产妇临盆，必须听其自然，勿宜催逼，安其神志，勿使惊慌，直待瓜熟蒂圆，自当落矣。所以凡用稳婆，必择老成
忠浓者，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，强勉试汤，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。故未有紧阵，不可令其动，切记紧。尝见奸诡之
妇，故为哼讶之声，或轻事报重，以显己能，以图酬谢，因致产妇惊疑，害尤非细，极当慎也。
一孕妇将产，不可占卜问神。如巫觋之徒哄吓谋利，妄言吉凶，产妇闻之，倍生疑惧，因令气血结滞，多
致难产，所宜戒也。
怀孕六七个月，或八九个月，偶略曲身，胎忽乱动，三二日间或痛或止，或有水下，惟腰不甚痛，胎未离
经，名曰弄产。又有临产一月前，忽然腰痛，却又不产，此是转胞，名曰试月。胎水有无俱不妨，但宜直身坐
卧行立，自然无事。又有伸手高处取物，忽然子鸣腹中，但令鞠躬，片时即安。
临产阵痛，有二三日，有五七日者，原非正产，惊动太早，子未出胞，非难产也。但听其坐卧任意，不得
扶坐努力，而令其忧疑气馁，惟劝其饮食，以药饵滋补之。
临产有七候∶脐腹急痛；腰间重坠；眼中出火；粪门迸急；产户肿满；手中指筋脉跳动；胞水或血俱下。
方是子出胞时，始可用力。如数证未备，即一二日，切不可使其努挣。又有胞水以下，儿头已至产门，三四
日仍不下者，因母气先馁。此时惟人参为专攻，力不能者，大剂八珍汤，补其元气，调其饮食，时至自生。
临产时饮食减少，最为可虑，即宜以独参汤常服，不可使其精力衰乏。若交骨不开，由气衰不能运达，
宜十全大补助之自开，加味归芎汤亦可。
临产时惊动太早，血先下而胎元干涸，僵死腹中，不必惊惶。惟令产母上床稳卧，切勿用力努挣，徒伤神
气，第宜勉进饮食，勿令气乏。予治极多，十可全十。惟以脱花煎加芒硝三五钱，水煎热服，其胎化水而下矣。古方以
平胃散加芒硝，下死胎、下胞衣，功虽最捷，而暗中有损。予见数人用此者，胞胎虽下，而产妇过一二年皆夭，无一免
者。大都平胃散克伐胃气，而芒硝咸寒伤血，所以脏腑暗中受损。今易用脱花煎，药味甘温，而归、芎生血活血，肉
桂暖血，更加附子一二钱，虽芒硝之寒，不能为害矣。此等之事，非临证久者，莫知其弊也。予尝治一少妇，年
二十四，原系初产，总由慌忙急促，产不如法，乃至久不能下，延予至而胎已死矣。问产妇腹内动否？曰不动，
小腹阴冷。知其胎死无疑，欲用前药，虑其初产，门户未舒，因与主家商酌，肯听予言，则万无一失。今死
胎僵硬，以药下之，恐交骨未开，必损其母，莫若以十全大补倍参、桂，一以扶产母精力，二可以暖其下元，使
胎自烂，始能保全无恙。主家以予言为是，根据此行之，以十全大补倍参、桂，服一剂后，腹中温暖，不痛不急。
予曰得之矣，所虑者腹痛作坠，今不痛不坠，可以耐之。更幸产妇年力本强，脾胃素健，每食干饭三盂，肥鸡
半只，予见更喜，以其中气不衰，自堪承任。仍每日如是调理，至五日而死胎自下，糜烂臭秽不堪，产母精神
如旧，毫无伤损。可见死胎不忙不乱，尚能保全，况生胎乎！第人不肯安静，必欲强为，奈之何哉！
产时子有出户之势，转身差缓，母力一逼，或手或足，或横或倒；又有生路未顺，儿头偏拄左右腿畔，名
曰偏产；又有儿头偏拄谷道，名曰枨后。此等数证，稳婆精巧者，则不须服药。若稳婆无用者，急扶产母上床，
正身仰卧，浓被覆之，令老成稳婆徐徐往上推之，内服补中益气汤升提之，须臾提上，重新转身，儿头已对产门，
急扶即下。
产时门户俱正，儿已露顶而不下，此转身时脐带绊其肩也。扶母正身仰卧，轻轻推儿向上，以手指轻按儿肩，
去其脐带，然后用力送下。
胎衣来迟，气虚弱也，急服脱花煎。若血流入衣中，胀闷疼痛，脱花煎加芒硝下之。或有能事稳婆，以手
循脐带而上，以中指顶其衣，轻覆衣中之血，从容候之亦下。此良法也。
产时用力太早，水衣先破，被风所吹，产户肿胀、干涩、狭小者，以紫苏煎汤熏洗，以香油和蜜润之，从
容俟之，无不下者。
产时肠先出，用净盆盛温水，少入香油养润，待儿与胞衣下时，母略仰卧，自己吸气上升，稳婆以香油涂
手，徐徐送入，或浓煎黄 汤浸之，内服补中益气汤即上。又有儿并胞衣下后，膀胱坠出产户者，用前法送
入，仍服补中益气汤。若稳婆不谨，膀胱扯破者，八珍汤加猪脬为引，服之可复。
产毕产门不闭，血气大虚，十全大补汤。若因胎大而擦伤产门者，蕲艾、益母草煎汤洗之。
产时胞胎既下，气血俱去，忽尔眼黑头眩，神昏口禁，昏不知人。古人多云恶露乘虚上攻，故致血晕。不知
此证有二∶一曰血晕，一曰气脱。若以气脱作血晕，而用辛香逐血化痰之剂，则立刻毙矣。不可不慎。
气脱证，产时血既大下，则血去气亦去，故昏晕不省。微虚者，少刻即苏；大虚者，竭脱即死。但察其面
目，如眼闭口开，手撒手冷，六脉微细之甚，或浮而散乱，此即气脱证也。速用人参，多则五七钱，少则三二
钱，加入炒米、煨姜、红枣，煎汤徐徐灌之，但得下咽，即可救活，若少迟延，则无及矣。无力备参者，以大
剂当归补血汤加炒米、煨姜、红枣，煎汤灌下，亦能救。
产妇临盆，必须听其自然，不宜催逼，安定其神志，不要使其惊慌，直到瓜熟蒂落，胎儿自然就会娩出。所以凡是使用接生婆（稳婆），一定要选择老成持重、忠诚厚道的人，预先嘱咐她们，等到临产时，务必让产妇从容镇静，不得用方法强行催逼。曾见过有些接生婆忙乱性急，恐怕顾此失彼，勉强试汤，掐弄胎儿，逼迫其下行，多导致胎头胎身未顺，而手足先伸出，或横或倒，危害不小。所以在宫缩阵痛未紧之前，不可令其动作，切记要“静”。曾见过奸诈狡猾的妇女，故意发出呻吟惊讶之声，或将轻症说成重症，以显示自己的能力，企图获取酬谢，因而导致产妇惊疑，危害尤其不小，极应当谨慎。
一位孕妇即将分娩，不可占卜问神。如有巫医之流哄吓谋利，妄言吉凶，产妇听闻后，倍生疑虑恐惧，因而导致气血结滞，多造成难产，这是应当戒除的。
怀孕六七个月，或八九个月，偶尔稍微曲身，胎儿忽然乱动，两三天间有时疼痛有时停止，或有羊水流出，只是腰部不太痛，胎儿未离经脉，名叫“弄产”。又有临产前一个月，忽然腰痛，却不生产，这是转胞，名叫“试月”。无论有无胎水，都不妨碍，只宜直身坐卧行立，自然无事。又有伸手高处取物，忽然胎儿在腹中踢动，只需身体弯曲，片刻即可安宁。
临产阵痛，有二三天，有五七天的，原本不是正产，是因为惊动太早，胎儿未出胞衣，并非难产。但听任其坐卧随意，不得扶坐用力，以免使其忧疑气馁，只劝其饮食，用药饵滋补。
临产有七种征兆：脐腹急痛；腰间重坠感；眼中似有火光；肛门紧迫；产门肿满；手中指筋脉跳动；胞水或血同时流出。这才是胎儿将出胞衣的时候，才可以开始用力。如果上述症状未备齐，即使过了一两天，也切不可让其努挣。又有胞水已下，儿头已到产门，三四天仍不下来的，是因为母体元气先衰。此时唯有用人参为专攻，力气不足的，用大剂量的八珍汤，补其元气，调理饮食，时机到了自然能生。
临产时饮食减少，最为可虑，应立即常服独参汤，不可使其精力衰乏。若交骨（耻骨联合）不开，是由于气衰不能运达，宜用十全大补汤补助，自然能开，加味归芎汤也可以。
临产时惊动太早，血先下而胎元干涸，僵死腹中，不必惊慌。只令产母上床安稳躺卧，切勿用力努挣，徒伤神气，只应勉力进食，勿令气虚乏力。我治疗过很多此类病例，十例可全愈十例。只用脱花煎加芒硝三五钱，水煎热服，死胎化为水而下。古方用平胃散加芒硝，下死胎、下胞衣，功效虽最快捷，但暗中会有损害。我见过几个人用此方的，胞胎虽下，但产妇过一两年都夭折了，无一幸免。大抵平胃散克伐胃气，而芒硝咸寒伤血，所以脏腑暗中受损。现在改用脱花煎，药味甘温，当归、川芎生血活血，肉桂暖血，再加附子一二钱，虽有芒硝之寒，也不能为害了。这类事情，非临床经验久者，不知其弊端。我曾治疗一位少妇，二十四岁，原是初产，总因慌忙急促，产程不如法，以至于久久不能生下，延请我到时，胎已死了。问产妇腹内是否还有动静？回答说没有，小腹阴冷。知道胎死无疑，想用前面的药，担心她是初产，产门未舒，于是与家属商量，肯听我的话，则万无一失。如今死胎僵硬，用药强行下胎，恐怕交骨未开，必损伤母亲，不如用十全大补汤加倍人参、肉桂，一来扶持产母精力，二来可以温暖下元，使胎自烂，始能保全无恙。家属认为我的话是对的，照此执行，服用十全大补汤加倍参、桂，一剂后，腹中温暖，不痛不急。我说这就对了，所担心的是腹痛下坠感，现在不痛不坠，可以忍耐。更庆幸产妇年力本强，脾胃素健，每餐吃干饭三碗，肥鸡半只，我看见她食欲更佳，因为其中气不衰，自能承受。仍每日如此调理，到第五天而死胎自然排出，糜烂臭秽不堪，产母精神如旧，毫无损伤。可见死胎不忙不乱，尚能保全，何况活胎呢！只是人不肯安静，必定想要强求，又能怎么办呢！
产时胎儿有出户之势，转身稍缓，母力一逼，或手或足，或横或倒；又有生路未顺，儿头偏拄左右腿畔，名叫“偏产”；又有儿头偏拄谷道（肛门），名叫“枨后”。这些情况，接生婆精巧的，就不须服药。若接生婆无用，急扶产母上床，正身仰卧，厚被覆盖，令老成接生婆徐徐往上推之，内服补中益气汤升提，片刻提起，重新转身，儿头已对产门，急扶即下。
产时门户俱正，儿已露顶而不下来，这是因为转身时脐带绊住了肩膀。扶母正身仰卧，轻轻推儿向上，以手指轻按儿肩，解开脐带，然后用力送下。
胎衣来迟，是气虚弱，急服脱花煎。若血流入衣中，胀闷疼痛，脱花煎加芒硝下之。或有能干的接生婆，以手循脐带而上，以中指顶其衣，轻覆衣中之血，从容等待也会下来。这是良法。
产时用力太早，水衣先破，被风所吹，产门肿胀、干涩、狭小的，用紫苏煎汤熏洗，用香油和蜜润之，从容等待，无不下来的。
产时肠子先出来，用干净盆盛温水，少许加入香油养润，待儿与胞衣下时，母略仰卧，自己吸气上升，接生婆以香油涂手，徐徐送入，或用浓煎黄芪汤浸之，内服补中益气汤即可回升。又有儿并胞衣下后，膀胱坠出产门的，用前法送入，仍服补中益气汤。若接生婆不谨慎，扯破膀胱的，用八珍汤加猪脬（猪膀胱）为引，服用可恢复。
产后产门不闭，是血气大虚，用十全大补汤。若因胎大而擦伤产门的，用蕲艾、益母草煎汤洗之。
产时胞胎既下，气血俱去，忽然眼黑头眩，神昏口禁，昏不知人。古人多说恶露乘虚上攻，故致血晕。不知道这个证候有两种：一曰血晕，一曰气脱。如果把气脱当作血晕，而用辛香逐血化痰的药剂，则会立刻毙命。不可不慎。
气脱证，产时血既大量流出，则血去气亦去，故昏晕不省人事。微虚者，片刻即苏醒；大虚者，竭脱即死。只要观察其面目，如眼闭口开，手撒手冷，六脉微细之甚，或浮而散乱，这就是气脱证。速用人参，多则五七钱，少则二三钱，加入炒米、煨姜、红枣，煎汤徐徐灌之，只要咽下，即可救活，若稍迟延，就来不及了。无力准备人参的，用大剂量当归补血汤加炒米、煨姜、红枣，煎汤灌下，也能救活。
When a woman is about to give birth, one must let nature take its course and avoid inducing labor. Her mind should be calmed to prevent panic. One should wait until the melon is ripe and the stem detaches naturally; the baby will then deliver itself. Therefore, when employing a midwife (Wenpo), one must select an experienced, loyal, and honest person, instructing them in advance. Upon delivery, they must ensure the mother remains calm and composed, without using methods to force labor. I have seen midwives who are hurried and impatient, fearing they might miss something, forcing the use of decoctions, pinching, or coercing the fetus downward. This often results in the head and body not being aligned while hands or feet emerge first, either transversely or breech, causing significant harm. Thus, before strong contractions begin, movement should be avoided; remember to remain still. I have also encountered deceitful women who intentionally moan or exaggerate symptoms to display their ability and seek higher rewards, causing the mother anxiety and fear, which causes even greater harm. This must be handled with extreme caution.
A pregnant woman nearing delivery should not consult fortune-tellers or spirits. If charlatans like shamans frighten her for profit, making false predictions of good or bad luck, the mother will become filled with doubt and fear. This leads to stagnation of Qi and Blood, often resulting in difficult labor, which should be strictly avoided.
During the sixth or seventh month, or eighth or ninth month of pregnancy, if the woman bends slightly, the fetus may move restlessly. Pain may come and go over two or three days, or amniotic fluid may leak, but with little lower back pain. The fetus has not left its meridian path; this is called "Playing Labor" (Nongchan). Another condition occurs one month before delivery, where sudden lower back pain appears but no delivery happens; this is called "Turning Bladder" (Zhuanbao) or "Trial Month" (Shiyue). Whether amniotic fluid is present or not does not matter; the woman should simply sit, lie, walk, or stand upright, and everything will resolve naturally. If she reaches high to fetch something and feels fetal kicks suddenly, she should just bend forward, and peace will return shortly.
Labor pains lasting two to three days, or five to seven days, are originally not true labor. They result from premature agitation, with the fetus still within the sac, so it is not difficult labor. Allow the woman to sit or lie as she wishes. Do not support her sitting up or urge her to exert effort, which would cause worry and depletion of Qi. Instead, encourage diet and nourish her with herbal tonics.
There are seven signs of impending delivery: urgent pain in the umbilical and abdominal area; heavy dragging sensation in the waist; feeling of fire in the eyes; urgency in the anus; swelling and fullness of the vaginal opening; pulsation of the tendons in the middle finger; and simultaneous discharge of amniotic fluid or blood. Only when these signs appear, indicating the fetus is leaving the sac, can effort be applied. If these symptoms are not fully present, even after one or two days, do not allow her to strain. If amniotic fluid has discharged and the fetal head is at the vaginal opening but delivery does not occur after three or four days, it is because the mother's Qi has weakened. At this time, Ginseng (Renshen) is the specific remedy. For those unable to tolerate large doses, use a large dose of Bazhen Tang (Eight-Treasure Decoction) to tonify primordial Qi and regulate diet; delivery will occur naturally when the time is right.
Reduced appetite during labor is most concerning. Immediately administer Dushen Tang (Single Ginseng Decoction) regularly to prevent exhaustion of energy. If the pubic symphysis (Jiaogu) fails to open due to Qi deficiency failing to transport, use Shiquan Dabu Tang (Ten-Ingredient Great Tonifying Decoction) to assist natural opening; Jiawei Guixiong Tang (Modified Angelica and Ligusticum Decoction) is also effective.
Premature agitation during labor may cause bleeding before the fetus dries out and dies in the womb. There is no need for panic. Let the mother lie steadily on the bed. Do not force straining, as this only damages Shen (Spirit) and Qi. Encourage food intake to prevent Qi deficiency. I have treated many such cases, achieving ten cures out of ten. Use Tuohua Jian (Decoction for Delivering the Fetus) with 1.5–2.5g of Mangxiao (Mirabilite), decocted in water and taken hot. The dead fetus will liquefy and pass. Ancient formulas used Pingwei San (Calm the Stomach Powder) with Mangxiao to expel dead fetuses and placenta. While fast, it causes hidden damage. I have seen several patients whose placentas were expelled but who died within one or two years. Pingwei San attacks Stomach Qi, and Mangxiao is salty and cold, damaging Blood, thus harming the Zang-Fu organs secretly. Now, using Tuohua Jian is easier; its herbs are sweet and warm. Danggui (Angelica Sinensis) and Chuanxiong (Ligusticum) generate and invigorate Blood, Rougui (Cinnamon Bark) warms Blood, and adding 0.5–1g of Fuzi (Prepared Aconite Root) neutralizes the coldness of Mangxiao. Such matters require extensive clinical experience to understand the pitfalls. I once treated a twenty-four-year-old primipara who failed to deliver due to haste and improper technique. By the time I arrived, the fetus had died. Asking if there was movement in the abdomen, she said no, and the lower abdomen felt cold. Knowing the fetus was certainly dead, I wanted to use the previous prescription but worried that as a primipara, her birth canal was not yet relaxed. After consulting with the family, who agreed to follow my advice, I prescribed Shiquan Dabu Tang with doubled Renshen and Rougui. This serves two purposes: supporting the mother's energy and warming the Lower Yuan (Lower Origin), allowing the fetus to decompose naturally for safe delivery. The family agreed. After one dose, the abdomen felt warm, with no pain or urgency. I noted that while we feared abdominal pain and bearing-down sensations, their absence allowed her to endure. Fortunately, she was young and strong with healthy Spleen and Stomach, eating three bowls of rice and half a fat chicken daily. Seeing her robust Middle Jiao (Middle Burner), I continued this regimen. On the fifth day, the dead fetus passed naturally, foul-smelling and decomposed. The mother’s spirit remained unchanged, with no injury. This shows that even a dead fetus can be delivered safely if done calmly; how much more so a live fetus! Yet people refuse to remain quiet and insist on forcing things. What can be done?
When the fetus attempts to exit but turns slowly, maternal effort may cause hands, feet, transverse, or breech presentations. If the birth path is obstructed by the fetal head pressing against the lateral thighs, it is called "Pianchan" (Oblique Labor). If the head presses against the anus, it is called "Chenghou". If the midwife is skilled, no medicine is needed. If the midwife is incompetent, quickly help the mother lie supine on the bed, cover her with thick blankets, and have an experienced midwife gently push upward. Administer Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction) internally to lift. Once lifted, reposition the fetus so the head aligns with the vaginal opening, and delivery will proceed quickly.
If the cervix is open and the fetal head is visible but not descending, it is likely the umbilical cord is entangled around the shoulders. Help the mother lie supine, gently push the fetus upward, press the shoulder lightly with fingers to release the cord, then assist delivery.
Delayed passage of the placenta indicates Qi deficiency; urgently administer Tuohua Jian. If blood enters the placenta causing distension and pain, add Mangxiao to Tuohua Jian to expel it. A skilled midwife may insert a hand along the umbilical cord, use the middle finger to push the placenta, and gently cover any blood inside, waiting patiently for expulsion. This is a good method.
Excessive early effort may rupture membranes prematurely. Exposure to wind can cause swelling, dryness, and narrowing of the vaginal opening. fumigate and wash with Ziisu (Perilla) decoction, lubricate with sesame oil and honey, and wait patiently; delivery will occur.
If intestines prolapse during labor, fill a clean basin with warm water and a little sesame oil for lubrication. When the fetus and placenta are delivered, have the mother lie slightly supine and inhale deeply to lift. The midwife, with hands lubricated in sesame oil, should gently insert the intestines. Alternatively, soak in concentrated Huangqi (Astragalus) decoction and administer Buzhong Yiqi Tang internally to restore position. If the bladder prolapses after delivery, use the same insertion method and continue Buzhong Yiqi Tang. If the midwife negligently ruptures the bladder, use Bazhen Tang with Zhu Pao (Porcine Bladder) as a guide; recovery is possible.
After delivery, if the vaginal opening remains unclose due to severe Qi and Blood deficiency, use Shiquan Dabu Tang. If the vaginal opening is abraded by a large fetus, wash with Qiai (Mugwort from Qi) and Yimucao (Motherwort) decoction.
After the placenta is delivered, with Qi and Blood depleted, sudden blackouts, dizziness, coma, locked jaw, and unconsciousness may occur. Ancients attributed this to Lochia attacking upward due to deficiency, causing "Blood Fainting" (Xueyun). However, there are two types: Blood Fainting and Qi Collapse. Mistaking Qi Collapse for Blood Fainting and using acrid-aromatic blood-invigorating and phlegm-resolving agents will lead to immediate death. Caution is essential.
In Qi Collapse, massive blood loss leads to concurrent loss of Qi, causing fainting and unconsciousness. Mild deficiency resolves quickly; severe deficiency leads to collapse and death. Observe the face: closed eyes, open mouth, flaccid hands, cold extremities, and extremely fine or floating/scattered pulses indicate Qi Collapse. Urgently administer Renshen (Ginseng), 1.5–3.5g for mild cases or 2.5–3.5g for severe, with fried rice, baked ginger, and red dates. Decoct and administer slowly. Once swallowed, life can be saved; delay is fatal. For those unable to afford Ginseng, use a large dose of Danggui Buxue Tang (Angelica Tonifies Blood Decoction) with fried rice, baked ginger, and red dates. This can also save lives.