（灌浆落痂二门参看）
凡痘家，能食者不问稠密皆吉，不能食者痘虽疏亦难发难靥，疮密者危。盖人
绝水谷则死，表里皆病则困也。有欲食而不能食者，必喉舌有痘作痛，艰于吞嚼也，
以烂粥米饮频频与之，以助脾胃之气，更以甘桔汤加牛蒡子以解咽喉，利胸膈也。〔翁〕夫痘疮之出也，固赖
元气以发之，而元气之壮也，必滋乳食以养之，自四五日以至痂落之后，饮食不减，二便如常，虽不起发，不红绽，
或陷塌，用药得宜，可保无虞。使乳食减少，兼以泄泻，则元气自此而日衰，虽无前证，日后必至药亦难
效，去生远矣。故四五日前而不食者，此毒盛于里，犹可治也，至六七日后而不能食者，杂证百出，行浆不实，虽
药之，亦何益哉。有禀受壮实，又发于五岁之外者，又不可以例论也。有痘已痂起而不食，宜调脾胃，若痘起而倍能
食，乃胃中宿热消谷，能食而大便秘，宜四顺饮之类微解之，恐胃热不去，为口疮。又有脾胃壮实能
食，大便如常，不必服药。此治痘者、可不知所审耶。〔张〕不食，有虚实之异，其人怯弱，精神慢而不食，或因犯胃
气脏腑自利而不食者为虚，当温养之，益黄（脾）理中（吐逆）姜附、辈主之。身热中满而不食者为实，当清利之，白
虎汤（发热）五苓散（惊）辈主之。如腹胀不食，口角流涎者，小异功散主之（吐泻）。
初出，胸前稠密而减食者，此毒盛脾弱也，宜消毒饮加酒洗紫草、山楂、人参辈。已出，或因烦渴饮冷过多，或
误投凉剂伤冷腹胀，大小便利，腹中虚鸣不能食
者，当以温中药疏逐冷气；治法见腹胀条。有内实之人，皮浓肉密，而毒瓦斯难于发越者，又当服解毒匀气之药。凡
痘出而饮食少进者，多因虚而毒发不透，或兼有积滞故也，以秘传大透肌散（出不快）加枳实、浓朴服之。饮
食不化，手足逆冷者，脾气虚寒也，四君子汤加干姜，甚则附子。疮痂既起，则中气暴虚，多不能食，只宜四君
子辈徐徐调养之。或有疮痂起而能食者，乃胃中宿有蕴热也，盖胃热则消谷，故能食，更兼大便秘结者，宜三黄丸
利之，庶不生他变也。然亦有一等脾胃素壮实者，亦自能食，大便亦不至有秘结之患，则不必用此药也。
靥后大小便如常而食少者，宜胃爱散、小异功散、双和散之类调补。痂落潮热，唇红口渴不食者，四君子汤加
陈皮、山楂、黄连。渴甚，白术散。不解，以大连翘饮去黄芩主之。
脾胃伤于饮食者，枳实丸（伤食）主之。大便酸臭，不消化，畏食或吐者，枳术丸（伤食）。伤冷冻饮料食者，宜温之，
神应丸（伤食）主之。然神应丸内有巴豆，善医者临证，须量虚实斟酌，少与之，庶不坏事。
赵氏治疮痘不进乳食，用白术苦参汤。宿食不消者陈皮枳实汤。如因热壅不食
者，二和汤加黄芩。胃虚弱不调，而不能食者，人参养胃汤、麦冬参术散、七珍散、
俱可选用。或有杂证者，去其杂证，气和自能食矣。或大小便秘者，利之。
四君子汤
人参 白茯苓 白术 甘草（各一两）
上 咀。用水一盏，生姜三片，煎四分，温服，每帖三钱。
六神散 治脾胃虚弱，津液燥少，内虚不食，身发虚热。
人参 白术 茯苓 甘草（炙） 白扁豆（炒） 黄 （密炙）
上等分，为细末。每服抄二钱，用水半盏，生姜一片，枣一枚，同煎至三分，
去滓温服之，不拘时候。身热甚者，加乌梅少许，同煎服。
七珍散 调胃进食。
山药 人参 茯苓 黄 白扁豆（各一钱） 白术（二钱） 甘草（七分）
上，锉为粗散。加粟米一撮，姜二片，枣三枚，水煎，不拘时温服。
人参养胃汤 补脾进食之剂。
白术 陈皮 神曲（各一钱五分） 人参 茯苓 栀子 黄芩（各一钱） 甘草（八分）
上锉散。分为二服，水煎，不拘时服。
麦冬参术散 调胃进食，兼消积之药。
麦门冬 白术（各二钱） 陈皮（一钱半） 人参 甘草（各一钱） 浓朴（七分）
上锉散。分为二服，水煎，无时。
二和汤 消食扶气之剂。
藿香 香附（各等分）
上，为极细末。滚水放温，调下二三钱。
白术苦参汤 治小儿患痘，不进乳食。
白术 白芍药 槟榔 诃子 柴胡 青皮（各一钱） 苦参（一钱二分） 鼠粘子 浓朴 陈
皮砂仁 乌药 紫草（各一钱）
上锉散。每服四五钱，水煎，食远服。
陈皮枳实汤 治患痘宿食不消。
陈皮（一钱二分） 鼠粘子 浓朴（各一钱一分） 枳实 青皮 乌药 紫草茸 砂仁 神曲
槟榔 草果 桔梗（各一钱） 升麻（八分）
上锉散。每服四五钱，水煎，食远服。
凡痘疮，饮食之间毋令太饥，毋令太饱，毋太寒、太热，以损脾胃，但与糜粥
烂饭，淡薄滋味以养之，切忌肥甘、煎炒、五辛、一切动风动火之物。
(For the situations regarding the "filling with pus" and "scab falling off" stages, please refer to the relevant chapters.)
In cases of smallpox (痘家), if the patient can eat, it is auspicious regardless of whether the rash is dense or sparse; if the patient cannot eat, even if the rash is sparse, it will be difficult for the lesions to erupt and form scabs, and if the rash is dense, the condition is critical. This is because humans die when deprived of water and grain, and become distressed when both exterior and interior are affected by disease. Some patients desire to eat but cannot, necessarily due to pain from smallpox lesions in the throat and tongue, making swallowing and chewing difficult. In such cases, frequent administration of well-cooked rice porridge should be used to support Spleen and Stomach Qi, along with Ganjie Tang (Licorice and Platycodon Decoction) added with Niubangzi (Arctii Fructus) to resolve throat toxicity and unblock the chest diaphragm. [Weng] The eruption of smallpox relies on Yuan Qi (Original Qi) to drive it, while the robustness of Yuan Qi must be nourished by milk and food. From four or five days until after the scabs fall off, if dietary intake does not decrease and urination and defecation remain normal, even if the lesions fail to rise, do not turn red and open, or appear sunken, proper medication can ensure safety. However, if milk and food intake decrease, accompanied by diarrhea, Yuan Qi will decline day by day from this point; even without the aforementioned symptoms, medications will likely be ineffective later on, distancing the patient from recovery. Therefore, inability to eat before the fourth or fifth day indicates excessive toxin within the interior, which is still treatable; but inability to eat after the sixth or seventh day, accompanied by various complications and incomplete pus formation, renders medication useless. Patients with strong congenital constitution who develop the disease after age five cannot be judged by general rules. If a patient cannot eat after scabs have formed, the Spleen and Stomach should be regulated; if the patient eats excessively after eruption, it indicates retained heat in the Stomach consuming food rapidly; if eating is accompanied by constipation, Sishun Yin (Four Compliance Decoction) or similar mild purgatives should be used to prevent mouth sores caused by persistent Stomach heat. For those with strong Spleen and Stomach function who eat normally with regular bowel movements, no medication is needed. Physicians treating smallpox must examine these details carefully. [Zhang] Anorexia differs between deficiency and excess syndromes. Weakness, lethargy, and anorexia, or anorexia due to impaired Stomach Qi and spontaneous organ dysfunction, indicate deficiency syndromes, requiring warming and nourishment, primarily using Yihuang San (Yellow Protecting Powder - Spleen), Lizhong Tang (Regulate the Middle Decoction - for vomiting), and ginger-attire formulas. Fever, abdominal fullness, and anorexia indicate excess syndromes, requiring clearing and draining, primarily using Baihu Tang (White Tiger Decoction - for fever) and Wuling San (Five Ling Powder - for fright). Abdominal distension with anorexia and drooling at the corners of the mouth is treated with Xiaoyigong San (Minor Extraordinary Success Powder - for vomiting and diarrhea).
During early eruption, if chest rashes are dense and appetite decreases, it indicates abundant toxin and weak Spleen; Xiaodu Yin (Toxin Eliminating Decoction) added with wine-washed Zicao (Lithospermi Radix et Rhizoma), Shanzha (Crataegi Fructus), and Renshen (Ginseng Radix et Rhizoma) is appropriate. After eruption, if excessive cold drinks due to thirst, or mistaken use of cooling agents causing cold injury, abdominal distension, free urination and defecation, and borborygmus lead to anorexia, warming herbs should be used to disperse cold qi; see the "Abdominal Distension" section for treatment. For individuals with internal excess, thick skin, and dense flesh where toxins struggle to vent, detoxifying and qi-regulating medicines should be administered. Generally, reduced food intake during smallpox eruption is due to deficiency preventing thorough toxin release or accumulation of stagnation; Mituan Datouji San (Secretly Transmitted Muscle-Penetrating Powder - for slow eruption) added with Zhishi (Aurantii Fructus) and Houpo (Magnoliae Officinalis Cortex) is suitable. Indigestion with cold extremities indicates Spleen Qi deficiency and cold, treated with Sijunzi Tang (Four Gentlemen Decoction) added with Ganjiang (Zingiberis Rhizoma), or Fuzi (Aconiti Lateralis Radix Praeparata) in severe cases. Once scabs form, Central Qi suddenly becomes deficient, often leading to anorexia; Sijunzi Tang or similar formulas should be used for gradual regulation. If the patient can eat after scabs form, it indicates retained heat in the Stomach; since Stomach heat promotes digestion, combined with constipation, Sanhuang Wan (Three Yellows Pill) should be used to promote bowel movement to prevent other complications. However, some patients with naturally strong Spleen and Stomach eat normally without constipation and require no such medication.
After scabbing, if urination and defecation are normal but appetite is low, Weitai San (Stomach Love Powder), Xiaoyigong San, or Shuanghe San (Double Harmony Powder) should be used for regulation and tonification. Post-scab tidal fever, red lips, thirst, and anorexia are treated with Sijunzi Tang added Chenpi (Citri Reticulatae Pericarpium), Shanzha, and Huanglian (Coptidis Rhizoma). Severe thirst is treated with Baizhu San (Atractylodis Macrocephalae Powder); if unresolved, Dalianqiao Yin (Great Forsythia Decoction) without Huangqin (Scutellariae Radix) is used.
Spleen and Stomach injury from diet is treated with Zhishi Wan (Immature Bitter Orange Pill - for food stagnation). Sour-smelling stool, indigestion, fear of eating, or vomiting are treated with Zhizhu Wan (Atractylodis Macrocephalae and Immature Bitter Orange Pill - for food stagnation). Injury from cold drinks/food requires warming, treated with Shenyin Wan (Divine Response Pill - for food stagnation). Note that Shenyin Wan contains Badou (Crotonis Semen); skilled physicians must assess deficiency/excess and administer cautiously to avoid harm.
Zhao's method for smallpox patients refusing milk/food uses Baizhu Kushen Tang (Atractylodis Macrocephalae and Sophorae Flavescentis Radix Decoction). Retained food not digesting is treated with Chenpi Zhishi Tang (Citri Reticulatae Pericarpium and Immature Bitter Orange Decoction). Heat obstruction causing anorexia is treated with Erhe Tang (Two Harmonies Decoction) added Huangqin. Weak Stomach failing to regulate and causing anorexia is treated with Ren Shen Yangwei Tang (Ginseng Nourishing Stomach Decoction), Maidong Shenzhu San (Ophiopogon, Ginseng, and Atractylodis Powder), or Qizhen San (Seven Treasures Powder), all selectable. If mixed syndromes exist, remove them, and harmonized Qi will restore appetite. Constipation should be purged.
**Sijunzi Tang (Four Gentlemen Decoction)**
Renshen (Ginseng Radix et Rhizoma), Baifuling (Poria), Baizhu (Atractylodis Macrocephalae Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma) (each 1 liang).
Chop ingredients. Decoct with one cup of water and three slices of Shengjiang (Zingiberis Rhizoma Recens) to yield four-tenths volume. Take warm, 3 qian per dose.
**Liushen San (Six Spirits Powder)**
Treats Spleen/Stomach weakness, dry fluids, internal deficiency anorexia, and deficiency heat.
Renshen, Baizhu, Fuling (Poria), Gancao (Honey-fried), Baibiandou (Faba Seed, stir-fried), Huangqi (Astragali Radix, honey-fried).
Equal parts, powdered finely. Take 2 qian each time, decoct with half cup water, one slice Shengjiang, and one Jujube (Ziziphi Spinosae Semen) to yield three-tenths volume. Strain and take warm, anytime. Add Wu Mei (Mume Fructus) for high fever.
**Qizhen San (Seven Treasures Powder)**
Regulates Stomach, promotes appetite.
Shanyao (Dioscoreae Rhizoma), Renshen, Fuling, Huangqi, Baibiandou (each 1 qian), Baizhu (2 qian), Gancao (0.7 qian).
Coarsely chopped. Decoct with a pinch of Millet (Setaria italica), two slices Shengjiang, and three Jujubes. Take warm, anytime.
**Ren Shen Yangwei Tang (Ginseng Nourishing Stomach Decoction)**
Tonifies Spleen, promotes appetite.
Baizhu, Chenpi, Shenqu (Medicated Leaven) (each 1.5 qian), Renshen, Fuling, Zhizi (Gardeniae Fructus), Huangqin (each 1 qian), Gancao (0.8 qian).
Chopped. Divide into two doses, decoct with water, take anytime.
**Maidong Shenzhu San (Ophiopogon, Ginseng, and Atractylodis Powder)**
Regulates Stomach, promotes appetite, resolves accumulation.
Maidong (Ophiopogonis Radix), Baizhu (each 2 qian), Chenpi (1.5 qian), Renshen, Gancao (each 1 qian), Houpo (0.7 qian).
Chopped. Divide into two doses, decoct with water, anytime.
**Erhe Tang (Two Harmonies Decoction)**
Resolves food, supports Qi.
Huoxiang (Agastaches Herba), Xiangfu (Cyperi Rhizoma) (equal parts).
Powdered finely. Mix with warm boiled water, take 2-3 qian.
**Baizhu Kushen Tang (Atractylodis Macrocephalae and Sophorae Flavescentis Radix Decoction)**
Treats pediatric smallpox with refusal of milk/food.
Baizhu, Baishaoyao (Paeoniae Radix Alba), Binglang (Arecae Semen), Hezi (Terminaliae Chebulae Fructus), Chaihu (Bupleuri Radix), Qingpi (Citri Reticulatae Pericarpium Viride) (each 1 qian), Kushen (Sophorae Flavescentis Radix) (1.2 qian), Niubangzi (Arctii Fructus), Houpo, Chenpi, Sharen (Amomi Fructus), Wuyao (Linderae Radix), Zicao (Lithospermi Radix et Rhizoma) (each 1 qian).
Chopped. Take 4-5 qian, decoct with water, take after meals.
**Chenpi Zhishi Tang (Citri Reticulatae Pericarpium and Immature Bitter Orange Decoction)**
Treats retained food in smallpox patients.
Chenpi (1.2 qian), Niubangzi, Houpo (each 1.1 qian), Zhishi, Qingpi, Wuyao, Zicaorong (Lithospermi Radix et Rhizoma), Sharen, Shenqu, Binglang, Caoguo (Tsaoko Fructus), Jiegeng (Platycodonis Radix) (each 1 qian), Shengma (Cimicifugae Rhizoma) (0.8 qian).
Chopped. Take 4-5 qian, decoct with water, take after meals.
Regarding smallpox diet: Do not let the patient become too hungry or too full; avoid extreme cold or hot foods that damage Spleen and Stomach. Provide soft porridge and bland flavors. Strictly avoid rich/sweet foods, fried items, pungent spices, and anything that generates wind or fire.