〔大全〕夫有产儿出，胞衣不落者，世谓之息胞。由产初时用力，比产儿出，而体
已疲惫，不复能用力，产胞经停之间，而外冷乘之，则血道涩，故胞衣不出。须急以方
药救治，不妨害于儿，所奈者胞紧连儿脐，胞不出即不得以时断脐浴洗，冷气伤儿，则成
病也。旧法胞衣不出，恐损儿者，根据法截脐而已。产处须顺四时方面，并避五行禁忌，若
有触犯，多令产妇难产。
郭稽中论曰∶胎衣不下者何？答曰∶母生子讫，流血入衣中，衣为血所胀，故不得
下。治之稍缓，胀满腹，以次上冲心胸，疼痛喘急者，但服夺命丹以逐去衣中之血，血
散胀消，胎衣自下。牛膝汤亦效。
〔薛〕有因恶露入衣，胀而不能出，有因元气亏损而不能送出，其恶露流衣中者，腹
中胀痛，用夺命丹或失笑散以消瘀血，缓则不救。其元气不能送者，腹中不胀痛，用保
生无忧散以补固元气，或用蓖麻子肉一两，细研成膏，涂母右脚心，衣下即洗去，缓则肠
亦出。如肠不上，仍用此膏涂脑顶，则肠自入。益母丸亦效。家人妇胎衣不出，胸腹
胀痛，手不敢近，此瘀血为患，用热酒下失笑散一剂，恶露胎衣并下。一产妇胎衣不
出，腹不胀痛，手按之痛稍缓，此是气虚而不能送出，用无忧散而下。前证余询诸稳婆
云，宜服益母草丸，或就以产妇头发入口作呕，胎衣自出，其不出者必死，授与前法甚
效。一产妇产后面赤，五心烦热，败血入
胞，胞衣不下，热有冷汗。思但去其败血，其衣自下，遂用乌豆二合，炒透，然后烧红铁
秤锤同豆淬其酒，将豆淋酒化下益母丹二丸，胞衣从血而出，余证尽平。
夺命丹
附子（半两，泡） 牡丹皮（一两） 干漆（二钱半，碎之，炒烟尽）
上为细末，以酽醋一升，大黄末一两同熬成膏，和药丸如梧子大，温酒吞五七丸，不拘时。
花蕊石散 治产后气欲绝，缘败血不尽，血迷血晕，恶血奔心，胎死腹中，胎衣不下、
至死者，但心头暖，急以童子小便调一钱，取下恶物如猪肝，终身无血风血气疾。膈上有
血，化为黄水，即吐出或小便中出也。若先下胎衣，则泛泛之药不能达，若先治血闷，则
寻常之药无此功，无如此药有两全之效。
花蕊石（一斤） 上色硫黄（四两，各研细）
上二味，相拌令匀，先用纸和胶泥固瓦罐子一个，内可容药，候泥干，入药在内，密
泥封口了，焙笼内焙令透热，安在四方砖上，（砖上书八卦五行字。）用炭一秤，笼叠周匝，自巳
午时从下生火，令渐渐上彻，有坠下火放夹火上，直至经宿，炭消火冷，又放经宿，冷
定取出，细研，以绢罗至细，瓷合内盛，根据法用之。（此药便是疗金疮花蕊石散，寻常人自宜时
时收蓄防急。）
一亲戚妇人，产后胞衣不下，血涨迷闷，不省人事，告之曰∶死矣。予曰∶此血胀也，
可用花蕊石散救之。因以一钱，童便调灌下即苏，其胎衣与恶水旋即下而无恙。
芎 散 治胎衣不下。
芎 当归（焙，各半两） 榆白皮（一两，锉）
为细末，每服二钱，食前用生地黄汁同温酒调下。
必效方牛膝汤 治胎衣不出，脐腹坚胀急痛，即杀人。服此药胞即烂下，死胎亦下。
牛膝 瞿麦（各四两） 当归（三两） 通草（六两） 滑石（八两） 葵子（五两）
上细切，以水九升，煮取三升，分三服。若衣不下，腹满即杀人，宜服此药，衣即烂
出也。
牛膝散 治妊娠五六月堕胎，胞衣不出。
牛膝 川芎 朴硝 蒲黄（各七钱半） 桂心（半两） 当归（一两半）
上为粗末，每服四钱，水一盏，姜三片，生地黄一分，煎至六分，去滓温，频服。
千金备急丹 治产后恶血冲心，胎衣不下，腹中血块。
以锦纹大黄一两为细末，用酽醋半升，同煎如膏，丸如桐子大，温醋汤吞五丸，或七
丸，须臾恶血即下，愈。
《保命》治胎衣不下，或子死腹中，或血冲上昏闷，或血暴下及胎干不能生产。半夏
汤主之。（方见前催生。）
下胎丸
半夏 白散（各半两）
上细末，丸如桐子大。食后半夏汤下三十丸，渐加至五十丸。如未效者，须广大其
药，榆白皮散主之。又不效，用大圣散主之。有宿热者，宜服人参荆芥散。
治胞衣不出，若腹胀则杀人。
黑豆一合（炒令熟）
上入醋一盏，煎三五沸，去豆，分为三服。酒煮亦可。
《必效方》治胎衣不下。服蒲黄如枣大。（《集验》、《千金》、《崔氏方》并同。）
又方 生地黄汁（一升） 苦酒（三合） 暖服之。
又方 牛膝（一两） 葵子（一合） 杵碎，以水一盏半，煎至一盏，去滓分二服。
《广济》治胎衣不出方。
以灶突中土三指撮，以水服之。（《集验》、《千金》、《备急》同。）
又方 伏龙肝（一大块，研碎） 用好醋调令相合，纳脐中，续煎生甘草汤三四合服。
又方 醋汤饮之出。
又方 鸡子（一枚） 苦酒（一合） 和饮之，立出
《延年方》治胎衣不出，腹胀则杀人。
吞鸡子黄三个，仍解发刺喉中令呕，即出。若困极，以水煮蝼蛄一枚，二十沸，灌
入口，汁下即出。（崔氏同。）
《救急方》赤小豆（男七粒，女十四粒） 东流顺水吞下。
疗胞衣不下方。
栝蒌实（一个取子研令细）
上酒、童便各半盏、相和，煎至七分，去滓温服。（如无实，根亦得。）
又方 红花（一两） 酒煮浓汁服。
又方 以鹿角镑屑，研细三分，煮葱白汤调下。
凡欲产时，必先脱常所着衣以笼灶，胞衣自下，仍易产。
《广济方》胞衣不出取夫单衣盖井上，立出。
又方 取产母鞋底，火炙热，熨小腹上下二七次。
又方 取路傍破草鞋前截，连鼻烧灰，童便和酒调下。
又方 皂角刺烧为末，每服一钱，温酒调下。
《宝庆方》云∶妇人百病，莫甚于生产，产科之难，临产莫重于催生，既产莫甚于胞
衣不下，惟有花蕊石散一药，最为紧要。如黑神散、琥珀散诸方之类，虽皆有验，然乡
居或远于药局，仓卒之间，无法可施。今有一妙法，若产讫胞衣不下，停待稍久，非特
产母疲倦，又且血流入胞中，为血所胀，上冲心胸，喘急疼痛，必致危笃。若有此证，宜
急断脐带，以少物系坠，（以物系坠之时，切宜用心，先系然后截断，不尔则胞上掩心而死。）使其子
血脉不潮入胞中，则胞衣自当痿缩而下，纵淹延数日，亦不害人。只要产母心怀安泰，终
自下矣。累试有验，不可轻信坐婆，妄用手法，多有因此而亡者，慎之慎之。
〔针灸〕
胞衣不下 三阴交 中极（各泻之。）
〔标幽〕又法 照海 内关
〔甲〕女子字难，若胞不出，昆仑主之。
[Daquan] When the infant is born but the placenta (fetal membrane) does not descend, this condition is commonly referred to as "Xi Bao" (Stagnant Placenta). This occurs because excessive exertion during the initial stage of labor leaves the mother exhausted after the delivery of the infant, unable to continue pushing. During the pause in the labor process, external cold pathogens invade, causing blood vessels to become sluggish and obstructed, thus preventing the expulsion of the placenta. Urgent treatment with herbal medicine is required. Although this does not directly harm the infant, the placenta remains tightly connected to the infant's umbilical cord. If the placenta is not expelled promptly, the umbilical cord cannot be cut and the infant bathed in a timely manner; exposure to cold air may cause illness in the infant. According to old methods, if there is concern that the retained placenta might injure the infant, the umbilical cord should be cut according to standard procedure. The location for childbirth should align with the directions favorable to the four seasons, and taboos related to the Five Elements should be avoided; violations often lead to difficult labor.
Guo Jizhong discussed: Why does the placenta fail to descend? He answered: After the mother gives birth, blood flows into the placenta, distending it, which prevents its descent. If treatment is delayed, abdominal distension will occur, followed by upward rushing to the chest and heart, accompanied by pain and rapid breathing. In such cases, administering Duoming Dan (Life-Rescuing Pill) can expel the stagnant blood within the placenta. Once the blood disperses and distension subsides, the placenta will naturally descend. Niuxi Tang (Achyranthes Decoction) is also effective.
Xue Ji stated: Some cases are due to lochia entering the placenta, causing distension that prevents expulsion; others result from deficiency of Yuan Qi (Primary Qi), which lacks the power to push the placenta out. In cases where lochia flows into the placenta, there is abdominal distension and pain; these should be treated with Duoming Dan or Shixiao San (Pain-Stopping Powder) to resolve blood stasis. Delayed treatment may be fatal. In cases where Yuan Qi is insufficient to expel the placenta, there is no abdominal distension or pain; these should be treated with Baosheng Wuyou San (Safe Birth Without Worries Powder) to tonify and secure the Yuan Qi. Alternatively, apply one liang of castor bean paste to the sole of the mother's right foot; wash it off immediately after the placenta descends. If delayed, the intestines may prolapse. If the intestines do not retract, apply this paste to the Baihui point (GV20) on the crown of the head, and the intestines will naturally retract. Yimu Wan (Motherwort Pill) is also effective. A relative’s wife suffered from retained placenta with chest and abdominal distension and tenderness, indicating blood stasis; she was given one dose of Shixiao San taken with hot wine, resulting in the simultaneous expulsion of lochia and placenta. Another patient had retained placenta without abdominal distension or pain, but slight relief upon pressure, indicating Qi deficiency; she was treated with Wuyou San, which led to the expulsion of the placenta. Regarding previous cases, I consulted midwives who suggested taking Motherwort Pills or inducing vomiting by placing the mother's hair in her mouth, which would cause the placenta to descend spontaneously; failure to do so would result in death. The aforementioned methods were very effective. Another postpartum woman presented with a red face, five-palm heat, retained placenta due to敗血 (decayed blood) entering the uterus, accompanied by cold sweat. I reasoned that removing the decayed blood would allow the placenta to descend spontaneously. Thus, I used two he of black beans, thoroughly stir-fried, quenched with wine using a red-hot iron weight, and administered two pills of Yimu Dan dissolved in this bean-drip wine. The placenta was expelled with the blood, and other symptoms resolved completely.
Duoming Dan (Life-Rescuing Pill)
Fuzi (Prepared Aconite Root, half liang, processed) Mudanpi (Moutan Cortex, one liang) Ganxi (Dry Resin, two qian and half, crushed, stir-fried until smoke ceases)
Grind all ingredients into fine powder. Mix with one sheng of strong vinegar and one liang of Rhubarb powder, boil into a paste, and form pills the size of wet buckwheat seeds. Take five to seven pills with warm wine at any time.
Huarui Shi San (Flower Ochre Stone Powder) Treats postpartum conditions where breath is faint due to incomplete expulsion of decaying blood, leading to blood confusion and syncope, evil blood rushing to the heart, fetal death in utero, retained placenta, and even approaching death. As long as the heart area remains warm, immediately administer one qian mixed with fresh urine from an uncircumcised boy. This will expel dark matter resembling pig liver, preventing lifelong blood wind and blood qi disorders. If blood stagnates above the diaphragm, it transforms into yellow fluid, which is then vomited or excreted via urine. If the placenta is addressed first, ordinary medicines cannot reach the pathology; if blood stagnation is treated first, common medicines lack this efficacy. Only this powder offers a comprehensive solution.
Huarui Shi (Flower Ochre Stone, one jin) Shangse Liuhuang (High-quality Sulfur, four liang, each ground finely)
Mix the two ingredients evenly. Seal a clay jar with paper and glue mud, ensuring it can hold the medicine. Once dry, place the mixture inside, seal tightly with mud, and bake in a kiln until thoroughly heated. Place on a square brick inscribed with Bagua and Five Elements characters. Cover with one picul of charcoal, lighting a fire from below starting at Si-Wu hours (9 AM - 1 PM), allowing heat to rise gradually. Catch falling sparks. Continue baking overnight until charcoal is consumed and fire cools. Leave for another night. Upon cooling, remove, grind finely, sieve through silk, and store in a porcelain container. Use according to method. (This is the Huarui Shi San for treating metal wounds; ordinary people should keep it for emergencies.)
A relative’s wife suffered from retained placenta postpartum, with blood distension causing coma and unconsciousness. She was told, "It is hopeless." I said, "This is blood distension; it can be saved with Huarui Shi San." One qian was mixed with fresh urine and administered orally. She revived immediately, and the placenta and lochia were expelled without incident.
Xiong San (Ligusticum Powder) Treats retained placenta.
Xiong (Ligusticum Chuanxiong Rhizome) Danggui (Angelica Sinensis Root, dried, half liang each) Yubai Pi (Ulmus White Bark, one liang, chopped)
Grind into fine powder. Take two qian before meals, mixed with juice of fresh Rehmannia root and warm wine.
Bixiao Fang Niuxi Tang (Must-Efficacy Achyranthes Decoction) Treats retained placenta with hard, distended, and painful umbilicus and abdomen, which can be fatal. This medicine causes the placenta to rot and descend; dead fetuses are also expelled.
Niuxi (Achyranthes Bidentata Root) Qumai (Dianthus Herb, four liang each) Danggui (Angelica Sinensis Root, three liang) Tongcao (Tetrapanax Pith, six liang) Huashi (Talcum, eight liang) Kuizi (Abelmoschus Seeds, five liang)
Chop finely. Boil in nine sheng of water to obtain three sheng. Divide into three doses. If the placenta does not descend and abdominal distension occurs, it is fatal; take this medicine to cause the placenta to rot and exit.
Niuxi San (Achyranthes Powder) Treats retained placenta after miscarriage at five or six months of pregnancy.
Niuxi (Achyranthes Bidentata Root) Chuanxiong (Ligusticum Chuanxiong Rhizome) Poxiao (Mirabilite) Puhuang (Lygodium Spore, seven qian and half each) Guixin (Cinnamon Twig, half liang) Danggui (Angelica Sinensis Root, one liang and half)
Grind into coarse powder. Take four qian per dose with one sheng of water, three slices of ginger, and one fen of fresh Rehmannia root. Decoct to six parts, strain, and drink warm frequently.
Qianjin Beiji Dan (Thousand Golden Emergency Pill) Treats postpartum evil blood rushing to the heart, retained placenta, and abdominal blood masses.
Take one liang of Jinwen Dahuang (Rhubarb with brocade-like texture), grind into fine powder. Simmer with half sheng of strong vinegar until paste-like. Form pills the size of paulownia seeds. Swallow five or seven pills with warm vinegar soup. Evil blood will descend shortly, curing the condition.
Baoming Ji treats retained placenta, fetal death in utero, blood rushing upwards causing syncope, sudden heavy bleeding, or dried placenta preventing delivery. The main formula is Banxia Tang (Pinellia Decoction). (See earlier section on promoting labor.)
Xitai Wan (Fetus-Expelling Pill)
Banxia (Pinellia Tuber) Baisan (White Powder, half liang each)
Grind into fine powder, form pills the size of paulownia seeds. Take thirty pills with Banxia Tang after meals, gradually increasing to fifty pills. If ineffective, increase dosage using Yubai Pi San (Ulmus White Bark Powder). If still ineffective, use Dasheng San (Great Sage Powder). For those with chronic heat, Ren Shen Jingjie San (Ginseng and Schizonepeta Powder) is suitable.
To treat retained placenta; if abdominal distension occurs, it is fatal.
One he of black beans (stir-fried until cooked)
Add one sheng of vinegar, boil for three to five boils, remove beans, divide into three doses. Can also be decocted in wine.
Bixiao Fang treats retained placenta. Take Puhuang (Lygodium Spore) the size of a jujube. (Jiyan Fang, Qianjin Fang, Cui Shi Fang agree.)
Another prescription: Shengdihuang Zhi (Fresh Rehmannia Juice, one sheng) Kujiu (Vinegar, three he). Warm and drink.
Another prescription: Niuxi (Achyranthes Bidentata Root, one liang) Kuizi (Abelmoschus Seeds, one he). Pound and crush. Decoct in one and a half sheng of water to one sheng. Strain and divide into two doses.
Guangji Fang treats retained placenta.
Take three finger-pinches of soil from the chimney flue, swallow with water. (Jiyan Fang, Qianjin Fang, Beiji Fang agree.)
Another prescription: Fulonggan (Long-stored Hearth Earth, large piece, ground) Mix well with good vinegar, apply to the umbilicus. Subsequently decoct and drink three to four he of Gancao Tang (Licorice Decoction).
Another prescription: Drink vinegar soup to expel the placenta.
Another prescription: One egg, one he of vinegar. Mix and drink; the placenta will emerge immediately.
Yannian Fang treats retained placenta; abdominal distension is fatal.
Swallow three chicken egg yolks. Untie hair and insert into throat to induce vomiting; the placenta will emerge. If extremely weak, decoct one mole in water for twenty boils, and pour into the mouth; the juice will cause expulsion. (Cui Shi Fang agrees.)
Jiuji Fang: Seven red adzuki beans (for males) or fourteen (for females). Swallow with east-flowing water.
Treatment for retained placenta.
Gualou Shi (Trichosanthes Fruit Seed, one fruit, seeds ground finely)
Mix half a cup of wine and half a cup of fresh urine. Decoct to seven parts. Strain and drink warm. (If fruit is unavailable, roots may be used.)
Another prescription: Honghua (Carthamus Flower, one liang). Decoct in wine, drink concentrated juice.
Another prescription: Take horn shavings from deer antler, grind finely (three fen). Mix with scallion white decoction and take.
When preparing for labor, one must first remove usual clothing and cover the stove with it; the placenta will descend spontaneously, facilitating delivery.
Guangji Fang: To treat retained placenta, place the husband's single garment over a well; the placenta will emerge immediately.
Another prescription: Take the mother's shoe sole, heat it over fire, and moxa/iron the lower abdomen up and down fourteen times.
Another prescription: Take the front part of a broken straw sandal found by the road, including the toe cap, burn to ash. Mix with fresh urine and wine, and take.
Another prescription: Burn Gaojiao Ci (Gleditsia Sinensis Thorn) to ash. Take one qian per dose, mixed with warm wine.
Baoqing Fang states: Among women's diseases, none are more severe than childbirth. In obstetrics, nothing is more critical than promoting labor during delivery. After delivery, nothing is more dangerous than retained placenta. Only Huarui Shi San is most crucial. Although formulas like Heishen San (Black Divine Powder) and Hupo San (Amber Powder) have effects, rural areas far from pharmacies may lack access in emergencies. Here is a clever method: If the placenta does not descend after birth and waiting too long causes maternal exhaustion, with blood flowing into the placenta, causing distension, rushing to the chest and heart, leading to panting and pain, resulting in critical danger. If these symptoms appear, urgently cut the umbilical cord and tie a small object to hang it. (Be careful when tying; tie first, then cut; otherwise, the placenta may rise and compress the heart, causing death.) This prevents blood from flooding into the placenta, allowing it to shrink and descend naturally. Even if delayed for days, it will not harm. As long as the mother remains calm, it will eventually descend. Tested repeatedly with success. Do not blindly trust midwives to use manual manipulation; many have died due to this. Be extremely cautious.
[Acupuncture]
Retained Placenta: Stimulate Sanyinjiao (SP6) and Zhongji (CV3) using reducing method.
[Biao You Fu] Another method: Zhaohai (KI6), Neiguan (PC6).
[Jia Yi Jing] Difficult childbirth in women; if placenta does not descend, Kunlun (BL60) governs.