平按∶此篇自篇首至末，见《素问》卷四第十二《异法方宜论》篇，又见《甲乙经》卷六第
二，又见日本《心医方》卷一《治病大体》第一。
黄帝问于岐伯曰∶医之治病也，一病而治各不同，皆愈何也？岐伯曰∶地势使然。（五方土
地各异，人食其土，生病亦异，疗方又别。圣人量病所宜，一病合以余方，疗之皆得愈者，大圣
之巧。平按∶
《素问》然下有也字，《医心方》无。《甲乙》无此一段。）故东方之域，天地之法始生也，鱼
盐之地，滨海旁水，其民嗜鱼而食咸，皆安其处，美其食，（天地之法，东方为春，万病始生之
方也。人生鱼盐之地，故安其处，美其食也。平按∶法《素问》作所，《医心方》作法。盐原抄
本省作 ，《医心方》作 ，按《史记·货殖传》注∶ ，谓盐。直用不炼为 。《素问》作盐，
取人易解，谨根据《素问》作盐。《甲乙》东方上无故字，东方下无之域至之地十三字。嗜鱼《素
问》作食鱼。食咸《素问》作嗜咸，《甲乙》、《医心方》同。《甲乙》无“皆安其处美其食”
七字，《医心方》同。）鱼者使人热中，盐者胜血，故其民皆黑色疏理，（鱼性是热，故食之令人
热中。盐，水也。血者，火也。水以克火，故胜血而人色黑也。平按∶盐《甲乙》作咸，《医心方》
作。）故其病皆为痈疡，其治宜砭石，故砭石者亦从东方来。（热中疏理之人，多生痈疡病也。
疡，养良反，疮也。砭铁破痈已成，冷石熨其初起，此言东方病异疗。平按∶为痈疡《甲乙》作
多壅肿，无故砭石下九字。）西方者，金玉之域，沙石之处也，天地之所收引也，其民陵居而多风，
水土刚强，其民不衣而叠篇，其民笮食而脂肥，故邪不能伤其形体，其病皆生于内，其治宜毒药，
毒药者亦从西方来。（笮，诈白反。西方金，亦金玉之所出，故为金玉之域也。西方为秋，故为
万物收引之方也。不衣者，不以绵为衣，而以叠篇其身。食物皆压笮磨碎，不以完粒食之。人多
脂肥，腠理致密，风寒暑湿外邪不伤，而为饮食男女内邪生病，故宜用毒药攻之。平按∶叠篇《素
问》作褐荐，按《史记·货殖传》索隐云∶叠，毛织也。《医心方》亦作叠篇，旁注云∶篇，竹
草也。笮食《素问》、《甲乙》作华食，《医心方》作笮食，注与杨注同。又注压上袁刻脱皆字。）
北方者，天地所闭藏
之域也，其地高陵居，风寒冰冻，其民乐野处而乳食，脏寒生病，其治宜灸 ，灸 者亦从北方
来。（北方为冬，故为万物闭藏之方也。北方其地渐高，是阴中之阴。故风寒也。所乐之处既于
寒，所美之食非温，故五脏寒而生病，宜以灸 。 ，烧也，而悦反。有本冻为湖，量北方无湖
也。平按∶冰冻《素问》、《甲乙》作冰冽。生病，《素问》病上有满字。）南方者，天地所养
长，阳气之所盛处也，其地污下，水土弱，雾露之所聚也，其民嗜酸而食 ，故其民致理而色赤，
其病挛痹，其治宜微针，故九针者亦从南方来。（南方为夏，万物养长，阳盛之方也。阳中之阳，
其地渐下，故水土弱，雾露之所聚也。污下，湿也。 ，快付反，义当腐。南方为火，色赤，故人
多赤色也。以居下湿，多挛痹病，故宜用九针也。平按∶《素问》阳下无气字，地污下作地下，
《甲乙》同，《医心方》作地洼下，旁注云∶洼，与瓜反。食 《甲乙》作食臊，《素问》新校
正云∶“全元起云∶食鱼也。”）中央者，其地平以湿，天地所生物色者众，（中央为土，故其地
平湿，中土之所生物色多。平按∶物色者众《素问》作万物也众，《甲乙》作物者众。）其民食杂
而不劳，故其病多痿厥寒热，其治宜导引按跷，故按跷亦从中央出。（跷，巨绍反。人之食杂则
寒温非理，故多得寒热之病；不劳则血气不通，故多得痿厥之病。故导引按跷则寒热咸和，血气
流通。此非但愈斯二疾，万病皆可用之。跷，又九绍反，举平也。平按∶其治宜导引按跷《医心方》
作道引，无按跷二字。故按跷《素问》作导引按跷。）故圣人杂合以治，各得
其所，故治所以异而病皆愈者，得病之情，知治之大体也。（五方水土生病不同，随疗各异，圣
人即知一病为众药所疗，故以所宜为工，得疗病之大体也。平按∶得其所下《素问》、《甲乙》、
《医心方》均有宜字，根据本注亦应有宜字。）
平按：本篇从篇首至篇末，见于《素问》卷四第十二《异法方宜论》篇，又见于《甲乙经》卷六第二，又见于日本《医心方》卷一《治病大体》第一。
黄帝向岐伯问道：医生治疗疾病时，同一种病却采用不同的治疗方法，但都能痊愈，这是为什么呢？岐伯回答说：这是地理环境造成的。（五方的土地各不相同，人们食用当地的食物，所患的疾病也因此不同，治疗的方药也各有区别。圣人根据病情适宜采取相应措施，对于同一种病结合其他方剂治疗，都能使其痊愈，这是大圣人的巧妙之处。平按：《素问》在“然”字下有“也”字，《医心方》没有。《甲乙经》没有这一段。）
所以东方地区，是天地生发之气开始产生的地方，也是产鱼和盐的地方，靠近海边且临近水域。那里的百姓喜欢吃鱼并且嗜食咸味，都安于那里的居住环境，以那里的食物为美。（天地的规律，东方对应春季，是万病开始滋生的方位。人生长在产鱼盐的地方，所以安于居住，以饮食为美。平按：“法”字在《素问》中作“所”，《医心方》作“法”。盐字原抄本省略偏旁写作某字，《医心方》写作某字，按《史记·货殖列传》注解说：某字指盐。直接使用不炼制的称为某字。《素问》作“盐”，取通俗易懂之意，谨依据《素问》作“盐”。《甲乙经》在“东方”上没有“故”字，“东方”下没有“之域至之地”十三字。“嗜鱼”在《素问》中作“食鱼”。“食咸”在《素问》中作“嗜咸”，《甲乙经》、《医心方》相同。《甲乙经》没有“皆安其处美其食”七字，《医心方》相同。）
吃鱼容易使人产生内热，吃盐过多会耗伤血液，所以那里的百姓皮肤多呈黑色且纹理疏松，（鱼的性质属热，所以吃了让人体内积热。盐属水。血属火。水能克火，所以盐能胜血而使人面色发黑。平按：盐字在《甲乙经》中作“咸”，《医心方》写作某字。）所以他们患的病多为痈疡，治疗适宜用砭石，所以砭石疗法也从东方传来。（体内有热且纹理疏松的人，多生痈疡病。疡，音养良，即疮。砭铁用于刺破已成脓的痈，冷石用于熨敷初起的病症，这里说的是东方疾病与治疗的特殊性。平按：“为痈疡”在《甲乙经》中作“多壅肿”，没有“砭石”下九字。）
西方地区，是金玉出产的地方，也是沙石遍布的地方，是天地收敛之气所在的地方。那里的百姓住在山陵高处且风大，水土性质刚强，百姓不穿丝绵衣服而以毛织品或草编物裹身，百姓吃的食物经过压榨磨碎且身体脂肪肥厚，所以外邪不能伤害他们的形体，他们的病都生于内部，治疗适宜用毒药（指具有偏性的药物），毒药疗法也从西方传来。（笮，音诈白。西方属金，也是金玉出产的地方，所以称为金玉之域。西方对应秋季，所以是万物收敛的方位。不穿衣是指不以绵絮为衣，而是用叠篇裹身。食物都经过压榨磨碎，不以完整颗粒食用。人多脂肪肥厚，腠理致密，风寒暑湿等外邪不能伤害，反而因饮食男女等内邪致病，所以适宜用毒药攻治。平按：“叠篇”在《素问》中作“褐荐”，按《史记·货殖列传》索隐说：叠，是毛织品。《医心方》也作“叠篇”，旁注说：篇，是竹草类。笮食在《素问》、《甲乙经》中作“华食”，《医心方》作“笮食”，注释与杨上善注相同。另外注疏指出压字上袁刻本脱漏了“皆”字。）
北方地区，是天地闭藏之气所在的地方，那里地势高峻，百姓居住在山陵，气候寒冷伴有冰冻。那里的百姓喜欢野外生活并以乳类为食，容易因内脏寒凉而生病，治疗适宜用灸法，灸法也从北方传来。（北方对应冬季，所以是万物闭藏的方位。北方地势逐渐增高，属于阴中之阴，所以寒冷。所喜欢的居住地既寒冷，所喜爱的食物也不温热，所以五脏寒凉而生病，适宜用灸法。 ，即烧的意思，音而悦反。有的版本将“冻”写作“湖”，推测北方没有湖泊。平按：“冰冻”在《素问》、《甲乙经》中作“冰冽”。“生病”在《素问》中“病”字上有“满”字。）
南方地区，是天地养育生长、阳气旺盛的地方，那里地势低洼污浊，水土柔弱，是雾露聚集的地方。那里的百姓喜欢吃酸味并食用腐臭发酵的食物，所以他们的百姓纹理致密且面色红润，他们患的病多为筋脉拘挛和痹症，治疗适宜用微针，所以九针疗法也从南方传来。（南方对应夏季，万物养育生长，是阳气旺盛的方位。阳中之阳，地势逐渐低下，所以水土柔弱，是雾露聚集的地方。污下即潮湿。 ，音快付反，义当腐烂。南方属火，色赤，所以人大多面色红润。因为居住在低湿之地，多患挛痹病，所以适宜用九针。平按：《素问》在“阳”字下没有“气”字，“地污下”作“地下”，《甲乙经》相同，《医心方》作“地洼下”，旁注说：洼，音与瓜反。“食 ”在《甲乙经》中作“食臊”，《素问》新校正说：“全元起说：食鱼也。”）
中央地区，地势平坦且潮湿，天地所生长的生物种类繁多，（中央属土，所以地势平湿，中土所生长的生物种类多。平按：“物色者众”在《素问》中作“万物也众”，《甲乙经》作“物者众”。）那里的百姓饮食繁杂且不从事体力劳动，所以他们的病多为痿证、厥证以及寒热往来之病，治疗适宜用导引按跷，所以按跷疗法也从中央地区产生。（跷，音巨绍反。人的饮食繁杂则寒温失调，所以多得寒热病；不劳作则气血不通，所以多得到痿厥病。所以导引按跷能使寒热调和，气血流通。这不仅能治愈这两种疾病，各种病都可以使用。跷，又音九绍反，意为举起平衡。平按：“其治宜导引按跷”在《医心方》中作“道引”，没有“按跷”二字。“故按跷”在《素问》中作“导引按跷”。）
所以圣人综合各种方法进行治疗，各得其宜，所以治疗方法虽然不同但病都能痊愈，是因为掌握了病情的实情，了解了治疗的根本原则。（五方水土导致生病不同，随疗法各异，圣人知道一种病可以用多种药物或方法治疗，所以以适宜的方法为工巧，掌握治疗疾病的根本原则。平按：在“得其所”之下，《素问》、《甲乙经》、《医心方》都有“宜”字，根据本注也应该有“宜”字。）
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.)