女人天癸既至。阴常不足。痘疮以气为主。血为辅。一有不足。则变易生。如发热之时。正遇经
来。此热从血解。疮自发出。最为吉兆。若四五日不止。则热入血室。血必妄内联动。中虚之证
也。小柴胡加芎、归。若非经行之期。于发热时而经忽至者。此毒火内炽。逼血妄行。必疮多毒
盛。急以犀角地黄汤加紫草、蝉蜕、牛蒡、连翘。使热清毒解。痘出经止。方无变患。迟则内虚
疮陷矣。又如起发灌浆之时。适遇经行。三四日不止。必难起发灌浆。或平塌。或灰色。或黑陷
。急用十全大补汤加熟附。使起发灌浆。或出赠痘为吉。若寒颤切牙喘满者为内脱。不治。又如
起发灌浆之时。经水适来。或口喑不能语者。乃血去心虚。不能上荣于舌。先与保元汤加归、地、
门冬、茯神、枣仁。待其能言。后以十全大补汤加猪心血调服。又经不断之时。适逢出痘。发热
神昏。言语狂妄。循衣撮空。如祟状者。此经后血室空虚。邪热乘虚而犯冲脉也。四物汤合导赤散
加麦冬。又如崩漏不止。气血俱虚之后出痘。此必不能胜任。虽十全大补。多不可救。又如向来经
闭不通。血海干涸。适逢出痘。毒瓦斯怫郁冲任之间。二阳之证并发。攻之则妄行不止。宜归脾汤
调其心脾。使毒得发泄。庶或可救。至如孕妇出痘。最为可虑。不问轻重。悉以安胎为主。胎动不
安者。四物汤加参、术、砂仁。有热证当用黄芩。必须酒炒。胎安痘出稠密。参 内托散加紫草
、归、芍。至如痘疮正在起发灌浆时。忽遇分娩。气血俱虚。十全大补倍参、 加熟附子。以补
气血。甚则大剂保元汤。更加胶、艾、姜、附。续续灌之。若小腹急痛。瘀血未尽。须加肉桂。
胎下之后。绝无瘀血。按之急痛者。此必瘀积小腹。加炮黑山楂。以伏龙肝煎汤代水煎药。临服
再加熬枯黑糖半两最妙。若切牙寒颤。腹痛作渴。手足冷身热者。此脾胃内虚。而显假热于外也
。十全大补汤加熟附。服后止者吉。不止者凶。如产后半月十日之间。适遇出痘。此气血新虚。
必以大补气血为主。大抵男妇婚嫁之后出痘。其顶必不能高
耸。其形多大而扁阔。其色多淡而不黄。不可拘小儿元气未发泄之例也。
妇女的天癸（指月经）已经来潮，阴血通常处于不足的状态。痘疮的发病以气为主，血为辅。一旦气血有所不足，就会发生病变。例如在发热的时候，正好遇到月经来潮，此时热邪可以从血液中得以解除，痘疮自然发出，这是最为吉祥的征兆。如果发热持续四五日不止，热邪就会陷入血室，血液必然妄动内扰，这是中气虚弱的证候。治疗用小柴胡汤加川芎、当归。如果不是行经期间，在发热时月经突然来潮的，这是毒火在内炽盛，逼迫血液妄行，必定痘多且毒盛，急需使用犀角地黄汤加紫草、蝉蜕、牛蒡子、连翘，使热清毒解，痘出而经止，这样才不会产生变证。拖延则会导致内虚痘陷。
又如在痘疮起发灌浆的时候，适逢月经来潮，三四日不止，痘疮必定难以起发灌浆，或者平塌，或者呈灰色，或者黑陷。急需使用十全大补汤加熟附子，以使痘疮起发灌浆，或者出现赠痘（额外发出的痘）为吉兆。如果出现寒战、咬牙、气喘胸满的症状，这是正气内脱，无法救治。又如起发灌浆时，月经恰好来潮，或者出现失音不能说话的，这是因失血导致心气虚弱，不能上荣于舌。先给予保元汤加当归、地黄、麦冬、茯神、酸枣仁，等到患者能说话后，再用十全大补汤加猪心血调服。
又在月经淋漓不断的时候，适逢出痘，出现发热、神志昏迷、言语狂妄、手摸衣被、抓空动作，像被鬼祟附身一样的症状，这是月经后血室空虚，邪热乘虚侵犯冲脉所致。用四物汤合导赤散加麦冬。又如崩漏（非经期大量出血或淋漓不尽）不止，气血俱虚之后才出痘，这必定身体无法承受，即使使用十全大补汤，大多也不可救药。
又如向来月经闭止不通，血海干涸，适逢出痘，毒气郁结在冲任二脉之间，阳明经的病证并发。攻伐则会导致出血不止，宜用归脾汤调理心脾，使毒气得发泄，或许可以挽救。至于孕妇出痘，最为令人担忧，不论轻重，都以安胎为主。胎动不安者，用四物汤加人参、白术、砂仁；有热证应当用黄芩，必须酒炒。胎安痘出稠密者，用参内托散加紫草、当归、芍药。
至于痘疮正在起发灌浆时，忽然遇到分娩，气血俱虚，用十全大补汤倍用人参、黄芪，加熟附子，以补益气血。严重时用大剂量的保元汤，再加阿胶、艾叶、生姜、附子，连续灌服。如果小腹急痛，瘀血未尽，须加肉桂。胎儿娩出后，绝无瘀血，但按压腹部却急痛的，这是瘀积在小腹，加炮制过的黑山楂，用伏龙肝（灶心土）煎汤代替水来煎药。临服用时再加熬成枯黑色的糖半两最好。如果出现咬牙、寒战、腹痛作渴、手足冷而身热的症状，这是脾胃内部虚弱，而在外部显现假热。用十全大补汤加熟附子。服药后症状停止的是吉兆，不停止的是凶兆。
如果在产后半个月或十天之间，适逢出痘，这是气血刚刚虚弱，必须以大补气血为主。大抵男女婚嫁之后出的痘，其痘顶必定不能高耸，其形状大多大而扁阔，其颜色大多淡而不黄，不可拘泥于小儿元气未发泄的成例。
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.