大般涅槃經義記 4.15

4.15

In the first part, there is first the simile and then the application. In the simile, "the natures of the four great elements are not the same, being contrary to one another" is a simile for the mutual opposition of the earlier two views of existence and non-existence. "A skilled physician understands well, regulating and adjusting them in accordance with their unbalanced arising" is a simile clarifying that the Tathāgata knows when an error is predominantly strong and eliminates it. In the application, the first line regarding the differences among the four great elements is abbreviated and not applied, but only the latter line regarding the skilled physician regulating and adjusting is applied. "The Tathāgata is also like this; toward sentient beings he is like a physician" matches the skilled physician above; "knowing the differences in the essential marks of all afflictions" matches knowing well above; "and eliminates them" matches regulating and adjusting them in their unbalanced arising above. The characteristics of elimination are as explained in the subsequent text.