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The Yellow Emperor asked, "How does the accumulation (Ji) begin to form, and how does it eventually become established?" Qibo replied, "The formation of accumulation begins with the invasion of cold pathogen. It is the reversal of Qi (Jue Qi) that leads to the establishment of accumulation."

Cold has the nature of coagulation and contraction, causing Qi and Blood to stagnate. Therefore, accumulation arises from cold. When Qi and Blood become knotted with the pathogen, and the reversal of Qi prevents normal circulation, the accumulation is thereby formed.

The Yellow Emperor asked, "How exactly is the accumulation formed?" Qibo said, "Reversal Qi originates in the feet, ascending to cause coldness in the shins. Coldness in the shins causes the blood vessels to become coagulated and sluggish. When the blood vessels are coagulated and sluggish, cold Qi ascends into the stomach and intestines. Once inside the stomach and intestines, it causes distension. Distension forces the fluid droplets outside the intestines to gather and prevents them from dispersing, gradually forming an accumulation. If one suddenly over-eats, the intestines become full. If daily routines are irregular and physical exertion is excessive, the collaterals (Luo Mai) are injured. Injury to Yang collaterals causes blood to overflow externally, leading to epistaxis or hematemesis. Injury to Yin collaterals causes blood to overflow internally, leading to hematochezia or melena. If the collaterals of the stomach and intestines are injured, blood overflows into the space outside the intestines. If there is cold and fluid droplets in this space, they contend with the spilled blood, merging and coagulating without dispersing, thus forming an accumulation. If one is suddenly struck by external cold, or internally injured by sorrow and anger, Qi will reverse upward. Upward reversal of Qi obstructs the Six Transporting Meridians (Liu Shu), preventing the movement of warming Qi. Coagulated blood becomes trapped and does not disperse; body fluids become sluggish and stagnant, adhering and remaining in place, resulting in the formation of accumulation."

This passage illustrates that both external pathogens and internal injuries can lead to accumulation. Reversal Qi originating in the feet and causing shin coldness indicates that external pathogens invade via the foot meridians. The term "chen" refers to a state of stifling distension or depression. Since the three Yin meridities of the foot ascend into the abdomen, this pathway allows for the coagulation and sluggishness of blood vessels, transmitting the pathogen inward to the stomach and intestines to form accumulation. Generally, the transmission of pathogens from exterior to interior, and from upper to lower, was clarified in previous texts; here, it further elaborates on pathogens entering from the lower part, as well as lesions caused by internal injury from the Seven Emotions and improper diet. Sudden overeating, irregular living habits, and excessive exertion damage the collaterals, causing blood to spill outside the intestines, where it combines with cold and fluid droplets to form accumulation. Additionally, external cold invasion combined with internal emotional injury (sorrow and anger) causes Qi to reverse upward, obstructing the Six Transporting Meridians. The Six Transporting Meridians refer to the meridians responsible for the transport functions of the Six Fu Organs. Since Fu organs belong to Yang, obstruction of their transport prevents the movement of warming Qi, leading to coagulated blood that does not disperse and body fluids that do not flow. These fluids seep laterally and remain stagnant, all contributing to accumulation; this represents a combination of external infection and internal injury. Yang collaterals are superficial, and Yang Qi tends to rise; thus, injury to Yang collaterals causes blood to overflow externally, resulting in vomiting or nosebleeds. Yin collaterals are deep, and Yin Qi tends to descend; thus, injury to Yin collaterals causes blood to overflow internally, resulting in bloody stools. Once blood leaves its vessels, it inevitably contends with the fluid droplets outside the intestines. When the accumulation is fully formed, it may adhere to Yin or Yang, to Fu or Zang organs. In all cases, there are external signs for verification, as detailed in the preceding and following texts.