凡痘家能食者，不问稠密皆吉。如不能食者，则痘虽稀疏，亦必难发难靥，盖人绝
水谷则死，表里皆病，则困也。然在初而不食者，但表其痘，痘出而自能食也。有欲食
而不能食者，必喉舌有痘作痛，艰于吞嚼也，宜以烂粥浓饮频频与之，以助脾胃之
气，更有甘桔、牛蒡解利之。然更有虚实寒热之别焉。如其人怯弱，精神怠慢，自利不
食者，虚也。如身热中满而不食者，实也。如因误伤生冷，二便清利，腹胀肠鸣不食
者，寒也。如皮浓肉密，毒瓦斯难于发越，烦燥不食者，热也。如初出而胸前稠密减食
者，此毒盛脾弱也。如大便酸臭，畏食或吐者，此有宿食也。因痘者，治其痘，因杂症
者，去其杂症，则一和自能食矣。如逆症并见，忽然倍食者，又宜防其邪火杀谷，未可
便为吉断也。
夫痘疮之出也，因赖元气以发之，元气之壮也，必资乳食以养之。自初起以至痂
落，饮食不减，二便如常，虽不起发，不红绽，用药得宜，自可无虞。若乳食减少，又
泄泻，则元气自此而日衰，虽无前症，日后必至渐渐成一矣。故四五日前不食者，此毒
盛于里，犹为易治也。至五六日后而不能食者，则必杂症 生，行浆勿实，虽药亦何益
哉！然有禀受壮实之不同，又发于五岁之外者，不可拘以概论也。有痘已痂起而不食
者，是或中气暴虚也，治宜调良脾胃。如因毒发不透者，则又仍宜攻托毒出，而自能食
也。若痘起而倍能食，发热烦燥，精神不长者，是胃中宿热，消谷地，大便秘者，宜四
顺饮之类微解之。恐胃热不去，则为口疮他变，若脾胃素壮，痘毒尽出，里无蕴热，是
以胸隔宽快，倍食痘美，二便如常者，则不可轻行解利也。夫治痘譬之种痘，生化皆藉
于土，土润浓而肥，则难出而易成熟，土燥薄而瘠，则易出而难结实，实者锄耨之，瘠
者灌溉之，不实不瘠，惟顺性而不使物害之，知此其保生化育之功也得矣。
凡是出痘患儿能够进食的，无论痘疹分布是稠密还是稀疏，都属于吉兆。如果无法进食，那么即使痘疹稀疏，也必然难以发出和结痂，因为人断绝了水谷饮食就会死亡，表里都受病邪困扰，就会陷入困境。然而如果在初期不能进食，只要痘疹发出后自然就能进食了。有的孩子想吃却吃不下，一定是咽喉舌头有痘疹导致疼痛，吞咽咀嚼困难，适宜用烂粥浓汤频繁喂服，以辅助脾胃之气，还可以配合使用甘草、桔梗、牛蒡子等具有解毒利咽作用的药物。但是这其中还有虚证、实证、寒证、热证的区别。如果患者体质怯弱，精神倦怠，自发性腹泻且不能进食，这是虚证。如果身体发热、胸腹胀满而不能进食，这是实证。如果因误食生冷食物，导致大小便清稀通畅，腹部胀气肠鸣且不能进食，这是寒证。如果皮肤致密肌肉厚实，毒邪难以透发，烦躁不安且不能进食，这是热证。如果痘疹刚发出时胸前部位稠密而减少进食，这是因为毒邪旺盛而脾气虚弱。如果大便酸臭，畏惧进食或呕吐，这是因为体内有积滞的食物。如果是因痘疹引起的，治疗痘疹即可；如果是因其他杂症引起的，去除杂症，那么脾胃调和自然就能进食了。如果出现逆证并见，突然加倍进食的情况，又应当防备是邪火消蚀谷物（即胃火亢盛导致的消谷善饥），不能轻易判断为吉兆。
痘疮的发出，依靠元气来推动，元气的壮实，必须依赖乳食来滋养。从发病初期到结痂脱落，如果饮食没有减少，大小便正常，即使痘疹不起发、不红绽，只要用药得当，自然就没有危险。如果乳食减少，又出现泄泻，那么元气从此日渐衰弱，虽然之前没有这些症状，日后也必然会逐渐形成坏证。所以发病四五天前不能进食的，这是因为毒邪在体内旺盛，还算容易治疗。到了五六天后仍然不能进食的，那么必然会产生杂症，浆液行而不充实，即使用药又有什么益处呢！然而由于禀赋体质的强壮与虚弱不同，又有在五岁以后发病的，不可以拘泥于一般概论来判断。有的痘疹已经结痂起发但仍然不能进食的，这是中气突然虚弱，治疗应当调理脾胃。如果是因毒邪发散不透发的，则又应当继续采用攻托的方法使毒邪外出，自然就能进食了。如果痘疹发出后反而加倍能进食，伴有发热烦躁，精神萎靡不振，这是胃中有宿热，消化食物过快，大便秘结，适宜用四顺饮之类的方剂轻微解之。担心胃热不去，会导致口疮等其他变证。如果脾胃素来强壮，痘毒全部发出，体内没有蕴积的热邪，因此胸膈宽畅舒适，食欲倍增且痘疹形态良好，大小便正常的，就不可以轻易使用解利之法。治疗痘疹好比种植庄稼，生化过程都依赖于土，土壤湿润浓厚肥沃，则难长出但容易成熟；土壤干燥稀薄贫瘠，则易长出但难结果实。对于实证的要锄草松土，对于虚弱的要灌溉施肥，对于不实不弱的，只顺应其本性而不让事物伤害它，懂得这个道理，就掌握了保全生命化育的功夫了。
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.