1, post-cholecystectomy biliary ascariasis Li, male, 50 years old, was first diagnosed on March 5, 1997. He had gallbladder stones and underwent cholecystectomy in our hospital. In recent January, he had intermittent pain in the right upper abdomen, nausea, loss of appetite and poor bowel movement, which was not obvious after treatment and became increasingly severe with paroxysmal pain, which radiated to the right shoulder and back and right lumbar region during attacks. He was found to have flat and soft abdomen, obvious pressure pain in the right upper abdomen, percussion pain in the liver area, stringent pulse, light tongue and thin yellow coating. Ultrasound showed that the gallbladder had been removed, the bile duct was dilated, and biliary ascaris was present. Urinalysis: red blood cells (1-2), strong positive urinary bilirubin, positive bilirubin. Prescribe Wu Mei Tang with addition and subtraction. Prescription: 30g each of Ume plum and Yin Chen, 5g each of Huang Lian, 20g each of Radix Angelicae Sinensis and Angelicae Sinensis, 8g of Pepper, 10g each of Radix Aconiti, Radix Bupleurum, Neem, Patchouli, Perilla leaf, and Coriolus Versicolor, 15g each of Yu Jin, 5g of Licorice. 3 doses, 1 dose daily with water. Second Diagnosis: The pain was relieved after 1 dose, and the symptoms subsided after 3 doses, and several roundworms were excreted. Ultrasound showed that the extrahepatic bile ducts were 9mm and no abnormal echogenicity was seen in them. The patient was given 3 doses of purging heat and bile and was settled. 2, cholecystitis, gallstones, biliary ascaris Niu, female, 26 years old, was first diagnosed on November 3, 1997. In the past three months, she had vague pain in the right upper abdomen, radiating to the back of the right shoulder, with bitterness in the mouth and dryness in the throat, poor food intake, and increased pain after eating fatty food. The pain was aggravated for 3 days, with paroxysmal intensification, nausea and vomiting, so he came to the clinic urgently. Ultrasound showed acute cholecystitis, gallstones (sediment-like) and biliary roundworms. The formula is Wu Mei Tang with addition and subtraction. Second diagnosis: the symptoms decreased greatly after the medicine, 3 roundworms were excreted, and light pressure pain in the gallbladder area. Ultrasound showed normal bile duct, gallstones (sediment-like) and cholecystitis. He was still treated with heat-clearing, bile-suppressing, and lithotripsy herbal medicine in bulk in an attempt to slowly close the work. 3, cholecystitis, biliary ascariasis Lu, male, 50 years old, was first diagnosed on August 6, 1997. In recent years, he had four episodes of severe pain in the right upper abdomen, all of which improved with treatment. This time, the attack was 4 days old and he came to the clinic after treatment was ineffective. The pain in the right upper abdomen radiates to the back of the right shoulder, accompanied by nausea and vomiting, unbearable pain, distention and stuffiness of the abdomen and bowels, with a pale tongue, thin yellow fur, and string pulse. The abdominal muscle is slightly hard, with strong positive Morphy’s sign and positive percussion pain in the liver area. Ultrasound shows: cholecystitis, biliary ascaris. Prescribe Wu Mei Tang with addition and subtraction. Prescription: 30g each of Radix et Rhizoma Polygonati, Umejae and Inulae, 5g each of Huang Lian and Pepper, 20g each of Huang Bai, Radix Angelicae Sinensis, Radix et Rhizoma Pseudostellariae, Chai Chuan Zi and Citrus Aurantium, 10g each of Licorice and Yan Hu Su, 15g of Betel nut. The second diagnosis: after the medicine symptoms obviously relieved, not discharged roundworms, followed by the above to remove Chai Hu, licorice, plus Huang (after the next) 5g, Mannitol (against) 10g, 3 doses, water decoction, after the medicine discharged roundworms 6, after the follow-up visit the disease did not recur. Note: Wu Mei (Pill) Tang is one of the main formulas in Zhang Zhong Jing’s Treatise on Typhoid Fever. The main pulse evidence is as follows: “In typhoid fever, the pulse is weak and syncopal, the skin is cold, and the patient is quiet and sometimes annoyed. The patient is still and sometimes annoyed. He stops for a while, gets food and vomits again, and often vomits roundworms. This formula has the function of lowering rebellion, stopping vomiting, warming the stomach and calming roundworm, and often treats intestinal roundworm disease and biliary tract roundworm disease with good effect in clinical practice. The symptoms of biliary tract ascariasis are paroxysmal onset of right upper abdominal pain and radiation to the right shoulder and back, nausea and vomiting, bitterness in the mouth, loss of appetite, even the pain is severe and unbearable, the pain can only be temporarily relieved with painkillers, the stool is not smooth, the tongue is light with thin yellow coating, the pulse is tight or smooth, combined with ultrasound examination is not misdiagnosed. This disease belongs to the category of hypochondriac pain, abdominal pain and worms in Chinese medicine. The pathogenesis is a mixture of deficiency, actuality and heat, and the formula of Wu Mei Tang fits this pathogenesis, so it is effective in treating biliary ascariasis. Biliary ascariasis is one of the common acute abdominal diseases, and most of them are combined with cholecystitis, gallstones biliary tract infection. According to the author’s experience, the effect of treating this disease with Wu Mei Tang is not yet ideal, and must be treated according to the clinical manifestations of the dialectical identification of the disease and flexible tailoring. The power of Wu Mei Tang to clear heat and bile, regulate qi and relieve pain is not enough, so Yin Chen, Chai Hu and Chuan Neem should be added to clear heat and bile and regulate qi and relieve pain; the power of warming the stomach is too much but not enough, so the cinnamon branch should be removed or the fine spice should be removed; the power of killing worms and driving away roundworms is thin, so Jun Zi, Neem Bark and Betel nut should be added. Therefore, the clinical evidence should be combined with the diagnosis of the disease, the division of the ancient but not the ancient, according to the main evidence of syncopal yin disease mixed and variable characteristics, from the usual to change, randomized tailoring, in order to reflect the characteristics of Chinese medicine treatment.