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Mrs. Luo experienced abdominal fullness and distension on July 23rd, which eased slightly after passing gas (flatus). She suffered from insomnia at night. When stool was passed, blood followed. Based on the symptoms, it resembles Spleen deficiency failing to control blood (Spleen Qi deficiency failing to maintain blood within vessels). However, since the stool is hard, it is definitely not Spleen organ deficiency, as Spleen deficiency would result in loose stools. The pulse is Wiry (Xian), indicating the suitability of Tao Ren Cheng Qi Tang (Peach Kernel Decoction to Order the Qi).

Tao Ren Ni (Peach Kernel Paste) 3 qian, Sheng Chuan Jun (Raw Rhubarb) 2 qian (added later), Chuan Gui Zhi (Cinnamon Twig) 3 qian, Sheng Cao (Raw Licorice Root) 1 qian, Mang Xiao (Mirabilite) 1.5 qian (dissolved).

[Note] After taking two doses, the patient had a smooth bowel movement and the bleeding stopped.

The Great Treatise (*Shanghan Lun*) states: If Taiyang disease is not resolved, heat binds in the Bladder, the person becomes manic-like, and if blood comes out spontaneously, they will recover. If the exterior is not yet resolved, attack is not yet indicated; one should first resolve the exterior. Once the exterior is resolved, and only the lower abdomen feels urgent and knotted, then attack is permissible, establishing Tao He Cheng Qi Tang (Peach Pit Decoction to Order the Qi).

This clause is what later generations relied upon to claim this formula treats Blood Stasis in the Taiyang Fu organ disease. Since the Bladder is the Fu organ of Taiyang, and this clause begins with "Taiyang disease," appearing in the Taiyang chapter, with these three evidences, can it not be believed? Zuo Jing, though foolish, wishes to point out the error.

There are slight variations in this clause among various editions: The original note says: Later it states resolving the exterior is suitable with Gui Zhi Tang (Cinnamon Twig Decoction). *Yu Han Jing* has the character "Bi" (must) before "You" (have); "Ji" (immediately) before "Yu" (recover). Cheng Shi's edition lacks the character "Qi" (its) after "Jie" (resolve). *Mai Jing* adds five characters "Shu Gui Zhi Tang Zheng" (belongs to Gui Zhi Tang syndrome) after "Qi Wai" (the exterior). *Qian Jin Yi Fang* is the same. I privately believe all such variations are irrelevant to the main point. Only the word "Bladder" is identical in all editions, which I find deeply suspicious. Let me first ask: What is the urination like in Blood Stasis syndrome? The Tao He Cheng Qi Tang clause does not mention it, but the three clauses for Di Dang Tang/Wan repeat it three times. It says: Because heat is in the Lower Jiao, the lower abdomen should be hard and full; if urination is free, passing blood leads to recovery. It also says: Lower abdomen hard, urination obstructed means no blood stasis. Urination free, person manic-like, is definitive evidence of blood stasis. It also says: Lower abdomen full, should have obstructed urination, now instead free, indicates blood stasis.

Thus, urination is free in Blood Stasis syndrome. Urination exits from the Bladder; now that urination is free, what disease does the Bladder have? Conversely, anyone with Bladder heat will have obstructed urination, even painful urination, suitable for Zhu Ling Tang (Polyporus Decoction) or Wu Ling San (Five-Ingredient Powder with Poria), which is known to everyone. Therefore, regarding Blood Stasis, the Bladder actually has no heat binding. People often overlook the error of the word "Bladder" due to habit. Since "Bladder" is erroneous, it is better to use "Lower Jiao." Lower Jiao refers to the interior of the lower abdomen. Although its meaning is too vague, it can serve as a substitute. Scholars wishing to know the precise location of the disease, I currently have no answer, but rather than saying the disease belongs to the Bladder, it is better to say it belongs to the Large Intestine and Uterus. Examining cases, women's blood stasis exits from the anterior orifice or from the stool; men exit entirely from the stool. The decoction instructions for Tao He Cheng Qi Tang also state "should cause mild diarrhea," which serves as evidence. Saying the disease location is the Large Intestine and Uterus is still not fully accurate; the unfinished meaning is left for experts to clarify. That heat binding is not in the Bladder can be asserted. Furthermore, the *Jueyin Chapter* of the Great Treatise states: The person has cold hands and feet, says "I do not have Jie Xiong (chest knotting)," lower abdomen is full, pressing causes pain; this is Cold Binding at the Bladder Guan Yuan point. Knowing the word "Bladder" originally used to replace the interior of the lower abdomen, one must not be too rigid. Otherwise, if the Bladder belongs to Taiyang, how can it also belong to Jueyin? My explanation of the Tao He Cheng Qi Tang clause shows that although prefixed with "Taiyang disease," the decoction is not limited to Taiyang formulas. The intent of this clause is: Someone suffers Taiyang disease, delays treatment, or receives improper treatment, so Taiyang disease is not resolved. Simultaneously, they develop another disease, i.e., heat binding in the Lower Jiao/lower abdomen interior, manifesting as manic behavior. If their righteous Qi is strong, they can naturally expel blood stasis; thus, if blood comes out spontaneously, the disease heals. If their righteous Qi is weak and unable to expel pathogenic factors, medication should be used to attack. But if the Taiyang exterior remains unresolved, attack is not yet indicated; resolve the exterior first. Once the exterior is resolved, and only the lower abdomen is urgent and knotted, Tao He Cheng Qi Tang can be used to attack. "Exterior unresolved, cannot attack" means Taiyang is not finished, so Yangming attack methods cannot be used. "Exterior resolved, only lower abdomen urgent/knotted, then can attack" means Taiyang is finished, only Yangming urgency remains, so Xiao Huang (Rhubarb and Mirabilite) purgation can be used. Resolving exterior is suitable with Gui Zhi Tang; people know Gui Zhi Tang is a Taiyang formula. Why don't people know Tao He Cheng Qi Tang is a Yangming formula? Thus, the whole clause speaks from Taiyang to Yangming. Why did predecessors only see the "Taiyang disease" prefix and miss the Yangming treatment? As for listing this clause in the Taiyang chapter, calling this formula a Taiyang formula is acceptable, why refute it? The presence of Gui Zhi in this formula is the source of predecessor misunderstanding, claiming Gui Zhi resolves Taiyang exterior. They do not know Gui Zhi in Gui Zhi Tang works to release the exterior, while Gui Zhi in Tao He Cheng Qi Tang works to assist downward movement. One medicine, two uses, is there an explanation? I said before: Gui Zhi can move arterial blood. Arterial blood moves from interior to exterior; Gui Zhi assists it to induce sweating and resolve the exterior—this is Gui Zhi's function in Gui Zhi Tang. Arterial blood exits the Heart, dividing into ascending and descending; ascending is less, descending is more. Heat binding and blood stasis in the lower abdomen are far below the Heart. Without Gui Zhi to assist arterial blood descending, how can stasis go? This is Gui Zhi's function in Tao He Cheng Qi Tang. Gui Zhi is a blood-level medicine; Tao He Cheng Qi Tang syndrome is a blood-level disease. Using blood-level medicine to treat blood-level disease, what is there to doubt? It clearly has nothing to do with Taiyang! Cao Yingfu said: The site of uterine blood stasis is at the two corners of the Bladder. In the past at the Red Cross Society, a man had lower abdominal distension and pain; after using Tao He Cheng Qi Tang to purge, although not thorough, the lower abdomen gradually softened. However, blood stasis exited via stool. Could it be that after taking this decoction, uterine blood stasis is absorbed upward and exits via stool? The words "Taiyang disease" should not be taken literally. In the *Taiyang Chapter*, it merely distinguishes whether it is Water Accumulation, hence distinguishing by the presence or absence of urination.

**Tao He Cheng Qi Tang Syndrome Case Two**

The younger sister of Shen Shiwang, a student living at Hongxing Li, Maojia Nong, was under twenty years old and quite emaciated. One day she went out shopping and was suddenly frightened. Upon returning, she became manic, beating anyone she met with immense strength. Shiwang was also struck in the waist and could not rise. Several days later, he invited me to diagnose. The illness had lasted seven or eight days, and the mania persisted. Shiwang came out to see me supporting his injury. Asking him, I learned the patient's menstruation had been absent for two months. While she slept, I entered to examine her. The pulse was Deep and Tight (Chen Jin); the lower abdomen seemed distended. I came out and told Shiwang: This is Blood Stasis syndrome; purging will cure it. I prescribed Tao He Cheng Qi Tang.

Tao Ren (Peach Kernel) 1 liang, Sheng Jun (Raw Rhubarb) 5 qian, Mang Xiao (Mirabilite) 2 qian, Zhi Gan Cao (Honey-fried Licorice) 2 qian, Gui Zhi (Cinnamon Twig) 2 qian, Zhi Shi (Immature Bitter Orange) 3 qian. The next day I asked, and learned that after taking it, a large amount of black blood was passed, mania stopped, the body was not fatigued, she could eat warm porridge, and she avoided people out of shame. I then wrote a follow-up prescription and did not visit again.

[Note] The cessation of mania and lack of fatigue occurred because the patient's weakness was not severe, and the dosage matched the condition. Even if the patient were overly deficient, or the dose excessive causing post-purge fatigue, one might use tonics to regulate. At this stage, the family must not panic, lest it hinder the physician's ability to complete the treatment.

**Tao He Cheng Qi Tang Syndrome Case Three (Attached Student's Verified Case)**

Cao You lived on Linyin Road. First visit, October 22nd. Menstruation had been absent for six or seven months. Epistaxis (nosebleed) occurred frequently. There was a mass in the abdomen, but it was not tender to pressure. The reason is that epistaxis vents upwards. Pain above the glabella (Yintang area). Generalized bone-joint baking heat and cough. This disease arises from blood levels. Given her robust constitution, Tao He Cheng Qi Tang with modifications is suitable: treating the upper by lowering.

Chuan Gui Zhi (Cinnamon Twig) 2 qian, Zhi Chuan Jun (Prepared Rhubarb) 3 qian, Zhi Shi (Immature Bitter Orange) 2 qian, Tao Ren Ni (Peach Kernel Paste) 4 qian, Sheng Gan Cao (Raw Licorice) 1.5 qian, Niu Xi (Achyranthes Root) 2 qian, Quan Dang Gui (Whole Angelica Sinensis) 2 qian, Da Bai Shao (Large White Peony Root) 2 qian.

[Note] Tao He Cheng Qi Tang is a formula I frequently use successfully. In Guangyi Traditional Chinese Medicine Hospital, many poor women present with amenorrhea and abdominal pain. Severe cases show epistaxis or hematemesis, known as "Reverse Menstruation." As long as I confirm they are not pregnant, I prescribe modified versions of this formula, invariably resulting in the passage of black, turbid material and recovery. This case is just one example.

Cao You is about thirty-something, with a dark complexion, obviously a laboring woman. She complained of dry cough without phlegm. The mass was in the left lower abdomen, fixed in place, causing abdominal pain but preferring pressure. If the abdominal mass were tender to pressure, it would be the exact indication for this formula, beyond doubt. Now that she prefers pressure, whether this formula applies requires careful consideration.

I considered her epistaxis as blood loss, so the method should guide it downward. I directly gave her this formula, though I hesitated before prescribing! Second visit, October 23rd. Bone-joint baking heat decreased, cough ceased, the mass moved, no longer occupying one side. Effective after half a day of taking medicine; only classical formulas can achieve this.

Chuan Gui Zhi (Cinnamon Twig) 3 qian, Zhi Shi (Immature Bitter Orange) 3 qian, Dang Gui (Angelica Sinensis) 3 qian, Zhi Chuan Jun (Prepared Rhubarb) 4 qian, Niu Xi (Achyranthes Root) 3 qian, Bai Shao (White Peony Root) 3 qian, Tao Ren (Peach Kernel) 4 qian, Gan Cao (Licorice) 3 qian.

[Note] "Half a day" means she took medicine at 5 PM yesterday, and today is 5 PM, making it one day. She came for the second visit at 9 AM today. She said the mass moved slightly upward and centrally from its original position. Bowels were smooth, color not observed. Cough and baking heat reduced, sleep improved. Why did cough improve without treating it, and bone-steaming heat reduce without treating it? Treating the root causes the branch to disappear.

On the third day, she did not come. On the fourth day, she returned, saying: After taking the second-visit prescription, appetite increased, body felt comfortable. The mass moved further upward and centrally, now in the middle of the abdomen. I said: This is excellent. The middle is like a thoroughfare; the mass can easily pass.

She said: Yesterday, due to bowel issues, I sought another doctor. After taking his medicine, I felt uncomfortable today, and the mass did not move. Reading his case: Amenorrhea, abdominal mass, afternoon tidal fever, old stasis blocking internally, uterine vessels obstructed. Suitable for removing stasis. Prescription: Tao Ren Ni (Peach Kernel Paste) 6 qian, Hua Bin Lang (Areca Seed) 3 qian, Liang Tou Jian (Lonicera Flower Bud) 2 qian, Da Bai Shao (Large White Peony Root) 3 qian, Qing Chen Pi (Green Tangerine Peel) 1.5 qian each, Chuan Gui Zhi (Cinnamon Twig) 1 qian, Cu Chao San Leng (Vinegar-fried Curcuma Zedoaria) 3 qian each, Cu Chao E Zhu (Vinegar-fried Curcuma Phaeocaulis) 3 qian each, Zi Dan Shen (Red Sage Root) 2 qian, Ze Lan Ye (Lycopus Leaf) 3 qian. I said: The case is good, the formula fits, the dosage is moderate, why would it be ineffective? She insisted I prescribe. I said: Take the second-visit formula; why make things complicated? On the fifth day, she did not return. Readers may worry she is in danger? I dare assert she is recovering.

However, the use of this formula presupposes the patient's robust constitution. If the patient is deficient and one prescribes rashly, the loss outweighs the gain, leading to regret. Readers, please check the previous Huang Qi Jian Zhong Tang case for details. That patient, Ms. Wang, took lung medicines with no effect and insisted on radical treatment. I said: The root is Dry Blood; it must be purged. I tentatively tried the lightest dose: Tao Ren Ni (Peach Kernel Paste) 3 qian, Zhi Chuan Jun (Prepared Rhubarb) 1.5 qian, Yuan Ming Fen (Niter) 0.5 qian divided into two doses dissolved. Plus other mild supportive herbs. After two doses, black mud-like material was passed. Logically, this is the removal of the disease root, a good omen. However, the patient could not get out of bed, appetite stagnated, and spirit declined. Although tonic herbs could be used afterwards, the family was terrified, making treatment difficult. This is "loss outweighs gain." Readers beware.

Cao Yingfu said: The action of Tao He Cheng Qi Tang lies precisely in its purgative power. The prescription given by other doctors after the second visit failed to purge; how could it be effective? Physicians' fear of Rhubarb is like fearing snakes and scorpions, an incurable chronic disease. If Ms. Wang passed mud-like foul matter and the root was removed, even with stomach stagnation and fatigue, one might use Xiao Jian Zhong Tang to regulate. Even without medicine, death is impossible; this is certain!

**Di Dang Tang Syndrome Case One**

I once treated a young girl surnamed Zhou, living in Xiao Nan Men, aged eighteen or nineteen. Menstruation had been absent for three months. Complexion was sallow, lower abdomen slightly distended. The syndrome resembled early-stage Dry Blood Labor (Gan Xue Lao). I instructed her to swallow Da Huang E Chong Wan (Rhubarb and Ground Beetle Pill), 3 qian per dose, three times daily. Recovery expected within a month. Afterwards, she never returned, assuming she had recovered. Three months later, a middle-aged woman brought a young woman to seek medical help. Looking at this girl, her face and cheeks below were emaciated to the point of being unrecognizable. Her back was hunched, abdomen distended. She rubbed her hands continuously, groaning incessantly. I asked strangely: Why not treat earlier when the illness reached this state? The woman cried and said: This is my daughter. Three months ago, she consulted you. You ordered pills. Now abdominal distension worsened, limbs wasted daily, back bones protruded, menstruation still absent, so we seek consultation again! I was horrified, deeply regretting the previous prescription. However, the patient was dying, and I could not fail to try my best. Observing her condition, skin and bones remained. Lower abdomen was hard and distended; deep pressure caused severe pain. This is internal accumulation of stasis. Without attacking the stasis, how can the disease be cured? I worried her Yuan Qi (Original Qi) was damaged and feared she could not withstand attack, considering tonifying first. But tonification retains pathogenic factors, which is unacceptable. Thus, I decided to give Di Dang Tang (Mustard Bee and Leech Decoction).

Meng Chong (Blue Bottle Fly) 1 qian, Shui Zhi (Leech) 1 qian, Da Huang (Rhubarb) 5 qian, Tao Ren (Peach Kernel) 50 grains. The next day, mother and daughter returned. The girl passed a large amount of black stasis. Distension reduced, pain subsided. However, the pulse was very deficient; further purging was unsuitable. So I used Sheng Di Huang (Rehmannia Root), Huang Qi (Astragalus Root), Dang Gui (Angelica Sinensis), Lu Dang Shen (Codonopsis Root), Chuan Xiong (Ligusticum Rhizome), Bai Shao (White Peony Root), Chen Pi (Tangerine Peel), Chong Wei Zi (Eclipta Fruit) to invigorate blood and move Qi, guiding the stasis out. After one dose, she did not return. Six years later, I met her on the road. She had borne a child, aged four or five.

[Note] Whether the pill is effective depends on whether the raw materials are authentic, processing is standard, and storage is proper. Therefore, failure of Da Huang E Chong Wan does not mean the pill is useless.

**Di Dang Tang Syndrome Case Two**

Blood Stasis syndrome appears often in women, rarely in men. One year, I treated a male patient surnamed [Name Omitted] from the Red Cross Society. He had lower abdominal distension and pain, clear and profuse urination, and blindness. The diagnosis confirmed Blood Stasis, but I secretly doubted it. I tentatively prescribed Tao He Cheng Qi Tang. After taking it, black stool was passed shortly, but the syndrome remained unchanged.

I prescribed two more doses, increasing the quantity, but the illness persisted. I was more surprised. I thought: If this were not Blood Stasis, three doses of purgatives should have caused a bad transformation. If it truly is this syndrome, why no slight improvement? This must be due to light medicine and heavy disease. At that time, my student Zhang Cigong was present. He said: How about Di Dang Wan (Mustard Bee and Leech Pill)? I said: Examining the syndrome, light medicine cannot cure it. I decided to use Di Dang Tang to purge. After taking it, black stool mixed with old blood was passed together. One more dose allowed the patient to lie quietly on the couch. Abdominal distension flattened, pain ceased. Knowing the medicine hit the target, I reduced the dosage of the previous formula: Meng Chong (Blue Bottle Fly) 2 qian, Shui Zhi (Leech) 1.5 qian, Tao Ren (Peach Kernel) 5 qian, Chuan Jun (Rhubarb) 5 qian. Later reduced to Meng Chong and Shui Zhi 0.25 qian each, Tao Ren and Chuan Jun 1.5 qian each. Zhang Cigong regulated the patient until recovery. Later inquiry revealed the patient had lifted heavy loads, causing blood coagulation and forming Blood Stasis.

**Di Dang Tang Syndrome Case Three**

In early autumn of the Dingmao year, Mrs. Hua Zonghai from Wuxi had missed menstruation for ten months. Her abdomen was not very large but distended. Initially, Doctor Ding used Qi-regulating and Blood-moving herbs, and the distension disappeared. Diet was normal. Western medical examination suggested a fetus in the abdomen, suppressed by corrupt matter, preventing growth. To attack and remove it would inevitably harm the fetus. Zonghai invited me to Wuxi to diagnose. The pulse was Choppy (Se) and not Slippery (Hua), unlike pregnancy. That evening, I discussed with Doctor Ding to administer Tao He Cheng Qi Tang. In the morning, white substance like gelatinous phlegm was passed. Further administration of Di Dang Tang resulted in more white substance. Distension completely resolved, but the abdomen suddenly enlarged. Over a month later, she gave birth to a daughter. Mother and child were safe. Sunzi said: Place in death ground, then live. Is this true? Cao Yingfu said: In *Jin Gui Yao Lue · Pregnancy Chapter*: If there is an existing mass disease, purge the mass; Gui Zhi Fu Ling Wan (Cinnamon Twig and Poria Pill) governs it. Danshen, Tao Ren, and Bai Shao in the formula maximize breaking blood and attacking stasis. Dan Pi and Tao Ren are harsh drugs in Da Huang Mu Dan Tang for treating intestinal abscess; Bai Shao is necessary for opening collaterals in abscess toxicity. Modern use of Jing Chi Shao (Beijing Red Peony) for external conditions is clear proof. Gui Zhi combined with Bai Shao supports the Spleen Yang that controls blood and disperses stasis knots. Observing Taiyang disease using Gui Zhi and Bai Shao to resolve muscle layer, does it not resemble Spleen governing muscles? Using Fu Ling (Poria) is merely to remove dampness and harmonize the Spleen. However, the treatment is mild and close, far inferior to the power of Tao He Cheng Qi Tang and Di Dang Wan. Yet, without Western medical examination and the effectiveness of Doctor Ding's blood-breaking herbs, I would not have dared to use this. That it succeeded implies the principle: "If there is a cause, no harm occurs; if no harm occurs, no harm results."

[Note] I previously stated Tao He Cheng Qi Tang is a Yangming purgative formula. Di Dang Tang goes a step further, thus also being a Yangming formula. The former treats fresh blood stasis; this one treats long-standing heat in blood. Hence, the manifestations clearly differ in severity.

The former says "lower abdomen urgent and knotted"; this says "lower abdomen hard and full." Hard and full is heavier than urgent and knotted. The former says "manic-like"; this says "mania." Mania is heavier than manic-like. The former has spontaneous blood discharge; this requires purging blood to heal, which is heavier than spontaneous discharge. The former does not specify pulse, implying Floating and Rapid; this says "pulse Micro and Deep," which is heavier. The former uses plant-based medicines; this uses animal-based medicines. Animal-based medicines are more potent than plant-based ones. These are obvious differences.

The clause for this formula states: Taiyang disease, six or seven days, exterior syndrome remains, pulse is Micro and Deep, contrary to Jie Xiong (chest knotting). The person is manic. Because heat is in the Lower Jiao, the lower abdomen should be hard and full. Urination is free. Passing blood leads to recovery. The reason is that Taiyang follows the channels, and stasis-heat is inside. Di Dang Tang governs it. Reading this together with the Tao He Cheng Qi Tang clause yields a new meaning, surpassing predecessors. Both clauses involve simultaneous Taiyang and Yangming disease. The former treats Taiyang first, then Yangming, representing the Norm (Jing).

This clause treats Yangming first, then Taiyang, representing the Expedient (Quan). The distinction between Norm and Expedient exists because blood syndromes vary in urgency. The former blood syndrome is merely urgent/knotted and manic-like. Thus, although it involves Yangming, Taiyang should be treated first. This blood syndrome has progressed to hard/full and mania, even hitting people or climbing roofs. The situation is urgent. Thus, temporarily abandoning Taiyang to treat Yangming first conforms to the principle of urgently saving the Interior.

The Great Treatise states: Originally intended to sweat, but purged instead; this is incorrect. If sweating is done first, treatment is not incorrect. Originally intended to purge, but sweated instead; this is incorrect. If purging is done first, treatment is not incorrect. This is the outline for both Tao He Cheng Qi Tang and Di Dang Tang clauses.