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Any case of vomiting roundworms (Ascaris) is necessarily caused by an underlying disease leading to vomiting, which expels the worms; it is not that the worms themselves cause the vomiting. Therefore, there is no need to treat the worms directly; one should only treat the cause of the vomiting, and the worms will naturally cease to be vomited.

In cases where roundworms are vomited due to Stomach Fire (Stomach Heat), it is because internal heat is excessive, leaving no room for the worms to reside, forcing them out. By clearing the fire, once the heat subsides, the worms will naturally become quiet. For mild cases, Chou Xin Yin (Draw Out the Fire Decoction) may be used; for severe cases, Wan Ying Wan (Ten Thousand Remedies Pill) or similar formulas are appropriate.

In cases where roundworms are vomited due to Stomach Cold, it is because internal cold is excessive, making it impossible for the worms to survive, forcing them out. By warming the Stomach, once the stomach becomes warm, the worms will naturally settle. Formulas such as Wu Mei Wan (Mume Pill) from Zhang Zhongjing are suitable for this.

In cases where roundworms are vomited due to Stomach Deficiency and lack of food, it is because the granary (Spleen and Stomach) is empty, prompting the worms to seek food and move upward. This is a sign of significant Qi deficiency in the Stomach. It is urgent to tonify the Stomach and warm the Middle Jiao to prevent the collapse of the root vitality. Formulas such as Wen Wei Yin (Warm the Stomach Decoction), Li Zhong Tang (Regulate the Middle Decoction), or Sheng Zhu Jian (Holy Atractylodes Decoction) may be used.

Although the above three methods address roundworms, the vomited worms may be dead or alive. If dead worms are vomited, treating the vomiting as described above suffices. However, if live worms continue to ascend and vomit, it becomes necessary to expel them. Since roundworms fear sour and bitter tastes, adding Wu Mei (Fructus Mume) as an assistant drug will cause the worms to subside. In cases of excess Fire in the Stomach, Ku Lian Gen (Cortex Meliae Radicis) or Huang Lian (Rhizoma Coptidis) can be added. Remaining details are listed in the chapter on Various Parasites and the clinical records on vomiting roundworms later in the text.

When treating vomiting due to Stomach Deficiency, one must carefully examine the nature and flavor (Qi and Wei) of the medicines. Patients with Excess pathogens and strong Stomach Qi can tolerate potent drugs, regardless of whether their flavors are superior or inferior. However, for those with weak Stomach Qi, especially severe deficiency, the choice of flavor and aroma is critical.

Those with Qi deficiency most fear unpleasant odors. Not only do they reject fishy, pungent, or dissipating aromas, but even slight fragrances, stagnant smells, or food odors are intolerable. Similarly, those with weak Stomachs most fear unpleasant tastes. They cannot tolerate extremely bitter or poor-tasting substances, nor even slightly salty, slightly bitter, or the natural flavors of grains. Thus, in vomiting due to Stomach Deficiency, the nature and flavor of medicines are paramount; if even slightly incompatible, the medicine will be vomited immediately upon entry, rendering it useless.

Therefore, when treating vomiting due to Yang Deficiency, all aromatic, dispersing, salty, sour, or harsh acrid substances should be carefully evaluated based on judgment. If deemed inappropriate, they must absolutely not be used. One should simply tonify Yang; once Yang returns, the vomiting will stop spontaneously. This is the most reliable method and should not be neglected.

I once observed a patient surnamed Shen, who was a physician by profession, worked very hard, and was nearly forty years old. He suffered from hernia descent and attempted to lift the Qi using a salt water-induced emesis method. Unaware that a deficient Stomach fears salty flavors, he induced uncontrollable vomiting, expelling all liquids for a day and night. Suddenly, he passed one or two bowls of black blood in his stool. His pulse was faint and thread-like, nearly imperceptible. This resulted from vomiting damaging Stomach Qi and extreme Spleen deficiency, compounded by the salt water moving Blood, causing Blood to fail to remain contained and exit through the bowels. I instructed him to quickly take a decoction containing Ren Shen (Radix Ginseng), Sheng Jiang (Rhizoma Zingiberis Recens), and Fu Zi (Radix Aconiti Lateralis Preparata) to restore the failing Yang, which might have saved him.

Suddenly, another physician arrived and stated: "All rebellious Qi rushing upward belongs to Fire. Hematochezia (blood in stool) is also due to Fire. How can you use Ren Shen and Fu Zi? You should quickly administer Tong Bian (Urine of a healthy young boy); this will cure the vomiting and stop the bleeding."

The patient found this reasoning sound. Upon swallowing the urine, he vomited violently in an unbearable manner. The vomiting continued until he died. Alas! Even a person with strong Stomach Qi would feel nauseated by the smell of urine; how could one administer urine to someone already suffering from incessant vomiting? This not only pitied the deceased but also exposed the absurdity of those who dared to call themselves physicians while practicing such reckless methods. I recorded this case to demonstrate the importance of medicinal flavors. Additional case studies on flavors are found in the pediatric section under vomiting, which should be consulted.