FWIW, I've used the practice of defining a "clinic state" macro for getting the module state in generated clinic code. It has proven useful if you want to tweak stuff afterwards (smaller diffs, less churn). You can git grep clinic_state **/*.c for inspiration.

IIUC, *_impl() should be passed a module state if the AC gets it in advance with some overhead. Also, _ctypes would need a module state getter to be specified in each function clinic input, making a class input have a type name without any operator, EDIT: or making the getter return st.

Ah, _PyType_GetModuleState(cls) or _PyType_GetModuleState(cls->tp_base) can be applied to each class. I'll try.