巢氏云∶蛔虫者，九虫之一也，长尺许，或五六寸者，因脏腑虚弱，及食甘肥而动，其动则
腹中攻痛，或作或辍，口吐涎水，贯心则死，用使君子丸之类下之。钱仲阳云∶吐水不心痛
者，胃冷也，吐沫心痛者，虫痛也，与痫相似，但目不斜，手不搐耳，安虫散主之。田氏云
∶虫痛者，啼哭俯仰，坐卧不安，自按心腹，时时大叫，面色青黄，唇色兼白，目无睛光，
口吐涎沫也。若因胃冷即吐，用理中汤加炒川椒五粒、槟榔五分煎下乌梅丸。古云∶虫蚀上
部，则上唇有白点，虫蚀下部，则下唇有白点。腹中诸虫，望前其头向上，望后其虫向下。
如欲用药，先以猪肝油炙香，令儿闻其香味，使虫头向上，则药易伏。若中气虚而虫不安者
，但调补脾胃自安。丹溪先生云∶冬月吐虫，多是胃气虚寒。用钱氏白术散加丁香二粒主之
。
治验
一小儿患虫动心痛，先服大芜荑汤下瘀秽，反作呕少食，右腮鼻准白中兼黄，此脾肺气虚也
，用异功散二服稍应，更加炮姜，一剂而安。
一小儿吐泻将愈，心痛吐水，手足并冷，忽自手按心腹，此胃气虚寒，类乎虫痛也，用益黄
散而愈。
一小儿病后吐水，心间作痛，余谓胃气虚寒，用五味异功散而愈。后每吐，凡患病，饮食不
进，手足并冷，即吐水心痛，余用前散加升麻、柴胡即愈。或用逐虫之剂，前症益甚，更加
腹痛重坠，余用补中益气汤加炮姜，治之而愈。
使君子丸 治五疳，脾胃不和，心腹膨胀，时复作痛，不食渐瘦，并宜服之。
使君子肉（一两） 浓朴（制） 橘红 白芍药 甘草（炒） 川芎（各一钱）
上为末，蜜丸如皂角子大。每服一丸，陈米饮化下。
安虫散 治虫痛。
胡粉（炒） 鹤虱（炒） 川楝子 槟榔（各二钱） 白矾（枯，二钱半）
上为末，每服三五分，米饮调下。
乌梅丸 治蛔厥当吐蛔，今反静而复烦，此为脏寒，蛔上入其膈，故须臾复止，得食而呕又
烦，蛔闻臭当自吐。及治久痢。（方见伤风咳嗽）
理中汤（方见冷泻）
大芜荑汤（方见疳症）
异功散（方见内钓）
白术散（方见积痛）
益黄散（方见脾脏）
巢元方说：蛔虫是九种寄生虫之一，体长约一尺，也有五六寸长的。因为脏腑虚弱，加上食用甘甜肥腻食物后引发活动。蛔虫活动时，会导致腹部攻冲作痛，疼痛时发时止，口中吐出涎水。如果蛔虫上窜穿透心脏部位则会导致死亡，治疗应使用使君子丸之类的药物来驱虫。钱乙（钱仲阳）说：呕吐清水但不心痛的是胃寒；呕吐泡沫且心痛的是虫痛。这种症状与癫痫相似，但区别在于眼睛不斜视，手脚不抽搐，治疗应以安虫散为主。田氏说：虫痛的症状是患儿啼哭、身体俯仰扭动、坐卧不安，自己用手按压心腹部，不时大声呼叫，面色青黄，嘴唇颜色苍白，眼神无光彩，口吐涎沫。如果是因胃寒引起的呕吐，可用理中汤加入炒制的川椒五粒、槟榔五分煎服，并送服乌梅丸。古书说：虫子侵蚀上部，上唇会出现白点；虫子侵蚀下部，下唇会出现白点。腹中的各种虫子，在农历每月初之前头朝上，之后头朝下。如果要用药驱虫，先用猪肝油烤香，让孩子闻到香味，使虫子头朝上，这样药物就容易制服虫子。如果中气虚弱导致虫子不安宁，只需调理补益脾胃，虫子自然安定。朱丹溪先生说：冬季呕吐出虫，多是胃气虚寒所致。应使用钱氏白术散加丁香两粒主治。
医案记录：
有一个小孩患蛔虫扰动引起的心痛，先服用大芜荑汤排出瘀秽之物，反而出现呕吐、食欲减少的情况，右脸颊和鼻准处肤色白中带黄，这是脾肺气虚的表现，服用异功散两剂后稍有见效，再加炮姜，一剂后病情安定。
另一个小孩吐泻症状即将痊愈时，出现心痛、吐水，手脚冰凉，忽然自己用手按压心腹部，这是胃气虚寒，类似虫痛的症状，使用益黄散治愈。
还有一个小孩病后呕吐清水，心间作痛，我认为这是胃气虚寒，使用五味异功散治愈。后来每次呕吐，凡是患病饮食不进，手脚冰凉，就出现吐水心痛，我使用前方的散剂加入升麻、柴胡即愈。如果使用驱虫的药物，前面的症状反而加重，更加腹痛且有重坠感，我使用补中益气汤加炮姜治疗，最终治愈。
使君子丸：治疗五种疳积，脾胃不和，心腹胀满，时常发作疼痛，不吃东西逐渐消瘦，都适宜服用此药。
组成：使君子肉（一两）、浓朴（制过）、橘红、白芍药、甘草（炒过）、川芎（各一钱）。
制作与用法：以上药材研为细末，用蜂蜜制成如皂角子大小的丸剂。每次服用一丸，用陈米汤化开送服。
安虫散：治疗虫痛。
组成：胡粉（炒过）、鹤虱（炒过）、川楝子、槟榔（各二钱）、白矾（枯矾，二钱半）。
制作与用法：以上药材研为细末，每次服用三至五分，用米汤调匀送服。
乌梅丸：治疗蛔厥证，应当呕吐蛔虫，现在反而安静却又心烦，这是因为内脏寒冷，蛔虫上行进入膈部，所以一会儿又停止，进食后呕吐并且心烦，蛔虫闻到臭味自然会吐出。也用于治疗久痢。（方剂详情见“伤风咳嗽”章节）
理中汤（方剂详情见“冷泻”章节）
大芜荑汤（方剂详情见“疳症”章节）
异功散（方剂详情见“内钓”章节）
白术散（方剂详情见“积痛”章节）
益黄散（方剂详情见“脾脏”章节）
Chao Yuanfang stated: Ascaris lumbricoides (Hui Chong, 蛔虫) is one of the nine types of parasites. It is approximately one chi long, or five to six cun long. Its movement is triggered by the weakness of the Zang-Fu organs and the consumption of sweet and fatty foods. When active, it causes attacking pain in the abdomen, which comes and goes intermittently, accompanied by salivation. If the worm penetrates the heart region, death ensues. Treatment should involve using formulas such as Shijunzi Wan (Scholar's Bean Pill) to expel the parasite. Qian Yi (Qian Zhongyang) stated: Vomiting clear fluid without heart pain indicates Cold of the Stomach; vomiting foam with heart pain indicates Parasite Pain. This condition resembles Epilepsy (Xian Bing, 痫), but differs in that there is no deviation of the eyes or convulsions of the hands and feet. An Chong San (Parasite-Calming Powder) is the primary treatment. Tian Shi stated: Symptoms of Parasite Pain include crying, twisting the body forward and backward, restlessness in sitting and lying down, self-pressing of the heart and abdomen, frequent loud shouting, a complexion that is greenish-yellow, pale lips, lackluster eyes, and salivation. If vomiting is caused by Stomach Cold, Lizhong Tang (Regulate the Middle Decoction) can be used with five fried Sichuan peppercorns (Chuan Chuanjiao, 川椒) and two fen of Areca Seed (Binglang, 槟榔) decocted, followed by administration of Wumei Wan (Mume Pill). Ancient texts state: If worms erode the upper part, white spots appear on the upper lip; if they erode the lower part, white spots appear on the lower lip. Regarding various worms in the abdomen, their heads point upward before the full moon and downward after the full moon. To administer medication, first roast pork liver oil until fragrant and let the child smell it to make the worms' heads point upward, making them easier to subdue by the medicine. If the Middle Qi is deficient causing the worms to be restless, simply regulating and tonifying the Spleen and Stomach will settle them. Master Zhu Danxi stated: Vomiting worms in winter is mostly due to Deficiency-Cold of Stomach Qi. Qian's Baizhu San (Atractylodes Macrocephala Powder) with two cloves (Dingxiang, 丁香) is indicated.
Clinical Cases:
One child suffered from heart pain due to moving parasites. After taking Da Wutai Tang (Greater Wormwood and Melia Decoction) to expel turbidity, he developed vomiting and reduced appetite. His right cheek and nasal tip were white with a yellowish tint, indicating Deficiency of Spleen and Lung Qi. Two doses of Yigong San (Extraordinary Power Powder) showed slight improvement, and adding Pao Jiang (Fried Ginger) resulted in stabilization after one dose.
Another child, whose vomiting and diarrhea were nearly cured, experienced heart pain, vomiting of water, and coldness in both hands and feet. He suddenly pressed his heart and abdomen with his hands. This was identified as Deficiency-Cold of Stomach Qi, resembling Parasite Pain, and was cured using Yihuang San (Yellow Regulating Powder).
A third child vomited clear fluid and had pain in the heart region after an illness. I diagnosed this as Deficiency-Cold of Stomach Qi and treated him with Wuwei Yigong San (Five-Ingredient Extraordinary Power Powder), resulting in a cure. Later, whenever he vomited, refused food during illness, and had cold extremities leading to vomiting and heart pain, I added Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix) to the previous powder, achieving recovery. Conversely, when vermifuge agents were used, the previous symptoms worsened, accompanied by severe abdominal pain and a bearing-down sensation. I treated this with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Pao Jiang, resulting in a cure.
Shijunzi Wan (Scholar's Bean Pill): Treats the five types of Gan syndrome (malnutrition in children), disharmony of the Spleen and Stomach, abdominal distension and fullness, intermittent pain, anorexia, and gradual emaciation. It is suitable for all these conditions.
Ingredients: Shijunzi Rou (Scholar's Bean Flesh, 1 liang), Houpo (Magnoliae Officinalis Cortex, processed), Juhong (Citri Reticulatae Pericarpium Rubrum), Shaoyao (Paeoniae Radix Alba), Gancao (Licorice Root, fried), Chuanxiong (Ligusticum Chuanxiong Rhizome) (each 1 qian).
Preparation and Administration: Grind the above into powder, form pills with honey the size of soap beans. Take one pill per dose, dissolved in aged rice water.
An Chong San (Parasite-Calming Powder): Treats Parasite Pain.
Ingredients: Hufen (Lead White, fried), Leshi (Chrysanthemi Indici Flos, fried), Chuanlianzi (Toosendan Fructus), Binglang (Areca Seed) (each 2 qian), Baifan (Alumen, calcined, 2.5 qian).
Preparation and Administration: Grind the above into powder. Take 3-5 fen per dose, mixed with rice water.
Wumei Wan (Mume Pill): Treats Reversal due to Ascaris (Hui Jue, 蛔厥) where vomiting of worms is expected but absent, replaced by quietness followed by irritability, due to Internal Cold causing worms to ascend into the diaphragm, stopping temporarily, then returning with eating-induced vomiting and irritability. The worms naturally vomit upon smelling odors. Also treats chronic dysentery. (Formula details see "Wind-Cold Cough")
Lizhong Tang (Regulate the Middle Decoction) (See "Cold Diarrhea")
Da Wutai Tang (Greater Wormwood and Melia Decoction) (See "Gan Syndrome")
Yigong San (Extraordinary Power Powder) (See "Internal Hook")
Baizhu San (Atractylodes Macrocephala Powder) (See "Accumulation Pain")
Yihuang San (Yellow Regulating Powder) (See "Spleen Organ")