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The *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) states: One asks, what are blood differentiation and water differentiation in diseases? The Master replies: If menstruation ceases first, followed by the onset of edema, it is named blood differentiation; this condition is difficult to treat. If edema occurs first, followed by the cessation of menstruation, it is named water differentiation; this condition is easy to treat. Why is this? Because once the pathogenic water is eliminated, menstruation will naturally flow downward.

The *Shengji Zonglu* (Compendium of Holy Relief) states: Blood differentiation refers to a situation where, at the time of menstruation, cold-dampness injures the Chong and Ren vessels. Qi becomes stagnant and fails to circulate, causing fluid retention to spread across the skin. Pathogenic factors contend with each other, separating menstrual blood into water, resulting in edema; hence it is called blood differentiation. The *Maijing* (Pulse Classic) states: When menstruation stops first and edema follows, it is named blood differentiation. If left untreated for a long time, it accumulates into severe edema, becoming difficult to treat.

The *Shengji Zonglu* further states: Water differentiation occurs when water qi overflows onto the skin and disperses into the four limbs, causing edema. The Kidney serves as the gatekeeper of the Stomach; if this gate functions improperly, water accumulates and gathers according to its kind. This condition resembles blood differentiation, differing only in the sequence of treatment and medication.

Wang Shishan states: Whenever menstruation ceases first, followed later by edema, the Shaoyin pulse is deep and slippery. A deep pulse indicates interior syndrome, while a slippery pulse indicates excess syndrome. The combination of deep and slippery pulses signifies blood stasis obstructing the uterine gate, constituting blood differentiation, which is difficult to treat. Conversely, if edema occurs first, followed by the cessation of menstruation, the Shaoyang pulse is firm, and the Shaoyin pulse is thin. In men, there is difficulty urinating; in women, menstruation is blocked. When menstruation flows freely, it transforms into blood; when urination is obstructed, it transforms into water. This is named water differentiation and is easy to treat. This arises from deficiency-cold of the Spleen and Lung, which fail to regulate water passages and transport fluids downward to the Bladder. The mechanism of seepage and excretion fails, and the vitalizing energy does not circulate. Li Dongyuan stated that retained water-drink accumulation is like soil turning to mud in the rain; exposed to harmonious air and warm sunlight, the water and dampness dissipate, allowing all things to grow naturally. Treatments include Jiajian Shenqi Wan (Modified Kidney Qi Pill), Guipi Tang (Restore the Spleen Decoction), or Liu Junzi Tang (Six Gentlemen Decoction) augmented with Muxiang (Aucklandiae Radix), Paojiang (Prepared Ginger), and Rougui (Cinnamon Bark).

Chen Liangfu states: In women, if menstruation is blocked, water transforms into blood; if blood circulation is obstructed, it reverts to transforming into water. Therefore, if menstruation ceases first, followed by edema of the four limbs and urinary obstruction, it is named blood differentiation, representing blood transforming into water; Jiaoren Wan (Pepper Seed Pill) is appropriate. If urinary obstruction occurs first, leading to facial and bodily edema, which subsequently causes menstrual blockage, it is named water differentiation, representing water transforming into blood; Tingli Wan (Descurainia Seed Pill) is appropriate. If meridian blockage leads to transformation into water, which flows through the four limbs causing generalized swelling and fullness, it is also named blood differentiation. Although its symptoms resemble water syndromes, it is essentially not caused by water pathogens; Ren Shen Wan (Ginseng Pill) should be used.

Zhang Huang's commentary: Edema appearing first, followed by menstrual blockage, clearly indicates Spleen Qi deficiency failing to control water, and Meridian blood deficiency failing to generate blood, thus stopping menstruation. Statements such as "water transforming into blood" are truly laughable.