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According to an article by Dr. C. Truman Davis, available at the link below, it meant that both His pericardium and heart muscle were pierced. According to Dr. Davis, "This is rather conclusive post-mortem evidence that Jesus died, not the usual crucifixion death by suffocation, but of heart failure due to shock and constriction of the heart by fluid in the pericardium."

It also meant that Jesus personally and corporeally fulfilled the Levitical requirement for the shedding of blood for the remission of sin, and became just what John the Baptist called Him: the Lamb of God that takes away the sin of the world.

11 For the life of the flesh is in the blood: and I have given it to you upon the altar to make an atonement for your souls: for it is the blood that maketh an atonement for the soul. (Leviticus 17:11)

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Q: What did the piercing in Jesus' side and the blood pouring out of Jesus mean?
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