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Huangdi said: I wish to hear about the strange pathogens that are not in the meridians. Qibo replied: They are the blood collaterals (fine vessels distributed on the body surface).

This passage continues from the previous chapter's discussion on the great collateral of the Shaoyin meridian, and further comprehensively discusses the twelve collaterals of the zang-fu organs. The *Suwen: Yubian Lunyao* states: The qi received by humans comes from grain. The place where grain gathers is the Stomach. The Stomach is the sea of blood and qi generated from water and grain. The clouds and qi flowing in the sea correspond to the airflow in the world. The blood and qi output from the Stomach travel through the Jing-Sui (meridian channels). The Jing-Sui refers to the great collaterals of the five zang and six fu organs. When grain enters the stomach, its essence is transmitted to the Lungs, flows and overflows within, and spreads outward. The purest part travels within the Jing-Sui. This describes the blood and qi generated from water and grain, with Ying Qi (Nutritive Qi) circulating inside the vessels. The fine essence of water and grain, from the great collateral of the stomach, pours into the Jing-Sui of the zang-fu organs, connects with the Sun-Luo (finest collaterals), emerges from the skin, and warms the muscles. This describes the blood and qi generated from water and grain, scattered outside the vessels. The great collaterals intersect with the main meridians; therefore, those strange pathogens that are not in the meridians but elsewhere refer to the blood collaterals. The previous chapter discussed the blood and qi of the five zang and six fu organs, as well as the fine essence of the Shaoyin Kidney, emerging from the skin via the Chong Mai (Penetrating Vessel). This chapter discusses the blood and qi generated by the Stomach organ, emerging from the skin via the great collaterals of the zang-fu organs. Yang Yuanru stated: According to the *Suwen: Miuci Pian*, "When pathogenic factors lodge in the skin and hair, they enter and stay in the Sun-Luo. If they remain without departing, they cause blockage and cannot enter the meridians, instead overflowing into the great collaterals and generating strange diseases." Thus, it is said that the so-called 'strange pathogens' refer to the blood collaterals.

Huangdi said: Why do patients faint after puncturing blood collaterals? Why does some blood shoot out? Why is some blood dark and turbid? Why is some blood clear with half of it being fluid? Why does swelling occur after removing the needle? Why does the complexion turn pale and cyan despite varying amounts of bleeding? Why is there no change in complexion but a feeling of vexation after removing the needle? Why is there no physical instability despite significant blood loss? I wish to understand the reasons. The so-called blood collaterals refer to the external collaterals and Sun-Luo visible between the skin. If blood and qi accumulate there, their normal mechanism of internal and external exchange is lost.

Qibo said: If the meridian qi is abundant while the superficial blood and qi are deficient, puncturing will lead to Qi collapse. Qi collapse causes fainting.

This explains that the blood and qi of the meridians and the skin all originate from the fine essence of water and grain in the stomach and follow their respective pathways, ideally remaining in a harmonious state. If the meridian qi is abundant but the superficial blood and qi are deficient, puncturing leads to Qi collapse. Qi collapse results in fainting. Zhu Jigong stated: The Qi of the Three Yang meridians primarily governs the skin and muscle layers. Blood deficiency leads to Qi collapse because blood serves as the anchor for Qi. The *Suwen: Yin-Yang Yingxiang Dalun* states: Yin resides within, serving as the anchor for Yang.

If both blood and qi are abundant, and Yin Qi predominates, the blood is slippery, causing it to shoot out upon puncture. If Yang Qi accumulates and remains stagnant without being released, the blood becomes dark and turbid, thus unable to shoot out.

This explains that blood and qi exist both within the meridians and between the skin, with distinctions between Yin and Yang. The meridians belong to Yin, and the skin belongs to Yang. "Both abundant" means the blood and qi inside and outside the meridian-zang organs are both abundant. If the Yin Qi within the vessels is predominant, the blood is slippery, causing it to shoot out upon puncture. If the Yang Qi of the skin accumulates and remains stagnant without being released, the blood becomes dark and turbid, thus unable to shoot out. Zhu Jigong stated: Accumulation of Yang Qi makes the blood dark and turbid because blood follows the movement of Qi.

Freshly consumed fluids seep into the collaterals before merging with the blood. Therefore, upon puncture, blood comes out separated from the fluid. In cases without recent fluid intake, if water-dampness remains in the body for a long time, edema develops.

This explains that the blood in the collaterals is transformed from the fluids of water and grain. Fluids pour into the skin and muscle layers, seep into the Sun-Luo, and merge with blood to transform into red blood. The *Lingshu: Yongju* chapter states: "The Qi emitted from the Middle Jiao is like dew, pouring upwards into the grain, and seeping into the Sun-Mai. When fluids are harmonized, they transform into red blood. When blood is harmonized, the Sun-Mai fills first, then pours into the Luo-Mai, which fill up before pouring into the Jing-Mai. With Yin and Yang expanded, movement occurs with respiration." Generally, when water and grain enter the stomach, their fluids accompany the Qi of the Sanjiao to warm the muscles and fill the skin, then seep into the Sun-Luo, merging with the blood in the Luo-Mai to transform into red blood. Therefore, freshly consumed fluids seep into the collaterals before merging with blood; thus, upon puncture, the blood is clear and half-fluid. If there is no recent fluid intake but fluid is expelled, it indicates internal water-dampness. As mentioned earlier regarding "strange pathogens not in the meridians," this refers to the blood and qi of the skin emerging from the distinct collaterals into the Sun-Luo and skin, intersecting with the meridians. This section discusses fluids pouring into the skin, seeping into the collaterals, and merging with the blood in the meridians. This shows that the skin's Sun-Luo communicates with the meridians, and the source of blood and qi in the skin's collaterals has another pathway. This chapter uses acupuncture to elucidate the generation, origin, and entry/exit of Yin-Yang blood and qi. Students should carefully contemplate these principles beyond just the techniques of acupuncture.

Yin Qi accumulates in the Yang aspect, stagnating in the collaterals. Therefore, upon puncture, Qi moves forward before blood, causing swelling.

This explains that the blood and qi of the Yang aspect emerge due to the great collaterals and Sun-Luo. The zang-fu and meridians belong to Yin, while the skin and muscle layers belong to Yang. The Yin Qi of the zang-fu accumulates in the Yang aspect of the skin, emerging due to the great collaterals and Sun-Luo. "Qi moving before blood" means the Qi of the zang-fu moves out first, followed by the blood. The previous section discussed how the blood in the collaterals is transformed from the fluids of the skin seeping into the Sun-Luo and Luo-Mai to become red. This section discusses how the blood of the skin emerges due to the great collaterals and Sun-Luo. This shows that the blood and qi of the skin's collaterals communicate internally and externally. Hence, the following text states: "The Qi of Yin and Yang meets newly but has not yet harmonized."

When the Qi of Yin and Yang meets newly but has not yet harmonized, applying draining methods will cause both Yin and Yang to collapse, separating the exterior and interior. Consequently, the complexion loses its luster and appears cyan.

This continues from the previous text, summarizing the harmony of Yin and Yang internally and externally. The skin is the exterior, and the meridians are the interior. The Yang of the skin surface is harmonized by the Yin Qi within the vessels; the Yin of the meridians is harmonized by the Yang Qi of the skin surface. This is the harmony of Yin-Yang and interior-exterior. If the Qi of Yin and Yang meets newly but has not yet harmonized, applying draining methods will cause both Yin and Yang to collapse, separating the exterior and interior. Consequently, the complexion loses its luster and appears cyan. "Cang-cang" refers to the color cyan. The *Suwen: Pingren Qixiang Lun* states: When Ying Qi is insufficient, the complexion turns green. Collapse of both Yin and Yang refers to the depletion of Ying Qi inside and outside the meridians.

If significant blood is lost but the complexion remains unchanged, accompanied by vexation, it is because puncturing the collaterals empties the meridians. Emptiness of the meridians belongs to Yin collapse, leading to vexation.

This discusses the scenario where both Yin and Yang collapse and the complexion changes, referring to the depletion of blood in the skin's collaterals. If blood is lost significantly but the complexion remains unchanged, it is because puncturing the collaterals empties the meridians. If the emptiness of the meridians belongs to Yin, it constitutes Yin collapse. The Heart governs the vessels, and the Pericardium governs the blood. Depletion of blood in the Yin organs leads to vexation. Essentially, this means that the blood and qi outside originate from the Yin of the zang-fu, emerging into the meridians, then from meridians to vessels, and from vessels to collaterals.

When the Qi of Yin and Yang matches and combines to form Bi (obstruction), it is because the blood and qi overflow internally into the meridians and externally into the collaterals. In such cases, both Yin and Yang are in excess. Even with significant blood loss, the condition cannot be considered truly deficient.

Internally belongs to Yin, externally belongs to Yang. The meridians belong to Yin, and the skin belongs to Yang. This summarizes the entry and exit of blood and qi externally and internally, matching and harmonizing. From outside to inside, it seeps from the skin into the Sun-Luo and Luo-Mai, then overflows internally into the meridians. From inside to outside, it emerges from the Yin of the zang-fu into the meridians, then from the meridians externally pours into the collaterals and skin. This is the mutual attunement of outside and inside. If both Yin and Yang are in excess, combining to cause obstruction between the inside and outside, even significant blood loss cannot render it deficient. Zhu Jigong stated: "Yin and Yang matching and combining to form Bi" has the same meaning as the earlier "Yin and Yang matching." Essentially, when Yin and Yang harmonize and flow, it is regulated; when Yin and Yang match but stagnate, it forms Bi. Bi means closure. Throughout the chapter, the generation, origin, and entry/exit of blood and qi in the meridians are discussed. Therefore, Huangdi only asked why significant blood loss did not cause physical instability. Qibo answered: Yin and Yang matching and combining to form Bi clarifies that this is not Bi caused by pathogenic factors.

Huangdi said: How should one observe them? Qibo said: Observe the blood vessels. If they are full, hard, transverse, and red, with no fixed location, small like a needle or large like a tendon, draining according to this pattern ensures complete safety. Do not lose the correct method. Losing the method reverses the effect, with degrees of severity varying.

This elaborates on the entry and exit of blood and qi in the meridians. "Xiang" means observation. Full, hard, transverse, and red indicates an abundance of blood in the vessels. No fixed location indicates the circulation of blood and qi. Small like a needle indicates retained blood in the Sun-Luo. Large like a tendon indicates retained blood in the Jing-Sui. "Shu" refers to the measure or rule of entry and exit in the blood vessels. For retained blood in the meridians and collaterals, draining according to this rule prevents losing the correct degree of exit. The degree of exit proceeds from Jing to Mai, from Mai to Luo, and from Luo to Sun. If one loses this degree and acts in reverse, it proceeds from Sun to Luo, from Luo to Mai, and from Mai to Jing, each following its respective degree of internal and external exchange. Yang Yuanru stated: "Complete safety" means that blood and qi circulate, penetrating internally and externally, like a circle without end, unknown in its termination.

Huangdi said: Why does the flesh adhere to the needle after insertion? Qibo said: Heat attaches to the needle, making the needle hot. Heat causes the flesh to adhere to the needle, making it feel firm.

The Qi of the Three Yang meridians primarily governs the skin surface. Heat refers to Yang Qi. Heat attaching to the needle makes the needle hot, causing the flesh to adhere, making the needle feel firm and difficult to withdraw.

Note: This chapter discusses the entry and exit of blood and qi in the collaterals, hence the title "Blood Collaterals." It discusses retention due to collaterals; draining according to the pattern ensures complete safety. If the muscle is targeted incorrectly, the flesh adheres to the needle, making it feel firm underneath.