Ascariasis (Worms)

Ascariasis is a common disease in children caused by an infection of ascarides. It is manifested as an abnormal desire for food, sallow complexion, periumbilical abdominal pain and fecal discharge with round worms. In serious cases, colic may appear. The cases with intestinal obstruction and biliary ascariasis may be treated with the principle for colic due to ascariasis mentioned in this section.

Etiology and Pathogenesis

The disease is caused by the ingestion of food contaminated by ascarid eggs. Prolonged infection of the worm may impair the spleen and stomach and consume qi and blood, inducing a series of pathological changes in the body, and in turn, dysfunction of the spleen and stomach may lead to stagnation of food and retention of dampness-heat which create a favorable environment for the reproduction of worms. Since the ascarides tend to accumulate to form a mass and penetrate the intestinal wall, intestinal obstruction and biliary colic may ensue.

Syndrome Differentiation and Therapeutic Principles

A. Syndrome differentiation

In mild cases, there may be no marked symptoms, or occasional periumbilical abdominal pain and irregular bowel movements may appear. In serious cases, sallow complexion, emaciation, paroxia, intermittent abdominal pain and palpable mass and even colic may be present.

B. Therapeutic principles

For an incipient case with a strong physique, anthelminthic therapy should be applied first and followed by therapies to regulate the spleen and stomach. For a debilitated patient, the therapy of regulating the spleen and stomach and tonifying qi and blood should be employed first and followed by the anthelminthic therapy, or both should be used at the same time. For the case with severe abdominal pain, the therapy of calming the worms should be adopted first, and then the anthelminthic therapy should be used.

Classification and Treatment

A. Ascariasis

Manifestations: Intermittent abdominal pain occurring during empty stomach in the morning or nausea, vomiting, poor appetite, sallow complexion, emaciation, listlessness or restlessness, teeth grinding during sleep, paroxia, irregular bowel movement or discharge of worms, white macules appearing on the face in some children or white and transparent granules on the mucosa of the lower lip or dark blue spots on the sclera, red tip of tongue with white and greasy or exfoliative coating.

Therapeutic principles: Dispel ascarids, relieve pain, and regulate the spleen and stomach.

Prescription: The Modification of Quisqualis Powder

Fructus Quisqualis 10 g
Fructus Meliae 10 g
Radix et Rhizoma Rhei 6 g
Fructus Aurantii 10 g
Radix Glycyrrhizae 6 g

Remarks: Add Rhizoma Picrorhizae (6 g) and Radix Scutellariae (6 g) for cases with heat-syndrome. Add Radix Aconiti Lateralis Praeparata (6 g) and Rhizoma Zingiberis (dried, 3 g), and omit Rhei for those with cold-syndrome. The above prescription is applicable to incipient cases with strong physique and should be discontinued in time when the disorder is relieved. For the debilitated cases and those with significant infestation, use Baby-Fattening Pill which is composed of Radix Codonopsis Pilosulae (10 g), Poria (10 g), Rhizoma Atractylodis Macrocephalae (10 g), Radix Glycyrrhizae Praeparata (3 g), Massa Fermentata Medicinalis (10 g), Fructus Crataegi (10 g), Fructus Hordei Germinatus (10 g). Rhizoma Coptidis (3 g), Rhizoma Picrorrhizae (6 g), Fructus Quisqualis (fried, 10 g) and Aloe (5 g). In addition, Decoction of Six Mild Drugs is recommended to strengthen the spleen and stomach for debilitated children before the application of anthelminthic and for strong children after anthelminthic treatment.

B. Colic due to irritation of ascarids

Manifestations: Sudden onset of severe abdominal pain, spontaneous sweating, pallor, deadly coldness of extremities, irritability, nausea, vomiting, vomiting of ascarids, yellow, greasy tongue coating and wiry or smooth and rapid pulse.

Therapeutic principles: Calm the ascarids, and relieve pain.

Prescription: Fructus Mume Bolus

Fructus Mume 10 g
Herba Asari 3 g
Pericarpium Zanthoxyli 6 g
Rhizoma Coptidis 3 g
Cortex Phellodendri 6 g
Radix Aconiti Lateralis Praeparata 6 g
Rhizoma Zingiberis (dried) 3 g
Ramulus Cinnamomi 6 g
Radix Ginseng 10 g
Radix Angelicae Sinensis 10 g

Remarks: Add Herba Artemisiae Scopariae (10 g), Radix et Rhizoma Rhei (6 g, decocted later), Fructus Aurantii (6 g) and Semen Arecae (10 g), and omit Aconiti Lateralis Praeparata, Zingiberis, Cinnamomi and Asari for cases with fever, chilliness, yellow-tinged sclera, yellow and greasy tongue coating due to the retention of dampness-heat and extravasation of bile.

Experiential Prescriptions

A. Mature vinegar; 20 to 30 ml hourly, 3 to 5 times; applicable to cases with severe abdominal pain.  

B. Fructus Quisqualis (fried); dose of one to two pieces per year of age; taken in the morning on an empty stomach for two to three days; overdosage may induce hiccups and should be avoided.

Copyright 1995 Hopkins Technology