胞衣不出，有以气血疲弱，不能传送，而停搁不出者。其证但见无力而别无痛胀，治当补气助血，宜速用
决津煎，或滑胎煎、保生无忧散、局方黑神散之类主之。有以恶露流入胞中，胀滞不出者。盖儿既脱，胞带
必下坠，故胞在腹中形如仰叶，仰则盛聚血水，而胀碍难出。惟老成稳婆多有识者，但以手指顶其胞底，以使
血散，或以指摸上口，攀开一角，使恶露倾泻，则腹空自落矣。
决津煎（见经期腹痛）
滑胎煎（见滑胎）
保生无忧散（见滑胎）
《局方》黑神散（见《妇人规古方》）一名乌金散。《灵苑方》名肉桂散。治产后恶露不尽，胎衣不
下，血气攻心，腹痛不止，及治脾肾阴虚，血不守舍，吐衄等证。
黑豆（二两炒） 当归（去芦酒洗） 熟地 蒲黄 白芍 甘草（炙） 干姜（炮） 肉桂（各一两）
上为末，每服二钱，童便、酒各半，调服。《良方》黑神散有炮附子半两，无蒲黄。
又一法∶以本妇头发搅入喉中，使之作呕，则气升血散，胞软亦自落矣。凡胎胞不出者，多死，授以此
法，甚效。
若血渗胞中，停蓄既久，而为胀为痛，或喘或急，则非逐血破血不可也。宜速用夺命丹，或用失笑散，以
热酒调服，使血散胀消，其衣自下。若气血兼虚者，亦
惟决津煎为善。
夺命丹（见鬼胎）
失笑散（见经期腹痛）
一方∶用蓖麻子仁一两，研烂，贴母右足心，衣下速洗去，缓则肠亦出。若肠不收，即以此膏涂脑顶，则
肠自入。
一方∶用红花一两，酒煮浓汁服。
一方∶用产妇鞋底炙热熨小腹上下，即出。
一方∶用皂角烧为末，每服一钱，温酒调服。
The placenta fails to be expelled. One scenario is due to deficiency and weakness of Qi and Blood, which cannot transport it, causing it to stagnate and remain inside. The symptoms present only as a lack of strength without other pain or distension. Treatment should tonify Qi and assist Blood; it is advisable to promptly use Juejin Decoction (Juejin Jian), or Shuaitai Decoction (Shuaitai Jian), Baosheng Wuyou Powder (Baosheng Wuyou San), Ju Fang Heishen San (Black Spirit Powder from the Bureau Formulas), and similar formulas.
Another scenario involves lochia (postpartum residual blood and turbid fluids) flowing into the uterus, causing distension and stagnation that prevents expulsion. Since the fetus has already detached, the umbilical cord must descend; consequently, the uterus within the abdomen assumes a shape like an inverted leaf. The upward-facing side collects blood and fluid, leading to distension that hinders expulsion. Experienced midwives often recognize this condition. They can use a finger to press against the fundus of the uterus to disperse the blood, or insert a finger to explore the upper opening and pull open one corner, allowing the lochia to drain. Once the abdominal cavity is emptied, the placenta will naturally fall out.
Juejin Decoction (See section on Abdominal Pain during Menstruation)
Shuaitai Decoction (See section on Spontaneous Abortion)
Baosheng Wuyou Powder (See section on Spontaneous Abortion)
Ju Fang Heishen San (Black Spirit Powder from the Bureau Formulas) (See "Ancient Formulas in Furen Gui"), also known as Wu Jin San (Black Gold Powder). In Ling Yuan Fang, it is called Rou Gui San (Cinnamon Twig Powder). It treats postpartum incomplete lochia, retained placenta, Blood and Qi attacking the Heart, unceasing abdominal pain, as well as Spleen and Kidney Yin deficiency with Blood failing to reside in its vessel, hematemesis, and epistaxis.
Hei Dou (Black Bean, two liang, stir-fried) Dang Gui (Angelicae Sinensis Radix, remove radicle, wash with wine) Shu Di Huang (Prepared Rehmanniae Radix) Pu Huang (Typhae Pollen) Bai Shao (Paeoniae Radix Alba) Gan Cao (Licorice Root, honey-fried) Gan Jiang (Dried Zingiberis Rhizoma, processed) Rou Gui (Cinnamomi Cortex, each one liang)
Grind the above into powder. Take two qian per dose, mixed with half child's urine and half wine. Heishen San in Liang Fang contains half a liang of Pao Fu Zi (Processed Aconiti Lateralis Radix) and lacks Pu Huang.
Another method: Insert the parturient woman's hair into her throat to induce vomiting. This causes Qi to ascend and Blood to disperse, softening the uterus so the placenta falls out naturally. Cases of retained placenta often result in death; this method is very effective.
If blood seeps into the uterus and stagnates for a long time, causing distension and pain, or even panting or urgency, then drugs that purge and break Blood are indispensable. Promptly use Duoming Dan (Life-Extending Pill) or Shixiao San (Laughing-Out Powder), taken with hot wine, to disperse Blood and reduce distension, after which the placenta will naturally pass. If there is concurrent deficiency of Qi and Blood, Juejin Decoction is best.
Duoming Dan (See section on Ghost Pregnancy)
Shixiao San (See section on Abdominal Pain during Menstruation)
One prescription: Use one liang of Bi Ma Zi Ren (Ricini Semen kernel), grind it into a paste, and apply it to the sole of the mother's right foot. Wash it off immediately after the placenta is delivered; if delayed, the intestine may prolapse. If the intestine does not retract, apply this paste to the vertex of the head, and the intestine will naturally return.
One prescription: Use one liang of Hong Hua (Carthami Flos), boil in wine to make a concentrated decoction and drink.
One prescription: Heat the sole of the parturient woman's shoe until hot and moxa-like compress the upper and lower abdomen; the placenta will be expelled.
One prescription: Burn Zao Jiao (Gleditsiae Fructus Spinulus) to ash, take one qian per dose, mixed with warm wine.