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Treats distension and fullness in the heart and abdomen, where one can eat in the morning but not in the evening. This is caused by the deficiency of Spleen Yuan (Spleen's primordial qi), which fails to control Water Qi (Water-related pathogenic factors). Consequently, Water Qi ascends and infiltrates the Earth/Spleen. The dampness of the Earth prevents the proper transformation and transportation of food and fluids. Qi fails to circulate freely, causing obstruction and blockage above and below, leading to central fullness. In the morning, Yang Qi is growing, and grain Qi digests easily, so one can eat; in the evening, Yin Qi advances, and grain cannot be transformed, so one cannot eat. The pulse is deep, solid, and slippery. The disease is named Grain Distension (Gu Zhang).

The prescription uses half a sheng of Ji Shi Bai (white part of chicken manure), soaked in one dou of fine wine for seven days. Take one zhan (cup) per dose, warmed and taken after meals before retiring.

The *Zhen Jing* (Classic of Acupuncture) states: Regarding "Ji" (accumulations), they arise from Jue Qi (rebellious/counterflow qi) originating in the feet, causing cold in the calves. Cold in the calves leads to coagulation and stagnation of blood vessels. Stagnation allows Cold Qi to ascend into the stomach and intestines. Once in the stomach and intestines, it causes abdominal distension. Distension forces the juices and foam outside the intestines to gather and condense, unable to disperse, forming an accumulation day by day. Sudden overeating causes intestinal fullness. Irregular living habits and excessive physical strain damage the collaterals. Damage to Yang collaterals causes external bleeding (e.g., epistaxis); damage to Yin collaterals causes internal bleeding (e.g., hematochezia). If the collaterals of the stomach and intestines are damaged, blood spills outside the intestines. Cold and juices mix with the blood, combining and condensing without dispersing, thus forming an accumulation. Alternatively, external invasion of Cold and internal injury from sorrow and anger cause Qi to rebel upward, blocking the six transport points. Warm Qi fails to move, coagulated blood remains trapped inside without dispersing, and body fluids become stagnant and adhere, failing to leave, resulting in an accumulation.

Regarding accumulations manifesting in the five Zang organs, each has a specific name: The accumulation of the Liver is called Fei Qi (Fat Qi), acquired on Wu/Ji days of late summer. Why? Lung disease transmits to the Liver. The Liver should transmit to the Spleen. However, the Spleen is prosperous in late summer; a prosperous organ does not accept pathogenic factors. The Liver attempts to return the pathogen to the Lung, but the Lung refuses to accept it. Thus, it stays and knots to form an accumulation, hence named Fei Qi, acquired on Wu/Ji days of late summer. The accumulation of the Heart is named Fu Liang (Hidden Beam); the Spleen's accumulation is named Pi Qi (Stagnant Qi); the Lung's accumulation is named Xi Ben (Panting Accumulation); the Kidney's accumulation is named Ben Tun (Running Piglet). These are the names of the Five Accumulations. Accumulations belong to Yin Qi, while Gatherings (Ju) belong to Yang Qi. Therefore, Yin is quiet and latent, while Yang floats and moves. Where Qi accumulates, it is called Ji; where Qi gathers, it is called Ju. Thus, Ji arises from the five Zang organs, and Ju forms in the six Fu organs. Ji has a fixed starting point; pain remains in its region, with definite upper/lower limits and left/right boundaries. Ju belongs to Yang Qi; it has no root, no fixed location for movement, and pain occurs in varying places, hence called Ju. This distinguishes Ji from Ju. There are also Seven Zheng and Eight Xia, as well as Shi Xia (Stone Xia) and Chang Tan (Intestinal Polyp). Chen Wuyue discusses that Zheng/Xia belong to the Liver sector, while Ji/Ju belong to the Lung sector. "Zheng" means evidence/symptom; "Xia" means false/provisional. It takes shape by borrowing objects. Although there are names for Seven Zheng and Eight Xia, classics do not detail them. Conditions like those caused by dragon snakes, turtle meat, hair, lice, or rice grains were not fixed names but accidental illnesses due to food interactions. In women, Zheng/Xia result from internal, external, or non-internal/external factors injuring the Qi and Blood of the five Zang organs. Ancients called these chronic diseases. Using dragon snakes etc. as causes for Xia is not rigidly adhered to; all belong to Blood diseases. Snake/hair issues arise accidentally from mistaken ingestion, gathering false blood, possessing vitality. For example, during the Yonghui era, a monk with dysphagia had a fish-like object in his abdomen, constituting a Sheng Xia.

Shi Xia (Stone Xia): Qibo states it originates in the Bao Zhong (uterus). Cold invades the Zi Men (cervical os). Zi Men closes, preventing the discharge of evil blood. Retained bad blood enlarges daily, resembling pregnancy, with menstrual irregularities. This occurs only in women and can be treated by guiding it downward. *Bao Jian* states: The Bladder is the mansion of body fluids; Qi transformation allows excretion. Cold at Zi Men blocks Qi, causing blood stasis. Bad blood stops and hardens like stone, named Shi Xia. Qi disease precedes Blood disease, causing amenorrhea, treatable by guiding downward. *Nan Jing* states: Ren Mai disease causes internal knotting; men present as Seven Hernias, women as Xia Ju. This refers to this condition. Only large acrid-hot medicines can cure it.

Chang Tan (Intestinal Polyp): Qibo states: Cold invades outside the intestines, battling the Stomach, lacking nourishment, attaching internally. Evil Qi rises, polyps grow. Initially egg-sized, gradually enlarging to resemble pregnancy. Duration may exceed a year. Pressing makes it hard; pushing moves it. Menstruation continues normally. "Chang" is Large Intestine; "Tan" is extension. Large Intestine governs transmission, is the mansion of the Lung, which governs Wei Qi (Defensive Qi). Wei Qi dissipates with heat but coagulates with cold. Cold in the Large Intestine prevents Wei Qi from nourishing, causing attachment and knotting. Prolonged extension is named Chang Tan. Dispersed Qi is clear; gathered Qi is turbid. Knotting forms Xia/Ju, raising evil Qi and polyps. Gradual enlargement leads to drum-like abdominal distension resembling pregnancy. This is Qi disease without Blood disease, so menstruation is normal. Not pregnancy; distinguish by pulse. *Yuan Bing Shi* states: Zheng is hard in the abdomen, tender to pressure. *Sheng Hui Fang* equates Zheng with evidence. Water is soft; hardness resembles Earth, indicating excess overcoming control. Xia is hard but fluctuates, gathering and scattering without constancy. *Sheng Hui Fang* says Xia means false, as it hasn't reached Zheng stage. Classics state: Blood stagnation with thin cold causes flesh/blood coagulation into Xia, causing abdominal pain. Small Intestine transferring heat to Large Intestine forms Xia. Two heats battle, causing blood spillage into Xia. Blood stagnation causes delayed menstruation, hence Xia is "chen" (sunken/deep). Same as "fu". Confusing Xia with Shan (hernia) is wrong. However, Xia can have heat patterns: Yang Qi constraint, stifling heat stagnation causing hardness not resolving by cold. Distinguish by pulse: Wang Shi says deep/floating pulse indicates Zheng, rapid/firm indicates Xia. *Nan Jing* describes Five Accumulations: Liver Fei Qi under left hypochondrium like an inverted cup; long-term causes cough/wheeze/malaria. Heart Fu Liang starts above navel, arm-sized, up to heart; long-term causes irritability. Spleen Pi Qi in epigastrium like a plate; long-term causes limb weakness, jaundice, poor muscle formation. Lung Xi Ben under right hypochondrium like inverted cup; long-term causes chills/fever, cough/pneumonia abscess. Kidney Ben Tun starts in lower abdomen, up to heart, pig-like movement; long-term causes panting, bone萎 (withering), shortness of breath. These vary by meridian involvement.

Li Dongyuan states: Accumulations arise from sudden anger/emotions or Six Evils. Early stages can be removed by Daoyin. If retained, they become Five Accumulations. Treat using methods for Five Stagnations. Classics say accumulations arise from Yin: Worry hurts Heart, heavy cold hurts Lung, anger hurts Liver, drunken sex with sweating wind hurts Spleen, excessive strain or sex with sweat/bathing hurts Kidney. Accumulations have long origins. Terms include Ji/Ju, Zheng/Xia, Pi. Names differ, pathology same. Dongyuan created five formulas for Five Accumulations based on classics. Observe pain location to identify correspondence. Tonify deficiency, drain excess, respect seasons, assess organ position. Cold treated with heat, knots with dispersion, invaders with removal, retention with movement, hardness with reduction, collapse with calming, masses with softening/acrid-bitter draining. Preserve True Qi, regulate diet, careful routine, harmonize interior/exterior for cure. Violent toxic drugs fail to remove accumulation, damage True Qi, making treatment difficult. Xu Xueshi summarizes: Attack what the accumulation dislikes, lure with what it likes. Sandar/Awei for Meat Accumulation, Gegen/Maiya for Wine Accumulation, Muxiang/Binglang for Qi Accumulation, Taoren/Honghua for Blood Accumulation, Nansing/Banxia for Phlegm Accumulation, Qiannian/Gansui for Water Accumulation, Sanleng/Ezhu for Pi Accumulation, Mengshi/Badou for Food Accumulation, Xionghuang/Nifen for Saliva Accumulation. Match category to syndrome. Using indiscriminate harsh drugs disperses power ineffectively. Identify specific accumulation and accompanying symptoms, then add assistants. Otherwise, harm ensues. Requires clinical discretion.

*Mai Jing* states: Fine pulse attached to bone indicates accumulation. Cun position: chest/throat. Guan position: umbilicus/epigastrium. Chi position: lower abdomen/Qi Street. Right/left pulse indicates right/left accumulation. Bilateral indicates central. Small/deep/solid pulse: gastric accumulation, anorexia, vomiting after eating. Lung accumulation: floating/hairy pulse, deflects on pressure. Heart accumulation: deep/hollow pulse, variable location. Liver accumulation: string-taut/thin pulse. Kidney accumulation: deep/rapid pulse. Heavy/dispersed pulse: cold-food Zheng. Left-turning heavy pulse: Qi Zheng in stomach. Right-turning not reaching Cun: Flesh Zheng. Jinggu states: Nourish righteousness, accumulation removes itself. Like a room full of gentlemen, a villain has no place to stay. Strong True Qi and Stomach Qi eliminate accumulation naturally. Jinggu's words are trustworthy. *Nei Jing* states: For major accumulations, stop when half reduced. Even with full/excess accumulation, avoid excessive toxic drugs, especially in deficiency-with-accumulation cases. This is one aspect of treating accumulation. Carefully examine pathogenic vs. righteous, excess vs. deficiency. Ancient discussions on pulse/pathology/treatment are mirrors for posterity. Physicians who emulate ancient wisdom will achieve efficacy.