently use Foshou San (Hand-of-Buddha Powder) added with Ren Shen (Ginseng Root, *Panacis Ginseng Radix*) two to three qian, mixed with hot Tongbian (Child's Urine). This utilizes pure Yang Sheng Qi (Vital Qi); do not let the medicine cool, as coldness dissipates Vital Qi and hinders treatment. Alternatively, send down Tubao Wan (Rabbit Brain Pills) with the previous medicine. Selecting a skilled midwife is crucial for dystocia. Only when fetal Qi rebels upward is medical intervention key. For Qi stagnation rebelling upward, frequently administer hot urine; white urine is good, child's urine is not strictly required. For Qi deficiency failing to guide the fetus downward causing rebellion, use Danshen Tang (Single Ginseng Decoction) added with urine. In cases of fainting, foaming, convulsions, enuresis, and delirium, urgently pull the crown hair, pry open the teeth, and administer urine. Delay means death. Danxi stated: Dystocia often affects depressed, idle people from wealthy families. It is rare among hardworking poor people. The ancient formula Shoutai Yin (Thin-Fetus Drink) was made for Princess Huyang and may not be universally applicable. My cousin suffered from dystocia and terminated pregnancies repeatedly. I pitied her; she was frail but diligent, indicating Qi deficiency worsened by sedentary habits. The fetus could not move due to maternal Qi deficiency. Nourishing maternal Qi facilitates fetal movement and delivery. She conceived again; at six months, I prescribed Zisu Yin (Perilla Decoction) with Qi-tonifying herbs for dozens of doses, resulting in a smooth male birth. I modified this formula based on constitution and season, achieving consistent success. At labor, remove Chuanxiong (Sichuan Lovage Rhizome, *Ligustici Chuanxiong Rhizoma*) and Shengjiang (Fresh Ginger, *Zingiberis Recens Rhizoma*), add Baizhu (Atractylodes Macrocephala Rhizome, *Atractylodis Macrocephalae Rhizoma*) and Huangyang Nao (Boxwood Knot, *Buxi Fructus*), reducing abdominal pain and maternal distress. Hence named Dasheng San (Birth-Ready Powder). For dystocia and retained placenta, moxa three cones (wheat-sized) on the tip of the right little toe; delivery follows immediately. Non-crying newborns should not have their umbilical cords burned, or they will fail to thrive later. Thick, blue umbilical cords with excessive bleeding, or early/late cord separation, indicate non-viability. Shiwan stated: Dystocia often stems from obstinate temperaments and lack of self-restraint during pregnancy, causing Qi and Blood disharmony and fetal malposition. Even with labor-inducing drugs, there is no effect. Months of discord cannot be resolved instantly. For those exhausted from prolonged labor, large doses of Danshen Tang (Single Ginseng Decoction) to tonify Qi forcefully aid delivery. It is strange that midwives and families forbid Ren Shen (Ginseng Root, *Panacis Ginseng Radix*) during labor, watching women die. Those harmed by Ren Shen (Ginseng Root, *Panacis Ginseng Radix*) are usually overworked, robust individuals whose diseases resolve through expulsion, not tonification. Forcing it on them causes heart/lung damage, heat, and lochia stasis. Conversely, pampered, fragile individuals tolerate Ren Shen (Ginseng Root, *Panacis Ginseng Radix*) well without adverse effects. My wife, frail and depressed, took one to two liang of Ren Shen (Ginseng Root, *Panacis Ginseng Radix*) concentrated in decoction during labor, allowing natural delivery. Her daughter-in-law had Qi-stagnation dystocia; despite midwife opposition, she took Ren Shen (Ginseng Root, *Panacis Ginseng Radix*). On the fourth day, the fetus died. We urgently administered large-dose Ren Shen (Ginseng Root, *Panacis Ginseng Radix*) decoction. Postpartum records state that before taking Ren Shen (Ginseng Root, *Panacis Ginseng Radix*), she experienced deafness, blindness, red vision turning purple-black. After taking it, vision cleared, spirit stabilized, and labor pains began. Recently, colleague Wang Gongjun’s wife had dystocia; self-administered seven qian of Ren Shen (Ginseng Root, *Panacis Ginseng Radix*) in one dose, resulting in immediate delivery. Its supportive efficacy surpasses other inducers. I detail this to dispel misconceptions.

**Obstetric Complications**: Arm presentation before birth is called transverse lie, caused by premature pushing. Have the mother lie supine; the midwife pushes the arm up, using the middle finger to press the shoulder, gently pulling the ear to correct position. Administer large Qi and Blood tonics like Danshen Tang (Single Ginseng Decoction) with Danggui (Angelica Sinensis Root, *Angelicae Sinensis Radix*) and Tongbian (Child's Urine). Do not frighten the mother to prevent Qi/Blood stagnation. Once the fetus is straight and aligned, push. Premature pushing with insufficient fetal Qi causes foot presentation (breech). Correct as above. If the head deviates left or right near the cervix due to premature pushing, it is oblique presentation. Correct as above. If the buttocks present due to forceful expulsion before full rotation, it is breech presentation. Correct as above. Administer Qi harmonizing and Blood nourishing herbs, rest, wait for strength, then push. If the umbilical cord wraps around the neck (nuchal cord), push back gently, clear it, then push. Natural vertex presentation occurs if the head turns to the birth canal. If unable to rotate, feet step on the placenta, and the cord presents first (prolapsed cord). Midwife must clear and push back quickly while the mother rests; delay causes re-prolapse. Intestinal prolapse during birth (rare, lacking mesenteric attachment) requires a lacquerware vessel washed with warm water, kept warm and moist to hold the intestine. Avoid dust or drying, which prevents retraction. Skillful midwifery is essential. In cold weather, blood stagnates; keep warm, avoid removing clothes or sitting on cold surfaces, use fire warmth and cotton wrapping on shoulders/back to promote blood flow. In spring/autumn chill, apply similar warming methods. In summer, keep the mother in cool, windless places, limit observers to prevent heat accumulation causing headache, flushed face, and unconsciousness (Blood Syncope). In cool/rainy summer days, avoid cooling off excessively to prevent severe illness.

**Palpation**: During labor pain, midwives must not palpate or probe. Even with ruptured membranes and extreme pain, endure it. Walk slowly with support to allow natural fetal alignment. If membranes rupture but the fetus does not descend, it is "testing waters," indicating slow labor, sometimes lasting 2-3 days. Take Bazhen Jiao'ai Tang (Eight Treasures with Gelatin and Mugwort Decoction) to stop pain and calm. Sometimes labor lasts 5-6 days. Feel fetal movement but do not allow midwives to handle or mothers to push. The fetus uses all strength to exit and may need days to regain strength for proper rotation and descent. Most dystocia cases stem from improper living habits and midwives' premature handling/palpation. Rural women rarely have difficult births. Wealthy women, unaccustomed to labor, sit/lie idly, causing meridian stagnation, overeat rich foods leading to large fetuses, and indulge in sex, depleting maternal Qi, unlike rural women's natural vitality. Calling midwives at the first sign of pain near term disturbs fetal Qi and damages congenital sources, harming mother and child, or causing postpartum complications due to organ injury. Infant mortality often relates to incomplete congenital Qi.

**Lying-in Posture**: Lie supine and straight during labor, not sideways. Do not sit too early. Male fetuses face inward, females outward, both head-up, feet-down. During labor, they must invert and exit smoothly. Walk slowly with support to facilitate rotation. Otherwise, transverse lie risks arise.

**Labor Induction**: During early labor, use Dasheng San (Birth-Ready Powder) removing Shaoyao (Peony Root, *Paeoniae Radix Alba*), adding Zhiqiao (Bitter Orange Peel, *Citri Reticulatae Pericarpium*), Huangyang Nao (Boxwood Knot, *Buxi Fructus*), and Tongbian (Child's Urine). Only give hot administration after membrane rupture and severe back pain. Too early induces lochia prematurely, causing dystocia. If under ten months, with intermittent or mild pain, it is "false labor" (Nongtai). If severe abdominal pain but mild back pain, high fetal position, no rectal pressure, no fluid rupture, or fluid out but no pain, it is Qi deficiency, not true labor. Use Danshen Tang (Single Ginseng Decoction). Do not give random drugs causing panic and useless pushing. Wait until the head presses the cervix, severe heavy back pain, burning eyes, and rectal protrusion before pushing and taking inducers. Qianjin Fang uses Ejiao (Donkey-hide Gelatin, *Asini Corii Colla*) three liang, Huashi (Talcum, *Talcum*), Cheqianzi (Plantago Seed, *Plantaginis Semen*) two liang, ground, taken with water. Repeat if needed. Take only when necessary, not beforehand.

**Dietary Taboos**: Diet during labor should be balanced. Do not starve, causing maternal weakness. Do not overeat, hindering fetal Qi movement. Harm to mother and child, postpartum fever, diarrhea, epigastric pain stem from dietary injury. Even fluids should be limited; excessive drinking causes bladder rupture due to overdistension. Various crises stem from pre-labor negligence. Alcohol is taboo, causing blood rebellion upward; suppress with hot Tongbian (Child's Urine), though often fatal. Pork kidneys and eggs are hard to digest; avoid in late pregnancy and labor.

**Preparation Methods**: For abnormal presentations, use 14 Castor Seeds (Ricini Semen, *Ricini Semen*), Cinnabar (Zhusha, *Cinnabaris*), Realgar (Xionghuang, *Realgar*), one chi of Snake Slough (Shetui, *Bomby Batryticatus*) burnt to ash, and Musk (Shexiang, *Moschus*) one zi. Mix with water into a pill. Wash navel with Sichuan Pepper soup, insert pill, cover with paper, bind. Delivery follows; remove pill. For transverse/breech with limbs presenting, rub salt on infant's palms/soles. For intestinal prolapse, mix fresh well water with vinegar and flour to retract. Alternative: Mash 14 Castor Seeds (Ricini Semen, *Ricini Semen*), apply to mother's vertex; intestine retracts upon removal. Alternative: Snuff Banxia (Pinellia Tuber, *Pinelliae Rhizoma*) powder to induce sneezing for retraction. Alternative: Smoke nose with paper wick soaked in Castor Oil (Ricini Oleum, *Ricini Oleum*), extinguished lamp smoke retracts intestine.

**Method for Expelling Dead Fetus**: Fetal death in utero results from heat damaging fetus, trauma, premature disturbance, taboos, or fetal obesity/Qi stagnation with drained lochia, causing dry, cold, immobile dead fetus. Signs: Mother's red face, blue tongue, cold/heavy abdomen. Purple-black blood clots/streaks are more definitive. Blue nails/tongue, abdominal distension, wheezing, foul breath indicate danger. Urgently employ midwife to expel. Delay is fatal. Ancient methods include Tongbian (Child's Urine) with Poxiao (Mirabilite, *Natrii Sulfas*) or Pingwei San with Poxiao, or Lizhong Tang with Mangxiao (Glauber's Salt, *Natrii Sulfas*) for cold-deficiency. Efficacy varies by maternal Qi strength. For twin pregnancy with one dead, Qianjin uses Crab Claws (Xiezhuo, *Portunus Spinimanus Unguis*) one sheng, Gancao (Licorice Root, *Glycyrrhizae Radix et Rhizoma*) two qian, Ejiao (Donkey-hide Gelatin, *Asini Corli Colla*) two liang. Boil claws and licorice, strain, dissolve gelatin. Add Rougui (Cinnamon Bark, *Cinnamomi Cortex*) three qian if blood congeals. Dead fetus exits, live one stabilizes. Crab claws disperse blood and detach easily. Other methods: Cow dung applied to abdomen, Hearth Earth (Zaoxin Tu, *Caulis Trapaehispidae) powder with wine, Husband's urine boiled, Dongkui Zi (Malva Seed, *Malvae Semen*) half sheng with Ejiao (Donkey-hide Gelatin, *Asini Corli Colla*), or Gancao (Licorice Root, *Glycyrrhizae Radix et Rhizoma*), Tonggui (Cassia Twig, *Cinnamomi Ramulus*), Puhuang (Pollen Typhae), Jiangcan (Fermented Soybean, *Sojae Fermentatum*) decoction with egg. For winter hard dead fetus with cold abdomen, use Xianggui San with Aconite, Heishen San, or Heilong Dan. For exterior/interior pathogens, Wuji San (Five Accumulations Powder) is best. For dead fetus/placenta with rebellious Qi/vomiting/fainting, administer hot urine. One swallow suffices. Red face/blue tongue: fetus dead, mother alive. Blue face/red tongue: mother dead, fetus alive. Blue lips/foaming or blue face/tongue: both die.

Lu Douyan treated a woman with 4-month pregnancy loss >10 days, abdominal distension, fever, wheezing, red face, black/blue tongue/nose. Pulse was surging. Stated: Fetus not yet expelled. Red face: Heart Fire excess, Blood dry. Blue tongue/black nose: Liver Qi extinct, fetus dead. Despite claims of long-standing loss, pulse/color remained. Decocted Snake Slough (Shetui, *Bomby Batryticatus*), administered Pingwei San with Mangxiao (Glauber's Salt, *Natrii Sulfas*) and Guiwei (Angelica Sinensis Root Tip, *Angelicae Sinensis Radix Apicula*). Shortly after, borborygmus like thunder, intermittent pain, passed dead fetus, cured.

**Retained Placenta**: Umbilical cord severed, lochia enters womb, causing distension preventing expulsion. Erwei Rensu Yin (Two-Ingredient Ginseng-Perilla Decoction) with Tongbian (Child's Urine). For robust individuals, Shixiao San (Instant Relief Powder) to resolve stasis. Severe cases: Pingwei San with Poxiao (Mirabilite, *Natrii Sulfas*). Ancient method: Snake Slough (Shetui, *Bomby Batryticatus*) one strip, burnt in sesame oil, mixed with Musk (Shexiang, *Moschus*), taken with Tongbian (Child's Urine). Or add Qiai (Mugwort, *Artemisiae Argyi Folium*), Ejiao (Donkey-hide Gelatin, *Asini Corli Colla*), Sumu (Sappan Wood, *Sappan Lignum*) one qian each, malt powder paste pills, named Wu Jin Wan (Black Gold Pill). For dystocia/dead fetus retention, take with Tongbian (Child's Urine). Or single Snake Slough (Shetui, *Bomby Batryticatus*) fried in butter, powder with Tongbian (Child's Urine). Qianjin treats rotting placenta with panting using Niuxi Tang (Achyranthes Decoction). For obese pregnant women with phlegm obstructing Qi causing dystocia/dead fetus/retained placenta, Banxia (Pinellia Tuber, *Pinelliae Rhizoma*) powder with urine, one cun spoon, three doses. Blow nose to induce sneezing to open orifices. Using Poxiao (Mirabilite, *Natrii Sulfas*) for dead fetus/placenta harms Stomach Qi and fails. Folk method: Castor Seed flesh (Ricini Semen, *Ricini Semen*) rubbed on right sole; wash immediately after placenta delivery, else intestine may prolapse. Modern method: Mother's hair induced vomiting expels placenta effectively. If it rebounds upward, death ensues.

**Failure of Pubic Symphysis Separation, Vaginal Orifice Incompetence, Uterine Prolapse**: All due to insufficient Yuan Qi (Primal Qi). For failure of pubic symphysis separation, Jiawei Foshou San (Modified Hand-of-Buddha Powder) tonifies Blood/Qi to open. Ancient Jiawei Xionggui Tang (Modified Ligusticum-Angelica Decoction, i.e., Foshou San plus Tortoise Shell Ash and Hair Ash) often causes lochia stasis and death. Only large dose Ren Shen (Ginseng Root, *Panacis Ginseng Radix*) and Tongbian (Child's Urine) added to Xionggui (Ligusticum/Angelica) formula rapidly restores opening/closing function. For grinding teeth/fainting, urgently administer hot urine. Delay is futile. If Qi is not deficient, use Foshou San with urine alone; Ren Shen (Ginseng Root, *Panacis Ginseng Radix*) unnecessary. For vaginal orifice incompetence, Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction) doubled Ren Shen (Ginseng Root, *Panacis Ginseng Radix*) and Guizhi (Cinnamon Twig, *Cinnamomi Ramulus*) to tonify and astringe. For initial swelling/pain without closure, Xiaoyao San (Free and Easy Wanderer Powder) added Jingjie (Schizonepeta, *Schizonepetae Spica*) and Mudanpi (Tree Peony Bark, *Paeoniae Moutan Cortex*). Avoid cold. For uterine prolapse, Buzhong Yiqi Tang (Middle-Boosting Qi-Rescuing Decoction) added Jiuchaobaishao (Wine-fried White Peony Root, *Paeoniae Radix Alba*) one qian, Rougui (Cinnamon Bark, *Cinnamomi Cortex*) five fen to tonify and lift. External treatments like Castor Seed (Ricini Semen, *Ricini Semen*) on vertex also help.

Xue Lizhai treated a woman with uterine enlargement, returning after two days, losing liver-like tissue. Subsequently pale, fatigued, anorexic, internal/afternoon fever, spontaneous/night sweats. Cured with twenty-plus doses of Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction). Resumed fertility.