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Ping An: This section, from the beginning to the end of the chapter, is found in Volume 4, Chapter 12 "Yi Fa Fang Yi Lun" (Discussion on Different Therapeutic Methods for Different Regions) of the *Suwen* (Basic Questions), also in Volume 6, Chapter 2 of the *Jiayi Jing* (Systematic Classic of Acupuncture and Moxibustion), and also in Volume 1, Chapter 1 "Zhi Bing Da Ti" (General Principles of Treating Diseases) of the Japanese *Ishinpō* (Medical Heart Method).

The Yellow Emperor asked Qibo: When physicians treat diseases, the same disease is treated with different methods, yet all result in recovery. Why is this? Qibo replied: It is caused by geographical conditions. (The lands of the five directions are different; people eat the food of their land, so the diseases they contract differ, and the therapeutic prescriptions also vary. The Sage measures what is suitable for the condition; treating one disease with various other methods and achieving recovery demonstrates the skill of the Great Sage. Ping An: The *Suwen* has the character "ye" after "ran"; the *Ishinpō* does not. The *Jiayi Jing* lacks this paragraph.)

Therefore, in the Eastern region, it is where the generative energy of Heaven and Earth begins. It is a land of fish and salt, located by the sea and near waters. The people there favor eating fish and consuming salty foods, are content with their dwellings, and delight in their diet. (According to the patterns of Heaven and Earth, the East corresponds to Spring, the direction where myriad diseases begin to arise. People born in lands producing fish and salt are thus content with their residence and delighted by their food. Ping An: The character "fa" is written as "suo" in the *Suwen* and as "fa" in the *Ishinpō*. The character for salt in the original manuscript omits the radical, written as [symbol]; the *Ishinpō* writes [symbol]. According to the commentary on the *Shiji: Huozhi Zhuan*, [symbol] refers to salt. Unrefined salt used directly is called [symbol]. The *Suwen* uses "yan" (salt) for ease of understanding; I strictly follow the *Suwen* using "yan". The *Jiayi Jing* lacks the character "gu" before "Dongfang" and the thirteen characters "zhi yu zhi di" after "Dongfang". "Shi yu" in the *Suwen* is written as "shi yu". "Shi xian" in the *Suwen* is written as "shi xian", consistent with the *Jiayi Jing* and *Ishinpō*. The *Jiayi Jing* lacks the seven characters "jie an qi chu mei qi shi"; the *Ishinpō* is the same.)

Eating fish causes heat to accumulate in the interior; excessive consumption of salt damages the blood. Consequently, the people there generally have dark skin and loose tissue texture. (Fish nature is hot, so eating it causes internal heat accumulation. Salt belongs to Water. Blood belongs to Fire. Water overcomes Fire, so salt overcomes blood, leading to dark complexion. Ping An: "Yan" is written as "xian" in the *Jiayi Jing* and as [symbol] in the *Ishinpō*.) Therefore, their diseases are mostly carbuncles and ulcers, and the appropriate treatment is Bian stone (stone scalpels). Thus, Bian stone therapy also originated from the East. (People with internal heat and loose textures are prone to carbuncles and ulcers. "Yang" (ulcer) sounds like "yang liang," meaning sore or ulcer. Bian iron is used to pierce established abscesses, while cold stones are used to compress early-stage lesions; this discusses the distinct diseases and treatments of the East. Ping An: "Wei yong yang" in the *Jiayi Jing* is written as "duo yong zhong"; the nine characters after "bian shi" are absent.)

In the Western region, it is a land of gold and jade, full of sand and stones, where the contracting energy of Heaven and Earth resides. The people live on hills and slopes and endure much wind; the water and soil are hard and strong. They do not wear silk but wrap themselves in woven mats or coarse fabrics; their food is pressed and ground, and they are fat and fleshy. Thus, external pathogens cannot harm their bodies, and their diseases arise internally. The appropriate treatment is using Du Yao (potent drugs/medicines with strong properties). Thus, Du Yao therapy also originated from the West. ("Ze" sounds like "zha bai." The West belongs to Metal, the source of gold and jade, hence the name Land of Gold and Jade. The West corresponds to Autumn, the direction of contraction for all things. "Not wearing clothes" means not wearing cotton/silk but wrapping the body in "die pian." Food is pressed and ground, not eaten as whole grains. People are often fat, with dense interstices (couli); external pathogens like Wind, Cold, Summer-heat, and Dampness cannot harm them, but internal pathogens from diet and sexual activity cause illness, so potent drugs are suitable for attacking them. Ping An: "Die pian" in the *Suwen* is written as "he jian." According to the *Suyin* commentary on the *Shiji: Huozhi Zhuan*, "die" means woolen weaving. The *Ishinpō* also writes "die pian," with a marginal note saying: "pian" refers to bamboo and grass. "Ze shi" in the *Suwen* and *Jiayi Jing* is written as "hua shi"; the *Ishinpō* writes "ze shi," with notes identical to Yang Shangshan's. Another note points out that the Yuan edition omitted the character "jie" above "ya".)

In the Northern region, it is where the closing and storing energy of Heaven and Earth resides. The terrain is high, people live on hills, and the climate features cold winds and freezing ice. The people enjoy living in the wild and consume dairy products. They suffer from illnesses due to cold viscera. The appropriate treatment is Moxibustion. Thus, Moxibustion also originated from the North. (The North corresponds to Winter, the direction of closure and storage for all things. The terrain in the North gradually rises, representing Yin within Yin, hence the cold. The places they enjoy are cold, and the foods they delight in are not warm, causing the Five Viscera to become cold and sick, making Moxibustion suitable. "[Symbol]" means burning, sounding like "er yue fan." Some versions write "dong" as "hu"; it is estimated there are no lakes in the North. Ping An: "Bing dong" in the *Suwen* and *Jiayi Jing* is written as "bing lie." "Sheng bing" in the *Suwen* has the character "man" before "bing".)

In the Southern region, it is where Heaven and Earth nurture and grow, and where Yang Qi is abundant. The terrain is low and damp, the water and soil are weak, and it is an area where fog and dew gather. The people favor sour tastes and consume fermented/putrid foods. Consequently, their tissues are dense, and their complexions are red. Their diseases involve spasms and Bi syndrome (obstruction). The appropriate treatment is fine needles. Thus, the Nine Needles also originated from the South. (The South corresponds to Summer, when all things are nurtured and grown, a direction of abundant Yang. Yang within Yang, the terrain gradually lowers, so water and soil are weak, gathering fog and dew. "Wu xia" means damp. "[Symbol]" sounds like "kuai fu fan," implying rotting/fermentation. The South belongs to Fire, color Red, so people often have reddish complexions. Living in low, damp areas leads to many cases of spasms and Bi syndrome, so the Nine Needles are suitable. Ping An: The *Suwen* lacks the character "qi" after "yang"; "di wu xia" is written as "di xia," consistent with the *Jiayi Jing*. The *Ishinpō* writes "di wa xia," with a marginal note: "wa" sounds like "yu gua fan." "Shi [symbol]" in the *Jiayi Jing* is written as "shi sao"; the *Suwen* New Correction states: "Quan Quanyuan says: eating fish.")

In the Central region, the terrain is flat and damp, and the variety of life produced by Heaven and Earth is numerous. (The Center belongs to Earth, so the terrain is flat and damp, and the biological varieties produced by Central Earth are many. Ping An: "Wu se zhe zhong" in the *Suwen* is written as "wan wu ye zhong"; the *Jiayi Jing* writes "wu zhe zhong".) The people there have diverse diets and do not engage in physical labor. Consequently, their diseases are mostly Wei syndrome (atrophy), Jue syndrome (cold limbs/fainting), and alternating cold and heat. The appropriate treatment is Dao Yin (guiding and pulling exercises) and An Qiao (pressing and kneading). Thus, An Qiao therapy also emerged from the Central region. ("Qiao" sounds like "ju shao fan." Diverse diets lead to improper regulation of cold and heat, causing many cold-heat diseases; lack of labor leads to blocked Qi and Blood, causing many Wei and Jue diseases. Therefore, Dao Yin and An Qiao harmonize cold and heat and circulate Qi and Blood. This not only cures these two diseases but can be applied to myriad ailments. "Qiao" also sounds like "jiu shao fan," meaning lifting and balancing. Ping An: "Qi zhi yi dao yin an qiao" in the *Ishinpō* is written as "dao yin," lacking the two characters "an qiao." "Gu an qiao" in the *Suwen* is written as "dao yin an qiao".)

Therefore, the Sage combines various methods for treatment, each suited to its context. Thus, although the treatments differ, the diseases all recover because the physician understands the true nature of the disease and grasps the general principles of treatment. (The water and soil of the five directions cause different diseases, treated differently according to the method. The Sage knows that one disease can be treated by many medicines/methods, so he employs the most suitable approach as skillful practice, mastering the general principles of treating diseases. Ping An: After "de qi suo," the *Suwen*, *Jiayi Jing*, and *Ishinpō* all have the character "yi"; based on this annotation, "yi" should also be present here.)