夫胎前产后。皆为易病之时。皆为易病而难治之时。尤不若临产时为更危险也。盖产之易者。诸凡顺当。母子俱安。
产之难者。生死反掌。必须救治。方能起死回生。稍不急救。多致夭枉。救不得法。药不应手。亦莫能全生。可不惧哉。
盖有少妇初生。神气怯弱。子户未舒。腰曲不伸。展转胎侧。儿不得出。故难产者。有中年妇人。生育多。气血虚。而
难产者。须胎前服调理之药。乃易产。有临产努力太早。儿转未逮。以致胎落于胯。及儿欲出时。母力已乏。而难产者。
先以独参汤接力。次服药。宜滑胎散。有将产之际。愚蠢稳婆。不审其偏正。每腹痛。努力催生。以致横生逆产者。宜
催生四物汤。有体肥脂浓。平素安逸而难产者。有石矮妇人。交骨不开而难产者。盖交骨不开。乃元气虚弱。胎前失于
调养。以致气血不能运达而然也。宜加味芎归汤、交骨不开方。有破胞久。浆水沥尽。产门风进。产路干涩而难产者。
俗名沥胞生。宜神应散。有血先下。或胞浆先下。子逆上冲者。宜子逆汤、黄葵子散。有产不下。横逆生而欲绝者。宜
加味芎归汤。有临产腰腹酸疼见红者。宜催生如意散。有胎死腹中不下者。验其舌色青黑腹冷是也。宜二陈汤加朴硝五
钱。即朴硝一味亦可。若天寒时。须使胎得暖气才下。急服药。宜官桂丸。此方暑天及内热者皆禁用。其死胎不下。反
上冲心而欲绝者。急服药。宜牛膝二两。砂仁、丹参各二钱煎。虚加人参。又方。伏龙肝末酒下。有腹中积水。腹大异
常。脉细而弱。名曰胞水。临产必去水斗余方产者。方载胎前。有临产去血太多。昏不知人。产下即死。曰血晕者。宜
芎归汤。若产后虚脱。兼防血晕。宜人参、鹿角胶、苏木煎。入童便服。有火盛血奔上而昏晕者。宜清魂散。如不醒。
以韭汁和醋灌之。或醋炭法熏之。又不醒。急掐人中。提顶心头发。姜汁童便灌之。即活。有失血过多。虚热太甚。目
暗神昏。手足冷者。宜川芎、当归、人参、姜、桂。汗多加黄 。有才产。忽然噤口。语言颠倒。乍见鬼神。由败血攻
心者。宜妙香散。有临盆用力太过。气血晕闷。不省人事者。宜胶珠汤。有将产而痢不止者。宜四君子汤加白芍、杜仲、
赤石脂、菟丝子、建莲、山药、芡实、砂仁。有子下而胞不下。由败血灌入胞中者。宜牛膝归尾汤、牛膝芒硝酒。或草
纸烟熏其鼻。令纳气自下。或胞不下。而脐腹坚。疼胀急。病更甚。宜牛膝汤。有儿胞下后。膀胱落下。名曰茄病。或
由临盆用力太过。或由血气两虚。其色紫者可治。白者难治。先用熏洗法。宜急以黄连、狗脊、五倍子、水杨根、枯矾
各一钱。为末煎汤。先熏后洗。乘热轻轻托进。一二日自愈。急服药。宜补中益气汤、十全大补汤。去 、苓。加陈皮、
枳壳、茱萸。有子宫落下。痛不可忍。名曰 疾者。宜铁粉散。外用托药或掺药。有气血虚而产门不闭。必须大补者。
宜加味芎归汤。一法用锻石炒热。淬水洗。即闭。至临产危症。莫有如偏产、倒产、横产、碍产、盘肠产、闷脐产、数
大端。最为生死交关之候。然亦非无法以处之者。切不可惊惶扰乱。致产母心怯。然后根据法治之。无弗安然也。其原由
方治。俱采前人之论。详录于后。以前人论极明当。毋庸续说也。其有胞水先破。不即产。甚至延及两三日、四五日者。
此亦甚险。急早调治。宜鱼胶五钱 存性酒下。或冬葵子三钱炒煎服。夫如是而临产之病。庶可免矣。
脉法 脉经曰。怀妊离经。其脉浮。设腹痛引腰脊。为今欲生也。又曰。怀妊六七月。脉实大坚牢。弦紧者生。
沉细者死。又曰。脉匀细。易产。大浮缓。气散难产。脉诀云。欲产之妇脉离经。沉细而滑也同名。夜半觉痛应分诞。
来朝日午定知生。又曰。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
虚陈。（以上附验看生死法）李 曰。临产六至。脉号离经。或沉细滑。如无即生。浮大难产。寒热又频。此是凶候。急
于色征。面颊唇舌。忌黑与青。面赤母活。子命必倾。若胎在腹。子母归冥。
产难 严用和曰。有欲产晕闷者。乃临产时气血忽然晕闷。不省人事。盖因用力太过。脉理衰微。精神困倦。
心胸痞闷。目眩口噤。面青发直。命在须臾。急用来苏散。有胞肥难产者。乃身居富贵。口厌甘肥。聚乐不常。食物无
度。既饱便卧。致令胞胎肥浓。根蒂坚固。行动气急。盖缘不曾预服瘦胎之药。故至难生。入月可服无忧散。则易生。
万全曰。凡临产一二日间艰难者。只以加减五苓散主之。如过二三日。人事强实。饮食能进者。此胞浆干涩也。加味四
物汤调益元散主之。如过二三日。人事困顿。饮食少者。此中气不足。不能运动其胎也。加味四君子汤主之。如三四日
不产。或胎死腹中者。夺命丹主之。又曰。凡儿逆生。切不可用针刺足心。及盐涂之法。儿痛上奔。母命难存。又曰。
凡患盘肠生。恐防再犯者。宜于此后无孕时。多服地黄丸。加五味子一两。肉桂一两。以固下元之关键。及有孕时。多
服胡连丸加人参一两以补气。又服三补丸以凉血。如滑胎瘦胎之药。切勿轻服于入月之时。再服八物汤加诃子、瞿麦、
蜜炙粟壳。服十余剂。庶可免矣。张介宾曰。妊娠将产。切不可占卜问神。使巫觋妄言凶险。恐吓谋利。祷神祈佑。产
妇闻之。致生疑惧。夫忧虑则气结。滞而不顺。多致难产。切戒。又曰。滑胎法。惟欲易产耳。然难产之由。在血之盈
虚。不在药之滑利。盖血多则润而易产。血亏则涩而难产。故于未产前。但宜以培养气血为主。如滑胎煎、五福饮、小
营煎、四物、八珍之类。即皆滑胎要药。若用过滑利。或产期未近。无火无滞。而妄用清火行气沉降等寒凉药。必能暗
残荣气。走泄真阴。多致血亏气陷。反为临期大害。若果肥盛气实者。紫苏饮、保生无忧散、滑胎枳壳散之类。皆可选
用。
死胎 陈自明曰。子死腹中。多因惊动太早。或触犯禁忌。其血先下。胎干涸而然也。须验产母舌。若青黑。
其胎死矣。当下之。用平胃散一两。入朴硝五钱。水酒煎妙。又热病至胎死。亦用前方效。郭稽中云。母本患热病。脏
腑极热。熏煮其胎致死。而用黑神散热药者。儿死身冷不能出。暖之即出也。刘完素曰。儿死腹中。及血暴下。胞干不
能产者。半夏汤。胞死不下。三一承气汤调益元散五钱。或须臾再用油浆调益元散温服。前后俱下而胎下。可活产母也。
夫难产死胎不一。皆由风热燥涩。紧敛结滞。产户不得自然开通。故其症逆。脉弦数而涩。面赤或青。或变五色。腹满
急痛。喘闷。胎已不动者是也。手足温而脉滑者。只为难产。但宜滑胎催生。慎不可下也。李 曰。双胎一死一生者。
用蟹爪一盏。甘草二两。东流水十盏。煎三盏。化阿胶三两。分三服。则死者出。生者安。又曰。通下死胎。用霹雳丹、
夺命丸。外用如圣膏涂足心。仍用催生药。及通关散。吹鼻即下。
胞衣不下 郭稽中曰。胞衣不下。因气力疲惫。不能努出。或血入衣中。胀大而不能下。致心胸胀痛喘急。速
服夺命丹。血散胀消即下。牛膝汤亦效。亦有胎下力弱。不能更用气力。产胞经停。遇风冷乘之。血道闭涩。故胞衣不
下者。急取黑豆一合炒热。入醋一大盏。煎三五沸。分三次温服。陈自明曰。若肠出而气虚不能入。补中益气汤。或蓖
麻子一两研涂母头顶心。即上。急洗之。胞不下。涂右足心。一下即洗去。缓则仍入。益母丸亦效。其血流胞下者。急
用夺命丹、失笑散。以消瘀血。缓则不救。其元气虚不能送者。腹中不胀痛。用保生无忧散。以补固元气。
催生法 王肯堂曰。滑以流通滞涩。苦以驱逐闭塞。香以开窍逐血。气滞者行气。胞浆先破疲困者固血。张介
宾曰。所谓催生者。不过助其气血而利导之。直待临期。乃可用脱花煎。或滑胎煎。随症加减主之。或经日久。产母困
倦难生。俱宜服滑胎煎。以助气血。令儿速生。其有气虚无力。艰于传送者。独参汤随多少接济其力。皆为催生要法。
若期未至。而妄用行气导血等剂。亦犹宋人之揠苗耳。
临产斟酌 保产要录曰。一临产时。最戒用力太早。（要紧）脉诀云。夜半觉痛应分娩。来朝日午定知生。由
此言之。则身痛半日后（便不宜早用力）恰当产也。但产之难易。人各不同。时亦有异。（便不可执定半日痛之说）有素
易产。素难产者。有先难后易。先易后难者。俱无一定。如临产腹痛不生。非是难生。还是子未出胎产。母切勿惧怕。
即一二日至三五日无妨。安心定气。任其自然。勉强忍痛。（要着）进其饮食。（要着）要坐则坐。要行则行。要睡则睡。
莫听稳婆逼迫。用力太早。自己亦勿求速。旁人亦勿多言。惊慌恐惧以乱其心。时至自然分娩。一稳婆逼迫有二。有不
知时候。惟恐后时者。有急完此家。复往他家者。极误大事。一未产前几个时辰。子亦要出产户。转身至手。被母用力
一逼。即手先出。转身至脚。母力一逼。即脚先出。横生倒生。皆因错于用力。其实无手足先出之理。但于将产时。稳
婆以意推度。产妇以意审详。必是脐腹痛急。腰间重痛。眼中如火。粪门迸急。胞水或血俱下。（要紧须令产母知之）此
时子已出胎。产母方用努力。庶不误事。如数征未到。即半日一日不产。切不可老少惊惶。求神许愿。（要紧）恐产母见
之。必生忧虑。一有忧虑。自然胆怯力衰。饮食难进。亦不可悯其痛楚急欲离身。强之用力。（更要紧）用力太早。关系
母子性命。可不畏哉。一有用力太早。致水衣先破。被风所吹。因而产户肿胀。干涩狭小。但从容俟之无妨。又有稳婆
无知。或有意害人。私掏破水衣者。极要关防。一将产。最戒曲身眠卧。（八九月即宜戒之临产尤要）盖产母畏痛。多不
肯直身行动。以致胎元转身不顺。儿将到产门。被母曲腰。遮闭再转。又转闭则必无力而不能动。决是难产。人见其不
动。则为死胎。其实因无力。非死也。此时任有良方妙药。不能令子有力而动。只要产母心安气和。渐渐调理。可保无
虞。又有胞水已下。子忽不动。停一二日三五日者。调治之外。切戒惊恐忧惧暴躁。盖惊则神散。忧则气结。躁暴则气
不顺。血必妄行。多至昏闷。知此善调。自然无患。一将产时。须戒喧闹。进饮食。盖进饮食。则气充胆壮。不致虚乏
无
力。戒喧闹则专静自安。不致疑惧惶惑。一临产腹痛。而腰不甚痛者。产未急也。须扶起直身而行。（要紧）若行不得。
则倚物而立。（要紧）一产时。以饮食为本。有等妇人。临产不能饮食。则精气不壮。以何用力。必未产前预买人参二三
钱。将产煎服。大助精力。胜于肉食。一交骨不开。由元气素弱。胎前失于调摄也。用加味芎归汤立验。一天气寒冷。
产母血气凝滞。儿不能速生。故衣裳宜浓。产室宜暖。背心亦宜温和。庶儿易生。一盛暑之月。产母宜温凉得宜。热甚
则头痛面赤昏晕。若产室人多。热气蒸逼。亦致此患。若夏月风凉阴雨。亦当谨避。一将产。错用努力。手先出者。名
横生。俗为觅盐生。夫盐主收敛紧缩。且蜇人痛。儿手得盐。且痛且缩。自然转身生下。其法急令产母仰卧。略以盐半
分。涂儿手心。仍抹香油轻轻送入。推上扶正。直待儿身转头出。然后服济生方药。以助精力。渴则以蜜半小盏。香油
半小盏。入滚水化开饮之。可以润燥滑胎。令其易产。饥则食稀粥。令其中气不乏。审是儿欲来。方扶挟起身。用力一
送。
儿即生矣。如送手入后。儿转身快。则不必服药。足先出者。亦治如上法。一手足先出之患。其始因稳婆不知时候。误
叫用力。其继稳婆无主张。任其出而不知治法。反叫用力而致伤命。今后但见儿手足稍有出意。即令产母仰卧。轻轻送
入。莫令多出。盖出少则易入。时未久则易入。若出久。则手足青硬。而子必伤。难以扶入。且手足出非药可入。又切
不可听凶妇用刀断儿手。（痛哉切戒）儿手一断。则必腹中乱搅而两伤矣。一产母危急时。当看面舌。面青母伤。舌青子
伤。面舌俱赤。子母无恙。唇舌俱青。子母难保。凡产时子死腹中。服回生丹三丸立下。产母无恙。若一时无此药。以
平胃散一两。投朴硝五钱。煎四五沸温服。其胎化水而出。即不服药。人不慌忙逼迫。亦迟迟生下而不伤母。盖人腹中
极热。惟不忙迫。产母安心饮食。腹内热气熏蒸。胎自柔软腐化。或一二日。三四日。自然生下。但所出秽气。令人难
闻。此可见死胎。不必用力。况活胎乎。一见有怪胎。人不惊慌。亦自然生下。但稳婆有见识者。勿令产母见之更妙。
妊娠和产后时期，都是容易发生疾病的阶段，也是因病难治的阶段。尤其是临产之时，更为危险。分娩顺利的情况，一切顺当，母子平安。
分娩困难的情况，生死只在顷刻之间，必须及时救治，才能起死回生。稍有不急救，多导致夭折死亡。如果救治不得法，药不对症，也不能保全生命。这能不让人畏惧吗？
有的年轻妇女初次生产，神气怯弱，子户（子宫）未舒展，腰部弯曲不能伸直，辗转于胎侧，胎儿无法产出，所以难产。有的是中年妇女，生育次数多，气血虚弱，而导致难产。这类情况必须在妊娠期间服用调理药物，才容易分娩。
有的临产时过早用力，胎儿转动不及，以致胎位卡在胯部；以及胎儿将要产出时，母亲体力已耗尽，而导致难产。这种情况先用独参汤接续元气，再服药，宜用滑胎散。
有的即将分娩之际，愚笨的稳婆不审察胎位正偏，每当腹痛就催促用力催生，以致横生逆产。这种情况宜用催生四物汤。
有的身体肥胖、脂肪浓厚，平时安逸而难产的；有的石矮妇人（指骨盆狭窄或身材矮小者），交骨（耻骨联合）不开而导致难产的。盖因交骨不开，是元气虚弱，妊娠期间失于调养，以致气血不能运达所致。宜用加味芎归汤、交骨不开方。
有的胞衣破裂已久，羊水沥尽，产门受风侵袭，产路干涩而导致难产的，俗名沥胞生。宜用神应散。
有的先见血，或胞浆先下，胎儿逆行上冲的。宜用子逆汤、黄葵子散。
有的胎儿不下，横逆出生且欲绝的。宜用加味芎归汤。
有的临产时腰腹酸痛、见红的。宜用催生如意散。
有的胎死腹中不下的，验其舌色青黑、腹部发冷即可确认。宜用二陈汤加朴硝五钱，单用朴硝一味也可以。如果是天寒时，须使胎儿得到暖气才能下行，急服药，宜用官桂丸。此方在暑天及内热者皆禁用。若死胎不下，反而上冲心胸欲绝的，急服药，宜用牛膝二两，砂仁、丹参各二钱煎服，体虚加人参。另一方法，伏龙肝末用酒送服。
有的腹中积水，腹部异常肿大，脉细而弱，名为胞水。临产时必须排出斗余羊水后才能分娩，此法记载于胎前篇。
有的临产时失血太多，昏不知人，产后即死，称为血晕。宜用芎归汤。若产后虚脱，兼防血晕，宜用人参、鹿角胶、苏木煎服，加入童便服用。
有火盛血奔上而昏晕的，宜用清魂散。如不醒，以韭汁和醋灌之，或用醋炭法熏之。仍不醒，急掐人中穴，提顶心头发，姜汁童便灌之，即可苏醒。
有失血过多，虚热太甚，目暗神昏，手足冷的，宜用川芎、当归、人参、姜、桂。汗多加黄芪。
有的刚生产完，忽然噤口不语，语言颠倒，乍见鬼神，由败血攻心引起的，宜用妙香散。
有的临盆用力太过，气血晕闷，不省人事的，宜用胶珠汤。
有的将产而痢疾不止的，宜用四君子汤加白芍、杜仲、赤石脂、菟丝子、建莲、山药、芡实、砂仁。
有的胎儿已下但胞衣不下，由败血灌入胞中引起的，宜用牛膝归尾汤、牛膝芒硝酒。或用草纸烟熏其鼻，令纳气自下。或胞衣不下，而脐腹坚硬，疼胀急迫，病情更重的，宜用牛膝汤。
有的儿胞下后，膀胱落下，名为茄病。或由临盆用力太过，或由气血两虚引起。其色紫者可治，色白者难治。先用熏洗法，宜急以黄连、狗脊、五倍子、水杨根、枯矾各一钱，研为末煎汤，先熏后洗。趁热轻轻托进，一二日自愈。急服药，宜用补中益气汤、十全大补汤，去茯苓、甘草，加陈皮、枳壳、山茱萸。
有子宫落下，痛不可忍，名为阴挺（原文缺字，据语境推测）疾的，宜用铁粉散。外用托药或掺药。
有气血虚而产门不闭，必须大补的，宜用加味芎归汤。另一种方法用煅石炒热，淬水洗，即可闭合。
至于临产危症，没有比偏产、倒产、横产、碍产、盘肠产、闷脐产等更为生死攸关的了。然而也并非没有办法处理。切不可惊慌扰乱，致使产母心怯。然后根据法治之，无不安然。其原由方治，都采录前人之论，详细记录在后面。因为前人论述极为明当，无需续说。
有胞水先破，不立即分娩，甚至延及两三日、四五日的，这也非常危险，急早调治。宜用鱼胶五钱存性，酒下。或冬葵子三钱炒煎服。像这样，临产之病庶可避免。
脉法 《脉经》说：怀孕离经之脉，其脉浮。如果腹痛牵引腰脊，是为即将分娩。又说：怀孕六七月，脉实大坚牢、弦紧者生，沉细者死。又说：脉匀细，易产；大浮缓，气散难产。《脉诀》说：欲产之妇脉离经，沉细而滑也同名。夜半觉痛应分娩，来朝日午定知生。又说：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，寻之贤哲不虚陈。（以上附验看生死法）李[阙]曰：临产六至，脉号离经。或沉细滑，如无即生。浮大难产。寒热又频，此是凶候。急于色征，面颊唇舌，忌黑与青。面赤母活，子命必倾。若胎在腹，子母归冥。
产难 严用和说：有欲产晕闷者，乃临产时气血忽然晕闷，不省人事。盖因用力太过，脉理衰微，精神困倦，心胸痞闷，目眩口噤，面青发直，命在须臾。急用来苏散。有胞肥难产者，乃身居富贵，口厌甘肥，聚乐不常，食物无度，既饱便卧，致令胞胎肥浓，根蒂坚固，行动气急。盖缘不曾预服瘦胎之药，故至难生。入月可服无忧散，则易生。
万全说：凡临产一二日间艰难者，只以加减五苓散主之。如过二三日，人事强实，饮食能进者，此胞浆干涩也。加味四物汤调益元散主之。如过二三日，人事困顿，饮食少者，此中气不足，不能运动其胎也。加味四君子汤主之。如三四日不产，或胎死腹中者，夺命丹主之。又说：凡儿逆生，切不可用针刺足心，及盐涂之法。儿痛上奔，母命难存。又说：凡患盘肠生，恐防再犯者，宜于此后无孕时，多服地黄丸，加五味子一两，肉桂一两，以固下元之关键。及有孕时，多服胡连丸加人参一两以补气。又服三补丸以凉血。如滑胎瘦胎之药，切勿轻服于入月之时。再服八物汤加诃子、瞿麦、蜜炙粟壳，服十余剂，庶可免矣。
张介宾说：妊娠将产，切不可占卜问神，使巫觋妄言凶险，恐吓谋利，祷神祈佑。产妇闻之，致生疑惧。夫忧虑则气结，滞而不顺，多致难产。切戒。又说：滑胎法，惟欲易产耳。然难产之由，在血之盈虚，不在药之滑利。盖血多则润而易产，血亏则涩而难产。故于未产前，但宜以培养气血为主，如滑胎煎、五福饮、小营煎、四物、八珍之类，即皆滑胎要药。若用过滑利，或产期未近，无火无滞，而妄用清火行气沉降等寒凉药，必能暗残荣气，走泄真阴，多致血亏气陷，反为临期大害。若果肥盛气实者，紫苏饮、保生无忧散、滑胎枳壳散之类，皆可选用。
死胎 陈自明说：子死腹中，多因惊动太早，或触犯禁忌，其血先下，胎干涸而然也。须验产母舌，若青黑，其胎死矣。当下之，用平胃散一两，入朴硝五钱，水酒煎妙。又热病至胎死，亦用前方效。郭稽中说：母本患热病，脏腑极热，熏煮其胎致死，而用黑神散热药者，儿死身冷不能出，暖之即出也。刘完素说：儿死腹中，及血暴下，胞干不能产者，半夏汤。胞死不下，三一承气汤调益元散五钱。或须臾再用油浆调益元散温服，前后俱下而胎下，可活产母也。夫难产死胎不一，皆由风热燥涩，紧敛结滞，产户不得自然开通，故其症逆，脉弦数而涩，面赤或青，或变五色，腹满急痛，喘闷，胎已不动者是也。手足温而脉滑者，只为难产，但宜滑胎催生，慎不可下也。李[阙]说：双胎一死一生者，用蟹爪一盏，甘草二两，东流水十盏，煎三盏，化阿胶三两，分三服，则死者出，生者安。又说：通下死胎，用霹雳丹、夺命丸。外用如圣膏涂足心，仍用催生药，及通关散，吹鼻即下。
胞衣不下 郭稽中说：胞衣不下，因气力疲惫，不能努出。或血入衣中，胀大而不能下，致心胸胀痛喘急，速服夺命丹，血散胀消即下。牛膝汤亦效。亦有胎下力弱，不能更用气力，产胞经停，遇风冷乘之，血道闭涩，故胞衣不下者，急取黑豆一合炒热，入醋一大盏，煎三五沸，分三次温服。陈自明说：若肠出而气虚不能入，补中益气汤。或蓖麻子一两研涂母头顶心，即上，急洗之。胞不下，涂右足心，一下即洗去，缓则仍入。益母丸亦效。其血流胞下者，急用夺命丹、失笑散，以消瘀血，缓则不救。其元气虚不能送者，腹中不胀痛，用保生无忧散，以补固元气。
催生法 王肯堂说：滑以流通滞涩，苦以驱逐闭塞，香以开窍逐血。气滞者行气，胞浆先破疲困者固血。张介宾说：所谓催生者，不过助其气血而利导之。直待临期，乃可用脱花煎，或滑胎煎，随症加减主之。或经日久，产母困倦难生，俱宜服滑胎煎，以助气血，令儿速生。其有气虚无力，艰于传送者，独参汤随多少接济其力，皆为催生要法。若期未至，而妄用行气导血等剂，亦犹宋人之揠苗耳。
临产斟酌 《保产要录》说：一临产时，最戒用力太早。（要紧）《脉诀》云：夜半觉痛应分娩，来朝日午定知生。由此言之，则身痛半日后（便不宜早用力）恰当产也。但产之难易，人各不同，时亦有异。（便不可执定半日痛之说）有素易产，素难产者，有先难后易，先易后难者，俱无一定。如临产腹痛不生，非是难生，还是子未出胎产，母切勿惧怕，即一二日至三五日无妨，安心定气，任其自然，勉强忍痛。（要着）进其饮食。（要着）要坐则坐，要行则行，要睡则睡，莫听稳婆逼迫，用力太早，自己亦勿求速，旁人亦勿多言，惊慌恐惧以乱其心，时至自然分娩。一稳婆逼迫有二，有不知时候，惟恐后时者，有急完此家，复往他家者，极误大事。一未产前几个时辰，子亦要出产户，转身至手，被母用力一逼，即手先出，转身至脚，母力一逼，即脚先出，横生倒生，皆因错于用力，其实无手足先出之理。但于将产时，稳婆以意推度，产妇以意审详，必是脐腹痛急，腰间重痛，眼中如火，粪门迸急，胞水或血俱下。（要紧须令产母知之）此时子已出胎，产母方用努力，庶不误事。如数征未到，即半日一日不产，切不可老少惊惶，求神许愿。（要紧）恐产母见之，必生忧虑。一有忧虑，自然胆怯力衰，饮食难进，亦不可悯其痛楚急欲离身，强之用力。（更要紧）用力太早，关系母子性命，可不畏哉。一有用力太早，致水衣先破，被风所吹，因而产户肿胀，干涩狭小，但从容俟之无妨。又有稳婆无知，或有意害人，私掏破水衣者，极要关防。一将产，最戒曲身眠卧。（八九月即宜戒之临产尤要）盖产母畏痛，多不肯直身行动，以致胎元转身不顺，儿将到产门，被母曲腰，遮闭再转，又转闭则必无力而不能动，决是难产。人见其不动，则为死胎，其实因无力，非死也。此时任有良方妙药，不能令子有力而动，只要产母心安气和，渐渐调理，可保无虞。又有胞水已下，子忽不动，停一二日三五日者，调治之外，切戒惊恐忧惧暴躁。盖惊则神散，忧则气结，躁暴则气不顺，血必妄行，多至昏闷。知此善调，自然无患。一将产时，须戒喧闹，进饮食。盖进饮食，则气充胆壮，不致虚乏无力。戒喧闹则专静自安，不致疑惧惶惑。一临产腹痛，而腰不甚痛者，产未急也。须扶起直身而行。（要紧）若行不得，则倚物而立。（要紧）一产时，以饮食为本。有等妇人，临产不能饮食，则精气不壮，以何用力。必未产前预买人参二三钱，将产煎服，大助精力，胜于肉食。一交骨不开，由元气素弱，胎前失于调摄也。用加味芎归汤立验。一天气寒冷，产母血气凝滞，儿不能速生，故衣裳宜浓，产室宜暖，背心亦宜温和，庶儿易生。一盛暑之月，产母宜温凉得宜。热甚则头痛面赤昏晕，若产室人多，热气蒸逼，亦致此患。若夏月风凉阴雨，亦当谨避。一将产，错用努力，手先出者，名横生，俗为觅盐生。夫盐主收敛紧缩，且蜇人痛，儿手得盐，且痛且缩，自然转身生下。其法急令产母仰卧，略以盐半分，涂儿手心，仍抹香油轻轻送入，推上扶正，直待儿身转头出，然后服济生方药，以助精力。渴则以蜜半小盏，香油半小盏，入滚水化开饮之，可以润燥滑胎，令其易产。饥则食稀粥，令其中气不乏。审是儿欲来，方扶挟起身，用力一送，儿即生矣。如送手入后，儿转身快，则不必服药。足先出者，亦治如上法。一手足先出之患，其始因稳婆不知时候，误叫用力，其继稳婆无主张，任其出而不知治法，反叫用力而致伤命。今后但见儿手足稍有出意，即令产母仰卧，轻轻送入，莫令多出。盖出少则易入，时未久则易入。若出久，则手足青硬，而子必伤，难以扶入。且手足出非药可入，又切不可听凶妇用刀断儿手。（痛哉切戒）儿手一断，则必腹中乱搅而两伤矣。一产母危急时，当看面舌。面青母伤，舌青子伤。面舌俱赤，子母无恙。唇舌俱青，子母难保。凡产时子死腹中，服回生丹三丸立下，产母无恙。若一时无此药，以平胃散一两，投朴硝五钱，煎四五沸温服。其胎化水而出，即不服药，人不慌忙逼迫，亦迟迟生下而不伤母。盖人腹中极热，惟不忙迫，产母安心饮食，腹内热气熏蒸，胎自柔软腐化，或一二日，三四日，自然生下。但所出秽气，令人难闻。此可见死胎，不必用力，况活胎乎。一见有怪胎，人不惊慌，亦自然生下。但稳婆有见识者，勿令产母见之更妙。
Prenatal and postnatal periods are times when diseases are prone to occur, and also times when diseases are difficult to treat. Especially during labor, it is even more dangerous. In cases of easy delivery, everything goes smoothly, and both mother and child are safe.
In cases of difficult delivery, life and death hang in the balance; timely treatment is required to revive the dying. If not treated urgently, it often leads to premature death. If the treatment is improper or the medicine does not act promptly, life cannot be saved. Should one not fear this?
Some young women giving birth for the first time have weak spirit and qi, their uterus (Zihu) has not yet expanded, their waist is bent and cannot straighten, they toss and turn on the side of the fetus, and the fetus cannot exit, leading to dystocia. Some middle-aged women have given birth many times, resulting in deficiency of qi and blood, leading to dystocia. Such cases require taking regulating medicines during pregnancy to facilitate easier delivery.
Some women exert effort too early during labor before the fetus has rotated sufficiently, causing the fetus to get stuck in the hip area; or the mother's strength is exhausted just as the fetus is about to be born, leading to dystocia. In such cases, first use Dushen Tang (Ginseng Decoction) to replenish vital energy, then take medicine, preferably Huatai San (Slippery Fetus Powder).
At the moment of impending delivery, foolish midwives may fail to assess fetal position correctly and urge pushing with every pain, leading to transverse or breech presentation. In such cases, use Cuisheng Siwu Tang (Labor-Inducing Four Substances Decoction).
Some obese women with thick fat layers, who are usually sedentary, experience dystocia. Some women with narrow pelvises or short stature have failure of the pubic symphysis (Jiaogu) to open, leading to dystocia. This is due to weakness of primordial qi and lack of regulation during pregnancy, causing qi and blood to fail to circulate properly. Use Jiawei Xionggui Tang (Modified Ligusticum and Angelica Decoction) or Jiaogu Bukai Fang (Formula for Opening Pubic Symphysis).
If the amniotic sac has ruptured for a long time, fluids are depleted, the birth canal is exposed to wind, and the passage is dry and rough, leading to dystocia (commonly known as Licbaosheng), use Shenyingsan.
If bleeding occurs first, or amniotic fluid leaks first, with the fetus reversing upward, use Zini Tang (Fetal Reversal Decoction) or Huangkui Zi San (Yellow Abelmoschus Seed Powder).
If the fetus does not descend, presenting transversely or inversely and nearing death, use Jiawei Xionggui Tang.
If there is lower back and abdominal soreness and spotting during labor, use Cuisheng Ruyi San (Labor-Inducing Ruyi Powder).
If the fetus is dead in the womb and not delivered, confirm by checking for a blue-black tongue color and cold abdomen. Use Erchen Tang (Two Aged Decoction) added with 5 qian of Poxiao (Mirabilite); using only Mirabilite is also effective. In cold weather, warmth is needed to help the fetus descend; urgently take Guigui Wan (Cinnamon Pill). This formula is contraindicated in summer or in cases of internal heat. If the dead fetus rises to the heart causing near-death symptoms, urgently take Niuxi (Achyranthes Root) 2 liang, together with Sharen (Amomum Fruit) and Danshen (Salvia Miltiorrhiza) each 2 qian decocted; add Renshen (Ginseng) for deficiency. Another method: take Fulonggan (Dragon's House Earth) powder with wine.
If there is accumulation of fluid in the abdomen with abnormal swelling, fine and weak pulse, named Baoshui (Womb Water), over a dou of water must be expelled before delivery can occur; this method is recorded in the prenatal chapter.
If excessive blood loss occurs during labor leading to unconsciousness and death immediately after delivery, called Xunyun (Blood Syncope), use Xionggui Tang. For postpartum collapse preventing syncope, use Renshen, Lujiaojiao (Deer Antler Glue), and Sumu (Sappan Wood) decocted, taken with Tongbian (Child's Urine).
For syncope caused by excess fire and rushing blood, use Qinghun San (Clear Soul Powder). If unresponsive, administer leek juice mixed with vinegar, or fumigate with vinegar-charcoal. If still unresponsive, press Renzhong (GV26), pull hair from the vertex, and administer ginger juice and child's urine to revive.
For excessive blood loss causing severe deficiency heat, dim vision, confusion, and cold limbs, use Chuanxiong, Danggui, Renshen, Ginger, and Cinnamon. Add Huangqi (Astragalus) if sweating is excessive.
After delivery, sudden mutism, inverted speech, and hallucinations caused by retained blood attacking the heart should be treated with Miaoxiang San.
Excessive effort during labor causing qi and blood syncope and unconsciousness should be treated with Jiaozhu Tang.
If dysentery persists during labor, use Sijunzi Tang (Four Gentlemen Decoction) added with Baishao, Duzhong, Chishizhi, Tusizi, Jianlian, Shanyao, Qianshi, and Sharen.
If the fetus is delivered but the placenta remains, caused by retained blood entering the uterus, use Niuxi Guiwei Tang or Niuxi Mangxiao Jiu. Alternatively, fumigate the nose with straw paper smoke to guide qi downward. If the placenta remains with hard, painful, and distended umbilical abdomen, use Niuxi Tang.
If the bladder prolapses after delivery, named Qiebing (Eggplant Disease), due to excessive effort or qi-blood deficiency: purple color is treatable, white is difficult. First use fumigation and washing with Huanglian, Gouji, Wubeizi, Shuiyanggen, and Kufan each 1 qian decocted; fumigate then wash. Gently push back while warm; it heals in 1-2 days. Urgently take Buzhong Yiqi Tang or Shiquan Dabu Tang, removing Fuling and Gancao, adding Chenpi, Zhike, and Zhuyu.
If the uterus prolapses with unbearable pain, named [missing character] disease, use Tiefen San. Apply external supporting or dusting medicines.
For non-closing vulva due to qi-blood deficiency requiring major tonification, use Jiawei Xionggui Tang. Another method: use calcined stone heated and quenched in water for washing to close it.
The most critical dangers in labor include lateral, inverted, transverse, obstructed, entangled cord, and suffocating navel presentations. These are life-and-death situations but are treatable. Do not panic; keep the mother calm and follow treatment methods. The causes and treatments are recorded below based on previous experts' theories.
If amniotic fluid breaks early without immediate delivery, extending to 2-5 days, it is very dangerous. Treat urgently with Yujiao (Fish Maw) 5 qian preserved nature, taken with wine; or Dongkuizi (Malva Seed) 3 qian fried and decocted. Following these measures can prevent labor complications.
Pulse Diagnosis: The *Mai Jing* states that the pulse of a pregnant woman nearing delivery becomes floating. If abdominal pain radiates to the lower back, delivery is imminent. It also states that at 6-7 months, a solid, large, firm, wiry, or tight pulse indicates survival, while a deep and thin pulse indicates death. A uniform and thin pulse facilitates easy delivery; a large, floating, and slow pulse indicates scattered qi and difficult delivery. The *Mai Jue* says: "When a woman is about to give birth, the pulse deviates; deep, thin, and slippery pulses are similar. Pain felt at midnight indicates delivery by noon the next day." It further states: "Heavy body, fever, and frequent chills; black and green veins under the tongue indicate fetal death and maternal peril. Red face and blue tongue suggest mother survives but fetus dies. Blue lips and tongue with froth indicate death of both. Blue face and red tongue with frequent froth indicate mother dies but fetus lives." Li [Name Missing] states: "Six rapid pulses and deviated pulse at labor; deep, thin, and slippery mean immediate birth. Large and floating means difficult delivery. Frequent chills and fever are ominous signs. Observe facial features; avoid black and blue colors. Red face means mother lives, fetus perishes. If fetus remains in womb, both die."
Dystocia: Yan Yonghe states: "Syncope and dizziness during labor" is caused by sudden qi-blood disturbance, unconsciousness, excessive effort, weak pulse, fatigue, chest oppression, dizziness, locked jaw, blue face, and straightened hair, indicating imminent death. Urgently use Lususan. "Obese womb dystocia" occurs in wealthy women consuming rich foods, lying down after eating, leading to a thick-walled, firmly rooted womb. Without prior "thin womb" medicine, delivery is difficult. Take Wuyou San in the final month for easier delivery.
Wan Quan states: For difficulty in the first 1-2 days of labor, use Jiawei Wuling San. If lasting 2-3 days with strong constitution and good appetite, indicating dry amniotic fluids, use Jiawei Siwu Tang调和 Yi Yuan San. If lasting 2-3 days with exhaustion and poor appetite, indicating insufficient middle qi failing to move the fetus, use Jiawei Sijunzi Tang. If no delivery after 3-4 days or dead fetus, use Duoming Dan. He warns against pricking soles or applying salt for breech presentation, as fetal pain causes upward rushing, endangering the mother. For entangled cord prevention, take Dihuang Wan with Wuweizi and Rougui when not pregnant to secure the lower origin. During pregnancy, take Hulian Wan with Renshen to boost qi, and Sanbu Wan to cool blood. Avoid slippery/thinning medicines in the final month. Instead, use Babatang with Hezi, Qumai, and Honey-fried Miguan for over ten doses.
Zhang Jiebin states: Do not consult fortune tellers or shamans before labor, as fear causes qi stagnation and difficult delivery. Slippery delivery depends on blood abundance, not just slippery drugs. Abundant blood lubricates; deficient blood causes friction. Therefore, nourish qi and blood before labor using Huatai Jian, Wufu Yin, Xiaoying Jian, Siwu, or Bazhen. Overuse of slippery/cold drugs damages yin and blood. For robust women, Zisu Yin, Baosheng Wuyou San, or Huatai Zhike San may be used.
Dead Fetus: Chen Ziming states: Fetal death is often due to early alarm or taboo violation, causing bleeding and fetal desiccation. Check the mother's tongue; if blue-black, the fetus is dead. Purge using Pingwei San 1 liang with Poxiao 5 qian decocted in water and wine. Effective for heat-induced fetal death. Guo Jizhong states: Heat in organs cooks the fetus; cooling herbs alone won't expel the cold corpse; warming helps expulsion. Liu Wansu states: For fetal death with sudden bleeding and dry womb, use Banxia Tang. For retained dead placenta, use Sanyi Chengqi Tang调和 Yi Yuan San 5 qian, or oil-paste Yi Yuan San. Expulsion saves the mother. Dystocia and dead fetus are caused by wind-heat, dryness, and constriction. Symptoms include rebellious pulse (wiry, rapid, choppy), red/blue face, abdominal fullness/pain, panting, and fetal immobility. Warm hands/feet and slippery pulse indicate simple dystocia; use slippery/labor-inducing methods, do not purge. Li [Name Missing] states: For twin pregnancy with one dead, use Crab Claw 1 cup, Gancao 2 liang, East-flowing water 10 cups, decoct to 3 cups, dissolve Ejiao 3 liang, divide into three doses. Dead exits, live survives. To expel dead fetus, use Pili Dan or Duoming Wan. Apply Rusheng Gao to soles, use labor-inducing drugs and Tongguan San blown into nose.
Retained Placenta: Guo Jizhong states: Retained placenta due to exhaustion or blood entering the sac causing distension and chest pain/panting. Urgently take Duoming Dan; blood disperses, distension resolves, placenta drops. Niuxi Tang is also effective. If weak after delivery, wind-cold closes blood channels. Urgently take 1 he of fried black beans decocted with 1 da zhan of vinegar, divided into three warm doses. Chen Ziming states: For prolapsed intestine due to qi deficiency, use Buzhong Yiqi Tang. Or apply crushed Castor Bean 1 liang to vertex, wash immediately. For retained placenta, apply to right sole, wash immediately after expulsion. Yimu Wan is also effective. For bleeding with retained placenta, use Duoming Dan and Shixiao San to resolve stasis; delay is fatal. For qi deficiency without distension, use Baosheng Wuyou San to consolidate yuan qi.
Labor-Inducing Methods: Wang Kentang states: Slippery agents clear obstruction, bitter agents drive out blockage, aromatic agents open orifices and expel blood. Regulate qi for stagnation, consolidate blood for ruptured membranes/fatigue. Zhang Jiebin states: Labor induction aids qi-blood and guides smoothly. Use Tuohua Jian or Huatai Jian near term, modified by symptoms. For prolonged labor with exhaustion, use Huatai Jian to boost qi-blood. For qi deficiency unable to transport, use Dushen Tang to supplement strength. These are key methods. Using qi-moving/blood-draining drugs before term is like pulling shoots to help them grow.
Labor Precautions: *Baochan Yaolu* states: Most importantly, avoid pushing too early. Pulse theory suggests pain at midnight leads to birth by noon. However, ease of delivery varies. Do not fear if labor pains last 1-5 days without birth; remain calm, eat well, rest/move/sleep as needed. Do not listen to midwives urging early pushing. Midwives err by either fearing lateness or rushing to other clients. Pushing before the fetus rotates causes hand/foot presentation. Assess signs of imminent birth: urgent umbilical pain, heavy waist pain, burning eyes, rectal pressure, fluid/blood discharge. Only then push. Do not panic if labor stalls; anxiety weakens qi. Do not force pushing due to pity for pain; early pushing risks life. Early rupture of membranes exposes the canal to wind, causing swelling/dryness. Guard against midwives tearing membranes. Avoid curling up during labor; straight posture aids fetal rotation. Curling blocks the path. If fetus stops moving after fluid release, avoid shock/anxiety. Eat well to strengthen qi; avoid noise to maintain calm. If abdominal pain without back pain, stand straight. Food is essential for strength; pre-buy Renshen for labor. For Jiaogu Bukai, use Jiawei Xionggui Tang. Keep warm in winter; keep cool/ventilated in summer. For hand presentation (Hengsheng/Miyansheng), apply half fen of salt to palm to induce contraction/rotation, lubricate with sesame oil, gently insert, correct position, wait for head/shoulders to rotate, then administer Jisheng Fang drugs. Drink honey-sesame oil water for thirst, congee for hunger. Once ready, assist standing and push. If foot presents, treat similarly. Never cut off protruding limbs. Check face/tongue for prognosis: Blue face/maternal injury, Blue tongue/fetal injury, Red face/tongue/safe, Blue lips/tongue/danger. For dead fetus, take Huisheng Dan. If unavailable, use Pingwei San with Poxiao. Natural decomposition occurs with heat if not rushed. Strange fetuses deliver naturally if mother is calm. Wise midwives hide abnormalities from the mother.