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Taiyang Fu Disease refers to the Fu organ of the Foot-Taiyang Bladder meridian. The Bladder has both a meridian (Jing, 经络) and a Fu organ. If pathogenic factors reside in the meridian, headache and fever occur; if they enter the Fu organ, thirst and dark, scanty urine occur. When Taiyang meridian symptoms are present externally, accompanied by thirst and dark urine, this indicates obstructed and difficult urination, constituting Taiyang Fu disease, unrelated to other Zang-Fu organs. Wuling San (Five-Ingredient Powder with Poria) is the primary formula. If exterior syndromes have not yet resolved, it may be used as a powder concurrently with exterior-resolving agents.

Wuling San Composition: Fuling (Poria, 3 qian), Zhuling (Polyporus, 8 fen), Zexie (Alisma, 8 fen), Guizhi (Cinnamon Twig, 1 qian), Baizhu (Atractylodes Macrocephala Rhizome, 1.5 qian). Decoct in water and take orally; stop when urination becomes smooth.

My Commentary: For the aforementioned symptoms, if spontaneous sweating and a floating pulse are present, it results from Wind-strike pathogens entering the primary Fu organ, and this formula can be used; if there is no sweating and a tight pulse, it results from Cold-pathogen invasion into the primary Fu organ, and adding Fuling and Zexie to Xiangsu San (Fragrant Su Dispersion) will yield immediate effect.

Question: Since there is water in the Bladder, why does thirst occur? Answer: Water has clear and turbid aspects. If turbid water is not eliminated, body fluids (Jinye, 津液) cannot be generated, leading to thirst. Moreover, stagnant water generates dampness; when pathogens invade, heat arises. The aggregation of dampness and heat causes thirst. By promoting diuresis to facilitate the flow of dampness and heat, thirst ceases naturally. If the pathogen is in the meridian and has not entered the Fu organ, one must absolutely avoid using diuretic herbs, as this would draw the pathogen deeper into the primary Fu organ.

The Foot-Yangming Stomach has both a meridian and a Fu organ. "Meridian" implies a pathway, like a road; "Fu organ" implies a vessel, used to hold food and fluids. If pathogens reside in the meridian, symptoms are limited to eye pain, nasal dryness, cracked lips, and the desire to rinse the mouth with water. Once pathogens enter the Fu organ, symptoms such as tidal fever, delirium, mania, insomnia, irritability, thirst, spontaneous sweating, and constipation arise. Baihu Tang (White Tiger Decoction) and Chengqi Tang (Downward-Pouring Decoctions) are both indicated. However, Yangming Fu disease may originate from the primary meridian entering the primary Fu organ; or from the Taiyang or Shaoyang meridians entering the primary Fu organ; or from the Three Yin meridians entering the primary Fu organ. Although the origin differs, the manifestations are identical; physicians must examine these details carefully.

In treating Yangming Fu disease, if the pulse is surging (Hongda, 洪大), with steaming fever, tidal fever, delirium, severe thirst, spontaneous sweating, or macules due to stomach heat, provided the abdomen is not hard and stool is not impacted, this represents diffuse heat in Yangming where pathogens have not yet coalesced. Therefore, this formula, a pungent-cool harmonizing agent, is used.

Baihu Tang Composition: Shigao (Gypsum Fibrosum, 5 qian), Zhimu (Anemarrhenae Rhizoma, 3 qian), Gancao (Licorice Root, 2 qian), Jingsmi (Rice Grain, a pinch). Decoct in water and take orally.

If heat is severe, double the dosage.

According to general principles, if spontaneous sweating is profuse, add Renshen (Ginseng Root), termed Ren Shen Baihu Tang (Ginseng White Tiger Decoction). If complicated by dampness, add Cangzhu (Atractylodis Rhizoma).

My Commentary: This formula should only be administered when the eight characters—severe thirst, tidal fever, spontaneous sweating, and surging pulse—are all present. If exterior syndromes persist without severe thirst, it must absolutely not be used. Furthermore, in Taiyang syndrome, if fever is accompanied by thirst and difficult urination, it is Bladder Fu disease, and Baihu Tang must not be given. If direct invasion of Yin-cold occurs, presenting with facial redness, irritability and heat, apparent but not true thirst, and a desire to sit or lie in mud/water, this is a True Cold False Heat syndrome, requiring warming and tonification. Additionally, fever due to Blood deficiency presents symptoms resembling Baihu Tang syndrome; Danggui Buxue Tang (Tangkuei Decoction for Invigorating Blood) should be used. If Shigao and Zhimu are mistakenly administered, critical danger ensues immediately.