〔脉诀〕欲产之妇脉离经，沉细而滑也同名。夜半觉痛应分诞，来日日午定知生。
（《脉经》曰∶离经其脉浮，腹痛引腰脊为欲生也，但离经者，不产也。又云∶其脉离经，
夜半觉，日中则生也。经者，常也，谓离其常处为离经。假如孕妇昨日见左沉实，为男之
脉，今日或脉浮，是离其寻常之脉，而异于昨日，又且腹痛，知是将诞也。通真子引
《难经》一呼三至曰离经为解。李 范又引《难经》一呼一至曰离经，以解沉细而滑，皆
非也。《难经》言损至二至虽同名离经，其脉与理则不同。且《脉经》明言离经其脉浮
也，不曾引援《难经》之文合《脉诀》。因其言脉浮，又添沉细而滑，同名离经，盖以
前所诊男女脉，或云浮大为女，若只脉浮为离经，若平常见浮大为女之脉，安辨离经，
故又增沉细而滑，以见离为浮大之常经，为常滑也。《圣惠方》云∶夜半子时觉腹痛，
来日午时必定生产。谓子午相冲，正半日时数也。通真子曰∶夜半痛，日午生，此言恐未
为的。又曰∶腹痛而腰不痛，未产也。若腹痛运腰痛甚者，即产。所以然者，肾系于腰，
胞系于肾，故也。诊其尺脉转急如切绳转珠者，即产也。生产有难易，痛来有紧慢，
安可定以半日，当以活法。）身重体热寒又频，舌下之脉黑复青，反舌上冷子当死，
腹中须遣母归冥。面赤舌青细寻看，母活子死定应难，唇口俱青沫又出，母子俱死总教
拼。面青舌赤沫出频，母死子活定知真，不信若能看应验，寻之贤哲不虚阵。（《脉指
南》作面青舌赤。盖面以候母，舌以候子，今云子活，合以舌赤为是，若云舌青，则
与前面赤舌青，母活子死之候相反。若胎先下，其子得活，如未下，子母俱亡。
自身重体热寒又频至此，并不用脉，只以外候参诀子
母生死，盖以临产脉不可定，但当以察色而知之。）
杨子建《十产论》
一曰正产者，妇人怀胎，十月满足，忽腰腹作阵疼痛，相次胎气顿陷，至于脐腹痛
极，乃至腰间重痛，谷道挺迸，继之浆破血出，儿子遂生，名曰正产。
二曰伤产者，盖一人之生，阴注阳定，各有时日，不可改移。今有未产一月以前，忽
然脐腹疼痛，有如欲产，仍却无事，是名试月，非正产也。但一切产母，未有正产之候，
即不可令人抱腰，产母亦不可妄乱用力，盖欲产之妇，脐腹疼痛，儿身未顺，收生之妇，
却教产母虚乱用力，儿身才方转动，却被产母用力一逼，使儿错路，忽横忽倒，不能正
生，皆缘产母用力未当之所致也。凡产母用力，须待儿子顺身，临逼门户，方始用力一
送，令儿下生，此方是产母之用力当也。若未有正产之候，而用力伤早，并妄服药饵，令
儿下生，譬如堰苗而助长，无益而有害矣。此名伤产。
〔娄〕上伤产一法，最为切要，慎勿轻忽也。凡十月未足，临产腹痛，或作或止，或
痛不甚者，名曰弄痛，非正产之候。或腹虽痛甚而腰不甚者，非正产之候。胎高未陷下
者，非正产之候。谷道未挺迸者，非正产之候。水浆未破，血未出者，非正产之候。浆
血虽出而腹不痛者，非正产之候。凡未有正产候，且令扶行熟忍，如行不得，或凭物坐
之，或安卧之，或服安胎药一二服，得安即止。慎勿妄服催生药饵，怆惶致令产母忧恐
而挫其志。务要产母宽心存养调停，亦令坐婆先说解论之。如觉心中烦闷，可取白蜜一
匙，新汲水调下，切勿亡乱用力，先困其母。直待子逼门户，腰重痛极，眼中如火，谷道
挺迸时，是正产候，方可用力，并服催生药也。予男妇于未产一月以前，腰腹俱痛，全
似将产，其痛至甚，但遇巳牌稍止。如此者将十余日，计无所出，因阅此条，遂与安胎
药加参、术数服，间与肉味养之，由是平复不痛，又二十余日始产一男。是时若妄动乱
用力，并服催生等药，立见危亡矣。
三曰催产者，言妇人欲产，浆破血下，脐腹作阵疼痛极甚，腰重谷道挺迸已见，是正
产之候。但儿却未生，即可服药以催之。或有经及数日，产母困苦，已分明见得是正产
之候，但儿子难生，亦可服药以助产母之正气，令儿速得下生，此名催产。
四曰冻产者，冬月天冷，产母经血得冷则凝，以致儿子不能生下。此害最深，若冬
月产者，下部不可脱去绵衣，并不可坐卧寒处，当满房着火，常有暖气，令产母背身向
火，令脐下腿膝间常暖，血得热则流散，使儿易生，此名冻产。
〔薛〕荆妇孟冬分娩艰难，劳伤元气，产子已死，用油纸捻烧断脐带，藉其气以暖
之，俄顷忽作声，此儿后无伤食作泻之证，可见前法之功不诬。
五曰热产者，盛夏之月，产妇要温凉得所，不可恣意取凉，伤损胎气，亦不可人多
热气逼袭产母，使产母血沸而有发热、头痛、面赤、昏昏如醉，乃至不知人事，此名热产。
（若夏月风凉阴雨，亦不可任意取凉，恐生大病。）
六日横产者，儿先露手，或先露臂，此由产母未当用力而用之过也。儿身未顺，用
力一逼，遂至身横不能生下，当令产母安然仰卧，后令看生之人，先推其手令入直上，渐
渐逼身，以中指摩其肩推上而正之，或以指攀其耳而正之，须是产母仰卧，然后推儿直
上，徐徐正之，候其身正，煎催生药一盏吃了，方可用力，令儿下生，此名横产。
七曰倒产者，产母胎气不足，关键不牢，用力太早，致令儿子不能回转，便直下先露
其足。当令产母仰卧，令看生之人，推其足入去，不可令产母用分毫力，亦不得惊恐，使
儿自顺云。
蛇蜕散 治妊妇欲产时，不肯伸舒行动，多曲腰眠卧忍痛，儿在腹中，不能得转，故
脚先出，谓之逆生，须臾不救，母子俱亡。
用乌蛇蜕（一条） 蝉蜕（十四枚） 血余（一握，用胎发）
并烧灰存性，研分二服，温酒调，连进之，仰卧少顷。或用小绢针于儿脚心刺三五
刺，用盐少许涂刺处，实时顺生，母子俱活。又法，以盐涂儿足底，又可爪甲搔之，并以
盐摩母腹上。又以手中指取锅底墨。交画儿足下，即顺生。又方，取其父名，书儿足下
即顺生。若孕妇横生不可出者，以车前子为末，酒服二钱匕。又方，菟丝子为末，酒调
服一钱匕，米饮调亦得。又以百草霜、香白芷（不见火各等分。）用童便与好醋各一合，调成
膏，沸汤浸服。甚者二服即生。若妇人横逆难产，子死腹中，先用黑豆一大合，炒，熟
水与重便合煎服，神效。又方，用艾叶半斤，酒四升，煮取一升，服之。又以当归为末，酒
服方寸匕，紫苏汤调服亦可。
八曰偏产者，儿身未正，产母用力一逼，致令儿头偏拄左腿，或偏拄右腿，故头虽露，
偏拄一畔，不能生下。当令产母仰卧，次令看生之人，轻轻推儿近上，以手正其头，令
儿头顶端正，然后令产母用力一送，即便生下。若是小儿头后骨偏拄谷道，只露其额，当
令看生之人，以绵衣炙温裹手，于谷道外方，轻轻推儿头令正，便令产母用力送儿生也。此
名偏产。
九曰碍产者，儿身已顺而露正顶，不能生下，盖因儿身回转，肚带攀其肩，以此露
正顶而不能生。当令产母仰卧，令看生之人，轻推儿近上，徐徐引手，以中指按儿肩下拨
其肚带，仍须候儿身正顺，方令产母用力一送，使儿生下，此名碍生。
上横产，倒产、偏产、碍产四法，若看生之人，非精良妙手，不要根据用此法，恐恣
其愚，以伤人命也。按∶倒产者，今世往往随其倒足生下，并无后患，子母双全，不必
根据推足上之法亦可。又碍产者，往往肚带有缠在儿顶上，而儿头自出在产门外，看生之
人，以手拨其肚带，从儿头顶过而下之者，又有肚带缠在顶上一匝，而儿与胞衣自然同下
者，皆无妨，不必以此碍产法入产门拨下也。
十曰坐产者，儿将欲生，其母疲倦久坐，椅褥抵其生路，急于高处系一手巾，令产母
以手攀之，轻轻屈足坐身，令儿生下，非坐在物上也。此名坐产。
十一曰盘肠产者，临产母肠先出，然后儿生。赵都运恭人，每产则大肠先出，然后
产子，产后其肠不收，甚以为苦，医不能疗。偶在建昌，得坐婆一法而收之，其法以醋半
盏，新汲水七分调停， 产母面，每 一缩，三 收尽，此良法也。
按∶前证古方以蓖麻子仁四十九粒，研涂产母头顶，肠收上，急洗去。其肠若干，以
磨刀水少许湿润之。内用磁石煎汤饮之即收上。磁石须阴阳家用有验者，若以水 母面，
恐惊则气散。
〔丹〕产后肠不收，香油五斤煎热，盛盆中，候温，坐油盆中约一食时，以皂角末
吹入鼻中，嚏作立上，妙。（《斗门》。）
〔大〕半夏为末，搐鼻中，则肠上矣。
又方以大纸捻蘸香油点灯吹灭，以烟熏产母鼻中，肠即上矣。
又方 肠出，盛以洁净漆器，浓煎黄 汤浸之，肠即上。
〔薛〕欲产之时，觉腹内转动，即当正身仰卧，待儿转身向下时作痛，试捏产母手
中指中节或本节跳动，方与临盆，即产矣。若初觉不仰卧，以待转胞，或未产而水频下，此
胞衣已破，血水先干，必有逆生难产之患。若胎衣破而不得分娩者，保生无忧散以固其血，
自然生息。如血已耗损，用八珍汤料一斤，益母草半斤，水数碗，煎熟不时饮之，亦有得
生者，凡孕妇只腹痛，未产也。若连腰痛甚者，将产也。盖肾候于腰，胞系于肾故也。凡
孕家宜预请有仁心知事稳婆，常以恩结其心，先与说知，倘有生息不顺，只说未产。或遇
双胎，只说胎衣未下，恐惊则气散，愈难生息。余家亲验之，大抵难产多患于郁闷安佚
富贵之家，治法虽云胎前清气，产后补血，不可专执。若脾胃不实，气血不充，宜预调补，
不然临产必有患难。如因难产，或大寒时，急以大油纸捻徐徐烧断其脐带，虽儿已死，令
暖气入腹，多得复生，切勿用刀断之。
【脉诀】将要分娩的孕妇，其脉象离开常经（指脉象发生显著变化，如由沉转浮等），表现为沉细而滑，这种脉象也被称为“离经”。如果在半夜感到腹痛，应当知道在次日中午时分必定分娩。
《脉经》说：所谓“离经”，其脉象是浮起的；如果伴有腹痛牵引腰脊，这是即将生产的征兆。但是，仅仅脉象离经，并不一定立即生产。又说：脉象离经，如果在半夜感觉到（腹痛），到日中时就会分娩。“经”就是常的意思，所谓“离经”，是指脉象离开了它平常的位置。例如，孕妇昨天诊得左手脉沉实，这是男胎的脉象；今天脉象变为浮，这就是离开了她平常的脉象，与昨天不同，再加上腹痛，就知道将要分娩了。通真子引用《难经》中“一呼三至”称为离经来解释。李范又引用《难经》中“一呼一至”称为离经，用来解释沉细而滑的脉象，这些说法都不对。《难经》说损脉和至脉虽然都叫离经，但其脉理是不同的。而且《脉经》明确说离经的脉是浮的，并没有引用《难经》的文字来附和《脉诀》。因为《脉诀》提到脉浮，又添加了沉细而滑，统称为离经，大概是因为之前诊断男女胎儿的脉象，有时浮大为女胎之脉，如果只说脉浮为离经，那么在平时见到浮大为女胎的脉象时，如何辨别是否是离经呢？所以又增加了沉细而滑，以显示离经是相对于浮大这一常经而言的，即相对于平常的滑脉而言。《圣惠方》说：半夜子时感到腹痛，第二天午时必定生产。这是因为子时和午时相对，正好是半天的时间。通真子说：半夜痛，日午生，这种说法恐怕不够确切。又说：只有腹痛而腰部不痛的，还没有生产。如果腹痛且腰痛严重的，就要生产了。之所以这样，是因为肾系于腰，胞宫系于肾的缘故。诊察尺脉，如果变得紧急，像切绳或转珠一样，就是要生产了。生产有难易之分，疼痛有紧慢之别，怎么能固定说是半天呢？应当灵活掌握。）身体沉重、发热、频繁发冷，舌下静脉黑而青紫，舌头反卷且上颚发冷，胎儿将会死亡，腹中胎儿若如此则母亲也会陷入冥界（死亡）。面色赤红、舌色青紫，仔细查看，母亲存活而胎儿死亡的情况很难避免；如果嘴唇和口角都发青，且有泡沫流出，母子都会死亡，只能拼死抢救。面色青紫、舌色赤红、频繁吐沫，母亲死亡而胎儿存活的判断是真实的。如果不相信，可以验证，寻找贤哲的经验是不会虚假的。（《脉指南》写作面青舌赤。大概面部候母，舌部候子，现在说子活，应该以舌赤为准，如果说舌青，则与前文所述面赤舌青、母活子死的征象相反。如果胎先露出，胎儿能活，如果未露出，母子俱亡。从自身重体热寒又频至此段，并不使用脉诊，只通过外部征象来判断母子生死，大概是因为临产脉象不可定论，只应当通过观察面色来知晓。）
杨子建的《十产论》
第一种叫正产，妇人怀胎十月满足，忽然腰腹部阵发性疼痛，接着胎气突然下降，直到脐腹部疼痛至极，进而腰部沉重疼痛，肛门挺进外突，随后破水出血，婴儿便出生，这叫正产。
第二种叫伤产，大概人的出生，阴注阳定，各有其时日，不可更改移动。现在有未足月一个月以前，忽然脐腹疼痛，好像要生产，但随后无事，这叫试月，不是正产。但是所有产妇，在没有出现正产的征候之前，不可以让人抱住腰部，产妇也不可胡乱用力。大概将要生产的妇女，脐腹疼痛，胎儿身体尚未顺位，接生的人却让产妇虚乱用力，胎儿身体刚刚转动，却被产妇用力一逼，使胎儿走错路，忽横忽倒，不能正常出生，这都是因为产妇用力不当造成的。凡是产妇用力，必须等到胎儿身体顺位，临近产门，才开始用力一送，让胎儿生下，这才是产妇用力的恰当时候。如果没有正产的征候就过早用力，并胡乱服药，导致胎儿提前出生，就像拔苗助长一样，无益而有害。这叫做伤产。
〔娄〕上面提到的防止伤产的方法，最为关键重要，千万不要轻视。凡是十月未满，临产腹痛，或作或止，或疼痛不严重的，名叫弄痛，不是正产的征候。或者腹部虽然疼痛严重但腰部不痛的，不是正产的征候。胎位高未下降的，不是正产的征候。肛门未挺进的，不是正产的征候。羊水未破、血未出的，不是正产的征候。羊水和血虽出但腹部不痛的，不是正产的征候。凡是没有正产征候的，暂且让产妇扶行忍耐，如果行走不得，或靠着物体坐着，或安静躺卧，或服用一两服安胎药，得到安宁就停止。千万不要胡乱服用催生药物，惊慌失措导致产妇忧恐而挫伤意志。务必要让产妇宽心存养、调理停当，也让坐婆先进行解说开导。如果觉得心中烦闷，可取白蜜一匙，新汲水调服，千万不要慌乱用力，先使母亲困乏。一直等到胎儿逼近产门，腰部沉重疼痛至极，眼中如火，肛门挺进外突时，才是正产的征候，才可以用力，并服用催生药。我的家人在未足月一个月以前，腰腹俱痛，完全像是要生产，疼痛非常剧烈，但每到巳时稍许缓解。像这样的情况持续了十多天，想不出办法，于是查阅此条内容，遂给予加人参、白术的安胎药服用几服，间或给予肉类食物调养，由此平复不再疼痛，又过了二十多天终于生下一个男孩。当时如果妄动乱用力，并服用催生等药，立刻就会危及生命。
第三种叫催产，指妇人想要生产，羊水破裂血液下行，脐腹部阵发性疼痛极甚，腰部沉重、肛门挺进外突已经显现，这是正产的征候。但是胎儿却没有生下来，就可以服药来催促生产。或者有经过数日，产妇困苦，已经分明见得是正产的征候，但胎儿难以生出，也可以服药来助产妇的正气，让胎儿快速生下，这叫做催产。
第四种叫冻产，冬月天气寒冷，产妇经血遇到寒冷则凝结，以致胎儿不能生下。这种危害最深，如果冬月生产，下部不可脱去棉衣，也不可以坐卧在寒冷处，应当在满房生火，常有暖气，让产妇背身向火，让脐下腿膝间常暖，血液得到温暖则流动散开，使胎儿容易出生，这叫做冻产。
〔薛〕荆氏在孟冬分娩艰难，劳伤元气，产下的孩子已死，用油纸捻烧断脐带，借其热气来温暖胎儿，不久后胎儿忽然发出声音，这个孩子后来没有伤食作泻的症状，可见前面的方法功效不虚。
第五种叫热产，盛夏之月，产妇要温凉适宜，不可肆意贪凉，损伤胎气，也不可多人热气逼迫产妇，使产妇血液沸腾而有发热、头痛、面色赤红、昏昏如醉，甚至不知人事，这叫做热产。（如果是夏月风凉阴雨，也不可任意贪凉，恐怕生大病。）
第六种叫横产，胎儿先露出手，或先露出臂，这是由于产妇未当用力而过早用力所致。胎儿身体未顺，用力一逼，致使身体横置不能生下，应当让产妇安然仰卧，然后让接生的人，先将手推入，直向上方，渐渐逼近身体，用中指按摩肩部推上并矫正它，或者用手指攀拉耳朵来矫正它，必须是产妇仰卧，然后推胎儿直向上方，徐徐矫正，等到身体端正，煎好一盏催生药喝下，才可以用力，让胎儿生下，这叫做横产。
第七种叫倒产，产妇胎气不足，关键不牢，用力太早，致使胎儿不能回转，便直下先露出其脚。应当让产妇仰卧，让接生的人，将脚推回去，不可让产妇用分毫力气，也不能惊恐，使胎儿自然顺位。
蛇蜕散 治疗孕妇将要生产时，不肯伸舒行动，多曲腰眠卧忍痛，胎儿在腹中，不能回转，所以脚先出来，叫做逆生，片刻不救，母子俱亡。
用乌蛇蜕（一条） 蝉蜕（十四枚） 血余（一握，用胎发）
一起烧灰存性，研末分为二服，温酒调服，连续服用，仰卧片刻。或者用小绢针在胎儿脚心刺三五下，用少许盐涂在刺处，实时顺生，母子俱活。又一种方法，用盐涂在胎儿脚底，也可以用指甲搔抓，并用盐摩擦母亲腹部。又一种方法，用手中指取锅底墨，交叉画在胎儿脚下，即顺生。又一方，取其父亲的名字，写在胎儿脚下即顺生。如果孕妇横生不可出的，用车前子为末，酒服二钱匕。又一方，菟丝子为末，酒调服一钱匕，米饮调服也可以。又用百草霜、香白芷（不见火各等分），用童便和好醋各一合，调成膏，沸汤浸服。严重的两服即生。如果妇人横逆难产，子死腹中，先用黑豆一大合，炒熟，用水与重便合煎服，神效。又一方，用艾叶半斤，酒四升，煮取一升，服之。又用当归为末，酒服方寸匕，紫苏汤调服也可以。
第八种叫偏产，胎儿身体未正，产妇用力一逼，致使胎儿头偏拄左腿，或偏拄右腿，所以头虽露出，偏拄一边，不能生下。应当让产妇仰卧，其次让接生的人，轻轻推胎儿近上方，用手矫正其头，让胎儿头顶端正，然后让产妇用力一送，即便生下。如果是小儿头后骨偏拄肛门，只露出其额头，应当让接生的人，用绵衣炙温裹手，在肛门外方，轻轻推胎儿头令正，便让产妇用力送胎儿生也。这叫做偏产。
第九种叫碍产，胎儿身体已顺而露出正顶，不能生下，大概因为胎儿身体回转，肚带攀住其肩，因此露出正顶而不能生。应当让产妇仰卧，让接生的人，轻推胎儿近上方，徐徐引手，用中指按在胎儿肩下拨动其肚带，仍须等到胎儿身体正顺，才让产妇用力一送，使胎儿生下，这叫做碍生。
上述横产、倒产、偏产、碍产四种方法，如果接生的人，不是精良妙手，不要根据使用此法，恐怕放纵其愚昧，以伤害人命。按：倒产者，今世往往随着倒着的脚生下，并无后患，子母双全，不必根据推脚向上的方法也可以。又碍产者，往往肚带有缠在儿顶上，而儿头自出在产门外，接生的人，用手拨开肚带，从儿头顶过而下之的，又有肚带缠在顶上一匝，而儿与胞衣自然同下的，都没有妨碍，不必以此碍产法入产门拨下。
第十种叫坐产，胎儿将要出生，其母亲疲倦久坐，椅褥抵住其生路，急于高处系一手巾，让产妇用手攀之，轻轻屈足坐身，让胎儿生下，并非坐在物体上也。这叫做坐产。
第十一种叫盘肠产，临产时母亲肠子先出来，然后胎儿出生。赵都运恭人，每次生产则大肠先出来，然后产子，产后肠子不收，非常痛苦，医生不能治疗。偶然在建昌，得到坐婆的一个方法来收摄肠子，这个方法是用醋半盏，新汲水七分调和，涂抹产妇面部，每收缩一次，三次收尽，这是良法。
按：前证古方用蓖麻子仁四十九粒，研涂产妇头顶，肠子收回，急洗去。肠子如果干燥，用磨刀水少许湿润之。内服磁石煎汤饮之即收上。磁石须阴阳家用有验者，如果用冷水洗脸，恐怕惊吓则气散。
〔丹〕产后肠不收，香油五斤煎热，盛盆中，候温，坐油盆中约一顿饭的时间，用皂角末吹入鼻中，打喷嚏立上，妙。（《斗门》。）
又一方用大纸捻蘸香油点灯吹灭，以烟熏产妇鼻中，肠即上矣。
〔薛〕将要生产时，觉得腹内转动，就应当正身仰卧，等待胎儿转身向下时作痛，试捏产妇手的中指中节或本节跳动，才与临盆，即产矣。如果初觉不仰卧，以待转胞，或未产而水频下，这是胞衣已破，血水先干，必有逆生难产之患。如果胎衣破而不得分娩者，保生无忧散以固其血，自然生息。如血已耗损，用八珍汤料一斤，益母草半斤，水数碗，煎熟不时饮之，亦有得生者，凡孕妇只腹痛，未产也。若连腰痛甚者，将产也。盖肾候于腰，胞系于肾故也。凡孕家宜预请有仁心知事稳婆，常以恩结其心，先与说知，倘有生息不顺，只说未产。或遇双胎，只说胎衣未下，恐惊则气散，愈难生息。我家亲验之，大抵难产多患于郁闷安佚富贵之家，治法虽云胎前清气，产后补血，不可专执。若脾胃不实，气血不充，宜预调补，不然临产必有患难。如因难产，或大寒时，急以大油纸捻徐徐烧断其脐带，虽儿已死，令暖气入腹，多得复生，切勿用刀断之。
[Mai Jue] The pulse of a woman about to give birth leaves the regular channel (referring to significant changes in pulse quality, such as from deep to floating), manifesting as deep, fine, and slippery; this pulse is also called "Li Jing" (Leaving the Regular Channel). If abdominal pain is felt at midnight, it should be known that delivery will definitely occur at noon the next day.
The *Mai Jing* (Pulse Classic) states: Regarding "Li Jing," the pulse is floating; if accompanied by abdominal pain radiating to the lower back and spine, this indicates imminent delivery. However, merely having a Li Jing pulse does not guarantee immediate delivery. It further states: If the pulse is Li Jing and pain is felt at midnight, birth will occur at midday. "Jing" means constant or regular. "Li Jing" refers to the pulse leaving its usual position. For example, if yesterday the pregnant woman's left wrist pulse was deep and solid (indicative of a male fetus), and today it has become floating, this represents a departure from her usual pulse pattern and differs from yesterday's. Combined with abdominal pain, one knows that delivery is impending. Tong Zhenzi cited the *Nan Jing* (Classic of Difficult Issues), defining "one breath three beats" as Li Jing, to explain this. Li Fan further cited the *Nan Jing*, defining "one breath one beat" as Li Jing, to explain the deep, fine, and slippery pulse; both interpretations are incorrect. The *Nan Jing* states that although both deficient (Sun) and excessive (Zhi) pulses may be termed Li Jing, their pulse principles differ. Moreover, the *Mai Jing* explicitly states that the Li Jing pulse is floating and does not cite the *Nan Jing* to support the *Mai Jue*. Because the *Mai Jue* mentions a floating pulse and adds deep, fine, and slippery qualities under the name Li Jing, it is likely because previous methods for diagnosing fetal sex sometimes showed a large floating pulse for females. If only a floating pulse were defined as Li Jing, how would one distinguish Li Jing from the normal large floating pulse seen in female pregnancies? Therefore, deep, fine, and slippery qualities were added to show that Li Jing is a departure from the usual large floating pulse, specifically relative to the usual slippery pulse. The *Sheng Hui Fang* states: If abdominal pain begins at Zi hour (midnight), delivery will surely occur at Wu hour (noon). This is because Zi and Wu hours are opposite, spanning half a day. Tong Zhenzi stated that "pain at midnight, birth at noon" is perhaps not entirely accurate. He also said: Abdominal pain without lumbar pain indicates labor has not started. Severe abdominal pain combined with severe lumbar pain indicates imminent delivery. This is because the Kidneys govern the lower back, and the uterus is connected to the Kidneys. Palpating the Chi (Cun Cun) pulse, if it becomes urgent, like cutting a rope or rolling beads, delivery is imminent. Delivery varies in difficulty, and pain varies in intensity; how can it be fixed at half a day? One must apply flexible methods.) A heavy body, fever, and frequent chills, blackish-blue sublingual veins, a tongue that curls backward with a cold palate indicate fetal death; if the fetus is in this state within the abdomen, the mother will also die. A red face and cyanotic tongue require careful examination; it is difficult for the mother to survive while the fetus dies. If lips and mouth are cyanotic with frothing, both mother and child will die, requiring desperate measures. A cyanotic face, red tongue, and frequent frothing indicate maternal death with fetal survival. If you do not believe this, verify it; the wisdom of sages is not false. (*Mai Nan Zhi* writes cyanotic face and red tongue. Generally, the face reflects the mother, and the tongue reflects the fetus. Since it says the fetus survives, the red tongue is correct. If the tongue were cyanotic, it would contradict the earlier sign of red face/cyanotic tongue indicating maternal survival/fetal death. If the fetus presents first, it may survive; if not, both perish. From "heavy body..." onwards, pulse diagnosis is not used; instead, external signs are consulted to determine maternal and fetal life or death, because the labor pulse is unpredictable, and one should rely on observing complexion.)
Yang Zijian's *Ten Types of Labor*:
1. **Zheng Chan** (Normal Labor): When a woman carries a fetus for ten months, she suddenly experiences paroxysmal lower abdominal and lumbar pain. Subsequently, the fetal Qi descends abruptly. Pain reaches the navel and abdomen intensely, followed by heavy lumbar pain, rectal protrusion (tenesmus), rupture of membranes, and bleeding, after which the infant is born. This is called Normal Labor.
2. **Shang Chan** (Injured/False Labor): Human birth is determined by Yin and Yang timing and cannot be altered prematurely. If a woman experiences sudden umbilical and abdominal pain resembling labor more than a month before term, but then nothing happens, this is called "Shi Yue" (Testing Month), not true labor. However, for all parturients, before true labor signs appear, no one should hold their waist, and the parturient must not strain uselessly. When a woman is about to deliver, if her abdomen hurts but the fetus is not yet in position, and the midwife encourages her to strain randomly, the fetus may shift incorrectly, becoming transverse or inverted, unable to deliver normally. This results from improper straining by the mother. Straining should only begin when the fetus is in position and approaching the cervix, pushing once to deliver. Straining too early before true labor signs, or taking drugs indiscriminately, is like pulling shoots to help them grow—harmful and useless. This is called Injured Labor.
[Lou] The method above to prevent Injured Labor is crucial and must not be neglected. If ten months are not complete, and there is labor-like pain that comes and goes or is mild, it is called "Nong Tong" (Playing Pain), not true labor. Severe abdominal pain without severe lumbar pain is not true labor. High fetal position not descended is not true labor. No rectal protrusion is not true labor. Ruptured membranes and no blood loss is not true labor. Blood and fluid discharge without abdominal pain is not true labor. If there are no signs of true labor, allow the woman to walk and endure patiently. If she cannot walk, let her sit leaning on something or lie down quietly. Administer one or two doses of An Tai (Fetus-Calming) medicine; stop once comfort is achieved. Do not recklessly administer Cu Chan (Labor-Inducing) drugs, causing panic and fear which damages her spirit. Ensure the parturient remains calm and composed, and have the midwife explain the situation. If she feels stifled, take one spoonful of white honey mixed with fresh water. Do not strain wildly, exhausting the mother first. Only when the fetus presses against the cervix, lumbar pain is extreme, eyes feel fiery, and rectum protrudes, is it true labor; only then strain and take labor-inducing drugs. My family member experienced severe lumbar and abdominal pain resembling labor more than a month before term, peaking until Si hour (9-11 AM) when it eased slightly. This lasted over ten days. Finding no solution, I reviewed this text and prescribed An Tai medicine with Ginseng and Atractylodes for several doses, supplemented with meat broth. She recovered and remained pain-free, delivering a boy twenty days later. Had we strained or used inducing drugs then, she would have faced immediate danger.
3. **Cui Chan** (Induced Labor): Refers to when a woman is ready to deliver, membranes rupture, blood flows, severe paroxysmal abdominal pain occurs, and signs of true labor (lumbar heaviness, rectal protrusion) are present, but the fetus has not yet been born. Medication can be administered to accelerate delivery. If several days pass, the mother is exhausted, and true labor signs are clear but the fetus struggles to emerge, medication can boost the mother's Zheng Qi (Upright Qi) to facilitate rapid delivery. This is Induced Labor.
4. **Dong Chan** (Cold Labor): In winter, cold weather causes menstrual blood to coagulate, preventing fetal descent. This is highly dangerous. In winter deliveries, the lower body must not be exposed to cold; cotton clothes should remain on. Avoid sitting or lying in cold places. Keep the room warm with fire. Have the mother face away from the heat source towards warmth, keeping the area below the navel and knees warm. Warmth promotes blood flow, facilitating easier delivery. This is Cold Labor.
[Xue] Jing's wife had difficult labor in early winter, damaging Yuan Qi (Primal Qi); the baby was stillborn. We burned an oil-paper wick through the umbilical cord, using its heat to warm the infant. Shortly after, the infant made sounds. This child never suffered from food stagnation or diarrhea, proving the efficacy of this method.
5. **Re Chan** (Hot Labor): In midsummer, mothers must maintain appropriate warmth and coolness. Do not excessively seek coolness, damaging fetal Qi. Also, avoid crowding with many people generating heat, which causes maternal blood to boil, leading to fever, headache, flushed face, dizziness like drunkenness, and unconsciousness. This is Hot Labor. (If summer is cool or rainy, do not seek excessive coolness, lest serious illness arise.)
6. **Heng Chan** (Transverse Lie): The fetus presents hand or arm first. This is caused by the mother straining improperly or too early. With the fetus malpositioned, forceful straining causes transverse presentation. The mother should lie supine. The attendant should gently push the presenting limb upward toward the body, massaging the shoulder with the middle finger to correct alignment, or pulling the ear. The mother must remain supine while the fetus is gently pushed up and corrected. Once aligned, administer a cup of labor-inducing decoction, then strain to deliver. This is Transverse Lie.
7. **Dao Chan** (Breech Presentation): Due to insufficient fetal Qi and weak pelvic floor, combined with premature straining, the fetus fails to turn and presents feet first. The mother should lie supine. The attendant should push the feet back up. The mother must exert zero effort and remain calm to allow natural repositioning.
**She Tuo San** (Snake Molt Powder): Treats pregnant women near term who refuse to move, curling in bed enduring pain, causing the fetus to be unable to turn, resulting in foot-first presentation (Ni Sheng). Without prompt rescue, both mother and child die.
Ingredients: One snake molt (Wu She Tui), fourteen cicada molts (Chan Tui), one handful of hair cinder (Xue Yu, preferably fetal hair).
Process: Calcine all ingredients to ash, retain nature, grind into powder. Divide into two doses. Mix with warm wine and consume continuously. Have the mother lie supine for a moment. Alternatively, prick the sole of the fetal foot 3-5 times with a small silk needle, apply a little salt to the puncture site. Delivery will proceed smoothly, saving both. Another method: Apply salt to the soles of the feet, scratch with fingernails, and rub salt on the mother's abdomen. Another method: Use the middle finger to collect soot from the bottom of a pot, draw cross marks on the soles of the feet; delivery proceeds smoothly. Another method: Write the father's name on the soles of the feet; delivery proceeds smoothly. For transverse presentation where the fetus cannot exit, take Che Qian Zi (Plantago Seed) powder, mix with wine, take 2 qian bi. Another method: Tu Si Zi (Cuscuta Seed) powder, mix with wine, take 1 qian bi; rice water is also acceptable. Another method: Bai Cao Shuang (Soil Soot) and Xiang Bai Zhi (Angelica Dahurica), equal parts not roasted. Mix with child's urine and good vinegar (1 he each) into a paste. Take immersed in boiling water. Severe cases resolve in two doses. If transverse/breech difficult labor with dead fetus in utero: First, stir-fry one large measure of black beans. Cook with water and heavy urine (repeatedly urinated water), drink. Miraculous effect. Another method: Boil 0.5 jin of Ai Ye (Mugwort Leaf) in 4 sheng of wine, reduce to 1 sheng, drink. Another method: Dang Gui (Angelica Sinensis) powder, taken with wine (1 cun bi); Zi Su Tang (Perilla Decoction) is also acceptable.
8. **Pian Chan** (Asymmetrical Presentation): The fetus is not upright. Forceful straining causes the head to press against the left or right thigh. The head emerges but is stuck on one side. The mother should lie supine. The attendant should gently push the fetus upward, manually correcting the head to ensure the vertex is centered. Then the mother strains to deliver. If the occiput presses against the anus, exposing only the forehead: The attendant, wearing warmed cotton-wrapped hands, should gently push the head from outside the anus to correct alignment, then the mother strains. This is Asymmetrical Presentation.
9. **Ai Chan** (Obstructed Labor): The fetus is in position, presenting the vertex, but cannot descend. This is often due to the fetus turning, causing the amniotic sac/belt to catch on the shoulder, blocking the vertex. The mother should lie supine. The attendant should gently push the fetus up, slowly guiding the hand, pressing the shoulder with the middle finger to dislodge the sac. Wait until the fetus is straight and smooth, then the mother strains to deliver. This is Obstructed Labor.
For the four methods above (Transverse, Breech, Asymmetrical, Obstructed), if the attendant is not highly skilled, do not attempt these manipulations, lest ignorance cause harm. Note: Breech births often result in healthy infants delivered feet-first without sequelae; manual correction is not always necessary. Regarding Obstructed Labor, sometimes the sac wraps around the vertex, but the head exits naturally past the perineum. Attendants may manually clear the sac over the head. Sometimes the sac wraps once around the vertex, and the fetus and placenta descend together naturally. These are harmless; do not insert hands to remove the sac unnecessarily.
10. **Zuo Chan** (Sitting Labor): As birth approaches, the mother sits for a long time due to fatigue. The chair/cushion obstructs the birth canal. Tie a handkerchief high up. Let the mother hold it, bend her legs, and sit in a semi-upright position to aid delivery. This is not sitting on an object. This is Sitting Labor.
11. **Pan Chang Chan** (Prolapsed Intestine Labor): The mother's intestine prolapses before the fetus is born. Lady Gong, wife of Zhao Duyun, always experienced rectal prolapse before delivery, causing great distress postpartum as the intestine did not retract. Doctors could not treat it. While in Jianchang, she learned a method from a midwife: Mix half a cup of vinegar with seven parts fresh water. Apply to the mother's face. Each time the intestine retracts slightly, repeat three times until fully retracted. This is an excellent method.
Note: Ancient formulas for this condition used 49 castor bean kernels, ground and applied to the crown of the mother's head to retract the intestine, then washed off immediately. If the intestine is dry, moisten slightly with knife-sharpening water. Internally, drink magnetite decoction to retract. Magnetite must be verified effective by Yin-Yang practitioners. Using cold water on the face may cause fright and Qi dispersion.
[Dan] Postpartum intestinal prolapse: Heat 5 jin of sesame oil, pour into a basin. When warm, sit in the oil basin for about one mealtime. Blow powdered Gleditsia sinensis (Zao Jiao) into the nose to induce sneezing, which instantly retracts the intestine. Excellent. (*Dou Men*)
[Dai] Rhizoma Pinelliae (Ban Xia) powder insufflated into the nose retracts the intestine.
Another method: Dip a large paper wick in sesame oil, light it, blow out, and smoke the mother's nose with the fumes; the intestine retracts.
Another method: Place the prolapsed intestine in a clean lacquerware vessel. Immerse in concentrated Scutellaria baicalensis (Huang Qin) decoction; the intestine retracts.
[Xue] At the onset of labor, feeling internal movement, lie supine upright. Wait for the fetus to turn downward and pain to begin. Test the middle joint or proximal phalanx of the mother's middle finger for pulsation. Only then prepare for delivery; birth will follow. If one does not lie supine initially to wait for fetal rotation, or if waters break frequently before labor starts, the membranes have ruptured, fluids dried up, risking malpresentation and dystocia. If membranes rupture but delivery fails, Bao Sheng Wu You San (Preserve Life and Peace of Mind Powder) stabilizes blood, allowing natural birth. If blood is depleted, use Ba Zhen Tang (Eight Treasures Decoction) 1 jin, plus 0.5 jin Motherwort (Yi Mu Cao), decoct in several bowls of water, drink intermittently; some survive. Generally, abdominal pain alone in pregnancy indicates pre-labor. Severe pain extending to the lower back indicates imminent labor, as Kidneys govern the back and connect to the uterus. Pregnant women should hire compassionate, experienced midwives in advance, building rapport. Inform them beforehand. If complications arise, tell the mother it is just pre-labor. If twins, say the placenta hasn't descended. Fear disperses Qi, making birth harder. My family experience confirms that difficult labor often affects depressed, idle, wealthy families. Treatment theories suggest clearing Qi before birth and tonifying blood after, but do not adhere rigidly. If Spleen/Stomach are weak and Qi/Blood insufficient, tonify in advance; otherwise, labor difficulties are inevitable. In case of difficult labor or extreme cold, slowly burn the umbilical cord with a thick oil-paper wick. Even if the infant is dead, warmth entering the abdomen may revive them. Never cut with a knife.