蛔虫为物，或谓为消谷虫，或谓为自湿热而生。弟子上总糟谷骏，尝着一书，曰∶蛔有宿蛔，有新蛔。宿蛔
者，犹龙蛇之于天地间，人所常有，触事而动，然不人人必有，有亦不多。新蛔者，犹蠹蛆之类，须湿热而生，
生必繁息，致疾最剧。余又以谓蛔之为患，往往使人善饥，则云之消谷，固无不可。然人身既有胃脘之阳，以
化水谷，以运精微，则倘云假力干蛔者，万无其理。但肠胃中不能无之，观经文而可见也。如其云必自湿热而
生，殆是知一不知二者已。骏之言能发前人之所未逮，余故表而出之，使读斯编者以有所考焉。
虫自湿热生 巢氏之衍九虫三 详矣，然虫之变，不可胜穷，要之皆以湿热为主，不可纯归土气虚与
食生。（《儒门事亲》）
《内经》曰肠胃为市，无物不受，无物不包。又曰饮食自倍，肠胃乃伤。若夫饮食不能谨节，则朝损暮伤，
自伤成积，积久成热，湿热泪生，而诸般奇形之虫，各从五行之气而化生矣。若夫膈噎、劳瘵、癞风、蛊胀、
狐惑、伤寒等证，无不生虫。医者宜于各类推而治之可也。（《正传》）（按∶石山意亦同，出后奇证中。）
饮食之入于胃也，非湿与热则不能腐化，化则虫随之以有其形，而与糟粕俱出于大肠者也。历象五月令曰∶
腐草化为萤。斯时也，湿热俱盛，故腐即化。人之饮食，可以类推。
今夫饮食湿热腐化而为虫，此固理之可有而不可多也。惟其不节，恣食浓味生冷，则邪气偏盛，湿热太过，是
以虫生过多则为害，故有腹痛食少呕吐清水之病生，而渐至于羸瘠而危者有矣。（《医统》）
九虫皆由脏腑不实，脾胃俱虚，杂食生冷甘肥油腻咸藏等物，节宣不时，腐败停滞，所以发动。又有神志
不舒，精魄失守，及五脏劳热，又病余毒，气血积郁而生，或食瓜果与畜兽内藏遗留诸虫子类而生。（《奇效》）
蛔者，阴类也，胃中湿热交蒸，顷刻而生。如物藏于器中，烘焙极燥，虽熟不坏。若有湿气，热即霉 而
生虫。（《胃气论》）
蛔之化生，有若蜒蚰，生长极速。（《金匮衍义》）
生冷生虫 虫之为病，人多有之，由于化生，诚为莫测。在古方书，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，则凡藏强气盛者，未闻其有虫，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，所以停聚而渐致生虫耳。然则或由湿热，或由生冷，或由肥甘，或因
滞腻，皆可生虫，非独湿热已也。然以数者之中，又惟生冷生虫为最，即如收藏诸物，但着生水，或近阴湿，
则最易蛀腐，非其义乎。故凡欲爱养小儿，极当节其水果，以防败脾，此实紧要之一端也。（《景岳》）
脉候 关上脉微浮，积热在胃中，呕吐蛔虫，心健忘。关上脉紧而滑者，蛔动。尺脉沉而滑者，寸白
虫。（《脉经》）
脉实大者生，虚小者死。（《正传》）
脉虚小者生，紧急者死。（《玉案》）
脉沉实者生，虚大者死。（《汇补》引《类案》）
九虫三虫（尸虫）（按∶此门主在蛔虫，然他诸虫亦不得不类及，以备参考。）九虫者，一曰伏虫，
长四分（《外台》引四寸）。二曰蛔虫，长一尺。三曰白虫，长一寸。四曰肉虫，状如烂杏。五曰肺虫，状如
蚕。六曰胃虫，状如虾蟆。七曰弱虫，状如瓜瓣。八曰赤虫，状如生肉。九曰蛲虫，至细微形如菜虫。伏虫，
群虫之主也。蛔虫贯心则杀人。白虫相生，子孙转大，长至四五尺（《外台》尺作丈，《千金》作子孙转多，
其母转大，长至四五丈），亦能杀人。肉虫令人烦满。肺虫令人咳嗽。胃虫令人呕逆，吐，喜哕。弱虫又名
膈虫，令人多唾。赤虫令人肠鸣。蛲虫居胴（《外台》注曰∶徒栋反，大肠也）肠，多则为痔，极则为癞。
因人疮处，以生诸痈疽癣 疥龋虫，无所不为。人亦不必尽有，有亦不必尽多，（《千金》、《外台》并此
有或偏有者四字）或偏无者。此诸虫根据肠胃之间，若腑脏气实，则不为害。若虚则能侵蚀，随其虫之动，而能
变成诸患也。（《病源论》）
三虫者。长虫赤虫蛲虫也。长虫蛔虫也。此既是九虫之三者。而今别立名。当以其三种偏发动成病。故谓
之三虫也。（同上）
寸白者，九虫内之一虫也，长一寸而色白，形小褊，因腑脏虚弱而能发动，或云饮白酒以桑枝贯牛肉炙食，
并生栗所成。又云∶食生鱼后，即饮乳酪，亦令生之。其发动则损人精气，腰脚疼弱。又云∶此虫生长一尺，
则令人死。（同上）
蛲虫，犹是九虫内之一虫也，形甚小，如今之蜗虫状，亦因腑脏虚弱而致发动，甚者则能成痔痿疥癣癞痈
疽诸疮。蛲虫是人体虚极重者，故为蛲虫，因动作无所不为也。（同上）
《肘后》三虫者，谓长虫、赤虫、蛲虫也。乃有九种，而蛲虫及寸白，人多病之。寸白从食牛肉。饮白酒
所成，相连一尺，则杀人。服药下之，须结裹溃然出尽乃佳。若断者相生未已，更宜速除之。蛲虫多是小儿患
之，大人亦有其病，令人心痛，清朝口吐汁烦躁则是也。（《外台》）寸白虫，乃九虫之一种，状似绢边葫芦
子，因藏气虚，风寒湿冷伏于肠胃，又好食生脍、干肉等，所以变化滋多，难于蠲治。说者谓食牛肉、饮白酒
所致，特一端尔，亦未必皆此缘由。（《圣济》）
人腹中有尸虫，此物与人俱生，而为人大害。尸虫之形状，似大马尾，或如薄筋，根据脾而居，乃有头尾，
皆长三寸。（《千金》）
蛔动证候 蛔虫者，是九虫内之一虫也，长一尺，亦有长五、六寸。或因腑脏虚弱而动，或因食甘肥
而动。其发动则腹中痛，发作肿聚，去来上下，痛有休息，亦攻心痛，口喜吐涎及吐清水，贯伤心者死也。
（《病源论》）（按∶其发动以下，本于《灵枢·厥病篇》，有少异，末一句经所无。）
《腹疾篇》曰∶干痛有时，当为虫。（《褚氏遗书》）
蛔虫，盖较之它虫，害人为多，观其发作冷气，脐腹撮痛，变为呕逆，以至心中痛甚如锥刺。（《圣济》）
面 白，心腹痛，口中沫及清水出，发痛有时，安虫散主之，小儿本怯者多此病。积痛、食痛、虚痛，大
同小异；惟虫痛者，当口淡而沫自出，治之随其证。小儿本怯，故胃虚冷，则虫动而心痛，与痫略相似，但目
不斜、手不搐也，安虫散主之。（《直诀》）（按∶此说可移之大人，故列于此，后小儿诸说皆仿此。）
赵氏家传，小儿或患伤寒不能得汗，亦由此虫所攻，仲
景所谓蛔厥者是也。凡有蛔者，眼多有赤脉。（《幼幼》）
蛔虫九虫之数，人腹中皆有之，小儿失乳而哺早，或食甜过多，胃虚虫动，令人腹痛恶心，口吐清水，腹
上有青筋。（《医说》引《医余》）
腹中有块起，急以手按之，便不见，五更心嘈，牙关挢硬，恶心而清水出，及梦中啮齿者，此谓之虫痛。
（同上）
本为从来吃物粗，虫生肚内瘦肌肤，爱甜吃了多生痛，怕药愁啼肉渐枯，形候只看人中上，鼻间唇上一时
乌，沫干痛定虫应退，取下蛔虫病始无。（《活法秘方》）
有虫痛者，面上白斑，唇红，能食，属虫，治以苦栋根、锡灰之类。（《丹溪》）
或痛而坐卧不安，自按心腹，时大叫，或青或黄，唇缓，口吐清水，目无光彩者，虫痛也。（《医统》）
凡虫症，眼眶鼻下青黑，面色痿黄，脸上有几条血丝，如蟹爪分明，饮食不进，肌肉不生，沉重寒热。若不
早治，相生不已，贯心杀人。（《入门》）
虫之为病，其类不一，或由渐而甚，或由少而多，及其久而为害，则为腹痛食减，渐至羸瘠而危者有之。
凡虫痛证，必时作时止，来去无定，或呕吐青绿水，或吐出虫，或痛而坐卧不安，或大痛不可忍，面色或青或
黄或白而唇则红，然痛定则能饮食者，便是虫积之证，速宜逐之。（《景岳》）
虫为病千态万状，凡证难识认者，即当究心于虫。其人或面黄肌瘦，脸生斑纹，偏食异物，或游行饮血，
或脏腑声言，其脉濡滑牢结伏数沉弦小短不等，皆虫候也。体实，生于脏腑者，打虫；体虚，生于肠外膜内者，
化虫。虫出后，补，（《女科百病问答补遗》）
虫病之人，面黄肌瘦，唇白毛竖，容颜不泽，脸多白印，时觉恶心，口吐清水，或心腹绞痛，饮食不为
肌肤，或头发狰狞，洒淅恶寒，或额面生疮湿痒，皆其症也。（《玉按》）
其人必面色黄，时吐涎沫，时作时止，食酸即安，食甜则甚，然而亦有寒有热，有虚有实。（《胃气论》）
病患嗜食甘甜或异物，饥时则痛，唇之上下有白斑点者，虫也。（《心悟》）
虫证，心嘈腹痛，或上攻心如咬（虫动则心慌乱不宁，故嘈杂。虫窜动咬啮则腹痛也），呕吐涎沫或青黄水
（虫多在胃中，胃气被虫扰动，则津液随气壅泛也。经谓虫动则胃缓，胃缓则廉泉开，故流涎。谓胃气为虫所
滞，不能行其津液，故上泛而从廉泉穴出耳），面色萎黄（胃脉上面，胃因虫病虚弱，故痿悴之黄色，见于面
也），或乍赤乍白乍青黑（青黑为痛色，白为少血色，赤为火色。虫扰动无常，痛甚则面色青黑。气血滞于内
不上行，则面无血色。久滞忽通，火得上伸则赤也），或面有白斑（胃中蚀痕斑驳，故面亦应之而成斑，若影
之肖形然），唇常红（脾血因热滞，故色见于唇），或生疮如粟米（《准绳》谓虫蚀下部，为狐，下唇有疮；
蚀上部，为惑，上唇有疮）（按∶此虫 ，非蛔虫。上或乍赤云云，下或沉默欲眠云云，亦似取《金匮》狐惑
中文，姑存之。），或沉默欲眠，卧起不安，不欲饮食，恶闻食臭（虫闻食臭即动，动则令人心烦，故不欲食，
恶闻食臭），饥则痛，得食痛更甚（虫饥动而求食，又虫争食而乱动也），饱即安（虫饱则不动矣），时痛时
止，以手拊击即息（一人心腹痛，百药不效，惟手捶即止。以捶则震动，虫惊畏而止也。不捶又作，取虫而愈），
腹上有青筋，或腹中
有块更起，下利黑血（小儿疳热生虫，土败木克，故青筋见腹，血败故利黑血也），体有寒热（气滞于里则恶
寒，滞久暴伸于外则发热），脉洪而大（乃湿热生虫之象），皆其候也。（《医碥》）
虫痛验法 验治法∶昔一人患心腹大痛，或止或作，痛不可忍。凡用去积行气等药，百方不效，但于
痛极时，须用拳捶之，痛得少止，而旋止旋作，久不能愈，日加困弊，莫测其故。忽一胡僧见之曰∶余能治也。
遂令病者先食香饵，继进一丸，打下一硬嘴异虫，遂愈。此因虫啮肠脏，所以痛极，捶之则五内震动，虫亦畏而
敛伏；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。（《景岳》）
虫痛之症，得食则痛减，无食则痛增。以酸梅汤一盏试之，饮下而痛即止者，乃虫痛；饮下而痛增重或少
减者，非虫痛也。（《石室秘 》）
吐蛔（宜参安虫诸方）藏寒蛔上入膈，吐蛔，此胃寒乃胃虚寒，非实寒也，治用仲景理中丸。（《宝
鉴·补遗》）
吐蛔乃胃寒所生，经云蛔者长虫也，胃中冷则吐蛔，成蛔厥，宜理中汤加炒川椒五粒，槟榔半钱，吞乌梅
丸。（《要诀》）
凡吐蛔者，必因病而吐蛔，非因蛔而致吐也。故不必治其蛔，而但治其所以吐，则蛔自止矣。有因胃火而
吐蛔者，以内热之甚，蛔无所容而出也，但清其火，火清而蛔自静。有因胃寒而吐蛔者，以内寒之甚，蛔不能
存而出也，但暖其胃，胃暖而蛔自安，仲景乌梅丸之属是也。有因胃虚无食而吐蛔者，以仓廪空虚。蛔因求食
而上出也，此胃气大虚之候，速宜补胃温中，以防根本之败。以上三者，固皆治蛔之
法，然蛔有死者，有活者。若吐死蛔，则但治呕，如前可也。若活蛔上出不已，则不得不有以逐之，盖蛔性畏
酸畏苦，但加乌梅为佐使，则蛔自伏也，若胃实火盛者，可加苦栋根或黄连亦善。（《景岳》）
有胃中热，使虫不能安而吐者，有多食甘甜之物，如甘蔗白糖类，引动蛔虫而吐者。病者壮盛，面色红活，
脉洪而数，乃胃热症也，用黄连、栀子等剂而愈。若胃冷吐虫，脉必微弱，色必黯淡，四肢厥冷。（《医彀》）
大凡热厥吐蛔者，蛔必多，随生随吐，神气必清，无烦躁不安之证，宜用黄连等苦燥之剂，以泻其湿热。
（《胃气论》）
偏嗜一物（治方见后安虫诸方中，又宜与《积聚》门虫积条互参。）间有偏嗜一物，吃米吃泥吃炭吃灰
吃茶叶吃布纱之类，乃内癖也。肇病之初，由于中气馁弱，饮食不思。偶将一物试嚼，入于肠胃，蛔 而甘之，
为其嗜好。若是投其所喜，蛔来吞受，心胸舒畅。若或非所喜，纵虽珍羞美馔，蛔无禀受而不安，食已入胃而
难化，反觉否闷靡宁。为日既久，病邪益深，容颜憔悴，肌肤瘦削。养生食品，憎之如仇，当戒之物，甘之如醴。
率由病魔作祟，实非吾心所主，明知明犯，欲改过而未能，病名曰癖，以其偏拗僻着，不能丸通故也。内癖与外
【背景信息】
书名：杂病广要 作者：日本·丹波元坚撰 朝代：清 章节：蛔虫(1/3) 类别：综合
蛔虫这种生物，有人说它是消耗谷物的虫，也有人说它是由湿热之气自然生成的。我的弟子上总糟谷骏曾经写过一本书，说：“蛔虫有旧有的蛔虫（宿蛔），也有新产生的蛔虫（新蛔）。所谓的宿蛔，就像龙蛇存在于天地之间一样，是人们体内常有的东西，遇到适当条件就会活动，但并不是每个人都有，即使有数量也不多。所谓的新蛔，就像蛀虫蛆类一样，必须依靠湿热环境才能生成，一旦生成必然大量繁殖，导致疾病非常严重。”我又认为，蛔虫造成的危害，往往使人容易感到饥饿，所以说它消耗谷物，也是没有不可以的。但是人体既然有胃脘的阳气来消化水谷、运化精微物质，如果说蛔虫是借助力量去干扰这个过程，那是绝对没有道理的。只是肠胃中不可能完全没有蛔虫，从经文就可以看出来。如果说是必定由湿热而生，这大概是只知其一不知其二的说法了。槽谷骏的话能够发掘前人未曾达到的见解，所以我特意表彰并列出这些内容，使阅读本书的人有所考证。
虫自湿热生：巢元方在《诸病源候论》中对九虫三虫的描述已经很详细了，然而虫类的变化无穷无尽，总之都是以湿热为主要原因，不能单纯归结为脾气虚弱和饮食停滞。（出自《儒门事亲》）
《黄帝内经》说肠胃像集市一样，什么食物都能接受，什么都包容。又说饮食加倍，肠胃就会受伤。如果饮食不能谨慎节制，那么早晨损伤晚上又受创，自我伤害形成积滞，积滞久了产生热邪，湿热蒸腾滋生，各种奇形怪状的虫，各自随着五行之气的变化而化生出来。至于膈噎、劳瘵、癞风、蛊胀、狐惑、伤寒等病症，无不生虫。医生应当在各类病症中推究并治疗即可。（出自《正传》）（按：石山的意思也相同，见后文奇证部分。）
饮食进入胃中，如果不是湿与热的作用就不能腐熟消化，消化之后虫就随之成形，并与糟粕一起排出到大肠。历象五月的时令说：腐烂的草化为萤火虫。这个时候，湿气和热气都很旺盛，所以腐败的东西就能化生。人的饮食情况可以由此类推。
现在饮食中的湿热腐熟化生为虫，这固然是道理上可能存在但不多的情况。只有因为不节制，恣意食用浓味、生冷食物，导致邪气偏盛，湿热太过，因此虫生得过多就成为危害，所以产生了腹痛、食少、呕吐清水的病，逐渐发展到身体消瘦衰弱甚至危及生命的情况。（出自《医统》）
九虫都是由脏腑不实、脾胃俱虚引起的，加上杂食生冷、甘肥、油腻、咸腌等物，生活起居调节不当，导致食物腐败停滞，从而引发疾病。又有神志不舒、精魄失守，以及五脏劳热、病后余毒、气血积郁而生，或者吃瓜果与畜兽内脏遗留的各种虫卵而生。（出自《奇效良方》）
蛔虫属于阴类，胃中湿热交蒸，顷刻间就能生成。就像物品藏在容器中，如果烘焙得极其干燥，虽然煮熟也不会坏；如果有湿气，受热就会发霉并生出虫来。（出自《胃气论》）
蛔虫的化生，像蜗牛一样，生长速度极快。（出自《金匮衍义》）
生冷生虫：虫这种病，人身上多有发生，由于化生而成，确实难以预测。在古代方书中，虽然说由湿由热、由口腹不节制、由饮食停积而生，这固然都有这种情况。然而以常见情况验证，凡是体质强壮、正气充沛的人，没听说过有虫病的，正是因为随吃随化，虫自然难以存活；而能因虫致病的，终究是因为脏气虚弱，运化迟缓，所以停聚而逐渐生虫。既然如此，那么或由湿热，或由生冷，或由肥甘，或因滞腻，都可以生虫，不仅仅是湿热而已。然而在几种情况中，又以生冷生虫最为多见，就像收藏各种物品，只要沾上生水，或靠近阴湿之处，就最容易蛀蚀腐烂，这不正是这个意思吗？所以凡是想要爱护养育小儿，极应当节制他们吃水果，以防败坏脾阳，这确实是重要的一点。（出自《景岳全书》）
脉候：关部脉微浮，说明积热在胃中，会出现呕吐蛔虫、心中健忘的症状。关部脉紧而滑，说明蛔虫在动。尺部脉沉而滑，说明有寸白虫（绦虫）。（出自《脉经》）
脉实大的预后良好，脉虚小的预后不良。（出自《正传》）
脉虚小的预后良好，脉紧急的预后不良。（出自《玉案》）
脉沉实的预后良好，脉虚大的预后不良。（出自《汇补》引《类案》）
九虫三虫（尸虫）（按：此门类主要讲述蛔虫，然而其他各种虫也不得不连带提及，以备参考。）九虫分别是：一曰伏虫，长四分（《外台秘要》引作四寸）。二曰蛔虫，长一尺。三曰白虫，长一寸。四曰肉虫，形状像烂杏。五曰肺虫，形状像蚕。六曰胃虫，形状像蛤蟆。七曰弱虫，形状像瓜瓣。八曰赤虫，形状像生肉。九曰蛲虫，极其细微，形状像菜虫。伏虫是群虫之主。蛔虫贯穿心脏则致死。白虫相生，子孙越来越大，长达四五尺（《外台秘要》尺作丈，《千金方》作子孙转多，其母转大，长达四五丈），也能致死。肉虫令人烦闷胀满。肺虫令人咳嗽。胃虫令人呕逆、吐酸、喜欢打嗝。弱虫又名膈虫，令人多唾液。赤虫令人肠鸣。蛲虫居于大肠，多了则生痔疮，极甚则生癞病。依附于人体疮处，而生各种痈疽癣疥龋齿等虫，无所不为。人也不必全有，有也不必全多（《千金方》、《外台秘要》在此处均有“或偏有者”四字），或有偏无者。这些虫都盘踞在肠胃之间，如果腑脏气实，就不为害。如果气虚则能侵蚀，随着虫的活动，能变成各种病患。（出自《诸病源候论》）
三虫是指长虫、赤虫、蛲虫。长虫就是蛔虫。这三种既是九虫中的三种，而现在单独立名，应当是因为这三种特别容易发动成病，所以称为三虫。（同上）
寸白虫，是九虫中的一种，长一寸且颜色白，形体小且扁，因为腑脏虚弱而发动，有人说饮用白酒并用桑枝穿牛肉烤食，以及吃生栗子所造成。又说：吃生鱼后立即喝乳酪，也会生出此虫。其发作会损害人的精气，腰脚疼痛软弱。又说：此虫长到一尺，就会使人死亡。（同上）
蛲虫，也是九虫中的一种，形体很小，像现在的蜗虫样子，也是因为腑脏虚弱而导致发动，严重的则能形成痔瘘疥癣癞痈疽等各种疮疡。蛲虫是人体极度虚弱重症时产生的，所以叫蛲虫，因为它动作起来无所不为。（同上）
《肘后备急方》说的三虫，是指长虫、赤虫、蛲虫。共有九种，而蛲虫及寸白虫，人多患病。寸白虫从吃牛肉、饮白酒所成，相连一尺，就会杀人。服药驱虫，必须结裹溃烂排出干净才好。如果断开的继续相生不止，更应迅速去除。蛲虫多是小儿患此病，大人也有此病，令人心痛，清晨口吐汁液烦躁不安就是这种情况。（《外台秘要》）寸白虫，是九虫的一种，形状像绢边的葫芦子，因为藏气虚，风寒湿冷潜伏于肠胃，又喜欢吃生鱼片、干肉等，所以变化滋长很多，难于治愈。有人说这是吃牛肉、饮白酒所致，这只是其中一方面，也未必都是因为这个缘由。（《圣济总录》）
人腹中有尸虫，此物与人共生，却对人危害极大。尸虫的形状，像大马尾，或像薄筋，依傍脾脏居住，有头尾，都长三寸。（《千金方》）
蛔动证候：蛔虫，是九虫中的一种，长一尺，也有长五、六寸的。或因腑脏虚弱而动，或因吃甘肥之物而动。其发作时腹中疼痛，发作时肿块聚拢，上下移动，疼痛有间歇，也会攻冲心痛，口中喜欢流涎沫及吐清水，贯穿心脏者死。（《诸病源候论》）（按：其发动以下的内容，本源于《灵枢·厥病篇》，略有不同，最后一句经文没有。）
《腹疾篇》说：干痛有时，应当是虫引起的。（《褚氏遗书》）
蛔虫，比起其他虫，害人更多，看它发作时的冷气，脐腹撮痛，变为呕逆，以至于心中痛得像锥刺一样。（《圣济总录》）
面色白，心腹痛，口中流出沫及清水，发作疼痛有定时，用安虫散主治，小儿本来怯弱者多患此病。积痛、食痛、虚痛，大同小异；只有虫痛者，应当口淡而沫自出，治疗根据症状进行。小儿本来怯弱，所以胃虚冷，则虫动而心痛，与痫证略相似，但眼睛不斜、手不抽搐，用安虫散主治。（《直诀》）（按：此说可移用于成人，故列于此，后文关于小儿的各种说法都仿照此例。）
赵氏家传经验，小儿如果患伤寒不能出汗，也是由此虫攻击所致，即张仲景所说的蛔厥。凡是有蛔虫的人，眼睛多有红血丝。（《幼幼新书》）
蛔虫九虫的数量，人腹中皆有，小儿断奶过早或喂食太早，或吃甜食过多，胃虚虫动，令人腹痛恶心，口吐清水，腹上有青筋。（《医说》引《医余》）
腹中有块突起，急忙用手按压，便不见了，五更时分心中嘈杂，牙关僵硬，恶心而流出清水，以及梦中磨牙的，这叫虫痛。（同上）
本来吃东西粗糙，虫生在肚内导致肌肤消瘦，爱吃甜的多生疼痛，怕药愁哭肌肉渐渐枯槁，观察形候只看人中部位，鼻间唇上一时发黑，沫干痛定虫应退下，取下蛔虫病始无。（《活法秘方》）
有虫痛者，面上有白斑，唇红，能进食，属虫证，治疗用苦楝根、锡灰之类。（《丹溪心法》）
或者疼痛而坐卧不安，自己按压心腹，时而大叫，面色或青或黄，嘴唇松弛，口吐清水，目光无光彩的，是虫痛。（《医统》）
凡是虫症，眼眶鼻下青黑，面色萎黄，脸上有几条血丝，像蟹爪一样分明，饮食不进，肌肉不生，沉重寒热。如果不早治，相生不已，贯穿心脏杀人。（《医学入门》）
虫这种病，其种类不一，有的逐渐加重，有的由少变多，等到久了成为危害，就会出现腹痛食减，逐渐发展到身体消瘦衰弱甚至危及生命的情况。凡是虫痛证，必定时作时止，来去不定，或者呕吐青绿水，或者吐出虫，或者痛而坐卧不安，或者大痛不可忍，面色或青或黄或白而嘴唇则红，然而痛定则能饮食的，便是虫积之证，速宜驱逐。（《景岳全书》）
虫为病千态万状，凡是证候难识别的，就应当用心探究是否为虫。其人如果面黄肌瘦，脸生斑纹，偏食异物，或者游行饮血，或者脏腑声音异常，其脉濡滑牢结伏数沉弦小短不等，都是虫的征候。体质实的，生于脏腑内部的，用打虫法；体质虚的，生于肠外膜内的，用化虫法。虫排出后，进行补益。（《女科百病问答补遗》）
患虫病的人，面黄肌瘦，唇白毛竖，容颜不润泽，脸上多有白印，时常觉得恶心，口吐清水，或者心腹绞痛，饮食不能转化为肌肤，或者头发狰狞，洒淅恶寒，或者额面生疮湿痒，都是其症状。（《玉案》）
其人必定面色黄，时常吐涎沫，时作时止，吃酸的即缓解，吃甜的则加重，然而也有寒有热，有虚有实。（《胃气论》）
病人嗜食甘甜或异物，饥时则痛，嘴唇上下有白斑点的，是虫证。（《得心集医案》）
虫证，心中嘈杂腹痛，或者上攻心如咬（虫动则心慌乱不宁，故嘈杂。虫窜动咬啮则腹痛也），呕吐涎沫或青黄水（虫多在胃中，胃气被虫扰动，则津液随气壅泛也。经谓虫动则胃缓，胃缓则廉泉开，故流涎。谓胃气为虫所滞，不能行其津液，故上泛而从廉泉穴出耳），面色萎黄（胃脉上面，胃因虫病虚弱，故痿悴之黄色，见于面也），或者乍赤乍白乍青黑（青黑为痛色，白为少血色，赤为火色。虫扰动无常，痛甚则面色青黑。气血滞于内不上行，则面无血色。久滞忽通，火得上伸则赤也），或者面有白斑（胃中蚀痕斑驳，故面亦应之而成斑，若影之肖形然），嘴唇常红（脾血因热滞，故色见于唇），或者生疮如粟米（《准绳》谓虫蚀下部，为狐，下唇有疮；蚀上部，为惑，上唇有疮）（按：此虫非蛔虫。上或乍赤云云，下或沉默欲眠云云，亦似取《金匮》狐惑文中内容，姑存之。），或者沉默欲眠，卧起不安，不欲饮食，厌恶闻食臭（虫闻食臭即动，动则令人心烦，故不欲食，恶闻食臭），饥则痛，得食痛更甚（虫饥动而求食，又虫争食而乱动也），饱即安（虫饱则不动矣），时痛时止，用手拍打即停止（一人心腹痛，百药不效，惟手捶即止。以捶则震动，虫惊畏而止也。不捶又作，取虫而愈），腹上有青筋，或者腹中有块更起，下利黑血（小儿疳热生虫，土败木克，故青筋见腹，血败故利黑血也），体有寒热（气滞于里则恶寒，滞久暴伸于外则发热），脉洪而大（乃湿热生虫之象），都是其征候。（《医碥》）
虫痛验法：检验治疗方法：从前有一人患心腹大痛，有时停止有时发作，痛不可忍。凡是使用去积行气等药，百方无效，只在痛极时，必须用拳头捶打，痛得稍微停止，但随即停止随即发作，久久不能痊愈，日渐困顿疲惫，不知其原因。忽然一位胡僧看见他说：“我能治好。”于是让病人先吃香饵，接着进服一丸药，打下一只硬嘴异虫，于是痊愈。这是因为虫咬肠脏，所以痛极，捶打则五脏震动，虫也畏惧而收敛潜伏；不捶打则虫得以自由活动，所以再次发作。这也是检验虫证的奇特方法，所以凡是见到心腹痛证，如果用揉按重捻而痛得暂时停止的，大多是因为虫引起的。（《景岳全书》）
虫痛的病症，得食则痛减，无食则痛增。用一盏酸梅汤试验，喝下去而痛立即停止的，是虫痛；喝下去而痛加重或稍减的，不是虫痛。（《石室秘录》）
吐蛔（宜参安虫诸方）：脏寒蛔上入膈，吐蛔，这是胃寒，乃是胃虚寒，不是实寒，治疗用张仲景的理中丸。（《宝鉴·补遗》）
吐蛔乃胃寒所生，经云蛔者长虫也，胃中冷则吐蛔，成蛔厥，宜理中汤加炒川椒五粒，槟榔半钱，吞服乌梅丸。（《要诀》）
凡是吐蛔者，必定因病而吐蛔，不是因为蛔而致吐。所以不必治其蛔，而只治其所以吐的原因，则蛔自然停止。有因胃火而吐蛔者，因为内热太甚，蛔无处容身而出，只需清其火，火清而蛔自然安静。有因胃寒而吐蛔者，因为内寒太甚，蛔不能生存而出，只需暖其胃，胃暖而蛔自然安宁，张仲景乌梅丸之类的方剂就是如此。有因胃虚无食而吐蛔者，因为仓廪空虚，蛔因求食而上出，这是胃气大虚的征候，速宜补胃温中，以防根本败坏。以上三者，固然都是治蛔的方法，然而蛔有死的，有活的。如果吐死蛔，则只治呕吐，如前所述即可。如果活蛔上出不止，则不得不有办法驱逐它，大概蛔性畏酸畏苦，只要加乌梅作为佐使，则蛔自然伏住，如果胃实火盛者，可加苦楝根或黄连也很好。（《景岳全书》）
有胃中热，使虫不能安而吐者，有多食甘甜之物，如甘蔗白糖类，引动蛔虫而吐者。病者壮盛，面色红活，脉洪而数，是胃热症，用黄连、栀子等剂而愈。若胃冷吐虫，脉必微弱，色必黯淡，四肢厥冷。（《医彀》）
大凡热厥吐蛔者，蛔必多，随生随吐，神气必定清醒，无烦躁不安之证，宜用黄连等苦燥之剂，以泻其湿热。（《胃气论》）
偏嗜一物（治方见后安虫诸方中，又宜与《积聚》门虫积条互参。）：间有偏嗜一物，吃米、吃泥、吃炭、吃灰、吃茶叶、吃布纱之类，这是内癖。肇病之初，由于中气馁弱，饮食不思。偶然将一物试嚼，入于肠胃，蛔虫觉得甘甜，成为其嗜好。如果是投其所喜，蛔来吞受，心胸舒畅。如果不是所喜，纵然珍羞美馔，蛔无禀受而不安，食已入胃而难化，反觉痞闷不宁。为日既久，病邪益深，容颜憔悴，肌肤瘦削。养生食品，憎之如仇，当戒之物，甘之如醴。率由病魔作祟，实非吾心所主，明知明犯，欲改过而未能，病名曰癖，以其偏拗僻着，不能贯通故也。内癖与外……
[Background Information]
Book: Zabing Guangyao (Comprehensive Requirements for Miscellaneous Diseases)
Author: Danbo Yuanjian (Japanese)
Dynasty: Qing
Chapter: Ascariasis (1/3)
Category: Comprehensive
Ascaris lumbricoides, as a creature, is said by some to be a "grain-consuming worm," while others claim it arises spontaneously from damp-heat. My disciple Shangzong Zaogu Jun once wrote a book stating: "There are old ascariasis (Su Xi) and new ascariasis (Xin Xi). Old ascariasis is like dragons and snakes existing between heaven and earth; it is commonly present in people, activated by certain events, yet not everyone has it, and even if present, the quantity is small. New ascariasis is like woodworms or maggots; it must arise from damp-heat, and once generated, it multiplies rapidly, causing severe disease." I further believe that the harm caused by Ascaris often makes people prone to hunger, so saying it consumes grain is acceptable. However, since the human body possesses Yang Qi of the stomach and epigastrium to transform food and fluids and transport essence and fine nutrients, claiming that Ascaris interferes with this process through borrowed power is absolutely illogical. It is merely that the intestines and stomach cannot be entirely free of Ascaris, which can be seen from the classic texts. To say it must arise solely from damp-heat is to know one part but not the other. Jun's words can uncover insights previously unattained by predecessors, so I have highlighted and presented them to enable readers of this compilation to verify these points.
Worms Arise from Damp-Heat: Chao Yuanfang's elaboration on the Nine Worms and Three Worms in *Zhubing Yuanhou Lun* (Treatise on the Pathogenesis and Manifestations of All Diseases) was quite detailed. However, the variations of worms are inexhaustible. Essentially, they are all primarily governed by damp-heat and cannot be solely attributed to Spleen Qi deficiency and food stagnation. (*Rumen Shiqin*)
The *Neijing* (Inner Canon) states that the intestines and stomach are like a market, accepting and containing everything. It also says that doubling food intake injures the intestines and stomach. If dietary habits are not disciplined, damage occurs morning and night. Self-injury leads to accumulation; long-standing accumulation generates heat. Damp-heat steams and breeds, and various strangely shaped worms transform and generate according to the Qi of the Five Phases. Conditions such as Ge Yi (dysphagia), Lao Zhai (consumption), Lai Feng (leprosy), Gu Zhang (abdominal distension), Hu Huo (fox-and-hu syndrome), and Shang Han (cold damage) all involve worm generation. Physicians should investigate and treat within each category. (*Zhengchuan*) [Note: Shishan's opinion is also the same, see later under Strange Cases.]
When food enters the stomach, it cannot rot and transform without dampness and heat. Upon transformation, worms take shape along with it and exit the large intestine together with waste. The *Lixiang* May calendar states: "Rotting grass transforms into fireflies." At this time, both dampness and heat are abundant, hence rotting matter transforms. Human dietary processes can be inferred analogously.
Now, diet transforming into worms via damp-heat rot is theoretically possible but not common. Only due to lack of restraint, indulging in rich flavors, raw, and cold foods, does pathogenic Qi become excessive, and damp-heat overwhelming. Consequently, excessive worm generation becomes harmful, leading to diseases such as abdominal pain, poor appetite, and vomiting clear fluid, gradually progressing to emaciation and critical conditions. (*Yitong*)
The Nine Worms all arise from deficient Zang-Fu organs and dual deficiency of the Spleen and Stomach, combined with miscellaneous consumption of raw, cold, sweet, fatty, greasy, and salty-preserved foods. Irregular regulation and excretion lead to corruption and stagnation, triggering the disease. Additionally, emotional distress, loss of spirit and soul, internal heat from Zang organ overwork, residual toxins from previous illnesses, and Qi-blood stagnation can generate worms. Eating fruits, vegetables, or leftover animal viscera containing worm eggs can also cause infection. (*Qixiao Liangfang*)
Ascaris belongs to the Yin category. In the steaming damp-heat of the stomach, it generates instantly. Like items stored in a container: if baked extremely dry, even cooked items do not spoil; but if moisture is present, heat causes mold and worm generation. (*Weiqi Lun*)
The generation of Ascaris resembles a slug, growing at an extremely rapid speed. (*Jinkui Yanyi*)
Raw and Cold Generate Worms: Worm diseases are common in humans, arising from spontaneous generation, which is indeed unpredictable. Ancient medical texts state they arise from dampness, heat, oral/gastric indiscretion, and food stagnation. While true, empirical observation shows that those with strong constitution and robust Qi rarely have worms because food is transformed immediately, making it hard for worms to survive. Those suffering from worms ultimately have weak organ Qi and slow digestion/metabolism, allowing stagnation and gradual worm generation. Thus, whether from damp-heat, raw/cold, rich/sweet, or sticky/greasy factors, worms can be generated, not just from damp-heat. Among these, raw and cold generating worms is most prevalent. Just as stored items easily rot and infest when exposed to water or near damp places, this principle applies. Therefore, to protect children, one must strictly limit fruit intake to prevent damaging Spleen Yang; this is a crucial point. (*Jingyue Quanshu*)
Pulse Diagnosis: A slightly floating pulse at the Guan position indicates accumulated heat in the stomach, presenting with vomiting of Ascaris and heart palpitations/memory loss. A tight and slippery pulse at the Guan position indicates moving Ascaris. A deep and slippery pulse at the Chi position indicates Tapeworm (Cestoda). (*Maijing*)
A solid and large pulse indicates survival; a deficient and small pulse indicates death. (*Zhengchuan*)
A deficient and small pulse indicates survival; a tense and urgent pulse indicates death. (*Yu'an*)
A deep and solid pulse indicates survival; a deficient and large pulse indicates death. (*Huibu*, citing *Lei'an*)
Nine Worms and Three Worms (Corpse Worm) [Note: This section focuses on Ascaris, but other worms are included for reference.] The Nine Worms are: 1. Fu Chong (Hidden Worm), 4 fen long (cited as 4 cun in *Waitai*). 2. Hui Chong (Ascaris), 1 chi long. 3. Bai Chong (White Worm), 1 cun long. 4. Rou Chong (Flesh Worm), resembling rotten apricot kernels. 5. Fei Chong (Lung Worm), resembling silkworms. 6. Wei Chong (Stomach Worm), resembling toads. 7. Ruo Chong (Weak Worm), resembling melon seeds. 8. Chi Chong (Red Worm), resembling raw meat. 9. Tuo Chong (Pinworm), extremely minute, resembling vegetable worms. Fu Chong is the master of all worms. Ascaris penetrating the heart causes death. White Worms reproduce, with offspring growing larger, reaching 4-5 chi (cited as 4-5 zhang in *Waitai*; *Qianjin Fang* says offspring multiply, mother grows larger, reaching 4-5 zhang); they can also cause death. Rou Chong causes irritability and fullness. Fei Chong causes coughing. Wei Chong causes regurgitation, vomiting, and hiccups. Ruo Chong, also called Ge Chong, causes excessive salivation. Chi Chong causes borborygmus. Tuo Chong resides in the large intestine (Dong Chang); excessive presence causes hemorrhoids, extreme cases cause leprosy-like conditions. Attaching to skin lesions, they generate various carbuncles, ulcers, tinea, scabies, and dental caries, doing no evil they do not commit. Humans need not have all types, nor many of any type (*Qianjin Fang* and *Waitai* add "some may have only some types"); some may lack them entirely. These worms reside between the intestines and stomach. If organ Qi is solid, they cause no harm. If deficient, they erode tissues, and depending on their movement, transform into various ailments. (*Bingyuan Lun*)
The Three Worms refer to Chang Chong (Long Worm), Chi Chong (Red Worm), and Tuo Chong (Pinworm). Chang Chong is Ascaris. Although these three are part of the Nine Worms, they are named separately because these three types are particularly prone to activation and disease, hence called the Three Worms. (Same source)
Tapeworm (Cun Bai Chong) is one of the Nine Worms, 1 cun long, white in color, small and flat. It activates due to Zang-Fu deficiency. Some say it results from drinking white wine and eating beef roasted on mulberry branches, or eating raw chestnuts. Others say eating raw fish followed by milk or cheese causes it. Its activation damages Jing-Qi, causing lower back and leg weakness/pain. Some say if this worm reaches 1 chi, it causes death. (Same source)
Pinworm (Tuo Chong) is also one of the Nine Worms, very small, resembling modern pinworms. It activates due to Zang-Fu deficiency. Severe cases lead to hemorrhoids, fistulas, tinea, leprosy, carbuncles, and ulcers. Pinworms appear when the human body is extremely deficient and critically ill, hence the name, as they act destructively. (Same source)
*Zhouhou Beiji Fang* mentions the Three Worms as Chang Chong, Chi Chong, and Tuo Chong. There are nine types, but Pinworm and Tapeworm are common in humans. Tapeworms result from eating beef and drinking white wine; connected strands reaching 1 chi cause death. Medicinal expulsion requires the worms to be bound and expelled completely; if broken, they regenerate, requiring swift removal. Pinworms mostly affect children, though adults suffer too, causing heart pain, morning salivation, and restlessness. (*Waitai*) Tapeworms, a type among the Nine Worms, resemble gourd seeds with silk edges. Due to visceral Qi deficiency, wind-cold-damp-cold lurks in the intestines/stomach. Preference for raw fish and dried meat leads to complex transformations, making them hard to cure. Some attribute them to beef and white wine, but this is only one aspect, not necessarily the sole cause. (*Shengji Zonglu*)
Humans harbor Corpse Worms (Shi Chong), born with us but highly harmful. Corpse Worms resemble large horse tails or thin tendons, residing against the Spleen, with head and tail, about 3 cun long. (*Qianjin Fang*)
Symptoms of Moving Ascaris: Ascaris is one of the Nine Worms, 1 chi long, sometimes 5-6 cun. It moves due to Zang-Fu deficiency or consumption of sweet/fatty foods. Activation causes abdominal pain, episodic mass formation, migration up and down, intermittent pain, attacking heart pain, profuse salivation, and vomiting clear fluid. Penetration of the heart causes death. (*Bingyuan Lun*) [Note: The description below originates from *Lingshu: Juebing Pian* with slight differences; the last sentence is absent in the classic text.]
*Fuji Pian* states: Intermittent dry pain suggests worms. (*Chushi Yishu*)
Ascaris harms more than other worms. Observing its attack: cold sensations, cramping umbilical/abdominal pain, turning into regurgitation, culminating in severe heart pain like needle pricks. (*Shengji*)
Pale complexion, heart/abdominal pain, mouth foaming/vomiting clear fluid, painful episodes with regularity: treat with An Chong San (Peace the Worm Powder). Children with naturally timid constitutions often suffer this. Accumulation pain, food pain, and deficiency pain are similar; only worm pain presents with bland taste and spontaneous foaming. Treatment follows symptoms. Naturally timid children have cold-deficient stomachs; moving worms cause heart pain, resembling epilepsy but without eye deviation or hand convulsions. Treat with An Chong San. (*Zhijue*) [Note: This applies to adults, listed here for reference; subsequent pediatric theories follow this pattern.]
Zhao family tradition: Children with Shang Han unable to sweat may be attacked by these worms, known as Zhang Zhongjing's Hui Jue (Ascaris Reversal). People with Ascaris often have red veins in their eyes. (*Youyou Xinshu*)
All humans harbor quantities of the Nine Worms. Early weaning or early feeding, or excessive sweet consumption, leads to stomach deficiency and moving worms, causing abdominal pain, nausea, vomiting clear fluid, and blue veins on the abdomen. (*Yishuo* citing *Yiyu*)
Abdominal masses appearing and disappearing upon pressure, mid-morning heartburn, jaw stiffness, nausea with clear fluid, and bruxism during sleep indicate worm pain. (Same source)
Coarse diet leads to internal worms and emaciation. Excessive sweets cause pain. Fear of medicine and crying lead to muscle wasting. Observe the Renzhong area; blackening around nose/lips indicates severity. When foam dries and pain stops, worms retreat. Expelling Ascaris cures the disease. (*Huofa Mifang*)
Worm pain presents with facial white spots, red lips, good appetite. Treat with Qulie Gen (Prinsepia root) and Xi Hui (Tin ash). (*Danxi Xinfa*)
Pain with restlessness, self-palpation of heart/abdomen, occasional screaming, green/yellow complexion, relaxed lips, vomiting clear fluid, dull eyes indicate worm pain. (*Yitong*)
General worm signs: Bluish-black under eyes/nose, sallow complexion, crab-claw-like blood vessels on face, anorexia, lack of muscle gain, heaviness, alternating chills/fever. Untreated, they multiply, penetrate the heart, and cause death. (*Rumen*)
Worm diseases vary, progressing gradually or increasing in number. Long-term harm includes abdominal pain, reduced appetite, progressing to emaciation and critical states. Worm pain is characterized by intermittent onset/cessation, unpredictability, vomiting green/yellow water, expelling worms, restlessness, unbearable pain, variable complexion (green/yellow/white) with red lips. Ability to eat after pain subsides confirms worm accumulation; expel promptly. (*Jingyue Quanshu*)
Worm diseases manifest in myriad ways. When diagnosis is difficult, investigate worms. Signs include sallow complexion, emaciation, facial mottling, pica, drinking blood, abnormal organ sounds. Pulses may be soft-slippery, firm-knotting, hidden-rapid, deep-string-tiny-short. These are worm indicators. For excess constitution/internal worms, use expulsive methods; for deficiency constitution/external intestinal membrane worms, use dissolving methods. After expulsion, tonify. (*Nvke Baibing Wenda Buyi*)
Worm patients show sallow complexion, emaciation, pale lips, erect hair, dull complexion, white facial marks, nausea, vomiting clear fluid, colicky pain, failure of food to nourish flesh, wild hair, aversion to cold, forehead/facial eczema/itching. (*Yu'an*)
Patients typically have yellow complexion, frequent salivation, intermittent symptoms, relief with sour foods, aggravation with sweets. Patterns include cold/heat, deficiency/excess. (*Weiqi Lun*)
Patients craving sweets or foreign substances, pain when hungry, white spots on upper/lower lips indicate worms. (*Xinwu*)
Worm syndrome: Heartburn, abdominal pain, or upward attack feeling like biting (worm movement causes panic/restlessness = heartburn; worm crawling/biting causes pain). Vomiting saliva or green/yellow water (worms in stomach disturb Qi, causing fluid overflow; classics say worm movement relaxes stomach, opening Lianquan acupoint, leading to drooling; stagnant Qi fails to transport fluids, causing upward flow from Lianquan). Sallow complexion (Stomach meridian passes face; stomach weakness from worms causes sallow hue). Fluctuating red/white/blue-black colors (Blue/black = pain; white = lack of blood color; red = fire. Unpredictable worm movement causes pain/color changes. Internal stagnation prevents blood from rising (pale); sudden release allows fire to rise (red)). White facial spots (stomach erosion marks reflect on face like shadows). Red lips (Spleen blood heat stagnation reflects on lips). Millet-grain sized sores (Quansheng says worm erosion of lower lip = Hu; upper lip = Huo). Note: This refers to non-Ascaris worms. Text borrows from *Jinkui* Hu/Huo descriptions. Silence/drowsiness, restless lying/rising, anorexia, aversion to food odors (worms move at food smell, causing心烦/anxiety, leading to dislike of food). Pain when hungry, worse after eating (hungry worms seek food; competing worms move chaotically). Relief when full (full worms stop moving). Intermittent pain relieved by percussion (one case: abdominal pain unresponsive to meds, stopped by punching; vibration startles worms). Blue veins on abdomen, recurring abdominal masses, black stool (pediatric malnutrition heat generates worms; Earth failure/Wood overacting causes blue veins; blood deterioration causes black stool). Alternating chills/fever (Qi stagnation internally causes chills; prolonged stagnation bursting outward causes fever). Surging-large pulse (indicates damp-heat generating worms). All are worm indicators. (*Yique*)
Verification Method for Worm Pain: Case study: A patient suffered severe, intermittent, unbearable heart/abdominal pain. Digestive and Qi-moving medicines failed. Only punching the abdomen provided temporary relief, but pain returned. Condition worsened daily. A monk appeared, saying he could cure it. He had the patient eat bait, then administer a pill, expelling a hard-mouthed strange worm. Cure achieved. Reason: Worms gnawed intestines/organs causing pain; punching vibrated organs, frightening worms into hiding. Without punching, worms moved freely, causing recurrence. This verifies worm pain. Any heart/abdominal pain temporarily relieved by rubbing/kneading/deep pressing is likely worm-related. (*Jingyue Quanshu*)
Worm pain improves with food, worsens without. Test with sour plum soup: if pain stops after drinking, it is worm pain; if pain increases or decreases slightly, it is not. (*Shishi Milu*)
Vomiting Ascaris (Refer to An Chong formulas): Visceral cold causes Ascaris to ascend to the diaphragm, vomiting worms. This is Stomach Cold, specifically Stomach Deficiency-Cold, not Excess Cold. Treat with Zhang Zhongjing's Lizhong Wan. (*Baojian Buyi*)
Vomiting Ascaris stems from Stomach Cold. Classics state Ascaris is a Long Worm; cold stomach causes vomiting, leading to Hui Jue. Use Lizhong Tang plus 5 fried Sichuan peppercorns, 0.5 qian Areca Nut, swallowed with Wu Mei Wan. (*Yaojue*)
Vomiting Ascaris is always due to illness causing vomiting, not vomiting caused by Ascaris. Thus, do not treat the worm directly, but treat the cause of vomiting; the worm will stop. Cases caused by Stomach Fire: excessive internal heat forces worms out; clear the heat, and worms settle. Cases caused by Stomach Cold: excessive internal cold expels worms; warm the stomach, and worms settle (e.g., Zhang Zhongjing's Wu Mei Wan). Cases caused by Stomach Deficiency/Lack of Food: granaries empty, worms seek food and emerge; this indicates severe Stomach Qi deficiency; urgently tonify Stomach and warm Middle Jiao to prevent fundamental collapse. These three are treatment methods. However, vomited worms may be dead or alive. If dead, treat vomiting as above. If live worms continuously emerge, expulsion is necessary. Ascaris fears sour and bitter; adding Wu Mei (Mume Fruit) as assistant guides worms to settle. For Stomach Excess-Fire, add Qulie Gen or Huanglian (Coptis Rhizome). (*Jingyue Quanshu*)
Stomach Heat causing worm unrest and vomiting: Often linked to excessive sweet foods (sugarcane, white sugar) stimulating Ascaris. Patient is robust, ruddy complexion, surging-rapid pulse, indicating Stomach Heat. Treat with Huanglian (Coptis Rhizome), Zhizi (Gardenia Fruit), etc. Stomach Cold vomiting worms presents with weak pulse, dull complexion, cold limbs. (*Yigou*)
Generally, Heat Reversal with vomiting Ascaris involves many worms, continuous generation/vomiting, clear consciousness, no restlessness. Use bitter-drying agents like Huanglian to drain damp-heat. (*Weiqi Lun*)
Partial Cravings (See An Chong formulas below; cross-reference with Ji Ju section on Worm Accumulation). Rarely, partial cravings exist: eating rice, mud, charcoal, ash, tea leaves, cloth threads. This is Ne Pi (Internal Fetishism). Initial stage: Middle Qi deficiency, lack of appetite. Accidentally chewing one item, entering intestines/stomach, Ascaris finds it sweet, forming a habit. If pleasing, Ascaris consumes it, bringing mental comfort. If displeasing, even delicacies are rejected by Ascaris, causing discomfort; food enters stomach but is hard to digest, causing bloating/distress. Over time, pathogen deepens, features deteriorate, muscles waste. Healthy foods hated like enemies; forbidden foods desired like honey. Driven by disease demons, not conscious will. Known but repeated, unable to correct. Disease named Pi (Fetishism), due to stubborn fixation preventing smooth flow. Internal Pi and External...