Library

After a woman's Tian Gui (menstrual blood) has arrived, Yin blood is often deficient. In the treatment of smallpox, Qi is primary and Blood is secondary. Once there is any deficiency, complications may arise. For instance, if fever occurs simultaneously with the onset of menstruation, this indicates that heat is resolving through the Blood level, and the rash will naturally erupt; this is the most auspicious sign. If the fever persists for four to five days without stopping, the heat enters the Blood Chamber (uterus), causing the Blood to move recklessly internally; this is a syndrome of Middle Jiao deficiency. At this time, Xiao Chai Hu Tang (Minor Bupleurum Decoction) should be administered with added Xiong Guizhi (Ligusticum Chuanxiong Rhizome) and Dang Gui (Angelica Sinensis). If it is not the time for menstruation, but the period suddenly arrives during fever, this indicates that toxic fire is blazing internally, forcing the Blood to flow recklessly. There will likely be numerous eruptions with severe toxicity. Urgently administer Xi Jiao Di Huang Tang (Rhino Horn and Rehmannia Decoction) with added Zi Cao (Arnebiae Radix seu Lithospermi Radix), Chan Tui (Cicada Slough), Niu Bang Zi (Arctii Fructus), and Lian Qiao (Forsythiae Fructus) to clear heat and resolve toxicity, allowing the rash to erupt while menstruation stops, thus avoiding complications. Delaying treatment will lead to internal deficiency and sunken lesions.

Furthermore, if during the stage of eruption and pustule formation, menstruation coincides and lasts for three to four days without stopping, it will be difficult for the lesions to erupt and fill with pus. The lesions may appear flat, grayish, or black and sunken. Urgently use Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) with added Shu Fu Zi (Prepared Aconite Root) to promote eruption and pustule filling. The appearance of supplementary eruptions is considered auspicious. If chills, teeth grinding, wheezing, and chest fullness occur, this indicates internal collapse of Yang Qi and is incurable.

Again, if during the eruption and pustule formation stage, menstruation happens coincidentally, or if aphonia (loss of voice) occurs, this is due to blood loss leading to Heart Qi deficiency, preventing nourishment from reaching the tongue. Initially administer Bao Yuan Tang (Protect the Origin Decoction) with added Dang Gui (Angelica Sinensis), Di Huang (Rehmanniae Radix), Mai Dong (Ophiopogonis Radix), Fu Shen (Poria with Hostwood), and Suan Zao Ren (Ziziphus Spinosae Semen). Wait until speech returns, then administer Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) mixed with Pig Heart Blood.

If menstruation is continuous and prolonged, coinciding with smallpox eruption, accompanied by fever, coma, delirious speech, picking at clothes, grasping at empty air, resembling possession, this is because the Blood Chamber is empty after menstruation, allowing pathogenic heat to invade the Chong Mai (Penetrating Vessel) due to deficiency. Use Si Wu Tang (Four Substances Decoction) combined with Dao Chi San (Direct Outward the Yellow Powder) with added Mai Dong (Ophiopogonis Radix).

If metrorrhagia and metrostaxis (profuse uterine bleeding) persist, followed by smallpox eruption after both Qi and Blood are severely deficient, this condition is likely beyond treatment capacity. Even with Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction), rescue is rarely possible.

If amenorrhea has been present for a long time, indicating dryness of the Sea of Blood, coinciding with smallpox eruption, toxic qi stagnates between the Chong and Ren Mai (Conception Vessel). Syndromes of the Two Yang meridians occur concurrently. Attack methods would cause uncontrollable bleeding; instead, Gui Pi Tang (Restore the Spleen Decoction) should be used to regulate the Heart and Spleen, allowing the toxin to vent, which might offer a chance of survival.

Regarding pregnant women contracting smallpox, this is most concerning. Regardless of severity, the primary focus must be on calming the fetus. For restless fetus, use Si Wu Tang (Four Substances Decoction) with added Ren Shen (Ginseng Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), and Sha Ren (Amomi Fructus). If heat signs are present, Huang Qin (Scutellariae Radix) should be used, but it must be stir-fried with wine. Once the fetus is calm and the rash erupts densely, use Shen Nei Tuo San (Ginseng Internal Support Powder) with added Zi Cao (Arnebiae Radix seu Lithospermi Radix), Dang Gui (Angelica Sinensis), and Bai Shao (Paeoniae Radix Alba).

If delivery occurs suddenly during the eruption and pustule formation stage, resulting in severe Qi and Blood deficiency, use Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) with doubled Ren Shen (Ginseng Radix) and added Shu Fu Zi (Prepared Aconite Root) to tonify Qi and Blood. In severe cases, use a large dose of Bao Yuan Tang (Protect the Origin Decoction) with added E Jiao (Colla Corii Asini), Ai Ye (Artemisiae Argyi Folium), Sheng Jiang (Zingiberis Rhizoma Recens), and Fu Zi (Aconiti Lateralis Radix Praeparata), administered continuously. If lower abdominal urgency and pain indicate incomplete expulsion of lochia stasis, add Rou Gui (Cinnamomi Cortex). After fetal delivery, if there is no stasis but pressing the abdomen causes acute pain, this indicates stasis accumulated in the lower abdomen; add Pao Shan Zha (Crataegi Fructus Preparata). Decoct the medicine using Fu Long Gan (Caulis Fictoratis Uterus) decoction as water. Before administration, add half liang of charred brown sugar for optimal effect.

If teeth grinding, chills, abdominal pain, thirst, cold limbs, and body heat occur, this indicates internal deficiency of the Spleen and Stomach manifesting as false heat externally. Use Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) with added Shu Fu Zi (Prepared Aconite Root). Cessation of symptoms after administration is auspicious; persistence is ominous.

If smallpox erupts between ten days and half a month postpartum, this represents newly depleted Qi and Blood, requiring major tonification of Qi and Blood. Generally speaking, smallpox occurring after marriage for men and women differs from childhood cases: the pustules typically do not stand high, their shape is often large and flat/broad, and their color is pale rather than yellow. One cannot rigidly apply the principle that children's primordial Qi has not yet been released.