（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。
（关于灌浆和落痂两个阶段的情况，请参考相关章节）
凡是患痘疮的患儿，如果能进食，无论痘疹是稠密还是稀疏，都属于吉兆；如果不能进食，即使痘疹稀疏，也难以发出和结痂，若痘疹密集则病情危重。这是因为人断绝了水谷饮食就会死亡，表里都受病邪困扰就会困顿。有的患儿想吃却吃不下，一定是因为咽喉舌头有痘疮导致疼痛，吞咽咀嚼困难，此时应频繁给予烂粥米汤以辅助脾胃之气，并用甘桔汤加牛蒡子来解咽喉之毒，通畅胸膈。〔翁氏〕痘疮的发出，固然依赖元气来推动，而元气的壮实，必须依靠乳汁和食物来滋养。从四五天直到结痂脱落之后，如果饮食没有减少，二便正常，即使痘疮不起发、不红绽，或者出现陷塌，只要用药得当，可以保证无虞。如果乳食减少，兼有泄泻，那么元气从此日渐衰弱，即使没有前面的那些症状，日后也必然导致药物难以见效，离生还就远了。所以四五天前不能进食的，这是毒气盛于体内，还可以治疗；到了六七天后还不能进食的，各种杂症百出，浆液行而不充实，虽然用药，又有什么益处呢？有先天禀赋壮实，又在五岁以后发病的，又不可以用常理来讨论。有的痘疮已经结痂起皮但仍不进食，应当调理脾胃；如果痘疮发出后反而加倍能进食，这是胃中有宿热消谷善饥，能进食但大便秘结，宜用四顺饮之类轻微通下，恐怕胃热不去，会形成口疮。又有脾胃壮实能进食，大便正常的，不必服药。这些治痘的方法，医生岂能不仔细审察呢？〔张氏〕不进食，有虚证和实证的区别。如果患者怯弱，精神萎靡而不进食，或者因为触犯胃气、脏腑自利而不进食的，属于虚证，应当温养，以益黄散（治脾）、理中汤（治吐逆）、姜附类方剂为主治。如果身热、腹部胀满而不进食的，属于实证，应当清利，以白虎汤（治发热）、五苓散（治惊）类方剂为主治。如腹胀不进食，口角流涎的，用小异功散主治（治吐泻）。
痘疮初出时，胸前痘疹稠密而减少进食的，这是毒盛脾弱的表现，宜用消毒饮加酒洗紫草、山楂、人参等药。痘疮已出，如果因烦渴冷饮过多，或者误投凉剂导致寒伤腹部胀满，大小便利，腹中虚鸣而不能进食的，应当用温中药疏逐冷气；治疗方法见“腹胀”条。有内实之人，皮肤厚肌肉密，导致毒瓦斯难以发散透出的，又应当服用解毒匀气的药物。凡是痘疮发出而饮食少进的，多因正气虚弱导致毒发不透，或者兼有积滞所致，可用秘传大透肌散（治出不快）加枳实、浓朴服用。饮食不化，手足逆冷的，是脾气虚寒，用四君子汤加干姜，严重的加附子。疮痂既已起，中气突然虚弱，大多不能进食，只宜用四君子汤之类慢慢调养。或者有疮痂起而能进食的，这是胃中素有蕴热，因为胃热则消谷，所以能进食，再加上大便秘结的，宜用三黄丸通利，以免产生其他变证。然而也有一类脾胃素来壮实的，也能自然进食，大便也不至于秘结，就不必用此药了。
结痂后大小便正常但吃得少的，宜用胃爱散、小异功散、双和散之类调补。痂落后出现潮热，嘴唇红、口渴、不进食的，用四君子汤加陈皮、山楂、黄连。口渴严重的，用白术散。不解的，用大连翘饮去黄芩主治。
脾胃被饮食所伤的，用枳实丸（治伤食）主治。大便酸臭，不消化，畏食或呕吐的，用枳术丸（治伤食）。被冷冻饮料食物所伤的，宜温中，用神应丸（治伤食）主治。然而神应丸内有巴豆，善于治疗的医生在临证时，必须衡量虚实斟酌剂量，少量给予，才不会坏事。
赵氏治疗疮痘不进乳食的，用白术苦参汤。宿食不消的用陈皮枳实汤。如因热壅而不进食的，用二和汤加黄芩。胃虚弱不调而不能进食的，人参养胃汤、麦冬参术散、七珍散，均可选用。如果有杂证，去除杂证，气机调和自然就能进食了。如果大小便秘结的，通利它们。
四君子汤
人参 白茯苓 白术 甘草（各一两）
以上药材切碎。用水一盏，生姜三片，煎至四分，温服，每帖三钱。
六神散 治疗脾胃虚弱，津液燥少，内虚不进食，身体发虚热。
人参 白术 茯苓 甘草（炙） 白扁豆（炒） 黄芪（蜜炙）
以上等分，研为细末。每次服用二钱，用水半盏，生姜一片，枣一枚，同煎至三分，去渣温服，不拘时候。身体热甚的，加少许乌梅，同煎服。
七珍散 调理胃气，增进食欲。
山药 人参 茯苓 黄芪 白扁豆（各一钱） 白术（二钱） 甘草（七分）
以上锉成粗散。加粟米一撮，姜二片，枣三枚，水煎，不拘时温服。
人参养胃汤 补脾进食的方剂。
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）
以上锉散。分为两服，水煎，不拘时服。
麦冬参术散 调理胃气增进食欲，兼消除积滞的药物。
麦门冬 白术（各二钱） 陈皮（一钱半） 人参 甘草（各一钱） 浓朴（七分）
以上锉散。分为两服，水煎，无固定时间。
二和汤 消食扶气的方剂。
藿香 香附（各等分）
以上，研为极细末。滚水放温，调下二三钱。
白术苦参汤 治疗小儿患痘，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）
以上锉散。每次服用四五钱，水煎，饭后服。
陈皮枳实汤 治疗患痘宿食不消。
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）
以上锉散。每次服用四五钱，水煎，饭后服。
凡是痘疮，饮食之间不要令其太饥，也不要令其太饱，不要太寒、太热，以免损伤脾胃，只给糜粥烂饭，淡薄滋味来滋养它，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.