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
三气虚与食生具。巢氏之衍九虫也，曰伏、蛔、白、肉、肺、胃、弱、赤、
蛲。伏虫，长四分，群虫之主也。蛔虫，长一尺，亦有长
五、六寸，其发动则腹中痛，发作肿聚，往来上下，痛有休息，亦攻心痛，口喜吐涎，及吐清
水，贯伤心则死。诊其脉，腹中痛，其脉法当沉弱，今脉反洪大，是
虫也。白虫，长一寸，相生子孙转大，长四、五尺，亦能杀人。寸白虫色白形扁
小，因饮白酒，以桑枝贯牛肉炙食之，并生粟所成。又云∶食生鱼后，即饮乳酪亦生。其发
动则损人精气，腰脚疼。此虫长一尺，则令人死。肉虫，状如烂杏，令人烦满。肺虫，状如
蚕，令人咳嗽。胃虫，状如虾蟆，令人呕逆吐喜哕。弱虫，状如瓜瓣，又名鬲虫，令人多唾。赤
虫，状如生肉，动则腹鸣。蛲虫，至微，形如菜虫，居肚肠中，多则为痔，极则为癞，因人疮处，
以生痈、疽、癣、 、疠 疥。龋虫，无故不为，人患亦不尽有，有亦不必尽
多，或偏无者。此诸虫根据肠
胃之间，若人脏腑气实，则不为害，虚则侵蚀，随其虫之动，能变成诸疾也。
三 者，
下唇生疮，是虫蚀下部，则肛门烂开。心 者，因虚而动，攻食心，谓之心匿。疳 者有
五，曰白、赤、蛲、 、黑。凡五疳，白者轻，赤者次，蛲者又次， 者，又次，黑者最重
。皆从肠里上食咽喉、齿龈，并生疮，下至谷道伤烂，下利脓血，呕逆，手足心热，腰脚痛，嗜卧
。秋冬可，春夏甚。巢氏之论虫 为病之状固详矣。然虫之变此数者，天地之间，气之
所至，百虫争出。如厥阴所至为毛化。其应春，其虫毛，其畜犬；其应夏，其虫羽，其畜马；其
应长夏，其虫 ；其应秋，其虫介，其畜鸡；其应冬，其虫鳞，其畜彘。其畜犬鸡，其虫毛
介；其畜彘，其虫羽鳞；其畜牛犬，其虫 毛；其畜鸡羊，其虫介羽；其畜彘牛，其虫鳞
。其脏肝脾，其虫毛介；其脏心肺，其
虫羽鳞；其脏脾肾，其虫 毛；其脏肺肝，其虫介羽；其脏肾心，其虫鳞 。
地气制己胜，天气制胜己。天制色，地制形。色者，青、黄、赤、白、黑；形者，毛、羽、 、介、鳞。
其生也，胎卵湿化；其成也，
行飞走。故五气、五味根于中，五色、五类形
于外，而有一岁之中，互有胜复，故厥阴司天，毛虫静，羽虫育，介虫不成，居泉，毛虫育
，虫耗，羽虫不育。少阴司天，羽虫静，介虫育，毛虫不成；居泉，羽虫育，介虫耗不育
。太阴司天， 虫静，鳞虫育，羽虫不成；居泉， 虫育，鳞虫不成。少阳司天，羽虫静，
毛虫育， 虫不成居泉，羽虫育，介虫耗，毛虫不育，阳明司天，介虫静，羽虫育，介虫不成
；居泉，介虫育，毛虫耗，羽虫不成。太阳司天，鳞虫静， 虫育；居泉，鳞虫耗， 虫不
育。如风胜则 虫不滋。此之类也，皆五行之相克也。惟湿复则鳞见于陆，为湿土相克，水
长则反增，水鳞虽多，然见于陆则反当死，故不同也。切巢氏言，脾胃虚而为水湿所乘者，
非也。乃脾胃大甚热为水湿多也。以《玄珠》考之，虫得木之气乃生，得雨之气乃化，以知
非厥阴风木之气不生，非太阴湿土之气不成。岂非风木主热，雨泽主湿所致耶？
故五行之中皆有虫，惟金之中其虫寡。冰之中无虫。且诸木有蠹，诸果有螟，诸菜有虫，诸菽有
，五谷有螟蝥 HT
翻，粟破虫出，草腐而萤蚊，粪积而游蛴。若此者，皆木之虫也。烈火之中有鼠，烂灰之
中有蝇。若此者，皆火之虫也。土中盘蛇，坯中走蚓，穴蚁墙蝎，田蝼崖蜴。若此者，皆土
之虫也。科豆 孕于古池，蛭马跃于荒湫，鱼满江湖，蛟
龙藏海。若此者，皆水中之虫也。
昔有冶者，碎一破釜，将入火炉，其铁HT 断处，窠臼中有一
虫，如米中虫，其色正赤，此釜烹饪，不啻千万，不知何以生了不可晓？亦金火之气也。惟
冰之中，未尝见虫焉。北方虽有冰鼠，止是食冰，非生于冰也。乃知木火属春夏，湿土属季
夏，水从土化，故多虫；金从秋气，水从冬气，故无虫焉。若以生物有被，曲有曲虫，酱
有酱虫，醯有醯虫，饮食停久皆有虫。若以为动物不生虫，如户枢不蠹之类。然动劳之人
亦有蛊，岂有不动者耶？且文籍衣服，故不阅不衣而不蠹。然非经季夏阴注，或暴干不待冷，纳
于笥中，亦不生虫蠹也。或瓮旁地湿，鼠妇来朋，墙下壤干，狗蚤居中，岂均生于湿耶？盖
蚤虽不生于湿，亦有生于冬。热则虫生，寒则不生，理故然也。
夫虫之所居，必于脾胃深处
。药之所过，在于中流。虫闻药气而避之，群者安得取之？予之法，先令饥甚，次以槟榔、
雷丸为引，予别下虫药，大下十数行，可以搐而空。HT 上张子政用此法，下虫数百，相
衔。长丈余。若夫疮久而
之药，皆具方中，此不具陈也。
巢元方在《诸病源候论》中推演九虫的情况，已经非常详细了。然而虫类的变化，多得无法穷尽，总之都以湿热为主要成因，不能单纯归结为三气（风、寒、暑）虚损或饮食不洁而生。
巢元方所衍生的九虫包括：伏虫、蛔虫、白虫、肉虫、肺虫、胃虫、弱虫、赤虫、蛲虫。
伏虫，长度四分，是群虫的首领。
蛔虫，长度一尺，也有长五、六寸的，它发作时腹部疼痛，肿块聚散无常，上下窜动，疼痛有间歇，也会攻冲心痛，口中喜欢流涎水，以及吐出清水，如果贯穿伤害心脏就会死亡。诊断其脉象，腹中痛时脉法应当沉弱，现在脉象反而洪大，这是有虫的表现。
白虫，长度一寸，相生子孙逐渐变大，长达四、五尺，也能杀人。寸白虫（绦虫）色白形扁小，是因为饮用白酒，用桑枝串着牛肉烤食，以及食用生粟米所形成。又说：吃生鱼后，立即饮用乳酪也会生出此虫。它发作时损伤人的精气，导致腰脚疼痛。这种虫长到一尺，就会使人死亡。
肉虫，形状像烂杏，令人感到烦闷胀满。
肺虫，形状像蚕，令人咳嗽。
胃虫，形状像蛤蟆，令人呕吐逆气、喜打嗝。
弱虫，形状像瓜瓣，又名膈虫，令人多唾液。
赤虫，形状像生肉，蠕动时腹部鸣响。
蛲虫，极微小，形状像菜青虫，居住在肚肠中，多了会导致痔疮，极严重会导致癞疮，侵入人体疮口处，会生成痈、疽、癣、疳、疥等病症。
龋虫（蛀牙虫），无缘无故并不存在，人患龋齿也不一定有，即使有也不必很多，有的人甚至完全没有。这些虫子都盘踞在肠胃之间，如果人体脏腑之气充实，它们就不为害；如果虚弱则侵蚀身体，随着虫子的活动，能变成各种疾病。
“三”（指下唇生疮），是虫蚀下部，导致肛门溃烂开裂。“心疳”，是因为虚而发动，攻噬心部，称为心匿。“疳积”有五种，分别是白、赤、蛲、黄、黑。凡是这五种疳积，白色的最轻，红色的次之，蛲色的又次之，黄色的再次之，黑色的最重。都是从肠里向上侵蚀咽喉、齿龈，并生成疮疡，向下至谷道（肛门）受伤溃烂，下利脓血，呕吐逆气，手足心发热，腰脚疼痛，嗜睡懒卧。秋冬季节较轻，春夏季节加重。巢元方关于虫疳致病的状况论述固然详细了。然而虫的变化不止这几类，天地之间，气运所至，百虫争出。如厥阴风木所至化为毛虫。它对应春季，其虫为毛虫，其畜为犬；它对应夏季，其虫为羽虫，其畜为马；它对应长夏，其虫为倮虫（无毛羽鳞介者）；它对应秋季，其虫为介虫（有甲壳者），其畜为鸡；它对应冬季，其虫为鳞虫，其畜为猪。其畜为犬鸡，其虫为毛介；其畜为猪，其虫为羽鳞；其畜为牛犬，其虫为倮毛；其畜为鸡羊，其虫为介羽；其畜为猪牛，其虫为鳞倮。其脏为肝脾，其虫为毛介；其脏为心肺，其虫为羽鳞；其脏为脾肾，其虫为倮毛；其脏为肺肝，其虫为介羽；其脏为肾心，其虫为鳞倮。地气制约己所胜之气，天气制约克制己之气。天制约颜色，地制约形体。颜色，即青、黄、赤、白、黑；形体，即毛、羽、倮、介、鳞。它们的生成，源于胎、卵、湿、化四种方式；它们的成熟，表现为行、飞、走三种形态。所以五气、五味根植于内，五色、五类形体显于外，而在一年之中，互有胜复变化。故厥阴司天时，毛虫安静，羽虫繁育，介虫不成；在泉之时，毛虫繁育，倮虫消耗，羽虫不育。少阴司天时，羽虫安静，介虫繁育，毛虫不成；在泉之时，羽虫繁育，介虫消耗不育。太阴司天时，倮虫安静，鳞虫繁育，羽虫不成；在泉之时，倮虫繁育，鳞虫不成。少阳司天时，羽虫安静，毛虫繁育，倮虫不成；在泉之时，羽虫繁育，介虫消耗，毛虫不育。阳明司天时，介虫安静，羽虫繁育，介虫不成；在泉之时，介虫繁育，毛虫消耗，羽虫不成。太阳司天时，鳞虫安静，倮虫繁育；在泉之时，鳞虫消耗，倮虫不育。如风气胜则倮虫不滋生。这类情况，都是五行相克的结果。只有湿气恢复时，鳞虫见于陆地，这是因为湿土与水相克，水气增长反而增加，虽然水中鳞虫虽多，但见于陆地则反而当死，所以不同。切责巢元方的言论，认为脾胃虚而为水湿所乘，是不对的。其实是脾胃大热导致水湿过多。以《玄珠密语》考证，虫得木之气乃生，得雨之气乃化，由此可知非厥阴风木之气不生，非太阴湿土之气不成。难道不是风木主热，雨泽主湿所致吗？
所以在五行之中皆有虫，只有金之中虫很少。冰之中没有虫。且各种树木有蠹虫，各种果实有螟虫，各种蔬菜有虫，各种豆类有虫，五谷有螟蝥，粟米破开虫出，草腐烂而有萤火虫蚊子，粪便堆积而有游动的蛴螬。像这样的，都是木之虫。烈火中有鼠，烂灰中有蝇。像这样的，都是火之虫。土中盘绕着蛇，坯土中行走着蚯蚓，洞穴中有蚂蚁，墙上有蝎子，田里有蝼蛄，崖壁上有蜥蜴。像这样的，都是土之虫。科豆孕育于古池，蚂蟥跳跃于荒潭，鱼充满江湖，蛟龙藏于大海。像这样的，都是水中的虫。
从前有个铁匠，砸碎一口破锅，准备放入火炉，在铁锅断裂处的凹槽中有一只虫，像米中的虫，颜色正红，这口锅烹饪过千万次食物，不知道为何生了虫，不可知晓？这也是金火之气的作用。只有冰之中，从未见过虫。北方虽然有冰鼠，只是吃冰，并非生于冰中。由此可知木火属于春夏，湿土属于季夏，水从土化，所以多虫；金从秋气，水从冬气，所以无虫。如果认为生物有被褥，曲酒有曲虫，酱有酱虫，醋有醋虫，饮食停久都有虫。如果认为动物不生虫，像户枢不蠹之类。然而劳动的人也有蛊疾，难道有不运动的人吗？况且书籍衣物，如果不翻阅不穿用就不会生蠹。但如果不经夏季阴注（潮湿），或者暴晒后不待冷却就收纳进箱笼中，也不会生虫蠹。或者瓮旁地面潮湿，鼠妇聚集，墙下土壤干燥，狗蚤居中，难道是均生于湿吗？大概蚤虽然不生于湿，也有生于冬天的。热则虫生，寒则不生，道理本来如此。
虫所居住的地方，一定在脾胃深处。药物经过的地方，在于中焦。虫闻到药气而躲避，群虫怎么能被取下来呢？我的方法，先让人极度饥饿，然后用槟榔、雷丸作为引经药，给予其他下虫药，大大泻下十几次，就可以将虫全部抽出排空。张子和使用这个方法，排出数百条虫，相互衔接，长达一丈多。至于治疗疮疡久而不愈的药物，都在方剂中具备，这里不再详细陈述。
Niao Yuanfang's elaboration on the nine worms in *Zhubing Yuanhou Lun* (Treatise on the Pathogenesis and Manifestations of Various Diseases) is quite detailed. However, the variations of worms are countless; fundamentally, they are primarily caused by damp-heat (Damp-Heat), and cannot be solely attributed to deficiencies of the three qi (Wind, Cold, Summer-heat) or improper diet.
The nine worms derived by Niao Yuanfang include: Fu worm (Hidden Worm), Ascaris (Roundworm), Bai worm (White Worm), Rou worm (Flesh Worm), Fei worm (Lung Worm), Wei worm (Stomach Worm), Ruo worm (Weak Worm), Chi worm (Red Worm), and Suo worm (Pinworm).
The Fu worm is four fen long and is the leader of the group of worms.
The Ascaris is one chi long, sometimes five or six cun long. When it acts up, it causes abdominal pain, with masses that gather and disperse, moving up and down, with intervals of relief from pain. It may also attack the heart region, cause excessive salivation, and lead to vomiting of clear fluid. If it penetrates and damages the heart, death ensues. In diagnosis, when there is abdominal pain, the pulse should typically be deep and weak; if the pulse is instead surging and large, this indicates the presence of worms.
The Bai worm is one cun long, reproducing and growing larger, reaching four or five chi, and can also be fatal. The Cestoda (Tapeworm/Bai worm) is white, flat, and small, formed by drinking white wine, eating beef roasted on mulberry branches, and consuming raw millet. It is also said that eating raw fish followed immediately by milk or cheese can generate this worm. Its activity depletes the body's essence and qi, causing pain in the waist and legs. If this worm grows to one chi, it causes death.
The Rou worm resembles rotten apricots and causes vexation and fullness.
The Fei worm resembles silkworms and causes coughing.
The Wei worm resembles a toad and causes vomiting, regurgitation, and hiccups.
The Ruo worm resembles melon seeds, also known as Ge worm (Diaphragm Worm), and causes excessive saliva.
The Chi worm resembles raw meat; when it moves, it causes borborygmus (abdominal rumbling).
The Suo worm is extremely minute, resembling vegetable larvae, residing in the intestines. An abundance leads to hemorrhoids, and extreme cases result in leprosy-like sores. Entering existing wounds, it generates carbuncles, ulcers, tinea, gan syndrome (nutritional deficiency disease), and scabies.
The Qie worm (Tooth-decay worm) does not exist without cause; not all people suffer from dental caries, and even if present, they are not necessarily numerous, with some having none at all. These various worms reside between the intestines and stomach. If the zang-fu qi is substantial, they do no harm; if deficient, they erode the body. Depending on their movement, they can transform into various diseases.
"San" refers to sores on the lower lip, indicating worms eroding the lower part, leading to anal fissures and rot. "Xin Gan" (Heart Gan Syndrome) occurs due to deficiency triggering activity, attacking the heart, termed Xin Ni. There are five types of Gan syndrome: Bai, Chi, Suo, Huang, and Hei. Among these five, Bai is the mildest, Chi is next, Suo is next, Huang is next, and Hei is the most severe. They all ascend from the intestines to erode the throat and gums, generating sores, and descend to damage the anus, causing dysentery with pus and blood, vomiting, heat in the palms and soles, waist and leg pain, and lethargy. Symptoms are milder in autumn and winter but worsen in spring and summer. Niao Yuanfang's discussion on the manifestations of worm-induced Gan syndromes is indeed detailed. However, worm variations extend beyond these few categories. Wherever qi reaches in heaven and earth, myriad worms emerge. For instance, where Jueyin Wind-Wood prevails, hairy animals (Mao) evolve. Corresponding to Spring, its worms are Mao, and its domesticated animals are dogs; corresponding to Summer, its worms are Feathered (Yu), and its animals are horses; corresponding to Late Summer, its worms are Naked (Luo); corresponding to Autumn, its worms are Shelled (Jie), and its animals are chickens; corresponding to Winter, its worms are Scaled (Lin), and its animals are pigs. Dogs and chickens correspond to Mao and Jie; pigs correspond to Yu and Lin; cattle and dogs correspond to Luo and Mao; chickens and sheep correspond to Jie and Yu; pigs and cattle correspond to Lin and Luo. Liver and Spleen correspond to Mao and Jie; Heart and Lung correspond to Yu and Lin; Spleen and Kidney correspond to Luo and Mao; Lung and Liver correspond to Jie and Yu; Kidney and Heart correspond to Lin and Luo. Earthly qi controls what it overcomes; Heavenly qi controls what overcomes it. Heaven controls color; Earth controls form. Colors are Green, Yellow, Red, White, Black; forms are Hairy, Feathered, Naked, Shelled, Scaled. Their generation arises from viviparous, oviparous, moist, and metamorphic modes; their maturity manifests as walking, flying, or crawling. Thus, the Five Qi and Five Flavors root internally, while Five Colors and Five Forms manifest externally. Within a year, there are mutual overcoming and restitution cycles. Therefore, when Jueyin governs the Heaven phase, Mao worms are quiet, Yu worms breed, and Jie worms fail to develop; in the Quan phase, Mao worms breed, Luo worms decline, and Yu worms fail to breed. When Shaoyin governs the Heaven phase, Yu worms are quiet, Jie worms breed, and Mao worms fail to develop; in the Quan phase, Yu worms breed, Jie worms decline and fail to breed. When Taiyin governs the Heaven phase, Luo worms are quiet, Lin worms breed, and Yu worms fail to develop; in the Quan phase, Luo worms breed, and Lin worms fail to develop. When Shaoyang governs the Heaven phase, Yu worms are quiet, Mao worms breed, and Luo worms fail to develop; in the Quan phase, Yu worms breed, Jie worms decline, and Mao worms fail to breed. When Yangming governs the Heaven phase, Jie worms are quiet, Yu worms breed, and Jie worms fail to develop; in the Quan phase, Jie worms breed, Mao worms decline, and Yu worms fail to develop. When Taiyang governs the Heaven phase, Lin worms are quiet, Luo worms breed; in the Quan phase, Lin worms decline, and Luo worms fail to breed. If Wind prevails, Luo worms do not thrive. Such phenomena are all due to the mutual overcoming of the Five Elements. Only when Dampness recovers do Scaled worms appear on land, due to the conflict between Damp-Earth and Water; although water increases, Scaled worms appearing on land would die, hence the difference. Critically, Niao Yuanfang's assertion that spleen-stomach deficiency allows water-dampness to invade is incorrect. Rather, it is excessive heat in the spleen-stomach leading to excessive water-dampness. Consulting *Xuanzhu Mi Yu*, worms arise from Wood qi and transform via Rain qi. Thus, without Jueyin Wind-Wood qi, they do not generate; without Taiyin Damp-Earth qi, they do not mature. Is this not due to Wind-Wood governing Heat and Rain governing Dampness?
Therefore, within the Five Elements, worms exist in all, except Metal has few. Ice has no worms. Trees have borers, fruits have moths, vegetables have insects, beans have pests, grains have weevils, millet reveals worms when broken, decaying grass produces fireflies and mosquitoes, and accumulated feces produce wriggling grubs. These are all worms of Wood. Mice exist in fierce fires, flies in rotting ash. These are worms of Fire. Snakes coil in soil, earthworms traverse clay, ants dwell in holes, scorpions hide in walls, mole crickets are in fields, lizards on cliffs. These are worms of Earth. Beans gestate in ancient pools, leeches leap in desolate pools, fish fill rivers and lakes, dragons hide in seas. These are worms of Water.
Once, a blacksmith shattered an old pot to melt in a furnace. In the depression of the broken iron, there was a worm like those in rice, bright red. This pot had cooked thousands of meals; how it generated a worm remains inexplicable. This is also the effect of Metal and Fire qi. Only in ice are worms never seen. Although Northern regions have "ice mice," they merely eat ice and do not originate from it. Thus, Wood and Fire belong to Spring and Summer; Damp-Earth belongs to Late Summer; Water transforms from Earth, hence many worms. Metal follows Autumn qi, Water follows Winter qi, hence no worms. If one argues that biological materials like bedding have lice, Qu (fermented grain starter) has Qu-worms, soy sauce has sauce-worms, vinegar has vinegar-worms, and stagnant food breeds worms, yet claims animals don't breed worms like "a door hinge never rots," this is flawed. Laborers also suffer from Gu (poison/parasite) disorders; are there truly inactive beings? Books and clothes only avoid mildew if not handled or worn. However, if not subjected to Yin moisture of Late Summer or dried violently before cooling and stored in chests, they too will breed worms. Or, if the ground near jars is damp, woodlice gather; if soil under walls is dry, dog fleas inhabit it. Are they all born of dampness? Fleas may not be born of dampness, but can appear in winter. Heat breeds worms; cold prevents it. This is the natural principle.
Worms reside deeply in the spleen and stomach. Medicaments pass through the middle jiao. Worms detect medicinal qi and flee; how can swarms be extracted? My method first induces severe hunger, then uses Areca Seed (Binglang) and Polyporus (Leiwuan) as guides, administering other anti-worm drugs, causing profuse diarrhea several times, thereby emptying the bowels of worms. Zhang Zijiang used this method, extracting hundreds of worms linked together, over one zhang long. Regarding treatments for chronic sores, formulas are provided elsewhere; I do not elaborate here.