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Guo Jizhong stated: Dystocia (difficult labor) occurs because, as the fetus turns, it breaks the blood clots of the "fetal pillow" (placenta and its appendages), which obstructs the fetal body with stagnant blood in the uterus, causing blockage in the birth canal. Therefore, difficult labor ensues. In such cases, one should urgently administer Shengjin San (Golden Victory Powder) to dissipate the blood stasis, allowing the fetus to be born naturally and easily. Chen Wuyue said: It is often due to the fetus not having turned into the correct position yet, sitting on the birthing mat too early, or exerting excessive effort, leading to the rupture of the amniotic sac and drying up of blood and fluids. This makes the birth passage slippery and difficult for the fetus to descend. It is appropriate to first administer Cui Sheng Rushen San (Divine Spirit Inducing Delivery Powder) to consolidate the yin blood. If breech presentation or transverse lie occurs, acupuncture methods described previously should be used.

The *Daquan* states: For treatment where the amniotic fluid ruptures prematurely, with excessive discharge of lochia and waters, resulting in a dry fetus unable to descend, one must first administer Siwu Tang (Four Substances Decoction) to tonify blood and qi. Next, decoct a strong scallion soup, let it cool, and have the midwife wash the vulva carefully, ensuring thorough cleaning to facilitate the free flow of qi up and down. Additionally, apply a mixture of butter and talcum powder to the vaginal opening. Subsequently, administer Shenmiao Ruzhu Dan (Miraculous Pearl Milk Pill) or Kuizi Rusheng San (Hibiscus Like-Saint Powder).

The first type is called Zhengchan (Normal Labor). When a woman has completed ten months of pregnancy, she suddenly experiences intermittent pain in the waist and abdomen, the fetal qi sinks abruptly, leading to extreme pain at the navel and abdomen, heavy pain in the lower back, and protrusion of the anus. Following this, the amniotic fluid ruptures and bleeding occurs, and the fetus is born naturally and smoothly.

The second type is called Shangchan (Injured Labor). Generally, human birth is determined by yin and yang, each having its specific time, which cannot be altered. However, sometimes before one month prior to delivery, there is sudden pain in the navel and abdomen, resembling labor, but nothing happens. This is called "Shiyue" (Testing Month) and is not normal labor. All parturient women, before the signs of normal labor appear, should not have their waists tightly held (tight holding prevents the fetus from turning, thus it is inadvisable), nor should they exert force recklessly. For women in labor, when abdominal pain occurs, if the fetus is not in the correct position, and the midwife instructs the mother to exert force blindly, the fetus may begin to turn but is then forced off course by the mother's exertion, resulting in transverse or inverted positions. This is all due to improper timing of the mother's effort. Parturient women should only exert force when the fetus is aligned and approaching the cervix, pushing once to deliver the baby. This is the proper way to exert effort (This is a method of child-rearing; daughters-in-law should hear this regularly). If effort is made too early without the signs of normal labor, and medicines are taken recklessly to induce birth, it is like pulling shoots to help them grow—harmful rather than beneficial.

The third type is called Cuichan (Induced Labor). This refers to situations where a woman desires to give birth, with ruptured membranes and bleeding, severe intermittent abdominal pain, heavy waist, and anal protrusion, showing clear signs of normal labor, but the fetus has not yet been born. Medicines can be administered to induce labor. If several days have passed, the mother is exhausted, and the signs of normal labor are evident, but the fetus remains stuck, medicines can also be given to boost the mother's healthy qi, facilitating a quick delivery. (Tonifying healthy qi is indeed the practice of skilled physicians; using five qian of Ginseng Radix et Rhizoma Rubra for induction is excellent.)

The fourth type is called Dongchan (Cold Labor). In winter, due to cold weather, the menstrual blood coagulates upon exposure to cold, preventing the fetus from being born. This harm is profound. For winter deliveries, the lower body must not be stripped of woolen garments, nor should one sit or lie in cold places. The room should be heated with fire to maintain warmth. The mother should face her back toward the fire, keeping the area below the navel and knees warm. Blood flows freely when warmed, making birth easier.

The fifth type is called Rechchan (Hot Labor). In midsummer, the parturient woman must maintain appropriate temperature balance, avoiding excessive cooling which damages fetal qi. There should not be too many people present, as heat oppression can cause the mother's blood to boil, leading to fever, headache, flushed face, dizziness as if drunk, and even loss of consciousness.

The sixth type is called Hengchan (Transverse Lie). The fetus presents a hand or arm first. This is caused by the mother exerting force improperly or excessively before the fetus is aligned. The force pushes the fetus sideways, preventing delivery. The mother should lie supine comfortably. Then, the attendant should gently push the presenting limb back inside, guiding it upward along the body. Use the middle finger to massage the shoulder and push it up to correct the position, or use fingers to adjust the ear. The mother must remain supine while the fetus is pushed upward and gradually corrected. Once the body is aligned, administer a cup of Cui Sheng Yao (Delivery-Inducing Medicine), drink it, and then the mother may exert force to deliver the fetus.

The seventh type is called Daochan (Breech Presentation). Due to insufficient fetal qi and weak pelvic floor muscles, combined with premature exertion (if caused by weak maternal qi, tonics should be used; if due to premature exertion, different measures apply), the fetus fails to turn and descends feet-first. The mother should lie supine. The attendant should gently push the feet back inside. The mother must not exert any force, nor should she be frightened, allowing the fetus to naturally align.

The eighth type is called Pianchan (Oblique Lie). The fetus is not upright, and the mother's forceful pushing causes the head to shift to the left or right thigh. Although the head is visible, it is deviated to one side, preventing birth. The mother should lie supine. The attendant should gently push the fetus upward, manually correcting the head so that the vertex is centered. Then, the mother exerts force to deliver the baby. If the occiput is deviated toward the anus, exposing only the forehead, the attendant, with hands wrapped in warm cotton cloth, should gently push the head from outside the anus to correct it, after which the mother exerts force to deliver. (Three methods for vertex correction)

The ninth type is called Aichan (Obstructed Labor). The fetus is aligned and the vertex is presenting, but cannot be born. This is because, during fetal rotation, the umbilical cord wraps around the shoulder, obstructing the vertex. The mother should lie supine. The attendant should gently push the fetus upward, slowly inserting a finger to press under the shoulder and dislodge the cord. Wait until the fetus is fully aligned, then instruct the mother to exert force to deliver.

The tenth type is called Zuochan (Sitting Labor). As birth approaches, the mother becomes fatigued and sits on cushions, obstructing the birth canal. Tie a handkerchief high up. Let the mother hold it, gently bend her legs, and assume a sitting posture to facilitate delivery. This does not mean sitting on an object during birth.

The eleventh type is called Panchangchan (Prolapsed Intestine Labor). The intestines prolapse before the fetus is born. Lady Gong, wife of Zhao Duyun, experienced prolapse of the large intestine before every delivery, which could not be retracted postpartum, causing great distress. Physicians could not treat it. While in Jianchang, she learned a method from a midwife to retract it: mix half a cup of vinegar with seven parts fresh well water. Apply this mixture to the mother's face. Each time the intestine retracts slightly, repeat three times until fully retracted. This is an excellent method. (Method for retracting prolapsed intestine is superb)