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Therefore, (the West) has much gold, jade, sand, and stone. However, the Qi of Heaven and Earth descends from the West, thus possessing the characteristics of gathering and drawing in, corresponding to Autumn in the seasons. The people there dwell on hills and are exposed to much wind; the water and soil are rigid and strong. (Dwelling on high places leads to much wind. The Metal Qi is solemn and killing, hence the water and soil are rigid and strong.) They do not wear silk but cloth made of coarse hair and grass mats; their food is rich and fatty, and they have abundant body fat. (Not attending to clothing and adornment. He refers to woolen cloth. Jian refers to grass mats. Hua refers to richness. This refers to things like butter, cheese, fat, and meat. Because their diet is rich and heavy, most people have abundant body fat.) External pathogens cannot harm their physical form; diseases arise internally. (The water and soil are rigid and strong, diet is rich and fatty, muscles are full, skin and pores are dense, so external pathogens cannot harm the exterior, but only diet, sexual activity, and the Seven Emotions cause diseases to arise internally.) Treatment is suitable for using "poisonous drugs" (medicines with strong properties), so the method of using poisonous drugs also comes from the West. (Since diseases arise internally, they cannot be treated by acupuncture, moxibustion, massage, or tui na, but require medicinal drugs. "Poisonous drugs" generally refers to all medicinal herbs. Any herb that can eliminate disease can be called a poisonous drug, yet treating such conditions does not necessarily require purely sweet and tranquil herbs. All methods of using medicines in later generations also originated from the West.)

The North is the region where Heaven and Earth close and store. (Heaven's Yin is in the North, so its Qi closes and stores, corresponding to Winter in the seasons.) The terrain is high, people dwell on hills, and the wind and cold are biting. (High terrain and dwelling on hills represent the northwestern topography. Biting wind and cold indicate the dominance of Yin Qi.) The people enjoy living in the wild and consume dairy products, leading to coldness in the viscera and distension diseases. (Living in the wild and eating dairy are characteristics of Northern people, which remains true in Hu regions today. The local Qi is cold, and dairy nature is also cold, causing coldness in the viscera. Coldness in the viscera causes stagnation, leading to diseases like distension.) Treatment is suitable for moxibustion, so the method of moxibustion also comes from the North. (Moxibustion involves burning mugwort, belonging to the category of fire needles. This method is similar to that used for treating cattle and horses. Northerners are suited to it, so the method of moxibustion in later generations also originated from the North. Wei [moxibustion], pronounced like Rui.)

The South is the place where Heaven and Earth grow and nourish, where Yang Qi is most abundant. (Heaven's Yang is in the South, so all things grow and nourish, corresponding to Summer in the seasons.) The terrain is low, the water and soil are weak, and it is an area where fog and dew gather. (The South is low and damp, so the water and soil are weak and prone to fog and dew.) The people crave sour taste and eat fermented/rotten foods. (Fu refers to fermentation and rot. Things that ferment include drum yeast and sauces. Fu, pronounced Fu.) Therefore, their people have dense skin texture and reddish complexion, and suffer from spasms and bi-syndrome. (Craving sourness implies astringency; eating fermented foods implies dampness. Thus, their people have dense skin and suffer from spasms and bi-syndrome. Spasms and bi-syndrome occur when Damp-Heat is excessive and affects the sinews and bones. The South belongs to Fire, hence the reddish complexion. Zhi means dense.) Treatment is suitable for fine needles, so the Nine Needles method also comes from the South. (Since the disease is in the sinews and collaterals, the Nine Needles are suitable. All needle methods used in later generations also originated from the South.)

The Center has flat and damp terrain, and the number of things generated by Heaven and Earth is great. (Earth is flat and damp; Earth resides in the center of the four directions and serves as the mother of all things, thus generating many organisms.) The people have a mixed diet and do not labor hard. (Converging from all four directions, it is the gathering place of all things, so the people have a mixed diet. Earth's nature is mild, so they do not labor hard.) Therefore, their diseases are mostly Wei syndrome (flaccidity), Jue syndrome (cold limbs/fainting), and alternating cold and heat. (Earth Qi connects to the Spleen and governs the four limbs; thus, damp stagnation leads to Wei syndrome, and cold/heat leads to Jue syndrome. In the Central region, Qi from the four directions converges, resulting in alternating cold and heat.) Treatment is suitable for Dao Yin (qigong exercises) and An Qiao (massage/tuina), so these methods also originate from the Center. (Dao Yin refers to shaking the sinews and bones and moving joints to circulate Qi and Blood. An refers to pressing/pinching. Qiao refers to the concept of Yang Qiao and Yin Qiao meridians, implying massaging the valleys and acupoints to remove disease. Since the disease is in the joints, this method is used. All Dao Yin and massage methods in later generations also originated from the Central Plains. Qiao, pronounced Qiao or Ji Nüe.)

Thus, the Sage combines all treatments, each being appropriate, and although the methods differ, all diseases are cured because he understands the condition of the disease and the general principles of treatment. (Combining the treatments of the five directions and adapting to changes ensures appropriateness. Thus, although treatment methods vary, no disease remains uncured. One who understands the way of adaptation possesses the abilities of the Sage, going beyond mere disease treatment.)

When the body is at ease but the mind is suffering, the disease arises in the vessels; treat with moxibustion and acupuncture. (Xing Le means the body is free from labor. Zhi Ku means the mind is burdened with worry. The Heart governs the vessels; deep thought and over-worry lead to vessel disease. Vessel diseases should be treated via the meridians, so one should apply moxibustion and acupuncture as appropriate.) When both body and mind are at ease, the disease arises in the flesh; treat with needles and stones. (Xing Le means leisure; Zhi Le means idleness. Eating until full all day without movement often injures the Spleen. The Spleen governs the muscles, so disease arises there. Flesh diseases involve either the retention of Wei Qi or the accumulation of pus and blood, so needles and stones should be used to drain them.) When the body labors but the mind is at ease, the disease arises in the sinews; treat with hot compresses and Dao Yin. (Xing Ku means the body labors; Zhi Le means the mind is carefree. Labor injures the sinews, so disease arises there. Yi refers to herbal hot compresses. Yin refers to Dao Yin.) When both body and mind labor, the disease arises in the throat/pharynx; treat with sweet medicines. (Xing Ku and Zhi Ku imply much worry and thought. Worry injures the Lung; thought injures the Spleen. Injury to Spleen and Lung Qi leads to deficiency and stagnation. The meridians of the Spleen and Lung ascend to the pharynx, so disease arises there. For example, excessive grief causes choking in the throat and difficulty swallowing; excessive thought causes upper jiao blockage and a sensation of a lump in the throat. Blockage prevents passage between upper and lower, characteristic of sudden severe grief. Since the disease in the pharynx stems from visceral damage, sweet medicines should be used to tonify and regulate.) When there is frequent fright and fear, meridians are blocked, and the disease manifests as numbness/anesthesia; treat with massage and medicinal wine. (Fright causes Qi chaos; fear causes Qi sinking. Frequent fright and fear scatter Qi and Blood and block meridians, leading to numbness. Numbness refers to stubborn bi-syndrome and weakness. Treatment should use massage to guide Qi and move Blood, and medicinal wine to support Zheng Qi and eliminate pathogens. Lao Yao refers to medicinal wine. Lao, pronounced Lao.) This is called the Five States of Body and Mind. (Reiterating that body and mind states differ, supplementing the previous text.)

Diseases have duration (old/new), formulas have size (large/small), and substances have toxicity (toxic/non-toxic); there are established regulations. (Heavy diseases require large doses; light diseases require small doses; non-toxic substances allow larger amounts; toxic substances require smaller amounts; these are standard regulations.) When using highly toxic drugs to treat disease, stop when 60% of the disease is eliminated; when using commonly toxic drugs, stop at 70%; when using slightly toxic drugs, stop at 80%; when using non-toxic drugs, stop at 90%. (Medicines vary in toxicity: high, common, slight, or none. The degrees of elimination (60-90%) exist because if medicine fails to reach the disease, it is useless; if it exceeds the disease, it harms Zheng Qi and causes other issues. Thus, one must know limits and advance/retreat with measure.) Use grains, meats, fruits, and vegetables for dietary therapy to clear the remainder. Do not overdo it, lest you injure Zheng Qi. (If 80-90% of the disease is gone but some remains, use diet to nourish Zheng Qi, allowing residual pathogens to clear. Diet must be appropriate; excess harms Zheng Qi.) If the disease is not fully cleared, repeat the method. (If still incomplete, repeat the previous method gradually, preferring caution.) First, ascertain the annual Qi (Sui Qi); do not violate the Harmony of Heaven (Tian He). (The Five Movements have order, Six Qi have sequence, Four Seasons have commands, Yin and Yang have rhythm; these constitute Sui Qi. Human Qi responds with growth, flourishing, harvesting, and storing, constituting Tian He. Ignoring Sui Qi changes and recklessly using cold/heat therapies confuses pathogen/excess and Zheng/deficiency, offending Sui Qi and harming Tian He. This is a major cause of premature death.) Do not reinforce excess, do not deplete deficiency, thereby avoiding causing premature death to others. (Reinforcing excess makes it more excessive; attacking deficiency makes it more deficient. This causes Zheng Qi to diminish and Pathogenic Qi to increase, leaving people vulnerable to disaster—a physician's fault.) Do not exacerbate pathogens, do not lose Zheng Qi, do not cut short lives. (Reinforcing excess is exacerbating pathogens; depleting deficiency is losing Zheng Qi. Repeating this warns against harming Tian He and cutting short lives, emphasizing caution regarding Sui Qi.)

For chronic diseases, some patients do not recover due to Qi disharmony; even after pathogens leave, they remain emaciated. Transformation (Hua) cannot be substituted; timing (Shi) cannot be violated. (Hua refers to transformation/nature. Shi refers to timing.) Nourish and harmonize; wait quietly for the time to recover. Guard the Qi carefully; do not let it collapse or shift. Then the form will become distinct, and Sheng Qi will grow. (Nourish with flavors/scents; harmonize with temperament. Waiting quietly implies preparation and awaiting the right moment to recover. For example, Yang deficiency prefers Spring/Summer; Yin deficiency prefers Autumn/Winter. Liver diseases heal in Summer; Heart diseases in Late Summer; Spleen diseases in Autumn; Lung diseases in Winter; Kidney diseases in Spring—all follow this principle. Guarding Qi prevents loss. Daily renewal is expected; this is the way to eliminate pathogens and gradually grow Sheng Qi.) The *Da Yao* says: Do not substitute for transformation, do not violate timing; must nourish and harmonize, waiting for recovery. This is what is meant. (*Da Yao* is an ancient book title. Quoting ancient words to show that transformation cannot be substituted, timing cannot be missed, and nourishment/harmonization are essential for recovery, which will inevitably succeed.)

If a pregnant woman takes toxic drugs, provided there is a specific pathology ("Gu"), neither she nor the fetus will be harmed. (Chong Shen refers to pregnancy. "Du Zhi" refers to potent/drastic drugs. Using such drugs because the pathology exists follows the principle "where there is disease, the disease receives the impact," so the mother and fetus remain unharmed. Yun means injury. Chong is read as a level tone. Yun, pronounced Yun.) For large accumulations and masses, one may use toxic drugs to attack them, but stop when the pathogen is reduced by more than half; exceeding this limit causes death. (Even during pregnancy, large accumulations require toxic drugs for attack, which is harmless if necessary. However, one should only reduce the pathogen by half and then stop medication, as with "highly toxic drugs... stop at 60%." Overuse may fail to clear the disease while injuring the fetus, often leading to death.)

Kui Du (measuring) and Qi Heng (abnormalities) refer to different things. (Kui Du means measuring/estimating. Qi Heng means abnormal. Different references include discussing diseases, pulses/colors, viscera, or Yin/Yang.) Kui Du measures the depth of the disease; Qi Heng discusses strange diseases. (Strange diseases are abnormal. Diseases differing from normal require detailed measurement of depth to understand.) Changes in Five Colors and Pulses, measuring abnormalities, the principle lies in one thing (Shen). (Although color and pulse abnormalities vary, the principle is one.) Shen turns and does not reverse; if it reverses, it does not turn, and the opportunity is lost. (Shen is the change of Yin and Yang. Zhuan means continuous operation. Hui means reversing into evil. The function of Shen Ji operates in endless cycles, relied upon by Heaven and Man to achieve transformation. This is Shen turning without reversal. If it reverses instead of turning, the numbers/rhythms become chaotic, and life force is lost. Hence, "When Shen leaves, Ji rests," and "Losing Shen means death.") The essence of the ultimate numbers (Zhi Shu) is proximate and subtle. (Zhi Shu is the mechanism of Shen. The key lies in Ji, which lies in Shen. The way of Shen Ji is seamless, extremely precise and subtle, applicable everywhere, hence "proximate and subtle.") Facial colors appearing in upper/lower/left/right positions correspond to their respective critical points. (Heaven's Shen Ji appears in climate; Human Shen Ji appears in pulse and color. All "upper/lower/left/right," along with depth, reversal/compliance, and days mentioned below, are critical points of color/pulse numbers, requiring careful observation.)

If the color appears shallow, treat with Tang Ye (grain decoctions); cure in ten days. (Shallow color indicates mild disease, so Tang Ye is suitable, and recovery is fast. Tang Ye refers to grain decoctions, representing nourishing methods, not later medicinal decoctions.) If the color appears deep, treat with Qi (formulas/doses); cure in twenty-one days. (Deep color indicates deep disease, so Qi treatment is needed, and recovery is slower. Qi and Ji are the same, meaning pharmaceutical preparations.) If the color appears very deep, treat with Lao Jiu (medicinal wine); cure in one hundred days. (Very deep color indicates severe disease, requiring medicinal wine. Lao Jiu is medicinal wine, e.g., Chicken Excrement Li.) If the color is dull and the face is sunken, it is untreatable; death occurs within one hundred days. (Dull color and sunken face indicate Shen Qi has departed, making it untreatable. One hundred days marks the end of seasonal Qi changes and the exhaustion of Zhi Shu. The former part discussed disease resolution; this part discusses death.) Short pulse and exhausted Qi indicate death. (Short pulse and exhausted Qi indicate central deficiency and Yang collapse, hence death.) Warm disease with extreme deficiency indicates death. (Warm disease implies excess pathogen; extreme deficiency implies insufficient Zheng Qi. Zheng cannot overcome the pathogen, hence death.)

Colors appearing in upper/lower/left/right correspond to their critical points: Upward movement is Ni (reversal/adverse); downward movement is Cong (compliance/favorable). (Yao refers to the key of Ni/Cong. Upward color movement indicates worsening disease; downward movement, like dispersing clouds, indicates resolving disease. Hence, up is Ni, down is Cong.) For women, Right is Ni, Left is Cong; for men, Left is Ni, Right is Cong. (Women are Yin; Right is also Yin. Color on the Right indicates severe Yin disease, so Right is Ni for women. Men are Yang; Left is also Yang. Color on the Left indicates severe Yang disease, so Left is Ni for men. Although stated regarding color, the Ni/Cong of disease follows the same logic.) Change (Yi): Heavy Yang leads to death; Heavy Yin leads to death. (Yi means change. If a man shifts from Right (Cong) to Left (Ni), it becomes Yang person with Yang disease, i.e., Heavy Yang. If a woman shifts from Left (Cong) to Right (Ni), it becomes Yin person with Yin disease, i.e., Heavy Yin. Heavy Yang/Yin indicates Yin/Yang excess. Excess leads to extremity/collapse, hence death.) When Yin and Yang reverse their functions, treatment lies in weighing and balancing (Quán Héng Xiāng Duó). (Fan Zuo means acting contrary to compliance, leading to disease. Treatment involves weighing severity and reducing excess to restore balance, like a scale.) Qi Heng deals with abnormalities; Kui Du deals with measurement. (This continues the previous text: Yin/Yang reversal is a Qi Heng matter; weighing/balancing is a Kui Du matter.)

Bo Mai (pulsing forcefully) is associated with Bi syndrome and alternating cold/heat. (Previous text discussed abnormal colors; this discusses abnormal pulses. Bo Mai beats forcefully against the hand, indicating pathogen excess, Zheng deficiency, and Yin/Yang disorder, leading to Bi, Bi [paralysis], and alternating cold/heat. Bi refers to stubborn bi-syndrome. Bi [Ti] refers to inability to walk.) Isolated pulse indicates Xiao Qi (consumption of Qi); Deficient pulse with diarrhea indicates Duo Xue (loss of Blood). (Isolated pulse means isolated Yin or Yang. Extreme Yang pulse is surging and large, consuming Yin Qi; extreme Yin pulse is weak, consuming Yang Qi. Hence, isolated pulse consumes Qi. Deficient pulse with diarrhea indicates Yin loss; Yin loss leads to Blood deficiency, hence deficient/diarrhea indicates blood loss.) Isolated is Ni (adverse); Deficient is Cong (favorable). (Isolated means extremity/collapse. Collapse cannot regenerate, hence Ni. Deficient means insufficiency. Insufficiency can be tonified, hence Cong.) To practice Qi Heng methods, start with Tai Yin. (The Lung is the assembly of all pulses, so distinguishing pulse abnormalities starts with Tai Yin. Tai Yin refers to the Qi Kou of Hand Tai Yin.)

Moving against what one cannot overcome is Ni (adverse), leading to death. (Moving against what one cannot overcome means being controlled by another element. E.g., Wood encountering Metal, or Metal encountering Fire.) Moving against what one overcomes is Cong (favorable), leading to survival. (Moving against what one overcomes means controlling another element. E.g., Wood encountering Earth, or Earth encountering Water.) The victory of Eight Winds and Four Seasons repeats endlessly. (The arrival of Eight Winds follows the victories of Four Seasons. Numbers have constancy, repeating endlessly; this is the command of normalcy.) If one reverses once and errs, it cannot be counted again; the essentials of the discussion are complete. (If seasonal commands失常 and reverse once, it becomes "reversing without turning," causing chaotic numbers, no longer countable. Guo means error. Metaphorically, if human color/pulse loses harmony, abnormalities arise chaotically, uncountable. This is the essence of Heaven-Human numbers, lying in Ni/Cong; observing Shen completes it.)

If the disease does not arise from the hairs/skin but from the exhaustion of Yang Qi in the Five Viscera, fluids fill the chest/abdomen (Guo), Po (Corporeal Soul) exists alone, Jing (Essence) is isolated internally, Qi is exhausted externally, the form cannot maintain its clothes, this is "Si Ji Ji Er Dong Zhong" (four extremities urgent and disturbing the interior), indicating Qi rejecting internally and form altering externally. (Not arising from hairs means disease originates internally. Exhaustion of Yang Qi in Five Viscera means Yin exists without Yang. Jin Ye refers to water. Guo refers to the body/chest-abdomen. Yin cannot move without Yang; water cannot transform without Qi. Now Yang Qi is exhausted, unable to regulate water passages, so fluids wander and fill the Guo. Po belongs to Yin; although form is full, Qi departs, so Po exists alone. Essence without Qi is isolated internally; Yin without Yang means Qi exhausts externally. San Jiao is blocked, water passages不通, skin swells, body wastes, so form cannot fit clothes. Limbs are the root of Yang; Yang Qi does not move, so four extremities have much Yin and swell urgently. Swelling is due to Yin stagnation; Stomach Yang cannot control water, injuring Lung and Kidney, leading to wheezing/cough, disturbing the interior. This is Yin Qi rejecting internally, causing water swelling and form alteration.)

Treat with balance, like a scale. (Treatment should be like a scale, seeking equilibrium. Regarding water swelling, the root is Kidney, the branch is Lung. If Yang Qi of Five Viscera is exhausted and Po exists alone, the main organ is Lung. Lung governs Qi; how to transform Qi? Fluids filling Guo and isolated Jing internally, the main organ is Kidney. Kidney governs Water; how to balance Water? Lung Metal is born from Spleen Earth; Kidney Water is controlled by Spleen Earth. Thus, treating swelling requires addressing Spleen, Lung, and Kidney, balancing them according to excess/deficiency, which is the way of the scale.)

Remove accumulated stagnant water (Wan Chen Cuo); therefore, slightly move the four extremities, wear warm clothes, employ Miao Ci (diagonal acupuncture) at the sites, to restore the form, open the Ghost Gate (sweat pores), purify the Clean House (bladder), let Jing circulate in time, let Five Yang spread, dredge and cleanse the Five Viscera, thus Jing generates spontaneously, form becomes robust, bone and muscle protect each other, and Ju Qi (Great Qi) becomes peaceful.
Wan means accumulation. Chen means old/long-standing. Cuo means cutting grass. It means removing old accumulated water qi, gradually eliminating it like cutting grass. Si Ji refers to four extremities. Slightly moving them promotes circulation and easy Qi flow. Wearing warm clothes helps assist surface Yang and disperse Yin coagulation. Then apply Miao Ci, taking left for right and right for left, to remove stagnation in large collaterals. Ghost Gate refers to sweat pores. Lung governs skin/hair and stores Po, belonging to Yin, hence "Ghost Gate." Clean House refers to the bladder; it has no inlet hole above but an outlet below, and impurities cannot enter, hence "Clean House." Pathogens in the exterior are dispersed; those in the interior are transformed, hence "Open Ghost Gate, Purify Clean House." When water qi leaves, true Jing circulates. Fu means circulate/move. When Yin pathogens are removed, Five Yang spread. Five Yang refers to the Stomach Qi of the Five Viscera. From this, Jing generates, form becomes robust, bone and muscle protect each other, and Great Qi becomes peaceful.
Wan and Yu are the same. Cuo, pronounced cuò.

In ancient times, people lived among birds and beasts, moved to avoid cold, dwelled in shade to avoid heat, had no internal burdens of attachment/longing, and no external forms of serving officials. In this tranquil and simple era, pathogens could not penetrate deeply. Thus, toxic drugs could not treat internally, and needles/stones could not treat externally, so one could merely transfer Jing and use Zhu You (spiritual healing/divination). (Ancient people nested in trees and dwelled in caves, possessing natural innocence...)