人禀天地之气以生，故其气体随地不同。西北之人，气深而浓，凡受风寒，难于透出，
宜用
疏通重剂；东南之人，气浮而薄，凡遇风寒，易于疏泄，宜用疏通轻剂。又西北地寒，当用
温热之药，然或有邪蕴于中，而内反热，则用辛寒为宜；东南地温，当用清凉之品，然或有
气邪随散，则易于亡阳，又当用辛温为宜。至交广之地，则汗出无度，亡阳尤易，附桂为常
用之品。若中州之卑湿，山陕之高燥，皆当随地制宜。故入其境，必问水土风俗而细调之，
不但各府各别，即一县之中风气亦有迥殊者。并有所产之物，所出之泉，皆能致病，土人皆
有极效之方，皆宜详审访察。若恃己之能，执己之见，治竟无功，反为土人所笑矣！
湖州长兴县有合溪，小儿饮此水，则腹中生痞。土人治法，用钱挂颈，以两头按乳头上
，剪
断，即将此线挂转，将两头向背脊上，一并拽齐。线头尽处将黑点记脊上，用艾灸之，或三
壮，或七壮好消，永不再发。服药无效。
天地之气运，数百年一更易，而国家这气运亦应之。上古无论，即以近代言，如宋之末
造，
，《局方》亦然。至于明季，主暗臣专，膏泽不下于民，故丹溪以下诸医，皆以补阴益下为
主。至我本运录极隆之会，圣圣相承，大权独揽，朝纲整肃，惠泽旁流，此阳盛于上之明征
也。又冠饰朱缨，口燔烟草，五行惟火独旺，故其为病，皆属盛阳上越之证，数十年前，云
间老医知此义者，往往专以芩、连、知、柏，挽回误投温补之人，应手奇效，此实与运气相
符。近人不知此理，非惟不能随症施治，并执宁过温热，毋过寒冷之说。偏于温热，又我矫
枉过正之论。如中暑一症，或有伏阴在内者，当用大顺散、理中汤，此乃千中之一。今则不
论何人，凡属中暑，皆用理中等汤，我目睹七窍皆裂而死者，不可胜数。至于托言祖述东垣
，用苍术等燥药者，举国皆然。此等恶习，皆由不知天时国运之理，误引旧说以害人也。故
古人∶不知天、地、人者，不可以为医。
人禀受天地之气而生成生命，因此人的体质随着地域的不同而有所差异。西北地区的人，气血深沉且浓密，凡是感受风寒之邪，难以通过汗出等方式透达体外，适宜使用药力较重的疏通剂；东南地区的人，气血浮浅且薄弱，凡是遇到风寒之邪，容易通过疏泄排出，适宜使用药力较轻的疏通剂。另外，西北地势寒冷，应当使用温热的药物，但如果体内有邪气蕴结导致内部反而发热，则使用辛寒性质的药物为宜；东南地势温暖，应当使用清凉的药物，但如果因为气候温热导致气随汗液外散，从而容易发生阳气亡脱的情况，又应当使用辛温性质的药物为宜。至于交州、广州等地，人们出汗没有节制，阳气亡脱尤其容易发生，附子、肉桂是常用的药物。如果是中原地区低洼潮湿，或者山西、陕西高地干燥，都应当根据当地情况制定适宜的治疗方案。因此，进入一个地方，必须询问当地的水土风俗并仔细调整治疗方案，不仅各个府县不同，即使在一个县内，风气也有显著差异。并且当地出产的物品、流出的泉水，都能导致疾病，当地人都有极其有效的方子，都应该详细审察访问调查。如果倚仗自己的才能，固执己见，治疗竟然没有功效，反而被当地人嘲笑！
湖州长兴县有一条合溪，小孩饮用这里的水，腹部就会生出痞块（腹内结块）。当地人治疗方法，是用线挂在脖子上，用线的两头分别按住乳头，剪断，然后将这根线翻转过来，将两头向背部脊柱方向拉齐。在线头尽头处将黑点标记在脊背上，用艾灸灼烧它，或者灸三壮，或者七壮就能消散，永远不再发作。服用药物无效。
天地的运气，几百年就会更替一次，国家的运势也与之相应。上古时代不必说，就拿近代来说，比如宋朝末年，《局方》也是这种情况。到了明朝末年，君主昏暗臣子专权，恩泽不能下达给百姓，所以朱丹溪以下的各位医生，都以补阴益下为主要治法。到了本朝国运极盛之时，圣主相继承袭，大权独揽，朝廷纲纪整肃，恩惠广泛流传，这是阳气旺盛于上的明显征兆。加上冠饰上有红色的缨穗，人口中燃烧烟草，五行之中唯独火气旺盛，所以他们得的病，都属于阳气过盛上越的证候。几十年前，云间地区的老医生懂得这个道理的，往往专门使用黄芩、黄连、知母、黄柏，来挽回误用温补药物的人，应手之间就有奇效，这确实与运气相符。近代人不懂这个道理，不仅不能随症施治，还执着于“宁可药性偏温热，也不要偏寒冷”的说法。偏向温热，又是我们矫枉过正的言论。比如中暑这一病症，如果有伏阴在内者，应当使用大顺散、理中汤，这只是千分之一的情况。现在则不论什么人，凡是属于中暑，都使用理中汤等方剂，我亲眼目睹七窍流血而死的人，数不胜数。至于借口推崇李东垣学说，使用苍术等燥湿药物的人，全国都是如此。这种恶劣的风气，都是因为不知道天时国运的道理，错误地引用旧说从而害人。所以古人说：不了解天、地、人三者关系的人，不可以做医生。
Human beings are born from the Qi of Heaven and Earth; therefore, their physiological constitution varies with geography. People in the Northwest possess deep and dense Qi. When they contract Wind-Cold, it is difficult for the pathogen to be expelled outward. Thus, heavy-dosing unblocking agents are indicated. People in the Southeast have floating and thin Qi. When they encounter Wind-Cold, it is easy for the pathogen to be dispersed through sweating. Thus, light-dosing unblocking agents are indicated. Furthermore, the Northwest is cold, so warm-hot medicines should generally be used. However, if pathogens are constrained internally causing internal heat, acrid-cold medicines are appropriate. The Southeast is warm, so cooling substances should generally be used. However, if the warmth causes Qi to dissipate with sweat, leading to a risk of Yang collapse, acrid-warm medicines become appropriate. In the regions of Jiaozhou and Guangzhou, excessive sweating occurs easily, making Yang collapse particularly common; *Fuzi* (Aconite Lateralis Radix Preparata) and *Guizhi* (Cinnamomi Ramulus) are commonly used herbs. For the low-lying dampness of the Central Plains or the high aridity of Shanxi and Shaanxi, treatment must be adapted to local conditions. Therefore, upon entering a region, one must inquire about the local water, soil, and customs to carefully adjust the treatment. Not only do practices differ between prefectures, but even within a single county, the local climate may vary significantly. Additionally, locally produced items and springs can cause diseases; locals often possess highly effective prescriptions for these, which should be thoroughly investigated. If one relies solely on personal skill and clings to preconceived notions, resulting in ineffective treatment, one will be ridiculed by the locals!
In Hexi Creek, Changxing County, Huzhou, children who drink this water develop abdominal masses (*Pi*). The local treatment involves hanging a thread around the neck, pressing both ends against the nipples, cutting the thread, then flipping it so the ends point toward the spine and pulling them taut. The point where the thread ends is marked with a black dot on the spine, which is then moxibusted. Three or seven moxa cones are sufficient to resolve the condition permanently without recurrence. Oral medication is ineffective.
The movement of Heaven and Earth's Qi changes every few hundred years, and the fortune of the state corresponds to it. We need not discuss ancient times; looking at recent history, such as the late Song Dynasty, the *Jufang* (Formulary of the Bureau of Imperial Medical Establishment) followed similar patterns. By the late Ming Dynasty, the ruler was dim-witted and ministers were autocratic, with benevolence failing to reach the people. Consequently, physicians following Zhu Danxi focused primarily on nourishing Yin and benefiting the lower body. During the current dynasty's peak prosperity, sage rulers succeeded one another, holding supreme power, restoring court discipline, and spreading grace widely. This is clear evidence of excess Yang ascending above. Furthermore, red tassels adorn headgear, and tobacco is smoked, meaning the Fire element is exceptionally vigorous among the Five Elements. Thus, diseases prevalent during this time belong to syndromes of excessive Yang ascending. Decades ago, old physicians in Yunjian who understood this principle often used *Qin* (Scutellariae Radix), *Lian* (Phellodendri Cortex), *Zhi* (Anemarrhenae Rhizoma), and *Bo* (Phellodendri Cortex) to reverse cases mistakenly treated with warming tonics, achieving miraculous results promptly. This truly aligns with the principles of Qi movement. Recent practitioners, unaware of this theory, not only fail to treat according to symptoms but also adhere to the saying: "Better to err on the side of warm-hot than cold." This bias toward warmth is an overcorrection. For example, in cases of Heatstroke (*Zhongshu*), some patients have latent Yin inside and require *Dashun San* (Great Smooth Powder) or * Lizhong Tang* (Regulate the Middle Decoction); this applies to only one in a thousand cases. Now, regardless of the patient, all Heatstroke cases are treated with *Lizhong Tang* and similar formulas. I have witnessed countless deaths where the seven orifices burst with blood. Others claim to follow Li Dongyuan, using drying herbs like *Cangzhu* (Atractylodis Rhizoma) nationwide. These bad habits stem from ignorance of the principles of heavenly timing and national fortune, erroneously citing old theories and harming people. Thus, the ancients said: "One who does not understand Heaven, Earth, and Man cannot be a physician."