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He Biejia's brother, Sixth Ji, invited me to examine his wife's illness. Upon pulse diagnosis, I said: "This is Zhai syndrome (Tuberculosis, a chronic consumptive infectious disease). The condition is critical and progresses rapidly; it is advisable not to use medication." I recalled that He Biejia Gong Ru Jun had previously suffered from this illness and died. Therefore, I told Brother Sixth: "Your wife's symptoms clearly belong to Chuan Shi (an ancient term for a contagious, fatal tuberculosis believed to be caused by parasites). This syndrome involves worms in the five internal organs; before death, the worms emerge first, spreading infection among people, causing the most severe harm. Be vigilant." Brother Sixth said: "I also suspected this. According to my wife: when our concubine was critically ill, she sat beside the couch and saw an object fly out of the curtain and enter her nostril; since then, she contracted the disease." I said: "Indeed so." Brother Sixth sought a strategy to prevent further spread, asking me to grind Tan Gan Mo (Dried Liver of Otter) into powder, with each person taking about one Qian (approx. 3-5g) daily. He reasoned that since the worm enters through the nose, methods should be employed to defend against it. He instructed to make paper balls wrapped in Xiong Huang (Realgar), carry them into the patient's room, and use them to plug the nose; if a worm is seen exiting, clamp it with tweezers and roast it in fire. One night, Brother Sixth entered the room, and suddenly an object flew onto his head, seeming to have many wriggling legs; he panicked, brushed it off, and it disappeared. Lighting a candle to look around, he glimpsed the object lurking under the bed, squirming. He urgently called family members to catch it with tweezers. It looked like a butterfly, with hairy wings of mixed colors. Thrown into the fire, it made chirping sounds like a mouse. Brother Sixth had a sister who was also severely ill at the time. The next day, his wife passed away. A neighbor came to console him and visited his sister's room to inquire about her health. Upon returning home and removing her clothes, she suddenly saw a worm attached to her skirt. She also roasted it to death using the same method. After the sister's death, the affliction ceased.

Previously, at Fang Lifeng Weng's residence, the wife died of this illness first, followed by the daughter-in-law, and later the younger brother's wife also died of it. Three people died of the same illness within one year. In the following spring, they all remarried, but soon the eldest son also died. Weng married a second wife, who was robust and healthy, believing herself immune. However, within a few months, she fell ill. His stepdaughter, now of marriageable age, served medicine to her stepmother. Suddenly, she saw something wriggling out of the patient's nostrils and felt strange. The object flew toward the girl's face and vanished instantly. The stepmother died. The girl then fell ill and died within less than one hundred days. Within one year, three more people died of the same illness. Can the disaster of Chuan Shi be fully described!

There was also Xu Yusheng Weng, who had four daughters. Initially, the second and third daughters both suffered from this syndrome and died successively. Not long after, the fourth daughter also became ill. I told him: "This syndrome involves parasitic transmission. After three generations of transmission, its nature becomes potent; talismans and medicines cannot control it. You must find ways to prevent future occurrences." Weng therefore sent his eldest daughter far away to relatives' homes and moved the sick daughter to the rear courtyard. The family took Tan Gan (Otter Liver) daily. After the daughter's death, the threat fortunately vanished. However, none of the three dying patients were observed to expel worms; perhaps they could transform, and humans simply could not see them.

In my opinion: Chuan Shi is a distinct type within Xu Lao (Deficiency Consumption). Xu Lao has no worms, whereas Chuan Shi does; Xu Lao is not contagious, but Chuan Shi is. However, this illness resembles Xu Lao in appearance, making it difficult to distinguish. Treatment methods vary among different theories. It is essential to clarify the syndrome and treatment so that one can take charge when facing illness; this is something physicians must study carefully. Let us first discuss the syndrome. Examining ancient teachings, such as those of Su You or statements in the Daoist Canon, are not insufficiently detailed. Yet later generations considered them unorthodox and absurd, making them hard to believe. The uniqueness of Chuan Shi lies in the worm, but this worm only appears when the patient is critically ill, unlike worms in other diseases which can be seen earlier in vomit or stool. The Zi Ting Formula suggests fumigating the patient's dorsal hand with Ru Xiang (Frankincense); if hair emerges, it is Chuan Shi. Although I have not tested this method, I fear it may not be effective. Another method involves burning An Xi Xiang (Benzoin) incense smoke for the patient to inhale; persistent coughing indicates Chuan Shi, while non-coughing indicates otherwise. This claim is also unreliable. Generally, Xu Lao patients often cough and fear smoke; it is illogical to inhale smoke without coughing. Only Yu Shi noted that Hu Huo disease (Chancroid/Behcet's-like condition) causes hoarseness, and Lao Zhai (Phthisis/TB) also causes hoarseness. Thus, hoarseness clearly indicates that the trachea has been eroded by worms. This statement serves as a verification for this syndrome. I have another insight: if in one household, someone dies of Xu Lao, and shortly after, another person suffers from the same syndrome, regardless of whether the previous case involved visible worms or whether the subsequent case presented with hoarseness, it can be diagnosed as Chuan Shi. This is because ordinary Xu Lao is not contagious. Regarding treatment, *Zhou Hou Bei Ji Fang* (Emergency Prescriptions Kept Up My Sleeve) mentions Tan Gan San (Otter Liver Powder) for treating Cold Lao and Gui Zhu (Ghost Transmission), where an entire family infects each other. *Qing Nang Shu* describes using woodpeckers to extract worms. Yu Shi also stated that prolonged heat in Xu Lao steams stagnant blood, transforming it into worms, thus forming Chuan Shi. Tan Gan San for Zhai syndrome can kill worms but cannot promote blood circulation and remove stasis. Da Huang Zhe Chong Wan (Rhubarb and Ground Beetle Pill) formulated by Zhang Zhongjing, and Bai Lao Wan (Hundred Deficiencies Pill) taught to Doctor Chen, drive out old blood and generate new blood; these are indeed unparalleled sacred methods. I examined the original texts of these two formulas in *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet), which only mention treating Wu Lao Qi Shang (Five Exhaustions and Seven Injuries) with dry blood inside, without mentioning Chuan Shi. Yu Shi deduced from the placement of Xu Lao under Xue Bi (Blood Stasis) in *Jin Gui* that Blood Stasis leads to stagnation, and stagnation generates worms. This requires exceptional insight. Nevertheless, Da Huang Zhe Chong Wan and Bai Lao Wan can cleanse the source of the worms, while Tan Gan San and Qing Nang remedies can eliminate the harm of the worms. There are methods to differentiate the syndrome and prescriptions to treat the worms. For Chuan Shi symptoms, survival might be possible if addressed early. If one waits until the condition is established, it will be too late to regret.

An Bo notes: Yu Shi's theory that stagnation transforms into worms truly elucidates the secrets of predecessors.