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Xue Lizhai treated a postpartum woman with retained placenta, accompanied by distension and pain in the chest and abdomen, such that she dared not let anyone touch the area. He administered one dose of Shixiao San (Pain-Relieving Powder) taken down with boiling wine, after which both the lochia and the placenta were expelled together.

In another case, a postpartum woman had a retained placenta and abdominal pain; the pain was slightly relieved upon pressure. This was due to Qi deficiency failing to expel the placenta. She was treated with Wuyou San (Worry-Free Powder), which resulted in the expulsion of the placenta. Regarding the former condition, midwives often advised taking Yimucao Wan (Motherwort Pill) or inducing vomiting by placing the mother's hair in her mouth, which would cause the placenta to be expelled naturally. If the placenta remains retained, death is inevitable. The aforementioned methods are effective.

Lv Dongzhuang treated Mrs. Chen, who suffered from a miscarriage with retained placenta. After taking four doses of blood-invigorating and placenta-expelling medicines without any lochia flowing, she developed chest pain and mental confusion. Lv examined her and stated, "This is a failure of the Spleen's function." He first prescribed Huangqi (Astragali Radix) in an amount of one liang. Upon swallowing the medicine, the mental confusion subsided immediately. At that time, someone presented a book on gynecology from *Zhunsheng* (Standard Rules) containing formulas for retained lochia and retained placenta, annotated with notes on their efficacy, and asked, "Are there any usable formulas here?" Lv replied, "None are usable." He then prescribed a large dose of Ren Shen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Baishao (Paeoniae Radix Alba), Huangqi (Astragali Radix), Danggui Shen (Angelicae Sinensis Radix), Fuling (Poria), and Gancao (Glycyrrhizae Radix et Rhizoma). After one dose, the lochia gradually began to flow. Everyone marveled, saying, "Among dozens of ancient formulas, none were usable; *Zhunsheng* can truly be discarded." Lv said, "Alas, what words are these! Wang Sun'an is a renowned physician in the Haidai region; it is merely that scholars fail to investigate properly. If one only seeks formulas in the sections on 'Ezu' (pregnancy-related disorders) and 'retained placenta' that match my approach, error is inevitable. Try looking in the sections on 'uterine bleeding' and 'lower bleeding'; my formulas will be found applicable. This disease originates from severe depletion of Qi and Blood, leading to miscarriage. The Spleen loses its function of controlling blood. Like water flooding and soil collapsing, a breach is imminent, causing mental confusion. Instead of reinforcing and repairing, we add destructive measures, further weakening the patient. I am worried about uncontrollable bleeding; how strange is it that my approach does not fit?" The person asked, "Can we avoid disaster by following your method?" Lv replied, "It cannot be avoided. Excessive intervention has caused the waters to break their banks; the turbulent waves are accumulated with no outlet, so uterine bleeding is certain. Urgently taking my medicine can only reinforce the dike to prevent total collapse." On the third day, he palpated the Chi pulse (Kidney pulse) as very active and said, "Uterine bleeding will occur before midnight tonight." He left a prescription and warned her, "Take it immediately when the bleeding starts." At dusk, the bleeding indeed started, and she survived as predicted. The prescription was Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with added Ren Shen (Ginseng Radix) and Huangqi (Astragali Radix), each two liang. Subsequently, she recovered using spleen- and kidney-tonifying medicines. (Note: The term 'placenta' is not emphasized again.)

Yu Dongfu stated: In cases of retained lochia, I have frequently used Ren Shen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Danggui (Angelicae Sinensis Radix), and Fuzi (Aconiti Lateralis Radix Praeparata) to facilitate expulsion. However, this is only appropriate if the pulse is fine and weak, the mouth is not dry or thirsty, and there is no internal irritability or heat. This case did not mention the pulse, only stating Spleen dysfunction. It is likely that the woman was constitutionally weak, leading to fetal descent. Moreover, administering four doses of blood-invigorating and placenta-expelling medicines is contrary to the correct treatment principle.

Xue Lizhai treated a woman who, after delivery, presented with a red face, five-palm heat, retained placenta due to retained blood entering the uterus, and cold sweats. He reasoned that removing the retained blood would allow the placenta to fall naturally. He used Erdou (Black Soybean) two he measured units, stir-fried thoroughly, then quenched them with wine using a red-hot iron scale weight. The resulting Doulin Jiu (Soybean Drip Wine) was used to dissolve Yi Mu Wan (Motherwort Pill). The placenta was expelled with the blood, and all other symptoms resolved.

Chen Liangfu said: A relative of mine, a woman, had a retained placenta after delivery, suffering from fainting and unconsciousness due to blood distension. I told her servant, "She is dead." The servant replied, "I possess genuine Huarui Shi San (Flower-Stone Powder) from Zhao Daguan's bureau, stored in my box. I gave him one packet, and he administered it with child's urine. The patient revived immediately, and the placenta and foul matter were expelled subsequently, leaving her safe." (From *Liangfang*).

Wei Yuheng said: The wife of Shi Jianfan, over thirty years old, suddenly became pregnant with twins. Postpartum, she was robust and could eat chicken and rice. For several days, she gradually developed fever and distension. Her pulse was floating, slippery, and rapid on light pressure, but knotted and choppy on deep pressure. Inquiry revealed that lochia had ceased for one day. I diagnosed stasis and recommended promoting circulation. I prescribed Shengdi (Rehmanniae Radix), Niuxi (Achyranthis Bidentatae Radix), Yimucao (Leonuri Herba), Honghua (Carthami Flos), Taoren (Persicae Semen), Danggui Wei (Angelicae Sinensis Radix), Danshen (Salviae Miltiorrhizae Radix et Rhizoma), and Walengzi (Arcae Shell). She feared to take them. A specialist doctor was consulted, who stated, "She is past her prime and giving birth for the first time; Qi and Blood are injured, indicating deficiency." He prescribed Jiaozhu (Charred Atractylodis Rhizoma), Paojiang (Prepared Zingiberis Rhizoma), Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Fushen (Poria with Hostwood), and Zaoren (Ziziphi Spinosae Semen). After one dose, the fever worsened; after a second dose, delirium ensued. Another specialist was consulted, offering similar advice and medication. After two more doses, she suffered from insomnia day and night, became comatose and manic, occasionally singing loudly. This resembled Yangming syndrome in Cold Damage where purgatives were neglected. Upon re-examination, I said, "Lochia stopped days after delivery; even a passerby would know this is stasis. If you wish her to live, you must urgently administer the previous formula." Reluctantly, she took it. After evening administration, lochia flowed at midnight. At dawn, a blackened object was expelled—the retained placenta. The midwife had only removed one placenta, assuming they were identical, unaware that one remained in the abdomen, causing this complication. Once the placenta was out and the blood moved, the illness vanished. However, I initially did not realize the placenta was retained. Medicine is indeed difficult! (Xiong's Note: Twin placentas may be separate or fused; midwives must have insight to avoid errors.)