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Huangdi said: I wish to hear about the strange pathogens that are not in the meridians. Qibo said: They are the blood collaterals. (Strange pathogens refer to the strange diseases mentioned in the *Miao Ci Lun*. Located in the collaterals rather than the meridians, they move without a fixed location, hence called "strange pathogens".) Huangdi said: Why does fainting occur after puncturing blood collaterals? Why does blood spray out? Why is the blood dark and turbid? Why is the blood clear with half of it being fluid? Why does swelling occur after removing the needle? Why does the complexion turn pale or bluish despite varying amounts of bleeding? Why does one feel irritable and stifled without a change in complexion after removing the needle? Why does heavy bleeding not cause body tremors? I wish to understand the reasons. ("Irritable and stifled" [Fan Man], pronounced 'mu ben qie', means mental agitation.)

Qibo said: When the pulse qi is abundant but the blood is deficient, puncturing will cause Qi depletion; Qi depletion leads to fainting. (Although Qi is abundant, Blood is deficient; if Qi is drained, both Yin and Yang will deplete, leading to collapse.) When both Blood and Qi are abundant, and Yin Qi is predominant, the blood is slippery, so puncturing causes it to spray. (The ability of blood to spray is caused by the Qi within Yin, thus described as abundance of both Blood and Qi.) When Yang Qi accumulates and remains stagnant for a long time without discharge, the blood becomes black and turbid, hence unable to spray. (Prolonged stagnation of Yang Qi allows Yang pathogens to increase daily while Yin Blood diminishes, resulting in black, turbid blood with low volume and no spraying force.) If one has recently drunk fluids, the liquid seeps into the collaterals before harmonizing with the blood, so the blood and fluid separate upon discharge. (Newly ingested fluids enter the stomach and seep into collaterals before transformation, resulting in equal parts blood and fluid.) If one has not recently drunk, but water retention exists in the body for a long time, edema develops. This is because Yin Qi accumulates in the Yang aspect, and Qi stagnates in the collaterals; thus, upon puncturing, Qi moves before Blood, causing Yin stagnation in Yang which is difficult to dissipate, leading to swelling. (Water in the muscle layer obstructs collaterals, with Yin Qi accumulating in the Yang division; puncturing causes Qi to precede Blood, trapping Yin in Yang and preventing dispersion, hence swelling.) When Yin and Yang Qi have just met but are not yet harmonized, applying draining methods will cause simultaneous depletion of Yin and Yang, separating the interior from the exterior, resulting in a loss of color and a bluish complexion. ("Just met but not harmonized" refers to the initial regulation of Qi and Blood and the stabilization of Ying and Wei. At this stage, the root is not yet solid; reckless draining causes depletion of Yin/Yang and Interior/Exterior, manifesting as a critical, wan complexion on the face.) If puncturing results in heavy bleeding, unchanged complexion, but irritability, it is because puncturing the collaterals empties the meridians; emptying the Yin-associated meridians leads to Yin depletion, causing irritability. (Blood extraction involves puncturing collaterals. Excessive bleeding inevitably empties the meridians. Meridians associated with Yin govern the Zang organs; Zang deficiency leads to Yin depletion, causing irritability.) When Yin and Yang Qi combine to form Bi syndrome, pathogens overflow internally into the meridians and externally into the collaterals. In such cases, both Yin and Yang have excess pathogens; even heavy bleeding cannot weaken the condition. ("Yin and Yang combining" refers to the convergence of Exterior and Interior pathogens. Both meridian and collateral pathologies are in excess; heavy bleeding only expels pathogens, failing to weaken the patient's Zheng Qi.)

Huangdi said: How should one inspect them? Qibo said: If the blood vessels are full, hard, transverse, and red, with locations varying up and down, small as needle points or large as sinews, draining according to these signs ensures complete safety; thus, do not deviate from this principle. Deviating from the principle leads to adverse reactions corresponding to the degree of error. ("Inspect" means visual examination. Observe blood collaterals that are full, hard, transverse, and red, regardless of position or size. Drainage should be tailored to the severity. Adhering to proper techniques ensures safety. Deviation leads to symptoms like fainting, depletion, weakness, or swelling, proportional to the technical error.)

Huangdi said: Why does the flesh adhere to the needle upon insertion? Qibo said: Heat adheres to the needle, making it hot; heat causes the flesh to stick to the needle, making it tight and firm. (Flesh adherence means the tissue attaches to the needle. Upon insertion, heat causes the flesh to bind tightly, making rotation difficult and extraction hard due to stiffness.)