既产毕，或未动，与参汤服过，或未下地，先已服参，乃与开水一杯，扶上床，以被褥靠住，闭目静坐。
如有汗出，随用硬炭烧红，浇上米醋一小碗，使酸味冲入口鼻，以收敛精神。或床前烧旧漆器，少顷，食白米
薄粥一小碗。数日内勿梳洗，切忌劳动。间有胞衣不下者。根据法行之。
胞衣不下，最关利害。或孕中食煎炒，或临产气力惫，皆不能出。宜于剪脐时，用苎线系定，不可即剪，
服以归芎汤即佛手散，自下。如血入胞衣之中，胀大不能下，以致心闷胀痛喘急者，速用失笑丸三钱，清酒吞
下。如不应，再用花蕊石散二钱，或牛膝散亦可，血散胀消，其胞即下。如不急取，恐瘀血上升，有伤产母之
患。是以失笑丸，花蕊石散，产科必有预备，以防急用。
胞衣不下，用盘肠生证中蓖麻子法，贴于足心，下即洗去。否则，连肠俱出。倘肠出，可移贴头顶即收。
（徐评）
失笑丸
薄黄（略炒） 五灵脂（洗去泥，略炒）
二味等分，用米饮丸，淡盐水吞二三钱（此方治儿枕痛，亦必用之方）。
花蕊石散
好花蕊石（一斤细研筛净） 上色硫黄（四两，研细）
二味和匀，分四次炼。先用好羊肾罐炼。无疤损者，用黄泥周身涂之，阴干，晒至裂缝即补好，恐进火气，
走出内中丹药。方将二药装入，再用瓦汕盏头一个，仰盖口上，用纸泥封固口缝，待干，用细铁在线下四围扎
好，如此四罐共已齐备，用大砂盆一个，中安大针钉三枚，品字好安且平，将罐安放钉上，周遭硬炭文武火炼。
大香三炷退去火，不可动。次日已冷，然后取出药研细，将装入瓷瓶内，收贮备用。此药十年五载收，陈不妨。
每服二钱，热酒童便调下，瘀血化水而下。如不应，再进可也。此药不但产后用，若有跌打损伤，积瘀腹内，疼
痛难忍者，酒服极妙，大有活人性命之功，医家不可缺此。产后败血晕迷，或胞衣胀急，不省人事但心头温者，
灌下即苏，亦是起死回生之法。然炼此药不易，如火候文武不匀，罐口封不如式，硫黄性最猛烈，每致放炮，人
宜防备。且药性俱走无用矣。
牛膝散
淮牛膝 川芎 蒲黄（微炒） 丹皮（各二钱） 当归（一两五钱） 肉桂（四钱）
共为末，每服水调五钱。薛氏云∶胞衣不下，则腹胀，急用此药加朴硝合服，自能腐化而下，缓则不救。一
方用灶下土四钱，醋调纳脐中绊定，煎生甘草汤半盏，或加醋，饮之立下。一方用产母旧鞋底，烘热熨小腹，
上下数次即下。
一方∶产妇自发含口中，作呕状即下。古方夺命丹、黑龙丹，然不如花蕊石散之极妙。
分娩结束后，如果胞衣尚未排出，先给产妇服用参汤；如果还没有下床活动，之前已经服用了人参汤，那么现在给她一杯温开水，扶她上床，用被褥支撑好身体，让她闭目静坐。
如果有出汗的情况，随即用硬木炭烧红，浇上一小碗米醋，让酸味冲入口鼻，以收敛精神。或者在床前焚烧旧的漆器，过了一会儿，吃一小碗白米薄粥。几天内不要梳洗，切忌劳累。偶尔有胞衣不下的情况，按照上述方法施行。
胞衣不下，关系非常重大。或者是怀孕期间吃了煎炸炒制的食物，或者是临产时气力疲惫，都导致胞衣无法排出。适宜在剪断脐带时，用苎麻线系住（防止缩入），不要立即剪断，服用归芎汤（即佛手散），胞衣自然就会下来。如果血液进入胞衣之中，使其胀大不能排出，以致出现心胸闷痛、胀痛、气喘急促的症状，迅速使用失笑丸三钱，用清酒送服。如果无效，再使用花蕊石散二钱，或者牛膝散也可以，瘀血消散、胀满消除，胞衣自然脱落。如果不紧急取出，恐怕瘀血上行，会有伤害产母的危险。因此失笑丸和花蕊石散是产科必须预备的药物，以防急用。
对于胞衣不下，可以使用“盘肠生”证候中提到的蓖麻子法，贴在足心，胞衣下来后立即洗去。否则，可能会导致子宫连同肠管一起脱出。如果肠管脱出，可以移到头顶贴敷，即可收回。
（徐评）
失笑丸
黄柏（略炒） 五灵脂（洗净泥土，略炒）
两味药等量，用米汤制成丸剂，用淡盐水吞服二三钱（此方治疗儿枕痛，也是必用的方剂）。
花蕊石散
优质花蕊石（一斤，细研筛净） 上等硫黄（四两，研细）
两味药混合均匀，分四次炼制。先用优质的羊肾罐进行炼制。如果没有疤痕破损的罐子，用黄泥全身涂抹，阴干，晒到出现裂缝就修补好，恐怕进火时热气冲出，导致内部丹药流失。然后将两味药装入，再用一个瓦汕盏头仰盖在口上，用纸泥封固缝隙，待干后，用细铁线在下部四周扎紧，这样四个罐子就准备好了。用一个大的砂盆，中间安放三枚大针钉，呈品字形安置且保持平稳，将罐子安放在钉子上，周围用硬炭以文火武火交替炼制。烧完三炷香的时间后撤去火源，不可移动。第二天冷却后，取出药物研细，装入瓷瓶内收藏备用。此药存放十年五年也没关系，陈药不妨事。每次服用二钱，用热酒和童便调服，瘀血化为水液而下。如果无效，可以再服用。此药不仅产后使用，如果有跌打损伤，积瘀在腹内，疼痛难忍的，用酒送服极妙，大有救人性命的功效，医家不可缺此药。产后败血导致的晕迷，或者胞衣胀急，不省人事但心头尚温的，灌服后即可苏醒，这也是起死回生的方法。然而炼制此药不容易，如果火候文武不均，罐口密封不合规范，硫黄性质最猛烈，往往导致爆炸，人们应当防备。而且药性都会因为失效而无用。
牛膝散
淮牛膝 川芎 蒲黄（微炒） 丹皮（各二钱） 当归（一两五钱） 肉桂（四钱）
共为末，每次服用五钱，用水调服。薛氏说：胞衣不下，则腹胀，急需此药加朴硝合服，自然能腐化而下，迟缓则无法救治。一方用灶底土四钱，醋调匀纳入脐中并固定，煎生甘草汤半盏，或者加醋，饮下即可立刻排出。另一方用产母旧鞋底，烘热熨烫小腹，上下数次即可排出。
另一方：让产妇自己头发含在口中，做出呕吐的样子即可排出。古方中的夺命丹、黑龙丹，都不如花蕊石散极其奇妙。
After delivery is completed, if the placenta has not yet been expelled, administer a Ginseng Decoction first; if she has not gotten out of bed and has already taken Ginseng earlier, now give her a cup of warm water, help her onto the bed, support her body with quilts, and have her sit quietly with eyes closed.
If sweating occurs, immediately burn hard charcoal until red-hot, pour a small bowl of rice vinegar over it, allowing the sour aroma to enter the mouth and nose to consolidate the spirit. Alternatively, burn old lacquerware near the bedside; after a short while, have her eat a small bowl of thin white rice porridge. For several days, do not comb or wash, and strictly avoid labor. Occasionally, there are cases where the placenta fails to descend. Follow these methods.
Failure of the placenta to descend is of critical importance. It may be due to consuming fried or roasted foods during pregnancy, or exhaustion of qi and strength at the time of childbirth, all of which prevent expulsion. When cutting the umbilical cord, it is advisable to tie it securely with ramie thread and not cut it immediately; administer Guixiong Tang (Foshou San / Cinnamon Twig and Angelica Decoction), and the placenta will naturally descend. If blood enters the placenta, causing it to swell and preventing descent, leading to chest oppression, distending pain, and rapid breathing, rapidly administer Shixiao Wan (Pain-Dismissing Pills) three qian, swallowed with clear wine. If there is no response, administer Huarui Shi San (Flower Reticulated Stone Powder) two qian, or Niuxi San (Achyranthes Powder) may also be used. Once the blood stasis dissipates and swelling subsides, the placenta will descend. If not urgently removed, there is fear that blood stasis will ascend, endangering the mother. Therefore, Shixiao Wan and Huarui Shi San must be prepared in obstetrics for emergency use.
For failure of the placenta to descend, use the castor seed method described in the "Placenta-Attached Intestine Birth" syndrome: apply it to the sole of the foot. Wash it off immediately after the placenta descends. Otherwise, the uterus may prolapse along with the intestines. If the intestines prolapse, applying the paste to the top of the head can retract them.
(M Xu's Commentary)
Shixiao Wan (Pain-Dismissing Pills)
Bo Huang (Phellodendri Cortex, lightly stir-fried) Wulingzhi (Trogopteri Dung, washed to remove mud, lightly stir-fried)
Equal parts of the two ingredients, made into pills using rice water, swallowed with light salt water, two to three qian per dose (This formula treats Zhen Tong / Pillow Pain, and is an essential prescription).
Huarui Shi San (Flower Reticulated Stone Powder)
Good quality Huarui Shi (Reticulatae Lapis, one jin, finely ground and sifted) Shangse Liuhuang (Sulfur, four liang, finely ground)
Mix the two ingredients evenly and divide into four batches for refining. First refine in high-quality sheep kidney pots. For pots without scars or damage, coat the entire exterior with yellow mud, dry in shade, and sun-dry until cracks appear, then repair them to prevent heat from escaping and damaging the internal medicine. Place the two drugs inside, cover the mouth with an inverted clay lid, seal the seams with paper mud, let dry, and bind tightly around the lower perimeter with fine iron wire. Thus, four pots are prepared. Place a large sand basin, install three large nail spikes in the center in a 'pin' character formation ensuring stability, place the pots on the spikes, and refine around the perimeter using hard charcoal with alternating mild and strong fire. After burning three incense sticks, remove the fire source and do not move anything. The next day, once cooled, take out the medicine, grind it finely, and store it in porcelain bottles for future use. This medicine can be stored for ten or five years; aged medicine is acceptable. Each dose is two qian, mixed with hot wine and child's urine (tongbian) to drink, transforming blood stasis into fluid for downward discharge. If ineffective, administer again. This medicine is not only for postpartum use; for traumatic injuries with accumulated blood stasis in the abdomen causing unbearable pain, taking it with wine is excellent, having great merit in saving lives. Physicians should not lack this. For postpartum fainting due to敗血 (defeated blood/stasis), or urgent placental distension causing unconsciousness but with warmth remaining in the heart region,灌下 (pouring down/administering) will cause immediate revival, representing a method of bringing the dead back to life. However, refining this medicine is difficult; if the fire control is uneven or the pot sealing is improper, the fierce nature of sulfur often causes explosions, so precautions are necessary. Otherwise, the medicinal properties become useless.
Niuxi San (Achyranthes Powder)
Huai Niuxi (Radix Achyranthis Bidentatae) Chuanxiong (Rhizoma Chuanxiong) Puhuang (Pollen Typhae, lightly stir-fried) Danpi (Cortex Moutan, each two qian) Danggui (Radix Angelicae Sinensis, one liang five qian) Rougui (Cortex Cinnamomi, four qian)
Grind together into powder. Each dose is five qian, mixed with water. Xue Shi says: If the placenta does not descend, abdominal distension occurs; urgently use this formula combined with Xiaomaxiao (Natrii Sulfas) to facilitate decomposition and descent; delay means no rescue. Another prescription uses Zaoxia Tu (Earth from under the stove) four qian, mixed with vinegar, applied into the umbilicus and secured; decoct Gancao Tang (Licorice Decoction) half a cup, or add vinegar, and drink to ensure immediate expulsion. Another method uses the parturient's old shoe sole, heated and applied as a compress to the lower abdomen, moving up and down several times until expulsion.
Another method: Have the parturient hold her own hair in her mouth, inducing a gagging sensation, which leads to expulsion. Ancient formulas such as Duoming Dan (Life-Seizing Pill) and Heilong Dan (Black Dragon Pill) are not as excellent as Huarui Shi San.