一、孕妇似产未产须知∶凡胎孕临月，胎忽乱动而腹痛不甚，或作或止，或一
二日，或三五日之后方生，名曰弄胎。不可孟浪坐草，须静以待时。或胎水已来，
腰不酸痛而不生者，亦曰弄胎。所以有沥浆生，其浆流一二日不产，俟流浆渐少方生。倘浆来过多，恐胞
干难产，亦非所宜，须八珍时服，助其血气可望无虑。又有一月前，忽然腹痛，状如即产，却不产者，名曰
试月。又有腹虽痛而腰不酸痛，脉未离经而不产者。又有腹虽痛而未下垂，胎虽转而儿身未正，亦非当
产时也。要知腹中痛阵，乃儿破衣转身也。气壮者转身自易，气弱者转身较难，衣薄则破速，衣浓则破迟，
所以有腹痛一二日方生。凡孕妇须当宽心，以待其自然之势，切不可乱用气力强产，以致枉命。至于自
然当产之时，必有紧阵，如脐腹痛急，腰酸重痛，眼中如火，肛门迸急等类齐至，待儿身已正，头到
产门，用力一送即下。然亦有腹觉微痛或腹竟不痛，止觉腰酸下坠而产者，盖肾候于腰，胞系于肾故
也。古人云∶时至自然分娩，譬如登厕，未急不能催，时急不能止。此理虽俗，知此免患。
一、临产自有先兆须知∶凡孕妇临产或半月数日前，胎腹必下垂，小便多频数。
至欲产时，脉先离经，拭捏产妇手中指中节、或本节跳动，方是临盆时候。
一、转胎调摄须知∶凡孕妇儿身转动，其腹必痛，虽迟日不生，切勿惊怕。
且令人扶持在房中行走，或倚物而立，直其体腹。倘精神稍困，则以被褥壅垫脊背，仰卧少顷，又令行
立。听腹中慢慢转身，虽迟无害。且宜稍宽裙带，以便儿在腹中转舒有余地也。若不禁痛苦，或伛偻屈
曲，斜倚侧靠，胎中不免为之拥挤，迷其出路。稳婆不解此理，但见生迟频频试水，误伤胎破，或风入
产户而成肿胀，或胎未至而胎水先干，分娩愈难矣。遇此者，惟令产妇勉强饮食，调其气息，或用
活血滑胎之药佐之。（活血滑胎药方，俱见催生门。）候子逼门户，方尽力一努，胎随浆下矣。此乃瓜
熟蒂落之理，切不可预使气力，令精神失倦，临期反致疲困，此产家最要紧处。曾见一妇临产畏痛，
曲身坐卧，以致胎元转动不顺。儿出胞时，寻到产门，被母曲身遮闭，因不得出。少顷再转，母又护痛
再闭，如此两三遭，则子无力而不能动，至于难生。人又见子不动，则谓死胎，其实子无力非死也。
随令产母正其体腹，不时行动坐立，心安气和，勉强饮食，俟儿少停气复，再转至产门，果顺易生下。
一、稳婆宜加选择须知∶凡孕妇临产，当选年高有经识稳婆，及纯谨妇女一二人扶持。倘误用无
知孟浪妇女收生，不审察是正产与转胎，一见腹痛，乱将双手
摸孕妇腹上，夹腹两边重按，欲其直下，以免横生，此第一误人性命者。夫腹初痛，则胞衣未破而欲
破之时也。儿将分娩，心中亦有灵性矣。见腹外揣摩，儿不知为何物，遽生惊恐，则缩不敢动，胞衣又何
时而得破乎？更有稳婆无知害人，私有手指掐破水衣者，极须防范。夫胞浆乃胞内养儿之水，儿既折破
自随水而下。若过时不得分娩，是胞元无力，转头较迟，恐致浆尽血来，闭塞道路，令子无路可通，胎涩
不行，用保生无忧散以固其血。如血已耗，八珍汤加益母草浓煎，时饮之。倘元气困惫，急用上好人参
两许，当归二钱煎饮。饮尽再煎服，助其气血最为得力。舍此而用催生耗气诸药，总无一效也。或先服
八珍补养气血，次煎浓葱汤，令稳婆洗产户，使气上下通畅。更用酥油滑石涂产门，次服催生万全汤亦妙。
一、临产避忌须知∶凡孕妇临产之月，不可洗头濯足，犯者胎多难产。若至临盆之际，凡系门窗箱
笼瓶瓮之属，俱宜松开。以及一切外来亲戚，并孀妇闺女，丧孝尼姑，与秽污不洁，或月经适至，或原
有体气妇女，皆足以触胎致殃，俱宜防备避忌。俗忌多人知觉，盖多一人入房，则多一时迟延。此虽俗
论，却有至理，恐
产妇心烦，以致难产也。
一、临产宜肃静须知∶凡孕妇临盆，房中不得喧闹，即有意外紧事，户外不得叫喊。倘令产母
恐惧惊心，则胎滞气结不行而难产。经云∶惊则神散，忧则气结，恐则气怯，怯则上焦闭，闭则气还，
还则下焦胀，气乃不行矣。此气结不行以致难产。更有产母两尺脉绝，他脉平和，此乃下焦胀，气闭
不行难产之脉，急用紫苏饮，散结行气而产矣。
一、临产饮汤须知∶凡孕妇分娩之时，心下烦闷口渴，用白蜜半杯，温汤化开饮之。如欲饮水，但
可与清米汤饮之。盖蜜能润燥滑胎，米饮能助中气也。有人临产进饮食及服药而皆吐出，吐后仍进饮食
服药，使其人不乏力，不干涩，亦自立下，不必虑其吐出也。是以产母不可令其饥饿，饥则中气虚乏，
无力送胎。须少用粳白米稀粥，或饮以母鸡煮汁。但不可食肉及坚硬食物，恐凝于上焦，气不得下，不
惟难产，须防内伤。又不可太饱，常令稍饥为佳。盖饥则气下，气下则产速也。予谓口渴不能食及吐，
须饮以独参汤最妙，且能催生。
一、孕妇产异须知∶几妇人常产之外，有异产者八∶曰横产、逆产、坐产、碍
产、偏产、胀后产、盘肠产、浪脐产等名。皆由孕妇气血亏虚，或坐草、探水、用力太早所致。凡遇此
等异产，须令产母仰卧，勿得惊惧，选其历练有经识稳婆料理。各产治法，列之于后。
如横产手先露者，世传为觅盐生。令产母安心仰卧，以盐涂儿手心，再以香油抹其所出之手，稳婆
轻轻送入。或儿手得盐，肌肉 螫，且痛且缩而收者。待儿转身头正，扶起产母用力一努，儿即出矣。
如逆产足先露者，相传为踏莲花生。令产母仰卧，不必惊忧，用盐涂足心，亦用香油抹其所露之足，
稳婆轻轻送入。候儿转身头正，用力生下。凡遇横逆之产，母子存亡在顷刻，若无急救之方法，何以成
医之神圣欤？其胎产之所以致横逆者，或因儿身尚未转顺，方转至手足，被产母用力逼出。或因产母气
血素亏，其子无力转身而手足先出者，俱速用涂盐、抹油法送入。其用力逼出手足者，送入犹易转正，
勿药亦可。若素虚无力转身者，急煎救逆汤服之，助其气血。送入少顷，儿自有力转身，俟头正产门
而生下矣。但儿之手足，切不可任其久出，更不可令其多出。若见儿手或足略出时，则急以盐涂法
治之。若出多及时久，则手足青硬，难以送入而
子必伤。切不可误听凶妇用刀断儿手足，一动刀刃，子必腹中乱扰而伤母矣。世有用针刺儿手足者，有
治逆产用手抓儿足心者，予谓恐儿惊缩，有伤触母心之虞，不若盐涂为便也。
如坐产臀先露者，世俗为坐臀生。令产母仰卧，亦如前法抹油推入。候儿转运扶正，然后用力送出。
或于当高处，牢系手巾一条，令产母以手攀之，轻轻屈足舒伸，以开生路，儿即顺生。
如碍产，乃门户俱正，儿亦露顶而不下者。此必脐带绊住儿肩，俗名背包生。亦令产母仰卧，稳
婆轻轻推儿向上，以手中指轻按儿肩，摸去脐带，扶正儿身，一努即生下。
如偏产，乃生路未正，被产母用力一逼，儿头偏抵产户不下者。不知者但云儿已露顶，非顶也，乃
额角也。亦令产母仰卧，轻轻推儿近上，以手正其头，用力一送即下。
如胀后产，乃儿头后骨偏柱产母谷道不得下者。令稳婆以棉衣炙暖裹手，急
于谷道外旁，轻轻推头令正，然后用力即生下矣。或用膝头令产母抵住亦可。
如盘肠产，子肠先出者，世人莫不惊畏，然无妨碍。令产母安心仰卧，急将净盆盛温水，冬则再
加稍热，加入香油养润，待儿并胞衣俱下，稳婆香油涂手，徐徐送入。令产母两足夹紧谷道，肠自收上。
有用醋和冷水令人喷面，一喷一收，以渐收之。又有神应丹贴法。然此喷贴之法，肠虽可收，予恐误事，
不若皂角末吹鼻，嚏作自上。又有肠被外风吹干不收者，用磨刀水少许，火上温过，以润其肠，后用
好磁石煎汤一盏服之，其肠自收。又有儿并胞衣下后，膀胱（即尿胞）。壅出产户者，同前法送入。凡
此子肠膀胱先出，皆平日气虚因努脱出，并用力太早五内动摇，气虚下元不固，关键不牢之故。若此
番经过，须防下次，此后无孕时，多服地黄丸加五味子、肉桂各一两，以固下元之关键。及有孕，多
服胡连丸加人参以补气，又服三补丸以凉血。如滑胎瘦胎等剂，不可轻服。八个月时，宜服八珍加诃
子、瞿麦、粟壳、蜜十余剂。予意须预服补中汤升提之药于前，庶临盆可免。较之服胡连、三补以及
粟壳等药，稳妥而不繁杂也。
如浪脐产，胞衣脐肠先出者。凡儿出胞时，头必转向产门，自然正产。若无力
转运，脚踏胞衣脐肠先出，急令稳婆理清推入，稍俟气平，乘势就其脚下，不可推转久延，久则
脐肠复下，便难收拾矣。
一、临产双生须知∶凡孕妇临产，一儿已下，又见一儿，此系双胞。惟稳婆自知之，只云取胞，
待生下方言，恐惊母成产患也。
一、候胞衣生下须知∶凡产母生子出户时，人即以两手抱产母胸前，产母亦自以手紧抱肚腹，令
胎衣下坠。如胎衣来迟，切勿慌忙，用草纸烧烟熏鼻即下。如再迟，则急断脐带洗儿，仍用软帛物系坠
脐带。此带极脆，系时尤宜轻巧牢固，然后截断。若不断脐带，恐血反潮入胞中，胀而不下，攻心则
伤。如稳婆谙事者，能以手指取下甚便。取法见后胞衣不下门。
一、闷脐生须知∶凡儿产下即啼，此正理也。如儿下地，气闷不啼，相传寤生呼父乳名，手拍儿
股即啼者，此理亦未讲明。盖儿粪门有一膜，闷住儿气，故不能出声，拍之则膜破而能叫哭矣。如拍之
犹不破，须令女人中有轻巧者，以银簪脚轻轻挑破甚便。或不能挑，急用棉絮暖衣，将儿紧包，拘于
怀内，勿令散放，未可
遽断脐带，速用热水浸其胞衣，寒天则置炭火中煨之，仍作大油纸捻，点灯于脐带上往来燎之。盖带连儿
脐，久则热气内鼓，其膜自破。膜破则出声而苏，方可断带洗浴。亦有用蕲艾为捻，香油浸润，熏脐
带至焦，使热气内鼓破膜。又一法用灯心囟门点爆数下，均治闷脐生法也。
一、儿生即死须知∶凡儿生下即死者，急看儿口中前上 上有泡，以手指摘破，用帛拭血令净。
若血入喉即死，去血即生。其泡中白米如针嘴尖，亦须刮去，不可令其入喉也。
一、冻产须知∶凡孕妇临盆，时值冬月天寒，产母经血因冷则凝，致儿不能速下。务于房内四处，
设炉置火，常有暖气如春。且下部不可脱去棉衣，并不可坐卧冷处，使产母背身温和，脐下腿膝间常暖。
血得热则行，儿自易生也。炭须在房外烧红送进产房，否则生炭气味，恐产妇发晕。
一、热产须知∶凡盛夏产妇，要温凉得所，用冷水房内洒洒，或多放水盆，或远设冰块，以解其
郁蒸之气。若遇风凉阴雨，亦当谨避，不可贪凉，恐增疾病。房
内不可人多，恐热气逼袭，令产母心烦，热血沸腾，有郁冒冲晕之患。
救逆汤 治产母气血素亏，子无力转头，手足先出。
人参（一两） 当归（三两） 川芎（二两） 红花（三钱）
水煎速服。久之不顺，再煎再服。
三补丸 专治血热。
黄芩（炒） 黄连（炒） 黄柏（炒）
各等分为末，蜜丸，白汤下。
八珍汤（见上卷诸痛门。） 保产无忧散（见本卷预服易产诸方。） 催生万全汤
（见本卷催生门。） 紫苏饮（见上卷安胎门。） 神应丹（见本卷惟生门。） 六味地黄丸
（见上卷诸能门，附六味地黄汤下。） 胡连丸（见上卷安胎门。）
补中益气汤（见上卷诸痛门。）
一、孕妇似产未产须知：凡是怀孕临近预产期，胎儿忽然乱动且腹痛不剧烈，疼痛时有时无，或者持续一两天，或者三五天之后才分娩，这叫做“弄胎”。不可鲁莽地坐在草垫上准备接生，必须安静等待时机。如果羊水已经流出，腰部没有酸痛感但仍未分娩的，也叫做“弄胎”。因此有“沥浆生”的情况，即羊水流出后一两天不生产，等到流出的羊水逐渐减少后才分娩。倘若羊水流出过多，恐怕会导致胞宫干燥而难产，这也是不适宜的，需要按时服用八珍汤，助益气血，这样就能无忧无虑地等待分娩。又有一种情况是一个月前，突然腹痛，样子像是要分娩，但实际上却不生产，这叫做“试月”。又有腹部虽然疼痛但腰部不酸痛，脉象尚未出现离经之象而未分娩的。又有腹部虽然疼痛但胎儿头部尚未下垂，胎儿虽然转动但身体姿势未正，也不是正当分娩的时候。要知道腹中阵痛，是胎儿破膜转身的过程。气壮的人转身容易，气弱的人转身较难，胎衣薄则破裂快，胎衣厚则破裂慢，所以会有腹痛一两天才分娩的情况。凡孕妇应当放宽心情，等待自然之势，切不可乱用气力强行催产，以致危及生命。至于自然当产之时，必然会出现紧阵，如脐腹疼痛急迫，腰酸重痛，眼中如火，肛门紧迫等症同时到来，等到胎儿身体已正，头部到达产门，用力一送即可生下。然而也有腹部感觉微痛或腹部竟不痛，只感觉腰酸下坠而分娩的，这是因为肾主腰，胞宫系于肾的缘故。古人说：时候到了自然分娩，就像上厕所一样，没到紧急时候不能催促，时间紧急也不能停止。这个道理虽然通俗，但懂得此理可免除祸患。
二、临产自有先兆须知：凡是孕妇临产前半个月或数日前，胎腹必定下垂，小便次数增多。到了即将分娩时，脉象先出现离经之象，擦拭并捏产妇手中指的中节或本节，若感到跳动，这才是临盆的时候。
三、转胎调摄须知：凡是孕妇胎儿在腹中转动，腹部必定疼痛，即使过几天不生，也切勿惊慌害怕。并且让人扶持在房中行走，或者倚靠物体站立，使身体和腹部保持正直。倘若精神稍感困倦，就用被褥垫高脊背，仰卧片刻，然后再令其行立。听任腹中慢慢转身，即使迟缓也无害处。并且宜稍微松开裙带，以便胎儿在腹中有足够的空间转动舒展。如果不禁受痛苦，或者弯腰屈曲，斜倚侧靠，胎中不免为之拥挤，迷了出路。稳婆不懂这个道理，只见分娩迟缓就频繁试探羊水，误伤胎膜破裂，或者风邪进入产道导致肿胀，或者胎儿未到而羊水先干，分娩就更加困难了。遇到这种情况，只令产妇勉强进食，调理气息，或者用活血滑胎的药物辅助。（活血滑胎药方，都见催生门。）等到胎儿逼迫产门时，才尽力努责，胎儿随羊水一起下来。这是瓜熟蒂落的道理，切不可预先使用气力，导致精神疲倦，临产时反而疲乏困顿，这是产家最要紧的地方。曾见过一位产妇临产畏惧疼痛，蜷缩身体坐卧，导致胎元转动不顺。胎儿出胞时，寻找到产门，被母亲蜷缩的身体遮挡闭住，因而无法出来。过了一会儿再转，母亲又因护痛再次闭住，如此两三次，则胎儿无力而不能动，以至于难产。别人见胎儿不动，就说是死胎，其实胎儿是因为无力而非死亡。随即令产母端正体腹，不时行动坐立，心安气和，勉强饮食，等到胎儿稍停歇恢复力气，再转至产门，果然顺利生下。
四、稳婆宜加选择须知：凡是孕妇临产，应当选择年长有经验识的稳婆，以及纯朴谨慎的一两名妇女扶持。倘若误用无知鲁莽的妇女接生，不审察是正产还是转胎，一见腹痛，就乱将双手摸在孕妇腹部上方，夹住腹部两边重按，想要使其直下，以免横生，这是第一会害人性命的错误。腹部初痛时，则是胞衣未破而欲破的时候。胎儿将要分娩，心中也有灵性了。见到腹部外被揣摩，胎儿不知是什么东西，就会惊恐，从而收缩不敢动，胞衣何时才能破呢？更有稳婆无知害人，私下用手指掐破水衣的，极须防范。胞浆是胞内养育胎儿的水，胎儿既然折破（此处指胎膜破裂）自然随水而下。如果过时不得分娩，是胞元无力，转头较慢，恐怕导致羊水耗尽血液涌来，闭塞道路，令胎儿无路可通，胎涩不行，用保生无忧散以固护其血。如果血已耗损，用八珍汤加益母草浓煎，时时饮用。倘若元气困惫，急用上好的人参一两许，当归二钱煎服。饮尽后再煎服，助其气血最为得力。除此之外如果用催生耗气的药物，总无一效。或者先服用八珍补养气血，其次煎浓葱汤，令稳婆清洗产户，使气上下通畅。再用酥油滑石涂抹产门，其次服用催生万全汤也很好。
五、临产避忌须知：凡是孕妇临产的月份，不可洗头洗脚，犯者胎儿多难产。如果到了临盆之际，凡是门窗箱笼瓶瓮之类的东西，都宜松开。以及一切外来亲戚，寡妇闺女，丧孝尼姑，与污秽不洁之人，或者月经刚来，或者原本体味重的妇女，都足以触动胎气招致灾殃，都应当防备避忌。世俗忌讳多人知晓，大概多一个人进房间，就多一时迟延。这虽然是世俗言论，却有至理，恐怕产妇心烦，以致难产。
六、临产宜肃静须知：凡是孕妇临盆，房中不得喧闹，即使有意外紧急事情，户外也不得叫喊。倘若令产母恐惧惊心，则胎滞气结不行而难产。经书说：惊则神散，忧则气结，恐则气怯，怯则上焦闭塞，闭塞则气还，还则下焦胀，气乃不行矣。这是气结不行以致难产。更有产母两尺脉绝，其他脉象平和，这是下焦胀，气闭不行难产的脉象，急用紫苏饮，散结行气而分娩。
七、临产饮汤须知：凡是孕妇分娩之时，心下烦闷口渴，用白蜜半杯，温开水化开饮用。如果想喝水，只可以给清米汤饮用。因为蜂蜜能润燥滑胎，米饮能助中气。有人临产进食及服药而全部吐出，吐后仍进食服药，使其人不乏力，不干涩，也能自行分娩，不必担心其吐出。因此产母不可令其饥饿，饥饿则中气虚乏，无力送胎。须少量食用粳白米稀粥，或者饮用母鸡煮汁。但不可吃肉及坚硬食物，恐怕凝滞于上焦，气不得下行，不但难产，还要防止内伤。也不可太饱，常令稍饥为佳。因为饥饿则气下，气下则产速。我认为口渴不能食及呕吐，须饮用独参汤最好，且能催生。
八、孕妇产异须知：几个妇人除了常产之外，有异产八种：叫做横产、逆产、坐产、碍产、偏产、胀后产、盘肠产、浪脐产等名。都是由孕妇气血亏虚，或者坐草、探水、用力太早所致。凡遇到这些异产，须令产母仰卧，不要惊恐，选其历练有经验识的稳婆料理。各产治法，列之于后。
如横产手先露者，世传为觅盐生。令产母安心仰卧，以盐涂儿手心，再以香油抹其所出之手，稳婆轻轻送入。或者婴儿手沾盐，肌肉刺痛，又痛又缩而收回的。等待胎儿转身头正，扶起产母用力一努，胎儿即出。
如逆产足先露者，相传为踏莲花生。令产母仰卧，不必惊恐忧虑，用盐涂足心，也用香油抹其所露之足，稳婆轻轻送入。等待胎儿转身头正，用力生下。凡遇横逆之产，母子存亡在顷刻，若无急救之方法，何以成就医之神圣呢？其胎产之所以致横逆的，或者因为胎儿身体尚未转顺，刚转到手足，被产母用力逼出。或者因为产母气血素亏，其子无力转身而手足先出的，都速用涂盐、抹油法送入。其用力逼出手足的，送入犹易转正，不用药也可以。若素虚无力转身的，急煎救逆汤服之，助其气血。送入少顷，胎儿自有力转身，等待头正产门而生下。但是胎儿的手足，切不可任其久出，更不可令其多出。若见婴儿手或足略出时，则急以盐涂法治之。若出多及时久，则手足青硬，难以送入而胎儿必伤。切不可误听凶妇用刀断儿手足，一动刀刃，胎儿必腹中乱扰而伤母。世有用针刺儿手足的，有治逆产用手抓儿足心的，我认为恐怕胎儿惊缩，有伤触母心之虞，不如盐涂方便。
如坐产臀先露者，世俗为坐臀生。令产母仰卧，也像前法抹油推入。等待胎儿转运扶正，然后用力送出。或者在高处，牢固系一条手巾，令产母以手攀之，轻轻屈足舒伸，以开生路，胎儿即顺生。
如碍产，乃门户俱正，胎儿也露顶而不下者。这必定是脐带绊住儿肩，俗名背包生。也令产母仰卧，稳婆轻轻推儿向上，以手中指轻按儿肩，摸去脐带，扶正儿身，一努即生下。
如偏产，乃生路未正，被产母用力一逼，儿头偏抵产户不下者。不知情的人只说儿已露顶，不是头顶，乃是额角。也令产母仰卧，轻轻推儿近上，以手正其头，用力一送即下。
如胀后产，乃儿头后骨偏柱产母谷道不得下者。令稳婆以棉衣炙暖裹手，急于谷道外旁，轻轻推头令正，然后用力即生下。或用膝头令产母抵住也可。
如盘肠产，子肠先出者，世人莫不惊畏，然无妨碍。令产母安心仰卧，急将净盆盛温水，冬天则再加稍热，加入香油养润，待胎儿并胞衣俱下，稳婆香油涂手，徐徐送入。令产母两足夹紧谷道，肠自收上。有用醋和冷水令人喷面，一喷一收，以渐收之。又有神应丹贴法。然而这喷贴之法，肠虽可收，我恐怕误事，不如皂角末吹鼻，喷嚏作则肠自上收。又有肠被外风吹干不收者，用磨刀水少许，火上温过，以润其肠，后用好磁石煎汤一盏服之，其肠自收。又有胎儿并胞衣下后，膀胱（即尿胞）壅出产户者，同前法送入。凡此子肠膀胱先出，皆平日气虚因努脱出，并用力太早五内动摇，气虚下元不固，关键不牢之故。若此番经过，须防下次，此后无孕时，多服地黄丸加五味子、肉桂各一两，以固下元之关键。及有孕，多服胡连丸加人参以补气，又服三补丸以凉血。如滑胎瘦胎等剂，不可轻服。八个月时，宜服八珍加诃子、瞿麦、粟壳、蜜十余剂。我的意见须预先服用补中益气汤升提之药于前，庶几临盆可免。较之服用胡连、三补以及粟壳等药，稳妥而不繁杂。
如浪脐产，胞衣脐肠先出者。凡胎儿出胞时，头必转向产门，自然正产。若无力转运，脚踏胞衣脐肠先出，急令稳婆理清推入，稍待气平，乘势就其脚下，不可推转久延，久则脐肠复下，便难收拾。
九、临产双生须知：凡是孕妇临产，一个胎儿已下，又见一个胎儿，这是双胞。只有稳婆自知之，只说取胞衣，待生下方言，恐怕惊吓母亲造成产患。
十、候胞衣生下须知：凡是产母生子出户时，人即以两手抱产母胸前，产母亦自以手紧抱肚腹，令胎衣下坠。如胎衣来迟，切勿慌忙，用草纸烧烟熏鼻即下。如再迟，则急断脐带洗儿，仍用软帛物系坠脐带。此带极脆，系时尤宜轻巧牢固，然后截断。若不断脐带，恐怕血反潮入胞中，胀而不下，攻心则伤。如稳婆谙事者，能以手指取下甚便。取法见后胞衣不下门。
十一、闷脐生须知：凡是胎儿产下即啼哭，这是正理。如胎儿落地，气闷不啼，相传寤生呼父乳名，手拍儿股即啼者，此理也未讲明。盖胎儿粪门有一膜，闷住儿气，故不能出声，拍之则膜破而能叫哭。如拍之犹不破，须令女人中有轻巧者，以银簪脚轻轻挑破甚便。或不能挑，急用棉絮暖衣，将儿紧包，拘于怀内，勿令散放，未可遽断脐带，速用热水浸其胞衣，寒天则置炭火中煨之，仍作大油纸捻，点灯于脐带上往来燎之。盖带连儿脐，久则热气内鼓，其膜自破。膜破则出声而苏，方可断带洗浴。也有用蕲艾为捻，香油浸润，熏脐带至焦，使热气内鼓破膜。又一法用灯心囟门点爆数下，均治闷脐生法。
十二、儿生即死须知：凡是胎儿生下即死的，急看胎儿口中前上腭上有泡，以手指摘破，用布拭血令净。若血入喉即死，去血即生。其泡中白米如针嘴尖，也必须刮去，不可令其入喉。
十三、冻产须知：凡是孕妇临盆，时值冬月天寒，产母经血因冷则凝，致胎儿不能速下。务必于房内四处，设炉置火，常有暖气如春。且下部不可脱去棉衣，并不可坐卧冷处，使产母背身温和，脐下腿膝间常暖。血得热则行，胎儿自易生。炭须在房外烧红送进产房，否则生炭气味，恐怕产妇发晕。
十四、热产须知：凡是盛夏产妇，要温凉得所，用冷水房内洒洒，或多放水盆，或远设冰块，以解其郁蒸之气。若遇风凉阴雨，亦当谨避，不可贪凉，恐怕增加疾病。房内不可人多，恐怕热气逼袭，令产母心烦，热血沸腾，有郁冒冲晕之患。
救逆汤 治疗产母气血素亏，胎儿无力转头，手足先出。
人参（一两） 当归（三两） 川芎（二两） 红花（三钱）
水煎速服。久之不顺，再煎再服。
三补丸 专治血热。
黄芩（炒） 黄连（炒） 黄柏（炒）
各等分为末，蜜丸，白汤下。
八珍汤（见上卷诸痛门。） 保产无忧散（见本卷预服易产诸方。） 催生万全汤（见本卷催生门。） 紫苏饮（见上卷安胎门。） 神应丹（见本卷惟生门。） 六味地黄丸（见上卷诸能门，附六味地黄汤下。） 胡连丸（见上卷安胎门。） 补中益气汤（见上卷诸痛门。）
1. Knowledge Regarding the State of "Seeming to Labor but Not Yet Delivering" for Pregnant Women: Whenever a pregnancy nears its term, if the fetus suddenly moves restlessly and abdominal pain is not severe, or if it comes and goes, lasting one or two days, or three to five days before delivery, this is called "Playing Fetus" (Nong Tai). One must not rashly sit on the straw mat ready for birth; one must wait quietly for the proper time. If the amniotic fluid has already broken, yet there is no lower back soreness/aching and delivery does not occur, this is also called "Playing Fetus." Therefore, there is a condition called "Dripping Fluid Birth" (Li Jiang Sheng), where fluid flows for one or two days without delivery, and delivery occurs only after the flow of fluid gradually decreases. If too much fluid flows out, it may lead to a dry uterus and difficult labor, which is undesirable. In such cases, one should take Bazhen Tang (Eight-Treasure Decoction) at regular intervals to assist Qi and Blood, so that one can await delivery without worry. There is another condition occurring a month before term, with sudden abdominal pain resembling imminent labor, yet no delivery occurs, called "Testing Month" (Shi Yue). There are also cases where the abdomen hurts but the lower back does not ache, and the pulse has not yet shown the "Departed from Meridian" sign, yet no delivery occurs. There are also cases where the abdomen hurts but the fetal head has not descended, and although the fetus turns, its body position is not correct, indicating it is not yet the proper time for delivery. One must know that intermittent abdominal pain is caused by the fetus breaking the membranes and turning. Those with strong Qi turn easily, while those with weak Qi find it harder. Thin membranes break quickly, thick membranes break slowly, hence the occurrence of delivery after one or two days of abdominal pain. All pregnant women should keep their minds at ease and wait for the natural course of events. One must absolutely avoid using force to rush delivery, lest it endanger life. When the natural time for delivery arrives, there will inevitably be intense contractions, such as urgent pain in the navel and abdomen, heavy soreness and pain in the lower back, eyes feeling like fire, urgency in the anus, etc., all appearing together. Once the fetal body is aligned and the head reaches the birth canal, exerting effort once will result in delivery. However, some deliver with only slight abdominal pain or no pain at all, feeling only lower back soreness and bearing down sensation. This is because the Kidney governs the waist, and the uterus is connected to the Kidney. The ancients said: "When the time comes, delivery happens naturally, just like defecating; one cannot urge it when not urgent, nor stop it when urgent." Although this reasoning seems common, understanding it prevents disasters.
2. Knowledge Regarding the Natural Prodromal Signs of Labor: Whenever a pregnant woman approaches labor, half a month or several days prior, the fetal abdomen must descend, and urination becomes frequent. When about to deliver, the pulse first shows the "Departed from Meridian" sign. Wiping and pinching the middle joint or proximal joint of the middle finger of the parturient woman; if a pulsation is felt, this is the time for entering the delivery room.
3. Knowledge Regarding Care and Regulation During Fetal Turning: Whenever a fetus turns in the womb, the abdomen must hurt. Even if delivery is delayed by several days, one must not panic. Have someone support her to walk in the room, or stand leaning against an object, keeping the body and abdomen straight. If she feels slightly tired, pad the back with quilts and lie supine for a moment, then have her walk and stand again. Allow the fetus to turn slowly in the abdomen; delay is harmless. Loosen the skirt belt slightly to give the fetus ample room to turn and stretch comfortably. If she endures pain poorly, bending over or leaning sideways, the fetus will be crowded and lose its way. Midwives who do not understand this principle, seeing slow labor, frequently test the waters, mistakenly rupturing the membranes, allowing wind pathogen to enter the birth canal causing swelling, or causing the amniotic fluid to dry up before the fetus arrives, making delivery even more difficult. In such cases, only urge the parturient to eat and drink despite discomfort, regulate her breathing, or use herbs that invigorate blood and facilitate lubricated delivery. (Herbal formulas for invigorating blood and facilitating delivery are found in the Chapter on Promoting Delivery.) Wait until the fetus presses against the cervix, then exert maximum effort; the fetus will follow the fluid down. This follows the principle of "when the melon is ripe, the stem falls." One must absolutely not exert effort prematurely, leading to mental fatigue and exhaustion at the critical moment, which is the most crucial point for childbirth. I have seen a woman afraid of pain during labor, curling up sitting or lying, causing the fetal origin to turn irregularly. When the fetus emerged from the sac, seeking the birth canal, it was blocked by the mother's curled body, preventing exit. After a short while, it turned again, but the mother, protecting herself from pain, closed off the passage again. Repeating this two or three times, the fetus lost strength and could not move, resulting in dystocia. Others saw the fetus motionless and assumed it was dead, but it was actually due to lack of strength, not death. Immediately instruct the mother to straighten her body and abdomen, move, sit, and stand occasionally, calm her mind and harmonize her Qi, eat and drink despite discomfort. Wait for the fetus to pause and regain strength, then turn to the birth canal again, resulting in smooth delivery.
4. Knowledge Regarding the Selection of Midwives: Whenever a pregnant woman approaches labor, select an elderly midwife with experience and knowledge, along with one or two pure and cautious women to support her. If ignorant and rash women are mistakenly used for delivery, failing to distinguish between normal labor and fetal turning, and upon seeing abdominal pain, they randomly place both hands on the upper abdomen, pressing heavily on both sides to force the fetus down, avoiding transverse presentation, this is the first and most fatal error. When the abdomen first hurts, the membranes have not yet ruptured but are about to. The fetus, about to be delivered, possesses a form of sensitivity/spirit. Feeling external manipulation, the fetus does not know what is happening, becomes frightened, contracts, and dares not move, so when will the membranes rupture? Furthermore, some ignorant midwives harm people by privately puncturing the water bag with their fingers; this must be strictly guarded against. Amniotic fluid is the water within the uterus nourishing the fetus. Once the membrane ruptures, the fetus naturally descends with the fluid. If delivery is delayed beyond the expected time, it is due to weakness of the uterine origin, causing slower turning. Fear that the fluid will be exhausted and blood will come, blocking the path, leaving the fetus with no way through, causing stagnation. Use Baochan Wuyou San (Guarantee Safe Childbirth Powder) to secure the blood. If blood has been depleted, decoct Bazhen Tang (Eight-Treasure Decoction) with Motherwort (Yimucao) strongly, and drink it frequently. If Yuan Qi (Original Qi) is exhausted and fatigued, urgently decoct high-quality Ren Shen (Ginseng Root) [1 liang] and Dang Gui (Angelica Sinensis Root) [2 qian]. Drink until finished, then decoct again to assist Qi and Blood, which is most effective. Using drugs that promote delivery and consume Qi will yield no effect. Alternatively, first take Bazhen Tang to tonify Qi and Blood, then decoct strong Scallion Juice, having the midwife wash the birth canal to ensure smooth circulation of Qi up and down. Apply Butter and Talcum Powder to the vulva, then take Cansheng Wanquan Tang (Thousand-Complete Delivery Pill) is also excellent.
5. Knowledge Regarding Taboos During Labor: In the month of impending labor, pregnant women must not wash their hair or feet; those who violate this often experience difficult labor. When approaching the delivery moment, all doors, windows, boxes, cabinets, bottles, and jars should be loosened/unfastened. Also, all visiting relatives, widows, unmarried girls, mourning nuns, unclean persons, women whose menstruation has just started, or women with strong body odors, can all disturb the fetus and bring disaster; precautions and taboos must be observed. Popular superstition avoids many people knowing, believing that each additional person in the room causes delay. Although this is a folk theory, it contains truth, fearing that the parturient's mind becomes troubled, leading to difficult labor.
6. Knowledge Regarding the Need for Silence During Labor: During labor, the room must not be noisy. Even in case of unexpected emergencies, shouting outside is prohibited. If the parturient is frightened and startled, fetal stagnation and Qi knotting will occur, leading to difficult labor. The Classics state: "Fright scatters the Spirit, Worry knots the Qi, Fear makes Qi timid; timidity closes the Upper Jiao; closure causes Qi to return; return causes Lower Jiao distension; thus Qi ceases to move." This Qi knotting and stagnation leads to difficult labor. If the Chi (Kidney) pulses on both wrists are absent, while other pulses are peaceful, this indicates Lower Jiao distension and Qi blockage, a pulse sign of difficult labor. Urgently use Zisu Yin (Perilla Decoction) to dissipate knots and move Qi to achieve delivery.
7. Knowledge Regarding Drinking Soup/Water During Labor: At the time of delivery, if the pregnant woman feels stifled and thirsty in the epigastrium, use half a cup of White Honey dissolved in warm water to drink. If she desires water, only clear Rice Water should be given. Honey moistens dryness and facilitates delivery; Rice Water assists Middle Qi. Some women vomit food and medicine taken during labor. If they continue to eat and take medicine after vomiting, ensuring they do not become weak or dry, they will still deliver spontaneously; there is no need to worry about the vomiting. Therefore, the parturient must not go hungry; hunger leads to deficiency of Middle Qi and lack of strength to expel the fetus. Eat small amounts of Congee made from Japonica Glutinous Rice, or drink broth from hen soup. Do not eat meat or hard foods, as they may stagnate in the Upper Jiao, preventing Qi from descending, causing not only difficult labor but also internal injury. Do not eat too full; being slightly hungry is best. Hunger causes Qi to descend; descending Qi accelerates delivery. I believe that for thirst, inability to eat, and vomiting, drinking Dushen Tang (Single Ginseng Decoction) is best and can also promote delivery.
8. Knowledge Regarding Abnormal Deliveries: Besides normal deliveries, there are eight types of abnormal deliveries: Transverse Presentation (Heng Chan), Breech/Foot First (Ni Chan), Sitting Presentation (Zuo Chan), Obstructed Presentation (Ai Chan), Oblique Presentation (Pian Chan), Posterior Occiput Presentation (Zhang Hou Chan), Prolapsed Intestine (Pan Chang Chan), and Prolapsed Umbilical Cord (Lang Qi Chan). These are caused by deficiency of Qi and Blood in the pregnant woman, or by sitting on the straw, testing waters, or pushing too early. Upon encountering these abnormalities, the parturient must lie supine, remain calm, and select an experienced midwife to manage. Treatments for each are listed below.
For Transverse Presentation (Hand presenting first), known popularly as "Seeking Salt Birth": Let the mother lie supine calmly. Apply salt to the infant's palm, then smear sesame oil on the protruding hand. The midwife gently pushes it back. If the infant's hand touches the salt, the muscles sting, causing pain and retraction. Wait for the fetus to turn and align the head, then help the mother push; the infant will emerge.
For Breech/Foot First Presentation (Foot presenting first), known as "Treading Lotus Birth": Let the mother lie supine, without fear or anxiety. Apply salt to the sole of the foot, and smear sesame oil on the protruding foot. The midwife gently pushes it back. Wait for the fetus to turn and align the head, then push to deliver. In cases of transverse or breech presentation, the lives of mother and child depend on moments. Without emergency methods, how can one claim medical sanctity? Causes include the fetus not yet turning smoothly, with limbs pushed out by maternal effort, or maternal Qi/Blood deficiency causing the fetus to lack strength to turn, resulting in limb presentation. Quickly use the salt-oil method to push back. If pushed out by force, it is easy to turn back without medication. If deficient and unable to turn, urgently decoct Niujie Tang (Rescue Reversal Decoction) to assist Qi and Blood. After pushing back for a short while, the fetus gains strength to turn, aligns the head, and delivers. Crucially, do not allow limbs to protrude for long or excessively. If hands or feet appear slightly, treat immediately with salt. If protruding too long, they become blue and hard, difficult to push back, injuring the fetus. Do not listen to wicked women suggesting cutting limbs with a knife; touching the blade disturbs the fetus internally and injures the mother. Some use needles on limbs or grasp the sole; I fear this frightens the fetus into contracting, potentially harming the mother's heart/mind. Salt application is preferable.
For Sitting Presentation (Breech/Rump presenting first), known as "Sitting Rump Birth": Let the mother lie supine, apply oil and push back as before. Wait for the fetus to turn and align, then push out. Alternatively, tie a towel firmly at a high point, let the mother hold it, gently flex and extend legs to open the path, resulting in smooth delivery.
For Obstructed Presentation (Cervix and opening correct, vertex showing but not descending): This is usually due to the umbilical cord entangling the shoulder, popularly called "Backpack Birth." Let the mother lie supine; the midwife gently pushes the fetus upward, uses the middle finger to press the shoulder, feels for the cord, removes it, aligns the fetus, and one push results in delivery.
For Oblique Presentation (Birth canal not aligned, pushed by maternal effort, head obliquely against the introitus): Laypeople think the vertex is showing, but it is actually the forehead. Let the mother lie supine, gently push the fetus up, align the head with hand, and one push results in delivery.
For Posterior Occiput Presentation (Occiput bone presses against the mother's anus, preventing descent): Have the midwife wrap hands in warmed cotton clothing, gently push the head from beside the anus to align it, then push to deliver. Alternatively, have the mother brace her knees.
For Prolapsed Intestine (Intestine presents first): People are terrified, but it is harmless. Let the mother lie supine calmly. Quickly prepare a clean basin with warm water, adding slightly more heat in winter. Add sesame oil for lubrication. Wait for the fetus and placenta to deliver. The midwife, with hands oiled, slowly pushes the intestine back. Have the mother clench her buttocks tightly; the intestine will retract. Some use vinegar mixed with cold water sprayed on the face to induce retraction. There is also Shenyin Dan (Miraculous Response Pill) paste. However, spraying/pasting may cause errors. Blowing Rhizoma Typhonii (Zaojiao) powder into the nose induces sneezing, which retracts the intestine naturally. If the intestine dries from wind exposure, use a little whetstone water, warmed over fire, to moisten it, then drink a cup of Magnetite (Cishi) decoction; the intestine will retract. If the bladder prolapses after the fetus/placenta, use the same method. All these prolapses of intestine/bladder are due to chronic Qi deficiency, straining, premature pushing disturbing the viscera, weakness of the Lower Yuan, and laxity of the "key" (sphincters/support). To prevent recurrence, when not pregnant, take Dihuang Wan (Rehmannia Pill) added with Fructus Schisandrae (Wuweizi) and Cortex Cinnamomi (Rougui) [1 liang each] to secure the Lower Yuan. When pregnant, take Hulian Wan (Coptis Pill) added with Ren Shen (Ginseng) to tonify Qi, and Sanbu Wan (Three Tonics Pill) to cool blood. Do not lightly use slippery/thinning fetus agents. At eight months, take Bazhen Tang added with Fructus Chebulae (Hezi), Herba Siegesbeckiae (Qumai), Pericarpium Papaveris (Suke), and honey for over ten doses. My opinion is to pre-administer Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) for lifting earlier, to avoid issues at labor. This is safer and less complex than Hulian, Sanbu, or Suke.
For Prolapsed Umbilical Cord (Placenta/Cord presents first): Normally, the head turns to the birth canal for normal delivery. If lacking strength to turn, the foot steps on the placenta/cord first. Urgently have the midwife arrange and push it back. Wait for breath to stabilize, then顺势 push from below. Do not delay pushing back; prolonged delay causes the cord to fall again, making it hard to manage.
9. Knowledge Regarding Twin Delivery: When a pregnant woman labors, if one fetus is delivered and another appears, it is twins. Only the midwife knows this; she should only say she is retrieving the placenta, speaking of the second birth only after the first is born, to avoid frightening the mother and causing complications.
10. Knowledge Regarding Awaiting Placental Delivery: When the baby emerges, two people should hold the mother's chest, and the mother should clutch her abdomen tightly, aiding placental descent. If the placenta is delayed, do not panic. Burn paper and smoke the nose to induce expulsion. If still delayed, cut the umbilical cord immediately, wash the baby, and tie the cord with soft cloth. The cord is fragile; tying must be light yet secure before cutting. If not cut, blood may reflux into the uterus, causing distension and failure to descend, attacking the heart and causing injury. Experienced midwives can remove the placenta manually with fingers (method see chapter on Retained Placenta).
11. Knowledge Regarding Muffled Navel Birth (Asphyxia): It is normal for the newborn to cry immediately. If the baby lands silent due to muffled Qi, popular belief says calling the father's name or patting the thigh induces crying, but the mechanism is unclear. There is a membrane in the anal region blocking Qi; patting breaks it, allowing crying. If patting fails, have a nimble woman gently pierce it with the tip of a silver hairpin. If piercing is impossible, quickly wrap the baby tightly in warm cotton batting, hold close, do not cut the cord yet. Quickly soak the placenta in hot water (warm over charcoal in cold weather). Make a large oil-paper wick, light a lamp, and pass the flame back and forth over the umbilical cord. Since the cord connects to the navel, prolonged heat will internally swell and break the membrane. Once broken, the baby cries and revives, then cut the cord and bathe. Another method uses Qiai (Mugwort) wicks soaked in sesame oil, smoking the cord until charred to generate internal heat. Another method involves popping the fontanelle with a lit rush pith. All treat muffled navel birth.
12. Knowledge Regarding Stillborn at Birth: If the baby is born dead, urgently check for bubbles on the anterior roof of the mouth. Pop them with a finger, wipe blood clean with cloth. If blood enters the throat, death occurs; removing blood restores life. The white rice-like substance in the bubble, sharp as a needle tip, must also be scraped off to prevent entry into the throat.
13. Knowledge Regarding Cold Birth: In winter, cold congeals maternal blood, delaying delivery. Place stoves/fire in all parts of the room to maintain spring-like warmth. Do not remove cotton clothes from the lower body; do not sit/lie on cold surfaces. Keep the mother's back warm and the area below the navel, legs, and knees constantly warm. Heat promotes blood flow, facilitating delivery. Charcoal must be burned red outside and brought in; raw charcoal fumes may cause dizziness.
14. Knowledge Regarding Hot Birth: In midsummer, maintain appropriate temperature. Sprinkle water in the room, place basins of water, or set ice blocks far away to resolve stagnant heat. Avoid cool winds and rainy days; do not seek excessive coolness to prevent illness. Limit the number of people in the room to prevent heat oppression, maternal agitation, boiling blood, and risk of fainting/dizziness.
Niujie Tang (Rescue Reversal Decoction): Treats maternal Qi/Blood deficiency, fetal inability to turn, limb presentation.
Ren Shen (Ginseng Root) [1 liang], Dang Gui (Angelica Sinensis Root) [3 liang], Chuan Xiong (Ligusticum Chuanxiong Rhizome) [2 liang], Hong Hua (Carthamus Tinctorius Flower) [3 qian].
Decoct in water and take quickly. If still不顺 (not smooth), decoct and take again.
Sanbu Wan (Three Tonics Pill): Specifically treats Blood Heat.
Huang Qin (Scutellaria Baicalensis Root, stir-fried), Huang Lian (Coptis Chinensis Rhizome, stir-fried), Huang Bai (Phellodendron Amurense Bark, stir-fried).
Grind equal parts into powder, make pills with honey, take with plain water.
Bazhen Tang (Eight-Treasure Decoction) (See Vol 1, Pain Chapter).
Baochan Wuyou San (Guarantee Safe Childbirth Powder) (See this Vol, Prenatal Easy Delivery Formulas).
Cansheng Wanquan Tang (Thousand-Complete Delivery Pill) (See this Vol, Delivery Chapter).
Zisu Yin (Perilla Decoction) (See Vol 1, AnTai Chapter).
Shenyin Dan (Miraculous Response Pill) (See this Vol, Weisheng Chapter).
Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) (See Vol 1, Abilities Chapter, attached to Liuwei Dihuang Tang).
Hulian Wan (Coptis Pill) (See Vol 1, AnTai Chapter).
Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) (See Vol 1, Pain Chapter).