孕妇卒然不语，名曰哑胎，不须服药，产则能言矣。盖声出于肾，胞络贯肾，故不能言也。
经曰∶九月而哑，十月当复便是。妊娠谵语，用四物汤，倍加白芍、当归，去生地，合二陈
加山楂、薄荷、姜汁治之。
孕妇舌青者，子死腹中也，用麝香五分，肉桂三分，为末，煮酒调服。如双胎一生一死，亦
宜
此方。因母患症熏蒸其胎，致儿灼死，死儿着冷，不能自出，或用黑神散之类，以暖其胎，
胎自下矣。
孕妇小便频数，名曰子淋，服内补汤立效，小便不通者，乃胎下坠而压膀胱，名曰转胞，宜
补中益气加车前。有内伤者，乃血郁不去，今之梗痛是也。
妊娠大便秘结，乃血枯气闭也，四物汤加枳壳、桃仁。孕妇水泻，宜分别而治之。忌理中五
积散。因有干姜、玉桂也。伤食泻者，养胃汤加消食药。有伤生冷而泻者，亦用养胃汤加木
香。火泻者，香薷饮，夏月暴注下迫者是也。暑泻者，胃苓汤加香薷。气虚作泻者，肠鸣而
不痛，水谷不化者是也，补中益气汤或四君子汤。胎前血泻，胃苓汤加木香、砂仁，或紫苏
饮加神曲、泽泻、黄连。胃口发饱，夹痰呕逆者，忌用参连。胎前产后痢，载《痢证汇参》
，故不赘。
怀孕五六个月，或七八月，胎忽乱动，两三日间或痛，或有水下，但腰不甚痛，是胎未离经
，名弄胎，又曰试胎。胎水有无俱不妨，但直身坐卧行立，不可惊忧逼迫，以致误事。二者
俱非正产，必因触犯所致。凡孕妇五六个月，或三四个月，常要紧束其身，勿令胎放肆，又
不可饮酒常沐浴。
《达生编》云∶小产当慎，三五月而堕者，谓之小产。此因脏腑损伤，胞系腐烂，以致堕胎
。此比之大产更甚。大产瓜熟蒂落，本无足虑，尚有多少艰难，何况损伤胞系而堕乎?轻视
小产，每致殒命。须倍加将息，宜服补血养气去瘀生新之药。世有服落胎之药者，害莫大焉
，此丐户稳婆所为，医者断无此事也。
催生之说，自古相传，然瓜熟蒂落，何必催也。催之非但无益，转或有害。有用兔脑丸者，
有用千年 者，有用催生石者，有急性子者，有笔头灰者，有蓖麻子捣烂涂足心者，用之多
有不验，徒增繁扰，嘻，平时失于调护，任意行房，以致难产，频以催之，又何济乎?此愚
夫愚妇之所为也。
儿在母腹，男女有别。男子负阳背阴，女子负阴背阳。在腹中亦然，男向于内，双手倾捧母
心，女向于外，居母心下，两手自捧头面，而背母足居下。至临盆时，倒转而顺出矣。若产
母侧卧，致儿倒运不转，即有横生逆产之患。故坐草切不可太早，须再三令人扶掖运动，方
免前祸。不知此理，徒归产母之气血不足，岂不误哉!然亦有卧而产者，必令仰卧平正，使
产门虚而不碍可也。卧而能产，惟血气充实者能之，若不坐不卧，无故顿住而难涩也。力可
委罪于气血不足耳。医者宜鉴诸。
孕妇临产之月，胞水未破而血先下者，此乃胎伤，非产也。宜八物汤与安胎饮治之。若胞水
已破，此欲产也，用紫苏饮以生其血。滑胎之药，须胞水破，痛阵急，十月满足者，方可服
。若胞水未破，腹痛未甚者，虽十月满足，恐未坐草，只服安胎饮或紫苏饮，白芍换赤芍，
当归用尾，去人参，加姜葱水煎，入童便一杯，忌用桃仁活血之药。胞水已破，儿即堕地，
谓之铺蓐，生产最快利。如胞水已破，儿不下者，谓之试水，此产反迟。有停一二日而产，
有服安胎饮而水止痛定，至五六日而方产者，切不可于破水时，即用稳婆动手，令胎妇费力
痛苦，多致受累。胎累日不下者，宜先气血助其胞水，佛手散或紫苏饮。临蓐先放红水，致
儿干搁，与行船无水同，宜紫苏饮以生其气血。如临蓐腰腹俱痛，不可用稳婆轻易探候，即
胞水已破，腰痛已极，止当令孕妇扶掖走动，则生育自然顺也。至于横生逆产之患，皆因先
动手故也。其脐带系于命门，儿将育时，两手洗荡，使脐带脱落，然后得出，安得不痛?即
所谓瓜熟蒂落是也。
孕妇突然不能说话，称为“哑胎”，不需要服药，分娩后就能说话了。因为声音出于肾，胞络贯通肾脏，所以导致不能言语。
《内经》说：“怀孕九月时失音，十月分娩后应当恢复。”妊娠期间出现谵语（神志不清、胡言乱语），使用四物汤，加倍加入白芍、当归，去掉生地黄，合用二陈汤，再加山楂、薄荷、姜汁来治疗。
孕妇舌头发青的，是胎儿死于腹中，用麝香五分、肉桂三分，研为细末，煮酒调服。如果是双胎，一死一生，也适宜用此方。这是因为母亲患有疟疾等病症，邪气熏蒸胎儿，致使胎儿被灼热而死，死胎附着且变冷，无法自行排出；或者使用黑神散之类的方剂，以温暖胞胎，死胎自然就会排出。
孕妇小便频数，称为“子淋”，服用内补汤立即见效；小便不通的，是因为胎体下坠压迫膀胱，称为“转胞”，适宜用补中益气汤加车前子。如果有内伤因素，则是血郁停滞不去，就是现在的梗痛（排尿涩痛）。
妊娠期间大便秘结，是由于血枯气闭所致，用四物汤加枳壳、桃仁。孕妇水样腹泻，应当分别情况治疗。忌用理中丸和五积散。因为其中含有干姜、玉桂（肉桂）等温热药物。因饮食积滞导致的腹泻，用养胃汤加消食药。因损伤生冷食物导致的腹泻，也用养胃汤加木香。火泻（热性腹泻），用香薷饮，这是夏季突发暴注下迫的症状。暑泻，用胃苓汤加香薷。气虚导致的腹泻，特征是肠鸣而不痛，水谷不化，用补中益气汤或四君子汤。胎前血泻，用胃苓汤加木香、砂仁，或者紫苏饮加神曲、泽泻、黄连。胃口发胀，夹杂痰湿呕吐逆气的，忌用人参和黄连。胎前产后痢疾，记载在《痢证汇参》中，故不再赘述。
怀孕五六个月，或七八个月，胎动忽然紊乱，两三天间有时疼痛，或有羊水流出，但腰部不太痛，这是胎元未离经脉，称为“弄胎”，又叫做“试胎”。无论有无胎水，都不妨碍，只要保持直身坐卧行走站立，不可惊恐忧虑逼迫，以致误事。这两种情况都不是正产，必定是因为触犯所致。凡是孕妇在怀孕三四个月或五六个月时，常要紧束身体，不要让胎元放肆，也不可以经常饮酒和沐浴。
《达生编》说：小产应当谨慎，在三五月时堕胎的，称为小产。这是因为脏腑损伤，胞系腐烂，以致堕胎。这比足月生产更严重。足月生产如同瓜熟蒂落，本来不足为虑，尚且有很多艰难，何况是损伤胞系而堕胎呢？轻视小产，往往导致丧命。必须加倍调养休息，适宜服用补血养气、去瘀生新的药物。世间有人服用落胎药，危害没有比这更大的了，这是乞丐户和稳婆所为，医生断然不会有这种事。
关于催生的说法，自古相传，然而瓜熟蒂落，何必催生呢？催生不仅无益，反而可能有害。有用兔脑丸的，有用千年健的，有用催生石的，有急性子的，有笔头灰的，有用蓖麻子捣烂涂脚心的，使用这些大多不灵验，徒增烦扰。唉，平时疏于调护，任意行房，以致难产，频繁使用催产方法，又有什么帮助呢？这是愚夫愚妇的行为。
婴儿在母腹中，男女有别。男子负阳背阴，女子负阴背阳。在腹中也是如此，男婴面向内，双手倾捧母心；女婴面向外，位于母心之下，两手自捧头面，背部和脚居下。到了临盆时，倒转而顺出。如果产母侧卧，导致胎儿倒运不转，就会有横生逆产的祸患。所以坐草（准备分娩）切不可太早，必须再三让人扶持运动，才能避免前面的祸患。不知道这个道理，只归咎于产母气血不足，难道不是错误吗！然而也有躺着生产的，必须令其仰卧平正，使产门空虚而不阻碍即可。躺着能生产，只有血气充实的人才能做到，如果不坐不卧，无故停顿而难产涩滞，力量不足只能归罪于气血不足罢了。医生应当以此为鉴。
孕妇临产之月，胞水未破而血先下的，这是胎伤，不是生产。适宜用八物汤与安胎饮治疗。如果胞水已破，这是将要生产，用紫苏饮以生其血。滑胎（催产）的药物，必须等到胞水破、痛阵急、十月满足者，方可服用。如果胞水未破，腹痛不严重者，即使十月满足，恐怕还未到坐草之时，只服用安胎饮或紫苏饮，将白芍换为赤芍，当归用尾，去掉人参，加姜葱水煎，入童便一杯，忌用桃仁等活血药物。胞水已破，胎儿随即落地，称为“铺蓐”，生产最快利。如果胞水已破，胎儿不下，称为“试水”，此时生产反而迟缓。有的停一二日才生产，有的服用安胎饮后水止痛定，至五六日才生产，切不可在破水时，就用稳婆动手，令胎妇费力痛苦，多致受累。胎累日不下者，适宜先用药物助其气血以生胞水，如佛手散或紫苏饮。临蓐先放红水，致使胎儿干搁，与行船无水相同，适宜用紫苏饮以生其气血。如果临蓐时腰腹俱痛，不可用稳婆轻易探候，即使胞水已破，腰痛已极，只当令孕妇扶持走动，则生育自然顺利。至于横生逆产的祸患，都是因为先动手探查的缘故。脐带系于命门，胎儿将出生时，双手洗荡，使脐带脱落，然后得出，怎么不痛呢？这就是所谓的“瓜熟蒂落”。
Pregnant women who suddenly lose the ability to speak are diagnosed with "mute pregnancy" (Ya Tai). Medication is not required; speech will be restored after delivery. This is because voice originates from the Kidney, and the uterine collateral connects to the Kidney, leading to the inability to speak.
The Classics state: "At nine months of pregnancy, loss of voice occurs; by the tenth month, it should recover." For delirium during pregnancy, use Siwu Tang (Four Substances Decoction) with doubled doses of Baishao (White Peony Root) and Danggui (Angelicae Sinensis Radix), removing Shengdihuang (Rehmanniae Radix), combined with Erchen Tang (Two Aged Things Decoction), plus Shan Zha (Crataegi Fructus), Bohe (Menthae Haplocalycis Herba), and Jiangzhi (Ginger Juice) for treatment.
If a pregnant woman's tongue appears cyanotic, it indicates fetal death in utero. Use 5 fen of Shexiang (Moschus) and 3 fen of Rougui (Cinnamomi Cortex), powdered, mixed with boiled wine for oral administration. If twins are present, one alive and one dead, this formula is also appropriate. This condition arises when maternal pathogenic factors, such as malaria, fume and scorch the fetus, causing fetal death due to heat. The dead fetus becomes cold and adheres, unable to expel itself spontaneously. Alternatively, formulas like Heishen San (Black Divine Powder) can be used to warm the uterus, allowing the dead fetus to pass naturally.
Frequent urination during pregnancy is called "Zi Lin" (Submersion Strangury); Neibu Tang (Internal Tonifying Decoction) yields immediate results. Urinary retention is caused by the descending fetus compressing the bladder, termed "Zhuan Bao" (Turning Uterus); Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Cheqianzi (Plantaginis Semen) is indicated. If there is an internal injury component, it involves stagnant blood that fails to resolve, manifesting as painful or difficult urination.
Constipation during pregnancy results from blood deficiency and qi stagnation; treat with Siwu Tang (Four Substances Decoction) plus Zhike (Aurantii Fructus) and Taoren (Persicae Semen). Watery diarrhea in pregnant women requires differentiated treatment. Li Zhong Wan (Regulate the Middle Pill) and Wuji San (Five Accumulations Powder) are contraindicated due to their warming ingredients like Ganjiang (Zingiberis Rhizoma) and Rongui (Cinnamomi Cortex). For diarrhea due to food stagnation, Yangwei Tang (Nourish Stomach Decoction) with digestive aids is used. For diarrhea caused by consuming raw/cold foods, Yangwei Tang (Nourish Stomach Decoction) plus Muxiang (Aucklandiae Radix) is applied. For fire-type diarrhea (heat diarrhea), Xiangru Yin (Elsholtzia Decoction) is used, which addresses sudden severe watery diarrhea in summer. For summerheat diarrhea, Weiling Tang (Stomach and Pinellia Decoction) plus Xiangru (Elsholtziae Herba) is prescribed. For diarrhea due to qi deficiency, characterized by borborygmus without pain and undigested food in stool, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) or Sijunzi Tang (Four Gentlemen Decoction) is suitable. For bloody diarrhea before delivery, Weiling Tang (Stomach and Pinellia Decoction) plus Muxiang (Aucklandiae Radix) and Sharen (Amomi Fructus), or Zisu Yin (Perilla Decoction) plus Shenqu (Massa Fermentata Medica), ZeXie (Alismatis Rhizoma), and Huanglian (Coptidis Rhizoma) may be used. For fullness in the stomach accompanied by phlegm-induced vomiting, Renshen (Ginseng Radix) and Huanglian (Coptidis Rhizoma) are contraindicated. Dysentery before and after delivery is detailed in *Li Zheng Hui Can* (Compendium of Dysentery Patterns), so it is not repeated here.
At five or six months, or seven or eight months of pregnancy, if fetal movement becomes chaotic, accompanied by intermittent pain over two to three days, or leakage of amniotic fluid, but without significant lower back pain, the fetus has not yet detached from its meridian connection. This is called "Nong Tai" (Playing Fetus) or "Shi Tai" (Testing Fetus). Whether amniotic fluid is present or not is not detrimental. The mother should maintain an upright posture while sitting, lying, walking, or standing, avoiding fear, anxiety, or pressure to prevent complications. Neither constitutes true labor; they are usually caused by physical strain or transgression. During the third to sixth months of pregnancy, the body should be securely bound to prevent excessive fetal movement, and frequent bathing and alcohol consumption should be avoided.
*Da Sheng Bian* (Guide to Childbirth) states: Miscarriage must be handled with caution. Abortion occurring between the third and fifth months is termed "miscarriage." This results from damage to the zang-fu organs and rotting of the uterine ligaments, leading to fetal expulsion. This is more severe than term delivery. Term delivery is like a ripe melon falling from the vine, inherently safe despite some difficulties; how much more dangerous is abortion due to damaged uterine ligaments? Underestimating miscarriage often leads to fatal consequences. Extra care and rest are essential, and herbs that tonify blood and qi while resolving stasis and generating new tissue should be taken. Those who take abortifacient drugs cause great harm; this practice belongs to beggars and midwives, never physicians.
The concept of inducing labor has been passed down since ancient times, but if the melon is ripe, why induce it? Induction is not only useless but potentially harmful. Methods include using Rabbit Brain Pills, Qiannianjian (Codonopsis Root), Labor-Inducing Stones, Jixingzi (Cardiospermi Semen), Bitouhui (Ink Stick Ash), or applying crushed Castor Bean seeds to the soles of the feet. These are often ineffective and merely create disturbance. Alas, neglecting proper care and engaging in unrestricted sexual activity leads to dystocia; frequently resorting to induction is futile. This is the behavior of the ignorant.
Male and female fetuses differ in position within the womb. Males carry yang on the front and yin on the back; females carry yin on the front and yang on the back. Similarly, male fetuses face inward, hands cupping the mother's heart area; female fetuses face outward, positioned below the mother's heart, hands holding their own head/face, with their back and feet downward. At birth, they rotate to emerge smoothly. If the mother lies on her side, the fetus may fail to rotate, leading to malpresentation. Therefore, preparing for labor ("sitting grass") should not be done too early. The mother should be assisted to move gently to avoid these hazards. Ignoring this principle and attributing difficulties solely to qi and blood deficiency is erroneous. However, some women do deliver while lying down; they must lie supine and straight to keep the birth canal open. Only those with sufficient qi and blood can deliver comfortably while lying down. If unable to sit or lie properly and labor stalls due to weakness, it is indeed due to qi and blood deficiency. Physicians should bear this in mind.
In the month of delivery, if bleeding occurs before the rupture of membranes, it indicates fetal injury, not labor. Treat with Bayi Tang (Eight Ingredients Decoction) and Antai Yin (Fetus-Securing Decoction). If membranes have ruptured, labor is imminent; use Zisu Yin (Perilla Decoction) to generate blood. Abortifacient or labor-inducing herbs should only be used when membranes are ruptured, contractions are urgent, and the full ten months are complete. If membranes are intact and abdominal pain is mild, even at term, wait until active labor begins. In such cases, use Antai Yin (Fetus-Securing Decoction) or Zisu Yin (Perilla Decoction), substitining Baishao (White Peony Root) with Chishao (Red Peony Root), using Danggui Wei (Angelicae Sinensis Radix tail), removing Renshen (Ginseng Radix), adding ginger and scallion decocted in water, and mixing with one cup of child's urine. Avoid Huoxue (blood-invigorating) herbs like Taoren (Persicae Semen). Once membranes rupture and the fetus descends quickly, it is called "Pu Ru" (Spreading Matting), indicating rapid delivery. If membranes rupture but the fetus does not descend, it is called "Shi Shui" (Testing Water), resulting in delayed labor. Some deliver after one or two days; others may experience relief from pain and fluid leakage after taking Antai Yin (Fetus-Securing Decoction), delivering after five or six days. Do not allow midwives to intervene manually immediately upon membrane rupture, as this exhausts and pains the mother, causing further complications. For prolonged retention, first tonify qi and blood to promote amniotic fluid production, using Foshou San (Buddha's Hand Powder) or Zisu Yin (Perilla Decoction). If red fluid leaks before labor, causing the fetus to dry out (like a boat without water), use Zisu Yin (Perilla Decoction) to nourish qi and blood. If lower back and abdomen hurt severely at onset, do not let midwives probe easily. Even with ruptured membranes and severe back pain, instruct the mother to walk with support for natural, smooth delivery. Malpresentations are often caused by premature manual intervention. The umbilical cord attaches to Mingmen (Gate of Life); as the fetus prepares to be born, it moves its hands, detaching the cord, which causes pain—this is the phenomenon of "ripe melon falling from the vine."