I. Traditional Chinese Medicine's Understanding of Biliary Ascariasis

I. Traditional Chinese Medicine's Understanding of Biliary Ascariasis

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Although Traditional Chinese Medicine does not have a specific term for biliary ascariasis, clinical manifestations similar to this condition were already observed by our diligent and wise ancestors as early as the Spring and Autumn and Warring States periods. For example, in "Ling Shu: Jue Bing," it is recorded: "If there are insect masses or dragon worms in the intestines, they must not be removed with small needles. When there is pain in the heart and intestines, a feeling of distention and swelling that moves up and down, with intermittent pain, accompanied by abdominal heat and thirst, and excessive salivation, this indicates dragon worms." By the end of the Eastern Han Dynasty, Zhang Zhongjing explicitly stated in his "Jin Gui Yao Lue": "In cases of ascarid-induced syncope, one should induce vomiting of the worms. If the patient becomes calm but then suddenly feels restless again, this is due to cold in the internal organs, causing the worms to ascend into the diaphragm and thus provoke restlessness. The symptoms will subside after a while. If the patient vomits upon eating and then becomes restless again, it means the worms are attracted by the smell of food and emerge. In such cases, the patient should naturally vomit out the worms. The treatment for ascarid-induced syncope is Wu Mei Wan." It is truly remarkable that Zhang Zhongjing was able to accurately describe the attack process of ascarid-induced syncope 1,700 years ago. The Wu Mei Wan he created for treating "ascarid-induced syncope" has become a classic prescription with confirmed efficacy in treating biliary ascariasis. Wang Shuhe of the Jin Dynasty stated in "Mai Jing": "If the pulse at Guan is tight and slippery, it indicates worm activity," thereby summarizing the characteristic pulse pattern during worm movement. Regarding the etiology and pathogenesis of ascarid-induced syncope, "Dan Xi Xin Fa: Jue Ni" believes: "Ascarid-induced syncope arises from stomach cold," which seems to be consistent with Zhang Zhongjing's concept of "cold in the internal organs." During the Qing Dynasty, physician Cheng Zhongling recorded his experience in treating ascarid-induced syncope in "Yi Xue Xin Wu": "...worms cause piercing pain in the heart, harming the body very quickly; therefore, they should be treated urgently. Zhuichong Wan is the main prescription. However, if stomach cold causes vomiting of worms, Lizhong Anhuo San should be used, which is different from the method for eliminating other types of worms."

The pathogenesis of biliary ascariasis mainly stems from irregular and unhygienic dietary habits, particularly indulging in raw and cold foods, leading to the proliferation of roundworms in the gastrointestinal tract. Roundworms have a tendency to cluster together and possess a burrowing habit, penetrating everywhere. When faced with hunger and an empty gastrointestinal tract, they begin to move upward, entering the thoracic diaphragm and ultimately the bile ducts. Once inside the bile ducts, the roundworms disturb the gallbladder, obstructing the smooth flow of gallbladder qi, resulting in qi stagnation and pain. To put it simply, because the roundworms invade the bile ducts, the ducts contract; the more they contract, the more vigorously the worms move, causing increasingly severe pain for the patient. During their activity, the worms' heads point toward the common bile duct, hence the sensation of "drilling through the top." Stagnation of gallbladder qi inevitably affects the stomach and spleen, and roundworms may even enter the stomach, leading to vomiting—sometimes even the expulsion of worms. When the qi of the internal organs is blocked and turbid qi fails to descend, prolonged stagnation can lead to damp-heat formation. From a Western medical perspective, secondary infection is therefore quite natural.

II. Treatment Based on Syndrome Differentiation