产妇有儿已下地，而胞衣留滞于腹中，二、三日不下，心烦意躁，时欲昏晕，人以为胞衣之蒂未断也，谁知
是血少干枯，粘连于腹中乎！世人见胞衣不下，未免心怀疑惧，恐其冲之于心，而有死亡之兆。然而胞衣究何能上
冲于心也。但胞衣不下，瘀血未免难行，恐有血晕之虞耳。治法仍宜大补其气血，使生血以送胞衣，则胞衣自然
润滑，润滑则易下，生气以助生血，则血生自然迅速，尤易催堕也。
方用送胞汤。
当归（二两酒洗） 川芎（五钱） 益母草（一两） 乳香（一两，不去油） 没药（一两，不去油） 芥穗
（三钱，炒黑） 麝香（五厘，研，另冲）
水煎服，立下。此方以芎、归补其气血，以荆芥引血归经，用益母、乳香等药，逐瘀而下胞衣，新血既生，则旧
血难存，气旺上升，而瘀浊自降，尚有留滞之苦哉！夫胞衣是包儿之一物，非根据于子，即根据于母，子生而不随子俱
下，以子之不可根据也，故停滞于腹，若有回顺其母之心，母胞虽已生子，而其蒂间之气，原未遽绝，所以留连欲脱
而未脱，往往有存腹六七日不下，而竟不腐烂者，正以其尚有生气也。可见胞衣留腹，不能杀人，补之而自降耳。
或谓胞衣既有生气，补气补血，则胞衣亦宜坚牢，何以补之而反降也？不知子未下，补则益于子；子已下，补则益
于母。益子而胞衣之气连，益母而胞衣之气脱。此胞胎之气关，通则两合，闭则两开矣。故大补气血而胞衣反降也。
有妇人子下地五、六日，而胞衣留于腹中，百计治之，竟不能下，而又绝无昏晕烦躁之状，人以为瘀血之粘
连也，谁知是气虚不能推送乎！夫瘀血在腹，断无不作祟之理，有则必然发晕，今安然无恙，是血已净矣。血净宜
清气升而浊气降。今胞衣不下，是清气下降而难升，遂至浊气上浮而难降。然浊气上升，又必有烦躁之病，今亦安
然者，是清浊之气两不能升也。然则补其气不无浊气之上升乎？不知清升而浊降者，一定之理，未有清升而浊亦升
者也，苟能于补气之中，仍分其清浊之气，则升清正所以降浊也。
方用补中益气汤。
人参（三钱） 生黄 （一两） 柴胡（三分） 炙草（一分） 当归（五钱） 白术（五分，土炒） 升麻
（三分） 陈皮（二分） 莱菔子（五分，炒，研）
水煎服。一剂而胞衣自下矣。夫补中益气汤乃提气之药也，并非推送之剂，何以能降胞衣如此之速也？然而浊
气之不降者，由于清气之不升也；提其气则清升而浊降，浊气降则腹中所存之物，即无不随浊气而尽降，正不必再
用推送之法也。况又加莱菔子数分，能理浊气，不至两相捍格，所以奏功之奇也。
眉批∶方极效。
歌括∶胞衣不下因何缘，血少干枯故粘连。
心烦意乱时昏晕，瘀血停留使之然。
送胞汤用益母草，归芍乳香与没药。
芥穗麝香宜少用，煎服胞衣离宫巢。
婴儿落生五六日，胞衣为何留腹中。
气虚力弱难推送，瘀血除尽免昏蒙。
补中益气用参 ，当归白术草陈皮。
柴胡升麻莱菔子，升清降浊奏功奇。
A parturient woman has delivered the fetus, but the placenta remains retained in the abdomen for two or three days without being expelled. She experiences mental restlessness and frequent fainting spells. People assume that the stalk of the placenta has not been severed; however, it is actually due to a deficiency of blood causing dryness and adhesion within the abdomen! When people see the retained placenta, they inevitably harbor suspicion and fear, worrying that it may rush upward to affect the Heart, leading to death. Yet, how can the placenta possibly rush upward to the Heart? The mere fact that the placenta is not expelled means that blood stasis is difficult to move, posing a risk of syncope due to blood (blood dizziness). The treatment method should still focus on greatly tonifying Qi and Blood, generating new blood to push out the placenta. Once the placenta becomes naturally lubricated, it will be easy to descend. Generating Qi to assist in producing Blood ensures rapid blood generation, making it even easier to expel the placenta.
Prescribe Songbao Tang (Placenta-Expelling Decoction).
Danggui Radix Angelicae Sinensis (2 liang, washed with wine), Chuanxiong Rhizoma Ligustici Chuanxiong (5 qian), Yimucao Herba Leonuri (1 liang), Ruxiang Resina Olibani (1 liang, oil not removed), Moyao Resina Myrrhae (1 liang, oil not removed), Jingjie Spica Schizonepetae (3 qian, stir-fried until black), Shexiang Moschus (5 li, ground, taken separately as a suspension).
Decoct in water and take orally; the placenta will be expelled immediately. This formula uses Chuanxiong and Danggui to tonify Qi and Blood, Jingjie to guide blood back to its vessels, and herbs such as Yimucao and Ruxiang to dispel blood stasis and facilitate the expulsion of the placenta. Once new blood is generated, old stasis cannot remain; when Qi flourishes and rises, turbid stasis naturally descends, eliminating any lingering discomfort. The placenta is an organ that envelops the fetus; it attaches either to the fetus or to the mother. After birth, if the placenta does not descend with the fetus, it is because there is no longer attachment to the fetus, causing it to stagnate in the abdomen. It seems as though it wishes to return to the mother. Although the uterine cavity has delivered the child, the Qi at the stalk has not immediately ceased, so it lingers, wanting to detach but unable to do so completely. It often remains in the abdomen for six or seven days without rotting, precisely because it still possesses vital Qi. Thus, a retained placenta in the abdomen is not fatal; tonification will cause it to descend naturally.
Some may ask: If the placenta possesses vital Qi, tonifying Qi and Blood should make it firmer; why does tonification cause it to descend instead? One must understand that before the fetus is born, tonification benefits the fetus; after the fetus is born, tonification benefits the mother. Benefiting the fetus keeps the Qi of the placenta connected; benefiting the mother causes the Qi of the placenta to detach. The key to the Qi of the chong and ren vessels lies in their connection: when open, they merge; when closed, they separate. Therefore, greatly tonifying Qi and Blood causes the placenta to descend.
There was a woman whose fetus had been delivered for five or six days, yet the placenta remained in the abdomen. Despite various treatments, it could not be expelled, and she exhibited absolutely no symptoms of fainting or irritability. People attributed this to adhesion caused by blood stasis, but it is actually due to Qi deficiency failing to push it down. Blood stasis in the abdomen invariably causes disturbances; if present, it would certainly cause fainting. Since she is safe and sound, the blood is already clear. When blood is clear, Clear Qi should rise and Turbid Qi should descend. Currently, the placenta is not descending because Clear Qi is sinking and difficult to rise, causing Turbid Qi to float upward and difficult to descend. However, if Turbid Qi rises, irritability should occur; since she is calm, both Clear and Turbid Qi fail to ascend or descend. Does tonifying Qi not risk raising Turbid Qi? No. It is a fixed principle that when Clear Qi rises, Turbid Qi descends; there is no case where both rise. If one can distinguish between Clear and Turbid Qi while tonifying, then raising the Clear Qi is precisely the method to lower the Turbid Qi.
Prescribe Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction).
Renshen Radix Ginseng (3 qian), Shenghuangqi Radix Astragali Membranacei (1 liang), Chaihu Radix Bupleuri (3 fen), Zhigancao Radix Glycyrrhizae Preparata (1 fen), Danggui Radix Angelicae Sinensis (5 qian), Baizhu Rhizoma Atractylodis Macrocephalae (5 fen, stir-fried with earth), Shengma Rhizoma Cimicifugae (3 fen), Chenpi Pericarpium Citri Reticulatae (2 fen), Laifuzi Semen Raphani (5 fen, stir-fried and ground).
Decoct in water and take orally. After one dose, the placenta descends naturally. Buzhong Yiqi Tang is a formula for lifting Qi, not for pushing; why does it expedite the descent of the placenta so quickly? The reason Turbid Qi fails to descend is that Clear Qi fails to rise; lifting the Qi causes Clear Qi to rise and Turbid Qi to descend. Once Turbid Qi descends, anything remaining in the abdomen will naturally descend with it, eliminating the need for pushing methods. Moreover, adding a small amount of Laifuzi regulates Turbid Qi, preventing conflict, which accounts for the miraculous efficacy.
Commentary: The formula is extremely effective.
Verse:
Why is the placenta retained? Due to blood deficiency and dryness causing adhesion.
Mental restlessness and frequent fainting are caused by lingering blood stasis.
Songbao Tang uses Herba Leonuri, Danggui, Shaoyao, Ruxiang, and Moyao.
Spica Schizonepetae and Moschus should be used sparingly; decocted and taken, the placenta leaves the womb.
The infant is born five or six days, why is the placenta retained in the abdomen?
Qi deficiency and weak force make pushing difficult; clearing all blood stasis prevents fainting.
Buzhong Yiqi uses Renshen, Danggui, Baizhu, Gancao, and Chenpi.
Chaihu, Shengma, and Semen Raphani raise the Clear and lower the Turbid, achieving miraculous results.