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A question was posed: "Pi (Pih, stagnation), Pi (Pi, hidden accumulation), Ji Ju (Accumulation and Gathering), and Jia (Jia, shifting mass) have similar symptoms but different names. Please explain each one in detail to enlighten future students, is that acceptable?" The response was:

"Pi" (Pih) corresponds to the concept of 'Bi' (Obstruction/Standstill), akin to the hexagram Bi in the I Ching where Heaven and Earth do not interact. It signifies an interior softness with exterior hardness, representing a state where all things are blocked. Since obstruction cannot persist indefinitely, prolonged Pi will develop into distension and fullness, becoming difficult to treat.

"Pi" (Pi) refers to something hanging isolated in a hidden and remote place; it is also a name suggesting profound mystery and unpredictability.

"Ji" (Accumulation) implies traces or marks. It forms through the entanglement of phlegm and blood, creating visible traces. It also refers to the result of long-standing depression and gradual accumulation.

"Ju" (Gathering) implies threads or beginnings. It takes root qi as its starting point, reflecting the nature of gathering and dispersing irregularly.

"Zheng" (Sign/Manifestation) means evidence or verification. It is named so because there are tangible signs, and it eventually evolves into Ji Ju (Accumulation and Gathering).

"Jia" (False/Mass) means borrowed or temporary. It also implies remoteness or longevity. It is formed by borrowing qi and blood to take shape, and refers to conditions lasting for many years.

Generally speaking, Pi (Pih) and Pi (Pi) are disorders of the chest and diaphragm region. Ji (Accumulation) and Ju (Gathering) are diseases of the abdomen. Because they belong to disorders of the Upper and Middle Jiao (Upper and Middle Burners), they are more common in men. In contrast, Jia (Mass) appears exclusively below the umbilicus, indicating a disorder of the Lower Jiao (Lower Burner), and is thus commonly seen in women.

In general, any lump in the abdomen, whether it is Ji, Ju, or Jia, constitutes a serious condition. One must not regard it as trivial nor delay seeking medical treatment. If one waits until distension is fully established, with swelling and drum-like sounds in the chest and hypochondrium, even if masters like Cang Gong or Bian Que were reborn, they would be unable to save the patient. Those afflicted with such diseases should certainly exercise caution!

The formation of Ji (Accumulation) occurs when righteous qi (Zheng Qi, healthy energy) is deficient, allowing pathogenic qi (Xie Qi, evil energy) to occupy the space. This is analogous to petty persons dominating the court due to the decline of virtuous gentlemen. Righteous qi and pathogenic qi are mutually exclusive. They rise and fall like waves; as one prevails, the other recedes. As pathogenic qi grows stronger day by day, righteous qi diminishes. If not attacked and expelled, death will ensue without remedy. However, attacking too aggressively damages righteous qi further. Therefore, the three methods of treating the early, middle, and late stages (Guo Zhong Mo San Fa) must be studied carefully.

1. Early Stage (Chu): When the pathogen has just begun, righteous qi is still strong, and the pathogen is shallow, aggressive treatment can be tolerated.
2. Middle Stage (Zhong): After the disease has persisted for some time, the pathogen is deeper, and righteous qi is weaker, simultaneous attack and tonification can be tolerated.
3. Late Stage (Mo): After the illness has lingered for a long time, the pathogen is invasive, and righteous qi is depleted, only tonification can be tolerated.

The nature of Ji (Accumulation) involves daily accumulation over months and years, not occurring overnight. Therefore, its removal should also be gradual. Attacking too hastily damages righteous qi; once righteous qi is damaged, it cannot transform and transport, causing the pathogen to become firmly entrenched.

I once formulated remedies for Yin and Yang accumulations. These medicines are slightly potent but used with measured dosage. I would tonify the Middle Jiao for several days before attacking. Regardless of the amount of accumulation, after tonifying again, waiting for the spirit to flourish, I would attack again. Repeated cycles of attacking and tonifying, aiming for balance, is my unique secret method, effective in every case.

The Classics state: "For large accumulations and great gatherings, one may use harsh treatments, but stop when the pathogen has been reduced by more than half." Thus, when eliminating accumulation up to half, purely use sweet and warm therapies to nourish. When the Spleen Earth becomes robust in its transporting and transforming functions, the remaining fragmented accumulation will dissipate without direct attack. If one insists on attacking completely, leaving nothing behind, the person is unlikely to survive without disaster.

The Classics also state: "Those who are vigorous recover as soon as their qi moves; those who are weak develop disease as the pathogen lingers." Jiegu (Zhang Yuansu) said: "Vigorous people do not have accumulations; only deficient people do." Therefore, one should nurture righteousness, and the pathogen will naturally eliminate itself. It is like having a room full of virtuous gentlemen; one or two petty persons will find no place to stand. Although this applies to mild and superficial cases, for large accumulations and great gatherings, if one does not search out and expel them, merely administering tonic decoctions daily is of no benefit.

One must ascertain which meridian is diseased and what substance forms the accumulation. Once clearly identified, send troops directly to suppress it. How could one worry about non-recovery? A good strategist in warfare makes the enemy unaware of his defenses; similarly, a skilled physician is a capable general in medicine.