经义
肠中有虫瘕及蛟 ，皆不可取以小针。心肠痛， 作痛，肿聚，往来上下行，痛有休止，腹热喜渴涎
出者，是蛟 也。以手按聚而坚持之，无令得移，以大针刺之，虫不动，乃出针。○帝曰∶人之涎下，何气使
然？岐伯曰∶胃中有热则虫动，虫动则胃
缓，胃缓则廉泉开，故涎下。○中热则消谷，消谷则虫上下作，肠胃充郭，故胃缓。胃缓则气逆，故唾出。（《灵枢》）
哲言
虫得木气乃生，得雨气乃化。故非厥阴风木之气不生，非太阴湿土之气不化。（张子和）
虫由湿热郁蒸而生，观之日中有雨，则禾节生虫，其理明矣。善乎！张戴人推言之也。曰∶水火属春夏，
湿土属季夏，水从土化，故多虫焉。人患虫积，多由饥饱失宜，或过餐鱼 酒酪，中脘气虚，湿热失运，故生
诸虫。小儿最多，大人间有其候。心 腹痛，呕吐涎沫，面色萎黄，眼眶鼻下青黑，饮食不进，肌肉不生，默
默欲眠，微有寒热，如不早治，相生不已。古人云∶虫长一尺，则能害人，虫若串贯，杀人甚急。（《证治准绳》）
湿热生虫，譬之沟渠污浊积久不流，则诸虫生于其中。（《推求师意》）
风字从虫，虫，风化也。湿热郁久则生虫，腐草为萤，陈麦为蛾之类。果实外壳完整，虫生于内，人之肠
胃，无物不受，岂得无虫？其猖狂于肠胃，为痛为呕，为嗽为嗜，种种烦苦，须仗医药。至蛔虫乃人之消化搬
运者，偶为食伤，则或吐出，或泻出，和中自安，不可攻伐。（《医学六要》）
一曰伏虫，长四寸许，为群虫之长。二曰蛔虫，长尺许，轻则呕吐腹痛，多则贯心杀人。三曰白虫，长五
寸余，母子相生，其形转大，至四五尺则杀人。四曰肉虫，状若烂杏，令人烦满。五曰肺虫，其状如蚕，令人
咳嗽声嘶。六曰 虫，状如虾蟆，令人呕吐。七曰弱虫，状如瓜瓣，令人多唾。八曰赤虫，状如生肉，令人肠
鸣。九曰蛲虫，状如菜虫，形至微细，居洞肠间，令人痔痢。又有三尸虫，状如马尾薄筋，根据脾而居，有头尾，
长三寸。又有劳虫、隔噎虫、癞虫、蛊虫、狐惑虫，未易枚举，类推而治之可也。（《医统》）
虫瘕之证，其痛则懊 难忍，或肚腹肿起而结聚于内，或往来上下而行无定处，或虫动则痛、静则不痛，
而有时休止，或腹热喜渴而口涎出者，是皆虫瘕之为患也，○虫之为病，人多有之，由于化生，诚为莫测。在
古书，虽曰由湿由热，由口腹不节，由食饮停积而生，是固皆有之矣。然以常见验之，则凡脏强气盛者，未见
其有虫，正以随食随化，虫自难存。而虫能为患者，终是脏气之弱，行化之迟，所以停聚而生耳。然生虫数者
之中，又惟生冷为最，即如收藏诸物，但着生水，或近阴湿，则易蛀腐。故凡爱养小儿，极当节其水果。至治
虫之法，虽当去虫，而欲治其生虫之本，以杜其原，尤当以温养脾肾元气为主。但使脏气阳强。非惟虫不能留，
亦不能生也。予制有温脏丸方最宜。（张景岳）
补编
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。○蛔厥者，乌梅圆主之。（《金匮》）
吐蛔一证，内伤者有热、有寒，有虚、有实，有风木所化，有湿热所生，小儿患者最多，大人亦复不少。
其证必兼心腹作痛，呕酸痰水。治法∶热者清之；寒者温之；虚者补之；风木所化者平之；湿热所生者清利之，
法固善矣。第物必先腐而后虫生，果实热为害，先暂治标，而后求本。若虚热为灾，宜急治本，而决无标可求。
否则虫可杀，而人独不可杀耶？又有时令吐蛔，始得之二、三日，壮热如烙，口渴喜冷，舌苔黄浓而燥，厥冷
不过肘膝，二便秘涩，其人强壮，脉洪大，或沉数有力者，乃邪在阳明，胃中热甚，蛔不能容。治宜清热逐邪，
如麦冬、丹皮、贝母、黑豆、银花、黄泥、黄连之属，此治阳明实热有余之吐蛔也。然亦有胃寒之人，时令二、
三日，吐蛔，在胃而不在厥阴者，即投理中汤治之，勿泥胃热而概用凉药也。如至七、八日后，身体微热，口
不渴饮，舌苔虽黄浓而润，厥冷过于肘膝，二便清利，其人体弱，或属老幼，脉虚大，或细迟无力者，乃邪陷
厥阴，胃中虚冷，
蛔不能安。治宜温脾胃、补肝肾，如理中汤加人参、桂、附、丁香、乌梅；或八味汤加人参、枸、菟、 、
术，此治厥阴虚寒不足之吐蛔也。夫内伤吐蛔，责在脾而先责在肾；时令吐蛔，治在邪而先治在正。若不知此，
而可谓之善医乎？（《会心录》）
虫类虽多，其原皆由饮食停滞，湿热郁蒸，变化而成。凡面色萎黄，饮食不为肌肤，起伏作痛，聚散不定，
痛止即能饮食者，皆有虫积。或从呕出，或从便出，治法当观其微甚。若虫势骤急者，暂为攻逐，如黑丑、槟榔、
大黄、胡粉、山棱、莪术，虫去则调其脾胃。缓者用酸苦泄热燥湿，兼以相制相畏之品，如川连、胡连、芦荟、
苦楝、乌梅、川椒、雷丸、芜荑、使君、榧肉，脾弱者兼运其脾，胃滞者兼消其滞。○吐蛔本属肝胃之病，盖
因厥阴之邪上逆，蛔不能安，故从上而出也。其因客邪为病而致吐蛔者，虽有泻心汤、桂枝黄连汤、安胃丸等
方，然皆不离乎仲景之乌梅丸法，以苦辛酸寒热并用。至于幼稚有吐蛔、泻蛔及诸虫之证，治标则有杀虫之方；
治本则温补脾胃，或佐清疳热。前人各有成法，不必重赘。（《临证指南》）
平时嗜酒，血入于酒，则为酒鳖；平时多气，血凝于气，则为气鳖；虚劳痼冷，败血杂痰，则为血鳖；摇
头掉尾，如虫行止，上侵胃脘，食人脂膜；或附胁背；或隐胸腹。惟芜荑炒煎服之，兼养胃益血理中，乃可杀
之。若徒以雷丸、锡灰，不能去也。（《仁斋直指》）
吐蛔，有寒、有热、有寒热交错。寒则手足厥逆，吐出之蛔色淡白者，理中汤加乌梅、蜀椒；甚则蛔死
而形扁者危矣。热则蛔色赤而多跳动不已，安蛔丸主之。寒热交错，则病者静而复时烦，得食而呕，蛔闻食臭
出，乌梅丸主之。大抵吐蛔寒热交错者多，方中每用川椒、黄连、乌梅之类。盖蛔闻酸则静，得苦则安，遇辣
则伏。（薛立斋）
如或希奇怪病，除痰、血外，百治不效者，即是虫为患。视其
经络虚实，更参脉证消息治之。○按古方杀虫，如雷丸、贯众、干漆、蜡虫、百部、铅灰，皆所常用。有加附
子、干姜者，壮正气也；加苦参、黄连者，虫得苦则安也；加乌梅、诃子者，虫得酸则伏也；加藜芦、瓜蒂者，
欲其带虫而吐也；加芫花、黑丑、大黄、巴豆者，欲其带虫而下也。又雄黄，川椒、蛇床、樟脑、水银、槟榔
治疥虫；胡桐泪、韭子、蟾酥治龋齿虫；川槿、海桐皮治癣虫；青葙子、覆盆叶治九窍虫；败鼓皮、桃符版、
虎粪骨、死人枕、獭爪、鹤骨驱瘵虫。或用东引苦楝根、石榴皮煎汤吞药，取其先得天地生长之气，以助人身
发生之气，又性能杀虫，皆有至理。（《医学六要》）
丹溪云∶虫头向下之时，必须俟其向上，法当行于月半之前也。若虫得食，则不食药，亦不能下虫，而
徒泻其虚也。故虽有方，不知其法，则亦不效。凡欲下虫，必先一日不食而使虫饥，次早五更，用油煎肉嚼之，
良久，腹内虫闻肉香，头皆向上而欲食，乃以鸡蛋煎饼和药，嚼而食之。须臾，服葱汤或白水，以助药力下行，
不萸时而虫俱下。然后以白粥补之，随服补剂调理脾胃，而疾可愈。（徐东皋）
按丹溪所云，皆治虫法之善者，然此惟缓治之法耳。若虫证甚急，安能必待其时乎？且以望前、望后辨
虫头，亦渺茫无据。观先用香饵而虫头可引，岂非望后之治，亦自有法也。（张景岳）
脉候
病腹痛有虫，其脉何以别之？曰∶腹中痛，其脉当沉若弦，反洪大，故有蛔虫。（《金匮》）
选案
吴少师得疾数月，肌肉消瘦，饮食下咽，少时腹如攒攻，且痒且痛，以为劳瘵。张锐切脉云∶明早忍饥，
勿啖一物，俟锐来为计。旦往请，选一卒往十里外取黄土一盂，而令厨人治面。将午，乃得食，才放筋，取土
适至，于是温酒一升，投土搅其内，
出药百粒，进饮之。觉肠胃掣痛，几不堪忍，急登溷，暴下秽恶斗许，有马蝗千余，宛转盘结，半已困死。吴
亦惫甚，扶息榻上，移时餐粥一器，三日而平。始悟去年夏夜中途躁渴，命挹涧水，甫入口，似有物焉，欲吐
之，则径入喉矣，自此遂得病。锐曰∶虫入滋生，常日遇食时，则聚丹田间吮咂精血，饱则散处，苟惟知杀之，
而不能扫尽，无益也。是以请公枵腹以诱之，此虫喜酒，又久不得土味，乘饥毕集，故一药能洗空之耳。（《证治准绳》）
杨 得异疾，每发言，腹中有声效之。有道人见而惊曰∶此应声虫也。宜读《本草》，遇虫不应者，可取
服之。如言读至雷丸，虫无声，服之愈。后一丐者疾同，亦服而愈。（《 斋闲览》）
郑春元年壮体肥，患寸白虫，昼夜从大孔出，饮食倍常， 瘦殊甚，诊脉紧滑。按丹溪云∶湿热生虫，犹
腐草为萤之义，寄于肠胃，为害不浅。治以化虫丸，去虫升许，已绝一月矣。间时，虫复出，思此必有大虫在
内，不除其根，生生不息。病者曰∶腹中常觉有大物搅之，公言其然乎？遂以雷丸、槟榔、鹤虱各三钱，苦楝
根七钱，浓煎，上半夜先以砂糖水引虫口向上，服药以五更，下小虫百数。再服二渣，果下大虫一条，约丈余，
色青白相间，若蛇状，意谓虫患再可绝矣。越七月，小虫又复出，仍以前方再服，复下一大虫，约长七尺许，
腹内小虫不可数计。自此雄雌二虫俱出，饮食如常，形体复旧。（余午亭）
一族兄卖水为生，好酒，夏月卧处尝湿。病寒热旬日，遍身发疮，疮中生虫，痒不可耐。以针挑出，小者
如粟，大者如米，或令以鸡蛋摊饼贴之，不能遍及。江藕塘先生命采桑叶一石，晒干，铺于楼板，夜卧其上。
桑叶能去风湿，虫闻桑香，尽皆钻出。再以黄柏、苦参作汤浴之，数日而愈。医者意也，此不药之药也。○一
女十岁，脾虚有湿，浮肿肚胀，服补脾利湿之剂，愈而复者再。脐中流出黄水，有虫一条，长四寸，此亦未见
之事。究水与虫，皆湿热所生，仍用前剂，加土炒黄连，渐愈后，服补脾末药，
病不复作。（许宣治）
一儿偶因饮食不调，幼科治用清火化滞之剂，更损胃气，反致呕吐溏泻，遂致吐蛔。初止数条，渐至数
十，成团而出，下亦如之，羸困至极。予与温胃饮二剂，虫多如故，不识何所从来，而神化之速一至如此。乃
翁切恳先逐此虫，虫不尽则病日甚，其能生乎？予弗之听，但以前药倍加人参，仍加附子，服二、三剂，吐稀
泻止。乃以理阴煎、温胃饮出入间用，旬日而虫渐少，月余食进肉生。其翁称谢，问曰∶小豚之病诚危，何以
不治虫，不治吐泻，而三者俱愈？予曰∶公之所畏者虫也，予之所畏者胃气也。且凡逐虫之药，无有不伤胃气，
向使胃气再伤，非惟不能逐虫，而命必随之。但使脾胃日强，则拔去化虫之原，而三病同归一得矣。○一人患
心腹痛不可忍，百药不效。但于痛极时用拳捶之，痛得少止，而旋止旋作，莫测其故。忽一僧见之曰∶余能治
也。令病者先食香饵，继进药丸，下一异虫，遂愈。此因虫嚼肠脏，所以痛极。捶之则五内震动，虫亦畏伏，
不捶则虫得自由，所以复作。此亦验虫奇法，故凡见心腹痛证，但用揉、按、重捻而痛得暂止者，多有因虫而
然也。（张景岳）
一人腹如铁石，脐中水出，旋变作虫行，绕身匝痒，拨扫不尽。用苍术浓煎汤浴之，仍以苍术入麝香少
许调服即愈。（《同寿录》）
附方
温脏丸 虫积多由脏气虚寒，宜温健脾胃以杜其源。人参、白术、当归、芍药、茯苓、川椒、榧肉、使
君子、干姜、吴萸、槟榔。为末，神曲糊丸，桐子大。每服五、七十丸或百丸，饥时白汤下。○脏寒者加制附子。
九味地黄丸 治肾疳。熟地、山药、萸肉、丹皮、赤茯苓、当归、川芎、川楝子、使君子。为丸，空心
温酒下。
【经文释义】
肠道中有虫瘕以及蛟蛕（一种寄生虫），都不可用小针治疗。如果心肠疼痛，腹部出现肿块聚结，上下移动游走，疼痛有间歇性，腹部发热、喜欢口渴且口中流出涎沫的，这是蛟蛕病。用手按住肿块并固定住，不让它移动，用大针刺入，虫子不动后，再拔出针。○黄帝问：人为什么流口水？岐伯回答：胃中有热则虫子躁动，虫子躁动则胃气松弛，胃气松弛则廉泉穴开启，所以口水流出。○体内有热则消化食物快，消化快则虫子在肠胃中上下活动，导致肠胃胀满，所以胃气松弛。胃气松弛则气机上逆，所以吐出唾液。（出自《灵枢》）
【哲人言论】
虫子得到木气才生成，得到雨气才变化。所以没有厥阴风木之气就不能生成，没有太阴湿土之气就不能化生。（张子和）
虫子是由湿热郁结蒸腾而产生的，看白天有雨时，稻节上就会生虫，这个道理就很明白了。张戴人推论得很好。他说：水和火属于春夏季节，湿土属于季夏（长夏），水从土中化生，所以多生虫。人患虫积，大多是因为饥饱失调，或者过量食用鱼肉、酒类、奶酪等，导致中脘气虚，湿热运化失常，所以生出各种虫子。小儿最多见，大人偶尔也有这种情况。症状包括心腹疼痛，呕吐涎沫，面色萎黄，眼眶和鼻下青黑，饮食不进，肌肉消瘦，默默想睡觉，轻微寒热，如果不早点治疗，病情会相生不已地加重。古人说：虫子长到一尺长，就能害人；如果虫子串联成串，杀人非常急迫。（出自《证治准绳》）
湿热生虫，就像沟渠污浊积聚久了不流动，就会在其中生出各种虫子。（出自《推求师意》）
“风”字里包含“虫”，说明虫是风化而成的。湿热郁结久了就生虫，比如腐草化为萤火虫，陈麦化为飞蛾之类。果实外壳完整，虫子却生在内部，人的肠胃无物不受纳，怎么可能没有虫？它们在肠胃中猖狂作乱，引起疼痛、呕吐、咳嗽、嗜食异物等种种痛苦，必须依靠医药治疗。至于蛔虫，是人体消化的搬运者，偶然因饮食损伤，就会吐出或泻出，只要调和脾胃自然安宁，不可强行攻伐。（出自《医学六要》）
第一种叫伏虫，长约四寸左右，是群虫的首领。第二种叫蛔虫，长约一尺，轻则呕吐腹痛，重则贯穿心脏杀人。第三种叫白虫，长约五寸多，母子相生，形体变大，达到四五尺长就能杀人。第四种叫肉虫，形状像烂杏，让人烦闷胀满。第五种叫肺虫，形状像蚕，让人咳嗽声音嘶哑。第六种叫蝚虫（ruǎn chóng），形状像蛤蟆，让人呕吐。第七种叫弱虫，形状像瓜瓣，让人多唾。第八种叫赤虫，形状像生肉，让人肠鸣。第九种叫蛲虫，形状像菜虫，形体极微小，居住在直肠间，让人患痔疮痢疾。又有三尸虫，形状像马尾薄筋，依附脾脏居住，有头尾，长三寸。还有劳虫、隔噎虫、癞虫、蛊虫、狐惑虫等，难以一一列举，可以类推治疗。（出自《医统》）
虫瘕的病证，疼痛时懊恼难忍，有的肚子肿起并在内部结聚，有的上下移动游走无定处，有的虫子动则痛、静则不痛，且有间歇性，有的腹部发热喜欢口渴且口流涎沫，这些都是虫瘕造成的危害。○虫作为疾病，很多人都有，由于化生而成，确实难以预测。在古代书中，虽然说是由湿、由热、由口腹不节制、由饮食停积而生，这些固然都存在。但以常见情况验证，凡是脏腑强壮、气血旺盛的人，没见到有虫病的，正是因为随吃随化，虫子很难存活。而能因虫致病的，终究是脏气虚弱，运化迟缓，所以停聚而生虫。然而在各种生虫的原因中，又以生冷食物最为严重，就像收藏的各种物品，只要沾上生水，或者靠近阴湿之处，就容易蛀蚀腐烂。所以凡是爱护养育小儿，极应当节制他们吃水果。至于治疗虫的方法，虽然应当去虫，但想要治好生虫的根本，以杜绝源头，尤其应当以温养脾肾元气为主。只要使脏气阳气强盛，不仅虫子不能留存，也不能生成了。我制作的温脏丸方剂最合适。（张景岳）
【补编内容】
蛔虫引起的病，让人吐涎水，心痛，发作有时，服用毒药无效，用甘草粉蜜汤主治。○蛔厥证，用乌梅丸主治。（出自《金匮要略》）
吐蛔这一证候，内伤导致的有热、有寒、有虚、有实，有风木所化生的，有湿热所生成的，小儿患者最多，大人也不少。其症状必然兼有心腹疼痛，呕吐酸痰水。治疗方法：热的清之；寒的温之；虚的补之；风木所化的平之；湿热所生的清利之，法度固然很好。但是物体必须先腐烂然后虫子才会生，果实被虫蛀害，先暂时治标，然后求本。如果是虚热为灾，应当急治本，绝对没有标可求。否则虫子杀死了，人难道也死了吗？又有时令吐蛔，刚得病二三天，壮热如火烙，口渴喜冷，舌苔黄厚而干燥，四肢厥冷不过肘膝，大小便涩滞，其人身体强壮，脉象洪大，或沉数有力的，这是邪气在阳明经，胃中热甚，蛔虫无法忍受。治疗宜清热逐邪，如麦冬、丹皮、贝母、黑豆、银花、黄泥、黄连之类的药物，这是治疗阳明实热有余导致的吐蛔。然而也有胃寒的人，时令病二三天，吐蛔，病位在胃而不在厥阴经的，立即投用理中汤治疗，不要拘泥于胃热而一概使用凉药。如果到了七八天后，身体微热，口不渴饮，舌苔虽黄厚但湿润，四肢厥冷超过肘膝，大小便清利，其人身体虚弱，或属于老幼，脉象虚大，或细迟无力的，这是邪气陷入厥阴经，胃中虚冷，蛔虫不得安宁。治疗宜温脾胃、补肝肾，如理中汤加人参、桂枝、附子、丁香、乌梅；或者八味丸加人参、枸杞、菟丝子、杜仲、白术，这是治疗厥阴虚寒不足导致的吐蛔。内伤吐蛔，责任在脾而先责在肾；时令吐蛔，治疗在邪气而先治在正气。如果不知道这些，能称为善于医术吗？（出自《会心录》）
虫类虽然多，其根源都是由饮食停滞，湿热郁结蒸腾，变化而成。凡是面色萎黄，饮食不能转化为肌肤，起伏作痛，聚散不定，痛止就能饮食的，都是有虫积。有的从呕吐出，有的从大便出，治疗方法应当观察病情的轻重。如果虫势突然紧急，暂时进行攻逐，如黑丑、槟榔、大黄、胡粉、三棱、莪术，虫去之后调理脾胃。缓慢的用酸苦泄热燥湿，兼用相制相畏的药物，如川连、胡连、芦荟、苦楝、乌梅、川椒、雷丸、芜荑、使君子、榧肉，脾弱的兼运脾，胃滞的兼消滞。○吐蛔本来属于肝胃的疾病，大概因为厥阴的邪气上逆，蛔虫不得安宁，所以从上而出。那些因客邪致病而导致吐蛔的，虽然有泻心汤、桂枝黄连汤、安胃丸等方剂，但都不离乎张仲景的乌梅丸法度，以苦辛酸寒热并用。至于儿童有吐蛔、泻蛔及诸虫的病证，治标则有杀虫的方剂；治本则温补脾胃，或佐以清疳热。前人各有成法，不必重复赘述。（出自《临证指南》）
平时嗜好喝酒，血液进入酒中，就成为酒鳖；平时多气，血液凝滞于气中，就成为气鳖；虚劳痼冷，败血夹杂痰浊，就成为血鳖；摇头摆尾，像虫子爬行停止，向上侵犯胃脘，吃人的脂膜；或者附着胁背；或者隐于胸腹。只有芜荑炒煎服用，兼养胃益血理中，才可以杀死它。如果只用雷丸、锡灰，不能去除。（出自《仁斋直指》）
吐蛔，有寒、有热、有寒热交错。寒则手足厥逆，吐出的蛔虫颜色淡白的，用理中汤加乌梅、蜀椒；严重的蛔虫死亡而形体扁平的就危险了。热则蛔虫颜色红且多跳动不止，用安蛔丸主治。寒热交错，则病人安静但时不时烦躁，吃东西就呕吐，蛔虫闻到食物气味就出来，用乌梅丸主治。大抵吐蛔寒热交错的很多，方中常用川椒、黄连、乌梅之类。大概蛔虫闻到酸味就安静，得到苦味就安宁，遇到辣味就潜伏。（薛立斋）
如果遇到希奇古怪的病，除了痰、血之外，百治无效的，就是虫在作祟。观察经络虚实，再参合脉证斟酌治疗。○按古方杀虫，如雷丸、贯众、干漆、蜡虫、百部、铅灰，都是常用的。有加附子、干姜的，是为了壮正气；加苦参、黄连的，是虫子得苦味就安宁；加乌梅、诃子的，是虫子得酸味就潜伏；加藜芦、瓜蒂的，是想让它带着虫吐出来；加芫花、黑丑、大黄、巴豆的，是想让它带着虫排下去。又有雄黄、川椒、蛇床、樟脑、水银、槟榔治疥虫；胡桐泪、韭子、蟾酥治龋齿虫；川槿、海桐皮治癣虫；青葙子、覆盆叶治九窍虫；败鼓皮、桃符版、虎粪骨、死人枕、獭爪、鹤骨驱除瘵虫。或者用东引苦楝根、石榴皮煎汤吞服药物，取其先得天地生长之气，以助人身发生之气，又能杀虫，都有至理。（出自《医学六要》）
朱丹溪说：虫子头向下的时候，必须等到它头向上时，用药法应当在农历月半之前进行。如果虫子吃了东西，就不吃药，也不能下虫，反而徒然泻伤正气。所以虽然有方子，不知道方法，也不见效。凡是要下虫，必须先一天不吃饭让虫子饥饿，第二天早晨五更天，用油煎肉嚼着吃，过一会儿，肚子里的虫子闻到肉香，头都向上想吃，然后用鸡蛋煎饼和药一起嚼着吃。不久，喝葱汤或白水，以助药力下行，不一会儿虫子都下去了。然后用白粥补养，随即服用补剂调理脾胃，病就可以痊愈。（徐东皋）
按朱丹溪所说的，都是治疗虫病的良法，但这只是缓治的方法罢了。如果虫病非常紧急，怎么能一定等待那个时机呢？而且用望前、望后来辨别虫头，也是渺茫没有依据的。观察先用香饵引诱而虫头可以引来，难道不是望后（月半之后）的治疗，也有自己的方法吗？（张景岳）
【脉候】
病腹痛有虫，脉象如何区别？回答说：腹中痛，脉象应当沉或弦，反而洪大，所以有蛔虫。（出自《金匮要略》）
【选案】
吴少师患病几个月，肌肉消瘦，饮食咽下后，不久腹部像被攒刺攻击，又痒又痛，以为是劳瘵（肺结核）。张锐诊脉说：“明天早上忍住饥饿，不要吃任何东西，等我来了再想办法。”第二天早上去请他，他选了一个士兵去十里外取一盂黄土，让厨师做面食。快到中午，才吃到面，刚放下筷子，取土的人刚好回来，于是用一升温酒，投入黄土搅拌其中，拿出药丸一百粒，让病人喝下。病人感觉肠胃牵拉疼痛，几乎不能忍受，急忙上厕所，暴泻出秽恶之物约一斗多，有一千多条马蝗（蚂蟥），宛转盘结，一半已经困死。吴少师也非常疲惫，扶息在榻上，过了一会儿吃了一碗粥，三天就好了。这才醒悟去年夏夜中途烦躁口渴，让人舀涧水，刚入口，好像有东西，想吐出来，却径自进入喉咙了，从此就得了这个病。张锐说：“虫子进入滋生，平常遇到进食时间，就聚集在丹田田间吮吸精血，吃饱了就散处各处，如果只知道杀它们，而不能扫尽，是没有益处的。所以请先生空腹来引诱它们，这种虫子喜欢酒，又很久没吃到土味，趁着饥饿全部聚集，所以一服药就能把它们洗空。”（出自《证治准绳》）
杨氏得了一种怪病，每次说话，腹中有声音模仿他。有道士看见惊讶地说：“这是应声虫。应该读《本草》，遇到虫子不应声的，可以取来服用。如读到雷丸时，虫子没声音，服用后就痊愈了。后来一个乞丐病相同，也服用后痊愈。”（出自《 斋闲览》）
郑春元年身体壮实肥胖，患寸白虫（绦虫），昼夜从肛门排出，饮食加倍，身体却极度消瘦，诊脉紧滑。按朱丹溪所说：湿热生虫，就像腐草化为萤火虫的道理，寄生在肠胃，危害不小。用化虫丸治疗，排出虫许许多，已经断绝一个月了。偶尔，虫子又出来，心想这必定有大虫在里面，不除根，生生不息。病人说：“腹中常觉得有大物搅动，您说得对吗？”于是用雷丸、槟榔、鹤虱各三钱，苦楝根七钱，浓煎，上半夜先用糖水引导虫口向上，五更天服药，排出小虫数百条。再服两次药渣，果然排出一条大虫，约一丈多长，颜色青白相间，像蛇一样，心里以为虫患可以再绝了。过了七月，小虫又出来，仍用前方再服，又排出一条大虫，约长七尺左右，腹内小虫不可胜数。从此雌雄二虫都出来了，饮食如常，形体恢复旧观。（余午亭）
一族兄靠卖水为生，好喝酒，夏天睡觉的地方常常潮湿。患寒热病十天，遍身发疮，疮中生虫，痒得不可忍耐。用针挑出，小的像粟米，大的像米粒，或者让他用鸡蛋摊饼贴在上面，不能遍及全身。江藕塘先生命采集桑叶一石，晒干，铺在楼板上，晚上睡在上面。桑叶能去风湿，虫子闻到桑叶香味，全都钻出来。再用黄柏、苦参煮汤洗澡，几天就好了。医者意也，这是不用药的药。○一个十岁女孩，脾虚有湿，浮肿肚胀，服用补脾利湿的药剂，好了又复发多次。脐中流出黄水，有一条虫，长四寸，这也是未见之事。究其水与虫，都是湿热所生，仍用前剂，加土炒黄连，渐渐痊愈后，服用补脾末药，病不再发作。（许宣治）
一个小孩偶然因饮食不调，儿科医生治疗用清火化滞的药剂，更损伤胃气，反而导致呕吐溏泻，遂致吐蛔。起初只几条，渐至数十条，成团而出，下泻也是如此，瘦困至极。我给他用温胃饮两剂，虫多如故，不知从何而来，而神化之速竟到如此地步。他的父亲恳切要求先驱逐此虫，虫不尽则病日甚，还能活吗？我不听，只用前药倍加人参，仍加附子，服二、三剂，吐稀泻止。然后用理阴煎、温胃饮交替使用，十日而虫渐少，月余进食长肉。他父亲称谢，问道：“小孩子的病确实危险，为什么不治虫，不治吐泻，而三者都好了？”我说：“您所害怕的是虫，我所害怕的是胃气。而且凡逐虫的药，无不损伤胃气，假如胃气再受伤，不仅不能逐虫，性命必随之而去。只要使脾胃日渐强壮，就拔去了化虫的根源，而三种病同归于一得。”○一人患心腹痛不可忍受，百药无效。只在痛极时用拳头捶打，痛得稍止，但旋即又发作，不知原因。忽然一僧人说：“我能治。”让病人先吃香饵，继进药丸，排下一异虫，于是痊愈。这是因为虫啃咬肠脏，所以痛极。捶打则五脏震动，虫也畏惧伏藏，不捶打则虫得自由，所以又发作。这也是验虫的奇法，所以凡见心腹痛证，如果用揉、按、重捻而痛得暂时停止的，多有因虫而然的。（张景岳）
一人腹部硬如铁石，脐中出水，随即变成虫行感，绕身匝痒，拨扫不尽。用苍术浓煎汤洗澡，仍以苍术入少许麝香调服即愈。（出自《同寿录》）
【附方】
温脏丸：虫积多由脏气虚寒，宜温健脾胃以杜其源。人参、白术、当归、芍药、茯苓、川椒、榧肉、使君子、干姜、吴茱萸、槟榔。研为末，神曲糊丸，梧桐子大。每服五、七十丸或百丸，饥时白开水送下。○脏寒者加制附子。
九味地黄丸：治肾疳。熟地黄、山药、山茱萸、牡丹皮、赤茯苓、当归、川芎、川楝子、使君子。制成丸剂，空心温酒送下。
[Scriptural Meaning]
There are worm masses (parasitic growths) and Jiaoyu (a type of parasite) in the intestines; they should not be treated with small needles. If there is heart and intestinal pain, abdominal masses that gather and move up and down, with intermittent pain, abdominal heat, thirst, and salivation, this is a Jiaoyu condition. Press the mass firmly with your hand to prevent it from moving, insert a large needle, and once the worm stops moving, withdraw the needle. ○ The Yellow Emperor asked: Why does a person drool? Qibo answered: Heat in the stomach causes worms to move; when worms move, the stomach qi becomes lax; when stomach qi is lax, the Lianquan acupoint opens, causing saliva to flow out. ○ Internal heat accelerates digestion; accelerated digestion causes worms to move up and down in the intestines and stomach, leading to fullness and distension, hence lax stomach qi. Lax stomach qi causes rebellious qi, resulting in spitting. (From *Ling Shu*)
[Philosophical Remarks]
Worms are generated by Wood Qi and transformed by Rain Qi. Therefore, without the Wind-Wood Qi of Jueyin, they cannot be generated; without the Damp-Earth Qi of Taiyin, they cannot transform. (Zhang Zihe)
Worms arise from the stagnation and steaming of damp-heat. Observe that during rainy days, worms grow on rice nodes; the principle is clear. Zhang Dairen’s deduction is excellent. He said: Water and Fire belong to Spring and Summer; Damp Earth belongs to Late Summer. Water transforms from Earth, thus producing many worms. Human worm accumulation often results from irregular eating habits or excessive consumption of fish, meat, alcohol, and dairy, leading to deficiency of Qi in the Zhongwan area, failure of damp-heat transport, and generation of various worms. This is most common in children, occasionally seen in adults. Symptoms include heart and abdominal pain, vomiting of saliva, sallow complexion, bluish-black discoloration around the eyes and nose, loss of appetite, emaciation, lethargy, mild chills and fever. If not treated early, the condition will worsen continuously. Ancients said: A worm reaching one chi in length can harm humans; if worms link together, death occurs rapidly. (From *Zheng Zhi Zhun Sheng*)
Damp-heat generating worms is like dirty ditches stagnating for a long time without flow, where various worms breed within. (From *Qiu Qiu Shi Yi*)
The character "Feng" (Wind) contains "Chong" (Worm), indicating worms are products of wind transformation. Long-term stagnation of damp-heat generates worms, such as decaying grass turning into fireflies or old wheat turning into moths. Fruits have intact shells but worms inside; the human gastrointestinal tract accepts all substances, so how could it lack worms? When rampant in the gut, they cause pain, vomiting, coughing, and pica, creating much suffering, requiring medical intervention. Ascaris lumbricoides (Hui Chong) assists digestion; if injured by diet, it may be vomited or excreted. Harmonizing the stomach and intestines brings peace; aggressive attack is unnecessary. (From *Yi Xue Liu Yao*)
1. Fu Chong (Hidden Worm): Approx. 4 cun long, leader of the worms.
2. Hui Chong (Roundworm): Approx. 1 chi long; mild cases cause vomiting and abdominal pain, severe cases pierce the heart causing death.
3. Bai Chong (White Worm): Approx. 5 cun long, reproducing母子-style, growing larger; reaching 4-5 chi causes death.
4. Rou Chong (Flesh Worm): Resembles rotten apricot kernels, causing irritability and fullness.
5. Fei Chong (Lung Worm): Resembles silkworms, causing coughing and hoarseness.
6. Ruan Chong: Resembles a toad, causing vomiting.
7. Ruo Chong (Weak Worm): Resembles melon seeds, causing excessive salivation.
8. Chi Chong (Red Worm): Resembles raw meat, causing borborygmus.
9. Tuo Chong (Pinworm): Resembles vegetable worms, extremely tiny, residing in the rectum, causing hemorrhoids and dysentery.
Also present are Sanshi Chong (Three Corpse Worms), resembling thin horsehair tendons, residing on the spleen, with head and tail, 3 cun long. Others include Lao Chong, Ge Ye Chong, Lai Chong, Gu Chong, and Huo Huo Chong, too numerous to list; treat by analogy. (From *Yi Tong*)
Worm mass conditions involve unbearable distressing pain, abdominal swelling with internal nodules, wandering pain, pain triggered by worm movement and relieved by stillness, intermittent episodes, abdominal heat, thirst, and salivation. These are all harms caused by worm masses. ○ Worm diseases are common, arising from unpredictable transformations. Ancient texts attribute them to dampness, heat, dietary excess, and food stagnation, which are valid. However, observing common cases, those with strong viscera and abundant Qi rarely have worms because food is digested immediately, leaving no room for worms. Those afflicted by worms invariably have weak visceral Qi and slow metabolism, allowing stagnation and worm generation. Among causes, cold and raw foods are most critical; just as stored items rot when exposed to water or dampness, so do humans. Thus, protecting children requires restricting fruit intake. While treating worms involves expelling them, addressing the root to prevent recurrence primarily requires warming and nourishing Spleen and Kidney Yuan Qi. Strengthening Yang Qi prevents both worm survival and generation. My prepared Wenzang Wan formula is most suitable. (Zhang Jingyue)
[Supplemental Content]
Ascaris lumbricoides disease causes salivation, heart pain, and intermittent attacks; when toxic drugs fail, Gancao Fenmi Tang (Licorice, Flour, and Honey Decoction) is indicated. ○ For Hui Jue (Ascaris Cold Reversal), Wumei Wan (Mume Pill) is indicated. (From *Jin Gui Yao Lue*)
Vomiting ascarides due to internal injury can stem from Heat, Cold, Deficiency, Excess, Wind-Wood transformation, or Damp-Heat generation. It is most common in children, frequent in adults. Symptoms necessarily include heart/abdominal pain and vomiting of sour phlegm/water. Treatment principles: Clear Heat, Warm Cold, Tonify Deficiency, Pacify Wind-Wood, Clear and Drain Damp-Heat. These methods are sound. However, objects must rot before worms breed. For fruit infestation, treat symptoms first, then the root. For Deficient-Heat disasters, urgently treat the root, as there is no symptom to address superficially. Otherwise, killing worms might kill the patient. In seasonal vomiting of ascarides, occurring 2-3 days after onset, with high fever like burning, thirst for cold drinks, thick dry yellow tongue coating, cold limbs only to elbows/knees, constipation/urinary difficulty, strong constitution, and surging or deep-rapid-forceful pulse, the pathogen is in the Yangming channel with intense Stomach Heat, intolerable to ascarides. Treat by clearing heat and expelling pathogens using Maidong, Danpi, Beimu, Heidou, Yinhua, Huangni, Huanglian, etc., for Yangming Excess-Heat vomiting. Conversely, some with Stomach Cold vomit ascarides 2-3 days into seasonal illness; if the location is Stomach, not Jueyin, use Lizhong Tang immediately; do not rigidly assume Stomach Heat and use cooling drugs indiscriminately. By day 7-8, if mild fever, no thirst, thick moist yellow tongue coating, cold limbs beyond elbows/knees, clear urine/stool, weak constitution (elderly/child), and deficient-large or fine-slow-weak pulse, the pathogen has sunk into Jueyin with Stomach Deficient-Cold, making ascarides restless. Treat by warming Spleen/Stomach and tonifying Liver/Kidney using Lizhong Tang plus Renshen, Guizhi, Fuzi, Dingxiang, Wumei; or Jiwei Dihuang Wan plus Renshen, Gouqi, Tusizi, Duzhong, Baizhu, for Jueyin Deficient-Cold vomiting. Internal injury vomiting blames the Spleen but prioritizes the Kidney; seasonal vomiting treats the Pathogen but prioritizes the Righteous Qi. Ignoring this precludes being a skilled physician. (From *Huixin Lu*)
Although diverse, all worms originate from food stagnation and damp-heat steaming. Symptoms include sallow complexion, inability to convert food to flesh, fluctuating pain, variable aggregation, and resumed eating after pain subsides, indicating worm accumulation. Expulsion via vomiting or stool dictates treatment intensity. For acute urgency, temporarily purge using Heiqiu, Binglang, Dahuang, Hufen, Sanleng, Ezhu, then regulate Spleen/Stomach. For chronic cases, use sour/bitter to drain heat and dry dampness, combined with mutually restraining herbs like Chuanlian, Hulian, Lvhui, Kulian, Wumei, Chuanjiao, Leiwan, Wuyi, Shijunzi, Feirou. For weak Spleen, promote transport; for stagnant Stomach, resolve stagnation. ○ Vomiting ascarides originates from Liver/Stomach disharmony, specifically Jueyin rebellious qi disturbing ascarides. Even with formulas like Xiexin Tang, Guizhi Huanglian Tang, or Anwei Wan, they follow Zhang Zhongjing’s Wumei Wan method, combining bitter, sour, pungent, cold, and hot properties. For children with vomiting/diarrhea of ascarides or other worms, treat symptoms with insecticides; treat the root by warming/tonifying Spleen/Stomach or clearing malnutrition heat. Predecessors had established methods; no need to repeat. (From *Lin Zheng Zhi Nan*)
Chronic alcoholism leads to "Wine Bi" (blood entering wine); chronic Qi excess leads to "Qi Bi" (blood coagulating with Qi); chronic deficiency-cold with failed blood and phlegm leads to "Blood Bi". Symptoms include head-shaking/tail-wagging sensations like crawling insects, invading the epigastrium, consuming fat membranes, attaching to ribs/back, or hiding in chest/abdomen. Only fried and decocted Wuyi, combined with Stomach-nourishing and Blood-tonifying methods, can kill them. Leiwan and Tin Ash alone are ineffective. (From *Ren Zhi Zhi Zhi*)
Vomiting ascarides presents as Cold, Heat, or Mixed Cold-Heat. Cold causes cold limbs and pale white ascarides; treat with Lizhong Tang plus Wumei, Shujiao. Severe cases with flat dead worms are critical. Heat causes red, twitching ascarides; treat with Anqi Wan. Mixed Cold-Heat causes alternating calmness and irritability, vomiting upon eating, and ascarides emerging at food odors; treat with Wumei Wan. Most mixed cases use Chuanjiao, Huanglian, Wumei. Ascarides quiet at sourness, settle at bitterness, and hide at pungency. (Xue Lizhai)
For bizarre diseases unresponsive to phlegm/blood treatments, suspect worms. Assess meridian deficiency/excess and pulse/symptoms. Ancient vermifuges include Leiwan, Guanzhong, Ganqi, Wax Worm, Baibu, Lead Ash. Added Fuzi/Ganjiang to strengthen Righteous Qi; Kushen/Huanglian because worms settle at bitterness; Wumei/Hezi because worms hide at sourness; Lilu/Gua Di to induce vomiting with worms; Yuanhua, Heiqiu, Dahuang, Badou to induce defecation with worms. Xionghuang, Chuanjiao, Chuangxiang, Zhangnao, Shuiyin, Binglang treat scabies worms; Hutonglei, Jiu Zi, Chansu treat dental worms; Chuanjin, Haitongpi treat tinea worms; Qingxiangzi, Fupeny e treat nine-orifice worms; Baigu Pi, Taofu Ban, Hu Fen Gu, Si Ren Zhen, Da Zhua, He Gu dispel TB worms. Using East-growing Kulian root or Pomegranate peel decoction to swallow meds leverages Heaven-Earth growth Qi to assist human vitality and kills worms effectively. (From *Yi Xue Liu Yao*)
Zhu Danxi stated: Wait for worms to face upward before medicating, ideally before the full moon. If worms eat, they won't take medicine, nor will medicine expel them, merely draining deficiency. Without knowing the method, formulas fail. To expel worms, fast for one day to starve them. At 5 AM, chew fried meat; worms smell it and face upward. Then eat egg pancake with medicine. Shortly after, drink green onion soup or plain water to aid downward movement. Worms exit quickly. Follow with white porridge and tonic to regulate Spleen/Stomach for cure. (Xu Donggao)
Danxi’s methods are good but for chronic cases. Acute cases cannot wait. Distinguishing worm heads by lunar phases is baseless. Using bait to attract worm heads shows post-full moon methods exist. (Zhang Jingyue)
[Pulse Signs]
How to distinguish worm-induced abdominal pain by pulse? Abdominal pain usually presents with sinking or wiry pulses; if surging and large, it indicates ascarides. (From *Jin Gui Yao Lue*)
[Selected Cases]
Minister Wu suffered for months, emaciated, with immediate post-prandial abdominal stabbing/itching/pain, mistaken for TB. Zhang Rui diagnosed: Fast until tomorrow morning, do not eat anything. I will devise a plan. Next morning, he sent a soldier 10 li away to fetch yellow earth, instructed the cook to make noodles. At noon, noodles were served. Just as noodles were placed, earth arrived. One sheng of warm wine was mixed with earth, 100 pills added, and administered. Patient felt severe intestinal pulling pain, endured barely, rushed to toilet, violently expelled foul matter (approx. 1 dou), containing over 1,000 leech-like worms, tangled and half-dead. Wu was exhausted, rested briefly, ate congee, recovered in three days. He recalled drinking stream water last summer night; something entered his throat, causing illness. Zhang Rui explained: Worms gather at meal times to suck essence, disperse when full. Killing them without sweeping them out is useless. Fasting lured them; liking wine and craving earth taste, they gathered hungrily, allowing one dose to clear them. (From *Zheng Zhi Zhun Sheng*)
Yang suffered from "Echoing Worm"; abdomen mimicked speech. A Daoist suggested reading *Ben Cao*; take herbs that don’t echo. Reading to Leiwan, silence ensued; taking it cured him. A beggar with same symptoms was also cured. (From *Xi Zhai Xian Lan*)
Zheng Chunyuan was obese but suffered from tapeworms (Cunbai Chong), expelling them daily, eating double portions yet wasting away. Pulse tight and slippery. Following Danxi: Damp-heat generates worms like fireflies from rotting grass. Treated with Huachong Wan, expelled significant amount, cured for a month. Recurrence suggested a large parent worm remained. Patient felt large object churning. Prescribed Leiwan, Binglang, Heshi (3 qian each), Kulian Gen (7 qian), strong decoction. First half-night, sugar water guided worms up; medicine taken at 5 AM expelled hundreds of small worms. Second dose expelled one large worm, approx. 1 zhang long, blue-white striped like a snake. Thought cured. Seven months later, recurrence. Same prescription expelled another large worm, approx. 7 chi long, countless small ones. Male and female worms expelled, diet normalized, body restored. (Yu Wuting)
A cousin selling water drank alcohol, slept in dampness in summer. Had chills/fever for 10 days, body-wide sores breeding worms, unbearable itch. Needles extracted worms (small as millet, large as rice). Egg pancakes applied couldn’t cover all. Jiang Outang ordered 1 dan of mulberry leaves dried and spread on floorboards. Sleeping on them drew worms out via scent. Mulberry clears wind-damp. Bathed in Huangbai/Kushen decoction, cured in days. This is "medicine of intent," non-drug therapy. ○ A 10-year-old girl with Spleen deficiency-dampness had edema/distension. Recurred despite Spleen-tonifying/damp-draining herbs. Umbilicus oozed yellow fluid with a 4-cun worm. Water and worms stem from damp-heat. Continued previous formula with soil-fried Huanglian, gradually cured. Followed with Spleen-tonifying powder, no relapse. (Xu Xuanzhi)
A child had dietary irregularities; pediatrician used cooling/stagnation-resolving drugs, damaging Stomach Qi, causing vomiting/diarrhea, leading to ascarides vomiting. Initially few, then dozens clumped, severe emaciation. Given Wenwei Yin (2 doses), worms unchanged. Father urged expulsion, fearing worsening. I refused, doubled Renshen in previous formula, added Fuzi. After 2-3 doses, vomiting/diarrhea stopped. Alternated Liyin Jian and Wenwei Yin. Worms decreased in 10 days, flesh returned in 1 month. Father asked why not treat worms/vomiting directly. I replied: You fear worms; I fear Stomach Qi. Vermifuges damage Stomach Qi. Further damage would kill the patient. Strengthening Spleen/Stomach removes the source of worm generation, curing all three simultaneously. ○ Another had unbearable heart/abdominal pain, unresponsive to drugs. Punching provided temporary relief, then recurrence. A monk treated: Feed bait, then pills. Expelled strange worm, cured. Pain was due to worms chewing intestines; punching vibrated organs, frightening worms. Rubbing/massaging relieving pain often indicates worm origin. (Zhang Jingyue)
One had iron-hard abdomen, umbilical fluid turning into crawling sensation, whole-body itching. Bathed in strong Cangzhu decoction, took Cangzhu with Musk, cured. (From *Tong Shou Lu*)
[Attached Formulas]
Wenzang Wan (Warm Viscera Pill): Worm accumulation often stems from Visceral Deficient-Cold; warm and strengthen Spleen/Stomach to cut the source. Ingredients: Renshen, Baizhu, Danggui, Shaoyao, Fuling, Chuanjiao, Feirou, Shijunzi, Ganjiang, Wuyu, Binglang. Powdered, pillified with Shenqu paste, size of paulownia seeds. Take 50-100 pills, fasting, with plain water. ○ Add Zhi Fuzi for Deficient-Cold.
Jiuwei Dihuang Wan (Nine-Ingredient Rehmannia Pill): Treats Kidney Malnutrition (Shen Gan). Ingredients: Shudi, Shanyao, Yurou, Danpi, Chifuling, Danggui, Chuanxiong, Chuanlianzi, Shijunzi. Pill form, taken fasting with warm wine.