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[Background Information]
Book: *Medical Outline* (Yixue Gangmu)
Author: Lou Ying
Dynasty: Ming
Chapter: Conception (Shoutai)
Category: Medical Theory

Zhu Danxi believed that the sex of the fetus is determined by the sequence in which paternal essence and maternal blood combine; this is Chu Cheng's theory, but I find it puzzling. Later, I read Li Dongyuan's works, which state: One or two days after menstruation ceases, the Blood Sea has just cleared; at this time, sperm prevails over blood, and conception results in a male fetus; four to five days later, blood vessels are vigorous, sperm cannot prevail over blood, and conception results in a female fetus. This argument is also not sufficiently clear. Why do I say so? The *I Ching* (Book of Changes) says: "The Way of Qian (Heaven) forms the male, and the Way of Kun (Earth) forms the female." Qian and Kun represent the nature of Yin and Yang. Left and right represent the pathways of Yin and Yang. Male and female represent the manifestations of Yin and Yang. Paternal essence and maternal blood combine through mutual influence. The emission of essence is the bestowal of Yang; the ability of blood to retain it is the transformation of Yin. Essence forms the bones, marking the beginning of all things from Qianyuan (Heaven/Yang); blood forms the uterus, marking the generation of all things from Kunyuan (Earth/Yin). When Yin and Yang intersect, pregnancy condenses. The place where the fetus resides is called the uterus, with one ligament below and two branches above, one leading to the left and one to the right. If sperm prevails over blood, and conception occurs on a Yang day/hour, Yang becomes dominant, the qi receives nourishment in the left uterus, and the male form is established. If sperm does not prevail over blood, and conception occurs on a Yin day/hour, Yin becomes dominant, the qi receives nourishment in the right uterus, and the female form is established. Someone asks: I understand the distinction between males and females, but what about twins? The answer is: This is because there is an excess of essence, which divides into two parts, and the blood consequently divides to retain them. As for cases where both male and female fetuses are conceived simultaneously (heterozygous twins), this happens when conception occurs during both Yang days/hours and Yin days/hours, causing Yin and Yang to mix. It belongs neither to the left nor the right, but receives qi in the space between the two branches. There are also triplets, quadruplets, quintuplets, and sextuplets, following the same principle. Someone asks: What about men who cannot be fathers, women who cannot be mothers, and individuals with ambiguous genitalia? How should these be distinguished? I say: Men who cannot be fathers have received deficient Yang Qi; women who cannot be mothers have received obstructed Yin Qi; those with ambiguous features are affected by mixed/adverse Qi, resulting in various forms. Regarding females with male characteristics, there are two types: one type can act as a wife to a man and a husband to a woman; the other type can only act as a wife but not a husband. Another type has a female lower body but a complete male upper body, representing a severe case of mixed Qi. Someone asks: Does this mixed Qi affect only the yin organs, yet result in such diverse physical forms? I say: The Yin body is deficient, making it susceptible to mixed Qi. Once affected, Yin and Yang mix without a dominant force, belonging neither to the left nor the right, receiving qi between the two branches. The resulting form depends on the severity of the mixed Qi, hence the variations in combined features.

The above discussion by Zhu Danxi is extremely subtle and elucidates points previously unexplored by predecessors. Thus, we know that the distinction between males and females was determined at the moment of creation from Qianyuan and the intersection of Yin and Yang. Ignorant people fail to comprehend this principle and foolishly attempt methods to change a female fetus into a male, which is delusional. All things originate from Qianyuan; why should the distinction between males and females be any different?

During pregnancy, one should clear heat and nourish blood. For prenatal fetal stabilization, Baizhu (Atractylodis Macrocephalae Rhizoma) and Huangqin (Scutellariae Radix) are excellent herbs. Near the end of pregnancy, use Sanbu Wan (Three Tonics Pill) added with fried Xiangfu (Cyperi Rhizoma) and fried Baishao (Paeoniae Radix Alba), formed into pills with steamed dough and taken orally. To suppress heat, use Sanbu Wan combined with Shengdi Huang paste pills (made from powders of Huangqin, Huanglian, and Huangbai bound with Rehmanniae Radix paste). In the eighth or ninth month of pregnancy, one must regulate Qi using Zhike (Aurantii Fructus) and Sujing (Perillae Caulis). By the eighth or ninth month, if palpitations and asthma arise due to Fire moving upward, Tiao Qin (Huangqin) and Xiangfu powder can be taken with water.

Haizang states that Shenfang Yantai San (Divine Formula for Testing Pregnancy Powder) is suitable for women aged two to three months of pregnancy whose menstruation has stopped. They suspect pregnancy but doubt blood stasis, experiencing irritability, alternating chills and fever, and mental confusion. This medicine can verify pregnancy upon internal administration. If external signs suggest pregnancy but the pulse lacks pathogenic indicators, applying the pulse diagnosis method from the *Suwen* (Basic Questions) yields correct results eight or nine times out of ten.
Zhen Que Nao Xiong (Ligusticum Chionantifolium Rhizome - Sparrow Brain Angelica, 1 liang)
Danggui (Angelicae Sinensis Radix, whole root used. If weighing 1 liang, use only 7 qian)
Grind the above two ingredients into fine powder, divide into two doses, and take with a cup of strong decoction of good Ai Ye (Artemisiae Argyi Folium) or mixed with good wine. After two to three shichen (4-6 hours), if slight movement is felt around the umbilicus accompanied by lingering irritability, pregnancy is confirmed. After the movement ceases, symptoms resolve, ensuring safety. If not pregnant, there will be no movement, and retained harmful substances will pass naturally, keeping the mother safe. If no effect is felt after taking the medicine, take again with Honghua (Carthami Flos) decoction, which will yield miraculous effects.

*Lingyuan* records a method to test for pregnancy in women whose menstruation has ceased for three months. Take Zhen Chuanxiong (Ligusticum Chuanxiong Rhizoma), grind into fine powder, and take one bi (a small spoonful) with strong Ai Ye decoction. Gradual movement inside the abdomen indicates pregnancy. This tests for the presence of a fetus.
Gancao (Licorice Root, 1 cun, roasted)
Zaojiao (Gleditsiae Sinensis Spina, 1 cun, peeled)
Huanglian (Coptidis Rhizoma, a little)
Grind into powder, take with wine. Vomiting indicates pregnancy; no vomiting indicates none. Each dose is 1.5 qian.

*Mai Jing* (Pulse Classic) states: If a woman is seven months pregnant and unaware, frequently suffering from epistaxis and muscle spasms, this is pregnancy; if she sneezes and feels vibration during epistaxis, it is not pregnancy.

*Suwen* states: If the Foot Shaoyin pulse beats strongly, the woman is pregnant. (*Pingren Qixiang Lun* refers to Taixi pulse; Quan Yuanqi wrote Foot Shaoyin, Wang Bing wrote Hand Shaoyin, but Foot Shaoyin is correct. Wang Bing notes: An active pulse moves like a bean; another interpretation is that 'strong beating' means excessive movement.) "Yin beats distinctly separate from Yang" is called having a child. (*Yinyang Bie Lun*: Wang Bing notes: Yin refers to the Chi position; Bo means pulsating against the fingers. If the Chi pulse differs significantly from the Cun pulse, it is a sign of pregnancy.)

*Mai Jing* states: At the beginning of pregnancy, the Cun pulse is minute and small, with five breaths per pulse beat; at three months, the Chi pulse is rapid. A slippery and rapid pulse that scatters under heavy pressure indicates three months of pregnancy; a pulse that does not scatter under heavy pressure but is rapid without slipperiness indicates five months of pregnancy. (This embodies the meaning of "Yin beats distinctly separate from Yang," meaning the Chi pulse is slippery and rapid while the Cun pulse is minute, distinguishing the pregnancy pulse.) If the Chi pulse is larger on the left, it is a boy; larger on the right, a girl; large on both sides, twins. "Large" implies a fullness similar to reality. (Also reflects "Yin beats distinctly separate from Yang," meaning the Chi pulse is substantial and distinct from the Cun pulse, distinguishing gender by left/right.) For a woman four months pregnant wishing to know the sex: rapid pulse on the left indicates a boy; on the right, a girl; rapid on both, twins. (Wang Ziheng says: If all three positions are slippery and rapid, left indicates boy, right indicates girl.) Have the pregnant woman walk facing south, then call her back. Turning her head to the left indicates a boy; to the right, a girl. When she is urinating, have her husband call her urgently from behind. Turning left indicates a boy; turning right, a girl.

Based on Zhu Danxi's statement that male fetuses conceive in the left uterus and female fetuses in the right uterus, this aligns perfectly with the above theory. Presumably, if the male fetus is on the left, the left side becomes heavier, so when turning, she instinctively protects the heavy side toward the left; if the female fetus is on the right, the right side becomes heavier, so she turns toward the right. Applying this to pulse diagnosis: if the fetus is on the left, Qi and Blood protect the fetus and become abundant on the left, so the pulse follows suit, with left rapidity indicating a boy and left largeness indicating a boy; if the fetus is on the right, Qi and Blood become abundant on the right, so the pulse follows, with right rapidity indicating a girl and right largeness indicating a girl. This is consistent with the classic saying: "Yin beats distinctly separate from Yang, called having a child." It means the conception site is below the navel, so Qi and Blood gather below, making the Yin Chi pulse strong and distinct from the Yang Cun pulse. Similarly, if a boil erupts above, Qi and Blood rise, making the Cun pulse strong; if below, the Chi pulse strong; if left, the left pulse strong; if right, the right pulse strong. Zhu Danxi's assertion that a large pulse on the doctor's left hand corresponds to a male fetus and on the right hand to a female fetus is likely an error regarding the physician's hands versus the patient's, a mistake even by wise minds.

Zhu Danxi states: Cravings for strange foods during pregnancy indicate deficiency in one Zang organ. For example, if the Liver Zang is deficient, its Qi and Blood can only nourish the fetus but not the Liver itself. Due to Liver deficiency, the woman craves sour foods.

*Da Lun* states: Restless fetus may be caused by falling or poisoning. Severe cases lead to miscarriage. Observe the mother's facial color and tongue color. If the mother's face is red and tongue blue, the fetus dies but the mother lives; if lips and mouth are blue with foam at the corners, both die; if the face is blue and tongue red with foam in the mouth, the mother dies but the fetus lives.

*Mai Jing* states: In the eighth month of pregnancy, a pulse that is solid, large, firm, strong, wiry, and tight indicates survival; a sinking and fine pulse indicates death.

Zhu Danxi states: A fine and uniform pulse facilitates easy delivery; a large, floating, and slow pulse indicates scattered Qi and difficult delivery.

*Mai Jing* states: During pregnancy, the first month is nourished by the Foot Jueyin meridian, the second by Foot Shaoyang, the third by Hand Jueyin (Pericardium), the fourth by Hand Shaoyang, the fifth by Foot Taiyin, the sixth by Foot Yangming, the seventh by Hand Taiyin, the eighth by Hand Yangming, the ninth by Foot Shaoyin, and the tenth by Foot Taiyang. Each Yin-Yang meridian nourishes for thirty days until birth. Hand Taiyang and Hand Shaoyin do not nourish the fetus because they govern menstruation downward and lactation upward, serving the mother after birth. Pregnant women should not undergo moxibustion or acupuncture on these meridians, as it will cause miscarriage. (Chen Shi's *Daquan* explains: Foot Jueyin Liver and Foot Shaoyang Gallbladder correspond to Spring Wood, starting the twelve meridians' fetal nourishment in months one and two. Hand Jueyin Pericardium and Hand Shaoyang Sanjiao belong to Fire and prosper in Summer, nourishing in months three and four. Foot Taiyin Spleen and Foot Yangming Stomach belong to Earth and prosper in Late Summer, nourishing in months five and six. Hand Taiyin Lung, Hand Yangming Large Intestine, Foot Shaoyin Kidney, and Foot Taiyang Bladder belong to Metal and Water and prosper in Autumn/Winter, nourishing in months seven through ten.)