Those who feel hungry but have no desire to eat, and vomit roundworms (Ascaris) after eating, are suffering from Jueyin disease (see discussion on "Qi rushing up to the heart").

Those with cold extremities, a pulse that suddenly becomes tight, mental restlessness, a sensation of hunger but inability to eat, have pathogenic factors lodged in the chest. They should be treated with Gengti San (Cantaloupe Seed Powder) to induce vomiting (see detailed discussion on "Jue" / Cold Extremities).

In Taiyang disease, if vomiting is followed by sweating, resulting in fever, aversion to cold being absent, a thin and rapid pulse at the Guan position, abdominal hunger but inability to eat, and regurgitation of food eaten in the morning by evening, this is considered a minor adverse reaction (see discussion on "Fever").

In Yangming disease, after purgation, if there is mental oppression and discomfort, hunger without desire to eat, and sweating only on the head, Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) is appropriate (see discussion on "Restlessness").

When Qi rushes up to the heart causing pain, accompanied by hunger without desire to eat and vomiting roundworms, it is Jueyin disease (can be treated with Guizhi Baizhu Fuling Tang or Lizhong Anhui San to calm the worms).

Patients with Huijue (Roundworm Syncope) typically vomit roundworms. If the patient is usually quiet but occasionally experiences mental restlessness, it is due to internal cold causing the worms to ascend into the diaphragm, thus causing restlessness; the restlessness subsides after a short while. If vomiting and renewed restlessness occur after eating, it is because the worms emerge upon smelling food odor, leading the patient to vomit them spontaneously. Huijue is primarily treated with Wumei Wan (Mume Pill). (Note: Huijue refers to cold extremities accompanied by vomiting roundworms. Zangjue (Visceral Syncope) is a fatal condition due to the exhaustion of Yang Qi. Although Huijue involves cold extremities, restlessness, and vomiting roundworms, the patient becomes quiet after vomiting the worms, unlike Zangjue which involves constant agitation without respite.)

If a patient suffers from internal cold and deficient stomach Qi, causing worm movement ascending to the diaphragm, and vomiting roundworms upon smelling food, presenting with dry tongue and mouth, a frequent desire for cold drinks but reluctance to swallow them, severe烦躁 (restlessness) and confusion, extreme distress, deep and slow pulses in both hands, cold feet extending to the knees, and in severe cases, expulsion of both roundworms and feces with constipation, this condition, though complex, is generally treatable. It should be treated with Jiawei Lizhong Anhui San (Modified Lizhong Roundworm-Calming Powder) or Wumei Wan.

If a patient has internal cold and is incorrectly induced to sweat, causing coldness in the stomach, they will inevitably vomit roundworms. (The *Huoren Shu* states: First administer Lizhong Wan, then Wumei Wan.)

**Wumei Wan Formula:**
Wumei (Mume Fruit, 300 pieces), Xixin (Asarum), Fuzi (Prepared Aconite Root), Guizhi (Cinnamon Twig, bark removed), Renshen (Ginseng Root), Huangbai (Phellodendron Bark) (each 6 liang), Danggui (Angelica Sinensis Root), Shujiao (Sichuan Pepper, perspiration removed, each 4 liang), Ganjiang (Dried Ginger, 10 liang), Huanglian (Coptis Rhizome, 1 jin). The above ten ingredients are separately pounded and sifted, then mixed. Soak Wumei in Kujiu (bitter wine/vinegar) overnight, remove the pits, steam over five sheng of rice until cooked, pound into a paste, mix with the herbs, place in a mortar with honey, and pound two thousand times. Form pills the size of tung tree seeds. Take ten pills before meals with warm water, three times daily, gradually increasing to twenty pills. Avoid raw, cold, slippery, and foul-smelling foods. (The Lung governs Qi and prefers astringency; urgently consume sour flavors to astringe Lung Qi; the sourness of Wumei astringes Lung Qi. The Spleen prefers relaxation; urgently consume sweet flavors to relax Spleen Qi; the sweetness of Renshen relaxes Spleen Qi. When Cold invades internally, use Pungent flavors to moisten and Bitter flavors to firm. The pungency of Danggui, Guizhi, Shujiao, and Xixin moistens internal cold. When Cold prevails excessively, use Pungent-Heat to level it; the pungent-heat of Ganjiang and Fuzi conquers Cold. Roundworms move when encountering Sweet flavors and settle when encountering Bitter flavors; the bitterness of Huanglian and Huangbai settles the roundworms.)

**Lizhong Anhui San:**
A secret formula by Tao Shangfu, effective in repeated use.
Renshen (3 qian), Baizhu (Atractylodes Macrocephala Rhizome), Baifuling (Poria, white part), Ganjiang (each 1.5 qian), Chuanjiao (Sichuan Pepper, 14 grains), Wumei (3 pieces). Prepare as one dose, decoct in two zhong of water until reduced to seven-tenths, and take. In treating roundworms, avoid using Gancao (Licorice Root) and sweet substances, as roundworms move upward when encountering sweetness, settle with bitterness, stop with acidity, and bury their heads downward with the pungency of Chuanjiao.

For those vomiting roundworms that do not cease, add Huanglian and Huangban (each 0.5 fen) and Chuanjiao (14 grains). If the cold is severe, add Fuzi (0.5 qian or 3 qian), adjusting according to the severity of the illness.

**Dai's Viewpoint:** Stomach cold inevitably causes vomiting of roundworms. Everyone knows that vomiting roundworms belongs to Yin syndromes, but there are also Yang syndrome cases of vomiting roundworms. This is likely because the stomach is empty and lacks grain Qi, so the worms ascend seeking food, reaching the throat and being vomited out. One must observe other symptoms and cannot solely attribute it to stomach cold. I recall a case of a patient with Yang Jaundice vomiting roundworms, accompanied by severe macules, belonging to Yang Toxin syndrome with mouth ulcers and sore throat; vomiting roundworms was resolved using cold-natured medicines. Thus, Yang syndromes exist.