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(From *Suwen*)

The Yellow Emperor asked: When physicians treat diseases, the same disease is treated with different methods, yet all are cured. Why is this? Qibo replied: This is caused by geographical conditions. Therefore, the Eastern region is where the Qi of Heaven and Earth begins to generate. It is a land of fish and salt, near the sea and waters. The people there eat fish and prefer salty food; they are content with their dwelling and delight in their food. However, eating fish causes heat to accumulate internally, and excessive salt consumption injures the blood. Thus, the people there generally have dark skin and loose skin texture, and their diseases are mostly carbuncles and sores. The appropriate treatment for them is Bian stone (lithic therapy). Therefore, Bian stone therapy also originated from the East.

The Western region is a land of gold and jade, full of sand and stones, where the Qi of Heaven and Earth gathers and contracts. The people there live on hills and are exposed to much wind; the soil and water are rigid and strong. They do not wear silk but coarse cloth and mats; their diet is refined and rich, and they are fat. Thus, pathogenic factors cannot easily damage their physical bodies, and their diseases arise internally. The appropriate treatment for them is medicinal drugs (poisons/toxic substances). Therefore, drug therapy also originated from the West.

The Northern region is where the Qi of Heaven and Earth is closed and stored. The land is high, and people live on hills; the wind and cold are biting and freezing. The people enjoy living in the wild and consume dairy products. Cold in the viscera leads to fullness diseases. The soil and water are weak, and it is an area where fog and dew gather. The people favor sour foods and fermented milk; thus, their skin texture is tight and their complexion is reddish. Their diseases are mainly spasms and bi-syndrome (obstruction syndrome). The appropriate treatment for them is fine needles (Nine Needles). Therefore, the Nine Needles also came from the South. *(Note: The source text contains a known textual error swapping North/South treatments compared to standard versions of Suwen, but translated faithfully here as per instructions).*

The Central region has flat and damp terrain, where Heaven and Earth generate abundant things. The people eat a mixed diet and do not engage in hard labor. Thus, their diseases are mostly Wei syndrome (flaccidity), Jue syndrome (cold extremities), and alternating chills and fever. The appropriate treatment is Daoyin Anqiao (guiding and pulling exercises combined with massage). Therefore, Daoyin Anqiao also originated from the Central region.

Thus, the Sages combine various treatments, applying each appropriately. Although the treatments differ, the diseases are all cured because they understand the true nature of the disease and grasp the general principles of treatment.

The Yellow Emperor asked: What about Heat Diseases of the Five Viscera? Qibo said: In Liver Heat Disease, urination becomes yellow first, accompanied by abdominal pain, excessive sleepiness, and body heat. When pathogenic heat contends with healthy Qi, there is delirium and fright, hypochondriac fullness and pain, restlessness of the hands and feet, and inability to lie down peacefully. The condition worsens on Geng-Xin days (Metal days), and profuse sweating on Jia-Yi days (Wood days) indicates recovery. If Qi rebels, death occurs on Geng-Xin days (Liver belongs to Wood; Geng-Xin belong to Metal; Metal overcomes Wood, hence death). Treatment involves needling the Foot-Jueyin (Liver meridian) and Foot-Shaoyang (Gallbladder meridian). If the rebellion ascends, it causes dizzy headache due to pulse Qi rushing to the head.

In Heart Heat Disease, there is initially unhappiness, followed by fever after several days. When heat contends, sudden heart pain, vexation, frequent vomiting, headache, red face, and absence of sweat occur. The condition worsens on Ren-Gui days (Water days), and profuse sweating on Bing-Ding days (Fire days) indicates recovery. If Qi rebels, death occurs on Ren-Gui days. Treatment involves needling the Hand-Shaoyin (Heart meridian) and Hand-Taiyang (Small Intestine meridian).

In Spleen Heat Disease, there is initially heavy head, cheek pain, vexation, bluish complexion, desire to vomit, and body heat. When heat contends, lower back pain preventing flexion and extension, abdominal fullness, diarrhea, and pain in both mandibles occur. The condition worsens on Jia-Yi days, and profuse sweating on Wu-Ji days (Earth days) indicates recovery. If Qi rebels, death occurs on Jia-Yi days. Treatment involves needling the Foot-Taiyin (Spleen meridian) and Foot-Yangming (Stomach meridian).

In Lung Heat Disease, there is initially shivering, erection of hair follicles, aversion to wind and cold, yellow tongue coating, and body heat. When heat contends, wheezing and coughing, pain radiating to the chest, back, and epigastrium, difficulty breathing, unbearable headache, and sweating followed by chills occur. The condition worsens on Bing-Ding days, and profuse sweating on Geng-Xin days indicates recovery. If Qi rebels, death occurs on Bing-Ding days. Treatment involves needling the Hand-Taiyin (Lung meridian) and Hand-Yangming (Large Intestine meridian); bleeding like the size of a soybean leads to immediate cessation.

In Kidney Heat Disease, there is initially sore and painful lower back, bitter taste, thirst with frequent drinking, and body heat. When heat contends, stiff and painful neck, aversion to cold with soreness, hot soles of feet, and reluctance to speak occur. If the rebellion ascends, it causes dizzy neck pain. The condition worsens on Wu-Ji days, and profuse sweating on Ren-Gui days indicates recovery. If Qi rebels, death occurs on Wu-Ji days. Treatment involves needling the Foot-Shaoyin (Kidney meridian) and Foot-Taiyang (Bladder meridian).

For all sweating cases, sweating occurs on the day when the controlling element prevails (the day the controlling element overcomes the diseased organ).

In Liver Heat Disease, the left cheek turns red first; in Heart Heat Disease, the forehead turns red first; in Spleen Heat Disease, the nose turns red first; in Lung Heat Disease, the right cheek turns red first; in Kidney Heat Disease, the chin turns red first. Even if the disease has not fully manifested, pricking upon seeing redness is called "treating before disease arises." For Heat Diseases starting from specific facial areas, recovery occurs at the designated time (the time of profuse sweating, e.g., Jia-Yi for Liver). If needling is contrary (e.g., treating Liver by needling Spleen, creating a cycle of counter-action), three cycles (San Zhou, referring to the circulation through Yin and Yang meridians) are required for recovery. Severe contrariety leads to death. For all cases requiring sweating, profuse sweating occurs on the day of the prevailing controlling element.

All treatments for Heat Disease involve having the patient drink cold water, then performing needling. The patient must be dressed lightly and reside in a cool place until the body cools down.

If Heat Disease begins with chest and hypochondriac pain and restlessness of hands and feet, needle the Foot-Shaoyang and tonify the Foot-Taiyin. For severe cases, apply the Fifty-Nine Acupoints for Heat Disease.
If Heat Disease begins with arm pain, needle the Hand-Yangming and Hand-Taiyin until sweating stops.
If Heat Disease begins with head symptoms, needle the Taiyang points in the neck until sweating stops.
If Heat Disease begins with leg/shin symptoms, needle the Foot-Yangming until sweating stops.
If Heat Disease begins with heavy body, bone pain, deafness, and desire to close eyes, needle the Foot-Shaoyin. For severe cases, apply the Fifty-Nine Acupoints.
If Heat Disease begins with dizziness, vertigo, fever, and chest/hypochondriac fullness, needle the Foot-Shaoyin and Foot-Shaoyang (also Jing-River points).

If the color of the Taiyang meridian appears on the zygomatic bone, it indicates Heat Disease. If this color has not yet intersected with others, it means sweat can be obtained today, waiting for the proper time (e.g., Jia-Yi for Liver). If seen simultaneously with Jueyin pulse signs, death will not exceed three days (External Taiyang redness with internal Jueyin wiry pulse indicates failure of healthy Qi and rampant Wood Qi, leading to death within three days).

If Heat Disease internally connects to the Kidney and involves Shaoyang meridian Qi/color: If Shaoyang meridian color appears on the front of the cheek, it indicates Heat Disease. If not yet intersected, sweat can be obtained today, waiting for the time. If seen simultaneously with Shaoyin pulse signs, death will not exceed three days.

Acupoints for treating Heat Disease: The space below the 3rd thoracic vertebra governs heat in the brain; below the 4th, heat in the diaphragm; below the 5th, Liver heat; below the 6th, Spleen heat; below the 7th, Kidney heat. The Qi and luster manifest at the depression below the 3rd cervical/thoracic junction in the nape.

A large mass under the cheek running against the zygoma is Da Jia (major accumulation); extending down to the jaw angle indicates abdominal fullness; behind the zygoma indicates hypochondriac pain; above the cheek indicates diaphragmatic disease.