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Various pathogens can accumulate and transform into heat. For instance, when heat from the Bao Palace (Uterus) transfers to the Bladder, it must exit through its orifices once inside. There are also cases of hematuria not caused by lower Jiao pathology, such as described in the *Nei Jing*: excessive grief causes internal movement of Yang Qi, leading to symptoms like submental collapse and frequent bleeding from urination. Diseases have a root (Ben) and a branch (Biao); in acute conditions, treat the branch; in chronic conditions, treat the root. Whenever encountering such syndromes, one cannot simply attribute them to "heat in the lower Jiao" without seeking their origin.

Loose stools indicate Cold in the Large Intestine, where Yang Qi is deficient and unable to solidify feces, resulting in thin, scanty stools with undigested food particles (Sun Xie). "Intestinal mucus" refers to the Large Intestine, which belongs to Metal and governs fluids. When Heat is present, it tends toward dryness, stagnating the fluids and causing涩 (astringency/stagnation), accumulating into intestinal mucus resembling pus or blood, accompanied by frequent tenesmus. Thus, even after repeated defecation, relief is incomplete. There are also cases where intestinal mucus arises not from heat transfer from the Large Intestine. Tenesmus and bloody stool from the Small Intestine resemble the "Jie Yin Bloody Stool" mentioned in the *Nei Jing*. The Small Intestine belongs to Fire and is the Fu organ of the Heart; the Heart governs Blood. If the Small Intestine is Cold, Yang Qi cannot diffuse freely, leading to stagnation and a sensation of heaviness in the anus. Blood does not enter the vessels but flows out following the stagnant Qi. However, bloody stool can also result from Fire-Heat forcing blood to overflow, which is not limited to the Small Intestine. Heat in the Small Intestine can cause hemorrhoids; the Small Intestine enters the Large Intestine and anus below the umbilicus, and the anus serves as the gateway for both intestines. Nevertheless, laxity of the Large Intestine's tendons and vessels can also cause hemorrhoids, and diseases of the Du Mai (Governing Vessel) can also manifest as hemorrhoids. Zhang Zhongjing mentions these in the context of Small Intestine Cold-Heat disorders because they relate to the Heart.

Q: What are Ji (Accumulation), Ju (Mass), and Ben Tun Qi (Rushing Pig Qi)?
A: Ji is a Zang organ disease, fixed in location and immobile. Ju is a Fu organ disease, occurring intermittently with migrating pain, and is treatable. Ben Tun Qi presents as pain under the hypochondrium, relieved by pressure but recurring later. The general principle for diagnosing Ji is: a pulse that is fine and deep, felt only upon pressing to the bone, indicates Ji. If the pulse appears at Cun Kou (Radial Artery at wrist), the accumulation is in the chest; if slightly beyond Cun Kou, in the throat; at Guan position, beside the umbilicus; slightly above Guan, below the heart; slightly below Guan, in the lower abdomen; at Chi position, at the Qi Chong point. If the pulse is prominent on the left hand, the accumulation is on the left side of the body; if on the right hand, on the right side; if on both hands, in the center. The location of the accumulation is determined by the pulse's position.

[Commentary] Zhang Zhongjing established the terms "Ji" and "Ju" likely because Zang organs belong to Yin and Fu organs to Yang. Yang moves, Yin is still. Zang governs Blood; Zang disease leads to Blood coagulation, which remains fixed, hence named "Ji". Fu governs Qi; Fu disease leads to Qi stagnation, which eventually moves, hence named "Ju". Ben Tun Qi refers to the pathogenic qi mentioned in the first chapter, entering via the mouth, consisting of retained food qi. The hypochondrium is the area of the Spleen's membrane, specifically the Zhangmen acupoint. When food enters the Stomach, essence is transported to the Spleen. If the Spleen cannot handle the appropriate Qi flow, it fails to distribute essence to the Three Yin channels, instead accumulating it in the Spleen's membrane. Pressure disperses this accumulated Qi, temporarily relieving pain, but recurrence causes pain again, termed Ben Tun Qi. Food flavors have specific affinities for certain Zang organs; thus, disease often arises from where the pathogen enters. Therefore, hypochondriac pain is not exclusive to Ben Tun Qi; Xuan Yin (Suspension Fluid) also causes pain, and Cold pathogen causing Liver Blood stasis also causes pain. The difference lies in whether the condition disperses upon pressure. Although Cold pathogen in small collaterals warms upon pressure and relieves pain, examining the *Nei Jing · Ling Shu*, there are only Ji and Jia (Firm Mass), no Ju. Zhang Zhongjing replaced Jia with Ju. The *Nei Jing* did not distinguish the mobility of Ji/Jia, whereas Zhang Zhongjing did. The *Ling Shu* discusses tendon channel dynamics, which Zhang Zhongjing omitted. Chao Yuanfang later expanded this into four categories: Ji, Ju, Ben Tun, and Jia. Ji and Ju result from Zang-Fu deficiency and Wind-Pathogen interacting with Qi. Jia results from undigested food accumulating and growing. Fixed and immovable masses are Ji; movable masses are Jia. Chen Wuyue attributed Qi-stagnation accumulations to the Lung and Blood-stagnation Jia to the Liver, and described Five Zang transmitted accumulations, differing from Zhang Zhongjing's nomenclature. The *Nei Jing · Ling Shu* considers Wind-Cold, diet, and Seven Emotions as causes of Ji/Jia. Chao and Chen categorized them differently. Zhang Zhongjing solely used mobility for classification, ignoring the *Ling Shu*. Chao may have added four names because Zhang didn't specify pathogens, and Chen further assigned Lung and Liver, making the theory more obscure despite finer distinctions. Names are human constructs and can change with times, but do pathogens change? The *Nei Jing · Ling Shu* never stated that Wind-Cold doesn't affect Blood or Diet doesn't affect Qi, yet classifications vary wildly. Is this the way of the ancients or the moderns?