蜘蛛（熬煎）十四枚 桂枝半两
右二味为散，取八分一匕，饮和服，日再服，蜜圆亦可。
【集解】
尤怡曰：蜘蛛有毒，服之能令人利，合桂枝辛温，入阴而逐其寒湿之气也。
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问曰：病腹痛有虫，其脉何以别之？师曰：腹中痛，其脉当沉，若弦，反洪大，故有
蛔虫。
【按】
腹痛有虫，以洪大脉别之，未详，必有缺文，不释。
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蛔虫之为病，令人吐涎，心痛，发作有时，毒药不止，甘草粉蜜汤主之。
【注】
蛔虫，即今之人所名食虫也。蛔虫之为病，发作有时，发则令人吐涎，心痛欲死，即
服攻下毒药，非积之痛，乃虫之痛，故不能止也。主之甘草粉蜜汤者，以虫得甘蜜而
上，得铅粉而杀，从治之法也。
【集注】
徐彬曰：发作有时，谓不恒痛也，则与虚寒之绵绵而痛者异矣。毒药不止，则必治气
治血，攻寒逐积之药，俱不应矣，故以甘草粉蜜主之。白粉杀虫，甘草与蜜既以和胃
，又以诱蛔也。
李□曰：『灵枢』云：蛔动则胃缓，胃缓则廉泉开，故涎下，令人吐涎也。蛔上入膈
，心在膈上，故心痛，须臾下膈，则痛止，故发作有时也。廉泉任脉穴名，在颔下骨
尖中。
甘草二两 粉一两 蜜四两
右三味，以水三升，先煮甘草，取二升，去滓，内粉蜜，搅令和，煎如薄粥，温服一
升，差即止。
【集解】
李□曰：蛔得甘则动，其性喜故也。胡粉有毒能杀虫，置粉于甘草蜜汤中，诱蛔食之
也。
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蛔厥者，当吐蛔，今病者静而复时烦，此为藏寒，蛔上入膈，故烦，须臾复止，得食
而呕又烦者，蛔闻食臭出，其人当自吐蛔。蛔厥者，乌梅丸主之。
【按】
此为藏寒之「此」字，当是「非」字，若是「此」字，即是藏厥，与辨蛔厥之义不属
。
【注】
蛔厥者，谓蛔痛手足厥冷也。若藏寒痛厥，则不吐蛔，此蛔厥、藏寒之所由分也。静
而时烦，乃蛔上入其膈，故烦，须臾复止，得食又吐又烦，是蛔闻食臭出故也。主之
乌梅丸者，以蛔得酸则静，得辛则伏，得苦则下，方中大酸、大辛、大苦，信为治虫
之要剂也。
【蜘蛛散方】
蜘蛛（经熬制）十四枚，桂枝半两。
以上两味药研成散剂，每次取一方寸匕的量，用温水调服，每日服用两次，做成蜜丸服用也可以。
【集解】
尤怡说：蜘蛛有毒，服用后能使人腹泻，配合桂枝的辛温之性，可进入阴分以驱逐寒湿之气。
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问：如果病人腹痛且有寄生虫，其脉象应如何辨别？老师说：腹中疼痛，脉象应当是沉脉或弦脉，如果反而出现洪大脉，说明有蛔虫。
【按语】
对于腹痛有虫的情况，仅凭洪大脉来辨别，尚不明确，原文必有缺漏之处，此处不作解释。
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蛔虫引起的病症，会导致病人吐涎水，心部疼痛，发作具有时间规律，使用一般的杀虫毒药无效时，应以甘草粉蜜汤为主治方剂。
【注释】
蛔虫，就是现在人们所说的食虫。蛔虫引起的病症，发作具有时间规律，发作时让人吐涎水，心痛欲死，即使服用攻下杀虫的毒药，因为这不是积滞引起的疼痛，而是虫扰引起的疼痛，所以疼痛不能停止。主治用甘草粉蜜汤的原因，是因为虫子遇到甘味会上行，遇到铅粉会被杀死，这是顺从其习性而治的方法。
【集注】
徐彬说：发作具有时间规律，是指疼痛不是持续不断的，这就与虚寒导致的绵绵不绝的疼痛不同了。使用杀虫毒药无效，那么治疗气、治疗血、攻逐寒邪、消除积滞的药物都不起作用了，所以用甘草粉蜜汤为主治。白粉（铅粉）能杀虫，甘草和蜂蜜既能调和胃气，又能引诱蛔虫。
李□说：《灵枢》记载：蛔虫活动则胃气松弛，胃气松弛则廉泉穴开启，所以唾液流出，让人吐涎水。蛔虫上行进入膈部，心脏位于膈上，所以心痛，片刻后蛔虫下行回到膈下，疼痛就停止，所以发作具有时间规律。廉泉是任脉的穴位名，位于下巴骨尖中间。
甘草二两，粉一两，蜜四两。
以上三味药，用水三升，先煮甘草，取二升药液，去掉药渣，加入粉和蜜，搅拌混合均匀，煎煮成稀粥状，温热服用一升，病愈即停药。
【集解】
李□说：蛔虫遇到甘味就会活动，这是它的本性。胡粉（铅粉）有毒能杀虫，将粉放在甘草蜜汤中，是为了引诱蛔虫吃下去。
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蛔厥的病人，通常会吐出蛔虫，现在的病人安静的时候却时不时心烦，这是因为内脏寒冷，蛔虫上行进入膈部，所以心烦，片刻后又停止，吃东西后呕吐并且心烦，是因为蛔虫闻到食物的气味而出动，这个人应该会自己吐出蛔虫。患蛔厥病的，以乌梅丸为主治方剂。
【按语】
这里的“此”字，应该是“非”字，如果是“此”字，那就是脏厥，与辨别蛔厥的意义不符。
【注释】
蛔厥，是指因蛔虫疼痛导致手足厥冷。如果是内脏寒冷引起的疼痛和厥逆，就不会吐蛔虫，这就是蛔厥与脏寒的区别所在。安静而偶尔心烦，是蛔虫上行进入膈部的缘故，所以心烦，片刻后又停止，吃东西又吐又烦，是蛔虫闻到食物气味而出的缘故。主治用乌梅丸的原因，是因为蛔虫遇到酸味就安静，遇到辛味就伏藏，遇到苦味就下行，方剂中的大酸、大辛、大苦，确实是治疗虫症的重要药剂。
[Spider Powder Formula]
Scorpion (roasted) 14 pieces, Cinnamon Twig (Guizhi) half tael.
The above two ingredients are ground into a powder. Take one "bi" (a spoon-shaped measure of approximately 8 fen) mixed with warm water for oral administration, twice daily. It may also be taken as honey pills.
[Ji Jie - Collected Explanations]
You Yi stated: Scorpions are toxic; ingestion can induce diarrhea. Combined with the acrid-warm nature of Cinnamon Twig, it enters the Yin aspect to expel cold-dampness qi.
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Question: If a patient suffers from abdominal pain due to parasites, how should the pulse be differentiated? The Master said: In cases of abdominal pain, the pulse should typically be deep or wiry. If it is instead surging and large, it indicates the presence of Ascaris lumbricoides (roundworm).
[An Yu - Commentary]
Differentiating parasitic abdominal pain solely by a surging pulse is unclear; there must be missing text in the original source, so no explanation is provided here.
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Disease caused by Ascaris lumbricoides leads to salivation, cardiac pain, and intermittent episodes. When standard antiparasitic drugs fail, Gancao Fenmi Tang (Licorice, Lead Powder, and Honey Decoction) is the primary treatment.
[Zhu - Annotation]
Ascaris lumbricoides is what modern people call roundworms. The disease caused by these worms occurs intermittently. During an episode, it causes salivation and severe cardiac pain. Even if purgative or toxic antiparasitic drugs are administered, the pain persists because it is not caused by food stagnation but by worm agitation. Gancao Fenmi Tang is used because the worms ascend when encountering sweet flavors and are killed by lead powder. This is a method of treating according to the parasite's nature.
[Ji Zhu - Collected Annotations]
Xu Bin stated: "Intermittent episodes" means the pain is not constant, distinguishing it from the continuous pain of deficiency-cold. Since antiparasitic drugs are ineffective, treatments targeting qi, blood, cold, or stagnation will also fail. Therefore, Gancao Fenmi Tang is used. White powder (lead powder) kills parasites, while Licorice and Honey harmonize the Stomach and lure the worms.
Li [Name Missing] stated: The *Ling Shu* records that when Ascaris moves, the Stomach qi becomes lax; when Stomach qi is lax, the Lianquan acupoint opens, causing saliva flow and spitting. When Ascaris ascends to the diaphragm, and since the Heart is located above the diaphragm, cardiac pain occurs. When the worms descend below the diaphragm after a moment, the pain stops, hence the intermittent nature. Lianquan is an acupoint of the Ren Mai (Conception Vessel), located at the midpoint of the mandible.
Licorice (Gancao) 2 taels, Powder (Fen) 1 tael, Honey (Mi) 4 taels.
Take the above three ingredients with 3 sheng of water. First decoct the Licorice until 2 sheng remains, then remove the dregs. Add the powder and honey, stir well, and simmer until it resembles thin porridge. Take 1 sheng warm. Discontinue use once the illness resolves.
[Ji Jie - Collected Explanations]
Li [Name Missing] stated: Ascaris becomes active upon encountering sweetness, which is its nature. Hu Fen (basic lead carbonate/lead powder) is toxic and kills parasites. Placing the powder in the Licorice-Honey decoction serves to lure the worms into ingesting it.
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Patients with Hui Jue (Roundworm Cold Syndrome) typically vomit roundworms. Currently, the patient is quiet but experiences occasional irritability. This is due to internal cold, where Ascaris ascends to the diaphragm, causing irritability, which subsides after a moment. If eating triggers vomiting and irritability again, it is because the worms emerge upon smelling food odor, and the person will likely vomit roundworms spontaneously. For Hui Jue, Wumei Wan (Mume Pill) is the primary treatment.
[An Yu - Commentary]
The character "ci" (this) in "this is internal cold" should likely be "fei" (not). If it were "this," it would indicate Zang Jue (Visceral Cold Syndrome), which does not align with the differentiation of Hui Jue.
[Zhu - Annotation]
Hui Jue refers to cold extremities accompanied by pain due to Ascaris. If the cold extremities and pain were due to pure visceral cold, roundworms would not be vomited; this distinguishes Hui Jue from visceral cold. Quietness with occasional irritability indicates Ascaris ascending to the diaphragm. Eating triggers vomiting and irritability again because the worms respond to food odors. Wumei Wan is used because Ascaris calms with sour flavors, subdues with acrid flavors, and descends with bitter flavors. The prominent sour, acrid, and bitter properties in this formula make it a crucial agent for treating parasitic diseases.