产后胎衣不下者，诚为可惧。盖有恶血填胀衣中，阻塞道路，急须用药助下，切不可用粗
鲁之妇以手采取，多致损肝伤胃者有之，此又不可不慎也。丹溪曰∶产后当大补气血为主，虽有
杂证，以未治之。诚万世不易之论也。原夫妊妇向以元气养胎，而体固不甚浓，抑兼产后大耗
气血，是则虚而又虚者也，夫安得不大补哉！虽然，此丹溪之言其常也。若果因其变证，又安
得不通其变而治之？抑执其常以补之乎？《易》曰∶化而裁之，存乎通；神而明之，存乎人。
然胎妊既分，而久积之污血须该尽脱。若然未尽，腹中硬痛者，用滑涩汤、黑神散之属，破而
行之，须要恶露驱尽，方用补剂。随以胎衣涤去污浊，修制为丸，予僭名为还元丹。此方产后
服之，诚足以补真元也。非达造化之至者，乌足与知之！余如因虚感冒风寒，祛风之药加之补
剂可也。如伤食发热者，消导之药加之补剂亦可也。余可类推。产毕宜先饮童便，服返魂丹一
丸，不得便就平卧，宜闭目倚坐须臾，坚膝挺胸，仰卧，令人以手从心按至脐下，使血不致凝
滞，可频频唤醒，慎勿熟睡而恣情焉。三日之内，常以干漆
烧烟，及淬醋炭，令产妇常闻其气，庶无血晕昏迷之状。若未盈月，其于忧思喜怒，行住坐
卧，俱取适中，不宜太过，恣食生冷炙爆、粘硬难消之物。又，慎勿以稍健无虞，放心固意，
不避风寒，沐浴费力，当时未觉，蕴疾在后，诚为终身之患不浅矣。贤者鉴之。
产后胎衣不下的情况，确实令人担忧。这是因为恶血充满并胀大胎衣，阻塞了产道，必须紧急用药帮助排出，千万不可让粗鲁的妇女用手去抓取，这往往会导致损伤肝脏和胃腑，这一点又不可不谨慎。朱丹溪说：“产后应当以大补气血为主，即使有其他杂病，也暂且不去治疗。”这确实是万世不变的正确言论。
原本孕妇在怀孕期间用元气来滋养胎儿，身体本来就不算充实，再加上产后大量消耗气血，这是虚上加虚的情况，怎么能不大补呢！虽然如此，这是朱丹溪所说的常法。如果确实因为出现了变证，难道不应该通权达变地进行治疗吗？还是拘泥于常法只用补益的方法呢？《易经》说：“变化而裁制它，关键在于通达；神妙而明察它，关键在于人。”
然而，胎儿娩出后，长久积聚的污血必须全部排尽。如果未能排尽，腹部出现硬痛，可以使用滑涩汤、黑神散这类方剂，破除瘀滞并推动其下行，必须等到恶露完全驱除干净后，才能使用补剂。随后将胎衣洗涤去除污浊，加工制成丸药，我冒昧地将其命名为“还元丹”。这个方子产后服用，确实足以补益真元。不是通达造化奥秘的人，哪里能够懂得其中的道理！
我如果遇到因虚弱而感冒风寒的情况，可以在补剂中加入祛风药物。如果是伤食发热，也可以在补剂中加入消导药物。其余情况可以类推。生产结束后，应当先饮用童便，服用一丸返魂丹，不要立刻平躺卧倒，应该闭目倚靠坐着片刻，挺直膝盖，挺起胸膛，仰卧时让人用手从心口按至脐下，使血液不至于凝滞，可以频繁唤醒产妇，千万不要让她熟睡而放纵情欲。三天之内，经常燃烧干漆产生烟雾，以及将醋淬烧红的炭块，让产妇经常闻到这些气味，这样才不会有血晕昏迷的症状。如果未满一个月，对于忧愁思虑、喜怒情绪，行走站立、坐下躺卧，都要保持适中，不宜太过分，不要恣意食用生冷、炙烤爆裂、黏硬难消化的食物。另外，千万不要因为稍微感觉健康就没有顾虑，放松警惕，不注意躲避风寒，进行费力的沐浴，当时可能没有察觉，但隐患会留在日后，这确实会成为终身不小的祸患。贤明的人请以此为鉴。
In cases where the placenta fails to be expelled after childbirth, it is indeed a matter of grave concern. This is often due to lochia (stagnant blood) filling and distending the placenta, obstructing the birth canal. It is imperative to use medication to assist its expulsion; one must absolutely avoid having unskilled women attempt to extract it by hand, as this frequently results in damage to the Liver and Stomach. This aspect requires utmost caution. Zhu Danxi stated: "After childbirth, the primary treatment should be massive tonification of Qi and Blood. Even if other miscellaneous disorders are present, they should not be treated initially." This is indeed an unchanging principle for all generations.
Originally, during pregnancy, the mother's Yuan Qi (Original Qi) nourishes the fetus, so her constitution is not particularly robust. Furthermore, childbirth causes a massive depletion of Qi and Blood, resulting in a state of "deficiency upon deficiency." How can massive tonification not be necessary? However, this represents the standard approach described by Zhu Danxi. If specific pathological variations occur, is it not necessary to adapt the treatment accordingly? Or should one rigidly adhere to the standard method of tonification? The *I Ching* states: "Transformation and adaptation depend on flexibility; divine understanding depends on the individual."
Once the fetus is delivered, the accumulated foul blood must be completely discharged. If it is not fully expelled and abdominal hardness and pain occur, formulas such as Huase Tang (Slippery-Astringent Decoction) or Heishen San (Black Divine Powder) should be used to break up stasis and promote movement. Only after the lochia has been entirely cleared should tonifying agents be administered. Subsequently, the placenta is washed to remove impurities, processed into pills, and presumptuously named Huanyuan Dan (Return to Origin Pill). Taking this formula postpartum is truly sufficient to tonify the True Yuan. Those who do not comprehend the profound mysteries of creation cannot possibly understand this!
If I encounter wind-cold invasion due to postpartum deficiency, wind-dispelling herbs may be added to the tonifying base. If fever arises from food stagnation, digestive-promoting herbs may also be added to the tonifying base. Other scenarios can be inferred by analogy. After delivery, one should first drink infant urine (Tongbian), take one pill of Fanhun Dan (Soul-Returning Pill), and must not lie flat immediately. Instead, one should sit leaning back with eyes closed for a moment, keep the knees firm and chest expanded. While lying supine, someone should massage from the heart region down to below the navel to prevent blood stasis. The mother should be awakened frequently; she must not fall into deep sleep or indulge in sexual activity. Within three days, smoke from burning dry lacquer (Ganqi) and charcoal quenched with vinegar should be used regularly so that the puerpera inhales the aroma, thereby preventing syncope due to blood loss (Xueyun) and coma.
For the month following childbirth, emotions such as worry, thought, anger, and joy, as well as activities like walking, standing, sitting, and lying, should be kept moderate and excessive exertion avoided. One should not recklessly consume raw, cold, roasted, fried, sticky, hard, or indigestible foods. Furthermore, one must not let guard down simply because one feels slightly healthy, nor ignore protection against wind and cold, nor engage in strenuous bathing. Although symptoms may not appear immediately, latent diseases may develop later, potentially causing significant lifelong harm. Wise individuals should take this as a warning.