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Niao Yuanfang's elaboration on the nine worms in *Zhubing Yuanhou Lun* (Treatise on the Pathogenesis and Manifestations of Various Diseases) is quite detailed. However, the variations of worms are countless; fundamentally, they are primarily caused by damp-heat (Damp-Heat), and cannot be solely attributed to deficiencies of the three qi (Wind, Cold, Summer-heat) or improper diet.

The nine worms derived by Niao Yuanfang include: Fu worm (Hidden Worm), Ascaris (Roundworm), Bai worm (White Worm), Rou worm (Flesh Worm), Fei worm (Lung Worm), Wei worm (Stomach Worm), Ruo worm (Weak Worm), Chi worm (Red Worm), and Suo worm (Pinworm).
The Fu worm is four fen long and is the leader of the group of worms.
The Ascaris is one chi long, sometimes five or six cun long. When it acts up, it causes abdominal pain, with masses that gather and disperse, moving up and down, with intervals of relief from pain. It may also attack the heart region, cause excessive salivation, and lead to vomiting of clear fluid. If it penetrates and damages the heart, death ensues. In diagnosis, when there is abdominal pain, the pulse should typically be deep and weak; if the pulse is instead surging and large, this indicates the presence of worms.
The Bai worm is one cun long, reproducing and growing larger, reaching four or five chi, and can also be fatal. The Cestoda (Tapeworm/Bai worm) is white, flat, and small, formed by drinking white wine, eating beef roasted on mulberry branches, and consuming raw millet. It is also said that eating raw fish followed immediately by milk or cheese can generate this worm. Its activity depletes the body's essence and qi, causing pain in the waist and legs. If this worm grows to one chi, it causes death.
The Rou worm resembles rotten apricots and causes vexation and fullness.
The Fei worm resembles silkworms and causes coughing.
The Wei worm resembles a toad and causes vomiting, regurgitation, and hiccups.
The Ruo worm resembles melon seeds, also known as Ge worm (Diaphragm Worm), and causes excessive saliva.
The Chi worm resembles raw meat; when it moves, it causes borborygmus (abdominal rumbling).
The Suo worm is extremely minute, resembling vegetable larvae, residing in the intestines. An abundance leads to hemorrhoids, and extreme cases result in leprosy-like sores. Entering existing wounds, it generates carbuncles, ulcers, tinea, gan syndrome (nutritional deficiency disease), and scabies.
The Qie worm (Tooth-decay worm) does not exist without cause; not all people suffer from dental caries, and even if present, they are not necessarily numerous, with some having none at all. These various worms reside between the intestines and stomach. If the zang-fu qi is substantial, they do no harm; if deficient, they erode the body. Depending on their movement, they can transform into various diseases.

"San" refers to sores on the lower lip, indicating worms eroding the lower part, leading to anal fissures and rot. "Xin Gan" (Heart Gan Syndrome) occurs due to deficiency triggering activity, attacking the heart, termed Xin Ni. There are five types of Gan syndrome: Bai, Chi, Suo, Huang, and Hei. Among these five, Bai is the mildest, Chi is next, Suo is next, Huang is next, and Hei is the most severe. They all ascend from the intestines to erode the throat and gums, generating sores, and descend to damage the anus, causing dysentery with pus and blood, vomiting, heat in the palms and soles, waist and leg pain, and lethargy. Symptoms are milder in autumn and winter but worsen in spring and summer. Niao Yuanfang's discussion on the manifestations of worm-induced Gan syndromes is indeed detailed. However, worm variations extend beyond these few categories. Wherever qi reaches in heaven and earth, myriad worms emerge. For instance, where Jueyin Wind-Wood prevails, hairy animals (Mao) evolve. Corresponding to Spring, its worms are Mao, and its domesticated animals are dogs; corresponding to Summer, its worms are Feathered (Yu), and its animals are horses; corresponding to Late Summer, its worms are Naked (Luo); corresponding to Autumn, its worms are Shelled (Jie), and its animals are chickens; corresponding to Winter, its worms are Scaled (Lin), and its animals are pigs. Dogs and chickens correspond to Mao and Jie; pigs correspond to Yu and Lin; cattle and dogs correspond to Luo and Mao; chickens and sheep correspond to Jie and Yu; pigs and cattle correspond to Lin and Luo. Liver and Spleen correspond to Mao and Jie; Heart and Lung correspond to Yu and Lin; Spleen and Kidney correspond to Luo and Mao; Lung and Liver correspond to Jie and Yu; Kidney and Heart correspond to Lin and Luo. Earthly qi controls what it overcomes; Heavenly qi controls what overcomes it. Heaven controls color; Earth controls form. Colors are Green, Yellow, Red, White, Black; forms are Hairy, Feathered, Naked, Shelled, Scaled. Their generation arises from viviparous, oviparous, moist, and metamorphic modes; their maturity manifests as walking, flying, or crawling. Thus, the Five Qi and Five Flavors root internally, while Five Colors and Five Forms manifest externally. Within a year, there are mutual overcoming and restitution cycles. Therefore, when Jueyin governs the Heaven phase, Mao worms are quiet, Yu worms breed, and Jie worms fail to develop; in the Quan phase, Mao worms breed, Luo worms decline, and Yu worms fail to breed. When Shaoyin governs the Heaven phase, Yu worms are quiet, Jie worms breed, and Mao worms fail to develop; in the Quan phase, Yu worms breed, Jie worms decline and fail to breed. When Taiyin governs the Heaven phase, Luo worms are quiet, Lin worms breed, and Yu worms fail to develop; in the Quan phase, Luo worms breed, and Lin worms fail to develop. When Shaoyang governs the Heaven phase, Yu worms are quiet, Mao worms breed, and Luo worms fail to develop; in the Quan phase, Yu worms breed, Jie worms decline, and Mao worms fail to breed. When Yangming governs the Heaven phase, Jie worms are quiet, Yu worms breed, and Jie worms fail to develop; in the Quan phase, Jie worms breed, Mao worms decline, and Yu worms fail to develop. When Taiyang governs the Heaven phase, Lin worms are quiet, Luo worms breed; in the Quan phase, Lin worms decline, and Luo worms fail to breed. If Wind prevails, Luo worms do not thrive. Such phenomena are all due to the mutual overcoming of the Five Elements. Only when Dampness recovers do Scaled worms appear on land, due to the conflict between Damp-Earth and Water; although water increases, Scaled worms appearing on land would die, hence the difference. Critically, Niao Yuanfang's assertion that spleen-stomach deficiency allows water-dampness to invade is incorrect. Rather, it is excessive heat in the spleen-stomach leading to excessive water-dampness. Consulting *Xuanzhu Mi Yu*, worms arise from Wood qi and transform via Rain qi. Thus, without Jueyin Wind-Wood qi, they do not generate; without Taiyin Damp-Earth qi, they do not mature. Is this not due to Wind-Wood governing Heat and Rain governing Dampness?

Therefore, within the Five Elements, worms exist in all, except Metal has few. Ice has no worms. Trees have borers, fruits have moths, vegetables have insects, beans have pests, grains have weevils, millet reveals worms when broken, decaying grass produces fireflies and mosquitoes, and accumulated feces produce wriggling grubs. These are all worms of Wood. Mice exist in fierce fires, flies in rotting ash. These are worms of Fire. Snakes coil in soil, earthworms traverse clay, ants dwell in holes, scorpions hide in walls, mole crickets are in fields, lizards on cliffs. These are worms of Earth. Beans gestate in ancient pools, leeches leap in desolate pools, fish fill rivers and lakes, dragons hide in seas. These are worms of Water.

Once, a blacksmith shattered an old pot to melt in a furnace. In the depression of the broken iron, there was a worm like those in rice, bright red. This pot had cooked thousands of meals; how it generated a worm remains inexplicable. This is also the effect of Metal and Fire qi. Only in ice are worms never seen. Although Northern regions have "ice mice," they merely eat ice and do not originate from it. Thus, Wood and Fire belong to Spring and Summer; Damp-Earth belongs to Late Summer; Water transforms from Earth, hence many worms. Metal follows Autumn qi, Water follows Winter qi, hence no worms. If one argues that biological materials like bedding have lice, Qu (fermented grain starter) has Qu-worms, soy sauce has sauce-worms, vinegar has vinegar-worms, and stagnant food breeds worms, yet claims animals don't breed worms like "a door hinge never rots," this is flawed. Laborers also suffer from Gu (poison/parasite) disorders; are there truly inactive beings? Books and clothes only avoid mildew if not handled or worn. However, if not subjected to Yin moisture of Late Summer or dried violently before cooling and stored in chests, they too will breed worms. Or, if the ground near jars is damp, woodlice gather; if soil under walls is dry, dog fleas inhabit it. Are they all born of dampness? Fleas may not be born of dampness, but can appear in winter. Heat breeds worms; cold prevents it. This is the natural principle.

Worms reside deeply in the spleen and stomach. Medicaments pass through the middle jiao. Worms detect medicinal qi and flee; how can swarms be extracted? My method first induces severe hunger, then uses Areca Seed (Binglang) and Polyporus (Leiwuan) as guides, administering other anti-worm drugs, causing profuse diarrhea several times, thereby emptying the bowels of worms. Zhang Zijiang used this method, extracting hundreds of worms linked together, over one zhang long. Regarding treatments for chronic sores, formulas are provided elsewhere; I do not elaborate here.