将息
妊娠临月，当安神定虑，时常步履，不可多睡饱食、过饮酒醴。产时不可多人喧闹。若见浆水，腰间痛
甚，是胎已离经，方可用药催生，坐草。（《妇人良方》）
保护
冬月天冷，产母经血得冷则凝，致儿难生。故冬月产者，下部不可脱去绵衣坐卧寒处，须要房内围炉，令
产母身背向火，腰腹腿膝和暖，血得热则流通，儿易生也。○夏月产者，须要温凉得所，不可恣意取凉，伤损
胎气；房内不可人多，热气逼袭，致令产母心烦，血热沸腾，而有郁冒冲晕之患。（杨子建）
产侯
产候有十∶一曰正产；二曰坐产；三曰卧产；四曰横产；五曰逆产；六曰偏产；七曰碍产；八曰盘肠产；
九曰热产；十曰冻产。（《妇人良方》）
临产真言∶一曰睡，二曰忍痛；三曰慢临盆。○孕妇临月，腹痛或作或止者，名曰弄胎，非正产之候。或腹
虽痛，而腰不甚
痛者，非正产之候。胎高未陷下者，非正产之候。谷道未挺进者，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。且令扶行熟忍，不可坐草。（《达生编》）
欲产之时，觉腹内转动，当正身仰卧，待儿转身向下。试捏产母手，中指中节跳动，方与临盆，即产矣。（薛立斋）
用力及时
临产必俟脐腹痛极，腰间重痛，眼中如火，谷道迸急，胞水与血俱下，脉见离经，此时子已出胎，产母方
可用力。（《冯氏锦囊》）
或曰∶大便亦须用力，如何生产不用力？不知大便呆物，必须人力；小儿自会转动，不但不必用力，而且
切忌用力。盖小儿端坐腹中，及至生时，垂头转身向下。腹中窄狭，他人有力难助，须听其自家慢慢转身，逼
到产门，头向下，脚向上，倒悬而出。若儿未转身，早妄用力，一逼则脚先出，俗赠美名曰∶脚踏莲花。或转
身未定，早妄用力，一逼则横卧腹中，一手先出，又名之曰∶讨盐生。即或转身向下，未得条直，用力过早，
或左或右，偏顶腿骨，而不得出。此等弊病，皆由时候未到，妄自用力故也。然亦非全不用力，但用力只须一
盏茶时耳。即如大便，未到肛门，纵然用力，亦不能出，况于人乎？○临产，小儿力尽，不能得出，宜令产母
安睡，使儿在腹亦安睡歇力，少刻自生。盖小儿向下时，而大人坐立，则倒悬矣，岂能久待？今大人睡下，儿
亦睡下，有何妨碍？或曰∶倘闷坏奈何？曰∶他在腹中十个月不闷坏，今片时乃得闷坏乎？○临产误用力，以
致横生、倒产，急令产母安睡，用大剂加味芎归汤服之，将手足缓缓托入，再睡一夜，自然顺生。（《达生编》）
稳婆
稳婆须择老成忠浓，预先嘱之，及至临盆，务令从容镇静，不得用法催逼。尝见有稳婆忙冗性急者，恐顾
此失彼，因而勉强
试汤，分之掐之，逼之使下，多致头身未顺，而手足先出，或横或倒，为害不小。若未有紧阵，不可令其动手。
又或有生息不顺及双胎未下之类，但宜稳密安慰，不可使产母闻知，恐惊则气散，愈难生下。又有尝见奸诡之
妇，故为哼讶，或轻事重报，以显己能，以图酬谢，因致产妇惊疑，害尤非细。（《景岳全书》）
催生
妊娠胎元完足，弥月而产，熟落有期，非可催也。所谓催生者，亦不过助其血气而利导之耳。直待临期，
乃可用脱花煎、滑胎煎。或经日久，产母困倦难生，俱宜服滑胎煎，以助其气血。其有气虚无力，艰于传送者，
必用独参汤，接济其力。皆为催生要法。若期未至，而妄用行气导血等剂，以为催生，亦犹摘花苞之萼，揠宋
人之苗耳。（《景岳全书》）
催生大法∶滑以流通滞涩，苦以驱逐闭塞，香以开窍逐血，气滞者行其气，胞浆先破，血干者固其血。
（《女科大全》）
预备药饵
花蕊石散，治血入胞衣，胀大不下，或恶露上攻。佛手散治血虚诸证。加味芎归汤入龟版，治交骨不开。
蓖麻子涂足心，治胎衣不下。失笑散治恶露腹痛。酥油调滑石涂产门，为滑胎之圣药。清魂散治血晕。平胃散
入朴硝化死胎。皆临产要药，宜预备也。若气血虚衰，又当以八珍汤、十全汤主治。（《妇人良方》）
临盆服药
或问∶临盆服药，有益无损否？曰∶安得无损？即以鼠兔二丸合回生丹言之，皆世俗临盆习用之药也。鼠
兔例用香窜，产时百脉开解，气血既虚，服此益加耗散。儿出而香未消，其损多矣。更令毛窍开张，招风入内，
祸不可言。回生丹以大黄、红花为君，其余亦多消导，血已亏而又破之，遗患无穷。又问∶然则总无可用之药
乎？曰∶有。只须加味芎归汤、佛手散二方，用之不尽矣。盖产时全要血足，血一足，如舟之得水，何患不行？二
方皆大用芎、归，使宿血顿去，新血骤生，且药味随地皆有，真正有益无损，世人求奇好怪，岂不可叹！（《达生编》）
难产七因
一因安逸。盖妇人怀胎，血以养之，气以护之，务宜时常行动，令其气血周流，胞胎自然活动，若久坐、
久卧，则气不营运，血不流顺，胎亦呆滞而不活动矣，故令产难。常见田野劳苦之妇，忽然腹痛，立便生产，
可知。○二因奉养。盖胎之肥瘦，气通于母，母之所嗜，胎之所养，如恣食浓味，不知减节，故致胎肥难产。
常见糟糠之妇，容易生产，可知。○三因淫欲。古者妇人怀孕，即居侧室，不共夫寝，以淫欲最所当禁也。盖
胎系胞中，全赖气血育养，静则神藏，若情欲一动，则气血随耗，火扰于中，则血气沸腾。三月以前犯之，
则易动胎。三月以后犯之，一则胞浓难产，一则胎元漏泄，子多肥白不寿，更兼疮毒痘毒，疾厄多端。且人与
物，均禀 之气以生，然人之生子，不能胎胎顺，个个存，而马、牛、犬、豕，胎胎俱易，个个无损者，何
也？盖马、牛、犬、豕，一受胎后，则牝牡绝不与交，而人受孕，不能禁欲，矧有纵而无度者也。○四因忧疑。
今人求子之心虽切，而保胎之计甚疏，往往问卜祷神，致令产母常怀忧惧，心悬气怯，是以产难。○五因软怯。
如少妇初产，神气怯弱，子户未开，且更腰曲不伸，辗转倾侧，以致儿不得出。又有中年妇人，生育既多，气
虚血少，生亦艰难。○六因仓皇。有等愚蠢稳婆，不审正产、弄产，但见腹痛，遽令努力，产妇无主，只得听
从，因此横生、倒生，子母有伤，皆由仓皇之失也。○七因虚乏。母当产时，儿身未出，用力太早，及儿欲出，
母力已乏，产户干涩，故尔产难。速以补血催生汤投之，或保产万全汤亦妙。（《冯氏锦囊》）
选案
丹溪曰∶方书瘦胎饮一论，为湖阳公主作也。予族妹苦难产，视其形肥，而勤于针黹。构思旬日，悟曰∶
此与湖阳公主相反。
彼奉养之人，其气必实，耗其气使之和平，故易产。今形肥知其气虚，久坐知其不运，当补其母气，则儿健而
易产矣。令其有孕至五、六月，与紫苏饮加补气药，十数剂，得男甚快。按∶同一难产，而有虚实之别，补气
之方，反从瘦胎饮悟出，可见读书不可泥也。（《吴医汇讲》）
救生三法
一有门户俱正，儿亦露顶而不下者。因儿转身，肚带攀其肩也，名曰碍产。其法∶令产母仰卧，轻轻推儿
向上，以手中指按定儿肩，去其肚带，候儿顺正，用力送下。○二有生路未正，被产母用力一逼，令儿偏拄左
右腿畔，儿头在产户不下。但云儿已露顶，然非顶也，乃额角耳，名曰偏产。其法∶亦令产母仰卧，以手轻轻
推儿近上，扶其头顶端正，用力一逼即下。○三有头之后骨偏拄谷道，儿乃露额，名曰枨后。其法∶以棉衣裹
手，急于谷道外旁轻轻推将儿头令正，然后用力逼下。或用膝头，令产母抵住亦可。○三产之难，皆由产母曲
腰眠卧，用力太早所致。三手法，非稳婆老练细心者，不能为也。（《冯氏锦囊》）
胞衣破
胞浆先破，恶水来多，胎干不下，先与四物汤补血，次煎浓葱汤洗其产户，令气上下通畅，更以酥油滑石
涂其产门。（《女科大全》）
未产胞衣先破，其因有二∶有因母质薄弱，胞衣不固，因儿转动触破者，此气血之虚也。有因儿身未转，
坐草太早，用力太过，而胞先破者，此举动之伤也。除服四物、八珍并葱汤洗阴户外，或用黄 、芎、归数斤
釜煎，药气满室，使产母口鼻吸受，亦良。（《景岳全书》）
交骨不开
交骨不开者，阴血虚也。用加味芎归汤，龟属至阴，版则交
错相解，故用之。（《薛氏医案》）
盘肠生
盘肠生者，因产母平日气虚，临时用力努挣，浑身气血下注，肠随儿下。一次如此，下次路熟，又复如
此。若能等待瓜熟蒂落，何得有此怪异。（《达生编》）
临产，母肠先出，子生而肠未收，法宜盛以洁净漆器，浓煎黄 汤浸之，肠即收上。又法∶以蓖麻子四
十九粒，研烂涂母头顶，肠收急洗去。（张景岳）
盘肠生，是必产母气血虚弱，因而下脱。当用补气血之药，佐以升提，则肠自收。大剂参、 、芎、归
加升麻主之。有以醋水喷面，使妇人惊寒，则气提肠缩。然恐惊则气散，寒则血凝，肠愈难收，而致他病。不
若用皂角末吹鼻，嚏作自上为稳。（李太素）
觅盐生
将产，儿手先出者，名曰横生。足先出者，名曰倒生。又相传手出者，名曰觅盐生。此亦有理，人未讲
明。盖盐主收敛紧缩，又腌螫肌肉疼痛，儿手得盐，且痛且缩，自然转身顺下。觅盐之名，本于此也。其法∶
如手足先出者，急令产母仰卧，略以盐涂手足心，仍以香油抹之，轻轻送入，即便自转顺生。不可任其久
出，久则手足青硬，难以送入，而子命伤矣。亦不可妄用催生方药，盖手足之出，非药可治。又切勿误听凶妇，
用刀断割，倘一断割，则子必腹中乱搅，而母命伤矣。
胞衣不下
胞衣不下有二∶有因恶露入衣，胀而不出；有因元气亏损，不能送出。恶露流衣中者，腹必胀痛，用夺
命丹，或失笑散，以消瘀血，缓则不救。元气虚弱，不能送出者，腹不胀痛，用保产无忧散，以补固元气；或
用蓖麻子一两，研膏涂母足心，衣下即洗去。○又法∶以本妇头发，搅入喉中，使之作呕，则气升血散，胞软
自落。凡胞衣不出者多死，授以此法甚效。（《景岳全书》）
胞衣不下，古方用花蕊石散。但恐石药非肠胃虚者所宜，莫若生化、万全二方选而用之。亦有用佛手散，
加红花、益母、香附、山楂、陈皮、牛膝煎成，冲童便服，更妙。（《冯氏锦囊》）
胞衣不下，总是临盆过早之故。当产之时，骨节开张，壮者数日而合，怯者弥月方合。今不待其开，而强
出之，故胎出而骨眼随闭，以致胞衣出不及耳。不必乱药惊惶，可用粗麻线将脐带系住，又将脐带双折，再系
一道，以物坠住，再断脐带。过三五日，其胞自萎缩干小而下，累验。（《达生编》）
脉候
欲产之妇脉离经，沉细而滑也同名，夜半觉痛应分娩，来日午候定知生。（《脉诀》）
《难经》曰∶一呼脉三至，曰离经，是阳加于阴也；一呼脉一至，亦曰离经，是阴加于阳也。盖由胎动于
中，是以脉乱于外，故知其欲产。○沉细而滑，乃肾脏本脉之形。肾系胞胎，故见此脉者，亦与离经同也。（《胎产秘书》）
欲产之脉曰离经，或曰沉细而滑，或曰散乱无根，皆非的论。离，异也；经，常也。脉异乎常，谓之离经。
与本人平日之脉不同，与常人平日之脉不同，皆是也。（《医参》）
调护
妊娠临近预产期时，应当安定心神、消除顾虑，经常散步活动，不可过度睡眠和饱食，也不可过量饮用甜酒。分娩时，室内不可有多人喧闹。如果见到羊水流出（浆水），且腰部疼痛剧烈，说明胎儿已经脱离正常位置（胎已离经），这时才可以用药催产，并准备接生。（《妇人良方》）
保护
冬季天气寒冷，产妇的经血遇冷则凝结，导致胎儿难以娩出。因此，冬季分娩者，下身不可脱去棉衣，不可坐在或躺在寒冷之处；必须在房内围起火炉，让产妇背部面向火源，保持腰、腹、腿、膝温暖，血液得热则流通顺畅，胎儿容易出生。○夏季分娩者，必须注意温度适宜，不可肆意贪凉，以免损伤胎气；房内不可人多，热气逼迫侵袭，导致产妇心烦意乱，血热沸腾，从而引发郁冒冲晕的危险。（杨子建）
产候
分娩的先兆有十种：一曰正产；二曰坐产；三曰卧产；四曰横产；五曰逆产；六曰偏产；七曰碍产；八曰盘肠产；九曰热产；十曰冻产。（《妇人良方》）
临产真言：一曰睡，二曰忍痛，三曰慢临盆。○孕妇临近预产期，腹痛时作时止的，称为“弄胎”，不是正产的征兆。或者腹部虽然疼痛，但腰部不特别痛的，不是正产的征兆。胎儿位置高、未下降的，不是正产的征兆。肛门未感到坠胀急迫的，不是正产的征兆。羊水未破、出血未出的，不是正产的征兆。虽然有浆血流出，但腹部不痛的，不是正产的征兆。此时应让产妇扶行休息，忍耐等待，不可急于上床待产。（《达生编》）
将要分娩时，感觉腹内胎儿转动，应当端正身体仰卧，等待胎儿转身向下。试着捏产妇的中指，若中指中节跳动，才是真正临盆，即将生产。（薛立斋）
用力时机
临产必须等到脐腹疼痛至极，腰部沉重疼痛，眼中如火烧感，肛门迸急，羊水和血一起下行，脉象出现离经脉，此时胎儿已经产出胎胞，产妇方才可以使用力。（《冯氏锦囊》）
有人问：大便也需要用力，为什么生孩子不用力？不知道大便中的糟粕是死物，必须依靠人力推动；而小儿自己会转动，不仅不必用力，而且切忌过早用力。因为小儿端正坐在腹中，到了出生时，垂头转身向下。腹中空间狭窄，外人有力也难以帮助，必须听任其慢慢转身，逼到产门，头向下，脚向上，倒悬而出。如果胎儿尚未转身，就妄自过早用力，一逼迫则脚先出来，俗话美其名曰：“脚踏莲花”。或者转身未定，就妄自过早用力，一逼迫则横卧在腹中，一只手先出来，又名之为：“讨盐生”。即使转身向下，但未摆正姿势，过早用力，或左或右，偏顶腿骨，而无法生出。这些弊病，都是因为时候未到，妄自用力造成的。然而也并非完全不用力，只是用力只需一盏茶的时间罢了。就像大便一样，未到肛门，纵然用力，也不能排出，何况是人呢？○临产时，如果小儿力气用尽，无法生出，应让产妇安静睡觉，使胎儿在腹中也安静睡觉以恢复体力，片刻后自然能生出。因为当胎儿向下时，如果大人坐着或站着，胎儿就是倒悬状态，怎能久待？现在大人躺下，胎儿也躺下，有什么妨碍？有人说：万一闷坏了怎么办？回答说：他在腹中十个月都没有闷坏，现在片刻就会闷坏吗？○临产时误用过早用力，导致横生、倒产，应立即让产妇安静睡觉，服用大剂量的加味芎归汤，将伸出的手足缓缓推入体内，再睡一夜，自然顺产。（《达生编》）
稳婆（接生婆）
接生婆必须选择老成稳重、忠厚诚实的人，预先嘱咐她，等到临盆时，务必让她从容镇静，不得用法子催逼。曾见过有些接生婆忙乱性急，恐怕顾此失彼，因而勉强试探汤药，分拉掐捏，逼迫胎儿下行，多导致头身未顺，而手足先出，或横或倒，危害不小。如果没有紧缩阵痛，不可令其动手。又或有呼吸不顺及双胎未下等情况，只宜稳妥密实地安慰，不可让产妇知晓，恐怕惊吓导致气散，更难生下。又有见识过奸诈诡谲的妇女，故意发出惊呼，或将小事说大，以显示自己的能力，图谋酬谢，导致产妇惊疑，危害尤其不小。（《景岳全书》）
妊娠胎元完备足月而产，成熟落体自有定期，不可强行催生。所谓催生，也不过是辅助其气血而引导之罢了。直到临产之际，才可使用脱花煎、滑胎煎。或者经过日久，产妇困倦难生，都适宜服用滑胎煎，以助其气血。那些气虚无力，难以传送胎儿的，必须使用独参汤，来接济其力量。这些都是催生的重要方法。如果期限未到，就妄用行气导血等药剂，以为可以催生，这就像摘取花苞的花萼、拔高宋人的禾苗一样愚蠢。（《景岳全书》）
催生大法：用滑利之品以流通滞涩，用苦味之品以驱逐闭塞，用芳香之品以开窍逐血，气滞者行其气，胞浆先破者固其血。（《女科大全》）
预备药饵
花蕊石散，治疗血入胞衣，胀大不下，或恶露上攻。佛手散治疗血虚诸证。加味芎归汤加入龟版，治疗交骨不开。蓖麻子涂于足心，治疗胎衣不下。失笑散治疗恶露腹痛。酥油调和滑石涂抹产门，是滑胎的圣药。清魂散治疗血晕。平胃散加入朴硝化解死胎。都是临产要药，应当预备。如果气血虚衰，又应当以八珍汤、十全汤主治。（《妇人良方》）
临盆服药
有人问：临盆服药，有益无损吗？回答说：怎么能无损？就拿鼠兔二丸合回生丹来说，都是世俗临盆习用的药物。鼠兔二丸通常使用香窜之品，产时百脉开放，气血既已虚弱，服用此药更加耗散。胎儿出来后香气未消，损害很多。更令毛孔开张，招致风邪入内，祸患不可言说。回生丹以大黄、红花为君药，其余也多属消导之品，血已亏损而又攻破它，遗患无穷。又问：那么总没有可用的药吗？回答说：有。只需要加味芎归汤、佛手散两方，用之不竭。因为产时全要靠血充足，血一旦充足，就像船有了水，还担心它不行吗？这两方都大量使用川芎、当归，使宿血顿去，新血骤生，而且药味随地皆有，真正有益无损，世人追求新奇怪异，难道不可叹吗！（《达生编》）
难产七因
一因安逸。妇女怀孕，血以养之，气以护之，务必时常行动，令其气血周流，胞胎自然活动，如果久坐、久卧，则气不营运，血不流顺，胎儿也会呆滞而不活动，所以导致产难。常见田野劳苦的妇女，忽然腹痛，立即生产，可知此理。○二因奉养。胎儿的肥瘦，与母体气息相通，母亲所嗜好的食物，就是胎儿所滋养的，如恣意食用浓味厚腻之物，不知节制，所以导致胎肥难产。常见吃糟糠的妇女，容易生产，可知此理。○三因淫欲。古时候妇女怀孕，就居住在侧室，不与丈夫同寝，因为淫欲是最应当禁止的。因为胎儿系于胞中，全靠气血育养，静则神藏，如果情欲一动，则气血随之消耗，火扰于中，则血气沸腾。三月以前犯之，则易动胎。三月以后犯之，一则胞浓难产，一则胎元漏泄，子女多肥白但不长寿，更兼疮毒痘毒，疾厄多端。况且人与物，都禀受元气而生，然而人生子，不能胎胎顺利，个个存活，而马、牛、犬、猪，胎胎都容易，个个无损，为什么呢？因为马、牛、犬、猪，一旦受孕后，雌雄绝不交配，而人受孕，不能禁欲，更何况是有纵欲无度的人呢。○四因忧疑。今人求子之心虽切，而保胎之计甚疏，往往问卜祷神，导致产妇常怀忧惧，心悬气怯，所以产难。○五因软怯。如少妇初产，神气怯弱，子户未开，且更弯腰曲背，辗转倾侧，以致胎儿不得出。又有中年妇女，生育既多，气虚血少，生产也艰难。○六因仓皇。有等愚蠢的接生婆，不审察是正产还是弄产，但见腹痛，就急忙令产妇努力，产妇无主见，只得听从，因此横生、倒生，母子受伤，都是由仓皇之失造成的。○七因虚乏。母亲在分娩时，胎儿身体未出，用力太早，等到胎儿欲出时，母亲力气已乏，产户干涩，所以产难。速以补血催生汤投之，或保产万全汤亦妙。（《冯氏锦囊》）
选案
丹溪说：方书中关于瘦胎饮的论述，是为湖阳公主所作的。我的族妹苦难产，观察她形体肥胖，而勤于针线活。构思旬日，领悟道：这与湖阳公主的情况相反。
那些奉养优厚的人，其气必实，耗其气使之平和，所以易产。现在形体肥胖知其气虚，久坐知其不运，应当补其母气，则儿健而易产矣。令其从怀孕至五、六月，给予紫苏饮加补气药，十数剂，得男非常顺利。按：同样是难产，而有虚实之别，补气的方剂，反而从瘦胎饮悟出，可见读书不可拘泥。（《吴医汇讲》）
救生三法
一有门户俱正，胎儿也露顶但不下来的。因为胎儿转身，肚带攀住其肩膀，名为碍产。其法：令产妇仰卧，轻轻推胎儿向上，以手中指按定胎儿肩膀，去掉肚带，等候胎儿顺正，用力送下。○二有生路未正，被产妇用力一逼，令胎儿偏拄左右腿畔，胎儿头在产户不下。只说胎儿已露顶，然而不是顶，乃是额角，名为偏产。其法：也令产妇仰卧，以手轻轻推胎儿近上，扶其头顶端正，用力一逼即下。○三有头之后骨偏拄谷道，胎儿乃露额，名为枨后。其法：以棉衣裹手，急于谷道外旁轻轻推将胎儿头令正，然后用力逼下。或用膝盖，令产妇抵住亦可。○这三种产难，都是由产妇曲腰眠卧，用力太早所致。三种手法，非接生婆老练细心者，不能做到。（《冯氏锦囊》）
胞衣破
胞浆先破，恶水来多，胎干不下，先给予四物汤补血，其次煎浓葱汤洗其产户，令气上下通畅，再以酥油滑石涂其产门。（《女科大全》）
未产胞衣先破，其原因有二：有因母质薄弱，胞衣不固，因胎儿转动触破者，这是气血之虚。有因胎儿身体未转，坐草太早，用力太过，而胞先破者，这是举动之伤。除服用四物、八珍并葱汤洗阴户外，或用黄芪、川芎、当归数斤釜煎，药气满室，使产妇口鼻吸受，也良好。（《景岳全书》）
交骨不开者，是阴血虚。用加味芎归汤，龟属至阴，龟版则交错相解，故用之。（《薛氏医案》）
盘肠生者，因产妇平日气虚，临时用力努挣，浑身气血下注，肠随胎儿下。一次如此，下次路熟，又复如此。若能等待瓜熟蒂落，何得有此怪异。（《达生编》）
临产，母肠先出，子生而肠未收，法宜盛以洁净漆器，浓煎黄芪汤浸之，肠即收上。又法：以蓖麻子四十九粒，研烂涂母头顶，肠收急洗去。（张景岳）
盘肠生，是必产妇气血虚弱，因而下脱。当用补气血之药，佐以升提，则肠自收。大剂参、芪、芎、归加升麻主之。有以醋水喷面，使妇人惊寒，则气提肠缩。然恐惊则气散，寒则血凝，肠愈难收，而致他病。不如用皂角末吹鼻，嚏作自上为稳。（李太素）
将产，儿手先出者，名为横生。足先出者，名为倒生。又相传手出者，名为觅盐生。此亦有理，人未讲明。盖盐主收敛紧缩，又腌螫肌肉疼痛，儿手得盐，且痛且缩，自然转身顺下。觅盐之名，本于此也。其法：如手足先出者，急令产妇仰卧，略以盐涂手足心，仍以香油抹之，轻轻送入，即便自转顺生。不可任其久出，久则手足青硬，难以送入，而子命伤矣。亦不可妄用催生方药，盖手足之出，非药可治。又切勿误听凶妇，用刀断割，倘一断割，则子必腹中乱搅，而母命伤矣。
胞衣不下有二：有因恶露入衣，胀而不出；有因元气亏损，不能送出。恶露流衣中者，腹必胀痛，用夺命丹，或失笑散，以消瘀血，缓则不救。元气虚弱，不能送出者，腹不胀痛，用保产无忧散，以补固元气；或用蓖麻子一两，研膏涂母足心，衣下即洗去。○又法：以本妇头发，搅入喉中，使之作呕，则气升血散，胞软自落。凡胞衣不出者多死，授以此法甚效。（《景岳全书》）
胞衣不下，古方用花蕊石散。但恐石药非肠胃虚者所宜，莫若生化、万全二方选而用之。亦有用佛手散，加红花、益母、香附、山楂、陈皮、牛膝煎成，冲童便服，更妙。（《冯氏锦囊》）
胞衣不下，总是临盆过早之故。当产之时，骨节开张，壮者数日而合，怯者弥月方合。今不待其开，而强出之，故胎出而骨眼随闭，以致胞衣出不及耳。不必乱药惊惶，可用粗麻线将脐带系住，又将脐带双折，再系一道，以物坠住，再断脐带。过三五日，其胞自萎缩干小而下，累验。（《达生编》）
脉候
欲产之妇脉离经，沉细而滑也同名，夜半觉痛应分娩，来日午候定知生。（《脉诀》）
《难经》说：一呼脉三至，叫做离经，是阳加于阴；一呼脉一至，也叫做离经，是阴加于阳。大概由于胎动于中，是以脉乱于外，所以知道其欲产。○沉细而滑，是肾脏本脉之形。肾系胞胎，故见此脉者，也与离经相同。（《胎产秘书》）
欲产之脉曰离经，或曰沉细而滑，或曰散乱无根，都不是确论。离，异也；经，常也。脉异乎常，谓之离经。与本人平日之脉不同，与常人平日之脉不同，都是可以的。（《医参》）
Regulation and Care
When pregnancy nears the due date, one should calm the mind and eliminate worries, walk frequently, and avoid excessive sleep, overeating, or drinking too much sweet wine. During labor, there should be no noise or clamor in the room. If amniotic fluid (shuǐ jiāng) is seen and lower back pain is severe, it indicates that the fetus has shifted from its normal position (tāi yǐ lí jīng), and only then can medication be used to induce labor and prepare for delivery. (*Furen Liangfang*)
Protection
In winter, when the weather is cold, the mother's menstrual blood may congeal upon exposure to cold, making it difficult for the fetus to be born. Therefore, for winter deliveries, the lower body must not be stripped of cotton clothing, nor should the mother sit or lie in cold places; a stove should be placed in the room, with the mother's back facing the fire, keeping the waist, abdomen, legs, and knees warm. Blood flows smoothly when warmed, facilitating easier birth. ○ In summer deliveries, temperature regulation must be appropriate; one must not indulge in cooling measures to the detriment of fetal qi. The room should not be crowded, as excessive heat may cause maternal restlessness, boiling blood heat, leading to risks of depression, dizziness, and fainting. (Yang Zijian)
Labor Signs
There are ten types of labor signs: 1. Normal labor (zhèng chǎn); 2. Sitting labor (zuò chǎn); 3. Lying labor (wò chǎn); 4. Transverse presentation (héng chǎn); 5. Breech presentation (nì chǎn); 6. Oblique presentation (piān chǎn); 7. Obstructed labor (ài chǎn); 8. Prolapsed intestine (pán cháng chǎn); 9. Heat labor (rè chǎn); 10. Cold labor (dòng chǎn). (*Furen Liangfang*)
True Words on Labor: 1. Sleep; 2. Endure pain; 3. Delay pushing. ○ When a pregnant woman nears her due date, intermittent abdominal pain is called "playing fetus" (nòng tāi) and is not a sign of true labor. Abdominal pain without significant lower back pain is not a sign of true labor. A fetus positioned high and not descended is not a sign of true labor. Absence of rectal pressure/urgency is not a sign of true labor. Unruptured membranes and no bleeding are not signs of true labor. Vaginal discharge of fluid and blood without abdominal pain is not a sign of true labor. At this stage, the mother should be supported to walk and rest, enduring patiently, and should not rush to bed for delivery. (*Dasheng Bian*)
When labor is imminent, and internal fetal movement is felt, the mother should lie supine with her body straight, waiting for the fetus to turn downward. Pinching the middle finger of the mother; if the middle joint throbs, true labor has begun, and delivery is imminent. (Xue Lizhai)
Timing of Pushing
One must wait until umbilical and abdominal pain is extreme, lower back feels heavy and painful, eyes feel like burning, rectum feels urgent/protruding, amniotic fluid and blood flow down together, and the pulse shows the "Li Jing" (departing from the channel) pattern. Only at this point, when the fetus has exited the sac, should the mother push. (*Fengshi Jinnang*)
Some ask: Defecation requires effort; why does childbirth not require effort? One must understand that feces are inert matter requiring human force to expel; whereas the fetus moves itself. Not only is effort unnecessary, but premature pushing is strictly forbidden. The fetus sits upright in the womb and turns head-down during birth. The uterine space is narrow, and external help is difficult; one must allow it to turn slowly, forcing its way to the cervix, head down, feet up, emerging inverted. If the fetus has not turned and the mother pushes prematurely, feet may emerge first, colloquially called "Feet Treading on Lotus." If turning is incomplete and pushing occurs, the fetus may lie transversely with a hand emerging first, called "Seeking Salt Birth." Even if turning downward is achieved but alignment is poor, premature pushing may cause the head to lodge against the leg bone, preventing delivery. These complications arise from pushing before the proper time. However, complete lack of effort is also incorrect; pushing should last only about the time it takes to drink a cup of tea. Just as defecation cannot occur before reaching the anus regardless of effort, so too with childbirth. ○ If the fetus exhausts its strength and cannot descend, the mother should sleep quietly, allowing the fetus to rest in the womb as well; natural birth will follow. When the fetus descends, if the mother sits or stands, the fetus remains inverted, which cannot be sustained. If the mother lies down, the fetus aligns accordingly, causing no harm. Some worry: What if suffocation occurs? Answer: It survived ten months in the womb without suffocating; how could it suffocate in a moment? ○ If premature pushing causes transverse or breech presentation, immediately have the mother sleep, administer a large dose of Jiawei Xionggui Tang, gently push the protruding limbs back inside, and let her sleep another night for natural delivery. (*Dasheng Bian*)
Midwife (Wěnpó)
The midwife must be selected for maturity, steadiness, and honesty, and instructed beforehand. Upon labor, she must remain calm and composed, avoiding coercive methods. I have seen midwives who are hurried and impatient, fearing mistakes, who forcibly test remedies, pull, pinch, and force the fetus down, often resulting in malpresentation (limbs emerging before the head) or transverse/breech positions, causing significant harm. If contractions are not tight, she should not intervene. For cases of irregular breathing or twins not yet delivered, only steady comfort should be provided; the mother must not be informed, as shock disperses qi, making birth harder. Also, beware of deceitful women who feign distress or exaggerate minor issues to display skill or seek reward, causing maternal panic and greater harm. (*Jingyue Quanshu*)
Inducing Labor
When the fetal essence is complete and the month is full, birth occurs naturally according to its term; it cannot be forced. "Inducing labor" merely means assisting qi and blood to facilitate guidance. Only at the onset of labor should Tuohua Jian or Huatai Jian be used. If prolonged labor leads to maternal exhaustion, Huatai Jian is suitable to boost qi and blood. For qi deficiency and weakness hindering expulsion, Dushen Tang is necessary to supplement strength. These are key methods for inducing labor. If used before the due date, agents that move qi and blood are akin to picking flower buds or pulling up seedlings to help them grow—both futile and harmful. (*Jingyue Quanshu*)
General Principles of Induction: Use slippery substances to unblock stagnation; bitter substances to drive out obstruction; aromatic substances to open orifices and move blood; regulate qi for qi stagnation; nourish blood if membranes rupture early and blood is dry. (*Nuke Daquan*)
Prepared Medicines
- Huarui Shi San (Coral Fossil Powder): Treats lochia entering the placenta, causing distension and retention, or upward attack of lochia.
- Foshou San (Buddha's Hand Powder): Treats various conditions of blood deficiency.
- Jiawei Xionggui Tang with Gui Ban (Tortoise Shell): Treats failure of the pubic symphysis to open (Jiaogu Bukai).
- Castor seeds applied to the sole of the foot: Treats retained placenta.
- Shixiao San: Treats lochia-related abdominal pain.
- Butter mixed with Talcum powder applied to the vulva: A sacred remedy for lubricating the birth canal.
- Qinghun San: Treats blood syncope (Xue Yun).
- Pingwei San with Xiao Ming (Mirabilite): Dissolves dead fetus.
These are essential medicines for labor and should be prepared. For qi and blood deficiency, Bazhen Tang or Shiquan Tang should be used. (*Furen Liangfang*)
Medication During Labor
Question: Is taking medicine during labor beneficial without harm?
Answer: How can it be without harm? Consider Shutu Er Wan combined with Huisheng Dan, commonly used by laypeople. Shutu Er Wan typically uses aromatic and penetrating herbs. During labor, all vessels open, and qi and blood are already deficient; these drugs further deplete them. After birth, the aromatic properties linger, causing much damage. They also open pores, inviting wind pathogens, leading to unspeakable disasters. Huisheng Dan uses Dahuang (Rhubarb) and Honghua (Safflower) as chief ingredients, mostly draining and breaking agents; using them on depleted blood causes endless trouble.
Question: Then are there no usable medicines?
Answer: Yes. Only Jiawei Xionggui Tang and Foshou San are sufficient. Childbirth relies entirely on abundant blood. With sufficient blood, like a boat with water, movement is assured. Both formulas use large doses of Chuanxiong and Danggui to remove old blood and generate new blood quickly. Their ingredients are available everywhere, truly beneficial without harm. It is lamentable that people seek novelty and strangeness. (*Dasheng Bian*)
Seven Causes of Difficult Labor
1. **Ease/Laziness**: Pregnancy requires blood to nourish and qi to protect. Constant movement ensures circulation and fetal activity. Prolonged sitting or lying causes qi stagnation and blood stasis, making the fetus sluggish and causing difficult labor. Laboring women in fields often give birth easily after sudden pain, illustrating this.
2. **Over-nourishment**: Fetal size relates to the mother's diet. Excessive consumption of rich, greasy foods leads to a large fetus and difficult labor. Women eating coarse food often deliver easily.
3. **Sexual Desire**: Ancient texts advise pregnant women to live separately from husbands to prohibit sexual desire, as it is most dangerous. The fetus relies on qi and blood; stillness preserves spirit. Sexual arousal consumes qi and blood, stirring fire and boiling blood. Before three months, it risks miscarriage; after three months, it causes thickened membranes (difficult birth) or fetal leakage (leading to weak, short-lived infants prone to sores and pox). Unlike horses, cattle, dogs, and pigs, which abstain from mating after conception, humans often fail to restrain themselves, especially with excess.
4. **Worry and Doubt**: Despite eager desires for children, precautions are often lax. Divination and prayer cause constant fear and anxiety, weakening qi and causing difficult labor.
5. **Timidity/Weakness**: Young women giving birth for the first time may have weak spirit and qi, with an unopened cervix. Bending and twisting hinders delivery. Middle-aged women with many births may suffer from qi and blood deficiency, making birth difficult.
6. **Panic/Haste**: Foolish midwives, failing to distinguish true labor from false labor, urge pushing upon seeing pain. The mother, lacking direction, complies, leading to transverse/breech presentations and injury to mother and child.
7. **Exhaustion**: Premature pushing before the fetus exits depletes the mother's strength. By the time the fetus is ready to exit, the mother is exhausted, and the birth canal is dry, causing difficult labor. Immediately administer Buchong Cuisheng Tang or Baochan Wanquan Tang. (*Fengshi Jinnang*)
Selected Case
Danxi stated: The theory of Shoutai Yin (Emaciating Fetus Decoction) in medical texts was created for Princess Huyang. My cousin suffered from difficult labor. Observing her obese physique and diligence in needlework, I pondered for ten days and realized: This is opposite to Princess Huyang's case.
Those well-nourished likely have excess qi; reducing it brings balance, facilitating birth. This obese woman likely has qi deficiency and immobility from sitting; thus, tonifying maternal qi will strengthen the fetus and ease birth. Prescribed Zisu Yin with qi-tonifying herbs from the 5th to 6th month of pregnancy. After several doses, she delivered a son swiftly. Note: While both cases involve difficult labor, one is excess and the other deficiency. The qi-tonifying formula was inspired by the emaciating decoction, showing that one must not read rigidly. (*Wu Yi Huijiang*)
Three Life-Saving Methods
1. **Obstructed Labor (Ai Chan)**: Cervix is open, fetal head is visible but not descending because the umbilical cord is around the shoulder. Method: Have the mother lie supine, gently push the fetus upward, press the shoulder with the middle finger to free the cord, wait for alignment, then push down.
2. **Oblique Presentation (Pian Chan)**: Birth path is misaligned due to premature pushing, causing the fetus to lean against the leg. The head appears to be the vertex but is actually the forehead. Method: Have the mother lie supine, gently push the fetus up, correct the head position, then push down.
3. **Occiput Posterior (Cheng Hou)**: The back of the fetal head presses against the rectum, exposing the forehead. Method: Wrap hand in cotton cloth, gently push the fetal head from the side of the rectum to correct position, then push down. Alternatively, use the knee to support the mother. These difficulties arise from bending the waist while lying and pushing too early. These techniques require experienced and careful midwives. (*Fengshi Jinnang*)
Premature Rupture of Membranes
If membranes rupture early with excessive amniotic fluid, causing the fetus to dry and not descend, first administer Siwu Tang to nourish blood. Then wash the vulva with strong scallion soup to ensure smooth qi flow, and apply butter mixed with talcum powder to the vulva. (*Nuke Daquan*)
Premature rupture before labor has two causes: 1. Weak constitution and unstable membranes ruptured by fetal movement (Qi and Blood deficiency). 2. Premature sitting on the birthing mat and excessive effort rupturing membranes before the fetus turns (Trauma from movement). Besides Siwu Tang, Bazhen Tang, and scallion wash, boiling Huangqi (Astragalus), Chuanxiong, and Danggui in large quantities to fill the room with vapor, which the mother inhales, is also effective. (*Jingyue Quanshu*)
Failure of Pubic Symphysis to Open (Jiaogu Bukai)
Caused by Yin blood deficiency. Use Jiawei Xionggui Tang. Tortoise belongs to extreme Yin; its shell interlocks, symbolizing the need to separate the bones. Hence, it is used. (*Xue Shi Yi An*)
Prolapsed Intestine (Pan Chang Sheng)
Caused by chronic qi deficiency and excessive straining during labor, causing qi and blood to sink, dragging the intestine out with the fetus. Once it happens, it may recur. If one waits for natural ripening, such anomalies would not occur. (*Dasheng Bian*)
If the intestine protrudes before the baby and does not retract, place it in a clean lacquerware container and soak in concentrated Huangqi (Astragalus) decoction to retract it. Another method: Grind 49 castor seeds and apply to the crown of the mother's head; once the intestine retracts, wash off immediately. (Zhang Jingyue)
Prolapsed intestine results from qi and blood deficiency leading to sinking. Tonify qi and blood with ascending agents. Large doses of Renshen (Ginseng), Huangqi (Astragalus), Chuanxiong, and Danggui with Shengma (Cimicifuga) are primary. Spraying vinegar water on the face to startle and chill the woman raises qi and retracts the intestine. However, shock disperses qi and cold coagulates blood, making retraction harder and risking other diseases. It is safer to blow Saponaria officinalis powder (Zao Jiao Mo) into the nose to induce sneezing, which naturally lifts qi. (Li Taisu)
Seeking Salt Birth (Mi Yan Sheng)
Hand presenting first is transverse presentation (Heng Sheng); feet first is breech presentation (Dao Sheng). Traditionally, hand presentation is called "Seeking Salt Birth." There is logic here: Salt causes contraction and pain. Applying salt to the hand causes pain and shrinking, prompting the fetus to turn and descend naturally. Method: If hands/feet present, have the mother lie supine, lightly apply salt to the palms/soles, then smear with sesame oil, and gently push back. Do not leave them exposed long, as they become stiff and hard to replace, endangering the fetus. Do not use indiscriminate induction drugs, as limb presentation is not treated by medicine. Never listen to malicious advice to cut the limb; cutting causes chaos in the womb and endangers the mother.
Retained Placenta (Baoyi Bu Xia)
Two causes: 1. Lochia enters the placenta, causing distension and retention. 2. Yuan Qi deficiency fails to expel it. If lochia causes distension/pain, use Duoming Dan or Shixiao San to resolve blood stasis; delay is fatal. If qi deficiency causes non-painful retention, use Baochan Wuyou San to tonify and secure yuan qi; or apply one liang of castor seed paste to the sole of the foot; wash off after delivery. Another method: Insert the woman's own hair into the throat to induce vomiting, raising qi and dispersing blood, softening the placenta for natural expulsion. This method is very effective for a condition often fatal. (*Jingyue Quanshu*)
Ancient formulas use Huarui Shi San, but mineral drugs may not suit those with weak spleen/stomach. Better to choose Shenghua Tang or Wanquan Tang. Alternatively, Foshou San with Honghua, Yimucao, Xiangfu, Shanzha, Chenpi, and Niuxi, decocted and taken with infant urine, is excellent. (*Fengshi Jinnang*)
Retained placenta is always due to premature labor. During birth, joints open; robust women close in days, weak ones in a month. Forcing delivery before opening causes the bony ring to close quickly after the fetus exits, trapping the placenta. Do not panic with random drugs. Tie the umbilical cord with coarse hemp rope, double-fold it, tie again, weigh it down, then cut. After 3-5 days, the placenta shrinks and falls naturally. Verified repeatedly. (*Dasheng Bian*)
Pulse Diagnosis
For a woman about to give birth, the pulse departs from the channel (Li Jing), appearing deep, fine, and slippery. Pain begins at midnight, and birth is certain by noon the next day. (*Maijue*)
*Nan Jing* states: Three pulses per breath is Li Jing, indicating Yang adding to Yin; one pulse per breath is also Li Jing, indicating Yin adding to Yang. Fetal movement internally causes pulse disorder externally, indicating impending birth. ○ Deep, fine, and slippery is the kidney pulse shape. Since the kidney governs the uterus, this pulse also indicates impending birth. (*Taichan Mishu*)
Saying the pulse is Li Jing, or deep/fine/slippery, or scattered/rootless, are not absolute. "Li" means different; "Jing" means normal. A pulse different from normal is Li Jing. Different from the patient's usual pulse or the average person's usual pulse is acceptable. (*Yican*)