9.盘肠未产肠先出, 已产婴儿肠不收, 顶贴萆麻服升补, 肠干润以
奶酥油.
【注】妊娠妇人有盘肠生者, 临产之时其肠先拖出, 及儿已产下, 其
肠有仍不收者, 须以萆麻仁捣烂贴于顶心, 内服升补之剂, 如补中益
气汤或八珍, 十全大补等汤加升麻, 以升补之, 其肠自收矣.
补中益气汤 十全大补汤 方俱见首卷
10.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.
11.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】产妇胞衣不下者, 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.
9. 胎盘未娩出而肠管先脱出，或婴儿已娩出但肠管仍不能回纳。治疗时可将蓖麻仁捣烂敷贴于头顶百会穴，内服具有升提补益作用的方剂；若肠管干燥，可用奶酥油润滑。
【注】妊娠妇女中有发生“盘肠生”（分娩时直肠脱垂）的情况，临产时肠管先拖出体外，待婴儿娩下后，肠管仍然无法回纳。此时须将蓖麻仁捣烂贴敷于头顶心（百会穴），内服升提补益的药剂，如补中益气汤，或八珍汤、十全大补汤等加入升麻，以起到升提补益的作用，肠管自然就会回纳。
补中益气汤和十全大补汤的方剂组成均见本书首卷。
10. 难产的原因不止一种，有的因孕期过于安逸、贪睡，有的因惊恐导致气怯，有的因过早用力，还有的因胞衣破裂、血液瘀滞或羊水干涸。
【注】妊娠期难产的原因，并非只有一种。或是孕期喜欢安逸而不耐劳碌，或是过度贪睡，都会导致气机阻滞而引起难产；或是临产时惊恐胆怯，或是用力过早，致使产妇困乏无力而导致难产；或是胞衣受损出血，血液瘀滞阻塞产道；或是胞浆过早破裂，羊水与血液干枯，这些都足以导致难产。临床医生不可不仔细审察。
11. 初产妇因用力过猛导致疲劳乏力，或因风冷侵袭致血凝，或因产后失血过多导致产道干涩，或因血液进入胞衣导致腹胀疼痛。应紧急服用夺命没竭散，防止恶露上冲心胸引发喘满危症，并嘱咐接生婆随胎儿娩出后立即取出胞衣，不要惊吓产妇，以免听到相关消息而加重病情。
【注】产妇出现胞衣不下（胎盘滞留），可能是因为初次生产用力过猛导致身体困乏，风邪与寒气相干扰致使血液瘀凝；或者因为产后下血过多，血液枯竭导致产道干涩；或者因为血液进入胞衣内部，导致胀满疼痛，这些情况都能使胞衣无法排出。都应当紧急使用夺命散，即由没药、血竭两味药研成的散剂。以避免病邪上攻心胸，引起胀满喘急，造成不小的危害。并且应当嘱咐接生婆随胎儿娩出后立即取下胞衣，不要让产妇听到此事，恐怕被惊吓后胞衣更难排出。
9. The intestines prolapse before the delivery of the placenta, or remain outside after the infant is delivered. Apply a paste of Ricinus communis seed (Bì Mǎn Rén) to the Baihui acupoint (Dùnníng, GV20) on the vertex, and administer internal decoctions that tonify and raise Qi. If the prolapsed tissue is dry, lubricate it with ghee (Nǎi Sū Yóu) to facilitate reduction.
[Annotation] In pregnant women experiencing "pan chang sheng" (prolapse of the uterus or rectum during labor), the intestines may protrude before delivery and fail to retract even after the infant is born. In such cases, apply crushed Ricinus communis seeds to the center of the vertex (Baihui acupoint). Internally, administer formulas that lift and tonify Qi, such as Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), or Bajun Tang (Eight Treasures Decoction) and Shiquan Dabu Tang (Ten Significant Tonifying Decoction) with added Chishengma (Radix Bupleuri et Rhizoma Cimicifugae, often referring to Chaihu in this context for lifting action). This will naturally cause the prolapse to retract.
The prescriptions for Buzhong Yiqi Tang and Shiquan Dabu Tang are found in the first volume of this book.
10. The causes of dystocia (difficult labor) are manifold: excessive comfort and sleepiness during pregnancy, fright and timidity at labor, premature pushing, rupture of the amniotic sac with blood stasis, and depletion of amniotic fluid.
[Annotation] The causes of dystocia in pregnancy are not singular. Some women prefer comfort and cannot endure physical labor during pregnancy, or sleep excessively, all of which can lead to stagnation of Qi and difficult labor. Others experience fright and Qi deficiency at the onset of labor, or push too early, leading to maternal exhaustion and difficult labor. Some suffer from injury to the amniotic sac with bleeding, causing blood stasis obstructing the birth canal; others have premature rupture of membranes with drying up of amniotic fluid and blood. All these can result in dystocia. Clinicians must carefully examine these factors.
11. Retained placenta in primiparas may be due to fatigue from excessive effort, cold-dampness coagulating blood, excessive postpartum bleeding causing dryness of the birth canal, or blood entering the placenta causing abdominal distension and pain. Urgently administer Duoming Shejie San (Life-Restoring Myrrh and Dragon's Blood Powder) to prevent evil qi from rushing to the heart and chest, causing panting and fullness. Instruct the midwife to remove the placenta along with the fetus. Do not alarm the mother, nor let her hear about it, to avoid fear exacerbating the condition.
[Annotation] When a parturient experiences retained placenta, it may be due to fatigue from excessive effort during first childbirth, combined with interference from wind-cold causing blood stasis and coagulation. Or it may be due to excessive postpartum hemorrhage leading to blood depletion and dryness of the birth canal. Or blood may enter the placenta, causing distension and pain, preventing its expulsion. In all cases, urgently use Duoming San (Life-Restoring Powder), which consists of Myrrha (Mò Yào) and Xuejie (Sanguis Draconis, Dragon's Blood) ground into powder. This prevents the pathogenic factor from attacking the heart and chest, causing distension, fullness, and急促 breathing, which would be harmful. Furthermore, instruct the midwife to remove the placenta following the delivery of the infant. Do not let the mother hear about it, as fear may make expulsion even more difficult.