《伤寒论》原文∶少阴病，下利便脓血者，桃花汤主之。
《伤寒论》原文∶少阴病，二、三日至四、五日，腹痛，小便不利，下脓血者，桃花汤主之。
少阴之病寒者居多，故少阴篇之方亦多用热药。此二节之文，未尝言寒，亦未尝言热。然桃花汤之药，
则纯系热药无疑也。乃释此二节者，疑下利脓血与小便不利必皆属热，遂强解桃花汤中药性，谓石脂性凉，
而重用一斤，干姜虽热，而只用一两，合用之仍当以凉论者。然试取石脂一两六钱、干姜一钱煎服，或凉
或热必能自觉，药性岂可重误乎？有谓此证乃大肠因热腐烂致成溃疡，故下脓血。《神农本草经》谓石脂
能消肿去瘀，故重用一斤以治溃疡，复少用干姜之辛烈，以消溃疡中之毒菌。然愚闻之，毒菌生于热者，惟
凉药可以消之，黄连、苦参之类是也；生于凉者，惟热药可以消之，干姜、川椒之类是也。桃花汤所主之下脓
血果系热毒，何以不用黄连、苦参佐石脂，而以干姜佐石脂乎？虽干姜只用一两，亦可折为今之三钱，虽分
三次服下，而病未愈者约必当日服尽。夫一日之间服干姜三钱，其热力不为小矣，而以施之热痢下脓血者，有
不加剧者乎？盖下利脓血原有寒证，即小便不利亦有寒者。注疏诸家疑便脓血及小便不利皆为热证之发现，遂
不得不于方中药品强为之解，斯非其智有不逮，实因临证未多耳。
辽宁何××，年三十许，因初夏在外地多受潮湿，下痢脓血相杂，屡治不愈。后所下者渐变紫色，有
似烂炙，杂以脂膜，腹中切痛，医者谓此因肠中腐败，故所下如此，若不能急为治愈，则肠将断矣。何××
闻之惧甚，遂乘火车急还辽宁，长途辛苦，至家，病益剧，下痢无度，而一日止食稀粥少许，求为延医。
其脉微弱而沉，左三部几不见，问其心中自觉饮食不能消化，且觉上有浮热，诸般饮食皆懒下咽，下痢一昼夜
二十余次，每欲痢时，先觉腹中坠而且疼，细审病因，确系寒痢无疑，其所下者如烂炙，杂以脂膜者，是其肠
中之膜，诚然腐败随痢而下也。西人谓此证为肠溃疡，乃赤痢之坏证，最为危险，所用之药有水银基制品，
而用于此证实有不宜。即愚平素所遇肠溃疡证，亦恒治以金银花、旱三七、鸭胆子诸药，对于此证亦不宜。
盖肠溃疡证多属于热，而此证独属于寒，此诚肠溃疡证之仅见者也。遂俾用生硫黄细末，掺熟面少许为小丸，
又重用生山药、熟地黄、龙眼肉，煎浓汤送服，连服十余剂，共服生硫黄二两半（日服药一剂，头煎次煎约
各送服生硫黄八分许），其痢始愈。
此证脉微弱而沉，少阴之脉也，下者如烂炙兼脂膜，较下脓血为尤甚矣。使其初得下脓血时，投以桃
花汤不即随手可愈乎？乃至病危已至极点，非桃花汤所能胜任，故仍本桃花汤之义，以硫黄代干姜（上
焦有浮热者忌干姜不忌硫黄），用生山药、熟地黄、龙眼肉以代石脂（病入阴虚，石脂能固下不能滋阴，山
药诸药能固下兼能滋阴），如此变通，仍不失桃花汤之本义，是以多服十余剂亦能奏效也。至此节之下节，下
利不止，下脓血，又添腹痛，小便不利证，亦桃花汤主之。盖小便不利因寒者亦恒有之，故投以桃花汤亦能愈也。
奉天石××，忽然小便不通。入西医院治疗，西医治以引溺管，小便通出。有顷，小便复存蓄若干。西
医又纳以橡皮管，使久在其中，有溺即通出。乃初虽稍利，继则小便仍不能出，遂来院求为延医。其脉弦
迟细弱；自言下焦疼甚且凉甚。知其小便因凉而凝滞也。为拟方用人参、椒目、怀牛膝各五钱，附子、肉
桂、当归各三钱，干姜、小茴香、威灵仙、甘草、没药各二钱。连服三剂，腹疼及便闭皆愈。遂停汤药，俾日
用生硫黄细末钱许分两次服下，以善其后。方中之义∶人参、灵仙并用，可治气虚小便不利；椒目、桂、附、
干姜并用，可治因寒小便不利；又佐以当归、牛膝、茴香、没药、甘草诸药，或润而滑之，或引而下
之，或馨香以通窍，或温通以开瘀，或和中以止疼，众药相济为功，所以奏效甚速也。观此小便不利及《伤
寒论》少阴症桃花汤后所附下利脓血治验之案皆为寒证，非热证也明矣。
【桃花汤方】赤石脂一斤（一半全用，一半筛末），干姜一两，粳米一升。
上三味，以水七升，煮米令熟，去滓，温服七合，纳赤石脂末方寸匕，日三服，若一服愈，余勿服。
石脂原为土质，其性微温，故善温养脾胃。为其具有土质，
颇有粘涩之力，故又善治肠 下脓血。又因其生于两石相并之夹
缝，原为山脉行气之处，其质虽粘涩，实兼能流通气血之瘀滞，故方中重用之以为主药。至于一半煎汤一半末
服者，因凡治下利之药，丸散优于汤剂，且其性和平，虽重用一斤犹恐不能胜病，故又用一半筛其细末，纳
汤药中服之也。且服其末，又善护肠中之膜，不至为脓血凝滞所伤损也。用干姜者，因此证其气血因寒
而瘀，是以化为脓血，干姜之热既善祛寒，干姜之辛又善开瘀也。用粳米者，以其能和脾胃，兼能利小便，亦
可为治下利不止者之辅佐品也。
《伤寒论》原文：少阴病，出现腹泻并伴有脓血便的情况，使用桃花汤主治。
《伤寒论》原文：少阴病，病程从二、三天发展到四、五天，出现腹痛，小便不通畅，排出脓血的情况，使用桃花汤主治。
少阴经的疾病多为寒证，因此少阴篇中的方剂也多使用温热药物。这两段条文，虽然没有明说寒或热，但桃花汤的药物组成，毫无疑问全是温热药。然而，解释这两段条文的医家，怀疑下利脓血和小便不利必然属于热证，于是强行解释桃花汤中药物的性质，认为赤石脂性凉，且重用一斤，干姜虽然性热，却只用一两，合用之后仍应视为凉性。但是，如果尝试取赤石脂一两六钱、干姜一钱煎服，是凉是热患者身体必然能自觉感知，药物的性质岂能被严重误判呢？有人称此证是大肠因热腐烂导致溃疡，所以排出脓血。《神农本草经》记载赤石脂能消肿去瘀，所以重用一斤来治疗溃疡，再少量使用干姜的辛烈之性，以消除溃疡中的毒菌。然而我听说，毒菌生于热者，只有凉药可以消除，如黄连、苦参之类；生于寒者，只有热药可以消除，如干姜、川椒之类。桃花汤所主治的下利脓血果真是热毒所致，为何不用黄连、苦参辅助赤石脂，反而用干姜辅助赤石脂呢？即使干姜只用一两，折算成现代约为三钱，虽然分三次服用，但如果病未痊愈，大约当天就会服完。在一天之内服用三钱干姜，其热力并不小，如果将其用于热痢下脓血的患者，难道不会使病情加重吗？大概下利脓血原本就有寒证，即小便不利也有寒证。注疏各家怀疑便脓血及小便不利都是热证的表现，于是不得不对方中的药品进行牵强的解释，这并非他们的智慧不足，实在是因为临床实践经验不多罢了。
辽宁何某某，三十岁左右，因为在初夏外地多受潮湿侵袭，出现痢疾脓血混杂，多次治疗无效。后来排出的物质逐渐变成紫色，类似烂肉，混杂着脂膜，腹部剧烈疼痛。医生称这是因为肠道腐败，所以排泄物如此，如果不能紧急治愈，肠道将会断裂。何某某听后非常恐惧，于是乘坐火车急忙返回辽宁，长途奔波劳累，到家后病情更加严重，痢疾无度，而一天只吃少许稀粥，请求我为他延请医生诊治。他的脉象微弱而沉，左手的寸关尺三部几乎摸不到。问他是否感觉心中饮食不能消化，且感觉上部有浮热，各种饮食都懒得吞咽，下痢一昼夜二十多次，每次想要排便时，先感觉腹部下坠而且疼痛。仔细审查病因，确系寒痢无疑。他所排出的物质像烂肉，混杂着脂膜，那是他肠中的黏膜，确实腐败随痢疾而下。西方医学称此证为肠溃疡，是赤痢的坏证，最为危险，所用的药物有水银基制品，而用于此证实在不适宜。即使是我平时遇到的肠溃疡病例，也常用金银花、旱三七、鸭胆子等药物治疗，对此证也不适宜。因为肠溃疡证多属于热，而此证独属于寒，这确实是肠溃疡证中罕见的情况。于是让他使用生硫黄细末，掺入少许熟面粉制成小丸，又重用生山药、熟地黄、龙眼肉，煎浓汤送服，连续服用十余剂，共服用生硫黄二两半（每日服药一剂，头煎、次煎各约送服生硫黄八分许），痢疾才痊愈。
此证脉象微弱而沉，这是少阴病的脉象；排泄物像烂肉兼带脂膜，比下脓血更为严重。如果在初得下脓血时，投以桃花汤，不是立刻就能痊愈吗？直到病情危急到了极点，非桃花汤所能胜任，所以仍然遵循桃花汤的本义，用硫黄代替干姜（上焦有浮热者忌用干姜但不忌硫黄），用生山药、熟地黄、龙眼肉代替赤石脂（病入阴虚，赤石脂能固涩止泻但不能滋阴，山药等药既能固涩又能滋阴），如此变通，仍然不失桃花汤的本义，所以多服十余剂也能奏效。至于这一节的下一节，下利不止，下脓血，又添腹痛、小便不利证，也是桃花汤主治。大概小便不利因寒引起的也常有，所以投以桃花汤也能痊愈。
奉天石某某，忽然小便不通。进入西医院治疗，西医采用导尿管，小便得以排出。过了一会儿，小便又积聚了一些。西医又插入橡皮管，使其长时间留置其中，有尿即排出。起初虽然稍有利尿效果，随后小便仍然无法排出，于是来院请求我为他诊治。他的脉象弦迟细弱；自述下焦疼痛严重且非常凉。知道他是由于寒冷导致小便凝滞。于是拟方用人参、椒目、怀牛膝各五钱，附子、肉桂、当归各三钱，干姜、小茴香、威灵仙、甘草、没药各二钱。连续服用三剂，腹痛及小便闭塞皆愈。于是停服汤药，让他每天服用生硫黄细末约一钱，分两次服用，以善后调理。方中之义：人参、威灵仙并用，可治疗气虚引起的小便不利；椒目、肉桂、附子、干姜并用，可治疗因寒引起的小便不利；又佐以当归、牛膝、茴香、没药、甘草诸药，有的润而滑之，有的引之下行，有的芳香以通窍，有的温通以开瘀，有的和中以止痛，众药相辅相成，所以奏效迅速。观察此小便不利案及《伤寒论》少阴症桃花汤后所附下利脓血治验的案例，皆为寒证，而非热证，这是很明显的。
【桃花汤方】赤石脂一斤（一半全块使用，一半研成细末），干姜一两，粳米一升。
以上三味药，用水七升，煮米至熟，滤去渣滓，温服七合，纳入赤石脂细末一方寸匕，每日三次服用。如果一次服用后病愈，剩余的药不要服用。
赤石脂原本是土质，其性微温，所以善于温养脾胃。因为它具有土质的特性，颇有粘涩之力，所以又善于治疗肠道下利脓血。又因为它生长在两块石头相并的夹缝中，原本是山脉行气之处，其质虽然粘涩，实则兼能流通气血的瘀滞，所以在方中重用作为主药。至于有一半煎汤、有一半研末服用，是因为凡是治疗下利的药物，丸散优于汤剂，且其药性平和，虽然重用一斤还恐怕不能胜任治病，所以又用一半筛成细末，纳入汤药中服用。而且服用其细末，又善于保护肠中的黏膜，不至于被脓血凝滞所损伤。使用干姜的原因，是因为此证的气血因寒而瘀结，从而化为脓血，干姜的热性既善于祛寒，干姜的辛味又善于开瘀。使用粳米的原因，是因为它能调和脾胃，兼能利小便，也可以作为治疗下利不止的辅助药物。
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.