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The various formulas discussed above in the Taiyang chapter of Shanghan Lun, although different from one another, are generally used to treat diseases of the Taiyang channel (Taiyang Channel Disease) located on the exterior. As for treating diseases of the Taiyang fu-organ (Bladder and Lower Jiao pathology), there were originally few formulas; however, for the most severe cases of Taiyang fu-organ disease, Taohé Chengqi Tang (Peach Pit Decoction to Direct Downward) is indicated. Let us further discuss this in detail.

The original text of Shanghan Lun states: When Taiyang disease (Taiyang Channel Disease) does not resolve, heat becomes bound in the Bladder, and the person exhibits a manic-like state. If blood discharges spontaneously, the condition will heal. If the exterior syndrome has not yet resolved, attack methods should not be used yet; instead, the exterior should first be resolved. Once the exterior is resolved, if only urgency and binding in the lower abdomen remain, then an attack method can be used, and Taohé Chengqi Tang (Peach Pit Decoction to Direct Downward) is appropriate.

[Formula of Taohé Chengqi Tang] Tao Ren (Persicae Semen, 桃仁) fifty kernels, skin and tips removed; Guizhi (Cinnamomi Ramulus, 桂枝) two liang, skin removed; Dahuang (Rhei Radix et Rhizoma, 大黄) four liang, skin removed; Mangxiao (Natrii Sulfas, 芒硝) two liang; Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) two liang, honey-fried.

Take these five herbs, boil them in seven sheng of water until two and a half sheng remains. Strain out the dregs, add Mangxiao (Natrii Sulfas, 芒硝), boil again briefly over fire, then remove from heat. Take five he (approx. 100 ml) warm before meals, three times a day. A mild purgation is expected.

This syndrome results from exogenous heat descending along the membranes of the Sanjiao (Triple Burner) and binding in the Bladder. The Bladder is connected via membranes to the Baozhong (Uterus/Pelvic Cavity). Heat steams upward, causing the Baozhong to accumulate excess heat and stagnant blood that fails to circulate. Furthermore, heat climbs along the Renmai (Conception Vessel), disturbing the Shen (Spirit/Mind), which causes the manic-like symptoms.

However, the pathogenesis is infinitely variable. If the stagnant blood in the Baozhong accumulates excessively and discharges spontaneously, the heat will descend with the blood, and the disease may heal. If the blood cannot discharge spontaneously and there is a tendency to discharge but fails to do so, it must be treated with purgation to force it downward. Because the exterior syndrome has not resolved, or because exogenous heat has re-deepened internally due to prior inappropriate purgation, it is necessary to first resolve the exterior before proceeding with internal purgation.

Dahuang (Rhei Radix et Rhizoma, 大黄): Bitter in taste, fragrant in aroma, cool in nature. It naturally opens qi and breaks blood stasis, belonging to purgative herbs. However, without specific herbs entering the blood level to guide it, its blood-breaking power is not focused. In this formula, Tao Ren (Persicae Semen, 桃仁) is used to guide the power of Dahuang specifically into the blood level to break stasis. Xu Lingtai stated: Peach blossoms grow in the harmonious qi of March, and their bright red color resembles blood. Therefore, for conditions of blood stagnation and binding that cannot self-regulate and flow freely, Tao Ren (Persicae Semen, 桃仁) can enter and harmonize/disperse them. Why is its ability to generate blood slight, while its ability to remove stasis significant? This is because the peach pit itself is not of the blood category, so it cannot provide tonification. Stagnant blood is ruined blood; without vital qi, it cannot circulate. The vital qi of the peach lies in the kernel, and its bitter taste allows for opening and draining, thus enabling it to expel old stasis without damaging new blood. Regarding the use of Guizhi (Cinnamomi Ramulus, 桂枝) in the formula, it is also because it excels at guiding other herbs into the blood level and directing them upward to clear heat in the upper jiao blood level. Thus, the Shen (Spirit/Mind) calms naturally, and the manic-like state heals.

Particularly, when using Taohé Chengqi Tang (Peach Pit Decoction to Direct Downward), careful consideration is required. If the patient habitually feels distension in the lower abdomen, and this distension worsens upon stimulation by exogenous pathogens, one must suspect pre-existing blood stasis. If Taohé Chengqi Tang (Peach Pit Decoction to Direct Downward) is mistakenly used to purge, the discharged material will certainly be purple, clotted dead blood. After such discharge, fewer than one or two out of ten patients may survive. If clinical circumstances necessitate the use of Taohé Chengqi Tang (Peach Pit Decoction to Direct Downward), this risk must be explained to the family to avoid misunderstanding.

Heat binding in the Bladder does not necessarily involve blood stasis in the Baozhong (Uterus/Pelvic Cavity). Some patients suffer from Taiyang disease for more than ten days without resolution. Symptoms are slightly lighter in the morning but include limb soreness and lethargy, heavy and dizzy head, sensation of burning heat in the body, aversion to cold, pure white tongue coating, and dark, difficult urination in the afternoon. This indicates heat binding in the Bladder without blood stasis in the Baozhong. This should be treated with a formula that resolves both the exterior and interior (Jing-Fu Dual Resolution). It is appropriate to use fresh Baimaogen (Imperatae Rhizoma, 白茅根) cut finely, two liang, and Huashi (Talcum, 滑石) one liang, boiled together for five or six boils to obtain a large cup of clear decoction. This should be taken with a small dose of Aspirin. Profuse sweating throughout the body will ensue, urination will become smooth, and both the exterior and interior of the Taiyang channel will be cleared.