《大全》曰∶儿产出，胞衣不落，谓之息胞。由初产时用力，儿出体已疲惫，不复能用力，产胞经停之间，
外冷乘之，则血道涩，故胞衣不出，急以药治之，庶不妨害于儿。所奈胞系连脐带，胞不下，即不得以时断脐
浴洗，冷气伤儿成病。旧法胞衣不出恐损儿，根据法截脐而已。
郭稽中曰∶胎衣不下者何？曰∶母生子讫，流血入衣中，衣为血所胀，故不得下。治稍缓，胀满腹中，上冲
心胸，疼痛喘急者难治。服夺命丹，逐去衣中之血，血散胀消，胞衣自下。牛膝汤亦效。
薛立斋曰∶胞衣不下有二，有因恶露入衣，胀而不能出；有因元气亏损，虚而不能出。恶露流入衣中者，腹
必胀痛，用夺命丹，或失笑散，以消瘀血，缓则不救。元气虚弱，不能送下者，腹中不胀痛，用保生无忧散，
以固元气。
《宝庆方》曰∶妇人百病，莫甚于生产。产科之难，临产莫重于催生。既产莫甚于胞衣不下，唯有花蕊石散
一药，最为紧要。更有一法，产讫胞衣不下，停久，非特产母疲倦，又血流胞中，必致危笃。宜急断脐带，以
物系坠，使血不潮入胞中，则胞衣自萎缩而
下。只要产母安心，以物系坠之时，宜用心先系，然后截断，不尔，胞上掩心而死，慎之。
慎斋按∶以上四条，序产后有胞衣不下之证也。胞衣不下，有冷乘血凝，有血流衣胀，有元气虚脱三证，
当分因用药急治。如冬天严寒，风冷乘虚而入，胞冷血凝而不下，则当用夺命丹、牛膝散、桂附热药以下之。如
血入胞衣胀满，恶露不下，则当用失笑散、花蕊石散，逐血消瘀药以下之。若元气弱，气血亏损不能下，则当
用无忧散、生化汤以温补之。寒热虚实之际，不可不详审施治也。
《大全》说：婴儿出生后，胞衣不脱落，称为“息胞”。这是因为在分娩时用力过度，婴儿出生时身体已经疲惫，不再能用力，在产程停顿的间隙，外来的寒气侵袭，导致血道涩滞，所以胞衣排不出来。此时应紧急用药治疗，以免对婴儿造成危害。无奈的是，胞系连接着脐带，胞衣不下，就不能及时剪断脐带并给婴儿洗澡清洗，冷气会伤害婴儿使其生病。旧的方法是，因为担心胞衣不出损伤婴儿，就按照这种方法截断脐带而已。
郭稽中说：胎衣不下的原因是什么？回答说：母亲生下孩子后，血液流入胎衣中，胎衣被血液胀满，所以不能排出。如果治疗稍微迟缓，胀气充满腹部，向上冲撞心胸，出现疼痛、气喘急促的症状，就很难治疗。服用夺命丹，驱逐胎衣中的瘀血，血液消散、胀满消除，胞衣自然排出。牛膝汤也有效。
薛立斋说：胞衣不下有两种情况，一种是因恶露进入胎衣，胀满而不能排出；另一种是因元气亏损，虚弱而不能排出。恶露流入胎衣中的，腹部必然胀痛，使用夺命丹或失笑散（一种活血化瘀止痛的方剂），以消除瘀血，如果拖延则无法挽救。如果是元气虚弱，无力推动胞衣下行的，腹部不胀痛，使用保生无忧散（一种补气安胎顺产的方剂），以巩固元气。
《宝庆方》说：妇女的各种疾病，没有比生产更严重的了。产科的困难，临产时没有比催生更重要的。既然已经生产，没有比胞衣不下更危急的，只有花蕊石散这一种药，最为紧要。另外还有一种方法，产后胞衣不下，停留时间过长，不仅使产妇疲倦，而且血液流入胞中，必定导致危重局面。应当紧急剪断脐带，用物体悬挂牵引，使血液不逆流进入胞中，那么胞衣自然会萎缩而下。只要产妇安心，在用物体悬挂牵引的时候，应该用心先系好，然后再截断，否则，胞衣上掩心脏会导致死亡，务必谨慎。
慎斋按语：以上四条，叙述了产后有胞衣不下的证候。胞衣不下，有寒气侵袭导致血液凝滞、有血液流入胎衣导致胀满、有元气虚脱三种证型，应当根据病因用药紧急治疗。如冬天严寒，风寒乘虚而入，胞宫寒冷血液凝滞而不下，则应当使用夺命丹、牛膝散、桂枝附子等热性药物来促使下行。如血液进入胞衣导致胀满，恶露不下，则应当使用失笑散、花蕊石散，通过逐血消瘀的药物来促使下行。若元气弱，气血亏损不能下行，则应当使用无忧散、生化汤（一种产后调理方剂）来温补。寒热虚实之间，不可不详细审察施治。
The *Daquan* states: After the infant is born, if the placenta (fetal membrane) does not descend, it is called "Xi Bao" (Stagnant Placenta). This occurs because excessive exertion during labor leaves the mother exhausted after delivery, unable to continue pushing. During the pause in the birth process, external cold pathogens invade, causing blood vessels to become obstructed and sluggish, thus preventing the placenta from descending. Medication should be administered urgently to prevent harm to the infant. However, since the umbilical cord is connected to the placenta, if the placenta does not descend, the cord cannot be cut and the infant bathed in a timely manner; cold air may injure the infant and cause illness. The old method was simply to cut the umbilical cord, fearing that retaining the placenta might harm the child.
Guo Jizhong asked: What is the cause of retained placenta? He answered: After the mother gives birth, blood flows into the placenta, distending it with blood, which prevents its descent. If treatment is delayed, distension fills the abdomen, rushing upward to strike the chest and heart, causing pain and rapid breathing; this condition is difficult to treat. Administer *Duoming Dan* (Life-Rescuing Pill) to expel the blood within the placenta. Once the blood disperses and distension subsides, the placenta will naturally descend. *Niuxi Tang* (Achyranthes Root Decoction) is also effective.
Xue Lizhai stated: There are two types of retained placenta. One type is caused by lochia entering the placenta, leading to distension and inability to descend; the other is due to deficiency of Yuan Qi (Primary Qi), resulting in weakness and inability to descend. In cases where lochia flows into the placenta, the abdomen will necessarily be painful and distended. Use *Duoming Dan* or *Shixiao San* (Pleasure-Losing Powder, a formula for resolving blood stasis) to eliminate blood stasis; if delayed, rescue is impossible. In cases of weak Yuan Qi lacking the power to push the placenta down, the abdomen will not be painful or distended. Use *Baosheng Wuyou San* (Safety and Peaceful Delivery Powder, a formula to secure primary qi) to consolidate Yuan Qi.
The *Baoqing Fang* states: Among women's diseases, none is more severe than childbirth. In obstetrics, nothing is more critical at the time of delivery than promoting labor. After delivery, nothing is more dangerous than retained placenta. Only *Huarius Shi San* (Arsenolite Powder) is most crucial. Additionally, there is another method: if the placenta fails to descend after delivery and remains for a long time, it not only exhausts the mother but also causes blood to flow into the uterus, leading to a critical state. One must urgently cut the umbilical cord and suspend it with an object to prevent blood from flooding into the placenta, allowing the placenta to shrink and descend naturally. The mother must remain calm. When suspending the cord, one must carefully tie it first before cutting it off. Otherwise, the placenta rising upward to compress the heart may cause death. Exercise extreme caution.
Shen Zhai commented: The above four passages describe the syndrome of retained placenta postpartum. Retained placenta presents in three forms: cold invasion causing blood coagulation, blood entering the placenta causing distension, and collapse of Yuan Qi. Treatment must be urgent and tailored to the etiology. In winter, when severe cold and wind enter through deficiency, causing uterine coldness and blood coagulation preventing descent, use *Duoming Dan*, *Niuxi San*, or hot herbs such as *Guizhi* (Cinnamon Twig) and *Fuzi* (Prepared Aconite Root) to promote descent. If blood enters the placenta causing distension and lochia stagnation, use *Shixiao San* or *Huarius Shi San*, employing blood-expelling and stasis-resolving herbs to promote descent. If Yuan Qi is weak and Qi and Blood deficiency prevent descent, use *Wuyou San* or *Shenghua Tang* (Transforming Stasis Decoction) to warm and tonify. One must carefully examine the patterns of cold, heat, excess, and deficiency before administering treatment.