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Original text from *Shanghan Lun*: In Shaoyin disease, if diarrhea with pus and blood in the stool occurs, Taohua Decoction is the primary treatment.
Original text from *Shanghan Lun*: In Shaoyin disease, progressing from two or three days to four or five days, if abdominal pain, difficulty in urination, and discharge of pus and blood occur, Taohua Decoction is the primary treatment.

Diseases of the Shaoyin channel are mostly cold patterns; therefore, formulas in the Shaoyin chapter also frequently use warm-hot herbs. These two sections do not explicitly mention cold or heat. However, the ingredients of Taohua Decoction are undoubtedly purely warm-hot in nature. Yet, commentators interpreting these sections suspect that diarrhea with pus/blood and dysuria must belong to heat patterns. Consequently, they force an interpretation of the herb properties in Taohua Decoction, claiming that Chishizhi (Red Clay) is cool in nature, and since a heavy dose of one jin is used, while Ganjiang (Dried Ginger) is hot but only one liang is used, the combined effect should still be considered cool. However, if one were to try decocting and taking 1.6 qian of Chishizhi and 1 qian of Ganjiang, the patient would surely perceive whether it is cool or hot. How can herb properties be so seriously misjudged? Some argue that this condition involves ulceration due to intestinal rot caused by heat, hence the discharge of pus and blood. The *Shennong Bencao Jing* states that Chishizhi can reduce swelling and remove stasis, so a heavy dose of one jin is used to treat ulcers, supplemented by a small amount of the pungent-hot Ganjiang to eliminate bacteria in the ulcers. However, I have heard that bacteria arising from heat can only be eliminated by cool herbs, such as Huanglian (Coptis Rhizome) and Kushen (Sophora Root); those arising from cold can only be eliminated by hot herbs, such as Ganjiang (Dried Ginger) and Chuanjiao (Sichuan Pepper). If the pus and blood discharge treated by Taohua Decoction were indeed caused by heat-toxin, why not use Huanglian and Kushen to assist Chishizhi, but instead use Ganjiang? Although Ganjiang is only used in the amount of one liang, which converts to approximately 3 qian in modern measurements, even if taken in three doses, if the illness is not cured, the full daily dose would likely be consumed. Consuming 3 qian of Ganjiang in one day exerts significant heat. Applied to a patient with heat-dysentery discharging pus and blood, would it not exacerbate the condition? Generally, diarrhea with pus and blood can originate from cold patterns; similarly, dysuria can also stem from cold. Commentators suspect that both pus/blood in stool and dysuria are manifestations of heat, forcing forced interpretations of the formula's ingredients. This is not due to lack of intelligence, but rather insufficient clinical experience.

He XX from Liaoning, aged about thirty, suffered from dampness exposure outdoors in early summer, leading to dysentery with mixed pus and blood, which resisted multiple treatments. Later, the discharged material gradually turned purple, resembling rotten meat, mixed with membranous tissue, accompanied by severe cutting abdominal pain. The physician stated this was due to intestinal corruption; if not urgently cured, the intestine might rupture. Terrified, He XX took a train back to Liaoning. After the arduous journey, his condition worsened upon arrival: uncontrolled dysentery, consuming only a little thin porridge per day. He requested medical attention. His pulse was weak, faint, and deep; the left cun, guan, and chi positions were barely palpable. He reported feeling that food could not digest in his heart/stomach area, and felt floating heat above. He lacked appetite for any food. Dysentery occurred more than twenty times in a day and night. Before each urge to defecate, he felt abdominal heaviness and pain. Careful examination confirmed this was undoubtedly cold dysentery. The discharged material resembling rotten meat and mixed with membranes indicated that the intestinal mucosa had indeed corrupted and was being discharged with the stool. Western medicine classifies this as intestinal ulcer, a severe complication of bacillary dysentery, which is highly dangerous. Western treatments often involve mercury-based preparations, which are inappropriate here. Even for intestinal ulcers I usually encounter, I typically treat them with Jinyinhua (Honeysuckle Flower), Hanzhisan (Notoginseng), and Yadanzi (Semecarpus Anacardium Nuts), which are also unsuitable for this case. Intestinal ulcers generally belong to heat patterns, whereas this case belongs exclusively to cold—a rare instance of intestinal ulcer. Therefore, I prescribed fine powder of Sheng Liuhuang (Native Sulfur), mixed with a little cooked flour to form small pills. Additionally, a heavy dose of Sheng Shanyao (Chinese Yam), Shu Dihuang (Prepared Rehmannia Root), and Longyanrou (Longan Aril) was decocted into a thick soup to take with the pills. After taking over ten doses, totaling 2.5 liang of Sheng Liuhuang (one dose per day, head and second decoctions each delivering approx. 8 fen of Sheng Liuhuang), the dysentery finally healed.

The pulse was weak, faint, and deep, characteristic of Shaoyin disease. The discharge resembling rotten meat with membranes is more severe than simple pus and blood. Had Taohua Decoction been administered when the pus and blood first appeared, recovery would likely have been immediate. By the time the condition reached critical severity, Taohua Decoction alone was insufficient. Thus, adhering to the principle of Taohua Decoction, I substituted Ganjiang with Sheng Liuhuang (Ganjiang is contraindicated for floating heat in the upper jiao, but Sheng Liuhuang is not), and replaced Chishizhi with Sheng Shanyao, Shu Dihuang, and Longyanrou (when the disease enters yin deficiency, Chishizhi can secure the lower jiao but cannot nourish yin; Shanyao and other herbs can both secure the lower jiao and nourish yin). This modification retains the original intent of Taohua Decoction, allowing efficacy even after many doses. Regarding the subsequent section mentioning persistent diarrhea, pus/blood discharge, abdominal pain, and dysuria, Taohua Decoction is also indicated. Dysuria caused by cold is common; thus, Taohua Decoction can also cure it.

Shi XX from Fengtian suddenly experienced urinary retention. Upon admission to a Western hospital, catheterization allowed urine passage. Shortly after, urine accumulated again. A rubber tube was inserted to remain in place for continuous drainage. Initially, there was slight relief, but subsequently, urination remained impossible. He sought my consultation. His pulse was wiry, slow, fine, and weak. He reported severe pain and extreme coldness in the lower jiao. I determined the urinary retention was due to cold coagulation. I prescribed a formula containing Renshen (Ginseng Root), Jiaomu (Black Cardamom Seed), and Huai Niuxi (Achyranthes Root) at 5 qian each; Fuzi (Prepared Aconite Root), Rougui (Cinnamon Bark), and Danggui (Angelica Sinensis Root) at 3 qian each; Ganjiang (Dried Ginger), Xiaohuixiang (Fennel Fruit), Weilingxian (Syringa Vulgaris Stem), Gancao (Licorice Root), and Moyao (Myrrh) at 2 qian each. After three doses, abdominal pain and urinary obstruction resolved. Herbal decoction was then stopped, and he was instructed to take approx. 1 qian of fine Sheng Liuhuang powder daily, divided into two doses, for convalescence. The rationale of the formula: Renshen and Weilingxian together treat qi-deficiency-induced dysuria; Jiaomu, Rougui, Fuzi, and Ganjiang together treat cold-induced dysuria; assisted by Danggui, Niuxi, Huixiang, Moyao, and Gancao, some moisten and lubricate, some guide downward, some open orifices with fragrance, some warm and unblock to resolve stasis, and some harmonize the middle to stop pain. The synergistic action of these herbs resulted in rapid efficacy. Observing this case of dysuria and the cases following the Shaoyin Taohua Decoction section in *Shanghan Lun* regarding pus/blood discharge, it is evident they are cold patterns, not heat patterns.

[Formula of Taohua Decoction] Chishizhi (Red Clay) one jin (half used whole, half sifted into powder), Ganjiang (Dried Ginger) one liang, Jingmi (Rice) one sheng.
Take the three ingredients, add seven sheng of water, boil until the rice is cooked, strain the dregs, and take seven he of the decoction warm. Mix in one fangcunbi of Chishizhi powder. Take three times daily. If symptoms resolve after one dose, do not take the remainder.

Chishizhi is originally earthy in substance, with a slightly warm nature, making it excellent for warming and nourishing the spleen and stomach. Due to its earthy quality, it possesses strong astringent properties, making it effective for treating intestinal discharge of pus and blood. Furthermore, because it grows in the crevice between two stones, originally a pathway for mountain qi circulation, although sticky and astringent, it actually promotes the flow of qi and blood stasis. Hence, it is used heavily as the chief herb in the formula. The reason for using half for decoction and half as powder is that for treating diarrhea, pills and powders are superior to decoctions. Its nature is mild; even with a heavy dose of one jin, it might not suffice to cure the disease. Therefore, half is sifted into fine powder and added to the decoction. Taking the powder also helps protect the intestinal mucosa from damage by stagnant pus and blood. Ganjiang is used because the qi and blood in this condition are stagnated due to cold, transforming into pus and blood. Ganjiang’s heat dispels cold, and its pungency opens stasis. Jingmi is used because it harmonizes the spleen and stomach and promotes urination, serving as an auxiliary herb for persistent diarrhea.