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The entire course of smallpox centers on the Spleen and Stomach. As long as the patient can eat, Qi and Blood will be sufficient, making all stages such as eruption, pustule formation, and scabbing dependent on this foundation. Therefore, those who can eat will not suffer harm even if the lesions are dense; those who cannot eat are a cause for concern even if the lesions are sparse. Thus, regulating the Spleen and Stomach is the priority. However, since syndromes vary, treatment must be administered after careful examination.

1. In cases where toxic heat is abundant and appetite is lost, during the initial eruption of lesions, although the patient may lack desire to eat, there is no harm provided the lesion color is authentic. Since the heat-toxin has not yet resolved, many lack appetite before or during eruption. Once the toxin dissipates naturally, appetite will return. If lesions have fully erupted but appetite remains absent, Siwu Tang (Four Substances Decoction) should be slowly administered with added Shenqu (Medicated Leaven), Sharen (Amomum Fruit), and Chenpi (Tangerine Peel). One or two doses will surely restore appetite.

2. If lesions appear grayish-white without other signs of severe heat stagnation, but food intake is low or absent, it indicates Spleen-Stomach deficiency. Wuyi Yigong San (Five-Ingredient Yigong Powder) or Sijunzi Tang (Four Gentlemen Decoction) is appropriate. If insufficient Yang Qi in the Stomach fails to transform food leading to poor appetite, this indicates Cold in the Middle Jiao. Wenwei Yin (Stomach-Warming Decoction), Yangzhong Jian (Middle-Nourishing Decoction), or Liuqi Jian (Six-Qi Decoction) should be used as the primary treatment.

3. When Mingmen Yuanqi (Primordial Qi of the Gate of Life) is insufficient, the Middle Jiao Stomach Qi lacks warmth, resulting in fullness and anorexia. When Lower Jiao Kidney Qi fails to transform, dysfunction of the anterior and posterior orifices often occurs. This requires treatment with Liyin Jian (Yin-Regulating Decoction) with modifications, which will show miraculous effects. Do not assume children do not suffer from Yin Deficiency syndromes.

4. In cases of diarrhea, nausea, or vomiting with anorexia, this particularly belongs to Stomach Qi Deficiency and Cold. For mild cases, Lizhong Tang (Center-Regulating Decoction) or Liuqi Jian (Six-Qi Decoction) is used; for severe cases, Chen's Twelve-Ingredient Yigong San or a combination of Liuqi Jian and Erxian San (Two Immortals Powder) is indicated.

5. If Spleen Qi is not deficient, but the Stomach opening is cold and stagnant, causing pain or vomiting with anorexia, Yihuang San (Yellow-Enhancing Powder) is appropriate.

6. For anorexia caused by food retention or overeating, Daxiao Hezhong Yin (Large and Small Harmonizing-Middle Decoctions) should be used to clear old stagnation. Alternatively, Wuyi Yigong San with added Shanzha (Hawthorn Fruit), Maidong (Ophiopogon Root), Maogen (Imperata Rhizome), Shenqu (Medicated Leaven), and Sharen (Amomum Fruit), or combined with Yunqi San (Qi-Harmonizing Powder), may be employed.

7. For inability to eat due to mouth ulcers or throat pain, clearing the throat will resolve the pain and restore eating ability naturally. Njie Tang (Twenty-Platycodon Decoction) or Jiawei Ganjie Tang (Modified Sweet Licorice-Pplatycodon Decoction) is suitable.

8. When external Wind-Cold pathogenic factors invade the Stomach opening causing anorexia, the Cold pathogen must be dispersed. Once the pathogen dissipates, appetite returns. Jiawei Rensu Yin (Modified Ginseng-Sophora Decoction), Chaichen Jian (Bupleurum-Chenpi Decoction), or Wuyi Yigong San with added Chaihu (Bupleurum Root) is appropriate.

9. If anorexia persists after smallpox without other symptoms, it is solely due to Spleen Qi insufficiency. Wuyi Yigong San, Wenwei Yin (Stomach-Warming Decoction), or Yangzhong Jian (Middle-Nourishing Decoction) should be used as the primary treatment.

Master Cheng stated: For cases where water and grain cannot be transformed and food intake is poor, only Baoyuan Tang (Protect-Yuan Decoction) with added Chenpi (Tangerine Peel), Maidong (Ophiopogon Root), Maogen (Imperata Rhizome), Shenqu (Medicated Leaven), Sharen (Amomum Fruit), Bidou (Lablab Bean), and Shengjiang (Fresh Ginger) should be used. For vomiting, add Zhen Huoxiang (True Pogostemon Herb).

Master Xu stated: Anorexia in smallpox presents as either Deficiency-Cold or Excess-Heat. Vomiting or diarrhea with blue-white or blue-black complexion indicates Deficiency-Cold, requiring warming and tonification. Dryness and astringency of stool and urine, red face with Qi stagnation, thirst or fever, yellow-red eyes, coarse breathing, and abdominal fullness indicate Excess-Heat, requiring clearing and draining.