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Background Information:
Book: *Xu Mingyi Leian* (Continued Cases of Famous Physicians)
Author: Wei Zhixiu
Dynasty: Qing
Chapter: Seeking Offspring
Category: Medical Discussion

Jianping Xiaowang's concubines, ladies-in-waiting, and attendants were all beautiful but childless. He selected young, unmarried women from good families to enter the palace, yet still had no offspring. The King asked Chancellor Chu Cheng, "Is there a method to conceive a male child?" Cheng replied, "When men and women unite, their ages must be appropriate. Although a man's essence may flow freely at sixteen, he should not marry until thirty; although a woman's Tian Gui (menstruation) may arrive at fourteen, she should not marry until twenty. Only after both parties' Yin and Yang qi are fully mature and solid should they engage in intercourse. Then, conception will occur, pregnancy will proceed smoothly, and the born child will be robust and long-lived. Now, those young girls whose Tian Gui has just arrived are engaging with men prematurely. Their Yin qi leaks early, damaging them before they are fully developed, and moving them before their vitality is solid. Thus, they fail to conceive upon intercourse, or if pregnant, fail to carry to term, or if they give birth, the child is fragile and short-lived. This is why the King has no children. However, some women bear only daughters, while others bear only sons. If Your Highness could seek out women who have borne many sons and bring them into the palace through matchmakers, there would be a way to have sons." The King said, "Good." Within one year, six boys were born. The principle that Old Yang meets Young Yin, and Old Yin meets Young Yang, is also a method for procreation. (From *Chushi Yishu*.)

Zhu Danxi stated: Obese women who cannot conceive do so because phlegm-dampness (lipid membranes) obstructs the uterus, preventing menstruation. Formulas such as Daotan Tang (Phlegm-Draining Decoction) can be used. Emaciated women who cannot conceive do so because the uterus lacks blood, and essence and qi do not gather. Siwu Tang (Four Substances Decoction) and other blood-nourishing and Yin-nourishing medicines can be used. My niece had a robust constitution and strong Qi, but due to late conception, she took Shenxian Jubao Dan (Immortal Treasure Gathering Pill). She subsequently developed a carbuncle on her back, presenting with critical symptoms. I diagnosed her pulse as scattered, large, and choppy. Urgently, I administered over one hundred doses of Jiajian Siwu Tang (Modified Four Substances Decoction) to tonify her Yin and blood. Fortunately, her thick constitution allowed for easier recovery. For those with thin constitutions, regret would come too late.

Gong Zicai treated Liu Xiaoting, aged forty, who was childless, impotent, and produced semen as cold as ice. Upon consultation, his Cun (inch) pulses on both hands were flooding, while his Chi (cubit) pulses were deep, faint, and powerless. This indicated exhaustion of the True Yuan (Original Qi) due to excessive depletion. Gong prescribed Guben Jianyang Dan (Root-Firming Yang-Strengthening Pill) added with Ren Shen (Ginseng), Fu Zi (Aconite), Gouqi (Goji Berry), and Fupenzi (Raspberry), each two liang. After finishing one dose, the patient felt warmth in the lower Jiao. A second dose was prepared similarly; upon consuming half of it, pregnancy occurred, resulting in the birth of a son. Later, Liu Baiting and Liu Min'an took this prescription and also fathered children.

Wang Shishan treated a woman who was obese with a pale-purple complexion, nearly thirty years old, and struggling to conceive. Her Chi pulses on both sides were deep and faint. According to principles, blood should be tonified. Given her obesity, which indicates Qi deficiency, Qi should also be tonified. He instructed her to take Babawu Tang (Eight Substance Decoction) frequently, along with Buyin Wan (Nourish-Yin Pill) added with Ren Shen (Ginseng) [missing herb], taken on an empty stomach. After more than three months, she became pregnant. Upon re-examination, her Chi pulses remained unchanged. Rationally, pregnancy should present differently. As ancients said, "Pulses cannot be entirely relied upon," likely referring to such cases.

Xue Lizhai treated the wife of the scholar Qian Sixi, who was over thirty and childless, suffering from prolonged, irregular uterine bleeding. They had lived apart for years. Qian wished to take a secondary wife and consulted Xue. Xue reasoned that this was caused by depression and anger injuring the Liver, Spleen deficiency with fire agitation, leading to blood failing to return to its vessels—Liver failing to store blood and Spleen failing to control it. He advised clearing Liver fire and tonifying Spleen Qi, prescribing Jiawei Guipi Tang (Modified Restore the Spleen Decoction) and Xiaoyao San (Free and Easy Wanderer Powder), four doses of each. He delivered them home and informed the mother-in-law that the illness would resolve naturally and conception would follow, negating the need for a secondary wife. Indeed, the illness resolved, and a son was born the following year.

Concubines in the harem who were not jealous bore many sons. In contrast, Prince Jing of Zhongshan, who loved wine and women, had 112 sons. It is said that Quanlu Wan (Whole Deer Pill) was formulated by King Wen of Zhou, and frequent use led to numerous offspring. Did Prince Jing also frequently consume this pill? Why did he have more children than King Wen? (From *Zhangshi Liyan*.)

Feng Chuzhan treated Jin Shaolao, who suffered from persistent morning diarrhea. His Cun and Guan pulses on both hands were deep, weak, and powerless, with Chi pulses even deeper and fainter. Feng said, "Acquiring this pulse pattern in youth not only makes cure difficult but also suggests difficulty in procreation, likely resulting in more daughters than sons." Mr. Xu, who happened to visit, had the same pulse. Both reported having several daughters but no sons. Feng prescribed Bawei Wan (Eight Ingredient Pill) minus Mudanpi (Moutan Cortex) and Zexie (Alisma), adding Buguzhi (Psoralea Fruit, 3 liang), Tusizi (Cuscuta Seed, 4 liang), and Wubeizi (Schisandra Fruit, 2 liang). Taken five qian before meals morning and evening, both later fathered sons. *Jingyao* states: "Long-term use makes one fat, healthy, and fertile." Truly so.

Wu Fuxian treated Cai Xiaolian, aged fifty, who suffered from lack of heirs. After ten years of trying various seed-conceiving prescriptions without success, his Right Chi pulse showed vigorous spirit, indicating the True Fire was not deficient. However, the Left Chi was weak, indicating dryness of True Water. Wu prescribed Liujun Dihuang Wan (Six-Ingredient Rehmannia Pill) added with Yuanwu Jiao (Turtle Shell Glue). Two years later, a son was born.

Wan Mizhai stated: I have often seen men with impotence leading to infertility, which must be considered. Due to urgency in seeking heirs, they are easily misled by mediocre physicians. Some use Fuzi (Aconite), Chuangxi (Cnidium Fruit), and Guozhi (Psoralea) for internal tonification. Others use Chansu (Toad Venom) and Afuyou (Opium) for external aid. Before sexual arousal, internal heat arises; although the penis becomes erect, it remains useless like rotten wood, leading to lifelong infertility or premature death. Seeing these innocent people harmed by medicine, I searched various formulas and found none superior to this one, which I named Zhuangyang Dan (Yang-Strengthening Pill). Shudihuang (Prepared Rehmannia Root, 4 liang), Bajitian (Morinda Root, heart removed, 2 liang), Guozhi (Psoralea, stir-fried, 2 liang), Xianlingpi (Epimedium, 1 liang), Sangpiaoxiao (Mantis Egg Case, genuine, salt-roasted, half liang), and Yangqishi (Calcined Augite, separately ground and water-washed, half liang). These six ingredients correspond to the number of Yin. Grind into powder, refine with honey, and make pills the size of sesame seeds. Take thirty pills on an empty stomach once, with warm wine. Do not rely on this to indulge oneself. Beware. (Xiong's Note: The use of mineral drugs causes severe harm.)

Shengdi (Raw Rehmannia Root, 4 liang), Shudihuang (Prepared Rehmannia Root, 4 liang), Tiandong (Asparagus Tuber, 4 liang), Maidong (Ophiopogon Tuber, 4 liang), Danggui (Angelica Sinensis, 2 liang), Gouqi (Goji Berry, 1 liang), and Xianlingpi (Epimedium, 8 liang) are crushed, placed in a silk bag, soaked in strong wine, and boiled in a double boiler from Mao hour to You hour. Buried underground for seven days, the couple drinks five to six cups daily. Women with irregular menstruation will have regular cycles and conceive. This formula is carved in the *Jiyan Fang* (Collected Effective Prescriptions) of Zou Nangao Renwen Academy. Wu Yintai and Xu Guanglu both claimed it was often effective, so I recorded it. (Li Rizhang, *Liuyan Zhai Biji*. Xiong's Note: This is the Jiling Gao formula.)

Wu Qiao treated Hu Yiqing. Hu enjoyed humor, hence his familiarity with Wu. Hu sought a Yang-strengthening prescription due to prolonged infertility. Wu diagnosed: "Your Cun pulse is flooding, and Chi is deep and choppy. Fire flares upward without descending, Water dries up without ascending. Water and Fire do not interact; this is the Hexagram Wei Ji (Before Completion). The treatment should be to nourish Yin and tonify Kidney. Perhaps then they will assist and generate each other. Using Yang-strengthening methods again will increase Fire and dry Water further, leading to hemoptysis and hematemesis, which will be incurable and dangerous." Hu laughed loudly, saying, "At fifty, I eat well, unlike young men. What illness? I only suffer from impotence and spermatorrhea and wish for medicine to strengthen me. Moreover, taking Yin-nourishing medicines is like holding a leaking vessel—it is useless." Wu said, "My skill ends here." Hu later met an older man from the state who fathered a child, obtained a Yang-strengthening prescription, and eagerly consumed it in the capital. He developed cough and loss of voice, followed by hemoptysis. Eventually, he emaciated and suffered frequent urination/defecation disturbances. He sent for Wu Qiao, who declined to visit due to busyness. When the illness deepened and Wu returned, Hu sighed, "I reached this state by ignoring your advice. Fortunately, my pulse is not rapid, voice is not hoarse, bones do not feel hot, and I do not cough blood; only frequent bowel movements remain." Wu replied, "No, no. If the pulse were rapid, voice hoarse, bones steaming, and blood coughed, the Yang Fire would not have subsided, and it could still be driven. Now it has extinguished; even ashes in the furnace are of no avail." Shortly after, Hu died.

Feng Chuzhan stated: The essence of the Five Viscera rotates to the Kidney. Thus, the Classics say, "Only when the Five Viscera are abundant can they excrete." Each viscera has its own essence, which pours into the Kidney as needed. Is it merely stored by the Kidney? Essence is generated from Blood; if Blood is scant, how can Essence be generated? The Heart governs Blood; thus, infertility is blamed on the Heart, and white hair on the Kidney. Therefore, those valuing procreation should not only tonify the Kidney but especially nourish the Heart. Not only nourish the Heart, but harmonize the Five Viscera, keeping their essence and Qi abundant, so that the Kidney's reservoir is full. If the other four viscera are dry and barren, what substance will transport to the Kidney to serve as the root of lineage? Thus, I formulated Yangxin Yupi (Nourish Heart, Nurture Spleen), He Gan Qing Fei (Harmonize Liver, Clear Lung), Zishen (Nourish Kidney), and Buying Yiwei (Tonify Ying and Wei) pastes and pills, taken concurrently with Bawei Wan. One tonifies congenital insufficiency; the other assists postnatal generation. Blood and Qi will grow daily, and descendants will multiply, which is certain. Formula: Huangqi (Astragalus Root, tender, 4 liang), stir-fried with honey water, combined with Ren Shen (Ginseng) to tonify Qi as Sovereign; Dangguishen (Angelica Sinensis Root Body, 3 liang), stir-fried with wine to nourish and circulate Blood, harmonizing Ying as Minister; Suanzaoren (Ziziphus Seed, roasted and crushed, 5 liang), calms Heart and benefits Liver, simultaneously nourishing Spleen Earth as Minister; Shudihuang (Prepared Rehmannia Root, 6 liang), nourishes Yin and moistens dryness. Combined with Baizhu (Atractylodes Macrocephala), Baizhu tonifies Spleen Qi, and Shudihuang nourishes Spleen Yin, also as Ministers; Yuqian Baizhu (Atractylodes Macrocephala from Yuqian, 4 liang), soaked in human milk, dried, and stir-fried yellow, specifically tonifies Spleen Origin as Minister; Yuanzhi (Polygala Root, 2 liang), boiled in strong Licorice juice to remove pungency, nourishes Heart Spirit and generates Spleen Earth, descends to aid Kidney Qi, securing True Essence, used as Assistant; Maidong (Ophiopogon Tuber, 3 liang), stir-fried with old rice to remove moisture, protects Lung Metal, alleviating Baizhu's dryness, used as Assistant; Baishao (White Peony Root, 2.4 liang), stir-fried with honey and wine. Sweet-cold enters Spleen; sour-astringent enters Liver. It assists Danggui to harmonize Liver Ying and assists Baizhu to nourish Spleen Yin, used as Assistant; Duzhong (Eucommia Bark, 3 liang), stir-fried with wine, guides herbs to the deepest Yin; Chuanxuduan (Dipsacus Root, 3 liang), stir-fried with wine. Shudihuang tonifies Kidney Essence; Duzhong tonifies Kidney Qi; Xuduan regulates joints and sinews, used as Envoy; Chuan Niuxi (Achyranthes Root, 3 liang), steamed with wine, dried, and ground, guides herbs to strengthen the Lower Yuan, used as Envoy. Lianzi (Lotus Seeds, 3 jin) are boiled in clear water to yield over thirty bowls of juice. Filter residue, add previous herbs, decoct to obtain the first and second juices. Filter residue and boil into paste. Add Ren Shen (2 liang), Fuling (Poria, 3 liang), and Fushen (Poria with Hostwood, 3 liang), ground fine, mixed with paste to form pills. Take 4 qian with warm water before sleep.

Shen Yaofeng stated: Conception relies entirely on sufficient Qi and Blood; deficiency leads to infertility. Thus, Xue Lizhai said the crucial point is examining the Chi pulses of men and women. If the Right Chi pulse is fine or hollow and large/powerless, use Bawei Wan (Eight Ingredient Pill); if the Left Chi is flooding and large but powerless upon pressure, use Liujun Wan (Six-Ingredient Pill); if both Chi pulses are minute/fine or floating/large, use Shibu Wan (Ten Tonifying Pill). Following the *Neijing* to diagnose via pulse and prescribe is excellent. However, this specifically addresses constitutional deficiency unable to conceive. If constitution is not deficient but conception fails, there must be another disease. Miao Zhongchun attributes it to Wind-Cold invading the uterus; Zhu Danxi attributes it to latent Heat in Chong and Ren vessels; Zhang Hezi attributes it to Phlegm-Excess in the Chest; Danxi attributes lipid membrane obstruction in obese women; Chen Liangfu attributes accumulated Blood in women sterile for decades, prescribing Dangbao Tang (Uterus-Cleansing Decoction). Although theories differ, they are all logically sound. One must examine pulses and differentiate syndromes for treatment. Dangbao Tang is the premier formula for seeking offspring in *Qianjin Fang*, highly valued by Sun Simiao.

Xiong's Note: Dangbao Tang has profound intent, but its herbs are too harsh; it should not be used lightly.
Baotai Shenyao Wan (Fetus-Preserving Divine Blessing Pill) is good at resolving Qi Stagnation and slowly eliminating Blood Stasis. It is not only an excellent fetal-preserving drug but also a fairy elixir for regulating menstruation and facilitating conception. Take seven pills daily; frequent administration is very effective. I have verified its efficacy repeatedly and append it here. Baifuling (Poria, 2 liang), Yuqian Baizhu (Atractylodes Macrocephala, soaked in rice wash for one day, fried in yellow soil until fragrant, 1 liang), Yimucao (Motherwort Leaf, clean, stems removed, 1 liang), and Zhen Moyao (True Myrrh, baked on tile to remove oil, 3 qian). Grind into powder, make pills the size of sesame seeds with honey. Take seven pills with boiling water. If fetal movement occurs, take three to five times a day; do not exceed one extra pill. Strictly adhere to this.