经曰∶东西南北中，五方人之土产浓薄，居处高下，风寒暑湿，各地不同，日
用谷 颇异。所以黄帝举五方之问，岐伯进五治之功，针砭 淋灸之法，乃五方得
宜之用，兼之年力衰壮，禀赋浓薄，五土之别，学人当详察之，不可不备也。
澄曰∶历观古人书集，有专主辛温者，有专主寒凉者，有专主施攻伐者，有纯用
补益者，岂各成一家耶？皆缘五方风土不齐，西北方苦寒，故多主辛温；东南方炎
热，多主寒凉；地土强浓者，堪以攻伐；水土薄弱者，固多补益。是以聚览群书，必
须体会各家着书义旨，以广其用。故医者经历其地，必先察其风土浓薄，并须留心
四时气候，如春当温而反寒，夏当热而反凉，秋当凉而反热，冬当寒而反温，皆为
四时不正之气，必多遏郁于中，又当看天时，久阴久亢，及非时之雷雾，乍寒乍热，
有是气必有是病，临病体察天时人事，五方风土，当温当凉，当攻当补，自无不当矣。
夫肥人多湿、多痰、多气虚，形体外实者，外虽多肉，其实内虚，凡体丰气虚
之人，疮疡故多痈。痈者，壅也。属阳在表，气虚即表虚，故多浮肿于外，皮薄色
赤，宜内托之，使邪毒不内陷，则易溃而易敛。丹溪云∶肥人宜二陈汤加参、 、归、
术、银花、连翘等类治之，无出于此。又曰∶大凡体肥则肉潭于气，加之斫丧，则
真气不足以维持，平日语言气短，行动喘急，一遇脓血出多，空火陡发，精散神离，每多暴脱。
《内经》说：东、西、南、北、中五个方位，各地水土产物的厚薄不同，居住地势的高低不同，风寒暑湿等气候各异，日常饮食谷物也有很大差异。所以黄帝提出关于五方的问题，岐伯进献五种治法的功效，针刺、砭石、淋洗、艾灸等方法，是适应五方情况的恰当运用，再加上人的年力强弱、禀赋厚薄、五方水土的区别，学习中医的人应当详细考察，不可不周全准备。
顾世澄说：遍观古人的医书文集，有的专门主张辛温药，有的专门主张寒凉药，有的专门主张攻伐药，有的纯用补益药，难道是他们各自自成一家吗？都是因为五方风土条件不齐备，西北方气候苦寒，所以多主张用辛温药；东南方气候炎热，多主张用寒凉药；土地肥沃强壮的，可以承受攻伐治疗；水土薄弱地区的，大多采用补益治疗。因此广泛阅览群书，必须体会各家著书的宗旨，以扩大其应用范围。所以医生如果经历过某地，必须先考察那里的风土厚薄，并且必须留心四季气候的变化，如春天应当温暖却反而寒冷，夏天应当炎热却反而凉爽，秋天应当凉爽却反而炎热，冬天应当寒冷却反而温暖，这些都是四季不正之气，必定多在体内郁结阻滞，又应当观察天时，长期阴雨或过度亢旱，以及非时节的雷雾，忽冷忽热，有这种气候就有这种病，临证时体察天时人事、五方风土，该温则温，该凉则凉，该攻则攻，该补则补，自然没有不恰当的。
大凡肥胖的人多湿、多痰、多气虚，形体外表看似结实的人，虽然外面肌肉多，其实内部虚弱，凡是身体丰满但气虚的人，疮疡往往容易生痈（一种阳证疮疡）。痈，就是壅滞的意思。属于阳证，在体表，气虚即表虚，所以多在外部出现浮肿，皮肤薄且颜色红，适宜用内托法治疗，使邪毒不向内陷，就容易溃破也容易收敛。朱丹溪说：肥胖的人适宜用二陈汤（燥湿化痰基础方）加入人参、白术、当归、金银花、连翘等类药物来治疗，没有超出这个范围的。又说：大凡身体肥胖则肌肉松弛于气机，加上过度耗损，则真气不足以维持，平时说话气短，行动喘急，一旦遇到脓血流出过多，虚火突然发作，精气涣散神志离散，常常发生暴脱（突然虚脱死亡）。
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*).