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Accumulations (Ji, 积) are formed in the Zang organs (Zang organs), while Gatherings (Ju, 聚) are formed in the Fu organs (Fu organs). A pulse that is Excess and Strong (Shiqiang, 实强) indicates survival, whereas a pulse that is Deep and Fine (Chenxi, 沉细) indicates death.

The *Nan Jing* (Classic of Difficult Issues), Chapter 55, states: "Accumulation belongs to Yin Qi (Yin energy); Gathering belongs to Yang Qi (Yang energy)." It further states: "Yin is quiet and latent; Yang is floating and active." It also says: "Accumulations arise from the Zang organs; Gatherings are completed by the Fu organs." Yue Ren (Bian Que) distinguished the Zang and Fu organs using Yin and Yang. Since the Zang and Fu were distinguished, there naturally arose the designations of Five and Six. However, a comprehensive examination of discussions on Accumulation, Gathering, and Jia (masses) in the *Ling Shu* (Spiritual Pivot) and *Su Wen* (Basic Questions) does not strictly divide them by Zang and Fu organs. For instance, the *Ling Shu · Bai Bing Shi Sheng Pian* (Chapter on the Origin of Hundred Diseases) states: "When an accumulation first forms, it must begin with the body's own deficiency, after which external pathogenic factors invade. It starts at the skin, interstices (Couli, 腠理), and hair; then enters the Luo vessels (Collaterals, 络脉); then the Jing vessels (Main Channels, 经脉); then the Shu points (Transport points, 输); then the Fu Chong vessel (Hidden Rush vessel, 伏冲); then the intestines and stomach; and finally outside the intestines and stomach, between the Mu Yuan (Marrow Original/Epigastric region, 募原). This describes the normal pathway of pathogenic factors moving from shallow to deep." Nevertheless, there are cases where transmission does not reach the deepest levels. Wherever the pathogen resides, regardless of depth, if stagnation remains, an accumulation forms there. Therefore, in this chapter, Qi Bo further states: "Some remain in the Sun vessels (Branch Collaterals, 孙脉); some in the Luo vessels; some in the Jing vessels; some in the Lv Jin (Muscles of the back, 膂筋); some in the Mu Yuan of the intestines and stomach, connecting upwards to the Huan Jin (Relaxing Muscles, 缓筋). The proliferation of pathogenic factors is incalculable." Subsequently, the text details the pathological manifestations of accumulations formed by lingering pathogens, stating: "When pathogens remain in the Sun collaterals forming an accumulation, the mass moves up and down. The Sun collaterals of the arms and hands are superficial and lax, unable to contain or stop the accumulation. Thus, the accumulation migrates between the intestines and stomach. Fluids gather and permeate, producing a gurgling sound. If cold is present, distension and fullness occur, with thunder-like radiating pain, causing frequent sharp pain." When pathogens remain in the Yangming channel, the mass resides flanking the umbilicus. It enlarges after eating and shrinks when hungry. When pathogens remain in the Huan Jin, symptoms resemble those of a Yangming accumulation: pain occurs after eating and relieves when hungry. When pathogens remain in the Mu Yuan of the intestines and stomach, pain extends outward to the Huan Jin. It relieves after eating and hurts when hungry. When pathogens remain in the Fu Chong vessel, palpation reveals movement under the fingers; upon lifting the hand, heat flows down into both thighs, resembling the sensation of hot water being poured. When pathogens remain in the Lv Jin behind the intestines, the accumulation is visible when hungry but invisible when full, and cannot be felt upon pressure. When pathogens remain in the Shu vessels, obstruction occurs, fluids fail to descend, and orifices become dry and congested. This describes the entry of pathogens from the exterior to the interior, and from above downwards. It further states: "Accumulations originate from Cold; they are formed by rebellious Qi (Jue Qi, 厥气)." It also states: "Rebellious Qi originates in the feet, causing cold in the shins. Cold in the shins leads to coagulation and stagnation of blood vessels. Coagulated blood vessels allow cold qi to enter the intestines and stomach. Once in the intestines and stomach, distension occurs. Distension forces the fluid droplets outside the intestines to gather and prevents them from dispersing, gradually forming an accumulation." It also states: "Sudden overeating causes intestinal fullness. Irregular daily routines and excessive physical effort damage the Luo vessels. Damage to Yang Luo vessels causes external bleeding, resulting in epistaxis or subcutaneous bleeding. Damage to Yin Luo vessels causes internal bleeding, resulting in hematochezia or hematuria. Damage to the Luo vessels of the intestines and stomach causes blood to overflow outside the intestines. Cold fluid droplets outside the intestines contend with the spilled blood, coagulating together and failing to disperse, thus forming an accumulation." It also states: "Sudden external invasion by Cold, or internal injury from worry and anger, causes Qi to rebel upward. Upward rebellion of Qi obstructs the Six Transport points, preventing the circulation of warming Qi. Coagulated blood remains trapped inside without dispersing, and fluid permeation becomes sluggish, adhering and remaining, thereby forming accumulations." Finally, the Yellow Emperor asks: "How do accumulations arise from Yin?" Qi Bo replies: "Worry and thought injure the Heart; severe Cold injures the Lungs; anger injures the Liver; sexual intercourse while drunk with sweating exposed to wind injures the Spleen; excessive physical effort or bathing with sweat after intercourse injures the Kidney. These are the five injuries of the Zang organs. Although the specific forms of accumulated masses are not detailed, calling them 'generated by the Zang organs' is appropriate. Calling them the causes of the five accumulations—Fei Qi (Liver Mass, 肥气), Fu Liang (Gallbladder Mass, 伏梁), Pi Qi (Stomach Mass, 痞气), Xi Ben (Lung Mass, 息贲), and Ben Tun (Kidney Mass, 贲豚)—is also correct." Based on the full text of this chapter and the *Su Wen · Mai Yao Jing Wei Lun* (Chapter on Essential Refinement of Pulse Diagnosis), which states: "Pushing the pulse outward, if the response is inward rather than outward, it indicates heart and abdominal accumulations." And the *Wu Zang Sheng Cheng Lun* (Chapter on the Generation of the Five Zang): "If the complexion is red, and the pulse arrives rapid and firm, it is diagnosed as having Qi accumulation in the middle, occasionally hindering food intake, named Xin Bi (Heart Obstruction, 心痹). (Red corresponds to the Heart. Red complexion with rapid/firm pulse indicates Heart Bi. The following follows this pattern.) If the complexion is white, and the pulse arrives rapid and floating, with upper deficiency and lower excess, palpitations, and Qi accumulation in the chest, with panting and deficiency, it is named Fei Bi (Lung Obstruction, 肺痹). If the complexion is green, and the pulse arrives long and pulsates left and right, with Qi accumulation supporting below the heart, it is named Gan Bi (Liver Obstruction, 肝痹). Caused by Cold-Dampness, treated similarly to Hernia. If the complexion is yellow, and the pulse arrives large and deficient, with Qi accumulation in the abdomen and rebellious Qi, it is named Jue Shan (Rebellious Hernia, 厥疝). If the complexion is black, and the pulse arrives upper-firm and large, with Qi accumulation in the lower abdomen and genitals, it is named Shen Bi (Kidney Obstruction, 肾痹)." Also, the *Ping Ren Qi Xiang Lun* (Chapter on Normal Human Phenomena) states: "A Cun Kou pulse that is Deep and Horizontal indicates accumulation under the hypochondrium and horizontal accumulation pain in the abdomen." It also states: "A pulse that is Excessive, Panting, and frequently interrupted indicates disease in the Middle Jiao. A pulse that is Knotted and Horizontal indicates accumulation." The *Da Qi Lun* (Chapter on Great Anomalies) states: "A Small and Urgent Kidney pulse, and a Small and Urgent Heart pulse that does not drum/beat strongly, both indicate Jia (soft masses)." It also states: "An Urgent Taiyang/Taiyin/Yangming pulse indicates Jia." The *Ling Shu · Xie Qi Zang Fu Bing Xing Pian* (Chapter on Pathogenic Factors and Organ Disease Manifestations) states: "A slightly Slow Heart pulse indicates Fu Liang, located below the heart. A slightly Urgent Liver pulse indicates Fei Qi, located under the hypochondrium, shaped like an inverted cup. A slightly Urgent Kidney pulse indicates Chen Jue Ben Tun (Deep Rebellious Running Piglet, 沉厥奔豚)." The *Wei Qi Pian* (Chapter on Defensive Qi) states: "Accumulation pain that can move is easy to cure; accumulation pain that does not move is difficult to cure." The *Nan Jing*, Chapter 18, states: "Diagnosing Qi accumulation in the right hypochondrium, one obtains a Knotted Lung pulse. A severe knot indicates a severe accumulation; a slight knot indicates a slight accumulation. What is the cause of right hypochondriac Qi accumulation without a Lung pulse? The answer is: although the Lung pulse is not visible, the Right Hand pulse should be Deep and Hidden." The *Mai Jing* (Pulse Classic) states: "A Slow and Choppy pulse indicates Interior Cold with Knotting." It also states: "Urgent and Wiry pulses indicate Hernia and Jia, with lower abdominal pain, also known as Pi disease (parasitic mass, 癖病)." It also states: "Wiry and Small pulses indicate Cold Pi." From this, we see that pulses that are Small, Micro, Small-Urgent, Wiry-Urgent, Deep, Deep-Hidden, Slow, Choppy, Excess, Interrupted, Deep-Horizontal, Knotted-Hidden, Long and Pulsating Left-Right are all pulses of Yin-Cold contraction and solidity. Thus, we know that the formation of accumulations mostly belongs to Yin-Cold. Yin-Cold cannot warm and dissipate, making it prone to coagulation and adhesion. Initially, it is merely a trace of retention, increasing day by day, like a pile. Over time, small becomes large, soft becomes hard, deficient becomes excess, and formless becomes formed. Yue Ren stated that at its onset, it has a fixed location; pain does not leave its area, with definite beginnings and endings above and below, and limits to the left and right. He also said: "Accumulation belongs to Yin Qi." And "Yin is quiet and latent," which are accurate statements. Gatherings are different. Yue Ren stated that Gatherings belong to Yang Qi and are formed by the Fu organs. He also said: "Yang is floating and active"; the disease arises without a root, and pain has no fixed location. Because there is no root and no fixed location, Qi does not stay. Occasionally contending with Blood and Qi, pathogenic and healthy factors interfere. Qi gathers causing pain; Qi scatters resolving pain. This is unlike Accumulations, which remain stationary and do not disperse. Conditions such as attacking and rushing in the intestines and abdomen, Hernia-Jia heat, chest and abdominal distension/fullness, sharp pain, and thunder-like sounds all belong to the category of Gatherings. Ancients discussing Accumulations and Gatherings, distinguishing by Zang and Fu, essentially categorized those that are Deep, Latent, Stationary, and Unmoving as Yin, which corresponds to Zang; and those that are Floating, Active, Gathering, and Scattering irregularly as Yang, which corresponds to Fu. In treatment, one should act according to whether the pathology involves stasis/stationarity or gathering/scattering, rather than focusing solely on the terms 'Zang' and 'Fu'. A pulse that is Excess and Strong is a Yang pulse. It reflects both the contention between pathogenic and healthy factors and the robustness of the patient's original constitution. Because it relates to Fu and Yang, it indicates survival. A pulse that is Deep and Fine is a Yin pulse. It reflects both the depth of the pathogen and the depletion of the patient's original constitution. Because it relates to Zang and Yin, it indicates death. Regarding these two conditions, Accumulation and Gathering, I, Pan Ji, have cited the *Ling Shu*, *Su Wen*, *Nan Jing*, and *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet, 金匮要略). The etiology and symptoms are described in detail. However, the descriptions of syndromes are not mutually exclusive nor exclusively singular. Therefore, although there are established formulas, they cannot be directly inserted. Observing the causes of Accumulation and Gathering, it seems appropriate to use Warmth and Movement, rather than Cold and Contraction; appropriate to move the pivot mechanisms, rather than relying solely on aggressive purgation. Therefore, I have selected nineteen famous formulas for selection and use.