王冰曰反甚为病则可根据时吴昆曰时谓主气主气合四时张志聪曰天气反时者如司气以热而天气反凉是当根据时而用温矣
及胜其王则可犯
王冰曰夏寒甚则可以热犯热寒气不甚则不可犯之张志聪曰如司气以热而寒反胜之又可用热而犯主气之热矣张介宾曰
胜其主者客气太过也如夏而寒甚客水胜也冬而热胜客火胜也春凉秋温其气亦然故可以热犯热以寒犯寒以温犯温以凉犯凉
而从其变乃所谓从治也
以平为期而不可过
王冰曰气平则止过则病生过而病生与犯同也吴昆曰过则反伤正气而为病也张志聪曰以气平为期不过用以伤司气之元
真张介宾曰过则伤正气而增病
是谓邪气反胜者
王冰曰气动有胜是谓邪客胜于主不可不御也六步之气于六位中应寒反热应热反寒应温反凉应凉反温是谓六步之邪胜
也差冬反温差夏反冷差秋反热差春反凉是谓四时之邪胜也胜则反其气以平之张志聪曰是谓邪气反胜者则可犯张介宾曰邪
气反胜则非时而至如应热反寒应寒反热应温反凉应凉反温皆邪气反胜反胜者故当反其气以平之
故曰无失天信无逆气宜无翼其胜无赞其复是谓至治
王冰曰天信谓至时必定翼赞皆佐之谨守天信是谓至真妙理也张志聪曰天信谓气之应时而至者无差失而妄犯之六气各
有所宜而不可逆有胜气又宜折之而无翼其胜有复气又当抑之而无赞其复调之正味使上下合德无相夺伦五运和平勿乖其政
是谓至治张介宾曰客主气运至必应时天之信也不知时气失天信矣寒热温凉用之必当气之宜也不知逆从逆气宜矣翼其胜赞
其复皆助邪也知而弗犯是谓至妙之治
王冰说：如果反常的邪气导致疾病严重，就应当根据时令来用药。吴昆说：“时”指的是主气，主气与四季相应。张志聪说：所谓“天气反时”，例如司天之气本应炎热，但天气反而凉爽，这时就应当顺应时令使用温性药物。
以及当邪气胜过主气（客气太过）时，就可以采取对抗性的治疗手段。
王冰说：夏季寒气极盛，就可以用热药去对抗热病（此处指因寒致病的假热或真寒，原文语境为以热治寒/胜寒，结合后文“寒气不甚则不可犯之”，意指若寒不盛则不可妄用热药犯其主气之热，此处逻辑稍显复杂，依原文直译：夏天若寒气极重，可以用热药去克制；若寒气不重，则不可冒犯主气的热）。张志聪说：例如司天之气为热，而寒气反而偏胜，这时又可以使用热药去对抗主气的热（此处张志聪观点似有笔误或特定语境，通常寒胜应用热，热胜用寒，但依原文翻译：如司气为热而寒反胜，又可用热而犯主气之热矣——注：此处原文逻辑可能存在传抄错误或特殊理论，按字面意译：如果主气是热，而寒气反胜，又可以用热药去侵犯主气的热？*修正理解*：结合张介宾解释“客水胜也...故可以热犯热”，意为客气（邪气）胜了主气，此时可以顺从客气之性进行治疗，即“从治”。若客气为寒，主气为热，用热药是“犯”主气之热，但却是为了治客气之寒？不，张介宾说“以热犯热...乃所谓从治也”。这意味着当客气（邪气）强于主气时，治疗应顺从客气（邪气）的性质。例如夏天主气热，客气寒且胜，此时若用热药，看似“犯”主气之热，实则是顺从客气之寒？不对，热药不能治寒。让我们重新审视张介宾的话：“胜其主者客气太过也...故可以热犯热...乃所谓从治也”。这里的“从治”通常指“反治”，即顺从疾病假象。但在六气胜复中，若客气胜主气，说明邪气盛，此时治疗需针对邪气。若客气为寒，应治以热；若客气为热，应治以寒。原文“以热犯热”可能指客气为热，主气亦为热（或主气被克），此时用热药？这不符合常规。再看王冰：“夏寒甚则可以热犯热”。夏天本热，若寒甚，是用热药治寒。那为什么叫“犯热”？可能是指“犯”了夏天的主气（热）？不，应该是“以热治寒”。让我们看张志聪：“可用热而犯主气之热矣”。这非常奇怪。通常“犯”指逆治。若客气寒胜，用热药，是正治。若客气热胜，用寒药，是正治。原文可能有误或特指某种情况。但作为翻译，必须忠实原文。原文说“及胜其王则可犯”，王冰解为“夏寒甚则可以热犯热”。这里“犯热”可能指“在热的季节/背景下处理热的问题”或者文字有误。鉴于任务要求忠实原文，我将直译并保留术语。*再次推敲*：有一种解释是，“犯”指干预。当客气胜主气时，可以干预。若夏寒甚（客气寒胜），用热药（治寒），这是正治。为何称“犯热”？或许是指“犯”了“寒”？不，原文写的是“犯热”。另一种可能是“犯”通“泛”或泛指治疗。但最可能的解释是：张介宾提到“以热犯热...乃所谓从治也”。在中医里，“从治”即“反治”，如“热因热用”。如果夏天出现真寒假热，或者客气寒胜导致格阳，可能需要热药。但更直接的理解是：当客气（邪气）胜过主气时，病情由邪气主导，治疗应针对邪气。若邪气是寒，用热药；若邪气是热，用寒药。原文“以热犯热”若指邪气为热，则应用寒药。若指邪气为寒，应用热药。原文张介宾列举“以热犯热、以寒犯寒...”，这暗示了“同气相求”或“顺势而为”的从治法。即：若客气表现为热（胜主气），则用热药（从治）；若客气表现为寒，则用寒药。但这违背“寒者热之”的基本原则，除非是“真热假寒”或“真寒假热”的极端情况，或者是针对“复气”的处理。考虑到《内经》背景，这很可能是在讲“六化”中的特殊情况，即当客气（邪气）极度强盛，压制主气时，治疗策略发生变化。无论如何，翻译需忠实原文。
王冰说：夏季寒气极盛，就可以用热药去治疗（原文作“犯热”，疑为“治寒”或特定术语，暂译为“用热药应对”）；若寒气不重，则不可冒犯主气的热。张志聪说：例如司天之气为热，而寒气反而偏胜，这时又可以使用热药去对抗（原文作“犯主气之热”，逻辑存疑，但依文意译）。张介宾说：胜过主气的是客气太过。例如夏季寒气极盛，是客气之水胜；冬季热气偏胜，是客气之火胜。春季凉、秋季温，也是同样的道理。因此，可以用热药去应对热证（从治），用寒药去应对寒证，用温药去应对温证，用凉药去应对凉证。这种顺从病情变化（客气之变）的治疗方法，就是所谓的“从治”。
王冰说：气机平和就停止，过度就会生病。“过而病生”与“犯”是一样的道理。吴昆说：过度就会反过来损伤正气而导致疾病。张志聪说：以气机平和为限度，不过度使用以免损伤司天之气的元气。张介宾说：过度会损伤正气并增加病情。
这就是所说的“邪气反胜”的情况。
王冰说：气机运行中有偏胜，这就叫做邪气客胜于主气，不可不抵御。六步之气在六个时段中，应寒反热、应热反寒、应温反凉、应凉反温，这就叫做六步之邪胜。冬季反暖、夏季反冷、秋季反热、春季反凉，这就叫做四时之邪胜。邪胜则反向使用其气机来平衡它。张志聪说：这就是所说的“邪气反胜”，此时就可以采取对抗性治疗。张介宾说：邪气反胜是指非时而至的气，例如应热反寒、应寒反热、应温反凉、应凉反温，这些都是邪气反胜。因为是反胜，所以应当反向使用其气机来平衡它。
所以说：不要违背天时信约，不要逆乱气宜，不要助长胜气，不要赞助复气，这叫做最高明的治理。
王冰说：“天信”是指到了时令必定有的气候特征。“翼”和“赞”都是辅助的意思。谨守天信，这叫做至真妙的道理。张志聪说：“天信”是指气应时而至，没有差错失误而妄加干预。六气各有所宜，不可逆乱。有胜气时，适宜折损它，但不要助长它的胜势；有复气时，应当抑制它，但不要赞助它的复发。调和药物的正味，使上下合德，不相夺乱，五运和平，不违背其政令，这叫做最高明的治理。张介宾说：客气主气运气到来，必定应合时令，这是天的信约。不知道时令之气，就失去了天信。寒热温凉的使用，必须恰当符合气之宜。不知道逆从，就逆乱了气宜。助长胜气、赞助复气，都是帮助邪气。知道了却不妄加干预，这叫做最高妙的治疗。
Wang Bing stated: If the pathogenic factor acting in opposition to the season causes severe disease, treatment should be based on the current season. Wu Kun explained that "season" refers to the Host Qi (Zhu Qi), which corresponds to the four seasons. Zhang Zhicong clarified that "Heavenly Qi contrary to the season" means, for example, if the ruling Qi is hot but the weather turns cool, one should use warm herbs according to the season.
When the Guest Qi (Ke Qi) overcomes the Host Qi, counteractive measures may be taken.
Wang Bing stated: In summer, if cold is extreme, heat can be used to treat it; if cold is not severe, one must not offend the Host Qi's heat. Zhang Zhicong stated: For instance, if the ruling Qi is hot but cold invades and prevails, heat may again be used to confront the Host Qi's heat. Zhang Jiebin stated: That which overcomes the Host Qi is excessive Guest Qi. For example, extreme cold in summer indicates an excess of Guest Water; excessive heat in winter indicates an excess of Guest Fire. The same applies to coolness in spring and warmth in autumn. Therefore, one may use heat to treat heat, cold to treat cold, warmth to treat warmth, and coolness to treat coolness. Following these variations is what is called "Following Treatment" (Cong Zhi).
The goal is balance, and one must not go to extremes.
Wang Bing stated: Stop when qi reaches balance; going beyond this leads to disease. "Disease arising from excess" is similar to "offending." Wu Kun stated: Excess will reverse-injure the Healthy Qi (Zheng Qi) and cause disease. Zhang Zhicong stated: Take balance as the limit; do not overuse so as to injure the primordial true Qi of the Ruling Qi. Zhang Jiebin stated: Excess injures Healthy Qi and exacerbates disease.
This is referred to as "Pathogenic Qi Prevailing in Opposition."
Wang Bing stated: When qi movement has a prevailing aspect, it is called Pathogenic Guest Qi overcoming the Host Qi, which must not be ignored. In the six phases of qi, within their respective positions, if cold should appear but heat does, or heat should appear but cold does, or warmth should appear but coolness does, or coolness should appear but warmth does, this is called the prevalence of pathogenic qi in the six phases. If winter is unusually warm, summer unusually cold, autumn unusually hot, or spring unusually cool, this is called the prevalence of pathogenic qi in the four seasons. When there is prevalence, one uses the opposite nature of qi to bring about balance. Zhang Zhicong stated: This is what is meant by "Pathogenic Qi Prevailing in Opposition"; in such cases, counteractive treatment is permissible. Zhang Jiebin stated: Pathogenic Qi prevailing in opposition refers to qi arriving out of season, such as heat expected but cold appearing, cold expected but heat appearing, warmth expected but coolness appearing, or coolness expected but warmth appearing. All these are examples of Pathogenic Qi prevailing in opposition. Since it is an oppositional prevalence, one should use the opposite nature of qi to achieve balance.
Therefore, it is said: Do not lose sight of the Trust of Heaven (Tian Xin); do not violate the appropriateness of Qi; do not assist the prevailing force; do not endorse the retaliatory force. This is called the highest form of governance.
Wang Bing stated: "Trust of Heaven" refers to the certainty of climate at the proper time. "Yi" and "Zan" both mean to assist. Strictly observing the Trust of Heaven is called the profound principle of Supreme Truth. Zhang Zhicong stated: "Trust of Heaven" refers to qi arriving in accordance with the season without error or妄 interference. Each of the Six Qi has its propriety and must not be violated. When there is a prevailing force, it is appropriate to curb it, but do not assist its prevalence. When there is a retaliatory force, it is appropriate to suppress it, but do not endorse its recurrence. Harmonize the correct flavors of herbs so that upper and lower harmonize in virtue, without interfering with each other's order. Keep the Five Movements (Wu Yun) in peace, ensuring they do not deviate from their administration. This is called the highest form of governance. Zhang Jiebin stated: When Guest, Host, and Movement-Qi arrive, they must correspond to the season; this is the Trust of Heaven. To not know the seasonal qi is to lose the Trust of Heaven. The use of cold, heat, warmth, and coolness must be appropriate to the qi. To not understand reversal and following is to violate the appropriateness of qi. Assisting the prevailing force and endorsing the retaliatory force are all aiding the pathogen. To know this and yet not interfere is called the most subtle form of treatment.