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Fan Chang, the eighth son of a she (landlord/gentry family), kept turtles in his courtyard for several years, producing over a hundred offspring. His family had four or five children, all suffering from turtle chest (a deformity where the chest protrudes like a turtle's shell) and kyphosis (curvature of the spine). This was caused by the pregnant women being influenced by its qi (vital energy).

At the end of the Zhiyuan era (Yuan Dynasty), a couple in Yue lived in a shelter made of bundled reeds beside the Vajra Deity at Dashan Temple. Their wife gave birth to a son with two fleshy horns on his head and nostrils that curled upward, resembling the form of a Yaksha (a nature spirit often depicted as monstrous). This was because the parturient woman relied upon earthen idols, thereby inheriting their form. The prenatal education (taijiao) of the ancients must not be neglected.

Xue Lizhai stated: A relative's wife had retained placenta, accompanied by distending pain in the abdomen and chest, and an aversion to touch. This was due to blood stasis. One dose of Shixiao San (Pain-Dispersing Powder) taken with hot wine resulted in the expulsion of both lochia and the placenta.

Another parturient had retained placenta with abdominal distending pain, which was slightly relieved by pressure. This was due to Qi deficiency failing to expel it. Youwu San (Worry-Free Powder) was used, resulting in expulsion.

My commentary: Retained placenta is mostly caused by敗血 (decayed blood) entering the uterus. Xue Lizhai had another case where two he (liang, approx. 30g) of black beans were thoroughly stir-fried, and a red-hot iron steelyard weight was quenched in wine. The wine was then used to dissolve Yi Mu Dan (Motherwort Pills), which led to the expulsion of the placenta along with blood. Another prescription involved three qian (approx. 9g) of Mangxiao (Natrii Sulfas), taken with child's urine, resulting in immediate expulsion. Alternatively, Niuxi (Achyranthis Bidentatae Radix, 2 liang) and Mangxiao (3 qian) were decocted together, mixed with child's urine, and drunk. I also consulted *Shen Zhai Quan Shu*, which records a case of a woman with retained placenta treated with Ren Shen Tang (Ginseng Decoction) to deliver Sha Ren (Amomi Fructus) powder (approx. 1 qian), administered twice or three times daily. After three or four days, the placenta rotted and was expelled, and the woman remained unharmed. How extraordinary! However, the pulse and syndrome were not recorded. Subsequently, a case by a doctor surnamed Li was recorded below for reference.

A woman suffered a miscarriage with retained placenta. After taking four doses of blood-invigorating and placenta-expelling medicines without any bleeding, she experienced chest pain and mental confusion. Li Xiye examined her and said: "This is a failure of the Spleen's function." He first prescribed Huang Qi (Astragali Radix, 1 liang) and Dang Gui (Angelicae Sinensis Radix, 1 liang). Upon ingestion, the mental confusion subsided immediately. Then, a large dose of Ren Shen (Ginseng Radix), Huang Qi, Bai Zhu (Atractylodis Macrocephalae Rhizoma), Dang Gui, Bai Shao (Paeoniae Radix Alba), Fu Ling (Poria), and Gan Cao (Glycyrrhizae Radix et Rhizoma) was administered. After one dose, lochia gradually appeared. Everyone was surprised and asked: "For retained lochia and placenta, there are no formulas using Ren Shen and Huang Qi in gynecological texts. Why did your tonifying method succeed?" Li replied: "You worry about the blood not coming down; I worry about the blood flowing uncontrollably. Hence, the methods are opposite. This disease originated from severe deficiency of Qi and Blood leading to miscarriage, causing the Spleen to lose its function of controlling blood. It is like water flooding and earth collapsing, with a breach imminent, hence the mental confusion. If one does not reinforce the embankment but instead digs through it, this is 'making the deficient more deficient' (Xu Xu). How can this be tolerated?" The patient asked: "If we follow your method, will we be safe?" Li said: "No. The previous aggressive treatments were excessive; the breached waters have left their channels, and turbulent waves are accumulating without outlet, so a flood (hemorrhage) is inevitable. Taking my medicine urgently can only consolidate the banks to prevent total destruction." On the third day, the Chi (Kidney) pulse was very active. Li said: "A hemorrhage will definitely occur before Zi hour tonight." He prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with added Ren Shen and Huang Qi (2 liang each), instructing her to take it as soon as bleeding started. At dusk, the hemorrhage indeed occurred as predicted, and she survived. She was subsequently cured with herbs to regulate and tonify the Spleen and Kidney.

My commentary: I have handled many cases of retained lochia treated successfully with Ren Shen, Fu Zi (Aconiti Lateralis Radix Praeparata), Bai Zhu, and Dang Gui. However, these must present with a fine and soft pulse, no dry mouth or thirst, and no internal irritability or heat; only then is the treatment effective. This case did not record the pulse, stating only that the Spleen failed in its duty, which is confusing. Moreover, most miscarriages are due to constitutional weakness leading to fetal expulsion. To administer four doses of blood-invigorating and placenta-expelling medicines would surely contradict the correct treatment principle.