临产将护，良方条列备已。陈自明编《妇人良方》，薛立斋附订《医按》。兹并考《纲目》、《医通》
诸家，张石顽老人着《医通》，武之望编《济阴纲目》。周 作《产宝》。张介宾《景岳全书》。撮举其要。
凡孕至八九月，服达生散数剂则易产，至临月胞浆未破，而血先下者，或者伤胎，尚非正产。宜大剂保元汤加
当归、阿胶。如胎气上逆，急服热童便，或用紫苏饮。若正产时，气血动荡，脉必滑疾异常。如脉尚安和，腹
虽痛而未紧，犹试痛也，必腹连腰阵痛益紧，儿欲转身顺产，自然胞破水下，如瓜熟蒂落。不用催生太早，
只须产前补血降气，用滑胎煎。继则活血行气，用保生无忧散。亦有胎衣不固，或用力太早，随触而破，至胞浆
下而仍不产，恐其水涸路涩，儿难转身。但服八珍汤，或大剂五物汤加葵子、枳壳。助其气血，则胎滑易产。
若持久力乏，用独参汤补接元气，虽逾数日旬日而产者有之。男胎向内，女胎向外，皆首居上，足居下，临产
时必倒转顺出，须再三缓缓扶掖走动，使得旋转，否则，有横逆之患。丹溪云∶催生只用佛手散，最稳而效。
或合济生汤亦佳。更有儿头正抵产户，而交骨不开，此阴气虚。用加味芎归汤，不应，加人参、童便。若坐产
艰难，用兔脑丸、如圣散、如意散。其儿手先出为横生，足先出为倒产，由产母用力太早，当令仰卧，以盐
少许，擦儿手足心，以中指摸其肩，攀正之。候其身正，方可用力。更有儿头偏注左右腿者，为偏产，由母力
逼致之，亦令仰卧，轻轻以手推上扶正。用力送下。若儿头已正，不能即产，因脐带绊其肩者，为碍产。亦令
仰卧，推儿向上，以指按儿肩，去其绊。若儿未出，产母肠先出者，为盘肠生，待儿并胎衣下后，用香油抹手，
徐徐送入。或用醋和水， 产母面，每 一缩，三 尽收。其蓖麻子研涂顶心，肠可吸入法，殊不效验。然后
半坐，以软布抵之。内服举元煎。若胎死腹中，须验产母舌青黑，爪青紫，口沫，腹阴寒而气秽，急用平胃
散加朴硝。若胎死久干着背者，葵子阿胶滑之。胎衣不下，先用软帛系住脐带，乃断儿脐带，勿令血入衣中。
胀而难下，内服回生丹，或牛膝汤。可下。如久不下，血入衣中，上冲心胸，喘急痛胀，急宜逐瘀，用牛膝散，
或失笑散，温酒调服，胎衣立下。景岳云∶胞在腹中，形如荷叶，上仰则聚血，而胀凝难出，当令稳婆以指
攀其上口，令恶露倾泻，则腹空胞自落矣。如气虚腹不胀痛，只宜无忧散，或黑豆二合炒透，烧红铁秤锤淬酒，
将豆淋酒，化益母丹二丸。既产，阴气虚，产门不闭，或阴火下流，阴挺突出，其气血虚而不闭者，十全大
补汤加五味子。补而敛之。
其忧思伤脾热痛者，加味归脾汤。肿而 痛者，逍遥散加丹皮、山栀、荆芥。暴怒伤肝动火者，龙胆泻肝汤。
元气虚，子宫不收，补中益气汤加桂心，醋炒白芍。补而举之。产时气随血去，忽头眩眼黑，神昏口噤，其
症有二，一为气脱，一为血晕。气脱者，面白眼闭，口开手冷，脉细欲绝，速用人参一二两，浓煎徐灌。但得
下咽即苏，稍迟则无救矣。血晕者，临产元气已损，恶露乘虚上攻，头晕眼花，心胸闷绝，速用热童便，灌服
清魂散。如下血多而晕，神昏烦乱者，芎归汤加人参三五钱，泽兰叶一握煎，童便半盏和服。补而兼散之。下
血少而上抢心者，童便煎失笑散，加郁金汁。痰壅气粗者，二陈汤加姜汁，并用烧红秤锤，以醋沃之，使产母
嗅其气，则晕可止。若狂乱失志，为败血冲心，多死。花蕊石散，或夺命散。呕恶腹满，为恶露冲胃，平胃散
加姜、桂。面赤呕逆，为气血冲肺，人参苏木煎。其恶露不行，腹痛拒按，用桃仁、归尾、延胡、赤芍等逐瘀。
恶露不止，淋沥太多，血热者，保阴煎。络伤者，固阴煎。肝脾气虚者，补中汤。气血虚，色淡者，十全大补
汤。怒火伤肝者，加味四物汤。儿枕作痛，用生熟山楂肉，砂糖煎服。或用延胡散。腹痛连腰，按之痛缓为虚，
宜当归、香附、炙草、杜仲、小茴香等。或用当归建中汤。此皆临产成法，撮举之，为因心化裁者鉴焉。
临产期的护理，良方已详细列出。陈自明编纂《妇人良方》，薛立斋在《医按》中附订补充。现综合考证《本草纲目》、《医学统旨》等各家著作：张石顽老人撰写《医学统旨》，武之望编纂《济阴纲目》，周氏著有《产宝》，张介宾著有《景岳全书》。从中摘录其要点。
凡是怀孕至八九月时，服用达生散数剂则容易生产；若临近预产期胞衣未破而先见红出血者，可能是伤胎，尚非正产。宜用大剂量保元汤加当归、阿胶。如果胎气上逆，急服热童便（童子尿），或使用紫苏饮。若是正产之时，气血动荡，脉象必然滑疾异常。如果脉象尚且安和，腹部虽痛但未紧缩，仍属试痛（假性宫缩），必须等到腹部连腰部阵发性疼痛逐渐加剧，胎儿欲转身顺产，自然胞衣破裂羊水流出，如同瓜熟蒂落。不必过早使用催生药，只需产前补血降气，使用滑胎煎。随后活血行气，使用保生无忧散。也有因胎衣不固，或用力过早，导致胞浆随触而破，但羊水流出后仍不生产，恐其羊水枯竭产道干涩，胎儿难以转身。此时只服八珍汤，或大剂量五物汤加冬葵子、枳壳。以助其气血，则胎滑易产。若持久力竭，使用独参汤补接元气，即使超过数日甚至旬日才生产的情况也有。男胎头向内，女胎头向外，皆头部居上，足部居下，临产时必须倒转顺出，须再三缓缓扶持协助走动，使其得以旋转，否则，会有横位难产的隐患。丹溪说：催生只用佛手散，最稳妥有效。或合用济生汤也很好。更有胎儿头部正抵产门，但交骨（耻骨联合）不开，此为阴气虚。用加味芎归汤，若无效，加人参、童便。若坐产艰难，用兔脑丸、如圣散、如意散。胎儿手先出为横生，足先出为倒产，由产母用力太早所致，当令其仰卧，以少许盐擦胎儿手足心，以中指摸其肩部，将其扶正。待其身正，方可用力。更有胎儿头部偏向左右腿侧者，为偏产，由母体用力逼迫所致，也令其仰卧，轻轻以手推上扶正，然后用力送下。若胎儿头已正，但不能立即产出，因脐带绊住其肩部者，为碍产。也令其仰卧，推胎儿向上，以指按压胎儿肩部，解开其羁绊。若胎儿未出，产母肠子先脱出者，为盘肠生，待胎儿及胎衣完全下来后，用香油涂抹双手，徐徐送入。或用醋和水喷洒产母面部，每宫缩一次，喷三次收进。那种蓖麻子研末涂顶心使肠吸入的方法，殊无效果。然后半坐，以软布托住。内服举元煎。若胎死腹中，须查验产母舌色青黑，指甲青紫，口吐白沫，腹部阴冷且气味秽臭，急用平胃散加朴硝。若胎死已久干枯附着于背部者，用冬葵子、阿胶润滑之。胎衣不下，先用软帛系住脐带，再剪断婴儿脐带，勿令血液流入胎衣中。胀而难下，内服回生丹，或牛膝汤。可促使排出。若久不下，血液流入胎衣中，上冲心胸，喘急痛胀，急宜逐瘀，用牛膝散，或失笑散，温酒调服，胎衣立落。景岳说：胞宫在腹中，形状如荷叶，上仰则聚血，因而胀凝难出，应当令稳婆以手指攀住其上口，令恶露倾泻，则腹空胞自落矣。若气虚腹不胀痛，只宜无忧散，或黑豆二合炒透，烧红铁秤锤淬酒，制成豆淋酒，化开益母丹二丸。既产后，阴气虚，产门不闭，或阴火下流，子宫下垂突出，其气血虚而不闭者，用十全大补汤加五味子。补而收敛之。
忧思伤脾致热痛者，用加味归脾汤。肿而痛者，用逍遥散加丹皮、山栀、荆芥。暴怒伤肝动火者，用龙胆泻肝汤。元气虚，子宫不收，用补中益气汤加桂心、醋炒白芍。补而升举之。产时气随血去，忽头眩眼黑，神昏口噤，其症有二，一为气脱，一为血晕。气脱者，面白眼闭，口开手冷，脉细欲绝，速用人参一二两，浓煎徐灌。只要咽下即苏醒，稍迟则无救矣。血晕者，临产元气已损，恶露乘虚上攻，头晕眼花，心胸闷绝，速用热童便，灌服清魂散。如下血多而晕，神昏烦乱者，用芎归汤加人参三五钱、泽兰叶一握煎，加童便半盏和服。补而兼散之。下血少而上抢心者，用童便煎失笑散，加郁金汁。痰壅气粗者，用二陈汤加姜汁，并用烧红秤锤，以醋浇之，使产母嗅其气，则晕可止。若狂乱失志，为败血冲心，多死。用花蕊石散，或夺命散。呕恶腹满，为恶露冲胃，用平胃散加姜、桂。面赤呕逆，为气血冲肺，用人参苏木煎。其恶露不行，腹痛拒按，用桃仁、归尾、延胡索、赤芍等逐瘀。恶露不止，淋沥太多，血热者，用保阴煎。络伤者，用固阴煎。肝脾气虚者，用补中汤。气血虚，色淡者，用十全大补汤。怒火伤肝者，用加味四物汤。儿枕作痛，用生熟山楂肉，砂糖煎服。或用延胡散。腹痛连腰，按之痛缓为虚，宜用当归、香附、炙甘草、杜仲、小茴香等。或用当归建中汤。此皆临产成法，撮举之，供因心化裁者借鉴。
Care during labor has been detailed in the excellent prescriptions. Chen Ziming compiled *Furen Liangfang* (Excellent Prescriptions for Women), and Xue Lizhai added supplementary notes to *Yi An* (Medical Records). Here, we examine various works including *Bencao Gangmu* (Compendium of Materia Medica) and *Yitong* (General Treatise on Medicine): Zhang Shiweng authored *Yitong*, Wu Zhiwang compiled *Jiyin Gangmu* (Outline of Gynecology), Zhou authored *Chanbao* (Precious Essentials for Childbirth), and Zhang Jiebin wrote *Jingyue Quanshu* (Complete Works of Jingyue). We extract their key points.
Whenever pregnancy reaches eight or nine months, taking several doses of Dasheng San (Daisheng Powder) facilitates delivery. If near term, the amniotic sac has not ruptured but bleeding occurs first, it may be fetal injury rather than true labor. A large dose of Bao Yuan Tang (Bao-Yuan Decoction) with Dang Gui (Angelicae Sinensis Radix) and E-Jiao (Colla Corii Asini) is appropriate. If fetal qi rebels upward, hot Tong Bian (Child's Urine) should be taken urgently, or Zi Su Yin (Perilla Decoction) used. During true labor, blood and qi are turbulent, and the pulse must be slippery and rapid abnormally. If the pulse remains calm and harmonious, and although there is abdominal pain, it is not tight, it is still "trial pain" (false labor). One must wait until abdominal pain radiates to the waist in increasingly tight paroxysms, as the fetus turns for natural delivery; only then will the sac rupture and water flow out, like a ripe melon falling from the stem. Do not induce birth too early. Instead, nourish blood and descend qi before labor using Hua Tai Jian (Slippery Fetus Decoction). Subsequently, invigorate blood and move qi using Bao Sheng Wu You San (Bao-Sheng Wuyou Powder). In cases where the placenta is unstable or force is applied too early, causing the membranes to rupture prematurely without delivery, fearing that fluid depletion leads to a dry and rough passage making fetal turning difficult, one should administer Bazhen Tang (Eight-Treasure Decoction) or a large dose of Wuwu Tang (Five-Ingredient Decoction) with Dong Kuizi (Malvae Semen) and Zhi Qiao (Aurantii Fructus). This assists blood and qi, making the fetus slip easily into delivery. If endurance fails, use Dushen Tang (Single Ginseng Decoction) to replenish yuan qi; even if delivery takes several days or ten days, it can occur. Male fetuses face inward, female fetuses outward, both with head up and feet down. At labor, they must invert to exit smoothly. One must gently assist walking repeatedly to allow rotation; otherwise, there is risk of transverse presentation. Danxi stated: For induction, only Foshou San (Buddha's Hand Powder) is used, which is safest and effective. Combining it with Jisheng Tang (Jisheng Decoction) is also good. In cases where the fetal head presses against the birth canal but the jiaogu (pubic symphysis) does not open, this indicates deficiency of yin qi. Use Jiawei Xiong Gui Tang (Modified Chuanxiong and Angelica Decoction); if ineffective, add Renshen (Ginseng Radix) and Tong Bian. For difficult sitting birth, use Tubrao Wan (Rabbit Brain Pill), Rusheng San (Rusheng Powder), or Ruyi San (Ruyi Powder). Hand-first presentation is transverse birth; foot-first is breech birth, caused by the mother pushing too early. The mother should lie supine. Rub a little salt on the fetal hands and feet. Use the middle finger to locate the shoulder and guide it straight. Wait until the body is aligned before exerting force. If the fetal head leans toward the left or right leg, it is oblique presentation, caused by maternal forceful pushing. Lie supine, gently push the head back up and align it with hand assistance, then push down. If the head is aligned but cannot deliver immediately because the umbilical cord is caught around the shoulder, it is obstructed birth. Lie supine, push the fetus up, press the shoulder with fingers to release the obstruction. If the fetus has not emerged but the mother's intestine prolapses first, it is called "panchang sheng" (intestine prolapse during childbirth). After the fetus and placenta are fully delivered, apply sesame oil to hands and slowly insert the intestine. Alternatively, spray a mixture of vinegar and water on the mother's face; spray three times with each contraction. The method of applying crushed castor bean paste to the crown to suck the intestine in is ineffective. Then sit semi-recumbent and support with soft cloth. Internally administer Juzhong Decoction. If the fetus dies in the womb, verify if the mother's tongue is blue-black, nails purple-blue, mouth foaming, abdomen cold, and breath foul. Urgently use Pingwei San (Pingwei Powder) plus Xiaomaxiao (Mirabilite). If the dead fetus has dried and adhered to the back for a long time, use Dong Kuizi and E-Jiao to lubricate. For retained placenta, first tie the umbilical cord with soft silk, then cut the infant's cord, preventing blood from entering the placenta. If distended and difficult to expel, internally administer Huisheng Dan (Huisheng Pill) or Niuxi Tang (Achyranthes Decoction) to promote expulsion. If retained for a long time, blood enters the placenta, rushing to chest and heart causing panting, urgency, pain, and distension. Urgently resolve stasis using Niuxi San (Achyranthes Powder) or Shixiao San (Shixiao Powder), mixed with warm wine, so the placenta falls immediately. Jingyue said: The uterus in the abdomen is shaped like a lotus leaf. If tilted upward, blood gathers, causing distension and difficulty in expulsion. The midwife should use fingers to lift the upper rim, allowing lochia to drain, emptying the abdomen so the uterus drops naturally. If qi deficiency causes no abdominal distension or pain, only Wuyou San (Wuyou Powder) is suitable, or stir-fry two heaping measures of black beans thoroughly. Quench a red-hot iron scale weight in wine to make Doulin Jiu (Bean-Dripping Wine), dissolve two pills of Yi Mu Dan (Motherwort Pill) in it. After delivery, if yin qi is deficient, the vaginal opening does not close, or yin fire flows downward causing uterine prolapse, due to blood and qi deficiency failing to hold, use Shiquan Dabu Tang (Ten-Ingredient Great Tonifying Decoction) with Wuweizi (Schisandrae Fructus). Tonify and astringe.
For worry and thought damaging spleen causing heat and pain, use Jiawei Guipi Tang (Modified Guipi Decoction). For swelling and pain, use Xiaoyao San (Xiaoyao Powder) plus Mudan Pi (Moutan Cortex), Zhizi (Gardeniae Fructus), and Jingjie (Schizonepetae Herba). For sudden anger damaging liver stirring fire, use Longdan Xiegan Tang (Gentian Liver-Draining Decoction). For yuan qi deficiency and uterine non-retraction, use Buzhong Yiqi Tang (Buzhong-Yiqi Decoction) plus Guixin (Cinnamomi Ramulus) and Cu Chao Baishao (Vinegar-Processed White Peony Root). Tonify and lift. During labor, qi follows blood loss, suddenly causing dizziness, blackouts, unconsciousness, and locked jaw. There are two syndromes: qi collapse and blood syncope. Qi collapse presents with pale face, closed eyes, open mouth, cold hands, and fine pulse nearly imperceptible. Quickly use 1-2 liang of Renshen, decoct strongly, and drip slowly. Once swallowed, consciousness returns; delay means no rescue. Blood syncope occurs when yuan qi is damaged at labor, and lochia attacks upward through deficiency, causing dizziness, blurred vision, and chest oppression. Quickly use hot Tong Bian, and administer Qinghun San (Qinghun Powder). If heavy bleeding causes syncope, unconsciousness, and restlessness, use Xiong Gui Tang (Chuanxiong and Angelica Decoction) plus 3-5 qian of Renshen and a handful of Zelan Ye (Lycopus Herba), decocted, mixed with half a cup of Tong Bian. Tonify while dispersing. If light bleeding rushes upward to the heart, decoct Shixiao San in Tong Bian, add Yu Jin (Curcumae Radix) juice. For phlegm obstruction and coarse breathing, use Erchen Tang (Erchen Decoction) plus Jiangzhi (Ginger Juice), and simultaneously pour vinegar on a red-hot scale weight for the mother to inhale the fumes to stop syncope. If maniacal and losing mind, it is败血 (decayed blood) attacking the heart, mostly fatal. Use Huarui Shi San (Huarui Stone Powder) or Xueming San (Xuemiao Powder). For vomiting, nausea, and abdominal fullness, it is lochia attacking the stomach; use Pingwei San plus Ginger and Cinnamon. For red face and vomiting, it is blood and qi attacking the lungs; use Renshen Sumu Jian (Ginseng and Sappanwood Decoction). If lochia does not flow, with abdominal pain and tenderness to pressure, use Tao Ren (Prunus Seed), Gui Wei (Angelicae Sinensis Radix Tail), Yanhu (Corydalis Rhizome), and Chi Shao (Red Peony Root) to resolve stasis. If lochia continues excessively with heat, use Baoyin Jian (Baoyin Decoction). If collateral damage, use Guyin Jian (Guyin Decoction). For liver and spleen qi deficiency, use Buzhong Tang. For blood and qi deficiency with pale color, use Shiquan Dabu Tang. For fire anger damaging liver, use Jiawei Siwu Tang (Modified Four-Substance Decoction). For "child pillow" pain, use raw and cooked Hawthorn flesh, decocted with rock sugar. Or use Yanhu San. Abdominal pain radiating to waist, relieved by pressure, indicates deficiency; use Dang Gui, Xiang Fu (Cyperi Rhizoma), Zhi Cao (Prepared Licorice), Duzhong (Eucommia Bark), and Xiao Huixiang (Fennel Fruit). Or use Danggui Jianzhong Tang. These are standard methods for labor, extracted here for reference in flexible application.