虫由少阳风木。湿热郁蒸而成。观日中有雨。则禾节生虫。人患虫积。多因饥饱失宜。中脘
气虚。湿热失运。故生诸虫。小儿最多。大人间有。其候心嘈腹痛。呕吐涎沫。面色痿黄。眼眶
鼻下有黑。嗜食米纸茶叶泥炭之类。沉沉默默欲眠。微有寒热。治宜随证用方。如心腹中痛。上
下往来。发作有休时。喜涎出者。虫也。乌梅丸。胃脘咬痛。发歇有时。痛发则吐涎沫。金匮九
痛丸。狐疑善惑者。妙功丸。噎膈呕吐者。剪红丸。肚腹常热者。化虫丸。四肢常冷者。集效丸。
腹中虫积。万应丸。膈上痰湿虫积。遇仙丹。谷道生疮。虫蚀痒痛。胶艾葙归汤。外用雄黄兑法。
随证取用。无不克应也。千金方用
猪胆一枚。苦酒半升和之。火煎令沸。三上三下。药成放温。空腹饮三满口。虫死便愈。治蛔攻
心痛神应。仁斋云。血入于酒。则为酒鳖。血凝于气。则为气鳖。败血杂痰。则为血痰。掉头掉
尾。上侵胃脘。食人脂膜。或附胁背。或隐胸腹。惟芜荑炒煎服之。然必兼养胃益血理中。乃可
杀之。若徒用雷丸、锡灰。不能去也。
治虫之药。必在夏月龙蛇起陆之时。服之方易奏功。若在万类蛰藏之际。虽有合剂。不能取
效也。丹溪以上半月。虫头向上。易治。当以上半日为是。先以糖蜜、肉汁、香甜物引起。后用
杀虫药。然须为散。以渣滓可入虫口也。痔漏中虫蚀下部。肛尽穿肠者。取虾蟆青背者一枚。入
芦荟一钱。用生雄鸡胫骨二茎。入满雌黄并用盐泥固济。烧存性。合和为散。入脑、麝、硼砂各
少许。再研极细。先以猪蹄甲三枚。胡葱七茎。煎汤日洗。纸捻 干。吹下部孔内。令深入。外
以黑膏盖之。日吹一次。以管尽为度。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。参脉证消息治之。虫在肝。令人恐怖。眼中赤壅。在心。心烦发躁。在脾。劳热。
四肢肿急。在肺。咳嗽气喘。医者不察。谬指凡动属火属痰。寒凉转伤脾胃。卒至夭枉。自非垣
视一方者。乌能辨哉。妇人阴蚀之虫。详妇人本门。
石顽曰。虫之怪证多端。遇之卒不能辨。昔人治例。有雷丸治应声虫之说。近有女子咳逆腹
痛后。忽喜呼叫。初时呀呷连声。渐至 唔不已。变易不常。或如母鸡声。或如水蛙鸣。或如舟
人打号。每作数十声。日发十余次。忍之则胸中闷闷不安。此为叫虫。即应声虫之类也。复有一
人患发热痞满后。常兀兀欲吐。吐中必有虫数枚。状如虾形。跳跃不已。诸治不应。或令服铜绿
涌之。不过二三度。遂绝不复见矣。
虫由少阳风木之气，在湿热郁蒸的环境中形成。观察自然现象可知，当烈日当空时若降下雨水，禾苗的节间就会生出虫子。人患虫积病，多是因为饮食饥饱失常，导致中脘部位气虚，湿热无法正常运化，从而滋生各种寄生虫。这种情况在小儿中最常见，成人偶尔也有。其症状表现为心中嘈杂、腹痛、呕吐涎沫、面色萎黄、眼眶和鼻下方发黑、嗜食米纸茶叶泥炭等异物、神情沉默想睡觉、伴有轻微的寒热感。治疗应当根据具体证候选用方剂。例如：心腹疼痛，痛处上下移动，发作有间歇时间，喜欢流涎水的，是虫积所致，用乌梅丸；胃脘部咬啮样疼痛，发作有定时，痛发时呕吐涎沫的，用金匮九痛丸；多疑善惑的，用妙功丸；噎膈呕吐的，用剪红丸；肚腹常感觉热的，用化虫丸；四肢常感觉冷的，用集效丸；腹中有虫积的，用万应丸；膈上有痰湿且伴有虫积的，用遇仙丹；肛门生疮，因虫侵蚀而瘙痒疼痛的，用胶艾葙归汤，外用雄黄兑法，随证取用，无不奏效。《千金方》用猪胆一枚，加苦酒半升混合，用火煎至沸腾，反复三次（三上三下），药成后放温，空腹饮下三口，虫死则病愈。此法治疗蛔虫攻心痛神效。仁斋说：血进入酒中，就变成酒鳖；血凝滞于气中，就变成气鳖；败血混杂痰浊，就变成血痰。这些虫类掉头摆尾，向上侵犯胃脘，吃人的脂膜，有的附着在胁背，有的隐藏在胸腹。只有将芜荑炒过后煎服才能杀灭它们。但必须兼用养胃益血理中的药物，才可以杀灭虫体。如果只用雷丸、锡灰，是不能去除虫病的。
治疗虫病的药物，必须在夏季龙蛇出洞之时服用，这样才容易见效。如果在万物蛰伏隐藏的时候，即使有合适的药剂，也不能取得疗效。丹溪认为上半月虫头向上，容易治疗，所以应当选择上半天服药。先用糖蜜、肉汁、香甜的食物引诱虫体，然后再用杀虫药。但是杀虫药必须制成散剂，因为残渣可以进入虫口。痔疮漏管中虫蚀下部，甚至肛门穿透肠道的，取一只背部青色的蛤蟆，加入一钱芦荟，再用两根生雄鸡胫骨，填满雌黄，并用盐泥密封固定，烧至存性，混合研成散剂。加入少许脑麝、硼砂，再研磨极细。先用猪蹄甲三枚、胡葱七茎煎汤，每日清洗患处，用纸捻擦干，将药粉吹入下部孔内，令其深入，外面用黑膏覆盖，每天吹一次，直到肛门孔愈合为止。如果是希奇古怪的病，除了痰血之外，百治不效的，就是虫在作祟。要视其经络虚实，参合脉证斟酌治疗。虫在肝，使人恐惧，眼中充血壅滞；虫在心，心烦发躁；虫在脾，出现劳热，四肢肿胀拘急；虫在肺，咳嗽气喘。医生如果不仔细考察，错误地指认凡是动症都属于火或痰，使用寒凉药物反而损伤脾胃，最终导致夭折死亡。如果不是像垣先生那样精通一方的人，怎么能辨别呢？妇人阴部被虫侵蚀的情况，详见妇人本门。
石顽说：虫病的怪异证候多种多样，遇到时往往不能立即辨别。前人治病案例中，有雷丸治疗应声虫的说法。近来有个女子在咳逆腹痛之后，忽然喜欢呼叫，起初呀呷连声，渐渐到唔唔不停，声音变化无常，有时像母鸡叫，有时像水蛙鸣，有时像船夫打号子，每次发作几十声，一天发作十几次，忍住的话胸中闷闷不安。这叫“叫虫”，也就是应声虫之类。另外有一人患发热痞满后，经常感到恶心欲吐，吐出的东西中必有几枚虫，形状像虾，跳跃不止，各种治疗都不见效。有人让他服用铜绿催吐，不过两三次，就不再复见了。
Insects (parasites) are formed from the wind-wood qi of Shaoyang, generated through the stagnation and steaming of dampness and heat. Observing nature, when rain falls under the scorching sun, insects are born in the joints of grain stalks. Humans suffering from intestinal parasites (Chong Ji) often do so due to irregular eating habits, leading to Qi deficiency in the Zhongwan region, where dampness and heat fail to transform properly, thus giving rise to various worms. This is most common in children and occasionally occurs in adults. Symptoms include heartburn (Xin Cao), abdominal pain, vomiting of saliva and foam, sallow complexion, dark circles under the eyes and nose, craving for non-food items such as rice paper, tea leaves, mud, or charcoal, lethargy with a desire to sleep, and slight chills and fever. Treatment should be tailored to the specific syndrome. For instance: if there is pain in the heart and abdomen that moves up and down, occurs intermittently, and is accompanied by salivation, it is caused by worms; use Wumei Wan (Mume Pill). If there is biting pain in the epigastrium occurring at fixed times, with vomiting of saliva upon onset, use Jingui Jiutong Wan (Nine-Pain Pill from the Golden Cabinet). For those who are suspicious and easily confused, use Miaogong Wan. For dysphagia and vomiting, use Jianhong Wan. For constant heat in the abdomen, use Huachong Wan. For constant coldness in the four limbs, use Jixiao Wan. For abdominal worm accumulation, use Wanying Wan. For phlegm-dampness and worm accumulation above the diaphragm, use Yuxian Dan. For ulcers at the anus caused by worm erosion with itching and pain, use Jiao'ai Xianggui Tang, applied externally with Xionghuang Dui method; used according to symptoms, all are effective. The Qianjin Fang prescribes one pig gallbladder mixed with half a sheng of vinegar, boiled over fire until bubbling three times (three ups and three downs). When cooled to warm temperature, drink three mouthfuls on an empty stomach; the worms die and the disease cures. This treats ascariasis attacking the heart with divine efficacy. Renzhai stated: Blood entering wine becomes "wine鳖" (jié); blood coagulating with Qi becomes "Qi鳖";敗血 (stagnant blood) mixed with phlegm becomes "blood-phlegm". These worms turn their heads and tails, invade the stomach upward, eat human fatty membranes, attach to the hypochondrium and back, or hide in the chest and abdomen. Only fried and decocted Yuanqi (Corydalis Rhizome) can kill them. However, it must be combined with herbs that nourish the stomach, benefit blood, and regulate the middle jiao to effectively eliminate the worms. Using only Leizhuang (Omphalia lapidescens) or Tin Ash cannot remove the disease.
Medicines for treating worms must be taken during the summer months when dragons and snakes emerge from hibernation, for this is when they are most effective. If taken during the time when all things are dormant and hidden, even correct formulas will not work. Danxi believed that in the first half of the lunar month, the head of the worm faces upward, making it easier to treat; therefore, medication should be administered in the first half of the day. First, attract the worms using sugar, honey, meat broth, and sweet foods, then administer vermifuges. However, these must be prepared as powders (San) because the residue can enter the worm's mouth. For worms eroding the lower part in hemorrhoids and fistulas, penetrating the anus and intestine, take one green-backed toad, add one qian of Lu Hui (Aloe), insert two raw rooster leg bones filled with Yan Huang (Realgar), seal with salt mud, calcine until the original nature remains, mix into a powder. Add small amounts of Nao (Camphor), She (Musk), and Pengsha (Borax), grind extremely fine. First, boil three pig trotter hooves and seven stems of Hu Cong (Wild Onion), wash the area daily, dry with paper twists, blow the powder deep into the anal opening, cover externally with Hei Gao (Black Plaster), apply once daily until the canal heals. If facing bizarre diseases unresponsive to treatments for phlegm and blood stasis, suspect worm pathology. Assess the excess or deficiency of meridians and consult pulse and symptoms for treatment. Worms in the Liver cause fear and redness/obstruction in the eyes; in the Heart, irritability and restlessness; in the Spleen, labor-fever and swollen/tight limbs; in the Lung, cough and asthma. Physicians who fail to examine carefully may mistakenly attribute all movement syndromes to Fire or Phlegm, using cold-cooling herbs that damage the Spleen and Stomach, leading to premature death. Only experts like Yuan Shi can distinguish this. Parasitic infection in women's genitals is detailed in the Women's Diseases section.
Shiwen said: Worm diseases present many strange symptoms, often difficult to identify immediately. Ancient cases mention Leizhuang treating Ying Sheng Chong (Echoing Worm). Recently, a woman developed cough, abdominal pain, then suddenly began shouting. Initially making gasping sounds, progressing to continuous humming, changing voices unpredictably—sometimes like a hen, sometimes like a frog, sometimes like boatmen calling out. Each episode lasted dozens of sounds, occurring ten-plus times daily. Suppressing it caused chest oppression. This is called "Jiao Chong" (Calling Worm), similar to Ying Sheng Chong. Another patient, after fever and fullness, frequently felt nauseous, vomiting several shrimp-like worms that jumped incessantly. Various treatments failed. Someone advised taking Tong Lv (Malachite Green) to induce vomiting; after two or three doses, the worms never reappeared.