Enterobiasis

　　The source of infection is patients and carriers of ascariasis. A large number of eggs are excreted in the feces of patients, contaminating vegetables and soil. Under suitable temperature and humidity conditions, they develop into mature eggs in about two weeks. Most of the mature eggs are killed by stomach acid when they reach the stomach, but a few enter the small intestine and hatch into larvae. When ascaris enter the cystic duct or intrahepatic bile duct, secondary bacterial infection can occur, leading to acute suppurative cholecystitis, cholangitis, or acute hemorrhagic necrotic pancreatitis.

　　I. Biliary ascariasis

　　1. Antispasmodic and analgesic with atropine, chlorpromazine, or Durodin;

　　2. Deworming treatment can be performed after the pain subsides;

　　3. Timely use of penicillin, streptomycin, and other antibiotics to control biliary tract infection.

　　II. Ascaris intestinal obstruction

      For incomplete intestinal obstruction, initial treatment includes medical treatment such as sedation, antispasmodics, analgesics, and gastrointestinal decompression. After the pain subsides, deworming can be performed. Taking 80-150ml of soybean oil or peanut oil (60ml for children) can soften the ascaris clump, alleviate symptoms, and deworming can be repeated 1-2 days after the symptoms disappear. Oxygen therapy can also soften the ascaris. In cases of complete obstruction, surgical treatment should be considered.

　　In some cases of few ascaris infections in the small intestine, there may be no symptoms.

　　A large number of infections can cause disease, known as ascariasis. Intestinal ascaris often causes recurrent upper abdominal or umbilical pain. The mechanical stimulation of the worms and the toxins and metabolic products they secrete can cause digestive tract dysfunction and allergic protein reactions, such as anorexia, nausea, vomiting, diarrhea, and urticaria. Severe infections in children can lead to malnutrition, restlessness, insomnia, bruxism, and night terrors. Intestinal ascaris are generally in a quiet state, but they can become restless and钻孔 when stimulated by various factors (such as high fever, indigestion, incorrect deworming, etc.), which can lead to severe complications.

　　1. Ascariasis is one of the most common intestinal parasitic diseases in childhood. The disease can affect a child's appetite and the digestive and absorptive functions of the intestines, hinder growth and development, and can lead to a variety of complications. In severe cases, it can even be life-threatening. Therefore, ascariasis should not be considered a trivial matter in children, and active preventive and treatment measures should be taken.

　　2. The adult worms of Ascaris lumbricoides are commonly found in the human intestines, and their eggs are excreted through feces. Infection with ascariasis can occur by mouth after food or hands are contaminated with eggs. When the eggs develop into adult worms in the intestines, they can cause a series of symptoms in children, such as abdominal pain, decreased appetite, nausea, vomiting, mild diarrhea, or constipation, among others.

　　3. The degree of abdominal pain is usually not severe, often presenting as intermittent, hidden pain around the umbilicus or slightly above it, which can recur without a fixed duration. Sometimes, abdominal pain in children can be more pronounced during periods of hunger.

　　4. Some children with intestinal ascaris may experience mental and neurological symptoms. Such as malaise or restlessness, headache, irritability, poor sleep, bruxism, and easy to be startled, etc. This is caused by the absorption of metabolic products or decomposition products of the worm body into the blood. Severe cases of intestinal ascaris may also lead to malnutrition, anemia, delayed development, and poor intellectual development.

　　5. Ascaris has the habit of wandering and boring. When there are too many ascaris in the intestines, or when a child has a high fever, poor digestion, or improper deworming, it can cause the ascaris to become restless, which may lead to serious conditions such as intestinal obstruction, biliary ascariasis, appendicitis, peritonitis, and liver abscess caused by ascaris.

　　6. It is not uncommon for ascaris to come out of a child's nose. For children with specific allergic体质, if they have ascariasis, they may repeatedly experience urticaria, skin itching, facial edema, and other systemic allergic symptoms.

　　7. The most reliable basis for diagnosing ascariasis is a history of vomiting or excreting worms. If a child often has intermittent mild abdominal pain around the umbilicus, accompanied by weight loss and poor appetite; or has bad habits such as eating soil or slag, then ascariasis should be highly suspected. If worm eggs can be found in the feces, the diagnosis of ascariasis can be established, but the absence of worm eggs does not rule out the disease. Because if there are only male worms or immature female worms in the body, there may be no worm eggs in the feces.

　　8. It should be noted that folklore believes that children with ascariasis may have white spots on the face (commonly known as worm spots), white spots on the nails, and blue or purple-brown spots on the sclera, etc. However, scientific investigation and research have proven that these are not unique to ascariasis, so they cannot be used as diagnostic criteria.

　　Direct smearing of feces for examination: This experiment is based on the observation of the color and characteristics of feces with the naked eye, as well as the microscopic observation of the presence of eggs, larvae, various cells, cysts, crystals, etc. in the smears of saline feces under a microscope. Larger worm bodies such as intestinal ascaris, pinworms, tapeworm segments, etc., can be distinguished with the naked eye.

　　First, health care: pay attention to diet

　　1. It is advisable to provide easily digestible, high-calorie, and high-protein diets, such as rice, noodles, and bread as staple foods.

　　2. Foods with high sugar content, such as pastries and candies, can be consumed.

　　3. Eat more eggs, animal lean meat, dairy products, soybeans, and their products;

　　4. Eat more vitamin-rich foods, such as fresh vegetables and fruits.

　　Second, family care

　　1. Sufficient sleep and rest are essential, and the patient should be on absolute bed rest during the attack and concurrent biliary tract infection.

　　2. Mental care is required. For the first attack, the patient may have a fear of the disease. Family members should actively care for and comfort the patient, and explain the condition to relieve their concerns.

　　3. The surrounding environment should be quiet to allow the patient to rest better and recover physical strength that was greatly consumed during the attack.

　　4. When the patient vomits, family members should promptly clear the vomit from the patient's mouth and gargle to prevent oral infection.

　　5, When the patient's pain worsens, hot compresses can be applied locally with a hot water bag in conjunction with medication to relieve pain.

　　Third, precautions

　　1, When in an attack, if the patient uses analgesics such as Dulingding for pain, it should not exceed 2-3 times a day to prevent addiction.

　　2, During the application of tetracycline for concurrent biliary infection, attention should be paid to not taking medication for too long, especially for children, as tetracycline can cause incomplete enamel development, yellow teeth, and slow bone growth.

　　3, When using traditional Chinese medicine magnolia bark syrup for treatment, strict control of dosage should be maintained to prevent poisoning, and it is forbidden to use for patients with poor heart function and weak constitution.

　　4, If there is no relief after conservative treatment (internal medicine) for more than 7 days, or even worsens, or recurs, with yellowing of the skin and mucous membranes and palpable enlarged gallbladder, consider hospitalization for surgical treatment (biliary exploration).

　　First, drug treatment dialectical selection of prescription

　　1, Ascariasis

　　Treatment method: Expel the worm, kill the worm, and regulate the stomach and spleen.

　　Medicines: Modified Dimocarpus longan seed powder decoction. Dimocarpus longan seed, areca nut each 12g,芜荑,鹤虱, bitter magnolia bark, Mylabris each 10g,甘草 3g. Add rhubarb and citrus peel if constipation, adjust the stomach and spleen with modified Yige powder after vermifuge.

　　2, Ascariasis syndrome

　　Treatment method: Soothe the worm and relieve pain, followed by vermifuge.

　　Medicines: Modified Wu梅 ball decoction. Wu梅 15g, 黄连,黄柏 each 6g,川椒,干姜 each 5g, 细辛,附子 each 3g. Remove Aconitum and ginger if there is jaundice and yellow greasy tongue, add Yin Chen, rhubarb, areca nut. Treatment method: Soothe the worm and relieve pain, followed by vermifuge.

　　3, Vermiform abscess syndrome

　　Treatment method: Soothe the worm and promote bowel movement.

　　Medicines: Modified Wu梅 decoction and Xiao Chengqi decoction. Wu梅 12g,枳实,厚朴 each 10g, 黄连,川椒 each 6g,大黄,芒硝 each 5g,甘草 3g.

　　Second, special and proven recipes

　　1, Vermifuge powder:10g of石榴皮, 10g of bitter magnolia bark, 12g of raw Cyathula fortunei, 15g of areca nut. Grind into fine powder. For a 3-year-old child, take 0.25g each time, for a 5-year-old, take 0.5g each time, take twice a day, before breakfast and dinner. Used for expelling ascaris.

　　2, Vermifuge decoction:6g of fried Dimocarpus longan seed, 6g of Areca catechu, 9g of bitter magnolia bark, 6g of Cyathula fortunei, 2 plums, 3g of licorice. Decoct and take before bedtime or on an empty stomach in the morning, take for 2 consecutive days. Used for pain relief during abdominal pain.

　　3, Pig gallbladder juice recipe:Pig gallbladder 1, Sichuan peppercorn 20g, pepper 20g, vinegar 300ml. Grind Sichuan peppercorn and pepper into fine powder, mix with pig gallbladder juice and vinegar, take in 2 doses. Used for biliary ascariasis.

　　4, Biliary ascariasis pain relief recipe:Sichuan peppercorn 20g, egg 1, sesame oil 50g. Grind Sichuan peppercorn into powder, fry the egg with sesame oil, then add the Sichuan peppercorn powder, take it all at once. Used for biliary ascariasis.

　　5, Raphanus sativus and rhubarb powder honey decoction:Raphanus sativus seeds 18g, rhubarb 15g, Alum 9g, Sichuan peppercorn 6g, honey 60g. First decoct Raphanus sativus seeds and Sichuan peppercorn, then add rhubarb, decoct honey separately, mix with the herbal decoction after boiling, take Alum with the herbal decoction, take 1 dose or 2 doses. Used for ascaris intestinal obstruction.

　　6. Oil pepper drink:6g of Sichuan pepper, 150ml of soybean oil. Heat the soybean oil, add Sichuan pepper when it boils, and remove the Sichuan pepper when it turns brown. Drink the oil in 1 to 2 doses. This is used for parasitic intestinal obstruction.

　　Three, other therapies

　　1. Plaster application:200g of fresh magnolia bark, 100g of scallion, 20 grains of pepper, all pounded into paste. Place in a pot, heat, add 150ml of vinegar, stir-fry to a very high temperature, wrap in gauze, apply heat compresses to the sides of the back, from top to bottom, repeat multiple times until the pain is reduced. This is used to treat abdominal pain in children with worm accumulation. Huanglian and Mangxiao each 45g, Bingpian 15g, finely ground together, mixed with vinegar to make a paste, apply externally to the painful area to treat children with intestinal ascaris.

　　2. Chinese herbs:

      (1) Driven tablet: It has the effects of killing parasites, regulating qi, and promoting the elimination of retained food and heat. It is suitable for symptoms of damp-heat and food retention caused by ascaris residing in the intestines, and is not suitable for those with weak bodies. For children aged 3 to 6 years, take 1 to 3 tablets each time, for children aged 6 to 9 years, take 3 to 5 tablets each time, and for children over 9 years old, take 5 to 8 tablets each time. Take twice a day for 1 to 2 days, or take again after one week, and do not take continuously.

　　(2) Huachong Pill: It has the effect of killing parasites and reducing accumulation. It is suitable for children with ascariasis. For children aged 3 to 6 years, take 2 to 3 grams each time, for children aged 6 to 9 years, take 3 to 5 grams each time, and for children over 9 years old, take 5 to 8 grams each time. Take 1 to 2 times a day, on an empty stomach in the morning or before bedtime.

　　(3) Shizhongzi Pill: It has the effects of reducing malnutrition, expelling parasites, and relieving pain. It is suitable for children with malnutrition or worm accumulation. For children aged 3 to 6 years, take 20 to 30 pills each time, for children aged 6 to 9 years, take 30 to 50 pills each time, and for children over 9 years old, take 60 pills each time. Take twice a day.

　　(4) Wu梅丸 (Wumei Pill): It has the effect of warming the interior and calming ascaris. It is suitable for biliary ascariasis. For children aged 3 to 6 years, take 1/3 of a pill each time, for children aged 6 to 9 years, take 1/2 of a pill each time, and for children over 9 years old, take one pill each time. Take twice a day. 5. Fufang Zhegucai powder: It has the effect of expelling parasites and reducing accumulation. It is suitable for ascariasis or biliary ascariasis. For children aged 3 to 6 years, take 1 to 2 packets each time, for children aged 6 to 9 years, take 2 to 3 packets each time, and for children over 9 years old, take 3 to 5 packets each time. Take once a day for 3 consecutive days.

　　3. Other treatments in traditional Chinese medicine:

      (1) The main acupoints for acupuncture are Dachang (both sides), with auxiliary points such as Zusanli (both sides) and Zhigou. The Dachang point is inserted perpendicularly, with the needle tip slightly pointing towards the umbilicus, using strong stimulation and the purgative method. Acupuncture is performed 1 to 2 times a day, for a continuous period of 2 days. This is used for ascariasis. The main acupoints are Yingxiang (transversely through Sibai) and Ganyang points, with auxiliary points including Neiguan, Zusanli, Zhongwan, and Renzhong, using strong stimulation and the purgative method. This is used for biliary ascariasis. The main acupoints are Tianshu and Zhongwan, with auxiliary points including Zusanli, Neiguan, and Hegu, using strong stimulation and the purgative method. This is used for parasitic intestinal obstruction.

　　(2) Massage and rub at the following points:揉一窝风 (rub the One Nest Wind point), 揉外劳宫 (rub the External Palace point), 推三关 (push the Three Passages), 摩腹 (rub the abdomen), 揉神阙 (rub the Shenque point). These techniques are used for parasitic abdominal pain. Press below the xiphoid process of the upper abdomen (based on the point of tenderness), using a method of press-push-relax, perform 7 to 8 consecutive push-pressure actions followed by a heavy press once, and repeat this process. This is used for biliary ascariasis. Use the palm to massage the child's abdomen in a clockwise direction with the旋摩法 (rotary friction method), gradually increasing the pressure, and combine with techniques such as扭揉法 (twisting and rubbing method) or 提抖法 (lifting and shaking method). This is used for parasitic intestinal obstruction.

　　Fourth, Western medical treatment methods for intestinal ascaris

　　1. Drug treatment:

　　(1) Mebendazole (Mebendazole) is 50-150mg per day for children, 100mg each time for adults, taken twice a day in the morning and evening, for three consecutive days; if not completely cured, the second course of treatment can be taken three weeks later. This drug has a good vermifuge effect, with rare side effects. Abdominal pain and diarrhea may occur when using this drug to deworm in cases of heavy infection, but they are mild.

　　(2) Albendazole (Albendazole) is a new broad-spectrum anthelmintic agent. The dose is 400mg, taken once. The efficacy reaches more than 90%. However, in large-scale treatment, there are occasional cases of vomiting ascaris.

　　(3) Levamisole is 150mg, taken once. Although the vermifuge effect of this drug is not as good as that of mebendazole, it is superior to piperazine. The side effects are mild, with occasional nausea, vomiting, decreased appetite, etc., and a few patients may experience mild liver function damage after taking the drug. It should be used with caution in early pregnancy, liver, and kidney diseases. Thiabendazole (Thiabendazole) is 25mg per kilogram of body weight for adults, taken once in the morning and evening, for three consecutive days, and the daily dose should not exceed 3g. This drug has been replaced by mebendazole.

　　(4) Thiabendazole (Pyrantel) (trade name Antiverm, Vermox) is a broad-spectrum antiparasitic drug that can cause severe muscle contraction in ascaris, leading to spastic paralysis. The dosage is 5-10mg/kg, taken once at night. Side effects include headache, dizziness, nausea, etc., and should be administered with caution to pregnant women, patients with acute hepatitis, nephritis, severe heart disease, and fever.

　　(5) Vermox (Piperazine citrate) adults take 3-4g each time, children 150mg per kilogram of body weight per day (not exceeding 3g at the highest dose), taken at bedtime for two consecutive days; add a laxative for constipation. Side effects are mild, with occasional dizziness, nausea, headache, etc. This drug is used less and less.

　　2. Other special treatments:There are reports of oxygen and acupuncture vermifuge, which sometimes have unexpected effects.