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Accumulation and aggregation with stubborn knotting refers to the condition where the Qi of the five Zang organs and six Fu organs has already accumulated internally. This is compounded by irregular diet and improper regulation of cold and warmth, causing pathogenic factors to overlap and firmly knot together. If this persists for a long time, it develops into *Zheng* (a fixed abdominal mass).

Accumulation (*Ji*) belongs to Yin Qi and originates from the five Zang organs; its pain remains in its specific location, so there are definite upper and lower boundaries. Aggregation (*Ju*) belongs to Yang Qi and originates from the six Fu organs; thus, it lacks a fixed root, moves up and down without staying in one place, and its pain occurs in no constant location. All these conditions arise because Cold Qi contends with the Zang and Fu organs, striking against Yin and Yang as they move up and down, resulting in heart and abdominal pain.

Palpating the Cun Kou pulse: if the pulse is deep and transverse, there is an accumulation under the hypochondrium and horizontal accumulation in the abdomen accompanied by pain. Furthermore, if the Cun Kou pulse is fine, deep, and slippery, there is accumulation in the hypochondrium, causing fullness on both left and right sides, with pain radiating to the back.

It is also stated: if the Cun Kou pulse is tight and firm, there is horizontal accumulation and knotting in the hypochondrium and abdomen, accompanied by pain and diarrhea/dysentery. A fine and subtle pulse indicates survival, while a floating pulse indicates death.

Accumulation (*Ji*) belongs to Yin Qi and originates from the five Zang organs; its pain remains in its specific location, so there are definite upper and lower boundaries. Aggregation (*Ju*) belongs to Yang Qi and originates from the six Fu organs; thus, it lacks a fixed root, moves up and down without staying in one place, and its pain occurs in no constant location. When accumulation and aggregation form a disease and knot internally, the movement of Qi becomes obstructed and unventilated. Qi contends with the Zang and Fu organs, leading to distension and fullness of the heart and abdomen. Distension and fullness of the heart and abdomen cause irritability and oppression, particularly manifesting as shortness of breath.

Accumulation (*Ji*) belongs to Yin Qi and originates from the five Zang organs; its pain remains in its specific location, so there are definite upper and lower boundaries. Aggregation (*Ju*) belongs to Yang Qi and originates from the six Fu organs; thus, it lacks a fixed root, moves up and down without staying in one place, and its pain occurs in no constant location. If accumulation and aggregation are accompanied by undigested food retention, it is because the Zang and Fu organs have been invaded by Cold Qi, and the Spleen and Stomach are deficient and cold, failing to digest food, which remains as retained food.

Palpating the pulse: if the pulse comes forth solid, accompanied by heart and abdominal accumulation and indigestion, this indicates cold in the Stomach.

*Fu Liang* (Hidden Beam) is one of the names for accumulations of the five Zang organs. The accumulation of the Heart is named *Fu Liang*; it begins above the umbilicus and is as large as an arm.

Palpating the pulse characteristic of Heart accumulation: the pulse is deep and hollow (*Kou*), moving up and down without a fixed location. Symptoms include palpitations, heat in the abdomen, red face, dry throat, mental restlessness, heat in the palms, and in severe cases, spitting blood or convulsions. The condition improves in summer and worsens in winter; spitting pus and blood indicates death. Additionally, a firm, strong, and rapid pulse indicates survival, while a weak and rapid pulse indicates death.