《金匮》天雄散，有方无论。近人不得其说，或疑为后人所附而议去之。泉谓此乃阳虚
失精
之祖方，未可去也。古者失精与梦失精分而为二∶梦因于风，梦失精者，虚而挟风，故仲景
以桂枝汤中加龙、蛎治之，桂枝汤中风方也；不梦而但失精者，虚而挟寒，故又以天雄散治
之，天雄祛寒壮阳之药也。其治失精，于何征之？《病源》引“失精家少腹弦急，阴头寒，
目眶痛，发落”一段经文于失精候，而《外台》即以范汪天雄散隶之，范汪方较仲景止少龙
骨一味，而注中引张文仲有龙骨，与仲景一味不差。此天雄散治失精之证也。古失精，近滑
精也。《局方》金锁正元丹，盖取诸此。
大凡思义必先顾名。仲景书名伤寒，则方义自系治寒。寒邪从表乘里，里气不支，挥霍
撩乱，
势将直捣。此时未暇顾表，先与建里，故但用参、术、甘、姜四味，而置头痛、发热、身疼
诸证于不问，亦以实其里，本无妨于表也。俟乱一定，然后解表，以截来路，方下所以有吐
利止而身痛不休者，当消息和解其外，宜桂枝汤之论也。理中专为此设，并无伏热痰食在
内，故无壅塞横决之虑，不然则有因而致变者矣。其缓者更有桂枝人参汤（即理中加桂枝）
，法与先理中后桂枝者同一表邪乘里，而分治合治犹尚有别，况于里实者，而可无别乎？
至于四逆亦为表邪乘里而设，但见厥，则所乘已在三阴，较理中症尤重，乃反不用参、术何
也
？盖以寒邪已入三阴，则里为实，与理中症寒邪将入三阴，其里犹虚者，先后止争一间。正
如
妇人临产可服补剂助力，已产则有血肉瘀不得再补之比，知此始可与言虚实矣。且吐利而又
厥逆，为表里同病，故既以干姜温里，即以生附托表，其与真武汤、附子汤之用熟附益气，
迥然不同。然则桂泄三阳，生附泄三阴，经有定例，非仅以“性热”两字了之。夫一寒之传
变，其别如此，则凡不止一寒，本先里实者，从可推已。用此二方，但将已所诊症，细细与
仲景论中义例相参，合则用，不合则否，毋执成见为也。
《金匮要略》中的天雄散，只有方剂而没有理论解释。近代人无法理解其含义，有人怀疑它是后人附加的内容而建议删除。我认为这是治疗阳虚导致失精的祖传方剂，不可以删除。古代将“失精”与“梦遗失精”分为两类：因风邪引起的梦遗，属于虚证兼夹风邪，所以张仲景在桂枝汤中加入龙骨、牡蛎来治疗，桂枝汤是治疗中风（外感风邪）的方剂；没有做梦但直接失精的，属于虚证兼夹寒邪，所以用天雄散治疗，天雄是祛除寒邪、壮阳的药物。如何证明天雄散治疗失精呢？《诸病源候论》引用了一段经文：“经常失精的人，小腹部拘急紧绷，阴部寒冷，眼眶疼痛，头发脱落”，将其归入失精的病候中，而《外台秘要》直接将范汪的天雄散归类于此。范汪的方子比张仲景的方子仅少一味龙骨，且注释中引用张文仲的方子有龙骨，与张仲景的方子完全一致。这就是天雄散治疗失精的证据。古代的失精，相当于近代的滑精。《太平惠民和剂局方》的金锁正元丹，大概是取法于此方。
大凡探究义理必须先顾全名称。张仲景的书名为《伤寒论》，那么方剂的义理自然关联于治疗寒邪。寒邪从体表侵入体内，里气不能支撑，病情急剧变化，势必将直捣脏腑。此时无暇顾及表证，先给予建立里气的方法，所以只用参、术、甘、姜四味药，而对头痛、发热、身痛等症状不予理会，这也是为了充实里气，原本并不妨碍解表。等到里气安定后，再解表，以截断病邪来源，所以方论中有“呕吐腹泻停止但身体疼痛不止时，应当斟酌和解其表，宜用桂枝汤”的论述。理中汤专门为此而设，体内并没有伏热、痰饮或食积，所以没有壅塞横决的顾虑，否则就会因此导致病变。病情较缓的还有桂枝人参汤（即理中汤加桂枝），治法与先服理中汤后服桂枝汤相同，都是表邪乘虚入里，但分治与合治仍有区别，何况对于里实证的患者，难道可以没有区别吗？至于四逆汤也是为表邪乘虚入里而设，只要见到四肢厥冷，说明邪气已经传入三阴经，比理中汤证的病情更重，为什么反而不用人参、白术呢？这是因为寒邪已经进入三阴经，里气表现为实，与理中汤证中寒邪即将进入三阴经、里气仍然虚弱相比，两者仅在虚实之间有一线之差。正如妇女临产时可以服用补剂助力，但产后则有瘀血血肉，不能再进补的道理一样，懂得这个原理才可以谈论虚实的问题。况且既有呕吐腹泻又有四肢厥逆，属于表里同病，所以既用干姜温里，又用生附子透达表邪，这与真武汤、附子汤中使用熟附子益气的作用截然不同。然而桂枝发散三阳经之邪，生附子发散三阴经之邪，这是经典中的定例，不能仅仅用“性热”两个字来概括。一个寒邪的传变，区别如此之大，那么凡是不仅仅是一个寒邪，且本质是先有里实的病症，就可以由此推知了。使用这两个方剂时，只需将自己诊断的症状，仔细与张仲景论述中的义理法则相互参照，符合的就使用，不符合的就不使用，不要固执于成见。
The Tianxiong San (Aconitum Kochii Root Powder) in the *Jingui Yaolue* (*Essential Prescriptions of the Golden Cabinet*) is presented with a formula but without theoretical explanation. Modern scholars have failed to understand its meaning; some suspect it was appended by later authors and have proposed its deletion. I believe this is the ancestral formula for treating seminal emission due to Yang deficiency, and it should not be deleted. In ancient times, "seminal emission" (Shijing, loss of essence) and "nocturnal seminal emission" (Meng Shijing, emission during dreams) were distinguished into two categories: Nocturnal emission caused by wind pathogenic factors belongs to a deficiency syndrome complicated by wind. Therefore, Zhang Zhongjing treated it by adding Longgu (Fossilized Bones) and Moli (Oyster Shell) to Guizhi Tang (Cinnamon Twig Decoction), which is a formula for treating Wind Strike (Zhongfeng, exogenous wind invasion). Emission without dreaming belongs to a deficiency syndrome complicated by cold. Therefore, Tianxiong San was used to treat it; Tianxiong (Koch's Aconite Root) is an herb that dispels cold and strengthens Yang. How do we verify that Tianxiong San treats seminal emission? The *Zhubing Yuanhou Lun* (*General Treatise on the Causes and Symptoms of All Diseases*) quotes a passage from the classics: "Individuals prone to seminal emission suffer from tightness and urgency in the lower abdomen, coldness at the glans penis, pain in the eye sockets, and hair loss," categorizing it under the symptoms of seminal emission. Furthermore, the *Waitai Miyao* (*Secret Essentials of the Outer Palace*) directly classifies Fan Wang's Tianxiong San under this category. Fan Wang's formula differs from Zhang Zhongjing's only by the absence of one ingredient, Longgu (Fossilized Bones); however, the annotation cites Zhang Wenzhong's formula which includes Longgu, making it identical to Zhang Zhongjing's prescription. This confirms that Tianxiong San treats seminal emission. Ancient "seminal emission" corresponds to modern "slippery ejaculation" (Huajing). The Jin Suo Zheng Yuan Dan (Golden Lock Correcting Origin Pill) from the *Ju Fang* (*Formulas of the Bureau*) is likely derived from this formula.
Generally, when exploring the rationale of a treatment, one must first consider the name. Since Zhang Zhongjing titled his book *Shanghan Lun* (*Treatise on Cold Damage*), the rationale of the formulas naturally relates to the treatment of Cold pathogens. When Cold pathogens invade the interior from the exterior, and the interior Qi fails to support itself, the condition becomes chaotic and severe, threatening to strike directly at the organs. At this moment, there is no time to attend to the exterior syndrome; instead, one must first strengthen the interior. Thus, only four herbs are used: Renshen (Ginseng Root), Baizhu (Atractylodes Macrocephala Rhizome), Gancao (Licorice Root), and Jiang (Ginger). Symptoms such as headache, fever, and body ache are ignored, not because they are irrelevant, but to solidify the interior, which originally does not hinder the resolution of the exterior. Once the interior is stabilized, the exterior can then be resolved to cut off the source of the pathogen. Hence, the text states: "If vomiting and diarrhea cease but body pain persists, one should carefully harmonize the exterior, preferably using Guizhi Tang (Cinnamon Twig Decoction)." Lizhong Tang (Regulate the Middle Decoction) is specifically designed for this purpose. There is no hidden heat, phlegm, or food stagnation inside, so there is no concern about obstruction or violent rebellion; otherwise, complications might arise. For milder cases, Guizhi Renshen Tang (Cinnamon Twig and Ginseng Decoction, i.e., Lizhong Tang plus Guizhi/Cinnamon Twig) is used. Its method is similar to taking Lizhong Tang followed by Guizhi Tang separately; both address exterior pathogens invading the interior due to deficiency, yet separate treatment and combined treatment still have distinctions. How much more so for patients with interior excess syndromes? As for Sini Tang (Frigid Extremities Decoction), it is also designed for exterior pathogens invading the interior. However, once Jue (cold extremities) is observed, it indicates the pathogen has entered the Three Yin meridians, making the condition more severe than in Lizhong Tang syndrome. Why, then, are Renshen (Ginseng Root) and Baizhu (Atractylodes Macrocephala Rhizome) not used? This is because once the Cold pathogen enters the Three Yin meridians, the interior presents as Excess (Shi), whereas in Lizhong Tang syndrome, where the Cold pathogen is about to enter the Three Yin meridians, the interior is still Deficient (Xu). The difference between the two lies merely in a thin line between Excess and Deficiency. It is like a woman who can take tonics to assist during labor, but after delivery, due to blood stasis and fleshy remnants, she cannot continue tonifying. Understanding this allows one to discuss the concepts of Deficiency and Excess. Moreover, since vomiting and diarrhea accompanied by cold extremities indicate simultaneous exterior and interior disease, Ganjiang (Dried Ginger) is used to warm the interior, while Sheng Fuzi (Raw Aconite Lateral Root) is used to vent the exterior. This is distinctly different from the use of Shu Fuzi (Processed Aconite Lateral Root) to boost Qi in Zhenwu Tang (True Warrior Decoction) and Fuzi Tang (Aconite Decoction). Therefore, Guizhi (Cinnamon Twig) vents the Three Yang meridians, and Sheng Fuzi (Raw Aconite Lateral Root) vents the Three Yin meridians; this is a fixed principle in the classics, and cannot be dismissed simply with the phrase "hot nature." The transmission and transformation of a single Cold pathogen differ so significantly that for conditions involving more than just Cold, especially those with pre-existing interior excess, the principles can be deduced accordingly. When using these two formulas, one should carefully compare one's own diagnosed symptoms with the principles and rules discussed by Zhang Zhongjing. If they match, use the formula; if not, do not. Do not adhere rigidly to preconceived notions.