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For patients with smallpox (Xiaochuang, 痘疮), those who can eat are auspicious regardless of whether the rash is dense or sparse. If they cannot eat, even if the rash is sparse, it will be difficult to erupt and crust over. This is because humans die without food and water; when both the exterior and interior are diseased, the patient becomes exhausted. However, if the inability to eat occurs in the early stage, once the rash erupts, appetite will naturally return. Some patients desire to eat but cannot due to pain from rashes in the throat and tongue, making swallowing and chewing difficult. In such cases, it is appropriate to frequently offer thick, soft porridge to support Spleen and Stomach Qi, possibly combined with herbs like Gancao (Licorice Root), Jiegeng (Platycodon Root), and Niubangzi (Arctium Fruit) for their detoxifying and soothing properties. Nevertheless, there are distinctions between deficiency (Xu, 虚), excess (Shi, 实), cold (Han, 寒), and heat (Re, 热). If the patient is weak, lethargic, has spontaneous diarrhea, and cannot eat, this indicates a deficiency pattern. If the body is hot, the chest and abdomen are full, and eating is impossible, this indicates an excess pattern. If caused by ingesting raw or cold foods, resulting in clear and profuse stools, abdominal distension, borborygmus, and loss of appetite, this indicates a cold pattern. If the skin is tight and flesh dense, preventing toxin release, accompanied by restlessness and loss of appetite, this indicates a heat pattern. If the rash is dense on the chest upon initial eruption and appetite decreases, it signifies strong toxins and weak Spleen Qi. If stools are sour and foul, with aversion to food or vomiting, it indicates retained food (Jiu Shi, 宿食). If the cause is smallpox, treat the smallpox; if caused by other miscellaneous diseases, remove the miscellaneous disease, and harmony will restore appetite. However, if adverse signs appear simultaneously and appetite suddenly doubles, one must guard against "evil fire digesting grain" (excessive gastric fire causing polyphagia); this should not be hastily judged as auspicious.

The eruption of smallpox relies on Yuan Qi (Primal Qi, 元气) to drive it forth, and the robustness of Yuan Qi depends on nourishment from milk and food. From onset until scabs fall off, if diet remains unchanged and bowel/bladder functions are normal, even if the rash fails to erupt or turn red, proper medication ensures safety. If milk/food intake decreases accompanied by diarrhea, Yuan Qi declines daily; despite lacking prior symptoms, a deteriorated condition will inevitably develop later. Thus, inability to eat within the first four to five days suggests strong internal toxins but remains relatively easy to treat. However, inability to eat after five to six days implies the emergence of miscellaneous diseases, leading to incomplete filling of pustules; at this stage, medication offers little benefit. Given variations in constitutional strength and cases occurring after age five, generalizations should not be rigidly applied. If a patient cannot eat after scabs have formed, it may indicate sudden weakness of Middle Jiao Qi; treatment should focus on regulating Spleen and Stomach. If toxins fail to fully express, further methods to expel toxins should be employed to restore appetite. If appetite increases significantly post-eruption with fever, restlessness, and listlessness, it suggests retained stomach heat accelerating digestion and constipation; mild resolution using formulas like Sixun Yin (Four-Smooth Decoction) is advised to prevent complications like mouth ulcers. Conversely, if the Spleen and Stomach are inherently strong, toxins are fully expressed, no internal heat lingers, the chest feels comfortable, appetite is robust with good rash morphology, and excretions are normal, resolving agents should not be used lightly. Treating smallpox is akin to farming: growth relies on Earth (Spleen/Stomach). Fertile, moist soil makes eruption difficult but maturation easy; barren, dry soil makes eruption easy but结实 (fruiting/completion) hard. Excess conditions require weeding/tilling; deficiency requires irrigation. For neither extreme, follow nature without hindrance. Understanding this principle achieves the功 (merit/function) of preserving life and nurturing development.