陈修园曰∶经云，三焦者，决渎之官，水道出焉。膀胱者，州都之官，津液藏焉，气化
则能
出矣。此数语，向来注家皆误。不知津液为汗之源，膀胱气化则能出汗，故仲景发汗取之太
阳。水道，为行水之道。三焦得职，则小水通调。须知外出为膀胱之津液，下出为三焦之水
道也。故凡淋沥等证，皆热结膀胱所致，而治者却不重在膀胱，而重在三焦。按此说本于张
隐庵，乍读似新奇可喜，而实违经背理之甚者也。夫下出为三焦之水道，是矣；外出为膀胱
之津液，则非也。三焦者，水所行之道，非水所藏之府也。汗与小便，俱由三焦经过，故汗
多则小便少者，水在三焦，即为热气蒸动，泄于膜外，达于皮肤，而不待传入膀胱也。非既
入膀胱，复外出而为汗也。气化则能出者，膀胱无下口，必借三焦之气化，有以转动之，使
之俯仰而倾出也，故曰“能”也。其曰水曰津液云者，水在三焦，气味清淡，犹是本质，发
而为汗则味咸，传为小便则气臊，是已受变于人气矣，故皆可以津液名之。非汗为膀胱之津
液，小便为三焦之水也。乃汗与小便皆三焦之水，而外出、下出者也。发汗取之太阳者，太
阳主表，以其经，非其腑也。
四时五脏阴阳揆度以为常也
尝谓∶读书须知其笔法之断续、起伏、伸缩、单复，今于此节备之矣。“饮入于胃”一
句，
当作一大断；“游溢精气”四句直下，再作一大断；“通调水道”二句，是双承肺、胃，非
单承肺也。水道本自胃，取道三焦，以下膀胱，非上入肺而后下也。然必借肺气以通调之，
故“通调”二字近承肺，“水道”二字远承胃也。水精者，水之精也，是遥承肺与水道，非
承膀胱也。肺受脾之精而布之矣，其精之吸取未尽者，复于取道三焦时，沿途抛洒也，故不
竟曰精，而仍曰水精也。五经者，五脏之经也。水精由五脏之经行于周身，是一时并行，而
无或先后者也。痹论曰∶水谷之精气，和调于五脏，洒陈于六腑，乃能入于脉也。其是之谓
乎?如是，则本节凡四断，俱有天梯石栈相钩连之妙矣。张隐庵谓∶津液出于膀胱，而以“
下输膀胱，水精四布”二句连读，是人身之精气皆臊矣。然乎否乎?
陈修园说：《内经》记载，三焦是决渎之官（负责疏通水道的器官），水道由此而出。膀胱是州都之官（汇聚津液的器官），津液在此贮藏，经过气化作用才能排出。这几句话，以往的注家都理解错了。他们不知道津液是汗液的源头，膀胱经过气化作用就能产生汗液，所以张仲景在发汗时取法于太阳经。水道，是运行水液的通道。三焦功能正常，则小便通调。需要明白的是，向外排出的称为膀胱的津液，向下排出的称为三焦的水道。因此，凡是淋沥等证候，都是热邪结聚于膀胱所致，但治疗者却不重视膀胱，而重视三焦。按照这种说法本源于张隐庵，乍读起来似乎新奇可喜，但实际上严重违背经典道理。向下排出作为三焦的水道，这是对的；向外排出作为膀胱的津液，这就错了。三焦是水运行的通道，而不是水贮藏的脏腑。汗和小便，都要经过三焦，所以出汗多则小便少，是因为水在三焦中，被热气蒸腾发动，泄于膜外，达于皮肤，而不必传入膀胱。并不是先入膀胱，再外出变成汗。所谓“气化则能出”，是因为膀胱没有下口，必须借助三焦的气化作用，来转动它，使其俯仰倾斜而排出，所以说“能”。所说的“水”、“津液”，水在三焦中，气味清淡，还是本质状态，散发出来成为汗则味道咸，传变为小便则气味臊，这已经是受到人体之气的影响而变化了，所以都可以称为津液。并不是汗为膀胱的津液，小便是三焦的水。而是汗和小便都是三焦的水，分别是向外和向下排出的。发汗取法于太阳经，是因为太阳主表，指的是太阳经，而不是太阳腑。
关于四时五脏阴阳的衡量准则，以此作为常理。我曾经认为：读书要懂得其笔法的断续、起伏、伸缩、单复，现在在这段文字中已经具备。“饮入于胃”这一句，应当看作一个大停顿；“游溢精气”四句直承而下，再作一个大停顿；“通调水道”两句，是双承肺和胃，不是单承肺。水道本来源自胃，取道三焦，下行至膀胱，不是先上入肺然后再下行。然而必须借助肺气来通调它，所以“通调”二字近承肺，“水道”二字远承胃。水精，就是水的精华，这是遥承肺和水道，不是承膀胱。肺接受了脾输送的精微物质并布散全身，其中未被完全吸取的精微，在取道三焦时，沿途洒落分布，所以不竟称为“精”，而仍称为“水精”。五经，就是五脏的经脉。水精由五脏的经脉运行于周身，是一时并行，而没有先后顺序的。《痹论》说：水谷的精气，调和于五脏，散布于六腑，然后才能进入脉中。说的就是这个意思吧？如果是这样，那么本节共有四个停顿，都有天梯石栈相互钩连的妙处。张隐庵说：津液出于膀胱，并将“下输膀胱，水精四布”两句连读，这意味着人身上的精气都变成臊味了。是这样吗？
Chen Xiuyuan stated: The Classic states, "The Sanjiao (Triple Burner) is the official of sluices, through which waterways flow. The Bladder is the official of the capital, where fluids are stored; only after Qi transformation can they be discharged." These few sentences have been misunderstood by commentators in the past. They did not realize that body fluids (Jinye, 津液) are the source of sweat, and when the Bladder undergoes Qi transformation, it can produce sweat. Therefore, Zhang Zhongjing utilized the Taiyang (Greater Yang) channel for inducing sweating. The waterway is the path for conducting water. When the Sanjiao functions properly, urination becomes smooth. It must be understood that what exits outward is the fluid of the Bladder, while what exits downward is the waterway of the Sanjiao. Thus, all conditions such as dribbling dysuria are caused by heat binding in the Bladder, yet practitioners do not focus on the Bladder but rather on the Sanjiao. This theory originates from Zhang Yinan. At first glance, it seems novel and pleasing, but in reality, it severely contradicts the Classics and reason. That which exits downward serves as the waterway of the Sanjiao—this is correct; that which exits outward serves as the fluid of the Bladder—this is incorrect. The Sanjiao is the pathway for water, not the storage organ for water. Both sweat and urine pass through the Sanjiao; therefore, when there is excessive sweating, urine decreases because the water within the Sanjiao is steamed and activated by heat, leaking outside the membranes and reaching the skin, without needing to enter the Bladder first. It does not mean water enters the Bladder and then exits outward as sweat. Regarding "Qi transformation enables discharge," this is because the Bladder lacks a lower opening; it must rely on the Qi transformation of the Sanjiao to rotate it, enabling it to tilt and pour out, hence the term "can" or "able." As for the terms "water" and "body fluids," water within the Sanjiao has a light taste and remains in its essential state. When emitted as sweat, it tastes salty; when transformed into urine, it smells pungent. In both cases, it has already been altered by human Qi, so both can be termed body fluids. It is not that sweat is the fluid of the Bladder and urine is the water of the Sanjiao. Rather, both sweat and urine are water of the Sanjiao, exiting outward and downward respectively. Inducing sweat via the Taiyang channel works because Taiyang governs the exterior, referring to the Taiyang channel, not the Taiyang Fu-organ.
Regarding the measurement of Yin-Yang among the Five Zang organs across the four seasons, this serves as the constant principle. I have often said that one must understand the writing techniques of interruption, rise and fall, extension and contraction, and singularity and multiplicity when reading texts. These are fully present in this section. The phrase "Drinking enters the Stomach" should be treated as a major pause. The four phrases following "floating and overflowing essence and Qi" continue directly, forming another major pause. The two phrases "regulating waterways" double-connect to both the Lung and the Stomach, not just the Lung alone. The waterway originally originates from the Stomach, takes the route of the Sanjiao, and descends to the Bladder; it does not go up to the Lung first and then descend. However, it must borrow the Qi of the Lung to regulate it. Therefore, the word "regulate" connects closely to the Lung, while the word "waterway" connects distantly to the Stomach. "Water essence" refers to the essence of water, connecting remotely to the Lung and the waterway, not to the Bladder. The Lung receives the essence transmitted by the Spleen and distributes it. The portion of essence not fully absorbed is scattered along the route of the Sanjiao. Hence, it is not called merely "essence," but still "water essence." The "Five Channels" refer to the meridians of the Five Zang organs. Water essence travels throughout the body via the meridians of the Five Zang organs simultaneously, without any sequence. The *Bi Lun* (Treatise on Bi Syndrome) states: "The essence of food and drink harmonizes within the Five Zang organs and spreads throughout the Six Fu-organisms, thereby entering the vessels." Does this not describe exactly this situation? If so, this section contains four pauses, each possessing the subtle connection akin to ladders and plank roads linking together. Zhang Yinan claimed that body fluids originate from the Bladder and read the phrases "transmitted downward to the Bladder" and "water essence spreads everywhere" together. This would imply that the essence and Qi of the entire human body become pungent-smelling. Is this true?