1 Ascariasis Stagnation Type

(1) Ascariasis Stagnation Type

① Symptoms: Drilling-like colic in the right upper abdomen, occurring in paroxysms, radiating to the shoulder and back, accompanied by restlessness, sweating, cold limbs, nausea, and vomiting; sometimes worms are expelled, and when the pain subsides, the patient returns to normal. The abdomen is soft, with mild or deep tenderness below the xiphoid process, thin white coating, pale red tongue, and弦紧 or沉弦 pulse.

② Treatment Principle: Calm the worms and relieve pain, promote bile flow and expel parasites.

③ Prescription: Modified Wu Mei Tang. Ingredients: 30g of Wu Mei, 15g of Chuan Lian Zi, 15g of Bin Lang, 10g of Huajiao. Decoct twice, mix well, and take in three doses. During the acute phase, administer 2–3 doses within a day and night. For those with more cold constitution, add 6g of Fu Pian, 6g of Gui Zhi, 3g of Xi Xin, and 3g of Gan Jiang; for those with more heat constitution, add 10g of Zhi Zi, 10g of Huang Lian, and 10g of Huang Bai; for those with mixed cold and heat conditions, include both the cold and heat herbs mentioned above.

④ Note: The ascariasis stagnation type corresponds to what Western medicine calls simple biliary ascariasis. It can be cured with traditional Chinese medicine alone. Wu Mei Tang is the classic first-choice prescription for treating ascarid-induced syncope throughout history. Extensive clinical practice has proven that using Wu Mei Wan or modified versions of Wu Mei Wan to treat biliary ascariasis achieves a cure rate of 60%–95%, making it currently the most satisfactory non-surgical treatment for this condition. It is believed that the unique efficacy of Zhang Zhongjing’s Wu Mei Wan in treating biliary ascariasis primarily stems from its precise formulation, which aligns with the characteristics of roundworms: "they descend when encountering bitterness, become tranquil when encountering sourness, and lie dormant when encountering spiciness." In fact, roundworms are highly sensitive to acidic medicines. Some patients, when Wu Mei Wan is temporarily unavailable, have substituted it with 60g of edible vinegar, 600mg of aspirin, or 15g of hawthorn, and all these alternatives have also been effective. Modern research indicates that the gastric juice of most patients with biliary ascariasis has relatively low acidity. This explains why acidic medicines are effective in treating roundworm infections. Combining sour, bitter, and spicy herbs not only prevents the worms from moving around but also makes them lie dormant and retract, eventually exiting the bile ducts. In fact, regarding parasite expulsion alone, most scholars believe that the direct anti-parasitic effect of Wu Mei Wan itself is not particularly strong; few large numbers of worms are expelled during treatment. Instead, the primary mechanism is to paralyze the worms, increase bile secretion, enhance the contractility of the gallbladder and bile duct walls, accelerate peristalsis, relax the sphincter of Oddi, and gradually make duodenal fluid more acidic, thereby destroying the conditions necessary for roundworms to reside and prompting them to exit the bile ducts. This results in a synergistic effect of spasmolysis, pain relief, parasite expulsion, and anti-infection. Clinical experience tells us that when using Wu Mei Wan to treat biliary ascariasis, it is best to avoid sweet and oily foods, and glucose injections should also be avoided, because excessive sweetness can dilute the sour-spicy flavor, rendering Wu Mei Wan ineffective. Some patients have reported that their pain recurred after eating sugarcane. Oily foods can attract roundworms with their aroma, just as described in "Shang Han Lun": "Roundworms come out when they smell food... and ascend into the diaphragm."