Library

Zheng (mass) arises from food stagnation. Its manifestations include distension and vexation in the hypochondrium and chest/epigastrium, difficulty in swallowing food, chronic vomiting, regurgitation, and nausea. If left untreated for a long time, it gradually forms a fixed mass, also known as "food knot" (Shi Jie). The pathogenesis belongs to Yin; since Yin is static, the mass remains fixed in one location and does not move.

Jia (shifting mass) arises from blood injury. Its manifestations include vexation in the chest and diaphragm, pain radiating to the lower abdomen, occasional attacking or pounding sensations, and upward rushing to the heart and chest. Although it does not obstruct food intake, it gradually forms a Jia knot, also known as "blood knot." Generally, both Zheng and Jia result from deficiency of Ying and Wei (Nutritive and Defensive Qi), external invasion of Wind-Cold, and internal stagnation of food. When these factors persist without transformation, pathogens merge into Yin to form Zheng, and merge into Yang to form Jia. Jia is named by analogy to objects; its characteristics are movement without cessation, unpredictability in location and timing. There may be stone-hard lumps between the hypochondria that are painful upon pressure but mild when untouched. If prolonged and unresolved, it leads to sallow complexion, emaciation, abdominal hardness and distension, visible subcutaneous veins on the abdomen, coolness during the day and fever at night. Appetite decreases, sometimes leading to pica (eating dirt), resulting in Gan accumulation (childhood malnutrition syndrome). Treatment should focus on regulating the Spleen and nourishing the Stomach, resolving accumulations, and clearing Gan heat. This condition cannot be cured in a single day or night.

Pi (fullness obstruction) arises from Qi injury. Its symptoms include fullness and distension in the heart and abdomen, enlarged abdomen with fullness in the hypochondria, pain radiating to the abdomen and hypochondria, typically located in the left hypochondrium. The patient presents with a sallow complexion, emaciation, fatigue, and weakness. If untreated for a long time, it gradually forms a Pi mass. "Pi" means blockage; "Jie" means solidity. When excessive heat accumulates in the chest and diaphragm, and retained fluids gather within the abdomen and hypochondria, Ying and Wei Qi fail to circulate freely, and Zang-Fu organs fail to communicate smoothly, resulting in formation of knots. Rapid purgation is contraindicated, as it may cause pathogens to become firmly entrenched. As stated in the *Classic* (*Huangdi Neijing*), "If it adheres and does not depart, the disease becomes excess." The appropriate treatment is to calm the Stomach and regulate the Spleen, assisted by methods to promote Qi flow and resolve stagnation. If there is Qi obstruction in the chest causing pain resembling Pi, this is due to the failure of Righteous Qi to transform and transport. It should not be treated as a tangible pathogen. Since the chest is the residence of Qi, deficiency prevents it from handling excess, meaning it is not a physical object. Therefore, "Pi" implies "Pi" (obstruction/stagnation).

Xi (hidden mass) arises from accumulation. Its symptoms resemble intestinal dysentery: uncontrolled bowel movements, resembling dysentery but not quite, resembling worms but not quite, sometimes passing fresh blood, dry and painful abdomen, and chest fullness. If untreated for a long time, stubborn accumulations do not disperse, presenting similarly to Pi. This is often caused by improper breastfeeding or feeding, leading to food stagnation and accumulation. Over time, blood membranes aggregate, forming Xi masses in the hypochondriac region with intermittent pain and tidal fevers. Variants include Food Xi, Milk Xi, Gan Xi, Shock Xi, Deficiency Xi, and Phlegm Xi. Although they differ in presentation, they all involve damage to Qi and Blood. If the condition progresses to a purple-black complexion, drum-like abdominal distension, stabbing pain near the heart, sudden passage of fresh blood, black lips and tongue, dry retching, shortness of breath, dry skin with purple spots, expulsion of worms in vomit or stool, borborygmus with spontaneous diarrhea, convulsions due to body weakness, bluish face with salivation, edema of the palms and soles, or black face with black stools, these are considered incurable.