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Wang: Jueyin (Liver and Pericardium channels) involvement causing vomiting of roundworms. Accompanied by alternating chills and fever, dry retching, obstruction and rejection in the chest and heart region, black tongue coating, thirst but no desire to drink. This is a critically severe condition. (Pathogenesis: Stomach deficiency with Liver Wood overacting on Spleen Earth).

Prescription: Semen Pruni Mume (Wumei, 1.5 qian), Ramulus Cinnamomi (Guizhi, 1 qian), Fructus Zanthoxyli (Chuanjiao, fried and charred, 0.4 qian), Radix Paeoniae Alba (Baishao, 1 qian), Rhizoma Coptidis (Xiaochuanlian, 0.3 qian), Cortex Phellodendri (Huangqin, 1 qian), Rhizoma Zingiberis Recens (Sheng Danganjiang, 1 qian).

Xi: Pulse shows intermittent pauses on the right side. Tongue coating is white with thirst and desire to drink. Epigastric region feels obstructed and hot. Frequent vomiting of thick phlegm. Previously vomited roundworms. This is latent summerheat-dampness, both injuring the Qi level. The pathogen originates from the interior. Spirit is about to become confused and obscured. Due to dampness failing to transform, there is spontaneous diarrhea with sticky phlegm. It is proposed to advance the Xiexin (Drain the Heart) method using Banxia Xiexin Tang (Pinellia Decoction to Drain the Epigastrium).

Furthermore: Whenever roundworms move up and down and emerge, it belongs to Jueyin invading Yangming. Internal wind enters the Stomach, causing vomiting of saliva and turbid foam. This is analogous to the case in Zhang Zhongjing's Jueyin chapter where cold extremities precede fever. Discussing after cold and heat symptoms, if there is absolutely no sweating resolution, it means the latent pathogen in the extreme Yin has penetrated deeply; how can it cross other channels to reach the Yang level? Reviewing previous medical prescriptions, initially treating Lung and Stomach was used, followed by Wendan Fuling Yin (Warm Gallbladder and Poria Decoction), merely harmonizing the Stomach and treating phlegm, without reaching the pathogen deeply hidden in Jueyin. Previously taking Xiexin Tang: Bitter flavors remove dampness, pungent flavors unblock obstruction. The location remains in the Upper and Middle Jiao. After taking it, the chest felt slightly relieved, slept for a while, and upon waking, vomited turbid phlegm with yellow-black coloration. Generally, colors with green or black hues must surge upward from the bottom of the Stomach or intestines. In the elderly, the Chong Mai (Penetrating Vessel) has declined. As stated, "When the Chong Mai moves, all vessels rebel." The patient described that during vomiting, the whole body was pulled and painful, extending to the soles of the feet. This indicates that the Yin and Yang Qiao Mai (Heel Vessels) and Wei Mai (Linking Vessels) cannot maintain their own integrity; this is certain. For pathogens at the half-exterior half-interior level, Zhang Zhongjing always uses Chai Hu (Bupleuri Radix) and Huang Qin (Scutellariae Radix). Now, with upper and lower obstruction, one should follow the method of Guizhi Huanglian Tang (Cinnamon Twig and Coptis Decoction), incorporating Jueyin guiding herbs as messengers to penetrate the interior, thereby soothing the Chong Mai. Subsequently, tonify and unblock the Yangming channel. This is the principle for treating Jueyin disorders.

Prescription: Gan Jiang (Dried Ginger), Guizhi (Cinnamon Twig), Chuanjiao (Zanthoxylum), Wumei (Mume Fruit), Chuanlian (Coptis), Xixin (Asarum), Fuling (Poria).

Furthermore: Liver Qi stagnation not smoothing out requires bitter-pungent regulation, assisted by sour flavors to prevent excessive rigidity. Following the example of vomiting after eating food.

Prescription: Renshen (Ginseng), Fuling (Poria), Wuyu (Evodia), Banxia (Pinellia), Chuanlian (Coptis), Wumei (Mume Fruit).

Furthermore: After malaria attacks induce sweating, the pathogen in the Yin level has already penetrated to the Yang channels. Although phlegm and vomiting have not decreased, the green-blue coloration has disappeared, which is highly auspicious. The white coating in the center of the tongue is not yet cleared, and the edges are gradually becoming red, but the spirit is fatigued and exhausted. Clear the pathogen while assisting the righteous Qi; this is a established method.

Prescription: Renshen (Ginseng), Banxia (Pinellia), Fuling (Poria), Zhishi Juice (Immature Bitter Orange Juice), Ganjiang (Dried Ginger), Chuanlian (Coptis).

Furthermore: Desire to vomit after eating, feeling warm fluid accumulation in the heart, salty-tasting saliva and foam, pulling pain along the spine. This is Kidney deficiency causing water fluids to float upward into saliva, and the Du Mai (Governor Vessel) failing to constrain. It is proposed to use Zhenwu Tang (True Warrior Decoction) to withdraw the rebellion of water-cold. After two doses, continue administration.

Prescription: Renshen (Ginseng), Banxia (Pinellia), Fuling (Poria), Guizhi (Cinnamon Twig), Weijiang (Roasted Ginger), Nanzao (Jujube).

Furthermore: Since separation, chills and fever occurred three times, halving compared to previous attacks. However, movement and speech cause Qi rushing upward, surging phlegm and vomiting/reversal, with limbs often cold. During chills/fever and sweating, limbs反而 (instead) become hot. This is Yang decline and Stomach deficiency, with Yin turbidity ascending, preventing clear Qi from transforming and relaxing. It is proposed to treat based on Stomach deficiency and rebellious guest Qi causing belching and vomiting, using Xuanshu Daizhe Tang (Inula and Hematite Decoction). Still assist with Yang-unblocking agents to control fluid reversal, adding Baishao (White Peony Root) and Fuzi (Aconite Root).

Furthermore: Although the anti-rebellious formula had slight effect, it is essentially a coercive method. All phlegm-fluids are transformed from turbid Yin. If Yang Qi does not rise, it will inevitably flare again. Zhang Zhongjing stated that fluid pathogens should be harmonized with warming medicines. The previous formula seized Stomach water to revive Yang, which is also this meaning. It is proposed to use Lizhong Tang (Regulate the Middle Decoction), reducing the retaining nature of Gancao (Licorice), still adding Jiang (Ginger) and Fu Zi (Aconite) to unblock Yang, and adding Caoguo (Tsaoko Fruit) to awaken the Spleen. After two doses, continue.

Prescription: Renshen (Ginseng), Ganjiang (Dried Ginger), Banxia (Pinellia), Sheng Baizhu (Raw Atractylodes Macrocephala Rhizome), Fuzi (Prepared Aconite Root), Sheng Baishao (Raw White Peony Root).

Wang: Pulse is deep and wiry. Abdominal pain and vomiting. Nose tip is coal-black, tongue is crimson, face has a blue-dull hue. Summer-autumn latent summerheat fever. Not a winter disease, but caused by mistaken exterior-releasing methods and fasting, injuring Stomach Qi, leading to Liver Wood overacting on Stomach Earth, roundworms emerging upward, thus becoming a severe illness. There is constant fear of Jue Ni (Cold Extremities). It is proposed to vent the Liver and harmonize the Stomach. Pain stops and vomiting slows, hoping for a turning point.

Prescription: Chuanjiao (Zanthoxylum), Chuanlian (Coptis), Wumei (Mume Fruit), Ganjiang (Dried Ginger), Renshen (Ginseng), Fuling (Poria), Sheng Baishao (Raw White Peony Root), Chuanlianzi (Szechwan Chinaberry Fruit).

Cheng: After a major illness, Stomach Qi is extremely injured. Liver Wood overacts on Earth. Roundworms desire to pierce through the diaphragm. Paroxysmal pain in the epigastrium and hypochondrium. This is Earth deficiency overcome by Wood. Ancients taught that Huhuo (Hu Disease) and Chong Jue (Worm Cold) are due to Stomach deficiency and lack of grain.

Anwei Wan (Stomach-Anchoring Pill), taken with Ren Shen Chuan Jiao Wu Mei Tang (Ginseng, Zanthoxylum, and Mume Fruit Decoction), 2 qian per dose.

Zhou (31 years old): Pain in both hypochondria, worse on the left. Vomiting roundworms. Previously liked eating raw rice. This is due to irregular diet combined with anger and fatigue, causing Stomach Earth disharmony and Liver Wood invasion. Observe children who eat rice, wheat, mud, or charcoal; these are long-accumulated interior stagnations, initially arising from damp-heat郁蒸 (stagnant steaming). One should harmonize Yang, ventilate the Fu organs, use pungent penetrating methods to unblock collaterals. When dampness leaves and heat dissipates, the Fu collaterals naturally harmonize.

Prescription: Chuanlian (Coptis), Ganjiang (Dried Ginger), Guizhi (Cinnamon Twig), Jinlingzi (Szechwan Chinaberry), Yanhu (Corydalis), Lvhui (Aloe), Baishao (White Peony), Zhishi (Immature Bitter Orange). Take Wumei Wan (Mume Pill), 3 qian.

Li: Body does not have high fever. Bowel and bladder movements are quite smooth. No longer a disease of Wind-Cold stagnation. Due to fright disturbing the Liver, Jue Qi (Rebellious Qi) floats downward, roundworms attack upward causing pain, vomiting clear saliva. Zhang Zhongjing said: Roundworm Jue all arise from fright. Use Renshen An Hui Fa (Ginseng Method to Pacify Roundworms).

Furthermore: Ancients said, rising leads to vomiting roundworms, descending leads to Huhuo. Both are due to Stomach deficiency and lack of grain, with Liver Jue Qi rebelling upward. Knowing the Stomach is deficient and guest Qi rushes upward to invade, then the anti-rebellious and Stomach-anchoring formula follows ancient treatment methods.

Prescription: Renshen (Ginseng), Daizheshi (Hematite), Wumei Rou (Mume Flesh), Chuanjiao (Zanthoxylum), Chuanlianzi (Szechwan Chinaberry), Fuling (Poria).

Furthermore: Renshen (Ginseng), Fuling (Poria), Chao Danggui (Fried Angelica Sinensis), Chao Baishao (Fried White Peony), Guixin (Cinnamon Heart), Zhigancao (Honey-fried Licorice), Weijiang (Roasted Ginger), Nanzao (Jujube).

Furthermore: Suddenly pain recurs. Pulse is faint and fine. Coinciding with early Li Xia (Start of Summer), righteous Qi fails to connect continuously. There is fear of recurrent Jue Ni.

Prescription: Renshen (Ginseng), Guizhimu (Cinnamon Twig Wood), Chuanlianzi (Szechwan Chinaberry), Chao Chuanjiao (Fried Zanthoxylum), Sheng Baishao (Raw White Peony), Wumei Rou (Mume Flesh), Chuanlian (Coptis), Xixin (Asarum).

Ye (17 years old): Heat Qi closes upward. Deafness and body heat. Consciousness is unclear. Should clear Xin Ying (Heart Nutrient Level) and Fei Wei (Lung Defensive Level). (Pathogenesis: Damp-Heat knotting in Jueyin).

Prescription: Zhuxinye (Bamboo Leaf Tip), Fei Huashi (Flown Talcum), Lianqiao (Forsythia), Chuanbei (Fritillaria Bulb), Shichangpu Gen (Acorus Root), Sheng Lv Dou Pi (Raw Mung Bean Skin).

Furthermore: Summerheat-Damp-Heat steaming internally. Vomiting roundworms. Thirst and deafness.

Prescription: Chuanlian (Water-fried Coptis, 0.4 qian), Banxia (Pinellia, 1.5 qian), Zhishi (Immature Bitter Orange, 1 qian), Guangpi Bai (Citrus Peel White, 3 qian), Changpu (Acorus, 1.5 qian), Xingren (Apricot Seed, 3 qian).

Furthermore: Body heat persists for three five-day periods (hou). Chest oppression. Delirium at night. Deafness and vomiting roundworms. This is Heat knotting in Jueyin, the most dangerous syndrome.

Prescription: Chuanlian (Coptis), Huangqin (Scutellaria), Ganjiang (Dried Ginger), Zhishi (Immature Bitter Orange), Banxia (Pinellia), Jiangzhi (Ginger Juice), Fuling (Poria), Changpu (Acorus).

Vomiting roundworms originally belongs to Liver-Stomach syndromes. Because Jueyin pathogen rebels upward, roundworms cannot settle, thus exiting from above. The cases compiled here are all caused by external pathogens leading to vomiting roundworms. Although Xiexin Tang, Guizhi Huanglian Tang, Anwei Wan etc. are used, they all adhere to Zhang Zhongjing's Wumei Wan method, utilizing bitter, pungent, sour, cold, and hot together. These should be referenced together with the Vomiting section. As for children vomiting/passing roundworms and other worm diseases, treating the branch involves vermifuge formulas, while treating the root involves warming and tonifying Spleen-Stomach, or assisting with clearing Gi-heat. Predecessors each had established methods; no need to repeat. (Commentary by Hua Yutang)

Xu Lingtai's Commentary: Most of the listed cases are vomiting/reversal syndromes, not purely worm diseases. The formulas for treating vomiting roundworms only modify Wumei Wan, lacking profound thought and broad knowledge to legislate according to specific symptoms. The use of Renshen, although derived from the intent of Wumei Wan, is mostly inappropriate for the symptoms. It is known that this old physician did not study this disease deeply.