大全云∶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，故胞之不出，须急以方药救治，不
妨害于儿。所奈者，胞系连儿脐，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，产处须顺四时方向，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，胀满腹中，以次上冲心胸，疼痛喘急者难治。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。
薛氏曰∶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（分别有余、不足），或用蓖麻子肉一两（蓖麻法少验），细研成膏，涂
母右足心，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。
家人妇胎衣不落，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（作呕者，为借力出
也，设不能出，徒伤气血），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，有冷汗，思但去其败血，其衣自下，
遂用黑豆二合炒透，然后烧红铁秤锤同豆淬酒，将豆淋酒化下益母丹二丸，胞衣从血而
出，余证尽平。（此方最佳）
夺命丹 治胞衣不下，盖儿之初生，恶血流入衣中，为血所胀塞，故不得下，须臾冲上
逼心即死，急服此药，（此郭稽中方，配制有神）
黑附子（炮，五钱） 丹皮（一两） 干漆（炒烟尽，二钱五分）
上为细末，用米醋一升，大黄末一两，同煮成膏，和前药为丸，如桐子大，每服五七丸，温酒下。
夺命丸 治胞衣不下，并治胎死。
牡丹皮 桃仁 茯苓 赤芍 桂心（各等分）
上为末，蜜丸弹子大，每一丸，醋汤化下，或葱白煎浓汤下，尤妙，连进两丸，死胎腐烂立出。
牛膝汤 治胞衣不出，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） 当归尾 通草（各六两） 滑石（八两） 葵子（五两）
一方有桂心二两。
上细切，以水九升煮取三升，分三服。
牛膝散 治胞衣不出，腹中胀痛，急服此药，腐化而下，缓则不救。
牛膝 川芎 朴硝 蒲黄（各七钱半） 当归（一两五钱） 桂心（五钱）
上锉，每服五钱，加生姜三片，生地黄一钱，水煎服。
加桂芎归汤 有胎衣不下，因产母元气虚薄者，以此温之自下。
川芎 当归（各二钱） 官桂（四钱）（至当之极，妙在官桂四钱）
上锉一服，水煎服。
黑龙丹 治难产及胞衣不下，血迷血晕，不省人事，一切危急恶证垂死者，但灌药得
下，无不全活。
当归 五灵脂 川芎 良姜 熟地黄（各二两，锉碎，入砂锅内，纸筋盐泥固济，火 过） 百草霜
（一两） 硫黄 乳香（各二钱） 琥珀 花蕊石（各一钱）
上为细末，醋糊丸，如弹子大，每用一二丸，炭火 红，投入生姜自然汁浸碎，以童便
合酒调灌下。（ 法、丸法、服法俱奇妙）
花蕊石散 治产后败血不尽，血迷血晕，胎死腹中，胎衣不下，至死心头暖者，急用一
钱，化下即出，其效如神。
花蕊石（一斤） 土色硫黄（四两，各研细）
上和匀，先用纸泥封固瓦罐一个，入二药，仍封固阴干。如急用以火笼内炙干，用炭
火赤去火，次日取出研细，每服一钱，童便热酒下。
一方 治胞衣不出。
牛膝（一两） 葵子（一合）
上锉，以水一升煮半升，去渣，分二服。
千金备急丸 治产后恶血冲心，胎衣不下，腹中血块。
锦纹大黄一两为细末，用酽醋半升，同煎如膏，丸如桐子大，温醋汤下，五丸或七丸，须
臾恶下，即愈。
胡氏法 治产后胞衣不下，惟有花蕊石散一件，最为要紧。若乡居药局远者，仓卒无
之，今有一妙法，产讫胞衣不下，稍久则血流胞中，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，以小物系带，必用力牢固系之，然后截断，使其子血脉不潮入胞
中，胞衣自当痿缩而下，纵淹延数日，亦不害人，屡验。
Quandashu records: In cases where the placenta fails to expel after the infant is born, this condition is commonly referred to as "Xi Bao" (Retained Placenta). This occurs because excessive exertion during labor leaves the mother physically exhausted by the time the infant is delivered, rendering her unable to continue pushing. During the pause in the delivery process, external cold pathogens invade, causing blood vessels to become obstructed and sluggish, thus preventing the expulsion of the placenta. It is imperative to urgently administer herbal remedies to prevent harm to the newborn. The concern lies in the fact that the placenta is connected to the infant's umbilical cord; if the placenta is not expelled, the cord cannot be cut and the infant bathed in a timely manner. Exposure to cold pathogens may injure the infant, leading to illness. The traditional method suggests that if there is fear of injury due to retained placenta, one should simply cut the umbilical cord according to established protocols. The location of delivery must align with the directions appropriate for the four seasons and avoid taboos related to the Five Elements; violations often result in difficult labor for the mother.
Guo Jizhong discusses: What is the cause of retained placenta? He answers: After the mother gives birth, blood flows into the placenta, causing it to swell and preventing its descent. If treatment is delayed, the swelling fills the abdomen and rises sequentially to oppress the heart and chest, causing pain and rapid breathing, which becomes difficult to treat. One should administer Duoming Dan (Life-Rescuing Pill) to expel the stagnant blood from within the placenta. Once the blood disperses and the swelling subsides, the placenta will naturally descend. Niuxi Tang (Achyranthes Decoction) is also effective.
Xue Ji states: There are cases where lochia enters the placenta, causing swelling that prevents expulsion; there are also cases where deficiency of Yuan Qi (Primordial Qi) prevents the placenta from being pushed out. In cases where lochia flows into the placenta, resulting in abdominal distension and pain, Duoming Dan or Shixiao San (Pain-Stopping Powder) should be used to resolve blood stasis; delay renders the condition incurable. In cases where Yuan Qi is insufficient to push the placenta out, the abdomen will not be distended or painful; Baosheng Wuyou San (Life-Preserving Worry-Free Powder) should be used to tonify and secure Yuan Qi (distinguishing between excess and deficiency). Alternatively, apply one liang of castor bean paste (the castor bean method is less frequently effective) finely ground into a paste onto the sole of the mother's right foot. Once the placenta is expelled, wash it off immediately. If applied too long, the intestines may prolapse; if they do not retract, apply the same paste to the crown of the head, and the intestines will naturally retract. Yimu Wan (Motherwort Pill) is also effective.
In the case of a family member's wife with retained placenta, chest and abdominal distension and pain, and tenderness to touch, this was caused by blood stasis. One dose of Shixiao San was administered with hot wine, resulting in the simultaneous expulsion of lochia and placenta. In another case of a postpartum woman with retained placenta but no abdominal distension or pain, with slight relief upon pressure, this indicated Qi deficiency failing to expel the placenta; Wuyou San was used successfully. Regarding previous cases, I consulted midwives who suggested administering Yimucao Wan (Motherwort Pill), or inducing vomiting by placing the mother's hair in her mouth to utilize the force of vomiting to expel the placenta (inducing vomiting leverages physical force; if it still does not expel, it merely damages Qi and Blood without benefit). If it remains undelivered, death is inevitable. The aforementioned methods proved highly effective.
In the case of a postpartum woman presenting with facial redness, heat sensation in the five centers, retained placenta due to敗血 (decayed blood) entering the uterus, accompanied by cold sweat, the strategy was to remove the decayed blood so the placenta would follow. Two he of black beans were thoroughly stir-fried, then quenched in wine with a red-hot iron scale weight. The resulting Doulin Jiu (Black Bean Dripping Wine) was used to dissolve two pills of Yimu Dan (Motherwort Pill), which resulted in the expulsion of the placenta along with blood, and all other symptoms resolved. (This formula is excellent.)
Duoming Dan: Treats retained placenta. Typically, after birth, evil blood flows into the placenta, causing obstruction and swelling that prevents expulsion. Within moments, it rushes upward to oppress the heart, leading to death. Urgent administration of this medicine is required. (This is Guo Jizhong's formula, with a miraculous preparation method.)
Prepared Fuzi (Cinnamon Twig Root, processed, 5 qian) Mudanpi (Tree Peony Bark, 1 liang) Ganxi (Dry Lacquer, stir-fried until smoke ceases, 2.5 qian)
Grind all into fine powder. Boil with one sheng of rice vinegar and one liang of Dahuang (Rhubarb) powder until a paste forms. Mix with the previous powders to form pills the size of paulownia seeds. Take 5-7 pills per dose with warm wine.
Duoming Wan: Treats retained placenta and intrauterine fetal death.
Mudanpi (Tree Peony Bark) Taoren (Peach Seed) Fuling (Poria) Chishao (Red Peony Root) Guixin (Cinnamon Heart) (equal parts)
Grind into powder, mix with honey to form pills the size of quail eggs. Dissolve one pill in vinegar-infused water before ingestion, or take with strong scallion white decoction, which is particularly effective. Consume two consecutive pills to cause the dead fetus to rot and expel immediately.
Niuxi Tang: Treats retained placenta, hard and distending pain in the navel and abdomen, which can be fatal if acute. Administration causes the placenta to soften and descend; dead fetuses are also expelled.
Niuxi (Achyranthes Root) Qumai (Dianthus Herb) Dangguiwei (Angelica Sinensis Tail) Tongcao (Tetrapanax Pith) Huashi (Talcum) Kuizi (Malva Seed) (4 liang each for Niuxi and Qumai; 6 liang each for Dangguiwei and Tongcao; 8 liang for Huashi; 5 liang for Kuizi)
One variation includes Guixin (Cinnamon Heart) 2 liang.
Chop finely, boil in nine sheng of water to obtain three sheng. Divide into three doses.
Niuxi San: Treats retained placenta with abdominal distension and pain. Administer urgently to cause the placenta to rot and descend; delay makes it incurable.
Niuxi (Achyranthes Root) Chuanxiong (Ligusticum Rhizome) Piaoxiao (Mirabilite) Puhuang (Lygodium Spore) (7.5 qian each) Danggui (Angelica Sinensis Root) (1.5 liang) Guixin (Cinnamon Heart) (5 qian)
Cut into pieces. For each dose, use 5 qian, add three slices of fresh ginger and one qian of Shengdi Huang (Rehmannia Root), decoct in water and drink.
Jia Gui Xiong Gui Tang: For retained placenta due to maternal Qi and Blood deficiency, this formula warms and tonifies, allowing the placenta to descend naturally.
Chuanxiong (Ligusticum Rhizome) Danggui (Angelica Sinensis Root) (2 qian each) Guanhui (Cassia Twig) (4 qian) (Most appropriate and excellent; the efficacy lies in using 4 qian of Guanhui)
Cut into pieces for one dose, decoct in water and drink.
Heilong Dan: Treats difficult labor, retained placenta, blood misting and fainting, loss of consciousness, and all critical conditions nearing death. As long as the medicine can be administered, survival is assured.
Danggui (Angelica Sinensis Root) Wulingzhi (Trogopterus Dung) Chuanxiong (Ligusticum Rhizome) Liangjiang (Galangal Rhizome) Shudihuang (Prepared Rehmannia Root) (2 liang each, chopped, placed in a clay pot, sealed with paper mud and salt mud, calcined over fire) Baicaoshuang (Soot from Hundred Herbs) (1 liang) Liuhuang (Sulfur) Ruxiang (Frankincense) (2 qian each) Hupo (Amber) Huaruishi (Rhodochrosite) (1 qian each)
Grind into fine powder, bind with vinegar paste to form pills the size of quail eggs. Use 1-2 pills per dose, heat red over charcoal, crush in fresh ginger juice, mix with child's urine and wine, and administer. (The preparation, pill-making, and administration methods are all ingenious.)
Huaruishi San: Treats incomplete expulsion of postpartum blood stasis, blood misting and fainting, intrauterine fetal death, and retained placenta. Even in cases of apparent death where the heart remains warm, urgently administer one qian dissolved for ingestion, and expulsion occurs instantly with miraculous effect.
Huaruishi (Rhodochrosite) (1 jin) Tuse Liuhuang (Earthen Sulfur) (4 liang, both ground finely)
Mix evenly. Seal a tile jar with paper mud, insert the two medicines, seal again, and dry in the shade. For urgent use, dry in a fire basket, heat red over charcoal, remove from fire, and grind finely the next day. Take one qian per dose with hot wine and child's urine.
Another Formula: Treats retained placenta.
Niuxi (Achyranthes Root) (1 liang) Kuizi (Malva Seed) (1 he)
Chop finely, boil in one sheng of water until reduced to half a sheng. Strain and divide into two doses.
Qianjin Beiji Wan: Treats postpartum evil blood rushing to the heart, retained placenta, and abdominal blood masses.
Jinwen Dahuang (Brocade-patterned Rhubarb) 1 liang ground into fine powder. Boil with half a sheng of strong vinegar until a paste forms. Form pills the size of paulownia seeds. Take 5-7 pills with warm vinegar-infused water. Evil blood will be expelled shortly thereafter, leading to recovery.
Hu's Method: For treating postpartum retained placenta, Huaruishi San is the most crucial remedy. However, in rural areas far from pharmacies, this may not be available in emergencies. Here is an ingenious alternative: After birth, if the placenta is retained and left untreated, blood flows into the uterus, causing swelling that rises to oppress the heart and chest, leading to gasping and pain, which becomes critical. In such cases, immediately cut the umbilical cord. Tie the cord securely with a small object, ensuring a tight knot, then sever it. This prevents fetal blood from flowing back into the placenta, causing it to shrink and descend naturally. Even if delayed for several days, it will not harm the infant. This method has been verified repeatedly.