矾昌高八舍家。轩墀间畜龟数年。生育至百余。其家产子四五人。皆龟胸伛偻。盖孕
妇感其气所致。
至正末。越有夫妇二人。于大善寺金刚神侧。缚苇而居。其妇产一子。首两肉角。鼻孔
昂缩。类所谓夜叉形。盖产妇根据止土偶。便禀得此形。古人胎教。不可不谨。
立斋曰。家人妇胎衣不落。腹胸胀痛。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。腹中胀痛。手按之痛稍缓。此是气虚而不能送出。用无忧散而下。
震按胞衣不下。因败血入胞者居多。立斋又有一案。用黑豆二合炒透。铁秤锤一个烧红
同以酒淬之。将酒化下益母丹二丸。胞衣从血而出。又方。芒硝三钱。童便冲服。立下。
或以牛膝二两。芒硝三钱煎。冲童便饮。及阅慎斋全书。载一妇胞衣不下。用人参汤送下砂
仁末钱许。一日二三次。三四日胞衣烂出。其妇无恙。奇矣。然不知脉证之何如也。继之者
有黎姓一案。亦录于左。以助参酌。
一妇半产。胎衣不下。连服行血催衣之药四剂。点血不行。胸痛瞀乱。黎西野视之曰。
此脾失职也。先与黄 一两。当归一两。下咽而瞀乱顿减。随用大剂参、 、术、归、芍、
苓、甘草等药。一服而恶露渐至。众皆惊曰。恶露不下。胞衣不下。女科书中并无参、 之
方。君独以补奏功。其义何居。黎曰。君等忧血其不下。吾正忧血下不止。故相反耳。盖此
病本气血大亏而致半产。脾失统血之职。水湮土崩。冲决将至。故生瞀乱。不为之修筑。而
反加穿凿。是虚虚也。乌乎可。曰。今从子法。遂得免乎。曰。不能也。穿凿过当。所决之
水。已离故道。狂澜壅积。势无所归。故必崩。急服吾药。第可固其堤岸。使不致荡没耳。
至第三日。诊尺内动甚。曰。今夜子以前必崩矣。用补中益气汤加参、 各二两。嘱以血至
即服。至黄昏果发。如其言。得无恙。次用调补脾肾之药而愈。
震按恶露不下。用参、附、术、归等药而下者。生平经手颇多。然必脉象细软。口不燥
渴。内不烦热。用之方效。此案不载脉象。只云脾失其职。亦属糊涂。但半产者多系体虚而
胎堕。且连服行血催衣之药四剂。宁不反其道以治之耶。
矾昌高八舍家中，庭院里饲养乌龟多年，生育的乌龟多达上百只。他家生了四五个孩子，都患有龟胸（胸部畸形隆起如龟背）和伛偻（脊柱弯曲）。这是因为孕妇接触了这种气息所致。
元至正末年，越地有一对夫妇，在大善寺金刚神像旁边，用芦苇捆绑搭建住所居住。他们的妻子生下一个儿子，头上长着两个肉角，鼻孔向上收缩，形状类似传说中的夜叉。这是因为产妇依靠土偶（偶像/神像），禀受了那种形态的缘故。古人的胎教，不可不谨慎。
薛立斋说：某家人的妻子胎盘滞留不下，腹部和胸部胀痛，手不敢触碰。这是瘀血为患，用热酒送服失笑散一剂，恶露和胎盘一并排出。
另一位产妇胎盘不出，腹中胀痛，用手按压疼痛稍缓解。这是气虚不能推动排出，用无忧散治疗而排出。
我按语：胎盘不下，大多是因为败血进入胞宫所致。薛立斋还有另一个医案，用黑豆二合炒透，铁秤锤一个烧红后同放入酒中淬火，将酒化开服用益母丹两丸，胎盘随着血液排出。又一个方子，芒硝三钱，用童便冲服，立即排出。或者用牛膝二两、芒硝三钱煎煮，冲入童便饮用。又查阅《慎斋全书》，记载一位妇女胎盘不下，用人参汤送下砂仁末约一钱，每天分两三次服用，三四天后胎盘腐烂排出，那位妇女安然无恙。真奇妙啊。然而不知道当时的脉象和证候如何。接着有一位黎姓医生的医案，也记录在下面，以供参考斟酌。
一位妇女半产（流产），胎盘不下，连续服用活血催排胎盘的药四剂，一点血都不行，胸痛且神志昏乱。黎西野诊视后说：这是脾脏失职。先给予黄芪一两、当归一两，咽下后神志昏乱顿时减轻。随即使用大剂量人参、黄芪、白术、当归、白芍、茯苓、甘草等药物，一服药后恶露逐渐到来。众人都惊讶地说：恶露不下，胎盘不下，妇科书中并没有用人参、黄芪的方子，您唯独靠补法奏效，其中的道理何在？黎医生说：你们担忧血下不来，我正担忧血下个不停。所以方法相反罢了。这个病本来是因为气血大亏导致流产，脾脏失去统摄血液的功能，如同水淹没、土崩塌，决堤即将发生，所以产生神志昏乱。如果不加以修筑加固，反而加以穿凿破坏，这就是“虚虚”（使虚者更虚）的错误治法，怎么可以呢？那人问：现在听从您的方法，就能免除危险吗？黎医生说：不能。因为之前的穿凿太过分，所决裂的水流已经离开故道，狂澜壅积，没有归宿，所以必然会发生崩漏。急服我的药，只能巩固堤岸，使其不至于荡然淹没罢了。到了第三天，诊察尺脉跳动剧烈，说：今晚子时以前必然发生崩漏。于是用补中益气汤加人参、黄芪各二两，嘱咐她见血就服用。到了黄昏果然发作，按照他的说法，得以安然无恙。随后使用调理补益脾肾的药物而痊愈。
我按语：恶露不下，用人参、附子、白术、当归等药而排出的，生平经手很多。但必须是脉象细软，口不干燥口渴，体内不烦热，使用才有效。这个医案没有记载脉象，只说是脾脏失职，也属于糊涂。但是半产的多数是体质虚弱而胎堕，而且连续服用活血催排胎盘的药四剂，难道不是违背治疗原则来治病吗？
Fan Chang, the eighth son of a she (landlord/gentry family), kept turtles in his courtyard for several years, producing over a hundred offspring. His family had four or five children, all suffering from turtle chest (a deformity where the chest protrudes like a turtle's shell) and kyphosis (curvature of the spine). This was caused by the pregnant women being influenced by its qi (vital energy).
At the end of the Zhiyuan era (Yuan Dynasty), a couple in Yue lived in a shelter made of bundled reeds beside the Vajra Deity at Dashan Temple. Their wife gave birth to a son with two fleshy horns on his head and nostrils that curled upward, resembling the form of a Yaksha (a nature spirit often depicted as monstrous). This was because the parturient woman relied upon earthen idols, thereby inheriting their form. The prenatal education (taijiao) of the ancients must not be neglected.
Xue Lizhai stated: A relative's wife had retained placenta, accompanied by distending pain in the abdomen and chest, and an aversion to touch. This was due to blood stasis. One dose of Shixiao San (Pain-Dispersing Powder) taken with hot wine resulted in the expulsion of both lochia and the placenta.
Another parturient had retained placenta with abdominal distending pain, which was slightly relieved by pressure. This was due to Qi deficiency failing to expel it. Youwu San (Worry-Free Powder) was used, resulting in expulsion.
My commentary: Retained placenta is mostly caused by敗血 (decayed blood) entering the uterus. Xue Lizhai had another case where two he (liang, approx. 30g) of black beans were thoroughly stir-fried, and a red-hot iron steelyard weight was quenched in wine. The wine was then used to dissolve Yi Mu Dan (Motherwort Pills), which led to the expulsion of the placenta along with blood. Another prescription involved three qian (approx. 9g) of Mangxiao (Natrii Sulfas), taken with child's urine, resulting in immediate expulsion. Alternatively, Niuxi (Achyranthis Bidentatae Radix, 2 liang) and Mangxiao (3 qian) were decocted together, mixed with child's urine, and drunk. I also consulted *Shen Zhai Quan Shu*, which records a case of a woman with retained placenta treated with Ren Shen Tang (Ginseng Decoction) to deliver Sha Ren (Amomi Fructus) powder (approx. 1 qian), administered twice or three times daily. After three or four days, the placenta rotted and was expelled, and the woman remained unharmed. How extraordinary! However, the pulse and syndrome were not recorded. Subsequently, a case by a doctor surnamed Li was recorded below for reference.
A woman suffered a miscarriage with retained placenta. After taking four doses of blood-invigorating and placenta-expelling medicines without any bleeding, she experienced chest pain and mental confusion. Li Xiye examined her and said: "This is a failure of the Spleen's function." He first prescribed Huang Qi (Astragali Radix, 1 liang) and Dang Gui (Angelicae Sinensis Radix, 1 liang). Upon ingestion, the mental confusion subsided immediately. Then, a large dose of Ren Shen (Ginseng Radix), Huang Qi, Bai Zhu (Atractylodis Macrocephalae Rhizoma), Dang Gui, Bai Shao (Paeoniae Radix Alba), Fu Ling (Poria), and Gan Cao (Glycyrrhizae Radix et Rhizoma) was administered. After one dose, lochia gradually appeared. Everyone was surprised and asked: "For retained lochia and placenta, there are no formulas using Ren Shen and Huang Qi in gynecological texts. Why did your tonifying method succeed?" Li replied: "You worry about the blood not coming down; I worry about the blood flowing uncontrollably. Hence, the methods are opposite. This disease originated from severe deficiency of Qi and Blood leading to miscarriage, causing the Spleen to lose its function of controlling blood. It is like water flooding and earth collapsing, with a breach imminent, hence the mental confusion. If one does not reinforce the embankment but instead digs through it, this is 'making the deficient more deficient' (Xu Xu). How can this be tolerated?" The patient asked: "If we follow your method, will we be safe?" Li said: "No. The previous aggressive treatments were excessive; the breached waters have left their channels, and turbulent waves are accumulating without outlet, so a flood (hemorrhage) is inevitable. Taking my medicine urgently can only consolidate the banks to prevent total destruction." On the third day, the Chi (Kidney) pulse was very active. Li said: "A hemorrhage will definitely occur before Zi hour tonight." He prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with added Ren Shen and Huang Qi (2 liang each), instructing her to take it as soon as bleeding started. At dusk, the hemorrhage indeed occurred as predicted, and she survived. She was subsequently cured with herbs to regulate and tonify the Spleen and Kidney.
My commentary: I have handled many cases of retained lochia treated successfully with Ren Shen, Fu Zi (Aconiti Lateralis Radix Praeparata), Bai Zhu, and Dang Gui. However, these must present with a fine and soft pulse, no dry mouth or thirst, and no internal irritability or heat; only then is the treatment effective. This case did not record the pulse, stating only that the Spleen failed in its duty, which is confusing. Moreover, most miscarriages are due to constitutional weakness leading to fetal expulsion. To administer four doses of blood-invigorating and placenta-expelling medicines would surely contradict the correct treatment principle.