胞衣不出，有以气血疲弱，不能传送而停阁不出者。其证但见无力，而别无痛胀，治当
补气助血，宜速用决津煎，或滑胎煎、保生无忧散、《局方》黑神散之类主之。有以恶露流
入胞中，胀滞不出者。盖儿既脱，胞带必下坠，故胞在腹中，形如仰叶，仰则盛聚血水而胀
碍难出。惟老成稳婆多有识者，但以手指顶其胞底，以使血散，或以指摸上口，攀开一角，
使恶露倾泻，则腹空自落矣。又一法，以本妇头发，搅入喉中，使之作呕，则气升血散，胞
软亦自落矣。凡胎胞不出者多死，授以此法，甚效。若血渗胞中，停蓄既久，而为胀为痛，
或喘或急，则非逐血破血不可也，宜速用夺命丹，或用失笑散，以热酒调服，使血散胀消，
其衣自下。若气血兼虚者，亦惟决津煎为善。
一方∶用蓖麻子仁一两，研烂贴母右足心，衣下速洗去，缓则肠亦出。如肠不收，以此
膏涂脑顶，则肠自入。
一方∶用红花一两，酒煮浓汁服。
一法∶用产妇鞋底炙热，熨小腹上下，即出。
一方∶用皂角刺烧为末，每服一钱，温酒调服。
牛膝散（妇四九 胎衣不下，腹胀）
产时胎胞既下，气血俱去，忽尔眼黑头眩，神昏口噤，昏不知人，古人多云恶露乘虚上
攻，故致血晕，不知此证有二∶曰血晕，曰气脱也。若以气脱作血晕，而用辛香逐血化痰等
剂，则立刻毙矣，不可不慎也。
一、气脱证∶产时血既大行，则血去气亦去，多致昏晕不省，微虚者少顷即苏，大虚者
脱竭即死。但察其面白眼闭，口开手冷，六脉细微之甚，是即气脱证也。速用人参一二两，
急煎浓汤，徐徐灌之，但得下咽，即可救活；若少迟延，则无及矣。余尝救此数人，无不随
手而愈，此最要法也。又尝见有禁参而毙者，云新产后不可用参，用参则补住恶血，必致为
害，即劝之亦不肯用，直待毙而后悔者亦数人矣。又有云产后必过七日方可用参，此等愚昧
讹传，不知始自何人，误人不浅，万万不可信也。
一、血晕之证，本由气虚，所以一时昏晕，然血壅痰盛者亦或有之。如果形气脉气俱有
余，胸腹胀痛上冲，此血逆证也，宜失笑散。若痰盛气粗，宜二陈汤。如无胀痛气粗之类，
悉属气虚，宜大剂芎归汤、八珍汤之类主之。
一、猝时昏晕，药有未及，宜烧秤锤令赤，用器盛至床前，以醋沃之，或以醋涂口鼻，
令酸气入鼻，收神即醒。或以破旧漆器，或用干漆烧烟熏之，使鼻受其气皆可。但此法惟轻
而暴晕者所宜，若气虚之甚而昏厥者，非用大补之剂，终无益也。
胞衣（胎盘）未能排出，有的是因为气血疲弱，无法推动传送而导致停滞不出。其症状仅表现为无力，而没有其他疼痛胀满感，治疗应当补气助血，宜迅速使用决津煎，或者滑胎煎、保生无忧散、《局方》黑神散等方剂为主治之。有的是因为恶露流入胞宫之中，导致胀滞而排不出。因为胎儿既已娩出，胞带必然下坠，所以胞宫在腹中，形状像一片仰着的叶子，仰着就会盛聚血水而胀碍难以排出。只有经验丰富的稳婆多有知晓此理的，只需用手指顶住胞底，以使血水散开，或者用手指摸到上口，攀开一角，使恶露倾泻而出，则腹中空虚，胞衣自然脱落了。又一种方法，用产妇自己的头发，搅入喉中，使之作呕，则气机上升血水分散，胞宫变软也自然脱落了。凡是胎胞不出的大多死亡，传授这种方法，非常有效。如果血液渗入胞中，停蓄时间既久，从而造成胀和痛，或者气喘或者急促，那就非逐血破血不可了，宜迅速使用夺命丹，或者使用失笑散，用热酒调服，使血散胀消，其衣自然落下。如果是气血兼虚的，也只有决津煎为好。
一方：用蓖麻子仁一两，研烂贴敷于母亲右脚心，胞衣下来后迅速洗去，如果慢了肠也会脱出。如果肠不收纳，以此膏涂于头顶，则肠自然回纳。
一方：用红花一两，用酒煮成浓汁服用。
一法：用产妇鞋底炙烤至热，熨烫小腹上下，胞衣即出。
一方：用皂角刺烧成粉末，每次服用一钱，温酒调服。
牛膝散（妇人篇第四十九条 胎衣不下，腹胀）
生产时胎胞既然已经娩出，气血俱去，忽然眼前发黑头晕目眩，神志昏迷牙关紧闭，昏倒不知人事，古人多说是恶露乘虚上攻，所以导致血晕，不知道这个证候有两种：叫血晕，叫气脱。如果把气脱当作血晕，而使用辛香逐血化痰等药剂，那么立刻就会死亡，不可不谨慎啊。
一、气脱证：生产时血大量流出，则血去气亦随之而去，多导致昏晕不省人事，轻微虚弱的片刻即可苏醒，极度虚弱的脱竭即死。只要观察其面色白、眼闭、口开、手冷，六脉极其细微，这就是气脱证。迅速用人参一二两，急煎浓汤，慢慢灌服，只要能够咽下，就可以救活；如果稍微迟延，就来不及了。我曾经救治过几个人，没有不随手痊愈的，这是最重要的方法。又曾经见到有人因禁止用人参而死亡的，说新产后不可用人参，用人参则会补住恶血，必定导致危害，即使劝说也不肯用，直到死亡后才后悔的也有好几个人了。又有说产后必须过七天方可用人参，这种愚昧讹传，不知道始自何人，误人不浅，万万不可信啊。
一、血晕之证，本来由气虚引起，所以一时昏晕，然而血壅痰盛的也或许有这种情况。如果形体气息脉象都显得有余，胸腹胀痛上冲，这是血逆证，宜用失笑散。如果痰盛气粗，宜用二陈汤。如果没有胀痛气粗之类症状，都属于气虚，宜用大剂量的芎归汤、八珍汤等方剂主治。
一、突然昏晕，药物来不及服用，宜烧秤锤使其通红，用器皿盛放至床前，用醋浇在上面，或者用醋涂于口鼻，让酸气进入鼻腔，收摄精神即刻苏醒。或者用破旧漆器，或者用干漆烧烟熏之，让鼻子吸入其气味都可以。但是这种方法只适合轻症且暴发的晕厥者，如果是气虚甚重而昏厥的，不用大补的药剂，终究没有益处。
Placenta retention can occur due to Qi and Blood deficiency and weakness, failing to propel the placenta out, causing it to remain lodged. The symptoms manifest solely as a lack of strength, without other pain or distension. Treatment should tonify Qi and assist Blood; one should promptly employ Juejin Decoction (Decoction for Crossing the Ford), Huatai Decoction (Decoction for Facilitating Placental Delivery), Baosheng Wuyou San (Preserve Life and Ensure Safety Powder), or Heishen San (Black Divine Powder) from *Jufang* (*Taiping Huimin Heji Jufang*) as primary treatments. Alternatively, it may be caused by lochia flowing into the uterus, leading to distension and stagnation preventing expulsion. Since the fetus has been delivered, the umbilical cord must descend; thus, the uterus within the abdomen takes the shape of an inverted leaf. Being inverted, it collects blood and fluids, causing distension that hinders expulsion. Experienced midwives often recognize this; they simply use a finger to push against the fundus of the uterus to disperse the blood, or reach up to open a corner at the upper opening, allowing the lochia to drain. Once the abdomen is emptied, the placenta will naturally fall out. Another method involves using the parturient's own hair to tickle the throat, inducing vomiting. This causes Qi to ascend and blood to disperse, softening the uterus so the placenta falls out naturally. Cases of retained placenta are often fatal; employing these methods is highly effective. If blood seeps into the uterus and remains stagnant for a long time, causing distension and pain, or panting and urgency, then purging blood and breaking blood stasis is imperative. One should promptly use Duoming Dan (Life-Rescuing Pill) or Shixiao San (Forget Sorrow Powder), taken with hot wine, to disperse blood and reduce distension, after which the placenta will naturally pass. In cases of combined Qi and Blood deficiency, Juejin Decoction is also suitable.
One prescription: Use one liang of castor bean kernel (Ricini Semen), grind it into a paste, and apply it to the sole of the mother's right foot. Wash it off immediately after the placenta is delivered; if delayed, the intestine may prolapse. If the intestine does not retract, apply this paste to the vertex of the head, and the intestine will naturally return.
Another prescription: Use one liang of Carthamus flower (Carthami Flos), boil it in wine to make a concentrated decoction, and drink it.
One method: Heat a shoe sole worn by the parturient until hot, and moxa-like compress the lower abdomen above and below; the placenta will be expelled.
Another prescription: Burn thorns of Gleditsia sinensis (Gleditsiae Spina) into powder, take one qian each time, mixed with warm wine.
Niuxi San (Bull-knee Root Powder) [From Women's Section, Article 49: Retained Placenta, Abdominal Distension]
After delivery, when the placenta has been expelled, Qi and Blood are depleted. Suddenly, the patient experiences blackouts, dizziness, unconsciousness, clenched jaw, and loss of consciousness. Ancients often attributed this to lochia attacking upward due to deficiency, causing "Blood Syncope" (Xue Yun). However, this condition actually has two types: Blood Syncope and Qi Collapse. If Qi Collapse is mistaken for Blood Syncope and treated with acrid-aromatic formulas that drive out blood and resolve phlegm, death will ensue instantly; caution is essential.
First, Qi Collapse Syndrome: During childbirth, with massive blood loss, Qi follows the blood out, often leading to fainting and unconsciousness. Those mildly deficient may recover shortly; those severely deficient will die from exhaustion. Observe if the face is pale, eyes closed, mouth open, hands cold, and the six pulses are extremely fine and weak; this indicates Qi Collapse. Promptly use one to two liang of Ginseng root (Ren Shen), decoct it into a thick liquid, and administer slowly. As long as it is swallowed, life can be saved; any delay renders it futile. I have rescued several such patients, all recovering swiftly; this is the most crucial method. I have also seen cases where the use of Ginseng was prohibited, leading to death. They claimed that Ginseng should not be used postpartum as it would trap lochia, causing harm. Even when advised, they refused, only regretting it after death. Others claim Ginseng should only be used after seven days postpartum. Such ignorant rumors, whose origin is unknown, mislead people greatly and must not be believed.
Second, Blood Syncope Syndrome: Originally caused by Qi deficiency, leading to sudden fainting. However, cases with blood congestion and abundant phlegm do occur. If the physical constitution, Qi, and pulse appear excessive, with chest/abdominal distension/pain rushing upward, this is a Blood Rebellion syndrome; use Shixiao San. If phlegm is abundant and breathing is rough, use Erchen Tang (Two-Cured Decoction). If there are no symptoms of distension, pain, or rough breathing, it belongs to Qi deficiency; use large doses of Xionggui Tang (Cyperi and Angelicae Sinensis Decoction) or Bazhen Tang (Eight-Treasure Decoction).
Third, in cases of sudden fainting where medication cannot be administered immediately, heat a metal weight until red-hot, place it in a vessel near the bed, and pour vinegar over it, or apply vinegar to the nose and mouth. The sour aroma entering the nasal cavity will help restore consciousness. Alternatively, burn old lacquered vessels or dry lacquer to produce smoke and inhale it. However, this method is only suitable for mild and acute syncope. For severe Qi deficiency leading to coma, without major tonifying agents, there is ultimately no benefit.