薛立斋治一产妇，胞衣不下，胸腹胀痛，手不敢近，用滚酒下失笑散一剂，恶露胞衣并下。
一产妇胞衣不下，腹作痛，手按痛稍减，此气虚而不能送出户也，用无忧散而下。前症常询诸稳婆云∶宜
服益母草丸，或就以产妇头发入口作呕，胎衣自出。其胎衣不下者，必死，授与前法，甚效。
吕东庄治陈氏妇，半产，胎衣不下，连服行血催衣之药四剂，点血不行，胸痛瞀乱。吕视之曰∶此脾失职
也。先与黄 一两，下咽而瞀乱顿减。时有以《准绳》女科中恶露不下及胞衣不下方书一本进者，上注某方经
验，某方试效，以示曰∶中有可用否？曰∶一无可用。遂用大剂人参、白术、白芍、黄 、归身、茯苓、甘草
等药，一服而恶露渐至。皆惊叹曰∶古方数十，无一可用，《准绳》一书，真可废也。吕曰∶恶，是何言也！
王损庵，医之海岱也，读书者，自不察耳。若惟以恶阻（恶阻二字，岂可用耶。）及胞衣不下条中，求合吾方，宜其谬也。
试以血崩及下血条中求之，吾方可见矣。盖此病本气血太亏，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，是愈虚也。吾正忧血之不不止，其不合又何怪焉？曰∶今从子法，可得
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，
使不致荡没耳。至第三日，诊尺内动甚，曰∶今夜子时以前，必崩矣。因留方，戒之曰∶血至即服。至黄昏果
发，如言得无恙。方即补中益气加参、 各二两也。次用调补脾肾之药而愈。（胞衣二字，却不重醒。）
俞东扶曰∶恶露不下，用参、术、归、附等药而下者，生平经手颇多。然必脉象细 ，口不燥渴，内不
烦热，方为合治。此案不言脉象，但曰脾失其职，谅此妇平昔怯弱，以致胎坠。且连服行血催衣药四帖，
宁不反其道以治之耶？
薛立斋治一妇人，产后面赤，五心烦热，败血入胞，胞衣不下，有冷汗。思但去其败血，其衣自下，遂用
黑豆二合炒透，然后烧红铁称锤，同豆淬酒，将豆淋酒化下益母二丸，胞衣从血而出，余症尽平。
陈良甫云∶有人亲戚妇人，产后胞衣不下，血胀迷闷，不记人事。告之曰∶死矣。仆曰∶某收得赵大观文
局中真花蕊石散，在笥中，漫以一帖赠之，以童便灌之，药下即苏，胞衣与恶物旋即随下，遂无恙。（《良方》。）
魏玉横曰∶施介繁室人，年三十余，忽有孕，又挛生，产后颇健，能食鸡啖饭。数日来，渐发热胀满。诊
之，脉浮按滑疾，沉按结涩。询至恶露已一日不行，谓为瘀也，宜通之乃可。与生地、牛膝、益母、红花、桃
仁泥、当归尾、丹参、瓦楞子，畏不敢服。延专科曰∶此年过壮，而初产育，气血俱伤，属虚也。与焦术、炮
姜、归、芍、茯神、枣仁等一剂，热益甚，再剂，遂谵语。更一专科，其说同，其药仿，又二剂，日夜不眠，
昏狂不省人事，时忽高声歌唱，与伤寒阳明失下无异。再延诊，曰∶产数日，恶露即停，虽执途人而语之，亦
必知为瘀滞。若欲其生，亟进前方可耳。不得已，乃服。黄昏进药，至夜分，恶露行。黎明，复下一物，已焦
黑，乃胞衣也。盖产时稳婆只收其一，谓二人同胞，不知其一犹在腹也，遂贻患乃尔。胞衣去，恶血行，其病
如失。然予初亦不知其为胞未下也，医诚难哉。（雄按∶挛生之胞，有分有合，稳婆须有识见，庶不贻误。）
薛立斋治疗一位产妇，胎盘滞留不下，胸腹部胀满疼痛，手不敢触碰。他用滚酒送服失笑散一剂，恶露和胎盘随即一起排出。
另一位产妇胎盘滞留不下，腹部疼痛，用手按压后疼痛稍减。这是气虚无力将胎盘推出所致，使用无忧散使胎盘排出。对于前一种症状，常听接生婆说：适宜服用益母草丸，或者让产妇入口头发以引发呕吐，胎盘自然就会排出。如果胎盘滞留不下，产妇必死无疑。传授上述方法，效果很好。
吕东庄治疗陈氏妇人，发生半产（流产），胎盘滞留不下，连续服用四剂活血催排胎盘的药，点滴恶露不行，出现胸痛、神志昏乱。吕东庄诊视后说：“这是脾脏失职。”先给予黄芪一两，药下咽后神志昏乱立刻减轻。当时有人拿着一本《准绳》女科中关于恶露不下及胎盘不下的方书进献，书上标注某方经验有效，某方试用见效，以此询问吕东庄：“其中是否有可用的？”吕东庄说：“完全没有可用的。”于是使用大剂量人参、白术、白芍、黄芪、当归身、茯苓、甘草等药物，服用一剂后恶露逐渐到来。大家都惊叹道：“古方数十种，没有一种可用，《准绳》这本书，真可以废弃了。”吕东庄说：“唉，这是什么话！王损庵是海岱地区的名医，读书人自己不加考察罢了。如果只在‘恶阻’（注：此处指妊娠反应或相关病症，非现代医学之恶阻）及‘胎盘不下’条文中寻找符合我方理论的，自然会谬误。试着在‘血崩’及‘下血’条文中寻找，我的方子就可见效了。因为此病本是气血极度亏损，导致半产。脾脏失去统摄血液的职能，如同水淹没土崩，冲决之势将至，所以产生神志昏乱。不加以修补加固，反而加以穿凿破坏，这是更加虚弱。我正担忧血止不住，它不合拍又有什么奇怪呢？”那人问：“现在听从您的方法，可以避免吗？”吕东庄说：“不能避免。穿凿过度，所决之水已经离开故道，狂澜壅积，势头无处归依，所以必然会发生血崩。急服我的药，只能加固堤防，使其不至于彻底荡涤淹没而已。”到了第三天，诊察尺脉跳动剧烈，说：“今晚子时以前，必然发生血崩。”于是留下处方，告诫她说：“血下来立即服用。”到了黄昏果然发作，按照预言得以安然无恙。处方即是补中益气汤加人参、黄芪各二两。随后使用调补脾肾的药物而痊愈。（注：此处未再次强调胎盘二字。）
俞东扶说：恶露不下，使用人参、白术、当归、附子等药物而使恶露排出的案例，我生平经手的很多。但必须脉象细弱，口不干燥口渴，体内不烦热，才符合治疗原则。此案未提及脉象，只说脾脏失职，推测这位妇女平素怯弱，以致胎坠。况且连续服用四帖活血催排胎盘的药，岂不是背道而驰地治疗了吗？
薛立斋治疗一位妇人，产后面色红赤，五心烦热，败血进入胞宫，胎盘滞留不下，伴有冷汗。思考认为只要去除败血，胎盘自然就会排出，于是用黑豆二合炒透，然后将烧红的铁秤锤投入豆中淬酒，用这种豆淋酒化开益母丸服用，胎盘随血而出，其余症状全部平息。
陈良甫说：有人的亲戚妇人，产后胎盘滞留不下，因血胀而迷闷，不记得人事。告知他说：“已死。”仆人回答说：“我收藏有赵大观文局中的真花蕊石散，在箱箧中，随便取一帖赠送给她，用童子尿灌服，药一下肚即苏醒，胎盘与污物随即随之排出，于是安然无恙。（出自《良方》。）”
魏玉横说：施介繁的妻子，三十多岁，忽然怀孕，又是双胎，产后颇为健壮，能吃鸡肉米饭。几天来，逐渐发热胀满。诊察发现，浮取脉滑疾，沉取脉结涩。询问得知恶露已一天未行，认为是瘀血，应当通利才行。给予生地、牛膝、益母草、红花、桃仁泥、当归尾、丹参、瓦楞子，患者畏惧不敢服用。延请专科医生诊治，医生说：“此人年过壮岁，且为初次生产，气血俱伤，属于虚证。”给予焦白术、炮姜、当归、白芍、茯神、枣仁等一剂，热势更甚，再服一剂，便出现谵语。又延请一位专科医生，说法相同，用药仿照前例，又服两剂，日夜不眠，昏狂不省人事，有时突然高声歌唱，这与伤寒阳明病失于攻下无异。再次延请诊视，医生说：“生产数日，恶露即停止，即使是路人告诉他也必定知道是瘀滞。若想让她活命，亟需进服前面的方子才行。”不得已，于是服用。黄昏进药，到半夜，恶露通行。黎明时分，又排下一物，已经焦黑，那就是胎盘。原来生产时接生婆只取出一个，以为两人是同胞，不知其中一个还在腹中，于是酿成如此祸患。胎盘排出，恶血运行，疾病如失。然而我起初也不知道是胎盘未下，医道确实难啊！（雄按：双胎的胎盘，有分有合，接生婆必须有见识，才不会贻误病情。）
Xue Lizhai treated a postpartum woman with retained placenta, accompanied by distension and pain in the chest and abdomen, such that she dared not let anyone touch the area. He administered one dose of Shixiao San (Pain-Relieving Powder) taken down with boiling wine, after which both the lochia and the placenta were expelled together.
In another case, a postpartum woman had a retained placenta and abdominal pain; the pain was slightly relieved upon pressure. This was due to Qi deficiency failing to expel the placenta. She was treated with Wuyou San (Worry-Free Powder), which resulted in the expulsion of the placenta. Regarding the former condition, midwives often advised taking Yimucao Wan (Motherwort Pill) or inducing vomiting by placing the mother's hair in her mouth, which would cause the placenta to be expelled naturally. If the placenta remains retained, death is inevitable. The aforementioned methods are effective.
Lv Dongzhuang treated Mrs. Chen, who suffered from a miscarriage with retained placenta. After taking four doses of blood-invigorating and placenta-expelling medicines without any lochia flowing, she developed chest pain and mental confusion. Lv examined her and stated, "This is a failure of the Spleen's function." He first prescribed Huangqi (Astragali Radix) in an amount of one liang. Upon swallowing the medicine, the mental confusion subsided immediately. At that time, someone presented a book on gynecology from *Zhunsheng* (Standard Rules) containing formulas for retained lochia and retained placenta, annotated with notes on their efficacy, and asked, "Are there any usable formulas here?" Lv replied, "None are usable." He then prescribed a large dose of Ren Shen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Baishao (Paeoniae Radix Alba), Huangqi (Astragali Radix), Danggui Shen (Angelicae Sinensis Radix), Fuling (Poria), and Gancao (Glycyrrhizae Radix et Rhizoma). After one dose, the lochia gradually began to flow. Everyone marveled, saying, "Among dozens of ancient formulas, none were usable; *Zhunsheng* can truly be discarded." Lv said, "Alas, what words are these! Wang Sun'an is a renowned physician in the Haidai region; it is merely that scholars fail to investigate properly. If one only seeks formulas in the sections on 'Ezu' (pregnancy-related disorders) and 'retained placenta' that match my approach, error is inevitable. Try looking in the sections on 'uterine bleeding' and 'lower bleeding'; my formulas will be found applicable. This disease originates from severe depletion of Qi and Blood, leading to miscarriage. The Spleen loses its function of controlling blood. Like water flooding and soil collapsing, a breach is imminent, causing mental confusion. Instead of reinforcing and repairing, we add destructive measures, further weakening the patient. I am worried about uncontrollable bleeding; how strange is it that my approach does not fit?" The person asked, "Can we avoid disaster by following your method?" Lv replied, "It cannot be avoided. Excessive intervention has caused the waters to break their banks; the turbulent waves are accumulated with no outlet, so uterine bleeding is certain. Urgently taking my medicine can only reinforce the dike to prevent total collapse." On the third day, he palpated the Chi pulse (Kidney pulse) as very active and said, "Uterine bleeding will occur before midnight tonight." He left a prescription and warned her, "Take it immediately when the bleeding starts." At dusk, the bleeding indeed started, and she survived as predicted. The prescription was Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with added Ren Shen (Ginseng Radix) and Huangqi (Astragali Radix), each two liang. Subsequently, she recovered using spleen- and kidney-tonifying medicines. (Note: The term 'placenta' is not emphasized again.)
Yu Dongfu stated: In cases of retained lochia, I have frequently used Ren Shen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Danggui (Angelicae Sinensis Radix), and Fuzi (Aconiti Lateralis Radix Praeparata) to facilitate expulsion. However, this is only appropriate if the pulse is fine and weak, the mouth is not dry or thirsty, and there is no internal irritability or heat. This case did not mention the pulse, only stating Spleen dysfunction. It is likely that the woman was constitutionally weak, leading to fetal descent. Moreover, administering four doses of blood-invigorating and placenta-expelling medicines is contrary to the correct treatment principle.
Xue Lizhai treated a woman who, after delivery, presented with a red face, five-palm heat, retained placenta due to retained blood entering the uterus, and cold sweats. He reasoned that removing the retained blood would allow the placenta to fall naturally. He used Erdou (Black Soybean) two he measured units, stir-fried thoroughly, then quenched them with wine using a red-hot iron scale weight. The resulting Doulin Jiu (Soybean Drip Wine) was used to dissolve Yi Mu Wan (Motherwort Pill). The placenta was expelled with the blood, and all other symptoms resolved.
Chen Liangfu said: A relative of mine, a woman, had a retained placenta after delivery, suffering from fainting and unconsciousness due to blood distension. I told her servant, "She is dead." The servant replied, "I possess genuine Huarui Shi San (Flower-Stone Powder) from Zhao Daguan's bureau, stored in my box. I gave him one packet, and he administered it with child's urine. The patient revived immediately, and the placenta and foul matter were expelled subsequently, leaving her safe." (From *Liangfang*).
Wei Yuheng said: The wife of Shi Jianfan, over thirty years old, suddenly became pregnant with twins. Postpartum, she was robust and could eat chicken and rice. For several days, she gradually developed fever and distension. Her pulse was floating, slippery, and rapid on light pressure, but knotted and choppy on deep pressure. Inquiry revealed that lochia had ceased for one day. I diagnosed stasis and recommended promoting circulation. I prescribed Shengdi (Rehmanniae Radix), Niuxi (Achyranthis Bidentatae Radix), Yimucao (Leonuri Herba), Honghua (Carthami Flos), Taoren (Persicae Semen), Danggui Wei (Angelicae Sinensis Radix), Danshen (Salviae Miltiorrhizae Radix et Rhizoma), and Walengzi (Arcae Shell). She feared to take them. A specialist doctor was consulted, who stated, "She is past her prime and giving birth for the first time; Qi and Blood are injured, indicating deficiency." He prescribed Jiaozhu (Charred Atractylodis Rhizoma), Paojiang (Prepared Zingiberis Rhizoma), Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Fushen (Poria with Hostwood), and Zaoren (Ziziphi Spinosae Semen). After one dose, the fever worsened; after a second dose, delirium ensued. Another specialist was consulted, offering similar advice and medication. After two more doses, she suffered from insomnia day and night, became comatose and manic, occasionally singing loudly. This resembled Yangming syndrome in Cold Damage where purgatives were neglected. Upon re-examination, I said, "Lochia stopped days after delivery; even a passerby would know this is stasis. If you wish her to live, you must urgently administer the previous formula." Reluctantly, she took it. After evening administration, lochia flowed at midnight. At dawn, a blackened object was expelled—the retained placenta. The midwife had only removed one placenta, assuming they were identical, unaware that one remained in the abdomen, causing this complication. Once the placenta was out and the blood moved, the illness vanished. However, I initially did not realize the placenta was retained. Medicine is indeed difficult! (Xiong's Note: Twin placentas may be separate or fused; midwives must have insight to avoid errors.)