【纲】仲景曰。厥阴之为病。消渴。气上撞心。心中疼热。饥而不欲食。食即吐蛔。下之。利
不止。
【目】朱肱曰。此是厥阴症。或病患有寒。复发其汗。胃中冷。及因发汗后身热。重发其汗。
胃中虚冷。故吐蛔。先用理中丸次乌梅丸。
龚信曰。伤寒有不必厥逆。但吐蛔者。虽有大热。忌下凉药。犯之必死。盖胃中有寒。则蛔不
安其所而上膈。大凶之兆也。急用理中汤。加乌梅二个。川椒十粒。煎服。待蛔定。却以小柴胡汤
退热。
李中梓曰。吐蛔而渴。理中汤加大黄入蜜利之。
陶华曰。吐蛔。若下之。利不止。用四逆汤。
张介宾曰。凡治伤寒。若见吐蛔者。虽有大热。忌用寒凉。盖胃中有寒。阳气弱极。则蛔逆而
上此大凶之兆也。急用炮姜理中汤。加乌梅二个。花椒一二十粒。盖蛔闻酸则静。见苦即安也。
柯琴曰。太阴厥阴。皆以里症为提纲。太阴主寒。厥阴主热。太阴为阴中至阴。厥阴为阴中之阳也。
太阴腹满而吐。食不下。厥阴饥不欲食。食即吐蛔。同是不能食。而太阴则满。厥阴则饥。同是一吐。
而太阴吐食。厥阴吐蛔。此又主脾主肝之别也。
【纲】仲景曰。伤寒脉微而厥。至七八日。肤冷。其人躁无暂安时者。此为脏厥。非蛔厥也。
蛔厥者。其人当吐蛔。今病者静而复时烦。此非脏寒。蛔上入其膈。故烦。须臾复止。得食而呕。
又烦者。蛔闻食臭出。其人故吐蛔。吐蛔者。乌梅丸主之。又主久利。
【目】戴原礼曰。胃中冷。必吐蛔。吐蛔。人皆知为阴也。然亦有阳症吐蛔者。盖胃中空虚。
既无谷气。故蛔上而求食。至咽而吐。又看别症如何。不可专以胃冷为说。曾医一人。阳黄吐蛔。
又大发斑。阳毒症口疮咽干。吐蛔。皆以冷剂取效。是亦有阳症矣。
王肯堂曰。蛔厥者。其人手足冷而吐蛔也。脏厥者死。阳气绝也。蛔厥虽厥而烦。吐蛔已则静。
不若脏厥之躁无暂安时。病患脏寒胃虚。蛔动上膈。闻食臭则出。因而吐蛔。舌燥口干。常欲冷冻饮料浸口
不欲咽。蛔上烦躁。昏乱欲死。两手脉沉迟。足冷至膝。甚者连蛔并屎俱出。大便秘而不行。此症虽
险。都可救治也。
鳌按。戴氏阳症吐蛔之说。往往有之。医者不可不察。而动以桂、附、干姜等热剂与之也。
[Outline] Zhang Zhongjing stated: The manifestations of Jueyin disease (Jueyin Disease) include: excessive thirst (Xiao Ke), a sensation of Qi rushing upward to strike the heart, pain and burning heat in the heart region, a feeling of hunger without desire to eat, and vomiting of roundworms (Hui Chong) upon eating. If purgatives are mistakenly used, it will result in unceasing diarrhea (Li Bu Zhi).
[Commentary] Zhu Gong said: This is a Jueyin syndrome. In some patients who originally had internal cold, if sweating methods are incorrectly applied, it causes coldness in the stomach; or if after inducing sweating for fever, sweating is induced again excessively, it leads to deficiency-cold in the stomach, resulting in the vomiting of roundworms. Treatment should first use Lizhong Wan (Regulate the Middle Pill) and subsequently Wumei Wan (Mume Pill).
Gong Xin said: In Shanghan (Cold Damage) disease, there are cases without necessarily having cold extremities, presenting only with vomiting of roundworms. Even if there is significant heat, one must avoid using cold-cooling medicines to purge. Violating this rule will certainly lead to death. This is because cold in the stomach causes the roundworms to become restless and move upward to the diaphragm, which is an ominous sign of great peril. One should urgently use Lizhong Tang (Regulate the Middle Decoction), adding two Mume fruits (Wumei) and ten Sichuan peppercorns (Chuanjiao), decocted and taken orally. After the roundworms settle, use Xiaochaihu Tang (Minor Bupleurum Decoction) to reduce the fever.
Li Zhongzi said: For vomiting of roundworms accompanied by thirst, use Lizhong Tang with added Rhubarb (Dahuang), mixed with honey to promote bowel movement.
Tao Hua said: For patients vomiting roundworms, if purgatives are mistakenly used causing unceasing diarrhea, Sini Tang (Four Reversal Decoction) should be used.
Zhang Jiebin said: Whenever treating Shanghan, if vomiting of roundworms is observed, even if there is significant heat, cold-cooling medicines must be avoided. This is because cold in the stomach indicates extreme weakness of Yang Qi, causing roundworms to reverse their direction and move upward, which is an ominous sign of great peril. One should urgently use Paojiang Lizhong Tang (Baked Ginger Regulate the Middle Decoction), adding two Mume fruits (Wumei) and ten to twenty Sichuan peppercorns (Huajiao). This is because roundworms become quiet when they taste sour and remain calm when they encounter bitter flavors.
Ke Qin said: Both Taiyin and Jueyin diseases take interior syndromes as their outline. Taiyin governs cold, while Jueyin governs heat. Taiyin is the Yin within Yin (Extreme Yin), whereas Jueyin is the Yang within Yin. Taiyin disease presents with abdominal fullness and vomiting, and inability to eat; Jueyin disease presents with hunger but no desire to eat, and vomiting of roundworms upon eating. Both involve the inability to eat, but Taiyin involves fullness, while Jueyin involves hunger. Both involve vomiting, but Taiyin vomits food, while Jueyin vomits roundworms. This distinguishes the pathology of the Spleen from that of the Liver.
[Outline] Zhang Zhongjing stated: In Shanghan, if the pulse is faint and there are cold extremities, and after seven or eight days, the skin becomes cold, and the patient is restless with no moment of peace, this is called Zang Jue (Visceral Cold Extremity), not Hui Jue (Roundworm Cold Extremity). Patients with Hui Jue should vomit roundworms. Now, if the patient is quiet but occasionally becomes vexed, this is not due to Visceral Cold, but because roundworms have moved up into the diaphragm, causing vexation. After a short while, it stops. When eating, vomiting occurs, followed by vexation, because the roundworms emerge upon smelling food odors, leading to the vomiting of roundworms. For vomiting of roundworms, Wumei Wan (Mume Pill) is the primary treatment. It also treats chronic diarrhea and dysentery.
[Commentary] Dai Yuanli said: Cold in the stomach inevitably leads to vomiting of roundworms. Vomiting of roundworms is generally known to be a Yin syndrome. However, there are cases of vomiting roundworms in Yang syndromes. This is because the stomach is empty and lacks grain Qi, so roundworms move upward seeking food, reaching the throat and being vomited out. One must observe other symptoms and cannot solely attribute it to stomach cold. I once treated a patient with Yang Jaundice (Yang Huang) who vomited roundworms, and another with severe macular eruption, and another with Yang Toxic Syndrome featuring mouth ulcers, dry throat, and vomiting of roundworms; all were successfully treated with cold-cooling agents. This demonstrates that Yang syndrome vomiting of roundworms does exist.
Wang Kentang said: In Hui Jue, the patient has cold hands and feet and vomits roundworms. Zang Jue is fatal due to the exhaustion of Yang Qi. Although Hui Jue involves cold extremities and vexation, the patient becomes quiet after vomiting roundworms, unlike Zang Jue where the patient is restless without any respite. The patient suffers from Visceral Cold and Stomach Deficiency, causing roundworms to disturb and move up to the diaphragm. Upon smelling food, they emerge and are vomited. Symptoms include dry tongue and mouth, a constant desire to rinse the mouth with cold drinks but no desire to swallow, restlessness and confusion due to roundworm disturbance, deep and slow pulses in both hands, cold feet extending to the knees, and in severe cases, simultaneous expulsion of roundworms and feces, with constipation. Although dangerous, this condition can be rescued.
Shen Jin'ao's Note: Dai's theory regarding Yang syndrome vomiting of roundworms is often encountered in practice. Physicians must examine carefully and not indiscriminately administer hot medicines such as Cinnamon Twig (Guizhi), Aconite Root (Fuzi), and Dried Ginger (Ganjiang).