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The principles governing the size of *Ji* (accumulation) and *Ju* (aggregation) are identical; however, individuals with robust vital energy (*Zheng Qi*) rarely develop accumulations, whereas children with weak vital energy are prone to them. Therefore, discussions on accumulations often focus on pediatrics ("mute department").

This text does not mention dysentery, diarrhea, or infantile malnutrition (*Gan*), but only discusses accumulations, addressing the root cause of disease prevention. It also omits the "Six Aggregations" (*Liu Ju*) in favor of discussing the "Five Accumulations" (*Wu Ji*), focusing on the more difficult aspects of treatment. Both *Ju* and *Ji* originate from undigested food and coagulated Yin blood; they share the same source but have different names. The *Classic* states: "Accumulations (*Ji*) arise from the Five Zang organs, while aggregations (*Ju*) are formed by the Six Fu organs." Where Qi stagnates, it is called *Ji*; where Qi gathers, it is called *Ju*. *Ju* belongs to Yang Qi; thus, Yang Qi is light, floating, and mobile. Its movement is irregular, stopping upon obstruction. It has no fixed root, pain occurs in varying locations, and as Qi becomes vigorous, it gradually dissipates, resolving spontaneously without treatment. *Ji* belongs to Yin Qi; thus, Yin Qi is heavy, sinking, and latent. It accumulates in one place and does not move. It has a fixed location, and pain remains localized to the pathogenic factor. Yin belongs to the Interior, making it difficult to treat. *Ji* has a fixed position and consists of tangible Blood stasis. *Ju* has no fixed position and consists of intangible Qi. *Ji* masses involve disease, food stagnation, and dead blood (blood stasis). Symptoms include yellowish and puffy complexion, abdominal distension with hollow sounds, urine resembling oil, scorched and yellow hair, dysentery with red and white discharge, yellow-red sclera, generalized edema, excessive heat in the abdomen, abdominal pain after eating, lethargy, and excessive sleepiness. These are all signs of accumulation requiring urgent treatment. If the condition progresses to pale complexion with rapid breathing, black complexion with staring eyes, dry heaving with inability to eat, cessation of diarrhea followed by its recurrence, drum-like abdominal tension, flaccid neck with locked jaw, and thin extremities, these are considered incurable.

However, there are names for accumulations formed by the five Zang organs: *Xia*, *Pi*, and *Pi*. There are distinctions among four types of syndromes and classifications into three types of accumulations: milk accumulation, Qi accumulation, and food accumulation. There are also differences between deficiency-type, excess-type, and fright-induced accumulations. We first detail the five Zang accumulations. The liver's accumulation is named *Fei Qi* (Fat Qi), located under the left hypochondrium, shaped like an inverted cup with heads and feet, resembling a turtle or tortoise. The heart's accumulation is named *Fu Liang* (Hidden Beam), starting above the umbilicus, as large as an arm, extending upward to below the heart. The spleen's accumulation is named *Pi Qi* (Stagnant Qi), located in the epigastrium, covering an area as large as a plate. The lung's accumulation is named *Xi Ben* (Gasping Accumulation), located under the right hypochondrium, shaped like a large inverted cup. The kidney's accumulation is named *Ben Tun* (Rushing Pig), originating in the lower abdomen and extending upward to below the heart, resembling a running pig, moving up and down without a fixed schedule. These are the manifestations of the five accumulations. *Pi* feels responsive to pressure and, like the five accumulations, does not shift position. *Xia* takes shape provisionally, such as blood-related or stone *Xia*. *Qin* refers to thickened skin/flesh, visible between the muscles. *Pi* implies seclusion; it forms internally in hidden places and is invisible externally. Milk accumulation presents with simultaneous vomiting and diarrhea, sour-smelling breath, caused by improper feeding. Food accumulation presents with hard, hot, thirsty abdomen, diarrhea or vomiting, borborygmus, and abdominal pain, caused by overeating. Qi accumulation presents with abdominal pain, crying, and dysentery-like stools resembling crab roe, caused by fright offending the child or maternal emotional fluctuations transmitted via breast milk. Deficiency-type accumulation presents with indigestion of milk/food and generalized edema, resulting from accumulation within a deficient state. Excess-type accumulation presents with hot abdomen, hard stool, fever, thirst, gluttony, and hunger, resulting from internal heat accumulation. Fright-induced accumulation results from feeding during fright, foul mouth odor, yellowing, and abdominal pain.

Treatment methods include warming for cold patterns, clearing for heat patterns, purging/draining for excess patterns, regulating for deficiency patterns, and harmonizing/calming for fright patterns. Treating accumulations involves methods of approaching, grinding, dissolving, and transforming accumulations, rather than rapid purgation. Zhu Danxi stated: "Accumulations must not be treated with harsh purgatives, as this merely damages true Qi without removing the disease." Moreover, accumulations form because of insufficient Zheng Qi, allowing pathogenic factors to occupy the space. This is akin to petty officials dominating the court due to the decline of virtuous ministers. Zheng Qi and pathogenic forces are mutually exclusive; when one wins, the other loses. As pathogens flourish daily and Zheng Qi declines daily, failure to attack them leads to imminent danger. However, overly aggressive attack damages Zheng Qi further. Thus, the initial, middle, and late-stage treatments must be understood. In the initial stage, pathogens are new, Zheng Qi is strong, and pathogens are shallow; aggressive treatment is tolerated. In the middle stage, illness persists, pathogens are deeper, and Zheng Qi is weaker; combined attacking and tonifying is tolerated. In the late stage, illness is chronic, pathogens invade deeply, and Zheng Qi is depleted; tonification is tolerated. Accumulations do not form overnight; thus, their removal must be gradual. Overly aggressive attack damages Zheng Qi, impairing transformation and transportation, causing pathogens to become entrenched. One must ascertain which meridian is affected and the nature of the injury, treating according to the etiology.

Zhang Zihe frequently advocated purgation, considering it appropriate. Zhang Zhongjing’s detailed analysis of the Three Chengqi Decoctions clarified indications for purgation, urgency, specific accumulations, and corresponding herbs with precision. For cold accumulation, use *Badou Yingwan* (Croton Seed Responsive Pill); for heat accumulation, use *Dahuang Chengqi Tang* (Rhubarb and Magnolia Bark Decoction); for blood accumulation, use *Taoren Honghua* (Peach Kernel and Safflower); for water retention, use *Qianniu* (Morning Glory Seed) and *Gansui* (Kansui Root); for blood in water, use *Machong* (Leech) and *Shengzhi* (Hirudo); for worm accumulation, use *Binglang* (Areca Nut) and *Leiwuan* (Vermifuge). Today, those who fear purgation commit the sin of ignorance; those who use it recklessly commit the sin of murder. For slightly deficient patients, support Zheng Qi and carefully push out pathogens. Do not rashly harm natural lifespan.

The five accumulations should be discussed in terms of Stagnation (*Yu*). As stated in the *Nan Jing*: When a person receives a pathogen that overcomes them, transmitting it to the organ they normally control, just as that organ is at its peak strength, it rejects the pathogen, which then stays and forms an accumulation. This is due to depression and failure to extend, leading to pathogenic invasion. Thus, the treatment for the five accumulations and six aggregations is similar to treating stagnation. *Fu Liang* is Fire stagnation; *Fei Qi* is Wood stagnation; *Pi Qi* is Earth stagnation; *Xi Ben* is Metal stagnation; *Ben Tun* is Water stagnation. Stagnation is Qi not flowing freely, leading to accumulation through depression. Not only aggregations can be explained by Qi. Therefore, the primary method for treating accumulations is regulating Qi, allowing fluids to circulate, preventing accumulation formation. However, tonification must not be omitted. Generally, robust individuals recover as Qi moves; frail individuals develop disease as Qi stagnates. Accumulations stem from Qi binding and Blood weakness. Hence, "Robust people have no accumulations; deficient people do." Skilled practitioners need not ask which meridian or Zang organ is affected; they must first regulate Middle Jiao Qi to restore appetite. Once Qi and Blood are robust, stagnation resolves naturally. Even for robust individuals suitable for draining, tonifying Qi and Blood herbs should be taken concurrently. The *Classic* states: "For major accumulations and aggregations, attack may be used, but cease when half is reduced." Thus, when reducing accumulation by half, use purely sweet-warm tonics to strengthen Spleen Earth. Remaining accumulations will recede without direct attack. Nourishing Zheng Qi eliminates pathogens, just as if the court were full of virtuous men, petty officials would have no place. If one waits until accumulations are completely gone before stopping, little Stomach Qi will remain.

Syndromes of accumulation, stagnation, and masses are caused internally by the seven emotions: joy, anger, worry, thought, sadness, fear, and fright. Attributing them solely to Zang organ transmission and overcoming is excessive. Qi, Blood, Ying, and Wei circulate throughout the body without pause. Once the seven emotions stir the fire of the five wills, Fire nature rises, ascending without descending. Consequently, Qi, fluids, and grain cannot follow order, leading to retention and inevitable accumulation. Zhu Danxi said: "Qi alone cannot form masses or aggregations." Masses are tangible objects formed by Phlegm, food stagnation, and dead blood. Those in the center are Phlegm-fluids; on the right, food stagnation; on the left, blood masses. Why? The left Guan position corresponds to Liver/Gallbladder, storing Blood. The right Guan position corresponds to Spleen/Stomach, storing food. Thus, left-sided accumulations are blood masses; right-sided are food stagnation. The center is the pathway for grain entry/exit. Fire from the five wills steams grain, creating Phlegm-fluids. Hence, central accumulations are Phlegm-fluids. Treatment follows the etiology, treating according to category. Generally, early accumulations are mostly Cold, while long-standing accumulations become Heat. One must distinguish new from old to select appropriate acrid-warm, acrid-neutral, or acrid-cool methods. However, accumulations, hernias, and heart/abdominal pains are often Heat-based, yet formulas often use warm/hot herbs like Cinnamon Twig (*Guizhi*) and Aconite (*Fuzi*) without causing toxicity. This is because various accumulations and pains prefer warmth and dislike cold. Hot herbs harmonize with the condition. Moreover, long-standing accumulations lead to stagnation and deep Fire pathogens. If cold symptoms appear, reverse treatment is needed; if heat symptoms appear, follow treatment is used. This mutual adherence of heat aligns with the principle "Excess causes harm, succession brings regulation," known as following-treatment (*Cong Zhi*). Laypeople see hot herbs working without error and assume the syndrome is deep-cold stubborn-cold, indiscriminately using hot agents, destroying Zheng Qi and drying Yin Blood, rendering it incurable. I have argued that physicians are troubled mainly by the difficulty of tonifying Yin deficiency and removing long-standing accumulations. "Jade mountain collapsing itself" refers to Yin deficiency; "Raising a tiger leaves trouble" refers to long-standing accumulation. Those suffering from these two must restrain desires to nourish nature, practice introspection to nourish spirit, remain indifferent and calm, and then entrust themselves to medical care to ensure preservation.