难产之由不一端，胎前安逸过贪眠，惊恐气怯用力早，胞破血壅血浆干。
【注】妊娠难产之由，非只一端。或胎前喜安逸不耐劳碌，或过贪眠睡，皆令气滞难
产；或临产惊恐气怯，或用力太早，则产母困乏难产；或胞伤血出，血壅产路，或胞浆
破早，浆血干枯，皆足以致难产。临证之工不可不审也。
胞衣不下因初产，用力劳乏风冷凝，下血过多产路涩，血入胞衣腹胀疼，急服夺命没竭散，勿使冲
心喘满生。谕令稳婆随胎取，休惊产母莫教闻。
【注】产妇胞衣下不者，或因初产用力困乏，风冷相干致血瘀凝；或因下血过多，血
枯产路干涩；或血入胞衣，胀满疼痛，皆能使胞衣不下。均当急用夺命散，即没药、血
竭二味为散也。免致上攻心胸，胀满喘急，为害不小。且宜谕令稳婆随胎取下，莫使产母
闻之，恐被惊则愈难下也。
产门不闭由不足，初产因伤必肿疼。不足十全大补治，甘草汤洗肿伤平。
【注】凡产后玉门不闭者，多由气血不足所致。亦有因初产伤重者，必肿而疼也。气
血不足者，用十全大补汤治之；因伤肿痛者，浓煎甘草汤洗之，其肿伤自平。
十全大补汤（方见首卷）
清魂散
产后血晕恶露少，面唇色赤是停瘀；恶露去多唇面白，乃属血脱不须疑。虚用清魂荆芥穗，人参芎
草泽兰随；腹疼停瘀佛手散，醋漆熏法总相宜。
【注】产后血晕，有因恶露去少，内有停瘀上攻迷晕者，面唇必赤色；有因去血过多，
血脱而晕者，面唇必色白。血弱者宜用清魂散，即荆芥穗、人参、川芎、甘草，泽兰叶
也。若停瘀腹痛者，用佛手散。二者俱宜频烧干漆及用火烧铁钉淬醋，不时熏之。
佛手散（方见首卷）
难产的原因不止一种，可能是产前过于安逸、贪睡，或因惊恐导致气虚胆怯，或是过早用力，导致胞衣破裂、血液壅滞、血浆干枯。
【注】妊娠期间发生难产，原因并非只有一种。有的因为产前喜欢安逸、不能耐受劳累，或者过度贪睡，都会导致气机阻滞而难产；有的因为临产时惊恐、气虚胆怯，或者用力过早，导致产妇困乏无力而难产；有的因为胞衣受损出血，血液壅塞产道，或者胞浆过早破裂，浆血干枯，都足以导致难产。临床医生不可不仔细审察。
胞衣不下多见于初产妇，因用力过度导致劳乏，加上风冷侵袭凝滞，或者产后出血过多导致产道干涩，或者血液进入胞衣导致腹胀疼痛，此时应紧急服用夺命没竭散，不要使瘀血上冲心胸导致气喘胸闷而危及生命。并告知接生婆随胎儿娩出后随即取出胞衣，不要惊吓产妇，不要让产妇听到取胞衣的过程。
【注】产妇胞衣不下的情况，可能是因为初产时用力过度导致疲劳乏力，风冷邪气干扰导致血液瘀凝；可能是因为产后出血过多，血液枯竭导致产道干涩；或者是血液进入胞衣，导致胀满疼痛，这些都能使胞衣不下。都应当紧急使用夺命散，即由没药、血竭两味药研成散剂组成。以免瘀血上攻心胸，引起胀满喘急，危害不小。并且应该告知接生婆随着胎儿娩出随即取下胞衣，不要让产妇听到（关于取胞衣的言语），恐怕被惊吓会导致更难排出。
产门不闭多由气血不足引起，初产妇因分娩损伤必然出现肿胀疼痛。气血不足者用十全大补汤治疗，用甘草汤清洗以消除肿胀和损伤。
【注】凡是产后玉门（阴道口）不闭合的情况，大多是由气血不足所致。也有因为初次分娩损伤严重的，必然会出现肿胀和疼痛。气血不足的，用十全大补汤来治疗；因损伤导致肿痛者，用浓煎的甘草汤清洗，其肿胀和损伤自然会平复。
十全大补汤（方剂见首卷）
清魂散
产后血晕若恶露量少，面唇色赤说明有瘀血停滞；若恶露去量多且唇色苍白，则属于血脱证，无需怀疑。虚证使用清魂散，由荆芥穗、人参、川芎、甘草、泽兰组成；腹痛且有瘀血停滞者使用佛手散，配合醋和干漆熏蒸的方法总为适宜。
【注】产后血晕，有因为恶露排出少，内有瘀血停滞上攻导致昏迷眩晕的，面唇必定呈红色；有因为失血过多，血脱而导致晕厥的，面唇必定呈白色。血虚者宜用清魂散，即由荆芥穗、人参、川芎、甘草、泽兰叶组成。若有瘀血停滞且腹痛者，用佛手散。这两种情况都适宜频繁烧灼干漆及用火烧红的铁钉淬入醋中，不时进行熏蒸。
佛手散（方剂见首卷）
The causes of dystocia are not limited to one aspect; they may result from excessive comfort and oversleeping during pregnancy, fright leading to qi deficiency and timidity, or premature exertion causing rupture of the amniotic sac, blood stasis, and drying up of plasma.
[Note] The causes of dystocia during pregnancy are not singular. Some cases arise because the pregnant woman prefers comfort and cannot endure labor, or sleeps excessively, all of which lead to qi stagnation and difficult delivery. Others occur due to fright and qi deficiency at the time of labor, or premature pushing, resulting in maternal exhaustion and difficulty in delivery. Still others result from injury to the amniotic sac with bleeding, blood stasis obstructing the birth canal, or premature rupture of membranes with drying up of fluids and blood, all of which can cause dystocia. Clinicians must carefully examine these conditions.
Retained placenta is often seen in primiparas, caused by exhaustion from excessive pushing combined with cold-wind invasion coagulating blood, or excessive postpartum hemorrhage leading to a dry and rough birth canal, or blood entering the placenta causing abdominal distension and pain. In such cases, immediately administer Duoming Shejie San (Life-Rescuing Myrrh and Dragon's Blood Powder), preventing the pathogenic factors from rushing to the heart and chest, which could cause asthma and fullness leading to death. Instruct the midwife to remove the placenta immediately after the fetus is delivered, avoiding startling the mother or letting her hear about the procedure.
[Note] Retained placenta may be due to fatigue and weakness from excessive pushing during first-time labor, where cold-wind interferes causing blood stasis and coagulation; or due to excessive blood loss leading to blood depletion and a dry, rough birth canal; or blood entering the placenta causing distension and pain, all of which prevent the placenta from being expelled. One should urgently use Duoming San, composed of Myrrha (Myrrh) and Draconis Sanguis (Dragon's Blood) ground into powder. This prevents the pathogen from attacking the heart and chest, causing distension and急促 breathing, which poses significant harm. It is advisable to instruct the midwife to remove the placenta immediately following fetal expulsion, ensuring the mother does not hear about it, as fear may hinder its expulsion.
Vulvar laxity (failure of the vaginal opening to close) is primarily due to insufficiency; in primiparas, it is necessarily accompanied by swelling and pain due to injury. Insufficiency is treated with Shiquan Dabu Tang (Ten Substance Great Tonifying Decoction), while swelling and injury are treated by washing with Gancao Tang (Licorice Decoction).
[Note] Postpartum failure of the Yumen (vaginal opening) to close is mostly caused by qi and blood deficiency. In some cases, severe injury during first-time labor inevitably leads to swelling and pain. For qi and blood deficiency, treat with Shiquan Dabu Tang (Ten Substance Great Tonifying Decoction); for swelling and pain due to injury, wash with concentrated Gancao Tang (Licorice Decoction), and the swelling and injury will naturally subside.
Shiquan Dabu Tang (Formula see Volume 1)
Qinghun San
Postpartum syncope with scant lochia indicates retained blood stasis, characterized by red face and lips; profuse lochia loss with pale lips indicates blood collapse, without doubt. For deficiency patterns, use Qinghun San, composed of Jingjie Sui (Schizonepeta Spike), Renshen (Ginseng), Chuanxiong (Ligusticum Rhizome), Gancao (Licorice Root), and Zelan Ye (Eupatorium Leaf). For abdominal pain due to retained stasis, use Foshou San (Buddha's Hand Powder), and fumigation with vinegar and dried lacquer is generally suitable.
[Note] Postpartum syncope can be caused by scant lochia with internal retained stasis rushing upward causing coma and dizziness, where the face and lips appear red; or by excessive blood loss leading to blood collapse and fainting, where the face and lips appear white. For blood deficiency, Qinghun San is appropriate, composed of Schizonepeta Spike (Jingjie Sui), Ginseng (Renshen), Ligusticum Rhizome (Chuanxiong), Licorice Root (Gancao), and Eupatorium Leaf (Zelan Ye). If there is retained stasis with abdominal pain, use Foshou San (Buddha's Hand Powder). Both conditions are suitable for frequent fumigation using burnt dried lacquer and iron nails heated in fire and quenched in vinegar.
Foshou San (Formula see Volume 1)