Library

Placenta retention can occur due to Qi and Blood deficiency and weakness, failing to propel the placenta out, causing it to remain lodged. The symptoms manifest solely as a lack of strength, without other pain or distension. Treatment should tonify Qi and assist Blood; one should promptly employ Juejin Decoction (Decoction for Crossing the Ford), Huatai Decoction (Decoction for Facilitating Placental Delivery), Baosheng Wuyou San (Preserve Life and Ensure Safety Powder), or Heishen San (Black Divine Powder) from *Jufang* (*Taiping Huimin Heji Jufang*) as primary treatments. Alternatively, it may be caused by lochia flowing into the uterus, leading to distension and stagnation preventing expulsion. Since the fetus has been delivered, the umbilical cord must descend; thus, the uterus within the abdomen takes the shape of an inverted leaf. Being inverted, it collects blood and fluids, causing distension that hinders expulsion. Experienced midwives often recognize this; they simply use a finger to push against the fundus of the uterus to disperse the blood, or reach up to open a corner at the upper opening, allowing the lochia to drain. Once the abdomen is emptied, the placenta will naturally fall out. Another method involves using the parturient's own hair to tickle the throat, inducing vomiting. This causes Qi to ascend and blood to disperse, softening the uterus so the placenta falls out naturally. Cases of retained placenta are often fatal; employing these methods is highly effective. If blood seeps into the uterus and remains stagnant for a long time, causing distension and pain, or panting and urgency, then purging blood and breaking blood stasis is imperative. One should promptly use Duoming Dan (Life-Rescuing Pill) or Shixiao San (Forget Sorrow Powder), taken with hot wine, to disperse blood and reduce distension, after which the placenta will naturally pass. In cases of combined Qi and Blood deficiency, Juejin Decoction is also suitable.

One prescription: Use one liang of castor bean kernel (Ricini Semen), 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.

Another prescription: Use one liang of Carthamus flower (Carthami Flos), boil it in wine to make a concentrated decoction, and drink it.

One method: Heat a shoe sole worn by the parturient until hot, and moxa-like compress the lower abdomen above and below; the placenta will be expelled.

Another prescription: Burn thorns of Gleditsia sinensis (Gleditsiae Spina) into powder, take one qian each time, mixed with warm wine.

Niuxi San (Bull-knee Root Powder) [From Women's Section, Article 49: Retained Placenta, Abdominal Distension]

After delivery, when the placenta has been expelled, Qi and Blood are depleted. Suddenly, the patient experiences blackouts, dizziness, unconsciousness, clenched jaw, and loss of consciousness. Ancients often attributed this to lochia attacking upward due to deficiency, causing "Blood Syncope" (Xue Yun). However, this condition actually has two types: Blood Syncope and Qi Collapse. If Qi Collapse is mistaken for Blood Syncope and treated with acrid-aromatic formulas that drive out blood and resolve phlegm, death will ensue instantly; caution is essential.

First, Qi Collapse Syndrome: During childbirth, with massive blood loss, Qi follows the blood out, often leading to fainting and unconsciousness. Those mildly deficient may recover shortly; those severely deficient will die from exhaustion. Observe if the face is pale, eyes closed, mouth open, hands cold, and the six pulses are extremely fine and weak; this indicates Qi Collapse. Promptly use one to two liang of Ginseng root (Ren Shen), decoct it into a thick liquid, and administer slowly. As long as it is swallowed, life can be saved; any delay renders it futile. I have rescued several such patients, all recovering swiftly; this is the most crucial method. I have also seen cases where the use of Ginseng was prohibited, leading to death. They claimed that Ginseng should not be used postpartum as it would trap lochia, causing harm. Even when advised, they refused, only regretting it after death. Others claim Ginseng should only be used after seven days postpartum. Such ignorant rumors, whose origin is unknown, mislead people greatly and must not be believed.

Second, Blood Syncope Syndrome: Originally caused by Qi deficiency, leading to sudden fainting. However, cases with blood congestion and abundant phlegm do occur. If the physical constitution, Qi, and pulse appear excessive, with chest/abdominal distension/pain rushing upward, this is a Blood Rebellion syndrome; use Shixiao San. If phlegm is abundant and breathing is rough, use Erchen Tang (Two-Cured Decoction). If there are no symptoms of distension, pain, or rough breathing, it belongs to Qi deficiency; use large doses of Xionggui Tang (Cyperi and Angelicae Sinensis Decoction) or Bazhen Tang (Eight-Treasure Decoction).

Third, in cases of sudden fainting where medication cannot be administered immediately, heat a metal weight until red-hot, place it in a vessel near the bed, and pour vinegar over it, or apply vinegar to the nose and mouth. The sour aroma entering the nasal cavity will help restore consciousness. Alternatively, burn old lacquered vessels or dry lacquer to produce smoke and inhale it. However, this method is only suitable for mild and acute syncope. For severe Qi deficiency leading to coma, without major tonifying agents, there is ultimately no benefit.