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Xu Aihui said: The *Ji Sheng Chan Jing* (Classic on Assisting Birth) states that the pulse during pregnancy should be robust, while the pulse postpartum should be deficient. During pregnancy, one should regulate qi to calm the fetus; postpartum, one should support deficiency and eliminate blood stasis. This is the key point. Zhu Danxi said: A postpartum pulse that is surging and rapid, or a prenatal pulse that is fine, small, choppy, and weak, often indicates death. During pregnancy, a surging pulse is normal. If a surging pulse persists after delivery, it often indicates death. Yang Zijian's *Shi Chan Lun* (Treatise on Ten Types of Childbirth) describes ten types: First is Zheng Chan (Normal Delivery). Second is Shang Chan (Injured Delivery): Pain resembling labor occurs before full term, but it is not true labor; this is called "trial month." Forcing effort prematurely constitutes injured delivery. Third is Cui Chan (Induced Delivery): When signs of normal labor are present but delivery is difficult, medication is used to induce labor. Fourth is Dong Chan (Cold Delivery): Winter delivery where cold causes blood coagulation and stagnation. Fifth is Re Chan (Hot Delivery): Excessive heat causes blood to boil, leading to fainting. Sixth is Heng Chan (Transverse Delivery): The fetus turns halfway, and premature effort causes the hand to present first; the midwife pushes the feet back in. Seventh is Pian Chan (Oblique Delivery): Caused by forcing effort before the fetus is correctly positioned. Eighth is Ai Chan (Obstructed Delivery): The fetus is aligned but cannot descend, possibly due to the umbilical cord entangling the shoulder; the midwife dislodges it. Ninth is Zuo Chan (Sitting Delivery): A towel is tied high up for the mother to hold onto; she gently bends her legs and sits to deliver. Tenth is Pan Chang Chan (Intestine Protrusion Delivery): The mother's intestines protrude before the baby is born; if they do not retract postpartum, mix half a cup of vinegar with seven parts fresh water and spray it on the mother's face; with each contraction, spray three times until all retract.

Pregnant women feeling only abdominal pain may not deliver immediately; if accompanied by lower back pain, delivery is imminent because the uterus is connected to the Kidney. Whenever there is lower back or abdominal pain, pinch the middle joint or proximal joint of the mother's middle finger; if a pulsation is felt, she can proceed to deliver.

Wang Mengying noted: Pulsation in the middle finger does not always lead to immediate delivery; some women experience little waist or abdominal pain but feel soreness and heaviness, yet deliver immediately.

Before birth, the fetal head is usually uppermost; as birth approaches, it turns downward, causing unbearable abdominal pain. At this time, the woman should lie supine with her body straight and belt loose, waiting until the fetal head reaches the vaginal opening before pushing. Pushing too early, or bearing down against a tight belly, prevents the fetus from turning, risking transverse or breech presentation with hands or feet presenting first.

Xu Shuwei said: Some cases involve days of labor without delivery, unresponsive to medicine; this is likely due to starting labor too early. Fear causes Qi stagnation. The Classics state: Fear causes Qi to sink; fear causes essence to become timid. Timidity leads to closure of the Upper Jiao; closure causes Qi to rebel upward; rebellion causes distension in the Lower Jiao, stopping Qi movement. One dose of Zi Su Yin (Perilla Decoction) results in delivery. (Formula see Zi Xuan section).

Wang Mengying noted: Dystocia has existed since ancient times. Duke Zhuang's "waking birth" (feet first) is recorded in the *Zuo Zhuan*. Thus, smooth delivery like a lamb being born, without tearing, was considered an omen by poets. However, difficult first births followed by easier subsequent ones is common, especially observable in late marriages. Yet, some late-married women have easy first births; non-late-married women may have easy first births but difficult subsequent ones; some have all easy births, interspersed with one very difficult one; some have all easy births throughout life; others have all difficult births. These may stem from constitutional differences or human actions, and cannot be generalized. As the proverb says: "Ten children, ten different births," which is profound truth! If the fetus descends smoothly, even if time passes, there is no need for panic; one should remain calm and wait.

When Shi Puzheng Maocai was born in Kuaiji, his mother delivered thirteen days post-due date, and both mother and child were safe. Laypeople do not understand this principle; upon slight difficulty, they panic themselves. Recently, cunning midwives intentionally frighten clients to demand high fees, forcibly cutting out the baby, taking their leave after payment. Ignorant people still praise their skill. I record this here hoping people will awaken. However, there is a rare constitution called "Mule Bone," where the pubic symphysis forms a ring and cannot separate, named "Lock Bone." Such individuals can conceive but cannot deliver, dying of dystocia. This is a unique constitution, one in ten thousand. If the symphysis can open, delivery is certainly possible. The "Luó" (Snail) mentioned in medical texts regarding five types of infertility is a corruption of "Mú" (Mule). Donkeys and horses mate to produce mules; pure females without males have a ring-like symphysis; they do not conceive unless mated, possessing pure Yin nature, gentle temperament, and superior running ability compared to donkeys and horses, yet belonging to the horse family. The *I Ching* says: Kun represents the horse, moving across the earth boundlessly, benefiting the steadfastness of the mare; these images refer to this concept. Humans endowed with this form who cannot maintain steadfastness will suffer in childbirth.

Divine Formula for Inducing Labor Treats cases where amniotic fluid has leaked but the fetus does not descend, or delays for two to three days. One dose induces delivery; frequently effective.
Dang Gui (Angelicae Sinensis Radix, 4 qian), Ren Shen (Ginseng Radix, 1 qian), Niu Xi (Achyranthis Bidentatae Radix, 2 qian), Chuan Xiong (Ligusticum Chuanxiong Rhizoma, 1 qian), Gui Ban (Testudinis Carapax et Plastrum, 3 qian), He Shi (Haematitum, 3 qian ground), Rou Gui (Cinnamomi Cortex, 1 qian peeled), Yi Mu Cao (Leonuri Herba, 2 qian). Decoct in water and take orally.

Wang Mengying noted: This formula must be used with extreme caution, especially in summer. It is suitable only for confirmed deficiency-cold patterns. Tongjin Yuling Tang is excellent. I have used boiled pork soup alone with good effect.

Attached Divine Efficacy Baosheng Wuyou San Administer one or two doses before labor for natural ease of delivery; or for transverse/breech presentation or prolonged labor, administer quickly for immediate effect.
Dang Gui (Angelicae Sinensis Radix, washed in wine 1.5 qian), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus, 1 qian), Huang Qi (Astragali Membranacei Radix, 0.8 qian), Bai Shao (Paeoniae Radix Alba, fried in wine 1.2 qian, 1 qian in winter), Tu Si Zi (Cuscutae Semen, 1.4 qian), Hou Po (Magnoliae Officinalis Cortex, fried in ginger juice 0.7 qian), Ai Ye (Artemisiae Argyi Folium, 0.7 qian), Jing Jie Sui (Schizonepetae Spica, 0.8 qian), Zhi Ke (Aurantii Fructus, fried 0.6 qian), Chuan Xiong (Ligusticum Chuanxiong Rhizoma, 1.3 qian), Qiang Huo (Notopterygii Rhizoma et Radix, 0.5 qian), Gan Cao (Glycyrrhizae Radix et Rhizoma, 0.5 qian).
Decoct two cups of water with two slices of ginger to eight parts; take warm on an empty stomach.

Cheng's Formula Analysis: This formula circulates widely, with users praising its efficacy, though few understand its mechanism. I believe that when a pregnant woman's fetal Qi is secure and the abdominal wall is tight, Qi and Blood wrap the fetus, making it hard to move. This formula uses a "supporting/pushing" method. Dang Gui, Chuan Xiong, and Bai Shao nourish and invigorate Blood; Hou Po removes stasis, using them to expand the vessels; Qiang Huo and Jing Jie unblock the Taiyang Meridian, providing posterior support; since the Taiyang Meridian is longest, treating it treats all meridians; Zhi Ke resolves stagnant Qi, providing anterior support; Ai Ye warms the uterus, stimulating uterine movement so the fetus becomes agile; Chuan Bei Mu and Tu Si Zi best facilitate fetal rotation and delivery, embodying natural vitality. This is truly a supreme formula.

Ru Shen San Take one pair of straw sandals found on the road, named "Thousand Li Horse." Take the rope from the bridge of the nose, wash clean, burn to ash, mix with children's urine and wine, take 3 qian. Highly efficacious. Wu Shuqing's *Ji Yin Gang Mu* states: Hard to explain theoretically, but practically effective.

Shen Yaofeng said: "Thousand Li Horse" absorbs the lowest Qi of humans, assisted by the descending nature of children's urine and the blood-moving property of wine, hence its efficacy. This medicine is neither cold nor hot, making it a stable agent.

Wang Mengying noted: Labor-inducing drugs should not be used lightly. They are applicable only when the fetus is near the birth canal but cannot descend. One must assess deficiency or excess: tonify Qi and Blood if deficient; expand the birth canal if obstructed; warm and move if cold; clear and descend if hot; suppress and anchor if rebellious. Do not rigidly adhere to established formulas for universal application.

The *Fu Ren Liang Fang* (Good Prescriptions for Women) states: Jia Wei Xiong Gui Tang added with Gui Testudinis Carapax et Plastrum treats pubic symphysis non-separation. Mix Hua Shi (Talcum) with vinegar and oil, apply to the vaginal opening, as a holy medicine for lubricating delivery. Hua Rui Shi San (Rubus Discolor Fruit Powder) treats blood entering the placenta, causing swelling and retention, or lochia attacking upward. Bi Ma Zi (Ricini Semen) treats retained placenta. Fo Shou San (Buddha's Hand Powder) treats critical blood-deficiency syndromes. Qing Hun San (Clear Soul Powder) treats syncope syndromes. Shi Xiao San (Laughing Without Pain Powder) treats lochia-related abdominal pain and unconsciousness.

Xu Aihui said: Fo Shou San also expels dead fetuses. If the fetus is dead, take this first to avoid damaging Qi and Blood. If it fails, use Ping Wei San added with Pu Xiao (Mirabilite).

Treatment Case of Cold Delivery Liu Fuzhen treated the daughter of a Prefectural Judge, who had died in labor and was being prepared for burial. He took Hong Hua (Carthami Flos), decocted it strongly, supported the girl on a stool, applied cotton cloth soaked in the hot liquid to her body, pouring more over the cloth, keeping it warm and wet. After a long time, she revived and delivered a male infant. Likely due to severe winter causing blood coagulation, warmth restored flow enabling delivery.

For breech presentation (feet first), apply salt to the infant's soles; for transverse presentation (hands first), apply salt to the palms.

Xu Aihui said: Salt irritates the limbs, causing pain and retraction, popularly known as "begging for salt birth."