何别驾少君六吉兄，召视令政病。诊之曰∶此瘵证也。危期甚速，可勿药。忆别驾公如
君，
前亦患此疾而殁。因谓六兄曰∶令政病状，显属传尸。此证五内有虫，人将殁，虫先出，迭
相传染，为害最烈，慎防之。六兄曰∶吾亦疑及此。据内子云∶家庶母病笃时，伊芳坐榻旁，
见帐中一物飞出，攒入伊芳鼻，自此得病。予曰是矣。六兄求杜患之策，令研獭肝末，每人日
服钱许，思虫由鼻入，当以法御之。嘱捻纸球外裹雄黄，入病患房，以此塞鼻，倘见虫出，
即钳置火中炼之，一夕六兄入房，突有物飞集于头，似觉蜿蜒多足，惊拨堕地而没。秉烛四
照，瞥见其物潜伏几下，蠢蠢然。急呼家人持钳夹住，视形如蝶，翅翼生毛，毛色杂花，投
诸火唧唧如鼠声。六兄有妹，时又病剧，越日令政逝。有邻媪来慰，顺至伊芳妹房中问疾，归
家脱衣，陡见一虫缀其裙，媪亦如法炼毙。伊芳妹殂后，患遂绝。
曩见方理丰翁宅中，始而妻死于是，继而媳死于是，后弟媳又死于是。一岁之中，同病
而死
者三人。次春皆续弦，未几长子死焉。翁娶继室，质伟体坚，自以为无患，不数月而病矣。
其前妻之女，年已及笄，侍继母汤药，忽见病患鼻内有物，蠕蠕而出，心异之。其物飞扑女
面，倏不见，继室殂。女疾作，未百日亦殒。一岁之中，又同病而死者三人。传尸之祸，可
胜言哉!
又许玉生翁，有女四人，先是二三两女，俱患此证，相继而夭。居无何，四女又病。予
谓之
曰∶此证有虫传染，三传乃灵，符药莫制，宜设法以杜后患。翁因将长女远送戚家，病女移
于后院，家人日服獭肝，女殁患幸泯。但三病临危，俱未睹有虫出，或能变化，而人莫之见
欤。
愚按∶传尸乃虚劳中另自一种，虚劳无虫，传尸有虫，虚劳不传染，传尸传染。但此
病与
虚劳形状仿佛，卒难认识，而治之之法，诸说不同，务将证治辨明，则临病庶有主持，亦医
家之不可不讲也。请先以证言之。稽求古训，如苏游之说，道藏之言，不为不详。然后人谓
其类于不经，流于妄诞，似难取信。夫传尸之异在于虫，但其虫须俟人之疾笃而后见，不比
别病之虫，可先从吐从便而见也。紫庭方用乳香熏病患手背，有毛出者，为传尸，法虽未试
，然恐不验。又烧安息香烟，令病患吸之，嗽不止者为传尸，不嗽者非也。此说亦不足凭。
凡虚劳多嗽，嗽最畏烟，断无吸之不嗽之理。惟喻氏谓狐惑声哑嗄。劳瘵亦声哑嗄，是则声
哑者，气管为虫所蚀明矣。斯言可为此证之一验。愚于此更有一得焉，如一家之中，先有患
虚劳而殁，未几又一人所患证同，不问前病之见虫有无，后病之声哑与否，即可断为传尸。
盖寻常虚劳不传染也。至于治法，《肘后》有獭肝散，治冷劳鬼疰，一门相染，《青囊》有
取虫用啄木鸟法，喻氏又谓虚劳热久，蒸其所瘀之血，化而为虫，遂成传尸。瘵证獭肝散，
非不可以杀虫，而未可以行血去瘀。仲景所制大黄 虫丸，及授陈大夫之百劳丸，驱旧生新
，诚有一无二之圣法。愚考二方，《金匮》原文，只言治五劳七伤，内有干血，并未云治传
尸。喻氏从《金匮》叙虚劳于血痹之下悟入，以为血痹则瘀，瘀则生虫，非具过人之识，不
能若是。然则 虫丸百劳丸可涤虫之原，獭肝散青囊药可除虫之害。证有辨之之法，虫有治
之之方。传尸之候，或有可生，然须及早图之。若待其势已成，噬脐何及。
安波按∶喻氏瘀化为虫，实阐前人之秘。
何别驾的六吉兄，请我去诊治他妻子的病。我诊脉后说：“这是瘵证（痨病，一种慢性消耗性传染病）。病情危重，发展迅速，建议不要用药。”我想起何别驾公如君，以前也患过这种病而去世。于是我对六吉兄说：“您夫人的病症表现，明显属于传尸（古代指具有传染性、致死性的痨病，认为由虫引起）。此证五脏内有虫，人将死时，虫先出来，互相传染，危害最烈，务必小心防范。”六吉兄说：“我也怀疑是这种情况。据内子说：家里的庶母病重时，她坐在榻旁，看见帐中有一个东西飞出来，钻入她的鼻孔，从此就得了病。”我说：“确实如此。”六吉兄请求杜绝祸患的办法，让我研碎獭肝末，每人每天服用一钱左右，想虫子是从鼻子进入的，应当用方法抵御它。嘱咐他用捻成的纸球外面裹上雄黄，进入病患房间，用它塞住鼻子；如果看见虫子出来，就用钳子夹住放在火里烧炼。一天晚上，六吉兄进入房间，突然有东西飞集在头上，似乎觉得蜿蜒多足，惊慌地拨弄掉在地上消失了。点燃蜡烛四处照看，瞥见那东西潜伏在床下，蠢蠢欲动。急忙叫家人拿钳子夹住，看形状像蝴蝶，翅膀生毛，毛色杂花，投入火中发出唧唧声像老鼠叫。六吉兄有个妹妹，当时又病得很重，第二天夫人去世了。有位邻居老妇来慰问，顺便到她妹妹房里问病，回家后脱衣服，突然看见一只虫子缀在她的裙子上，老妇也用同样的方法烧死了它。妹妹死后，祸患才断绝。
从前我在方理丰翁家里见过，先是妻子死于这个病，接着儿媳死于这个病，后来弟媳又死于这个病。一年之中，同病而死的人有三个。次年春天都续弦，不久长子也死了。翁娶了继室，体质伟岸坚固，自以为没有祸患，不到几个月就病了。他前妻的女儿，年纪已经成年，侍奉继母喝汤药，忽然看见病患鼻子里有东西，蠕蠕而出，心里觉得很奇怪。那东西飞扑向女子的脸，瞬间不见了，继母去世。女子发病，不到一百天也死了。一年之中，又同病而死三个人。传尸的祸害，可以说尽吗！
还有许玉生翁，有四个女儿，起初第二和第三个女儿，都患这个证，相继夭折。没过多久，第四个女儿又病了。我对他说：“这个证有虫传染，三传之后灵性很强，符咒药物无法控制，应该想办法杜绝后患。”翁于是把长女远远送到亲戚家，生病的女儿移到后院，家人每天服用獭肝，女儿死后祸患幸而泯灭。但是三个病人临危时，都没有看见虫子出来，或许是能变化，而人看不见吧。
我认为：传尸是虚劳中另外的一种，虚劳没有虫，传尸有虫，虚劳不传染，传尸传染。但是这个病与虚劳形状相似，很难识别，而治疗的方法，各种说法不同，务必将证候和治疗辨明，那么面对疾病才有主见，这也是医生不可不讲求的。请先从证候来说。考察古训，如苏游的说法，道藏的话，不算不详细。但后人说它类似不经之谈，流于妄诞，似乎难以取信。传尸的奇异之处在于虫，但这种虫子必须等到病人病重后才出现，不像别的病的虫，可以先从呕吐或大便中看到。紫庭方用乳香熏烤病人的手背，有毛出来的，就是传尸，这个方法虽然没试过，但恐怕不灵验。又燃烧安息香烟，让病人吸入，咳嗽不止的是传尸，不咳嗽的不是。这种说法也不足以凭借。凡是虚劳大多咳嗽，咳嗽最怕烟，绝对没有吸入而不咳嗽的道理。只有喻氏说狐惑病声音嘶哑，劳瘵也声音嘶哑，那么声音嘶哑的，显然是气管被虫侵蚀所致。这话可以作为此证的一个验证。我对此更有心得，比如一家之中，先有人患虚劳而死，不久又有一个人患的病相同，不问前病是否见虫，后病声音是否嘶哑，就可以断定为传尸。因为寻常虚劳是不传染的。至于治疗方法，《肘后备急方》有獭肝散，治冷劳鬼疰，一门相染；《青囊书》有取虫用啄木鸟的方法；喻氏又说虚劳热久，蒸腾所瘀积的血，化而为虫，遂成传尸。瘵证獭肝散，并非不能杀虫，但不能行血去瘀。张仲景所制的大黄䗪虫丸，以及传授给陈大夫的百劳丸，驱除旧血生成新血，确实是一无二的圣法。我考证这两个方子，《金匮要略》原文，只说治五劳七伤，内有干血，并没有说治传尸。喻氏从《金匮》叙述虚劳在血痹之下悟入，认为血痹则瘀，瘀则生虫，不是具有过人见识的人，不能做到这样。然而，大黄䗪虫丸和百劳丸可以涤除虫之源，獭肝散和青囊药可以除去虫之害。证候有辨别的方法，虫子有治疗的方子。传尸的症状，或许有可生的希望，但必须及早谋划。如果等到病势已成，后悔莫及。
He Biejia's brother, Sixth Ji, invited me to examine his wife's illness. Upon pulse diagnosis, I said: "This is Zhai syndrome (Tuberculosis, a chronic consumptive infectious disease). The condition is critical and progresses rapidly; it is advisable not to use medication." I recalled that He Biejia Gong Ru Jun had previously suffered from this illness and died. Therefore, I told Brother Sixth: "Your wife's symptoms clearly belong to Chuan Shi (an ancient term for a contagious, fatal tuberculosis believed to be caused by parasites). This syndrome involves worms in the five internal organs; before death, the worms emerge first, spreading infection among people, causing the most severe harm. Be vigilant." Brother Sixth said: "I also suspected this. According to my wife: when our concubine was critically ill, she sat beside the couch and saw an object fly out of the curtain and enter her nostril; since then, she contracted the disease." I said: "Indeed so." Brother Sixth sought a strategy to prevent further spread, asking me to grind Tan Gan Mo (Dried Liver of Otter) into powder, with each person taking about one Qian (approx. 3-5g) daily. He reasoned that since the worm enters through the nose, methods should be employed to defend against it. He instructed to make paper balls wrapped in Xiong Huang (Realgar), carry them into the patient's room, and use them to plug the nose; if a worm is seen exiting, clamp it with tweezers and roast it in fire. One night, Brother Sixth entered the room, and suddenly an object flew onto his head, seeming to have many wriggling legs; he panicked, brushed it off, and it disappeared. Lighting a candle to look around, he glimpsed the object lurking under the bed, squirming. He urgently called family members to catch it with tweezers. It looked like a butterfly, with hairy wings of mixed colors. Thrown into the fire, it made chirping sounds like a mouse. Brother Sixth had a sister who was also severely ill at the time. The next day, his wife passed away. A neighbor came to console him and visited his sister's room to inquire about her health. Upon returning home and removing her clothes, she suddenly saw a worm attached to her skirt. She also roasted it to death using the same method. After the sister's death, the affliction ceased.
Previously, at Fang Lifeng Weng's residence, the wife died of this illness first, followed by the daughter-in-law, and later the younger brother's wife also died of it. Three people died of the same illness within one year. In the following spring, they all remarried, but soon the eldest son also died. Weng married a second wife, who was robust and healthy, believing herself immune. However, within a few months, she fell ill. His stepdaughter, now of marriageable age, served medicine to her stepmother. Suddenly, she saw something wriggling out of the patient's nostrils and felt strange. The object flew toward the girl's face and vanished instantly. The stepmother died. The girl then fell ill and died within less than one hundred days. Within one year, three more people died of the same illness. Can the disaster of Chuan Shi be fully described!
There was also Xu Yusheng Weng, who had four daughters. Initially, the second and third daughters both suffered from this syndrome and died successively. Not long after, the fourth daughter also became ill. I told him: "This syndrome involves parasitic transmission. After three generations of transmission, its nature becomes potent; talismans and medicines cannot control it. You must find ways to prevent future occurrences." Weng therefore sent his eldest daughter far away to relatives' homes and moved the sick daughter to the rear courtyard. The family took Tan Gan (Otter Liver) daily. After the daughter's death, the threat fortunately vanished. However, none of the three dying patients were observed to expel worms; perhaps they could transform, and humans simply could not see them.
In my opinion: Chuan Shi is a distinct type within Xu Lao (Deficiency Consumption). Xu Lao has no worms, whereas Chuan Shi does; Xu Lao is not contagious, but Chuan Shi is. However, this illness resembles Xu Lao in appearance, making it difficult to distinguish. Treatment methods vary among different theories. It is essential to clarify the syndrome and treatment so that one can take charge when facing illness; this is something physicians must study carefully. Let us first discuss the syndrome. Examining ancient teachings, such as those of Su You or statements in the Daoist Canon, are not insufficiently detailed. Yet later generations considered them unorthodox and absurd, making them hard to believe. The uniqueness of Chuan Shi lies in the worm, but this worm only appears when the patient is critically ill, unlike worms in other diseases which can be seen earlier in vomit or stool. The Zi Ting Formula suggests fumigating the patient's dorsal hand with Ru Xiang (Frankincense); if hair emerges, it is Chuan Shi. Although I have not tested this method, I fear it may not be effective. Another method involves burning An Xi Xiang (Benzoin) incense smoke for the patient to inhale; persistent coughing indicates Chuan Shi, while non-coughing indicates otherwise. This claim is also unreliable. Generally, Xu Lao patients often cough and fear smoke; it is illogical to inhale smoke without coughing. Only Yu Shi noted that Hu Huo disease (Chancroid/Behcet's-like condition) causes hoarseness, and Lao Zhai (Phthisis/TB) also causes hoarseness. Thus, hoarseness clearly indicates that the trachea has been eroded by worms. This statement serves as a verification for this syndrome. I have another insight: if in one household, someone dies of Xu Lao, and shortly after, another person suffers from the same syndrome, regardless of whether the previous case involved visible worms or whether the subsequent case presented with hoarseness, it can be diagnosed as Chuan Shi. This is because ordinary Xu Lao is not contagious. Regarding treatment, *Zhou Hou Bei Ji Fang* (Emergency Prescriptions Kept Up My Sleeve) mentions Tan Gan San (Otter Liver Powder) for treating Cold Lao and Gui Zhu (Ghost Transmission), where an entire family infects each other. *Qing Nang Shu* describes using woodpeckers to extract worms. Yu Shi also stated that prolonged heat in Xu Lao steams stagnant blood, transforming it into worms, thus forming Chuan Shi. Tan Gan San for Zhai syndrome can kill worms but cannot promote blood circulation and remove stasis. Da Huang Zhe Chong Wan (Rhubarb and Ground Beetle Pill) formulated by Zhang Zhongjing, and Bai Lao Wan (Hundred Deficiencies Pill) taught to Doctor Chen, drive out old blood and generate new blood; these are indeed unparalleled sacred methods. I examined the original texts of these two formulas in *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet), which only mention treating Wu Lao Qi Shang (Five Exhaustions and Seven Injuries) with dry blood inside, without mentioning Chuan Shi. Yu Shi deduced from the placement of Xu Lao under Xue Bi (Blood Stasis) in *Jin Gui* that Blood Stasis leads to stagnation, and stagnation generates worms. This requires exceptional insight. Nevertheless, Da Huang Zhe Chong Wan and Bai Lao Wan can cleanse the source of the worms, while Tan Gan San and Qing Nang remedies can eliminate the harm of the worms. There are methods to differentiate the syndrome and prescriptions to treat the worms. For Chuan Shi symptoms, survival might be possible if addressed early. If one waits until the condition is established, it will be too late to regret.
An Bo notes: Yu Shi's theory that stagnation transforms into worms truly elucidates the secrets of predecessors.