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After intercourse, conception occurs, and the fetus develops into one male and one female. What is the reason? Is it the principle that conception on odd days yields a male, and on even days yields a female? Yu Zimu also said: Weak Yang cannot penetrate Yin, and weak Yin cannot hold Yang. Believing this statement, in the world there are emaciated husbands and frail wives who conceive repeatedly, while those with robust blood and Qi and abundant vitality often remain infertile throughout their lives. Why is this? Zhu Danxi’s discussion focuses on the woman’s menstruation. However, in wealthy families with many concubines, surely not all have regular menstruation? Furthermore, some women who frequently bore children for a previous husband fail to conceive after marrying a new husband seeking fertility. How can they conceive with one but not the other? Generally speaking, parents giving birth to children is like Heaven and Earth generating all things. The *I Ching* (Book of Changes) states: "The way of Kun (Earth) is its submission, receiving from Heaven and acting according to time." Knowing that Earth generates all things by submitting to Heaven, we know that a mother giving birth to a child is merely submitting to the father. Understanding that the mother submits to the father, then when seeking offspring, the focus should be primarily on the man. How can blame be placed solely on the woman! For men, regardless of age, strength, health, or illness, whether semen is easily or difficult to ejaculate, the best condition is that during intercourse, the Qi and Blood of all meridians arrive simultaneously. Regarding the distinction between male and female fetuses, do not拘泥 (be constrained by) the order of sperm and egg arrival, the number of days after menstruation ends, the time of intercourse relative to midnight, or the strength of the parents. Only distinguish based on which—sperm or egg—arrives via the simultaneous flow of all meridians with greater force. If the simultaneous arrival of sperm's Qi and Blood surpasses that of the egg, a male is formed; if the egg's surpasses the sperm's, a female is formed. "Simultaneous arrival of all meridians" means reaching the peak of smooth and unimpeded flow, without any strain. (This section explains that fetal sex is determined by the simultaneous arrival of Qi and Blood in all meridians.)

Li Shizhen said: The *I Ching* says, "One Yin and one Yang is called the Dao. When male and female intertwine their essence, all things are transformed. The Dao of Qian (Heaven) forms the male, and the Dao of Kun (Earth) forms the female." This speaks of the generative mechanism of males and females and the virtuous power of Yin-Yang creation. Chu Cheng said: If blood arrives first and envelops the essence, a male is born; if essence arrives first and envelops the blood, a female is born. If Yin and Yang arrive equally, the body is neither male nor female; if essence and blood scatter separately, it indicates twins or multiple births. The *Daozang* (Daoist Canon) states: Conception one, three, or five days after menstruation ends results in a male; two, four, or six days results in a female. Li Dongyuan said: One or two days after the sea of blood (uterus) is clean results in a male; three, four, or five days results in a female. The *Shengji Jing* (Holy Relief Classic) states: If Qi moves to the left, Yang nourishes it to form a male; if Qi moves to the right, Yin nourishes it to form a female. Zhu Danxi criticized Chu Cheng and endorsed Li Dongyuan, basing his theory on the left-right explanation of the *Shengji Jing*. I believe Chu Cheng should not be criticized, nor is Li Dongyuan entirely correct. Chu Cheng spoke from the perspective of the sequence of essence and blood; the *Daozang* from the parity of days; Li Dongyuan from the waxing and waning of female blood; and the *Shengji Jing* and Zhu Danxi from the left and right of the uterus. Integrating these perspectives reveals the underlying logic.

Zhu Danxi asked: What causes twins? The answer is: Excess essence and Qi divide and separate, and blood follows to nourish them. If a male and female are conceived together (fraternal twins), under Yang times on Yang days and Yin times on Yin days, the sensation mixes Yin and Yang, belonging neither to the left nor the right, receiving Qi between the two divisions. There are also triplets and quadruplets, following the same principle. The *Renjing Jing* (Mirror of Humanity Classic) states: Abundant essence and Qi produce two males; abundant blood and Qi produce two females; abundant essence and blood produce one male and one female; mixed essence and blood produce a hermaphrodite. A male cannot be a father due to deficiency in the Yang path; a female cannot be a mother due to obstruction in the Yin path. Neither possesses pure Qi. If influenced by evil spirits or ghosts, abnormal forms may result.

Zhang Jingyue commented: The *Neijing* (Inner Canon) states: "Yang provides the upright Qi, Yin acts as the master." This means Yang imparts upright Qi, allowing all things to grow, while Yin presides, establishing various forms. Observing the *I Ching*, the way of Kun submits to Heaven and acts according to time. Thus, Earth generates things by submitting to Heaven, and mothers bear children by submitting to fathers. Therefore, the key to conception lies with the man, not solely the woman. This is indeed the great principle of Heaven creating and Earth completing, and the ultimate truth of Yang imparting and Yin growing. It is often observed that men with surging six pulses and strong chi pulses tend to have more sons than daughters, while those with deep, fine six pulses and weak chi pulses tend to have more daughters than sons, and even sons may die young. This is verified. Moreover, when two spirits interact, they combine to form shape. Spirit refers to the formless. Because it is formless, it can generate the有形 (form). The principle of creation arises from the formless. Is it merely about days and physical essence? No. Spirit is the root of life. But why must it rely on essence and Qi? Spirit has no body, taking Qi as its body; Essence has no fixed shape, taking form through Qi. These three constitute matter, yet share one root. Although Spirit is the master, nourishing essence and Qi allows Spirit to attach to matter; Essence can condense Spirit. They use each other mutually and cannot be separated. As Pingshu said, one must seek the beginning of life and reception of Qi. The essence of water becomes Will (Zhi), and the essence of fire becomes Spirit (Shen). Fire does not move unless stirred. This trace amount of formless True Fire of Yuan Yang stirs the formless, silent True Spirit. The *Neijing* says: "Rooted within, it is called Shen Ji (Spirit Mechanism)." Spirit is the master of initiation and movement, occurring spontaneously without human knowledge. If it can be described in words, it is not the function of Spirit. Consider illicit unions: unconsciously conceiving, acting by chance, pregnancy is easily achieved because the mind is focused, spirit is sincere, desire-fire is intense, and the misty Qi is dense. In contrast, those living peacefully and intending to conceive with great care often fail because their mind dissipates, spirit wanders, desire-fire declines, and the misty Qi becomes thin. Thus, everything depends on Spirit, everything depends on Fire, and most importantly, on the function of Yang. Having received the Dao of Heaven and Earth, one cannot escape the principles of Yin and Yang. Therefore, excess Yang leads to more sons, and excess Yin leads to more daughters, consistent with the meaning of Qian forming males and Kun forming females. Ancient records show that birth conditions are often caused by external factors. Emotional responses are also functions of Spirit. Spirit, however, is nothing but the essence of Fire. Without Fire to fill Spirit, there is no Qi to generate Essence. If these three are lost, one becomes a lump of dead ash, devoid of the way of Yang harmony and nurturing, or the utility of emotional interaction. Ancients said conception begins at three months, with no fixed pattern. Qi classes subtly sense and transform secretly. This is part of Heaven and Earth's creative work; how can it be rigidly defined? Sages stated: "Yang generates, Yin grows." And "Yang generates, Yin transforms." Do "grow" and "transform" imply intent?

Pregnancy at one month is called "Shi Gao" (Beginning Paste); at two months, "Shi Pei" (Beginning Embryo); at three months, "Shi Tai" (Beginning Fetus). At the start of embryo and paste formation, True Qi meets, resembling condensed peach blossoms, soft and fragile, easily injured. Diet must avoid spicy foods to prevent scattering the condensation; flavors should be slightly sweet to support fragility. Once the two Qi condense, like clay on a potter's wheel or metal in a furnace, only the shaping process matters. The fetus receives Qi from the mother's food to nourish its form, and flavor to nourish its essence. Form and essence are nurtured by Qi and Flavor, which are fundamental. Heaven's Five Qi and Earth's Five Flavors are consumed by the mother and then the fetus, externally filling the form and substance, internally nourishing fetal Qi. If the mother is cold, the fetus is cold; if hot, the fetus is hot; if full, the fetus is full; if hungry, the fetus is hungry. Due to deficiency, pathogens enter, and changes follow. Wealthy families indulge their appetites, rage, and lust, accumulating fire from diet and seven emotions internally. Fetal Qi suffers; the weak become ill immediately, while the strong may not show symptoms immediately but suffer later from smallpox, measles, sores, or convulsions. Thus, prenatal care requires caution!

Chao Yuanfang said: In the first month of pregnancy, a grain condenses like a dewdrop, representing Taiji moving to generate Yang, named Embryo. "Heaven generates Water," called Pei, nourished by the Foot Jueyin Meridian. Menstruation stops, and diet changes slightly. In the second month, it is called Shi Gao, turning red like peach petals, representing Taiji stillness generating Yin. "Earth generates Fire," called Gao, nourished by the Foot Shaoyang Meridian. Nausea and vomiting occur, or specific cravings appear, indicating deficiency in one Zang organ. In the third month, it is called Shi Tai, nourished by the Hand Jueyin Pericardium Meridian. The image begins to transform, distinguishing male and female, following the Taiji principle of Qian forming males and Kun forming females. In the fourth month, it receives Water Essence to form blood vessels; the image is complete, six Fu organs form, nourished by the Hand Shaoyang Sanjiao Meridian. In the fifth month, it receives Fire Essence to form Yin and Yang Qi; bones and sinews are formed, hair begins to grow, nourished by the Foot Taiyin Spleen Meridian. In the sixth month, it receives Metal Essence to form sinews; mouth and eyes form, nourished by the Foot Yangming Stomach Meridian. In the seventh month, it receives Wood Essence to form bones; the Hun (Ethereal Soul) roams, the left hand moves, nourished by the Hand Taiyin Lung Meridian. In the eighth month, it receives Earth Essence to form skin; the body grows, nine orifices form, the Po (Corporeal Soul) roams, the right hand moves, nourished by the Hand Yangming Large Intestine Meridian. In the ninth month, it receives Stone Essence to form hair and fur; all joints are complete, the body turns three times, nourished by the Foot Shaoyin Kidney Meridian. In the tenth month, the Foot Taiyang Bladder Meridian nourishes it; spirit and essence are sufficient, receiving Qi to be born. The Monarch (Heart) acts non-actionally, thus providing no specific nourishment. However, miscarriage prevention is crucial in months 1, 3, 5, and 7, as single months involve Zang organs nourishing the fetus, and the third month is governed by Ministerial Fire, making the fetus most prone to movement. Caution is needed, and cooling-blood, calming-fetus herbs should be taken. Since various meridians have varying amounts of Qi and Blood, regulation should follow the monthly nourishing Zang organs' Qi and Blood deficiency or excess to avoid miscarriage.

Some discuss fetal nourishment using the Five Elements and Four Seasons. From conception in the uterine gate, the twelve meridians of hands and feet circulate Qi and Blood to nurture the fetal origin. How can there be a theory that specific meridians nourish specific months? Ma Xuantai refuted this, so it is not detailed here. Chao Yuanfang's discussion of months one and two regarding conception timing is closer to reason.

The *Shengji Zonglu* states: Some argue against treating pregnancy due to fears of damaging the fetus or breaking blood. They do not realize that if pathogenic Qi is violent and healthy Qi is weak, sticking rigidly to formulas without flexibility and refusing medication will weaken the mother, endangering the child. Ancient sages said: "For a pregnant woman with toxicity, if there is pathology, there is no harm; reduce it by more than half and stop." Medicines are meant to treat disease. If used moderately and appropriately, stopping halfway, why doubt treatment? Caution is only against harsh purgatives or blood-breaking drugs that might harm the fetus.

There are two methods for calming the fetus: If the mother's illness disturbs the fetus, treating the mother calms the fetus. If fetal instability causes maternal illness, calming the fetus heals the mother.

For young women, before Tian Gui (menstruation) arrives, the condition belongs to Shaoyin; after it arrives, it belongs to Jueyin; after it ceases, it belongs to Taiyin. Treating obstetric diseases via Jueyin addresses the source of ancestral Qi generation. Treatment methods must not violate Stomach Qi, the source of postnatal transformation. Also, the upper, middle, and lower prohibitions: no sweating, no purging, no promoting urination, to prevent loss of fluids and damage to vital Qi.

The interaction of Yin and Yang Qi condenses to form shape. Robust Qi and Blood lead to easy conception without disease; weak Qi and Blood lead to frequent illness and difficulty nurturing. The fetus receives Qi from the mother to nourish essence, and flavor to nourish form. Thus, fetal origin relies on Spleen and Stomach digestion. Modern people consume rich foods, feel depressed and angry, leading to declining Qi and Blood, blazing Phlegm-Fire, causing nausea, eclampsia, edema, etc. Prenatal symptoms should prioritize calming the fetus, ensuring harmonious Qi and Blood to prevent disease. If Qi is excessive and hot, consuming Qi and Blood makes the fetus unstable; clear heat and nourish blood. With proper lifestyle and diet, avoiding desires, even other syndromes cause little harm. Zhu Danxi said: Atractylodes macrocephala (Baizhu) and Scutellaria baicalensis (Huangqin) are holy medicines for calming the fetus. Common doctors think warm agents nourish the fetus, not knowing that clearing heat is best prenatally to keep blood in the meridians. Baizhu benefits the Spleen to nurture the mother of all things; Huangqin clears fire to nourish the Yin of the uterus. Removing harm ensures fetal stability, so Huangqin works on the upper and middle jiao. Motherwort (Yimucao) regulates blood and Qi, having Yin-nourishing properties, preventing stagnation prenatally and deficiency postnatally. For sudden abdominal pain at 3-4 months, Amomum villosum (Sharen) and slight Costus root (Muxiang) calm the fetus by moving Qi. At 8-9 months, regulate Qi using Aurantium fructus (Zhike) and Perilla folium (Zisu). For Qi deficiency, tonify Qi to move stagnation using Ginseng (Renshen), Baizhu, Citrus reticulata (Chenpi), Angelica sinensis (Danggui), Paeonia lactiflora (Baishao), Licorice (Gancao), and Tugela bark (Fupi); for Qi excess, deplete Qi to suppress Yang using Huangqin, Baizhu, Chenpi, Gancao, and Zhike. Near term, for fetal heat, use Sanbu Wan plus Fragrant Soup Baishao or Rehmannia paste. For blood deficiency, use Siwu Tang with Shudi and Yimucao to prepare for delivery. Worldly doctors often use Mugwort (Aiye), Aconite (Fuzi), and Sharen, which are harmful. Clear and harmonious Qi and Blood without fire ensure fetal stability. Qi deficiency fails to hold; blood heat causes leakage. How can the fetus not miscarry? Cyperus rotundus (Xiangfu) opens depression but damages upright Qi if overused. Sharen moves Spleen Qi but consumes True Qi if overused. Aromatic-dry agents injure both Qi and Blood, harming rather than calming the fetus. Only suitable for Cold stagnation.

Zhao Yangkui asked: Are Baizhu and Huangqin indispensable for calming the fetus? Not necessarily. The fetal stem connects to the Kidneys like a bell hangs from a beam. If pillars are unstable, beams bend. Thus, calming the fetus first secures the Kidneys, warming them so the Spleen gains vitality. Why insist on Baizhu and Huangqin? Heat in the abdomen requires cooling; cold requires warming. The Kidneys contain the source of Water and Fire, roots of Chong and Ren meridians, crucial for the fetus, beyond Baizhu and Huangqin. Kidney Yin deficiency uses Liuwei Dihuang Wan; Yang deficiency uses Bajia Dihuang Wan. Regulating menstruation uses Eucommia (Duzhong), Dipsacus (Xuduan), Donkey-hide gelatin (Ejiao), Mugwort (Aiyè), Danggui, Schisandra (Wuweizi), modified within Liuwei or Bajia decoctions. Zhao's innovation highlights that organ constitution varies. Some with cold organs conceive only after taking Bajia or Shibu pills; continue post-conception as organs adapt, avoiding perceived heat from Cinnamon and Aconite, safely nurturing the fetus. Stopping warm agents and adding Huangqin to clear heat may cause miscarriage, as tonifying Yang lifting opposes Yin descending. Extremely deficient people have less rising Qi in spring/summer and more descending Qi in autumn/winter. Zhang Jingyue treated persistent nausea with cold limbs and faint pulse using Fuzi Lizhong Tang plus Wuweizi, heavily dosed with Renshen, Baizhu, and roasted Gancao to support the fetus. Ginger and Aconite warmth supports the Middle Jiao via these tonics, preventing Aconite's downward drift from acting alone.

Ancients used Huangqin for fetal heat causing restlessness. If Qi and Blood are robust and Spleen-Stomach harmonious, the fetus is safe. Deviation leads to miscarriage. The fetus relies on Qi and Blood for nourishment, which derive from grain Qi. The Spleen is the hub of internal and external Qi, essential for fetal respiration and transformation. Thus, Baizhu aids the Spleen. Suitable for thin individuals with blood heat and rapid Ying circulation causing fetal pressure and restlessness. For obese individuals with Qi deficiency and fetal dropping, Renshen lifts. For blood deficiency with fire and abdominal stagnation, Sharen and Muxiang move Qi. For blood deficiency with fire and acute pain, Danggui and Baishao nourish. For obesity with phlegm, vomiting, and dizziness, Pinellia (Banxia) and Poria (Fuling) resolve phlegm. Guizhi Tang, Xiangsu San, Congbai Xiangchi Tang are appropriate. For latent pathogens, urgent purging is needed. This is the key to calming the fetus. Mangxiao (Mirabilite) must never be used. Using Baizhu with exterior pathogens traps heat; using Huangqin in chronic cold damages Middle Qi, both harming the fetus.

Earth is heavy, but Heaven's Qi covers it, sustaining life. In cold, dark regions, growth is rare. Obese individuals have abundant blood but prone Qi deficiency. Qi and Blood must balance. Qi dominance drives blood flow; blood dominance hinders Qi flow, appearing as Qi deficiency. Thus, flesh-tonifying drugs are contraindicated; Qi-depleting drugs may help, as Qi needs assistance to move. Over time, blood returns to control. Princess Huyang was obese and had difficult labor; Daoist Nan Shan prescribed a slimming formula for smooth delivery. In an obese body, the fetus fills space, leaving no gap. Drugs that harm the fetus only deplete external Qi, not internal True Qi. This is the subtlety of medication. Prenatal care should regulate Qi; smooth Qi prevents stagnation. Zhike San and Shutai Yin are for Qi-excess, obese, sedentary, depressed types. For Qi deficiency, Yuanqi insufficiency, false distension, or cold pain, Renshen and Baizhu tonification is necessary. Can we say prenatal care always requires Qi-depleting drugs?

Pregnancy requires suppressing Yang and assisting Yin. Prenatal drugs should not be mixed杂乱. Lack of specificity causes Yin-Yang confusion and other diseases. Nan Shan Daoist's Zhike San suppresses Yang; Siwu Tang assists Yin. Zhike San alone is too cold, risking fetal cold pain. Combine with Neibu Wan to balance Yin and Yang, ensuring safety. Normally, women have slight Yang excess without disease, allowing amenorrhea to nourish the fetus. Excessive Yang attacks Yin, causing irregular bleeding and fetal instability. Hence, suppressing Yang and assisting Yin is crucial.

Zhu Danxi said: Difficult labor often occurs in depressed, sedentary, wealthy individuals. Poor, hardworking women rarely experience this. Medical texts only list Shutai Yin, designed for Princess Huyang, who had excessive nourishment and excess Qi. Depleting Qi brought harmony, easing birth. This is the Daoist's Zhike San suppressing Yang and lowering Qi, supplemented by Wen Juju with Muxiang and Danggui. Obese individuals have Qi deficiency and stagnation from sitting, weakening Qi further. The fetus in the womb...