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In cool and cold regions, the *Couli* (pores and interstitial spaces of the skin) open less and close more. When they close more, *Yang Qi* (defensive and warming energy) cannot dissipate, leading to abdominal and cardiac distension when adapting to cold environments. In humid and hot regions, the *Couli* open more and close less. When they open more, *Yang Qi* easily dissipates, causing skin sores and ulcers when visiting warm and damp places.

Using purgation therapy depletes the *Zhong Qi* (middle jiao/spleen-stomach qi), thus resolving the abdominal distension; using diaphoresis therapy causes *Yang Qi* to leak outward, thus healing the skin sores. Wu Kun stated: "Shi" here also refers to adapting to the environment. Adapting to cold lands causes the *Couli* to become tight and closed, preventing *Yang Qi* from leaking, resulting in internal distension. The greater the coldness, the more severe the distension; the lesser the coldness, the milder the distension. Adapting to warm lands causes the *Couli* to become loose and expanded, allowing *Yang Qi* to float and leak on the surface, resulting in sores and ulcers. The greater the heat, the more severe the sores; the lesser the heat, the milder the sores. Purgation treats internal conditions, while diaphoresis treats external conditions; this is the standard method of treatment.

Zhang Zhicong stated: Cold environments cause *Yin Jing* (essence/fluids) to ascend and *Yang Qi* to descend and store, leading to distension, as described in "Cold in the zang organs generates fullness." Warm environments cause *Yin Jing* to descend and *Yang Qi* to ascend, leading to sores, as described in "Pain, itching, sores, and ulcers all belong to fire." Therefore, purgation lowers *Yin Jing*, allowing *Yang Qi* to rise naturally, resolving distension; diaphoresis allows *Yin fluids* to rise with sweat, causing *Yang Qi* to descend, healing sores. Ma Shi stated: In the *Suwen: Liuyuan Zhengji Dalun*, it is said that in high, cold lands, winter qi prevails, *Yin Qi* stagnates, causing abdominal distension, which is resolved by purgation; in low, wet lands, spring qi prevails, pathogens are easily contracted, causing body sores, which are resolved by diaphoresis dispersing the pathogens. Zhang Jiebin stated: Although this is the normal pattern of *Couli* opening and closing, severe cold/heat leads to severe disease, and mild cold/heat leads to mild disease, accounting for differences in severity.

I (Zhang Ji) note: The methods of diaphoresis and purgation have various examples in the *Neijing*. The *Suwen: Reliang Lun* states: For diseases not exceeding three days, use diaphoresis; for diseases exceeding three days, use purgation. The *Yinyang Yingxiang Dalun* states: For light/pathogenic factors, use dispersal; for retained pathogens, use water immersion for sweating; for pathogens in the skin, use diaphoresis; for lower body conditions, use draining methods; for chest/abdominal fullness, use internal purgation; for excess conditions, use dispersal and purgation. The *Tangye Laolao Lun* states: Open the ghost gate (sweat pores), cleanse the empty mansion (bladder). It also states: If the body sweats and bowels move freely, excess conditions can be cured. Unblocking *Couli*, promoting fluid generation, and unblocking qi mechanisms—discussions on diaphoresis and purgation are numerous, detailed in the *Fangyi Pian* chapter of the *Neijing*.

The Yellow Emperor asked: What is the impact on longevity?

Wang Bing commented: This discusses how land residence affects human longevity.

Qibo stated: People in lands where *Yin Jing* is nourished live long; people in lands where *Yang Jing* descends die young.

Wang Bing commented: "Yin Jing being nourished" refers to high, cold lands; "Yang Jing descending" refers to low, hot lands. In Yin lands, *Yang Qi* does not leak wantonly, cold qi holds externally, pathogens do not frequently invade, and righteous qi remains firm, leading to extended life. In Yang lands, *Yang Qi* dissipates, excretion is excessive, wind-damp pathogens frequently invade, and true qi is exhausted, leading to premature death. Empirical evidence shows that in central China, people in the northwest tend to live long, while those in the southeast tend to die young, though there are variations within each group. This represents a major difference in longevity.

Zhang Zhicong stated: Regarding *Yin Jing* and *Yang Jing*, one must know that earth has essence and heaven has essence. On earth, it is Yin; in heaven, it is Yang. Zhang Jiebin stated: Lands where *Yin Jing* is nourished refer to lofty, high places; lands where *Yang Jing* descends refer to dirty, low places.

I (Zhang Ji) note: The discussion of longevity and short life here specifically refers to the natural laws of heaven and earth. From a human perspective, *Yin Jing* and *Yang Jing* are what Laozi called "the essence of two fives, wondrously combined and condensed." "Two fives" refers to the Heavenly Number Five and Earthly Number Five. Earth's generating number is five, and completing number is five; thus, Earth is the mother of all things, while Water is truly the origin. Without Yang, Yin cannot generate; thus, the root of life lies in Fire preceding Water. Without Yin, Yang cannot transform; thus, the root of life lies in Water assisting Fire secondarily. The classics say "Yang generates, Yin grows," and Fire is the father of all things. Therefore, maintaining the body and nurturing the limbs is governed by the essence and qi of the zang-fu organs; enriching the zang-fu and anchoring Yuan Qi is governed by the two kidneys. The function of the two kidneys is endless generation, ascending and descending, wondrously combining without gap, relying solely on *Yin Jing* and *Yang Jing*. When these two essences are sufficient, people live long; when weak, people die young; when balanced, people are healthy; when biased, people are sick; when extinguished, people die. Thus, *Yin* and *Yang* essences are the root of congenital constitution and postnatal destiny, and the root of the two kidneys. Longevity or short life depends on human effort; heaven and earth cannot dominate. Humans are the heart of heaven and earth, one of the Three Powers. How can one fail to understand the principles of longevity and regulate the two essences of *Yin* and *Yang*?

The Yellow Emperor asked: Excellent. If illness occurs, how should it be treated?

Qibo stated: The qi of the northwest is dispersing and cold; treatment should use dispersing and cooling methods. The qi of the southeast is gathering and warm; treatment should use gathering and warming methods. This is called "treating the same disease differently."

Wang Bing commented: People in the west and north have dense skin and *Couli* and eat hot foods, so dispersing and cooling methods are suitable. People in the east and south have loose skin and open *Couli* and eat cold foods, so gathering and warming methods are suitable. "Dispersing" refers to warm baths to promote internal and external flow; "Gathering" refers to warming the interior without releasing the exterior. Current customs are reversed; treating according to ancient methods would worsen the condition. The New Correction notes that detailed regional treatments are found in the *Yifa Fangyi Lun*. Wu Kun stated: Northwest qi is cold; cold solidifies externally, heat郁stagnates internally, so one should disperse external cold and clear internal heat. Southeast qi is hot; heat leaks externally, cold generates internally, so one should gather external leakage and warm internal cold. Such cases are all called diseases, but treatment methods differ. Thus: For cold and cool climates, treat with cold and cool medicines, accompanied by water immersion; for warm and hot climates, treat with warm and hot medicines, strengthening internal retention. One must align the medicinal qi with the bodily qi to achieve balance. For false patterns, reverse the treatment.

Wang Bing commented: Cold formulas use cold herbs, hot formulas use hot herbs, warm formulas use warm herbs, cool formulas use cool herbs; this is the correct method, following similar qi. "Water immersion" refers to soaking the body in decoctions. "Ping" means balancing. If patients in the west/north have cold diseases presenting as false heat, use warm/hot formulas to remove them; if patients in the east/south have heat diseases requiring cool/cold formulas, this violates the above correct methods and employs counter-treatment. Wu Kun stated: Diseases have Yin and Yang; medicines also have Yin and Yang. In terms of ascending, descending, floating, and sinking, one must align medicinal qi with pathological qi to achieve balance. Or, treat false cold with apparent cold, and false heat with apparent heat; this borrows medicine for counter-treatment. Zhang Zhicong stated: Northwest patients with cold pathogens presenting as false heat should be treated with warm-hot methods; southeast patients with heat pathogens presenting as false cold should be treated with cold-cool methods. This is "false patterns require reversal." Zhang Yushi stated: The previous section discussed the regular qi of the four directions; the final sentence discussed pathogenic qi of the four directions. Zhang Jiebin stated: Heaven and earth qi have Yin-Yang ascent and descent; disease treatment also involves Yin-Yang ascent and descent. Medicines should harmonize with qi suitability, aligning medicinal qi with pathological qi to resolve disease. However, the northwest may have false heat, and the southeast may have false cold. Counter-treatment for false patterns means the northwest may require hot medicines, and the southeast may require cold medicines. Yet, having traveled extensively, I find hot formulas often treat heat diseases, and cold formulas often treat cold diseases; this too must be known.

I (Zhang Ji) note: The classics state that treating diseases involves contrary and compliant, direct and reverse methods. Treating heat with cold, but administering with warmth; treating cold with heat, but administering with coolness; treating warmth with clearing, but administering with cold; treating coolness with warming, but administering with heat. These include contrary direct treatment and compliant reverse treatment. Only when the disease allows direct treatment is the true form easy to see; when reverse treatment is required, the false image is hard to clarify. Taking cold-heat as an example: True cold presents with deep, weak, or slow pulses and cold symptoms; treat contrary (with heat). However, Yang syndromes resembling Yin, extreme fire resembling water, where extreme heat mimics cold transformation with deep/floating pulses, is true heat with false cold (Yang excess repelling Yin). True heat presents with floating, slippery, large, or rapid pulses and heat symptoms; treat contrary (with cold). However, Yin syndromes resembling Yang, extreme water resembling fire, where extreme cold mimics heat transformation with floating/scattered pulses, is true cold with false heat (Yin excess repelling Yang). False cold and false heat are suitable for reverse treatment, hence "false patterns require reversal." Deficiency/excess true/false patterns can be inferred similarly.

The Yellow Emperor asked: Excellent. Why do different regions have different biological production and longevity?

Qibo stated: The principle of height and depth is determined by terrain. Lofty areas are governed by Yin Qi; low areas are governed by Yang Qi. Yang excess leads to "Xiantian" (early arrival/short life); Yin excess leads to "Houtian" (late arrival/long life).

Wang Bing commented: "Xiantian" refers to early timing; "Houtian" refers to late timing. This describes the sequence of growth, flourishing, withering, and falling in lands. As with plants, so with humans. Zhang Zhicong stated: This re-discusses that qi in one region also varies in Yin-Yang and cold-heat. Yang excess means seasonal qi arrives before the season; Yin excess means seasonal qi arrives after the season. Ma Shi stated: High areas have ascending Yin Qi governing; Yin excess implies sluggish Yin nature, so flora/fauna flourish/wither late, leading to long life (Houtian). Low areas have descending Yang Qi governing; Yang excess implies swift Yang nature, so flora/fauna flourish/wither early, leading to short life (Xiantian). Zhang Jiebin cited Sun Simiao: For children aged 3-10, observing their temperament and physical development indicates longevity. Early brilliance often indicates short life (e.g., Xiang Tuo, Yan Hui). Slow maturation and dignified demeanor indicate long life; precocious insight indicates short life (e.g., Yang Xiu, Kong Rong). Thus, late bloomers live long (like plum blossoms enduring winter, chrysanthemums blooming late). This is the meaning of Xiantian and Houtian.

This is the constant law of geography and biological production. The Yellow Emperor asked: Is there variation in longevity?

Qibo stated: High areas have qi of longevity; low areas have qi of short life. Differences vary by the size of the land. Small differences yield small variations; large differences yield large variations.

Wang Bing commented: "Large" refers to distances of ten thousand li between east, west, south, north. "Small" refers to proximity of 20-30 li or up to 100 li. If terrain elevation differs greatly, consider 10-20 li as small; if terrain is flat and qi connects, consider 200-300 li as small. Different earth qi creates differences. Wu Kun stated: Small areas receive less qi; large areas receive more qi. Zhang Zhicong stated: Cold and heat cycles emerge from the earth. This is the division of high/low and thick/thin earth qi, the normal exit/entry of Yin/Yang. Biological production refers to growing, harvesting, storing qi. Yang-governed qi favors growth; Yin-governed qi favors storage. Xu Zhen Gong stated: This section discusses central earth including four directions. High areas store qi, favoring longevity; low areas release qi, favoring short life. Regional qi has size variations. Small/high-low differences yield small variations; large differences yield large variations, referring to longevity disparities.

Therefore, treating physicians must understand heavenly dao, geographical li, Yin-Yang alternation, qi precedence, and human longevity/biological periods to comprehend human form and qi.

Wang Bing commented: Ignoring heaven-earth qi and Yin-Yang signs leads to mistaking longevity for short life and vice versa. Even mastering supreme life-saving arts and meridian/herbal skills, one risks ridicule if ignorant. Wu Kun stated: Form is Yin; Qi is Yang. Zhang Zhicong stated: Heavenly Dao is heaven's transformation; Geography is earth's four directions. Yin-Yang alternation refers to Five Movements and Six Qi having excess/deficiency, overacting, depression, and recovery. Qi precedence refers to excess arriving early (Xiantian), deficiency arriving late (Houtian); low/dirty areas arrive early, high/thick areas arrive late. The *Lingshu* states: If form and qi support each other, longevity; if not, short life. If skin and flesh match, longevity; if not, short life. If blood/qi/meridians exceed form, longevity; if not, short life. Full form with relaxed skin indicates longevity; full form with slack skin indicates short life. Healthy people with qi exceeding form live long; sick people with flesh loss and qi exceeding form die; form exceeding qi is critical. Ma Shi stated: Northwest Yin excess leads to delayed qi; Southeast Yang excess leads to advanced qi. Zhang Jiebin stated: Not understanding Heavenly Dao ignores luck changes; not understanding Geography ignores regional suitability; not understanding Yin-Yang alternation loses root and branch; not understanding qi precedence reverses urgency; not knowing longevity periods lacks certainty and invites blame. All are indispensable. Observe externals via form, internals via qi, ensuring safe treatment.