孙文垣治马迪庵内人，原以饮食过伤，又为风寒外袭。或以内伤外感治之，致五更发热，（盛于阳分。）唇燥，
胸中冲跳不已，手足皆冷，（热厥。）脉两寸俱滑数，（寸盛是火上冲。）曰∶此奇痰症也。（杜撰。）以小陷胸
汤加白芍、萝卜子、前胡、酒芩，二帖，次早大便行，下蛔虫八条，（却不见有奇痰。）胸中既不冲跳，但觉
力怯。再诊之，两寸减半，尺脉稍起，以二陈汤加白芍、酒芩调理，后四帖加当归全愈。（雄按∶伏痰挟火上冲，
而胸中跳动者，亦有其证。余尝治蒋左侯室人之病，以雪羹和竹沥调紫雪而瘳焉。证虽非奇痰，其论未可浓非。）
按∶此由发热过散，则扰动其火，上冲胸跳，蛔亦不安而动。辄以小陷胸汤投之，则黄连之苦寒能降
火，蒌仁之甘寒能清火，枳实之峻削能攻下，病去厥止，蛔亦从而下行。其力怯，良由攻之猛耳，非真有
奇痰为病也。孙君生平专以痰揣病，其不经处，类多如此。（雄按∶蛔因热动，以致胸跳，热降蛔下，则
病自安。孙君之治，固为幸中；魏氏之评，亦有未当。）
张景岳治王氏少妇，年未二旬，素喜瓜果生冷，常病心腹痛，每发必数日不食，后数年发必吐蛔。初吐尚
少，既而日多，每吐必一二十条，每发必旬日不食。医者但知攻虫，旋去旋有，百药不瘳。察其脉症，因知其
伤于生冷，致脾胃虚寒，阴湿气聚，故为是症。使不温胃养脾，以杜寒湿生化之源，虫去复生，终无济也。乃
制温脏丸与之，药未完而病愈。后仍耽生冷果，旧病复作，与前药而安。（原注∶凡治虫之法，但察以别无疳
热等症者，悉以温补脾胃为主。雄按∶议论超卓，然因于热者较多也。）
孙文垣诊治马迪庵的妻子，她原本因为饮食过度损伤脾胃，又遭受风寒外邪侵袭。有人用治疗内伤和外感的方法处理，导致她在五更时分发热（阳气旺盛之时），嘴唇干燥，胸中感觉有气冲撞跳动不止，手脚冰凉（热厥证），两手寸脉都呈现滑数之象（寸脉盛大是因为火气上冲）。孙文垣说：这是奇异的痰症（杜撰的说法）。于是用小陷胸汤加入白芍、萝卜子、前胡、酒炒黄芩，服用两帖后，第二天早晨大便通畅，排出蛔虫八条（并没有看到所谓的奇异痰液）。胸中的冲撞跳动停止了，但只感到力气虚弱。再次诊察时，两手寸脉减弱了一半，尺脉稍微升起，使用二陈汤加入白芍、酒炒黄芩进行调理，后来在方剂中加入当归，共四帖后完全痊愈。（徐大椿按语：潜伏的痰饮挟带火气上冲，导致胸中跳动的情况，也是确实存在的病症。我曾经治疗蒋左侯妻子的病，用雪羹汤配合竹沥调服紫雪散而治愈。虽然此证并非奇异痰症，但不能因此过分否定孙文垣的理论。）
按语：这是因为发热时发散太过，扰动体内火气，火气上冲导致胸中跳动，蛔虫也不安而动。随即使用小陷胸汤投药，其中黄连的苦寒性质能降火，瓜蒌仁的甘寒性质能清火，枳实的峻烈削伐作用能攻下积滞，病邪去除，厥逆停止，蛔虫也随之下行。患者感到力气虚弱，确实是由于攻伐太猛所致，并不是真的有奇异痰症致病。孙文垣平生专门以“痰”来揣测病情，其不恰当之处，大多像这样。（徐大椿按语：蛔虫因热而动，导致胸中跳动，火气下降蛔虫下行，病自然安定。孙文垣的治疗，固然侥幸中的；魏氏的评价，也有不妥当的地方。）
张景岳诊治王氏的年轻媳妇，年龄不到二十岁，平时喜欢吃瓜果生冷食物，经常患心腹疼痛，每次发作必定几天不吃东西，几年后每次发作都会吐出蛔虫。起初吐出的蛔虫还少，后来每天增多，每次必吐出一二十条，每次发作必定十天不吃东西。医生只知道驱虫，虫子刚去掉又长出来，各种药物都不见效。张景岳观察她的脉象和症状，推断出是因为损伤了生冷食物，导致脾胃虚寒，阴湿之气聚集，所以出现这种病症。如果不温养胃脾，以杜绝寒湿生化之源，虫子去掉了还会再生，终究没有帮助。于是制作温脏丸给她服用，药还没吃完病就好了。后来她又沉迷于吃生冷水果，旧病复发，服用之前的药物便安稳了。（原注：凡是治疗寄生虫的方法，只要检查没有其他疳积发热等症状的，都以温补脾胃为主。徐大椿按语：议论高超卓越，然而因热导致的病例较多。）
Sun Wenyuan treated the wife of Ma Di'an, who had originally suffered from dietary excess damaging her interior, compounded by an external invasion of wind-cold. Previous treatments using methods for internal injury and external contraction resulted in fever at dawn (when Yang energy is flourishing), dry lips, incessant palpitations and rushing sensations in the chest, cold hands and feet (heat jue syndrome), and slippery-rapid pulses in both cun positions (a full cun pulse indicates fire rushing upward). Sun stated: "This is a rare phlegm disorder" (a fabricated diagnosis). He prescribed Xiao Xian Xiong Tang (Small Chest-Opening Decoction) modified with Bai Shao (White Peony Root), Luobo Zi (Radish Seed), Qian Hu (Peucedani Radix), and Jiu Qin (Scutellariae Radix prepared with wine). After two doses, bowel movement occurred the following morning, expelling eight roundworms (no rare phlegm was observed). The chest rushing ceased, but she felt weak. On re-examination, the cun pulses were halved, while the chi pulses slightly rose. She was managed with Er Chen Tang (Two-Cured Decoction) modified with Bai Shao and Jiu Qin. Later, Dang Gui (Angelicae Sinensis Radix) was added to four additional doses, resulting in complete recovery. (Xu Dachun's commentary: There are indeed cases where latent phlegm carrying fire rushes upward, causing chest palpitations. I once treated the wife of Jiang Zuhou with Xue Geng Tang (Snow Broth) combined with Zhuli (Bamboo Sap) and Zixue San (Purple Snow Powder), achieving a cure. Although this case was not a rare phlegm disorder, one should not overly dismiss Sun's theoretical framework.)
Commentary: This condition arose because excessive dispersal during fever disturbed the internal fire, causing it to rush upward and induce chest palpitations, which agitated the roundworms. The immediate use of Xiao Xian Xiong Tang utilized Huang Lian (Coptidis Rhizoma) for its bitter-cold property to descend fire, Gua Lou Ren (Trichosanthis Semen) for its sweet-cold property to clear fire, and Zhi Shi (Aurantii Fructus Immaturus) for its harsh purgative action to attack stagnation. With the pathogen removed and jue resolved, the roundworms descended accordingly. The weakness was indeed due to the harshness of the purgation, not the presence of rare phlegm. Sun Wenyuan specialized in diagnosing based on "phlegm," and his inaccuracies often resemble this case. (Xu Dachun's commentary: Roundworms move due to heat, causing chest palpitations; when heat descends and worms move downward, the illness resolves naturally. Sun's treatment was fortunate in hitting the mark; Wei's critique has some impropriety.)
Zhang Jingyue treated a young woman surnamed Wang, under twenty years old, who habitually enjoyed melons and raw/cold foods. She frequently suffered from heart and abdominal pain, lasting several days without eating upon each onset. Years later, each episode involved vomiting roundworms. Initially few, the number increased daily, with each episode expelling 10-20 worms and lasting ten days without food intake. Physicians only knew how to attack parasites; they returned after removal, and various medicines failed. Observing her pulse and symptoms, Zhang deduced that damage from raw/cold foods caused spleen-stomach deficiency-cold and accumulation of yin-dampness, leading to this syndrome. Without warming the stomach and nourishing the spleen to cut off the source of cold-damp generation, removing worms would be futile as they would regenerate. He prepared Wen Zang Wan (Warm Viscera Pill) for her, and she recovered before finishing the medication. Later, indulging again in raw fruits caused a relapse, which was settled with the previous medicine. (Original note: Regarding parasite treatment, if no other malnutrition-heat syndromes are present, the primary approach should be warming and tonifying the spleen and stomach. Xu Dachun's commentary: The argument is outstanding, yet many cases are caused by heat.)