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Gu Mingzhong suffered from an abdominal disease for nearly thirty years. Symptoms were mild in the morning and severe in the evening. During each major exacerbation, abdominal distension persisted for more than ten days before subsiding. The condition responded immediately to the consumption of damp noodles or sexual exertion. There was a vague, slight elevation on the left side of the abdomen, producing audible sounds upon palpation during respiration. Previous treatments using methods for *pi* masses (abdominal masses), including internal purgatives and external plasters, ultimately failed to cure him. I employed a diagnostic approach akin to looking into an inner mirror, first explaining the pathology to him, and then proceeding with treatment.

The conditions of the Five Accumulations (*Wu Ji*) and Six Gatherings (*Liu Ju*) involve pathogenic factors from the Heart, Liver, Spleen, Lung, and Kidney organs knotting in the upper, lower, left, right, and central umbilical regions of the abdomen; these present as high elevations resembling an inverted bowl. Pathogens of the Gallbladder, Stomach, Small Intestine, Large Intestine, Bladder, and Mingmen (Gate of Life) knot at their respective anatomical positions and are not easily manifested externally. This case involves Yin Qi of the Kidney gathering in the Yang Meridian of the Bladder, resembling a *pi* mass. How do we know this? The Kidneys have two orifices: the orifice of the Left Kidney connects anteriorly to the Bladder, and the orifice of the Right Kidney connects posteriorly to the Mingmen. Pathogens knotting on the left side of the abdomen indicate that the Left Kidney and Bladder serve as their residence. Among the Six Fu Organs, only the Gallbladder lacks a mechanism for drainage and discharge; the other five Fu Organs receive turbid Qi transmitted from the Zang Organs and cannot retain it long, instead discharging it. Now, Kidney pathogens have transmitted to the Bladder, which has lost its function of drainage and discharge. Old pathogens remain while new ones follow, inevitably penetrating gradually into the *Moyuan* (Membrane Source, a region between the exterior and interior), similar to a leather bag wrapping objects. The Classics state: "The Bladder is the official of the provincial capital, storing fluids; through Qi transformation, they can be excreted." Thus, if Kidney Qi gathers for a long time without exiting, is it not due to the Bladder's failure in transportation and transformation?

Within the abdominal cavity, the Small Intestine, Large Intestine, and Bladder reside, and the Uterus resides within the Bladder. It is precisely because these organs do not retain pathogens for long and facilitate discharge that the abdomen feels spacious. Now, Kidney Qi fails to self-regulate and is entirely transmitted to the Bladder. The Bladder accumulates but does not discharge, behaving like the Gallbladder maintaining a state of purity and non-action. Can it regulate itself properly? Distension is inevitable, rooted in congenital predisposition. The Classics state: "Patients with Kidney disease often suffer from distension; in severe cases, the buttocks replace the heels, and the spine replaces the head." If the Bladder could manage its drainage, how could it reach such an extreme? Furthermore, it is stated: "When the Juyang (Great Yang) meridian guides Essence and Qi normally, distension lasts only three days." Yet this distension has lasted for decades; where is the power of guiding Essence and Qi?

The treatment method should tonify Kidney Water to ensure sufficiency, allowing Essence and Qi to be deeply stored, thereby naturally resolving Bladder distension. Tonifying the Bladder to strengthen its Qi prevents Kidney pathogens from accumulating, naturally enriching the mechanisms of drainage and transformation. This is because the Kidney cannot store Essence without tonification, and the Bladder cannot drain turbidity without tonification. However, tonifying the Kidney is easy, while tonifying the Bladder is difficult, as most herbs in materia medica have draining properties rather than tonifying ones. The Classics assign a fatal prognosis to insufficiency of the Bladder, a reason later generations failed to understand. Upon careful consideration, is it not because insufficient Bladder leads to greater distension, which eventually transmits reversely to the Kidney? Extreme Kidney distension transmits reversely to the Small Intestine; extreme Small Intestine distension transmits reversely to the Spleen, until the Qi of the entire body scatters without control. A physician who detects this early and plans preemptively before transmission occurs has fulfilled their duty.

Mr. Hu Youchen remarked: "Discussing abdominal pathology is like touring a celestial grotto with a torch; the deeper one goes, the clearer it becomes."