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The *Neijing* states: In the five directions—East, West, South, North, and Center—the richness or thinness of local products varies; the altitude of dwellings differs; the climatic factors of wind, cold, summer-heat, and dampness are distinct in each region; and daily dietary grains also vary significantly. Therefore, when Huangdi raised questions regarding the five directions, Qibo presented the efficacy of five treatment methods. Techniques such as acupuncture (*Zhenjiu*), bi stone therapy (*Bianshi*), washing (*Lin*), and moxibustion (*Jiu*) are appropriate applications adapted to the five directions. Furthermore, considering the strength or weakness of age and physical power, the richness or thinness of innate constitution, and the differences among the five soils, students of medicine must examine these details carefully and prepare comprehensively.

Gu Shicheng said: Reviewing ancient medical texts, some exclusively advocate acrid-warm herbs, others exclusively advocate cold-cool herbs, some exclusively advocate purgative/attacking therapies, and others purely use tonifying methods. Is it because they each formed their own school? It is actually due to the uneven environmental conditions of the five directions. The Northwest is bitterly cold, so treatments predominantly use acrid-warm herbs; the Southeast is hot and humid, so treatments predominantly use cold-cool herbs. In regions with fertile and robust soil, patients can tolerate attacking/purgative therapies; in regions with weak water and soil conditions, tonifying therapies are mostly used. Thus, when extensively reading various books, one must comprehend the underlying principles of each author's work to broaden its application. Therefore, a physician who has experienced a specific locality must first investigate the richness or thinness of its local environment and must pay attention to seasonal climate variations. For example, if spring is warm but turns cold, summer is hot but turns cool, autumn is cool but turns hot, and winter is cold but turns warm, these constitute "abnormal qi of the four seasons." Such abnormal qi often causes stagnation and depression within the body. One must also observe meteorological phenomena such as prolonged overcast weather, excessive drought, thunder and fog out of season, and fluctuating temperatures. Where there is such climate, there will be corresponding diseases. At the bedside, by observing the interplay of heavenly timing, human affairs, and the five-directional environments, determining whether to warm, cool, attack, or tonify will naturally result in appropriate treatment.

Generally speaking, obese individuals tend to have dampness, phlegm, and Qi deficiency. Those whose external appearance seems solid may have abundant flesh externally but actual deficiency internally. Individuals who are corpulent yet Qi-deficient are prone to developing carbuncles (*Yong*, a type of Yang-pattern abscess). "Yong" implies obstruction or congestion. It belongs to the Yang category and manifests on the exterior. Qi deficiency leads to exterior deficiency, resulting in frequent external edema/swelling, thin skin, and redness. Treatment should employ the method of internal support (*Neituo*) to prevent the pathogenic toxin from sinking inward, thereby facilitating suppuration and healing. Zhu Danxi stated: Obese individuals are suitable for treatment with *Erchen Tang* (Two-Aged Decoction) supplemented with *Renshen* (Ginseng Radix), *Baizhu* (Atractylodis Macrocephalae Rhizoma), *Danggui* (Angelicae Sinensis Radix), *Yinhua* (Lonicerae Japonicae Flos), *Lianqiao* (Forsythiae Fructus), and similar herbs; no other approach surpasses this. He further stated: Generally, obesity leads to loose muscles failing to secure Qi. Coupled with excessive depletion, the True Qi becomes insufficient to sustain the body. Such individuals typically suffer from shortness of breath during speech and panting upon movement. If pus and blood are lost excessively, deficient fire may suddenly flare up, causing the scattering of essence and separation of spirit, often leading to sudden collapse (*Baotuo*).