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Hunger without desire to eat, and vomiting roundworms (Ascaris lumbricoides) after eating, indicates Jueyin disease (see discussion on "Qi rushing up to the heart").

Coldness of the hands and feet, a pulse that suddenly becomes tight, mental restlessness, hunger but inability to eat, indicates pathogenic factors in the chest. It is appropriate to induce vomiting with Gengdi San (Thistle Seed Powder) (for details, see "Jue").

In Taiyang disease, if vomiting is followed by sweating, resulting in fever, aversion to cold absent, fine and rapid Guan pulse, hunger in the abdomen but inability to eat due to oral obstruction, and regurgitation of food eaten in the morning by evening, this is considered a minor adverse reaction (see discussion on "Fever").

In Yangming disease, after purgation, if there is inner vexation, hunger without desire to eat, and sweating only on the head, Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) is appropriate (see discussion on "Vexation").

Qi rushing up to the heart accompanied by pain, hunger without desire to eat, and vomiting roundworms indicate Juevin disease. (Guizhi Baizhu Fuling Tang or Lizhong Anhui San can be used to regulate and calm the worms.)

Patients with Huijue syndrome (Roundworm-induced syncope/cold extremities) typically vomit roundworms. If the patient is quiet but experiences intermittent mental restlessness, it is because of internal cold causing the worms to move upward into the diaphragm, thus causing restlessness; the restlessness stops after a short while. If vomiting occurs after eating, followed by renewed restlessness, it is because the worms emerge upon smelling food odor, and the patient will likely vomit them spontaneously. Huijue syndrome should be primarily treated with Wumei Wan (Mume Pill). (Note: Huijue presents with cold extremities and vomiting of roundworms. Zangjue syndrome (Visceral Cold Syncope) has a poor prognosis due to exhaustion of Yang Qi. Although Huijue involves cold extremities, restlessness, and vomiting of worms, the patient becomes quiet after vomiting the worms, unlike Zangjue where the patient remains restless with no respite.)

If a patient suffers from internal cold and weak Stomach Qi, causing worms to disturb and move upward to the diaphragm, emerging upon smelling food and inducing vomiting, symptoms may include dry tongue and mouth, frequent desire for cold drinks but reluctance to swallow, severe irritability and confusion, extreme distress, deep and slow pulses in both wrists, cold feet extending to the knees, and in severe cases, expulsion of worms mixed with stool along with constipation. Although complex, this condition is generally treatable. Jiawei Lizhong Anhui San (Modified Lizhong Roundworm-Calming Powder) or Wumei Wan (Mume Pill) is appropriate.

If a patient has internal cold and is mistakenly subjected to sweating therapy, leading to coldness in the Stomach, vomiting of roundworms is inevitable. (The *Ren Shu* states: First administer Lizhong Wan, then Wumei Wan.)

**Wumei Wan Formula:**
Wumei (Fructus Mume, 300 pieces), Xixin (Herba Asari), Fuzi (Radix Aconiti Lateralis Preparata), Guizhi (Ramulus Cinnamomi, bark removed), Renshen (Radix Ginseng), Huangbai (Cortex Phellodendri) (each 6 liang); Danggui (Radix Angelicae Sinensis), Shujiao (Pericarpium Zanthoxyli, sweat removed) (each 4 liang); Ganjiang (Rhizoma Zingiberis Recens, 10 liang); Huanglian (Rhizoma Coptidis, 1 jin).
These ten ingredients are separately pounded and sifted, then mixed. Soak Wumei in Kujiu (bitter wine/vinegar) overnight, remove pits, steam over five sheng of rice until cooked, mash together with rice into a paste, mix with the herbs, place in a mortar with honey, and pound two thousand times. Form pills the size of tung tree seeds. Take ten pills before meals with warm water, three times daily, gradually increasing to twenty pills. Avoid raw, cold, slippery, and foul-smelling foods.
*(Commentary: The Lung governs Qi and prefers astringency; sour flavors astringe Lung Qi, so Wumei's sourness astringes Lung Qi. The Spleen prefers relaxation; sweet flavors relax the Spleen, so Renshen's sweetness relaxes Spleen Qi. When cold invades internally, pungent flavors moisten and bitter flavors strengthen; the pungency of Danggui, Guizhi, Shujiao, and Xixin moistens internal cold. When cold excess prevails, pungent-hot flavors level it; the pungent-hot nature of Ganjiang and Fuzi defeats cold. Roundworms become active with sweet flavors but settle with bitter ones; the bitterness of Huanglian and Huangbai settles the worms.)*

**Lizhong Anhui San:** Secret formula of Tao Shangfu, proven effective through repeated use.
Renshen (3 qian), Baizhu (Rhizoma Atractylodis Macrocephalae), Baifuling (Poria), Ganjiang (each 1.5 qian), Chuanjiao (Sichuan Pepper, 14 grains), Wumei (3 pieces).
Take as one dose, decoct in two zhong of water until reduced to seven-tenths, and drink. In treating roundworms, avoid Gancao (Licorice) and sweet substances, as roundworms become active upwards with sweetness, settle with bitterness, stop with acidity, and bury their heads downward with the pungency of Chuanjiao.

For persistent vomiting of roundworms, add Huanglian and Huangbai (each 0.5 fen) and Chuanjiao (14 grains). If cold is severe, add Fuzi (0.5 qian or 3 qian), adjusting according to severity.

**Dai's Viewpoint:** Coldness in the Stomach inevitably causes vomiting of roundworms. While vomiting roundworms is known as a Yin syndrome, Yang syndrome cases also exist. This occurs when the Stomach is empty lacking grain Qi, causing worms to seek food upward and vomit at the throat. One must consider other symptoms and not attribute it solely to Stomach cold. I recall a case of Yang Jaundice with roundworm vomiting and severe macules, classified as Yang Toxin syndrome with mouth ulcers, sore throat, and worm vomiting, which was successfully treated with cold-natured medicines. Thus, Yang syndrome presentations do occur.