妇人儿已生地，而胞衣尚留于腹，三日不下，心烦意躁，时欲晕去，人以为胞
胎之蒂未断也，谁知血少干枯粘连于腹乎。世见胞衣不下，心怀疑惧，恐其上冲于
心，有死亡之兆，然胎衣何能冲于心也。但胞衣未下，则瘀血未免难行，有血晕之
虞耳。治法仍大补气血，使生血以送胎衣，则胎衣自然润滑，生气以助生血，则血
生迅速，尤易推堕也。方用送胎汤∶
当归（二两） 川芎（五钱） 乳香末（一钱） 益母草（一两） 没药末（一钱） 麝香（半分，研）
荆芥（三钱） 水煎调服。立下。
此方以当归、川芎补其气血，以荆芥引气血归经，用益母草、乳香等药逐瘀下
胎。新血既长，旧血难存，气旺上升，瘀浊自然迅降，无留滞之苦也。盖胞衣留腹，
有回顾其母胎之心，往往有六、七日不下，胞衣竟不腐烂，正以其有生气也。可见
胎衣在腹，不能杀人，补之自降也。或谓胞衣既有生气，补气补血，则胞衣宜益坚
牢，何补之反降？不知子未下，补则益于子，子已下，补则益于母，益子而胞衣之
气连，益母而胞衣之气脱，实有不同。故此补气、补血，乃补各经之气血，以推送
之，非补胞胆之气血，是以补气、补血，而胎衣反降也。
用加味佛手散殊效。
当归（二两） 川芎（一两） 益母草（五钱） 乳香末（一钱） 败龟板（一具） 水煎服。一剂
即下也。
妇人子生五、六日，胞衣留于腹中，百计治之，竟不肯下，然又绝无烦躁昏晕
之状，人以为瘀血之粘连也，谁知气虚不能推送乎。夫瘀血在腹，断无不作祟之理，
有则必然发晕，今安然无恙，是血已净矣。血净宜清气升而浊气降，今胞胎不下，
是清气下陷难升，遂至浊气上浮难降。然浊气上升，必有烦躁之病，今反安然者，
是清浊之气两不能升也。然则补其气，不无浊气之上升乎？不知清升而浊降者，
一定之理也。苟能于补气之中，仍分其清浊之气，则升清正所以降浊矣。方用补中益
气汤∶
人参（三钱） 黄 （一两） 当归（五钱） 升麻（三分） 柴胡（三分） 陈皮（二分）
甘草（一分） 白术（五钱） 加萝卜子（五分） 水煎服。一剂胎衣自下。
夫补中益气汤补气之药，即提气之药也。并非推送之剂，何能下胎衣如此之速？
不知浊气之下陷者，由于清气之不升也。提其气，则清气升而浊气自降，腹中所存
之物无不尽降，正不必又去推送之也。况方中又加萝卜子数分，能分理清浊，不致
两相 格，此奏功之所以神耳。
用加味补血汤亦神效。
黄 （二两） 当归（一两） 升麻（五分） 益母草（三钱） 水煎服。一剂即下。
The woman’s fetus has already been delivered, but the placenta remains retained in the abdomen for three days without being expelled. She experiences mental restlessness and irritability, frequently feeling faint. Others assume that the stalk connecting the fetus to the uterus has not yet detached; however, it is actually due to a deficiency of blood causing dryness, which leads to the adhesion of the placenta to the abdominal wall. People seeing retained placenta often harbor suspicion and fear, worrying that it may rush upward to affect the heart, signaling death. Yet, how can the placenta assault the heart? The danger lies only in the fact that if the placenta is not expelled, stasis of blood will inevitably hinder circulation, posing a risk of syncope due to blood stasis (Xue Yun). The treatment method should focus on greatly tonifying Qi and Blood, generating new blood to push out the placenta, thereby making the placenta naturally lubricated. By tonifying Qi to assist in generating Blood, blood production becomes rapid, facilitating the expulsion of the placenta. The formula used is Song Tai Tang (Placenta Expulsion Decoction): Dang Gui (Radix Angelicae Sinensis) 2 liang, Chuan Xiong (Rhizoma Chuanxiong) 5 qian, Ru Xiang Mo (Boswelliae Resina Pulvis, Frankincense Powder) 1 qian, Yi Mu Cao (Herba Leonuri, Motherwort Herb) 1 liang, Mo Yao Mo (Myrrhae Resina Pulvis, Myrrh Powder) 1 qian, She Xiang (Moschus, Musk) 0.5 fen, ground. Decoct in water and take with the mixture. The placenta will be expelled immediately.
This formula uses Dang Gui and Chuan Xiong to tonify Qi and Blood, Jing Jie (Herba Schizonepetae, Schizonepeta Herb) to guide Qi and Blood back into their meridians, and Yi Mu Cao and Ru Xiang to dispel stasis and expel the placenta. Once new blood grows, old blood cannot remain; when Qi is vigorous and rises, turbid stasis naturally descends rapidly, avoiding the suffering of stagnation. Generally, because the retained placenta retains a connection to its origin (personified as "remembering the mother"), it may remain for six or seven days without rotting, precisely because it still possesses Sheng Qi (vital energy). This demonstrates that a placenta retained in the abdomen does not kill; tonification will cause it to descend. Some might ask: If the placenta has vital energy, tonifying Qi and Blood should make it more firm and secure; why does tonification cause it to descend instead? One must understand that before the fetus is delivered, tonification benefits the fetus; after the fetus is delivered, tonification benefits the mother. Tonifying the fetus keeps the Qi of the placenta connected; tonifying the mother causes the Qi of the placenta to detach. These are indeed different. Therefore, tonifying Qi and Blood here refers to tonifying the Qi and Blood of the various meridians to push the placenta, not tonifying the Qi and Blood of the Bao Dan (uterus/bladder), which is why tonification results in the descent of the placenta.
Jia Wei Fo Shou San (Modified Fo Shou Powder) yields remarkable effects.
Dang Gui (Radix Angelicae Sinensis) 2 liang, Chuan Xiong (Rhizoma Chuanxiong) 1 liang, Yi Mu Cao (Herba Leonuri, Motherwort Herb) 5 qian, Ru Xiang Mo (Boswelliae Resina Pulvis, Frankincense Powder) 1 qian, Bai Gui Ban (Testudinis Carapax et Plastrum Putrefactum, Decomposed Turtle Shell) 1 piece. Decoct in water and take. It will be expelled after one dose.
Five or six days after childbirth, the placenta remains in the abdomen. Despite numerous treatments, it refuses to descend. However, there are absolutely no symptoms of restlessness or syncope. Others attribute this to adhesion caused by blood stasis, but it is actually due to Qi deficiency failing to push it down. Stasis of blood in the abdomen would certainly cause disturbances; if present, it would inevitably lead to dizziness. Since she is currently safe and sound, the blood is clean. When blood is clean, clear Qi should rise and turbid Qi should descend. Now, since the placenta does not descend, it indicates that Clear Qi has sunk and is difficult to ascend, leading to Turbid Qi floating up and being difficult to descend. However, if Turbid Qi rises, it must be accompanied by restlessness. The fact that she is calm indicates that both Clear and Turbid Qi fail to ascend or descend. Then, if we tonify Qi, won't it cause Turbid Qi to rise? No. The principle that Clear Qi rises and Turbid Qi descends is fixed. If, while tonifying Qi, one distinguishes between Clear and Turbid Qi, then raising the Clear Qi is precisely the way to lower the Turbid Qi. The formula used is Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction): Ren Shen (Radix Ginseng, Ginseng Root) 3 qian, Huang Qi (Radix Astragali, Astragalus Root) 1 liang, Dang Gui (Radix Angelicae Sinensis) 5 qian, Sheng Ma (Cimicifugae Rhizoma, Black Cohosh Rhizome) 3 fen, Chai Hu (Bupleuri Radix, Bupleurum Root) 3 fen, Chen Pi (Citri Reticulatae Pericarpium, Tangerine Peel) 2 fen, Gan Cao (Glycyrrhizae Radix et Rhizoma, Licorice Root) 1 fen, Bai Zhu (Atractylodis Macrocephalae Rhizoma, Atractylodes Rhizome) 5 qian, plus Luo Bo Zi (Raphani Semen, Radish Seed) 5 fen. Decoct in water and take. After one dose, the placenta will naturally descend.
Bu Zhong Yi Qi Tang consists of herbs that tonify Qi, which are also herbs that lift Qi. It is not a pushing agent, so how can it expel the placenta so quickly? One must realize that the sinking of Turbid Qi is due to the failure of Clear Qi to ascend. Lifting the Qi causes Clear Qi to ascend and Turbid Qi to descend naturally; everything remaining in the abdomen will descend completely, eliminating the need for specific pushing agents. Moreover, the addition of a few fen of Luo Bo Zi in the formula helps distinguish Clear from Turbid Qi, preventing mutual obstruction (Ge Ju). This is why the efficacy is miraculous.
Jia Wei Bu Xue Tang (Modified Blood-Tonifying Decoction) also yields miraculous effects.
Huang Qi (Radix Astragali, Astragalus Root) 2 liang, Dang Gui (Radix Angelicae Sinensis) 1 liang, Sheng Ma (Cimicifugae Rhizoma, Black Cohosh Rhizome) 5 fen, Yi Mu Cao (Herba Leonuri, Motherwort Herb) 3 qian. Decoct in water and take. It will be expelled after one dose.