Sangaku: Show line segment is perpendicular to diameter of container circle
Let $A$ be the big circle with centre $O$ and diameter $PQ$
Let $B$ be the circle internally tangent to $A$ at $P$ and intersecting $PQ$ again at $M$
Let $R$ be on $A$ such that $\overline{MR} = \overline{QR}$
Let $C$ be the circle that is tangent to $A$, $B$, $MR$ and inside $A$ and outside both $B$ and completely on the same side of $PQ$ as $R$
Invert at $M$, mapping $P$ to $Q$
Then $A$ maps to $A$, $B$ maps to the line $T$ that is tangent to $B$ at $Q$, $MR$ maps to $MR$, and thus $C$ maps to the circle $D$ that is tangent to $A$, $T$, $MR$ and outside $A$ and on the same side of $T$ as $M$ and completely on the other side of $PQ$ as $R$
Let $K$ be the point on $MQ$ such that $RK \perp MQ$
Let $N$ be the point such that $PQ \perp MN$ and $\overline{MN} = 2\overline{MR}$ and $N$, $R$ are on the opposite side of $PQ$
Let $X$ be the intersection of $NO$ and $A$ between $N$ and $O$
Let $Y$ be the point on $T$ such that $NY \perp T$
Let $Z$ be the point on $MR$ such that $NZ \perp MR$
Let $\overrightarrow{MO} = r \overrightarrow{OQ}$ and WLOG $\overline{OQ} = 1$
Then $\overline{MR}^2 = \overline{RK}^2 + \overline{MK}^2 = \overline{OR}^2 - \overline{OK}^2 + \overline{MK}^2 = 1 - (\frac{1-r}{2})^2 + (\frac{1+r}{2})^2 = 1+r$
Thus $\overline{NO}^2 = \overline{MN}^2 + r^2 = 4 \overline{MR}^2 + r^2 = 4+4r+r^2 = (2+r)^2$
Thus $\overline{NX} = (2+r)-1 = \overline{MQ}$
Also it is clear that $\overline{NY} = \overline{MQ}$
Also since $\triangle MNZ \sim \triangle RMK$, $\overline{NZ} = 2 \overline{MK} = \overline{MQ}$
Since $D$ is uniquely defined and $N$ is the centre of an identically defined circle, $N$ is the centre of $D$
Since the centres of $C$ and $D$ are collinear with $M$, the centre of $C$ lies on $MN$, therefore the line through both $M$ and the centre of $C$ is perpendicular to $PQ$
(QED)
Note that the same solution applies to both cases where $C$ is on either side of $PQ$, with very minor changes. Inversion seems to simplify most of these kind of questions. Quite a few can be found online.