Worm-expelling agents

Worm-expelling medicinals are medicinals that expel worms from the digestive tract through defecation.

Chinese medicine traditionally recognized a number of intestinal worms (roundworm, inch white worm disease, etc.). However, the biomedical classification is used in modern textbooks, since it enables the practitioner to determine more effective treatments.

The nature and flavor of worm-expelling medicinals are irrelevant to their worm-expelling action. All enter the stomach channel.

Properties

Nature: The nature of worm-expelling medicinals is of no significance in regard to their worm-expelling action.

Flavor: Bitterness and sweetness predominate. However, this is of minor significance for the action of treating worm disease (see Further Study).

Channel entry: All enter the stomach, and some also enter the spleen as well.

Actions And Indications

Worm-expelling medicinals paralyze worms in the digestive tract so that they are unable to cling to the intestinal wall and are thereby expelled from the body.

Intestinal worm diseases are traditionally referred to as worm accumulation (虫积 chóng jī). They are generally characterized by abdominal pain, diarrhea, vomiting or passing of worms in the stool, either no thought of food and drink or rapid hungering with increased eating, predilection for strange foods, and anal itching. In prolonged cases, there may be emaciation, withered-yellow complexion, enlarged abdomen with prominent green-blue veins, and puffy swelling. Mild cases may present with no obvious symptoms, in which case the worms may only be detected by modern biomedical testing.

Chinese medicine traditionally recognizes several important worm diseases that are known to modern medicine.

Roundworm disease (蛔虫病 huí chóng bìng): A disease caused by a pale white or yellow worm, Ascaris lumbricoides, that is shaped like an earthworm. Roundworm disease is attributed to indiscriminate eating of cold, raw, unclean foods or sweet and fatty foods. It is characterized by intermittent abdominal pain. At the painful spot, there is sometimes a lump that wriggles up and down. The face is bright white or mixed yellow and white, sometimes with whitish patches called worm macules. Other signs include emaciation and vomiting of clear fluid, sometimes containing roundworms. In biomedicine, roundworms are called ascarids, and the disease is called ascariasis.

Tapeworm disease (绦虫病 tiāo chóng bìng): Traditionally called inch white worm disease (寸白虫 cùn bái chóng), this disease is attributed to eating raw or improperly cooked pork or other meat. It is characterized by abdominal pain and distension, diarrhea, and the passing of white segments (known in modern medicine as proglottids) in the stool. Inch white worm is so called because the worm is passed in short segments. In biomedicine, tapeworms are called cestodes, and the disease is called cestodiasis or taeniasis.

Pinworm disease (蛲虫病 náo chóng bìng): A worm disease most common in infants and children, and associated with nighttime anal itch that can affect sleep and produce heart vexation and susceptibility to fright. Pinworms were described in the Zhū Bìng Yuán Hòu Lùn (Origin and Manifestation of Diseases) as being very small, and shaped like slugs. In biomedicine, pinworms are called oxyurids, and the disease is called oxyuriasis.

Large intestinal fluke disease (姜片虫病 jiāng piàn chóng bìng): In Chinese medicinal literature, this is traditionally called redworm disease (赤虫病 chì chóng bìng). It is a worm disease that is caused by worms traditionally described as having the appearance of raw meat. It is characterized by puffy swelling, rumbling intestines, abdominal pain, diarrhea, and sometimes stool containing pus and blood.

In China, this condition mostly occurs in Southeastern coastal areas (Shànghǎi, Jiāngsū, Zhèjiāng, Fújiàn, and Táiwān). It can be treated effectively with bīng láng (Arecae Semen) without the need to add draining-precipitants. In biomedicine, intestinal flukes can often be traced to an organism of the genus Fasciolopsis; the infestation is called fasciolopsiasis.

Hookworm disease (钩虫病 gōu chóng bìng): According to biomedical knowledge, hookworm refers to any of numerous bloodsucking nematode worms that have buccal hooks, by which they attach to the intestinal lining.

Hookworm corresponds to the traditional Chinese medical concept of yellow obesity (黄胖 huáng pàng) or yellow swelling (黄肿 huáng zhǒng). It can be treated with bīng láng (Arecae Semen), fěi zǐ (Torreyae Semen), kǔ liàn pí (Meliae Cortex), guàn zhòng (Aspidii Rhizoma), and tǔ jīng pí (Pseudolaricis Cortex).

Blood fluke disease, snail fever (血吸虫病 xuè xī chóng bìng, 罗汉病 luó hàn bìng): According to modern knowledge, blood flukes or schistosomes are an elongated trematode of the genus Schistosoma. The infestation is called schistosomiasis. It is common in tropical and subtropical regions of Africa, South America, the Far East, the Middle East, and the Caribbean.

Blood flukes are parasitic in the portal system and mesenteric veins of the bladder and rectum. Infection is often asymptomatic, but can be chronic and debilitating. Depending on the offending species, it can cause intestinal disease, liver disease, portal hypertension, and urinary tract disease (including bladder cancer).

Filariasis (丝虫病 sī chóng bìng): Infection by any of an important group of slender filamentous nematodes that as adults are parasites in the blood or tissues of mammals and as larvae usually develop in biting insects that belong to the Filariidae and related families.

Filariasis is common in tropical and subtropical regions, especially western Africa, India, southeastern Asia, and South America. Signs and symptoms vary according to the offending species. Wucheria bancrofti and Brugia malayi are associated with lymphatic obstruction, which may result in elephantiasis and chyluria. Onchocerca volvulus causes river blindness, rashes, and subcutaneous nodules. Dracuculus medinensis (the guinea worm) causes drancontiasis, which is characterized by bullous lesions.

Combinations With Other Agents

Draining and precipitating agents are usually combined with worm-expelling medicinals because they enhance the elimination of worms.

Concurrent cold, heat, depletion of right qì, or food stagnation is more effectively treated when corresponding medicinals are added. Mild cases of worm disease can be treated simply with worm-expelling agents.

For patients in weak health, apply the principle of supplementation followed by attack or attack followed by supplementation. Simultaneous supplementation and attack is not used because supplementing medicinals, when taken at the same time as worm-expelling agents, are simply expelled in the elimination process and hence will not benefit the patient.