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Zihe said: The formation of accumulations (Ji, 积) may result from sudden emotional disturbances such as anger, joy, sorrow, worry, or fear; damage caused by food of the five flavors; retention of beverages that are warm, cool, cold, or hot; or exposure to pathogenic factors of the six qi.

Initially, the symptoms are very slight and can be dispelled through breathing exercises and massage guidance. Unfortunately, if treated by incompetent physicians who forcibly administer tonics, the pathogen is retained. If it remains and does not disperse, it eventually forms the Five Accumulations (Wu Ji, 五积).

The so-called "Feiqi" (Fatty Qi, 肥气) is not merely an excess of Qi but also involves blood, because the Liver stores blood.

"Fuliang" (Hidden Beam, 伏梁) is a stagnation of Fire. Using hot herbs to disperse it will exacerbate the condition, and using moxibustion will cause further accumulation. Moreover, there are two types of Fuliang syndrome with the same name but different natures, which must be distinguished in detail. One type has roots above, below, left, and right, located outside the intestines and stomach, containing large amounts of pus and blood; this type of Fuliang is equivalent to intestinal abscess (Chang Yong, 肠痈). The other type presents with swelling of the body, thighs, and back, and pain around the umbilicus; this is the "Wind Root" (Feng Gen, 风根), which must not be disturbed, as movement will lead to water retention and difficult urination. Although the *Neijing* states that these should not be "moved," it refers to avoiding drastic purgation, not that purgation is completely forbidden, for fear that while the disease might be removed, harm could ensue.

"Piqi" (Stagnant Qi, 痞气): The world generally believes that Cold causes Pi, whereas the *Neijing* holds that Dampness causes Pi. Although the disease may arise from drinking cold fluids, the Yang Qi becomes trapped by Dampness. Using hot herbs to attack it will not disperse the pathogen, while using cold herbs will remove the Dampness but leave Cold behind.

"Xiben" (Gasp Accumulation, 息贲): This refers to panting and oppressive Qi rising upward, according to old theories. I believe that "Ben" refers to the cardia (Benmen, 贲门). The sinews of the Hand-Taiyin Lung Meridian knot within the chest, passing through and connecting below the cardia down to the hypochondrium. Pain radiating and twisting into spasms, when severe, forms Xiben. The Pericardium Meridian knots at the cardia, causing chest pain and Xiben. It is also stated that if the Lung is low, it resides near the cardia and presses on the Liver, leading to hypochondriac pain; if the Liver is high, it extends upward to the cardia, causing hypochondriac distension, which is termed Xiben. Thus speaking, it implies Qi accumulating at the cardia without dispersing. This description comes from the *Lingshu* discussing the positions of the Zang organs. Since the term "Ben" has multiple meanings, I have elucidated it here.

"Bentun" (Rushing Pig, 贲豚): "Ben" is interchangeable with "Beng." The *Tongren* text suggests it may result from excessive reading, which is not necessarily always true. The Kidney governs bones; this accumulation is deep and difficult to detect. Vomiting and emesis are strictly contraindicated because the pathology is located lower in the body; only purgation is suitable. Therefore, I once used Dusheng San (Unique Sage Powder) to induce vomiting for Feiqi. This must be done in a warm room, where vomiting induces sweating. Regarding the Liver's accumulation, wind is mentioned. After vomiting several sheng, one or two drops of blood may appear; do not doubt this, as it is the natural course of the disease. Subsequently, medications that grind down accumulations are used for regulation.

I once treated Fuliang by first inducing vomiting with Chetiao San (Tea Regulation Powder), accompanied by sweating, then using Yugong San (Yu Gong Powder) to guide out water and drain the pathogen, followed by regulating with fire-descending medications.

I once treated Piqi with great success. First, I induced vomiting of sour, bitter, yellow, gelatinous, fishy, and putrid substances (two to three sheng) using Gouti San (Melon Seed Powder). Then, I administered Yugong San to induce defecation twenty to thirty times. Finally, I regulated with mild diuretics like Wuling San (Five-Ingredient Powder with Poria).

I once treated Xiben using Gouti San, regardless of the season, placing the patient in a warm room and adding a stove to assist sweating. The methods of vomiting, sweating, and purging were applied simultaneously. This disease must not be delayed, as prolonged stagnation harms the body.

I once treated Bentun using Daoshui Tongjing San (Water-Guiding and Meridian-Unblocking Powder), administering a purge every three days, ten times over a month, resulting in over a hundred bowel movements. Subsequently, medications for treating blood, transforming Qi, and grinding down accumulations were used for regulation. Although this type of accumulation does not kill, it allows the patient to live out their life.

As for the Six Gatherings (Liu Ju, 六聚), they reside in the Fu organs, belong to Yang, are formless, and have no fixed treatment method. Following this approach, what difficulty would there be?

Commentary: This discussion on the similarities and differences of the Five Accumulations thoroughly captures the essentials of the pathology. Accumulations are due to stagnation, and using vomiting therapy is indeed a subtle mastery of ancient methods. However, following every vomiting session with Yugong San to guide out water should not be taken as a standard protocol. Furthermore, ancient practitioners based their use of vomiting on the specific cause of the accumulation. For example, Xu Wenbo used oil to induce vomiting of hair tumors in palace maids; Chu Cheng used garlic to help Li Daonian vomit egg accumulations; Zhen Quan used realgar to help a person vomit a snake-like tumor. These cases differ in etiology and thus in medication. Generally, methods involving multiple purgations with Yugong San or Wuling San are applicable only to patients with abundant Damp-Heat and robust constitutions. What about those with Yin deficiency and Qi collapse, where the accumulation is solid but Qi and Blood are weak? Can such methods be applied indiscriminately?