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[Mai Jue (Pulse Aphorisms)] For a woman about to give birth, the pulse is termed "Li Jing" (Departing from the Regular Pulse), presenting as deep, fine, and slippery. If labor pain begins at midnight, delivery should occur at dawn; if pain begins at noon the next day, delivery will surely happen that day.
(The *Mai Jing* [Pulse Classic] states: The Li Jing pulse is floating; abdominal pain radiating to the lower back and spine indicates impending birth, but merely having a Li Jing pulse does not guarantee immediate delivery. It also says: With a Li Jing pulse, if pain is felt at midnight, birth occurs at midday. "Jing" refers to the constant or regular state. "Li Jing" means departing from one's usual pulse pattern. For example, if a pregnant woman had a deep and solid pulse on the left side yesterday—indicative of a male fetus—and today her pulse has become floating, this represents a departure from her usual pulse and differs from yesterday's. Coupled with abdominal pain, it indicates imminent delivery. Tongzhenzi interpreted this using the *Nan Jing* [Classic of Difficult Issues], defining Li Jing as three pulses per breath. Li Fan further cited the *Nan Jing*, defining Li Jing as one pulse per breath, to explain the deep, fine, and slippery pulse; both interpretations are incorrect. The *Nan Jing* mentions that both deficient and excessive pulses can be named Li Jing, but their pulse characteristics and principles differ. Moreover, the *Mai Jing* explicitly states that the Li Jing pulse is floating, without citing the *Nan Jing* to harmonize it with the *Mai Jue*. Because the text mentions a floating pulse, it adds "deep, fine, and slippery," all termed Li Jing. This is likely because previous diagnoses for fetal sex showed that a large floating pulse might indicate a female fetus. If only a floating pulse were defined as Li Jing, how would one distinguish a Li Jing pulse from the common large floating pulse seen in female pregnancies? Thus, "deep, fine, and slippery" was added to show that departing from the usual large floating pulse results in a slippery pulse. The *Shenghui Fang* [Prescriptions of Holy Grace] states: If abdominal pain is felt at midnight (Zi hour), delivery will definitely occur at noon (Wu hour). This is because Zi and Wu hours oppose each other, spanning half a day. Tongzhenzi stated that "pain at midnight, birth at noon" is perhaps not entirely accurate. He also said: Abdominal pain without lower back pain indicates no delivery yet. Severe abdominal pain accompanied by severe lower back pain indicates imminent delivery. This is because the Kidneys govern the lower back, and the uterus is connected to the Kidneys. Palpating the Chi position [pulse at the wrist] showing urgency like cutting a rope or rolling beads indicates imminent delivery. Delivery varies in difficulty, and pain intervals vary in tightness or slowness; how can one fixate on half a day? One must apply flexible methods.) Body heaviness, fever, and frequent alternating chills; blackish-blue sublingual veins; tongue turning backward and cold on top indicate fetal death, leading to maternal death. Red face and blue tongue require careful examination; if the mother survives, fetal survival is difficult. Blue lips and mouth with frothing indicate death for both mother and child. Blue face and red tongue with frequent frothing indicate maternal death but fetal survival. If you do not believe this, observe the verification; the words of sages are not false. (*Maizhi Nan* [Guide to Pulse Indications] reads "blue face and red tongue." The face reflects the mother, the tongue reflects the fetus. Since it states the fetus lives, red tongue is correct. If the tongue were blue, it would contradict the earlier sign of red face/blue tongue indicating maternal survival/fetal death. If the fetus presents first, it may survive; if not, both perish. From "body heaviness..." onwards, pulse diagnosis is not used; instead, external signs are consulted to determine the life or death of mother and child, because the labor pulse is not fixed, and color observation is relied upon.)

Yang Zijian's *Ten Types of Labor*
First is Zheng Chan [Normal Labor]: When a woman carries a fetus for ten months, she suddenly experiences阵痛 (paroxysmal pain) in the waist and abdomen. Subsequently, the Qi of the fetus descends abruptly. Pain reaches its peak in the umbilical and abdominal region, extending to severe heaviness and pain in the lower back. The anus protrudes (tenesmus-like sensation). Then, the amniotic sac ruptures, blood flows, and the infant is born. This is called Normal Labor.
Second is Shang Chan [Injured/Preterm Labor]: A person's birth is determined by Yin and Yang at specific times, which cannot be altered. If a woman experiences sudden umbilical and abdominal pain resembling labor more than a month before term, but nothing happens, this is called "Shi Yue" [Testing Month], not Normal Labor. However, for all parturient women, before the signs of Normal Labor appear, one must not hold the woman by the waist, nor should she exert force recklessly. In women about to deliver, when the abdomen hurts, the fetus is not yet in position. If the midwife encourages the mother to exert force prematurely, causing the fetus to shift, and the mother pushes hard, the fetus may turn sideways or upside down, unable to be born normally. This is caused by improper timing of maternal effort. Maternal effort should only begin when the fetus is in position and approaching the cervix ("gate"), pushing once to deliver the baby. This is the proper use of force. Exerting force early without Normal Labor signs, or taking drugs indiscriminately to induce early birth, is like pulling shoots to help them grow—it is harmful and useless. This is called Injured Labor.
[Lou] The method regarding Injured Labor above is crucial; do not neglect it. If it is less than ten months, and there is labor pain that comes and goes, or is mild, it is called "Nong Tong" [Playing Pain], not a sign of Normal Labor. If abdominal pain is severe but lower back pain is mild, it is not Normal Labor. If the fetus is high and has not descended, it is not Normal Labor. If the anus does not protrude, it is not Normal Labor. If water and blood have not issued, it is not Normal Labor. If water and blood issue but there is no abdominal pain, it is not Normal Labor. In the absence of Normal Labor signs, let the woman walk and endure patiently. If she cannot walk, let her sit leaning on something, lie down, or take one or two doses of Fetus-Anchoring Medicine. Stop once she is calm. Do not recklessly take Parturition-Inducing Drugs, causing panic and fear, which damages her spirit. Ensure the mother remains relaxed and nurtured; the midwife should explain and comfort her. If she feels stifled, take one spoonful of white honey mixed with fresh water. Do not exert force wildly, exhausting the mother first. Only when the fetus presses against the cervix, causing extreme lower back heaviness/pain, eyes feeling fiery, and anus protruding, is it the sign of Normal Labor. Then, exert force and take Parturition-Inducing Drugs. I had a relative who, more than a month before term, experienced severe waist and abdominal pain resembling labor, peaking until the Si hour (9-11 AM) when it subsided. This lasted over ten days. Having exhausted ideas, I consulted this text and prescribed Fetus-Anchoring Medicine with Ginseng and Atractylodes for several doses, along with meat broth for nourishment. She recovered and felt no pain, delivering a boy twenty days later. Had she exerted force wildly or taken inducing drugs then, she would have faced immediate danger.
Third is Cui Chan [Induced Labor]: When a woman is ready to deliver, with ruptured membranes, bleeding, severe paroxysmal abdominal pain, heavy lower back, and protruding anus, these are signs of Normal Labor. But if the fetus has not yet been born, one may administer medicine to induce delivery. Or, if several days have passed, the mother is suffering, and the signs of Normal Labor are clear, but the fetus is difficult to deliver, one may administer medicine to boost the mother's healthy Qi, facilitating rapid delivery. This is called Induced Labor.
Fourth is Dong Chan [Cold Labor]: In winter, due to cold weather, the mother's menstrual blood coagulates upon exposure to cold, preventing the fetus from being born. This harm is profound. In winter deliveries, the lower body must not be stripped of cotton clothes, nor should the mother sit or lie in cold places. The room should be heated with fire to maintain warmth. The mother should face the fire with her back, keeping the area below the navel and knees warm. Warmth causes blood to flow freely, making delivery easier. This is called Cold Labor.
[Xue] Lady Jing suffered difficult labor in early winter, damaging her Yuan Qi. The child was born dead. We burned an oil-paper wick to sever the umbilical cord, using its heat to warm the infant. Shortly after, the infant made a sound. Later, this child never suffered from food stagnation or diarrhea, proving the efficacy of this method.
Fifth is Re Chan [Hot Labor]: In midsummer, the parturient woman must maintain appropriate warmth and coolness. She must not indulge in cooling herself excessively, damaging fetal Qi. Nor should many people crowd around, generating heat that oppresses the mother, causing her blood to boil, resulting in fever, headache, red face, dizziness like drunkenness, or loss of consciousness. This is called Hot Labor. (If summer brings cool winds or rain, one must not seek coolness arbitrarily, lest serious illness arise.)
Sixth is Heng Chan [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 in position, forceful pushing causes the body to lie transversely, preventing birth. The mother should lie supine. The attendant should first push the limb back inside, guiding it up towards the body. Using the middle finger, rub the shoulder and push upwards to correct it, or pull the ear to straighten it. The mother must be supine while the attendant pushes the fetus up gently. Once the body is aligned, administer a cup of Parturition-Inducing Medicine. After ingestion, the mother may exert force to deliver the fetus. This is called Transverse Lie.
Seventh is Dao Chan [Breech Presentation]: Due to insufficient fetal Qi and lax pelvic ligaments, premature exertion prevents the fetus from turning, causing the feet to present first. The mother should lie supine. The attendant should push the feet back up. The mother must not exert any force, nor should she be frightened, allowing the fetus to naturally assume the correct position.
She Tuo San [Snake Molt Powder]: Treats pregnant women about to deliver who refuse to stretch and move, preferring to curl up and endure pain. The fetus cannot turn in the womb, so the feet present first, called "Ni Sheng" [Reverse Birth]. Without prompt rescue, both mother and child die.
Use Black Snake Molt (one piece), Cicada Slough (fourteen pieces), Xue Yu [Scorched Hair] (a handful, using fetal hair).
Burn all to ash while retaining their nature, grind into powder, divide into two doses. Mix with warm wine and take consecutively. Lie supine for a short while. Alternatively, prick the sole of the fetal foot three to five times with a small silk needle. Apply a little salt to the puncture sites. Delivery will proceed smoothly, saving both mother and child. Another method: Apply salt to the sole of the fetal foot, scratch with fingernails, and rub the mother's abdomen with salt. Use the middle finger to collect soot from the bottom of a pot. Draw crosswise marks on the sole of the fetal foot; delivery will proceed smoothly. Another prescription: Write the father's name on the sole of the fetal foot; delivery will proceed smoothly. For transverse presentation where the fetus cannot emerge, take Plantago Seed powder, mix with wine, and take two qianbi. Another prescription: Take Dodder Seed powder, mix with wine, and take one qianbi. Rice water decoction is also acceptable. Combine Bai Cao Shuang [Allay Dust] and Xiang Bai Zhi [Angelica Dahurica] (equal parts, not roasted). Mix with child's urine and good vinegar (one he per each) to form a paste. Soak in boiling water and ingest. Severe cases resolve in two doses. For difficult transverse/breech labor with fetal death in utero, first stir-fry one dahe of black beans. Cook with water and "heavy urine" (late-stage pregnancy urine) and ingest. Miraculous effect. Another prescription: Boil half a jin of Mugwort Leaf in four sheng of wine until one sheng remains. Ingest. Alternatively, take Angelica Root powder, mix with wine, and take a fangcunbi. Perilla Decoction is also acceptable.
Eighth is Pian Chan [Oblique Lie]: The fetus is not upright. Forceful maternal pushing causes the head to rest obliquely against the left or right leg. Although the head emerges, it is stuck on one side and cannot be born. The mother should lie supine. The attendant should gently push the fetus upward, manually correcting the head so the vertex is centered. Then, the mother exerts force to deliver. If the occiput rests against the anus, exposing only the forehead, the attendant should wrap hands in warmed cotton cloth and gently push the head from outside the anus to correct it, then instruct the mother to push. This is called Oblique Lie.
Ninth is Ai Chan [Impeded Labor]: The fetus is in position and the vertex presents, but cannot be born. This is because the fetus turned, and the amnion/chord wrapped around the shoulder, preventing the vertex from descending. The mother should lie supine. The attendant should gently push the fetus upward, slowly reaching in. Using the middle finger, press under the shoulder to dislodge the membrane. Wait until the fetus is properly aligned, then instruct the mother to push. This is called Impeded Birth.
Regarding the four methods above (Transverse, Breech, Oblique, Impeded): If the attendant is not highly skilled, do not attempt these methods, lest ignorance cause harm. Note: In modern times, breech births often occur naturally with feet presenting first, with no sequelae, and both mother and child survive. It is not necessary to forcibly push the feet up. Regarding Impeded Labor: Often, the amnion wraps around the vertex, but the head emerges naturally. The attendant may simply dislodge the membrane from the vertex. Sometimes the membrane wraps once around the vertex, and the fetus and placenta descend together naturally. These are harmless; there is no need to insert fingers into the vagina to dislodge the membrane as described in the Impeded Labor method.
Tenth is Zuo Chan [Sitting Labor]: As the fetus is about to be born, the mother sits for a long time out of fatigue. The chair/cushion obstructs the birth canal. Tie a handkerchief high up. Let the mother grasp it, bend her legs slightly, and sit in a semi-squatting position to facilitate delivery. This does not mean sitting on an object. This is called Sitting Labor.
Eleventh is Pan Chang Chan [Prolapsed Intestine Labor]: During labor, the mother's intestine prolapses before the fetus is born. Lady Gongren, wife of Zhao Duyun, always experienced rectal prolapse before delivery. Postpartum, the intestine did not retract, causing great distress. Doctors could not treat it. While in Jianchang, she learned a method from a midwife to reduce it: Mix half a zhan of vinegar with seven parts fresh water. Apply to the mother's face. Each time the intestine retracts slightly, repeat three times until fully reduced. This is an excellent method.
Note: Ancient prescriptions for this condition used forty-nine kernels of Castor Bean, ground and applied to the mother's vertex to reduce the intestine. Wash off immediately. Moisten the prolapsed intestine slightly with water used for sharpening knives. Internally, drink a decoction of Magnetite. Use Magnetite verified by Feng Shui masters for efficacy. Washing the face with water may cause fright and scatter Qi.
[Dan] For postpartum intestinal prolapse, heat five jin of Sesame Oil. Pour into a basin. When warm, sit in the oil basin for about the duration of a meal. Blow Rhinolithis Powder [Gleditsia Sinensis Powder] into the nose to induce sneezing, which reduces the intestine instantly. Excellent. (*Doumen*)
[Da] Grind Pinellia Tuber into powder. Snuff into the nose; the intestine rises.
Another prescription: Dip a paper twist in Sesame Oil, light it, blow it out, and smoke the mother's nose with the smoke; the intestine rises.
Another prescription: Place the prolapsed intestine in a clean lacquerware vessel. Immerse in a strong decoction of Scutellaria Baicalensis [Chinese Skullcap] soup; the intestine rises.
[Xue] At the onset of labor, when internal movement is felt, the mother should lie supine upright. Wait for the fetus to turn downward and pain to begin. Test the mother's middle finger; if the middle or proximal phalanx pulses, she is ready for delivery, and birth will follow. If she does not lie supine initially to wait for fetal rotation, or if water leaks frequently before labor, the membranes have ruptured, and blood/fluids are depleted. This risks reverse or difficult birth. If membranes rupture but delivery fails, use Bao Sheng Wu You San [Treasure Life Fearless Powder] to consolidate blood, ensuring natural birth. If blood is already depleted, use one jin of Ba Zhen Tang [Eight Treasures Decoction] ingredients plus half a jin of Motherwort Herb. Decoct in several bowls of water. Drink frequently. Some survive. Generally, if a pregnant woman has only abdominal pain, she has not delivered. If severe lower back pain accompanies it, delivery is imminent. This is because the Kidneys manifest in the lower back, and the uterus connects to the Kidneys. Pregnant women should hire a compassionate and experienced midwife in advance, building rapport through kindness. Inform her beforehand. If birth is difficult, tell her to say "not yet in labor." If twins, say "placenta not yet delivered." Fright scatters Qi, making birth harder. My family has verified this. Generally, difficult labor is common among wealthy families who are sedentary and depressed. Treatment theory states clearing Qi during pregnancy and tonifying blood postpartum, but one must not adhere rigidly. If Spleen/Stomach are weak and Qi/Blood insufficient, pre-conditioning tonification is necessary. Otherwise, labor difficulties are inevitable. In case of difficult labor or extreme cold, urgently burn the umbilical cord slowly with a thick oil-paper wick. Even if the infant is dead, warmth entering the abdomen may revive the child. Never cut with a knife.