虫由湿热郁蒸而生，观之日中有雨，则禾节生虫，其理明矣。古分九虫三尸等论，余谓
自积
成虫，难以定名。若盗食人之气血，得其清者，谓之灵虫，久能移害于人，即劳虫、传尸、
尸疰之类是也。若采人之饮食，得其浊者，谓之物虫，久而能变异，即寸白、蛔虫、鱼鳖、
瘕之类是也。故物虫者，多因自积而成，乃有形可验之物，治宜以有形相制相畏之药，如
丸、芜荑、使君、川椒、黄连、苦楝之属。灵虫者，多因自虚而致，乃变化莫测之物，治宜
以气类相感之药，如桃仁、川椒、天灵盖、苏合香、麝香、朱砂之属。外有鬼气中恶，亦灵
虫之类也。因饮食虫蛭，及果中毒虫，亦物虫之类也。治宜格其物理，考其所畏以制之。又
有久患劳瘵，气亢血热之人，勿用辛烈等药，大抵人面萎黄，四肢无力，饮食不为肌肤，乃
血气虚损，起伏作痛，聚散不定，皆有虫害，宜急攻之。若待成灵，伤残脏腑，不可救矣
。服虫药宜前半月上半日，虫头向上时，忌妄言预泄，盖虫既有灵，能拒避汤药故也。
丹溪云∶疸证不必分五，同是湿热，如HT 酱相似，斯言已得大义。然考之《内经》有上
中下
之分，有曰目黄曰黄胆者，有曰黄瘅暴病久逆之所生也。少阴厥阴司天，四之气溽暑，皆发
黄胆者，悉是上焦湿热病也。有云食已如肌曰胃疸者，与脾风发瘅腹中热出黄者，又脾脉搏
坚而长，其色黄者，《灵枢》所谓脾所生病黄胆，皆中焦湿热病也。有谓溺黄赤安卧者黄胆
，及肾脉搏坚而长其色黄，《灵枢》所谓肾所生病黄胆，皆下焦湿热病也。独仲景妙得其义
，详于伤寒证中。有曰邪热入里，与脾经相交，则发黄；或内热已甚，复被火热，两阳相灼
亦发黄；或阳明热甚无汗，小便不利，湿热不泄亦发黄；或发汗已，身面目俱黄者，为寒湿
在里不解，故发黄。是知非特湿热发黄，而寒湿亦发黄也，但寒湿之黄，黑暗不明，热甚之
黄，明如橘色。大抵黄家属太阴，太阴者脾也，为湿热所蒸，则土之本色外现，或脉沉小，
腹硬，小便自利，其人如狂者，又为血在下而发黄也。治疸须分新久，新疸湿热少张，即当
消导渗利，如茵陈五苓散、茯苓渗湿汤之类，无不效者。久病脾胃受伤，血气必弱，宜用补
剂，如参术健脾汤、当归、秦艽之类，使正气盛则邪气自退，庶可收功。若口淡怔忡，耳鸣
脚软，或微寒热，小便赤白浊，又当作虚治，宜养荣汤，或八味丸、四君子皆可用，不可过
用凉剂，强通小便。恐肾水枯竭，久而面黑黄色，不可治矣。
虫是由湿热郁结蒸腾而产生的，看白天有雨时，禾苗的节间会长出虫子，这个道理就很明白了。古人将虫分为九虫、三尸等论述，我认为这些虫多由体内积滞而成，难以确切命名。如果它们偷食人的气血，吸取其中清轻的部分，就称为灵虫，时间久了能转移危害于人，这就是劳虫、传尸、尸疰之类的情况。如果它们摄取人的饮食，吸取其中浑浊的部分，就称为物虫，时间久了能发生变异，这就是寸白虫（绦虫）、蛔虫、鱼鳖（指类似形态的寄生虫）、瘕（腹中结块）之类的情况。所以物虫，大多因为体内积滞而形成，是有形可查的实体，治疗适宜用具有克制和畏惧关系的有形药物，如使君子、芜荑、榧子、川椒、黄连、苦楝皮之类。灵虫，大多因为人体虚弱而导致，是变化莫测的存在，治疗适宜用气味相感应的药物，如桃仁、川椒、人脑骨（天灵盖）、苏合香、麝香、朱砂之类。此外还有鬼气中恶，也属于灵虫一类。因饮食误入水蛭，以及水果中毒虫，也都属于物虫一类。治疗应当探究事物的物理规律，考察其所畏惧的药物来制约它。又有长期患有劳瘵（肺结核等慢性消耗性疾病），气亢血热的人，不要使用辛烈等药物。大抵面色萎黄，四肢无力，饮食不能转化为肌肉，这是气血虚损；疼痛起伏不定，聚散无常，都有虫害的可能，应当紧急攻逐。如果等到变成灵虫，伤残脏腑，就无法救治了。服用驱虫药宜在每月上半月的前半日进行，此时虫头向上，忌讳妄言预先泄泻，因为虫既然有了灵性，能够抗拒回避汤药的原因。
丹溪说：黄疸证不必分为五种，都是湿热所致，就像酱发酵相似，这话已经抓住了大义。然而考证《内经》中有上、中、下的区分，有的说眼睛发黄叫黄疸，有的说是黄瘅暴病久逆之所生。少阴、厥阴司天，四之气时的溽暑，都发黄疸，这些都是上焦湿热病。有的说吃完饭后感到饥饿但身体消瘦叫胃疸，与脾风发瘅腹中热排出黄色粪便的，还有脾脉搏动坚实而长，面色黄的，《灵枢》所谓脾所生病的黄疸，都是中焦湿热病。有的说小便黄赤且嗜睡的是黄疸，以及肾脉搏动坚实而长面色黄的，《灵枢》所谓肾所生病的黄疸，都是下焦湿热病。只有张仲景巧妙地得到了其中的义理，在伤寒证中阐述详细。有的说邪热入里，与脾经相交，就会发黄；或者内热已经很甚，又被火热侵袭，两阳相灼也会发黄；或者阳明热盛无汗，小便不利，湿热不排泄也会发黄；或者发汗后，身面目俱黄的，是寒湿在里不解，所以发黄。由此可知，不仅是湿热发黄，寒湿也会发黄，只是寒湿之黄，颜色黑暗不明，热甚之黄，明亮如橘色。大抵黄病归属于太阴，太阴就是脾，被湿热蒸腾，则土的本色外现。如果脉象沉小，腹部硬满，小便自利，其人如狂的，又是瘀血在下导致发黄。治疗黄疸须分新久，新发的黄疸湿热稍盛，就应当消导渗利，如茵陈五苓散、茯苓渗湿汤之类，没有不有效的。久病脾胃受伤，气血必然虚弱，适宜用补剂，如参术健脾汤、当归、秦艽之类，使正气旺盛则邪气自然退去，才可以收效。如果口淡、心悸怔忡、耳鸣脚软，或微有寒热，小便赤白浑浊，又当作虚证治疗，适宜用养荣汤，或八味丸、四君子汤都可以使用，不可过用凉剂，强行通利小便。恐怕肾水枯竭，久而久之面呈黑黄色，就无法治疗了。
Insects (parasites) are generated by the stagnation and steaming of damp-heat. Observing that during daytime rain, insects grow on the nodes of rice stalks makes this principle clear. The ancients classified parasites into nine types and three corpses (San Shi), but I believe these parasites arise from internal accumulation and are difficult to name definitively. If they steal and consume human Qi and Blood, extracting the pure and light parts, they are called "Spirit Parasites" (Ling Chong). Over time, they can spread harm to humans, such as in cases of Consumption Parasite (Lao Chong), Transmitted Corpse (Chuan Shi), or Corpse Dampness (Shi Zhu). If they ingest human food and drink, extracting the turbid parts, they are called "Material Parasites" (Wu Chong). Over time, they can mutate, such as Tapeworm (Cun Bai), Roundworm (Hui Chong), leech-like worms, or abdominal masses (Jia). Therefore, Material Parasites often form due to internal accumulation; they are tangible entities. Treatment should employ drugs with tangible restraining and fearing properties, such as *Quisqualis Fructus* (Shi Jun Zi), *Terminalia Chebula Retz.* (Wu Yi), *Torreya Grandis* (Fei Zi), *Zanthoxylum Bungeanum* (Chuan Jiao), *Coptis Chinensis* (Huang Lian), and *Melia Azedarach* (Ku Lian). Spirit Parasites, however, often result from internal deficiency; they are unpredictable entities. Treatment should employ drugs that resonate through Qi and flavor, such as *Prunus Persica* (Tao Ren), *Zanthoxylum Bungeanum* (Chuan Jiao), Human Skull Bone (Tian Ling Gai), *Styrax Tonkinensis* (Su He Xiang), *Moschus* (She Xiang), and *Cinnabar* (Zhu Sha). Additionally, Ghost Qi and Evil Midsection also belong to the category of Spirit Parasites. Ingestion of leeches via food/drink, or poisoning from fruit worms, belongs to the category of Material Parasites. Treatment requires investigating the physical nature of things and examining what they fear to control them. Furthermore, in patients suffering long-term from Phthisis (Lao Zhai) with hyperactive Qi and hot Blood, acrid and fierce drugs should not be used. Generally, a sallow complexion, weakness in the four limbs, and inability of food intake to nourish muscles indicate Qi and Blood deficiency. Pain that fluctuates, gathers and scatters unpredictably suggests parasitic infestation, requiring urgent attack. If one waits until they become Spirit Parasites, damaging the Zang-Fu organs, it will be incurable. Administering anti-parasitic drugs is best done in the first half of the lunar month, during the first half of the day when the parasite's head faces upward. One should avoid rashly prescribing purgatives, as parasites, having gained spirit, can resist and evade decoctions.
Danxi stated: Jaundice need not be divided into five types; all are caused by damp-heat, similar to the fermentation of soy sauce paste. This statement captures the general principle. However, consulting the *Nei Jing*, there is a distinction among Upper, Middle, and Lower Jiao. It states that yellow eyes indicate Jaundice (Huang Dan), which arises from sudden illness and prolonged reversal. When Shaoyin and Jueyin govern the year, and during the fourth Qi period of humid heat, jaundice occurs; these are all diseases of damp-heat in the Upper Jiao. It mentions that feeling hungry after eating but remaining emaciated is Stomach Jaundice (Wei Dan); combined with Spleen Wind causing damp-heat, abdominal heat, and excretion of yellow stool, along with a firm and long Spleen pulse and yellow complexion, as described in the *Ling Shu* regarding diseases produced by the Spleen, these are all diseases of damp-heat in the Middle Jiao. It also states that yellow-red urine and lethargy indicate Jaundice, and a firm and long Kidney pulse with a yellow complexion, as described in the *Ling Shu* regarding diseases produced by the Kidney, are all diseases of damp-heat in the Lower Jiao. Only Zhang Zhongjing skillfully grasped this essence, detailing it within the context of Cold Damage (Shang Han). It states that if pathogenic heat enters the interior and interacts with the Spleen Meridian, yellowing occurs; or if internal heat is severe and further aggravated by fire, the interaction of two Yangs causes yellowing; or if Yangming heat is severe without sweating and urination is obstructed, preventing the discharge of damp-heat, yellowing occurs; or after sweating, if the body, eyes, and face turn yellow, it is due to unresolved cold-dampness in the interior, causing yellowing. Thus, it is known that not only damp-heat causes yellowing, but cold-dampness does as well. However, yellowing from cold-dampness is dark and dull, while yellowing from severe heat is bright like an orange peel. Generally, Jaundice belongs to Taiyin; Taiyin refers to the Spleen. Steamed by damp-heat, the true color of Earth appears externally. If the pulse is deep and small, the abdomen is hard, urination is free, and the patient behaves like someone delirious, this indicates yellowing caused by blood stasis in the lower part. Treating Jaundice requires distinguishing between new and old cases. For new Jaundice where damp-heat is slightly prevalent, one should use resolving, guiding, and diuretic methods, such as *Yinchen Wuling San* (Artemisia Capillaris and Five-Ingredient Poria Decoction) or *Fuling Shen Shi Tang* (Poria and Dampness-Draining Decoction), which are invariably effective. For chronic cases where the Spleen and Stomach are damaged and Qi and Blood are weak, tonifying formulas should be used, such as *Shenzhu Jianpi Tang* (Ginseng and Atractylodes Spleen-Strengthening Decoction), *Angelica Sinensis* (Dang Gui), and *Gentiana Scabra* (Qin Jiao). When righteous Qi is strong, evil Qi naturally retreats, allowing for success. If there is a bland taste, palpitations, tinnitus, weak legs, slight chills and fever, or red-white turbid urine, it should be treated as deficiency. *Yangrong Tang* (Nourishing Ying Decoction), *Bawei Wan* (Eight-Ingredient Pill), or *Sijunzi Tang* (Four Gentlemen Decoction) may be used. Cool agents should not be overused to forcibly promote urination, lest Kidney Water be depleted, leading to a black-yellow complexion in the long run, which becomes incurable.