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The five regions each have their specific suitability, and the methods of treating diseases vary accordingly; this is a general discussion on regional differences. However, regarding individuals with unique constitutions, the North may present heat patterns while the South presents cold patterns; due to abnormal climatic influences, summer may bring aversion to cold while winter brings aversion to heat. These situations cannot be discussed rigidly according to a single rule; thus, flexibility and adaptability are essential.

The Yellow Emperor asked: "When physicians treat diseases, the same disease is treated differently, yet all recover. Why is this?" (The term "different" refers to treatments such as bian stones [stone needles], moxibustion, toxic medicines, daoyin [guiding and pulling exercises], and anqiao [massage].)

Qibo replied:
"It is caused by geographical terrain." (Commentary: Even within the same general area, the characteristics of the five directions differ; therefore, when illness occurs, treatment must naturally vary.) Thus, in the Eastern region, it is where heaven and earth begin to generate qi. (Commentary: Corresponds to the season of Spring.) It is a land of fish and salt, near the sea coast and waters. The people eat fish and favor salty flavors, are content with their environment, and delight in their food. (Commentary: Human nature adapts through habit.) Eating fish causes heat to accumulate in the interior; excessive salt consumption depletes blood. (Fish induces sores, confirming internal heat; salt causes thirst, indicating blood depletion.) Therefore, the people there generally have dark skin and loose texture, and their diseases are mostly carbuncles and ulcers. (Commentary: Caused by blood heated.) The appropriate treatment is bian stones. Bian stones refer to needles made of stone. The *Classic of Mountains and Seas* states: "On Mount Gao, there are stones like jade that can be used for needles." This is what is meant by bian stones. Thus, the method of using bian stones also originated from the East. (Commentary: Meaning bian stones started in the East.)

In the Western region, it is a domain of gold and jade, a place of sand and stones, where heaven and earth gather and contract qi. (Commentary: Corresponds to the season of Autumn.) The people live on hillsides, experience much wind, and the water and soil are tough and strong. (Commentary: People in the West dwell in caves or mounds, which remains true today; living on mounds is called 'ling ju'. The *Book of Songs* mentions 'tao xue' referring to this. Commentaries stating houses resemble tombs or that people live on high hills miss the point. Their exposure to wind and robust constitution is due to the clear and vigorous qi of the West.) The people do not wear silk but wear coarse woolen cloth and fine grass mats. Their diet is rich and delicate, resulting in plump and fatty bodies. (Not wearing silk is called 'bu yi'. 'He' refers to woolen cloth, 'jian' to fine grass. 'Hua' means delicious, such as butter, cheese, meat, and bones. Because the food is exquisite, the body becomes fat.) Therefore, external pathogens cannot harm their physical form, and their diseases arise internally. (Internal refers to excesses in emotions—joy, anger, worry, grief, fear—and dietary or sexual indulgence. Commentary: Pathogens refer to external evils; the six climatic evils enter from outside. Now, being fat implies dense interstices, and wearing wool/grass maintains body temperature, preventing external entry. However, overeating rich foods accumulates in the intestines and stomach, and emotional/sexual excesses deplete true yuan; thus, illness arises internally rather than externally.) The appropriate treatment is toxic medicines. (Commentary: Diseases of the zang-fu organs cannot be treated with mild drugs, hence toxic medicines are suitable. 'Toxic medicine' refers to substances with heavy qi and strong flavors.) Thus, the use of toxic medicines also originated from the West. (Commentary: Suitable for Westerners and spread throughout the world.)

In the Northern region, it is a domain of closure and storage by heaven and earth. The terrain is high, people live on mounds, (Commentary: Referring to earthen hillocks.) the wind and cold are biting and icy, (Commentary: Corresponds to the season of Winter.) and the people enjoy living in open fields and consume dairy products. Coldness in the zang organs leads to fullness disorders. (Commentary: Living in open fields lacks thick walls, allowing wind and cold to enter easily. Moreover, consuming butter and cheese, which are cold and greasy, stagnates in the middle. Can the zang organs remain un-cold? Once the zang organs are cold, qi closes and fails to circulate, leading to abdominal distension, with the chest, abdomen, and intestines swelling like drums. This is because the local climate is cold and the zang organs are cold. Fullness disorders mostly stem from cold; this applies not only to the North but also to Southerners who prefer cold foods, indulge in melons and pears, or drink cold water during summer heat, causing cold stagnation. Ignorant practitioners, failing to investigate, believe the South has much fire and use only clearing and draining methods without warming the middle, which is not the way to treat fullness.) The appropriate treatment is moxibustion. Thus, moxibustion also originated from the North. (Commentary: Nothing dispels cold better than moxibustion. Moxibustion involves burning mugwort; 'ruo' refers to fire needles and fire cups. Northerners use it, and the method passed down to later generations.)

In the Southern region, it is where heaven and earth grow and nourish, and yang qi is abundant. (Commentary: Corresponds to the season of Summer.) The terrain is low, the water and soil are weak, and it is a gathering place for fog and dew. (Commentary: Fog and dew are rising dampness; the South is low and wet, hence prone to fog and dew.) The people favor sour flavors and eat fermented/putrid foods. (Commentary: Zhang Jingyue said: 'Yi means putrefied, such as soybean paste, yeast, and sauces. Yi sounds like fu.') Therefore, the people there have dense skin textures and reddish complexions, and their diseases are mainly spasms and bi-syndrome (painful obstruction). (Commentary: Zhang Jingyue said: Fearing sourness leads to astringency, eating putrid food introduces dampness, hence dense texture and spasms/bi. Spasms and bi indicate abundant damp-heat affecting sinews and bones. The South belongs to Fire, hence the red complexion. Zhi means dense. Zhi sounds like zhi.) The appropriate treatment is fine needles. Thus, the Nine Needles also originated from the South. (Commentary: Spasms and bi involve meridians, hence needles are suitable. The method started in the South and was transmitted to later generations.)

In the Central region, the terrain is flat and humid, and heaven and earth produce many things. (Commentary: Earth prospers in the Center; its form is flat and its nature is humid. The Center is the convergence of the four directions, and Earth is the mother of all things, hence many organisms grow here.) The people have a mixed diet and do not engage in hard labor. (Commentary: Everything is available, so the diet is mixed; located centrally, they respond to all directions, so they do not labor.) Therefore, their diseases are mostly wei syndrome (flaccidity), jue syndrome (cold extremities/reversal), and alternating chills and fever. (Commentary: Zhang Jingyue said: 'Earth qi connects to the Spleen and governs the four limbs; thus, damp stagnation causes wei syndrome, and cold/heat causes jue syndrome. In the Central region, qi from the four directions converges, so illnesses manifest as either cold or heat.') The appropriate treatment is daoyin and anqiao. Thus, daoyin and anqiao also originated from the Central region. (Commentary: Zhang Jingyue said: 'Daoyin refers to shaking muscles, bones, and joints to promote qi and blood circulation. Qiao refers to the Yang Qiao and Yin Qiao vessels, implying massaging valleys and qiao acupoints to remove disease. Since the disease is in the joints, this method is used. All subsequent daoyin and massage methods also emerged from the Central Plains. Qiao sounds like qiao.')

Therefore, the sages combine various methods for treatment, each obtaining its appropriateness. The reason why different treatments lead to recovery in all cases is that they understand the true nature of the disease and grasp the general principles of treatment. (Commentary: The five regions differ, so diseases in the five regions naturally vary. Applying treatment according to the disease allows recovery despite different methods. Only sages can fully utilize these appropriate measures.)