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This question made His Majesty the Emperor and Marshal Qiu ask each other several times every day.

Regarding the fact that the real body of Feng Zun who has appeared all along is Yun Zun, in fact, the old marshal and His Majesty the Emperor also knew it early on. The original Feng Zun could never do what he did now.

Only Yun Zun, the Nine Wisdom Zun, could have such a plan and such a big picture.

But since Yun Zun did not show his true face, he should use the identity of Feng Zun as a cover, which has its own deep meaning. Yu Tang naturally has to help conceal it.

But now the whole world is afraid that it has already known that the reappearing Feng Zun is actually Yun Zun. In the future, I am afraid there is no need to cover it up.

Some time ago, the top leaders of Yu Tang received news that the Ziyou Empire had set up a trap to trap Yun Zun. When receiving the news, His Majesty the Emperor almost fell ill with anxiety.

Fortunately, news came soon afterwards that Yun Zun had caused a big disturbance in Zilong City, fought a bloody battle with the army, broke through calmly, and retreated unscathed. In front of Zilong City, he caused the water of Yuehun River to flood the Ziyou Empire as a threat, forcing the Ziyou Emperor and others to surrender. His mighty power shocked the world!

In this battle, he also brought back the bones of General Shangguan Wudi, the general of Shangguan Jiangmen, and made the heroic spirit of Shangguan Jiangmen return!

This news made the impatient Emperor Yu Tang feel like he had taken a pill, and he smiled in an instant, and the so-called acute illness was cured all at once! .

What’s more, the Ziyou Empire withdrew its troops because of this incident and left the Four-Nation Alliance, which immediately reduced the pressure on the Yu Tang front.

After confirming the situation, he immediately sent an order to separate half of the western garrison and rush to the eastern defense at night to shake the powerful enemy Dongxuan and deal with Hanshanhe!

A few days later, when we heard that Lord Yunzun had come to the aid of the southern frontier, and had displayed his divine power on the battlefield of southern Xinjiang, repelling the Yuan army in one fell swoop and completely stabilizing the southern Xinjiang defense line, Yu Tang was filled with cheers and the people were in high spirits!

Jiuzun is Jiuzun!

Even if there is only one left, he is still the patron saint of Yu Tang!

With Jiuzun, Yu Tang is worry-free!

After finishing the battle in southern Xinjiang, Yunzun told the commander of the southern frontier that he would immediately leave for the eastern defense to provide assistance, which made the Emperor of Yu Tang and the civil and military officials of the whole court feel relieved. With Yunzun’s assistance, even if the eastern front could not counterattack, at least it would be safe!

Who knew…

Since then, there has been no more information about Yunzun!

Yunzun seemed to have disappeared just like that.

It seems that he really turned into clouds halfway through the journey, and there was no movement at all!

Twenty days have passed to this day!

Even the troops transferred by the Western Army to the Eastern Defense will reach Tiegu Pass in a few days at most…

Lord Yunzun, who set off earlier and was extremely fast, not only showed up on the Eastern Front, but there was no news at all. This was not only a huge strange thing, but also a bad omen!

The Eastern Defense was in full swing, and it was so tragic that the land was barren for thousands of miles!

But Yunzun’s whereabouts were still unknown…

“What happened? How come there is no news at all? Even the soul-controlling formation of Zilong City is helpless against Yunzun. What other power in the world can check and balance him?”

Qiu Jianhan paced back and forth in the military hall anxiously. On the other side, His Majesty the Emperor was also pacing back and forth like an irritable lion.

“What happened?” His Majesty the Emperor frowned.

In the past few days, some people have even begun to criticize Yunzun, saying that if Yunzun did not insist on leaving Yutang and going to Ziyou, how could such a thing happen?

This is clearly a trap, but they still jumped into it. It is clearly disregarding the national crisis. It is really unkind!

For such remarks, not only Marshal Qiu, but also His Majesty the Emperor was furious.

“Relatives and old friends were captured. For the sake of national affairs, must we remain indifferent? Are we heartless?”

“What’s more, it was still the Taiping State Letter period. The countries jointly agreed that there would be no war before the New Year. This Taiping State Letter announced to the entire Tianxuan Continent. Who would have thought that the four countries would tear it up together?!”

“Not to mention the midwinter season, heavy snow blocked the mountains and roads. It has always been a time for military strategists to recuperate. Who could have thought that the war would come at this moment…”

But, at the end of the scolding, His Majesty the Emperor also sighed. He really didn’t expect it!

Even himself, even Qiu Jianhan, Leng Daoyin and others, could never have imagined that the Taiping State Letter would be broken!

This is the Taiping State Letter witnessed by the way of heaven and connected with the destiny of the entire continent!

Are those kings collectively dying? ?

Heavy panting sounded, and a soft bag was carried in. On it, the old Taiwei Fang Qingtian raised half of his body anxiously: “Is there any news about Yunzun?”

His eyes were full of eager anticipation!

Now the old Taiwei, whose life was like a candle in the wind, was still worried, and he directly asked someone to carry him over.

“…” Qiu Jianhan shook his head silently.

Disappointment and sadness flashed across the old Taiwei’s eyes.

He murmured, “Although no news is good news, I still want to know Yun Zun’s whereabouts… As long as I know… news about Lord Yun Zun! Even if it’s news that he’s not rushing to the battlefield… Even if I close my eyes now, I can die with my eyes closed…”Vigrx Plus The Best Male Enhancement Supplement Ever Clinically Proven

His Majesty the Emperor’s eyes were cold: “Old Qiu, Yun Zun lost his voice on the way from Southern Xinjiang to Dongxuan this time… Over there, there are mountains stretching for tens of thousands of miles… It’s possible for Yun Zun to get into trouble there and trap him…”

Qiu Jianhan’s eyes flashed with murderous intent: “Only Four Seasons Tower! It must be them!”

“Only Four Seasons Tower can send out such earth-shaking masters to trap Yun Zun now!”

“Well, now it can be confirmed… Yun Zun must have had an accident, and he must be facing the masters of Four Seasons Tower now. I just don’t know… Yun Zun is just trapped, or his life is in danger!!”

Qiu Jianhan’s eyes flashed with deep worry, and he didn’t want to say the last sentence!

But Yun Zun, where are you?

“Important military information!”

Leng Daoyin rushed in: “Dongxuan, send another 800,000 troops! Set off in batches, the first batch of 300,000 is on the way, the second batch has been assembled, and the third batch is assembling. Is Han Shanhe crazy? This is already the scale of destroying a country! Either his Dongxuan will be destroyed in this battle, or my Yutang will end!”

His Majesty the Emperor and Marshal Qiu changed color immediately after hearing this!

Now, even if Fu Baoguo’s men add the reinforcements that have been continuously sent out during this period and the warriors who have spontaneously gone there, there are only less than 500,000 troops. Even if the half of the troops stationed on the western front also arrived, they only have 150,000 reinforcements!

With no more than 650,000 troops, against an army of 2.2 million?

This pressure alone… is enough to drive anyone crazy!

Fu Baoguo is also a human being, can he be an exception? !

Leng Daoyin said loudly: “Your Majesty, the new army is about to complete training. I, an old minister, request to go to the east defense to assist Fu Baoguo and garrison Tiegu Pass!”

His Majesty the Emperor immediately pondered.

The current situation is obvious. Fu Baoguo alone is probably not enough! One person has limited energy and will die if he endures it.

The enemy can take turns to rest, but there is only one backbone of Tiegu Pass.

Fu Baoguo cannot rest.

As long as the opponent’s follow-up reinforcements arrive, it may be the time for Fu Baoguo to die!

Sending people and reinforcements is a must.

In this case, a major military general must rush to assist! Moreover, the strength and prestige of this candidate cannot be lower than Fu Baoguo.

These two people are the pillars of the Yu Tang Empire’s military. Once they go to the east line, they will have a great encouraging effect!

His Majesty the Emperor made up his mind and agreed.

“Wait!” Qiu Jianhan’s white beard fluttered, and he said in a deep voice: “I am the most suitable person to go to the East Defense!”

Leng Daoyin said angrily: “Am I not suitable?”

Qiu Jianhan said: “Old Leng, family members know their own affairs best. I have been stationed in the East Defense for twenty years! I can almost remember every plant and tree there. You have always been wandering in the south and the west. Can you be more familiar with the East Front than me? Let you tell me, who is more suitable for us to go?”

“Let’s take a step back. Although I have been in the capital for these years, I am confident that my prestige in the East Front is still there, as solid as a rock, and indestructible! If you don’t need it at this time, what are you waiting for?”

“Let you tell me, who is more suitable for us to go to the East Front!” Qiu Jianhan was merciless and said it bluntly.

Leng Daoyin blushed, but he said humiliatingly: “What you said is reasonable, but old people are not strong in muscles and bones. Let me go… Old Qiu… You will be older than me after all…”

He looked at Qiu Jianhan worriedly.

Everyone knows that if we go to the east to rush to the rescue, Qiu Jianhan is indeed the most suitable.

But… looking at his white hair, how can we really bear to let the old general put on armor again and embark on the expedition again! ?

Especially facing Han Shanhe, the troops and combat power are not as good as Han Shanhe, and accidents are most likely to happen.

Qiu Jianhan said sternly: “Just because you are old… can’t you kill Han Shanhe?!”

He turned around: “Your Majesty, I ask for your order! Tomorrow morning, I will lead 200,000 reinforcements to the east!”

His Majesty looked deeply at his old comrade-in-arms and elder brother, took a deep breath, and finally said: “Okay! Qiu will go in this battle, but it will not be 200,000 reinforcements. I will give you another 100,000 people from the Imperial City Guards and the Imperial Guards! If the border defense is unfortunate, even if the Imperial Guards are left, what is the use of the Imperial City Guards?!”

“Okay!”

The plan was finalized.

“Your Majesty, if one day you hear the news of my defeat…” Qiu Jianhan took a deep breath: “Please move the capital to the southern border immediately to preserve the vitality of Yu Tang!”

His Majesty turned his head away, without saying a word, and said for a long time: “No need to say more, Yu Tang will not be destroyed!”

Leng Daoyin came up eagerly and said: “Old Qiu…”

He said two words, and his voice suddenly choked. After a long time, he said: “Take care!”

Qiu Jianhan smiled heroically and said: “If Dong Xuan does not retreat, this old man will really be handed over to Han Shanhe!”

After that, he turned around and strode away!

That night, all families in the country collectively petitioned to join the war!

Including Shangguan Jiangmen.

The Leng family and the Qiu family almost came out in full force, and even the women with cultivation were dressed and ready to go!

Shangguan Lingxiu had just returned and asked for a fight immediately, and all the Shangguan family’s military strength was assembled!

Two thousand battle-hardened soldiers, ready to fight at any moment!

But in the entire Yu Tang country, everyone’s heart is heavy. This battle is unprecedentedly dangerous!

The Eastern Front is in danger!

Dong Xuan has mobilized the entire country’s fighting power, assembled an army of two million, and has the scale of destroying a country. There is also a generation of military gods, the world’s first general as the commander!

The entire Yu Tang is immersed in an atmosphere of impending storm.

Everyone is anxiously calling in their hearts.

Yun Zun!

Where are you?

…………

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