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(Pain) radiating downward to the yin region, resulting in inability to urinate.) For women with infertility due to stagnant blood within that does not descend, Guan Yuan (CV4) is indicated. (*Qian Jin Fang* records: "Zhuo Bao" (displacement of the bladder) causing inability to urinate, with fullness in the lower abdomen, is named Shi Shui pain.) For women with malposition of the Zi Men (vaginal opening), bitter cold in the lower abdomen, itching and pain in the yin, and amenorrhea with obstruction, Zhong Ji (CV3) is indicated. For women with infertility, Yong Quan (KI1) is indicated. For infertility caused by large hernia, Zhu Bin (KI9) is indicated. For infertility, Shang Qiu (SP5) is indicated. (The acupoint is located in the depression anterior to the medial malleolus.) For women with absolute sterility, if they have never given birth, Yin Lian (LR11) is indicated. (Puncture depth is half cun; moxibustion is applied one cun below the point.)

[Nourishing Essence]
Mr. Yuan Liaofan stated: The methods for gathering essence are: first, reduce desires; second, conserve labor; third, calm anger; fourth, abstain from alcohol; fifth, be cautious with flavors (diet). Those who discuss health preservation nowadays often speak of extracting yin to supplement yang, enduring long intercourse without ejaculation, which is a great fallacy. The Kidney is the mansion of essence. Whenever sexual intercourse occurs, it inevitably disturbs the Kidney Qi. When Kidney Qi moves, essence and blood flow along with it. Although externally there may be no emission, the essence has already left its palace. Even if one can endure and refrain from ejaculating, a few drops of true essence will inevitably overflow as Yang Qi wanes; this is the verification. Just as fire produces smoke and flames, how can the smoke return to the firewood? Therefore, reducing desires is precious. Essence is formed from blood. It is not only sexual intercourse that damages our essence; all daily activities that consume blood should be deeply guarded against. For example, excessive visual strain consumes blood through seeing; excessive auditory strain consumes blood through hearing; excessive mental strain consumes blood through thinking. If I moderate these according to circumstances, blood will be nourished and accumulate day by day. Therefore, conserving labor is precious. The organ responsible for closure and storage is the Kidney; the organ responsible for dispersion and excretion is the Liver. Both organs contain Ministerial Fire, and their connections ascend to belong to the Heart, which is the Sovereign Fire. Anger injures the Liver and stirs up Ministerial Fire. When stirred, the function of dispersion takes over, and the function of closure fails its duty. Even without intercourse, essence will secretly flow and be consumed. Therefore, calming anger is necessary. Blood in the human body remains coagulated when it returns to its residence. Alcohol can disturb blood; after drinking, people's faces turn red, and hands and feet become red, indicating that blood is disturbed and driven into rapid circulation. In people whose Qi and blood are already declining, even if there has been no sexual activity for months, the essence begins to become thick and usable. However, if one gets heavily drunk in one night, the essence becomes thin. Therefore, abstaining from alcohol is advisable. *Nei Jing* states: "For deficiency of essence, supplement with flavor." However, rich and greasy flavors cannot generate essence; only bland flavors can supplement essence. All things possess true flavor; when flavors are overly harmonized or strong, the true flavor declines. Regardless of whether meat or vegetarian, if boiled lightly and properly, there will naturally be a mild, peaceful, and bland qi that benefits the stomach and intestines. *Hong Fan* discusses flavors, stating that grains produce sweetness. Among worldly things, only the five grains obtain the correct flavor. Eating bland grain food best nourishes essence. Furthermore, when cooking porridge or rice, if a thick liquid rolls into a ball in the center, this is where the essence of the rice gathers. Eating it best generates essence; trials have proven effective. The secret to refining essence lies entirely in working on the Kidney system. The inner Kidney has an aperture called Xuan Guan (Mysterious Pass); the outer Kidney has an aperture called Pin Hu. If true essence is not leaked and the body is intact, the Yang Qi of the outer Kidney rises at Zi hour (11 PM - 1 AM). The Qi of the human body aligns with the Qi of Heaven and Earth. If essence is leaked and the body damaged, the time for Yang Qi generation in the body gradually delays. Some arise at Chou hour (1 AM - 3 AM), some later at Yin hour (3 AM - 5 AM), and some even later at Mao hour (5 AM - 7 AM); some never arise at all, beginning to be out of sync with Heaven and Earth. The secret to refining essence requires rising from bed and sitting up at midnight Zi hour. Rub hands until extremely hot. Use one hand to cup the outer Kidney and the other hand to cover the navel, concentrating spirit on the inner Kidney. Practicing this for a long time will make essence abundant.

Bao Zhen Wan (Preserve Truth Pill) specifically treats the Nine Uglinesses: penis weak and not erect; erect but not full; full but not sustained; sustained but not solid; solid but not firm; firm but not lasting; lasting but without essence; having essence but no offspring. These are called the Nine Uglinesses. This medicine tonifies the twelve meridians, raises Yin and stimulates Yang, allows Yang Qi to enter the chest, calms the soul, opens accumulations in the San Jiao (Triple Burner), resolves grain stagnation and promotes appetite, strengthens Yin and benefits seminal essence, calms the Five Viscera, clears latent heat in the Heart, strengthens sinews and bones, lightens the body, improves vision, dispels cold and wind, and treats everything. This medicine is a mild tonic; taking more and taking it regularly is best. A seventy-year-old elder can still father children, demonstrating extraordinary power. It also treats infertility caused by the Five Exhaustions and Seven Injuries.

Lu Jiao Jiao (Deer Antler Glue) (half jin [approx. 250g], cut into bean-sized pieces, stir-fried with Lu Jiao Shuang [Deer Antler Powder] until pearl-like, then ground fine) Du Zhong (Eucommia Bark) (remove coarse bark, cut into pieces, stir-fry with 1 liang [approx. 50g] fresh ginger juice and a little honey until fibers break, 3 liang) Gan Shan Yao (Dried Chinese Yam) Bai Fu Ling (Poria) (remove coarse bark, mix with human milk and sun-dry, repeat 5-7 times) Shu Di Huang (Prepared Rehmannia Root) (each 2 liang) Tu Si Zi (Cuscuta Seed) (steam with wine, crush and bake) Shan Zhu Yu (Cornus Fruit) (each 1.5 liang) Bei Wu Wei Zi (Schisandra Berry) Chuan Niu Xi (Cyathula Root) (remove rhizome, steam with wine) Yi Zhi Ren (Alpinia Oxyphylla Fruit) (remove shell) Yuan Zhi (Polygala Root) (boil in rice water, remove woody core) Xiao Hui Xiang (Fennel Fruit) (stir-fry with 3 qian [approx. 15g] green salt) Chuan Lian Zi (Sichuan Chinaberry Fruit) (remove skin and seeds, take pure flesh, roast with酥 [pastry fat]) Chuan Ba Ji (Morinda Root) (soak in wine, remove heart, each above 1 liang) Po Gu Zhi (Kochia Seed/Burkholdia Seed) Hu Lu Ba (Trigonella Foenum-Graecum Seed) (cook together with Po Gu Zhi inside sheep intestine, dry and roast, each 1 liang) Bai Zi Ren (Biota Seed) (remove shell, grind separately into paste, half liang) Chuan Shan Jia (Pangolin Scale) (roast with pastry fat) Chen Xiang (Aquilaria Wood) (each 3 qian) Quan Xie (Scorpion) (remove toxicity, 1.5 qian)
Process all ingredients into extremely fine powder. Take 4 liang of high-quality tender Rong Cong Rong (Cistanche Stem), wash clean with wine, remove scales, armor, skin, and dirt, open up, remove any yellow-white membrane, take 2 liang of pure material. Boil in good wine until it forms a paste. Mix with refined honey and the previous medicinal powders, pound over a thousand times, form pills like tung tree seeds. Take 50 pills per dose, down with light Autumn Stone soup or warm wine, followed by dry food to settle. Gradually increase to 100 pills. After seven days of服用 (taking), limbs become lustrous, lips and face turn red, hands and feet become warm, face and eyes become moist, digestion improves, spleen functions well, body feels light, Qi harmonizes, speech becomes clear and bright; these are its effects.

Qian Jin Zhong Zi Dan (Thousand Gold Seed-Producing Elixir) Taking this formula makes one have many children and also treats deficiency damage, nocturnal emission, white turbidity, and rectal prolapse. (For men.)
Sha Yuan Ji Li (Astragalus Complanatus Seed) (take 4 liang of pure powder, resembling silkworm eggs; those from Tongzhou are best. Sift twice through very fine sieves to get 2 liang of very fine powder and 2 liang of coarse powder. Simmer in one large bowl of water until it forms a paste for later use) Lian Xu (Lotus Stamen) (4 liang, very fine powder; golden color consolidates essence, red color destroys essence) Shan Zhu Yu (Cornus Fruit) (very fine powder 3 liang; need 1 jin [approx. 500g]; choose fresh, red, fleshy ones best, remove excess flesh and process into powder) Fu Pen Zi (Raspberry) (Southern origin is best, remove impurities, fine powder 2 liang) Ji Tou Shi (Euryale Seed/foxnut) (500 units, remove shells; if sizes vary, take fine powder 4 liang) Long Gu (Fossilized Bone) (5 qian [approx. 25g]; five-colored ones are best, calcine by fire. Method: place Long Gu in a small clay pot, place the pot inside another larger pot containing soil/ashes, heat until red-hot, remove fire toxicity before use.)
Use 1 jin [approx. 500g] of Fu Mi (ancient honey) to refine. Use paper to skim off floating foam several times until drops form pearls in water. Use only 4 liang. Pass the previous five ingredients through a fine sieve again. First mix with Ji Li paste into a block, then add refined honey. Pound in a stone mortar over a thousand times. Form pills like pea seeds. Take 30 pills per dose on an empty stomach with salt water. Abstain from sexual desire for twenty days. This medicine prolongs life and increases longevity, making one have many children; details cannot be fully listed.

Ju Jing Wan (Gather Essence Pill) (For men.)
Huang Yu Biao Jiao (Yellow Fish Swim Bladder Glue) (white and clean, 1 jin [approx. 500g], cut into pieces, stir-fry with Ge Fen [Clam Powder] until pearl-like, stop when silent) Sha Yuan Ji Li (Astragalus Complanatus Seed) (8 liang, soak in horse milk for two nights, steam over water for the time it takes one incense stick to burn, take out and dry-roast)
Grind into powder. Form pills with refined honey like tung tree seeds. Take 80 pills per dose on an empty stomach with warm wine or plain water. Avoid eating fish and beef.

Wu Zi Yan Zong Wan (Five Seeds Deriving Ancestry Pill) Men taking this medicine add essence and marrow, unblock and benefit Kidney Qi. Regardless of deficiency/excess or cold/heat in the Lower Jiao, taking it naturally brings balance. It was formerly called the number one seed-producing formula since ancient times. There is a saying that families who took this medicine for generations had proliferating descendants, forming villages. In the Dinghai year of the Jiajing era, it was obtained from the residence of Vice Censor Zheng Guangxin. Descendants of Immortal Zhang for four generations and several others used it with remarkable effect.
Gan Zhou Gou Qi Zi (Goji Berry from Ganzhou) Tu Si Zi (Cuscuta Seed) (steam with wine, crush into cakes, each 8 liang) Liao Wu Wei Zi (Schisandra Berry from Liaoning) (1 liang) Fu Pen Zi (Raspberry) (4 liang, wash with wine to remove eyes) Che Qian Zi (Plantago Seed) (stir-fry, 2 liang)
Select the five items carefully, choosing authentic and fresh materials. Dry-roast and sun-dry. Grind into fine powder. Form pills with refined honey like tung tree seeds. Take 90 pills on an empty stomach, 50 pills before going to bed. Down with boiling white water or salt water. In winter, down with warm wine. On the day of preparation, in Spring choose Bing, Ding, Ji, Wu days/hours; in Summer choose Wu, Ji, Chen, Xu, Chou, Wei days/hours; in Autumn choose Ren, Gui, Hai, Zi days/hours; in Winter choose Jia, Yi, Yin, Mao days/hours. Avoid letting monks, nuns, widows, widowers, chickens, dogs, and livestock see it.

Shi Zi Wan (Ten Seeds Pill) Shen Jiazhe from Siming had no children; after taking it in his seventies, he continuously had sons.
Huai Jiao Zi (Sophora Pod Seed) (steam seven times with He Shou Wu) Fu Pen Zi (Raspberry) Gou Qi Zi (Goji Berry) (remove dried parts and stems) Sang Shen Zi (Mulberry Fruit) Dong Qing Zi (Ilex Aquifolium Seed) (these four steamed together, each 4 liang) Tu Si Zi (Cuscuta Seed) (processed, remove shell, steam with wine) Bai Zi Ren (Biota Seed) (soak in wine, steam) Mo Shi Zi (Myrobalan Fruit) (process according to Lei Gong's method) She Chuang Zi (Cnidium Seed) (steam) Bei Wu Wei Zi (Schisandra Berry) (remove dried parts, crush, steam with honey. Each above 2 liang)
Grind into powder. Form pills with refined honey like tung tree seeds. Take 50-60 pills per dose, down with light salt water, pressed with dry snacks.

Zhao Shi Jia Wei Liu Zi Wan (Mr. Zhao's Modified Six-Seed Pill)
Tu Si Zi (Cuscuta Seed) (wash, steam with wine) Chuan Niu Xi (Cyathula Root) (remove rhizome, steam with wine) Mai Men Dong (Ophiopogon Tuber) (remove heart, steam with wine) Shan Zhu Yu (Cornus Fruit) (take flesh) Yuan Can E (Silkworm Moth) Wu Wei Zi (Schisandra Berry) (each 1.3 liang) She Chuang Zi (Cnidium Seed) (steam with wine, 1.6 liang) Che Qian Zi (Plantago Seed) (wash, 1.7 liang) Da Gan Cao (Licorice Root) (roasted, 1 liang) Sha Yuan Ji Li (Astragalus Complanatus Seed) (soak in horse milk, steam) Fu Pen Zi (Raspberry) (each 2.2 liang) Po Gu Zhi (Kochia Seed) (2.3 liang, wash and stir-fry) Rou Cong Rong (Cistanche Stem) (2.5 liang, soak in wine to remove scales)
Although the Kidney belongs to Water, it should not be too cold. Cold essence makes conception difficult, just as plants cannot sprout in cold heaven and earth. This formula is carefully balanced, neither cold nor hot, achieving neutrality. Prepared and taken, it is like the initial movement of Yang Qi, where all things transform and generate. After two or three months, pregnancy will surely occur. The previous medicines are all dry-roasted, cut, and ground into powder. Form pills with refined honey like tung tree seeds. Take 30 or 40 pills per dose, down with clear salt water, taken morning and evening.

[Acupuncture]
To treat men with infertility, use a ball of prepared mugwort (Ai Ye). Fill the navel completely with salt. Then, on top of the salt, make Ai balls matching the size of the salt and apply moxibustion. If it hurts, change the salt. Continue moxibustion until the Ai is exhausted. If one day is not enough, continue on the second or third day. It has been effective.

[Knowing the Time]
Mr. Yuan Liaofan stated: Heaven and Earth must have moments of union to create life; all things must have moments of joyful nourishment to transform and generate. Even tiny creatures like cats and dogs, when about to conceive, the female will cry wildly and jump around, unable to stop due to the touch of the Qi of joyful nourishment. This is the natural seasonal rhythm, the true mechanism of transformation and generation. People seeking offspring say: "Thirty shichen (two and a half days), you must calculate twenty-eight or twenty-nine." This speaks only of the general rule, not the exact truth. *Dan Jing* says: In a month, there is only one day; in a day, there is only one shichen. Whenever a woman menstruates once a month, there must be one day of fertile opportunity within one shichen. The Qi steams and heats, feeling dizzy and stifled, with an unbearable desire for intercourse. This is the exact fertile window. Taking it inversely at this time creates elixir; applying it顺势 (following the trend) creates a fetus. "The moon appears in Geng on the third day" and "Warm lead cauldron, light penetrates the curtains" both describe these phenomena. When desire is strongly aroused, inside the uterus, something like a lotus stamen naturally protrudes from the yin, regardless of how many days after menstruation ends. It looks like a newly opened lotus stamen. The woman washing her lower body can feel it with her hand, though she may be shy to speak of it. The man should secretly inform her to let her speak of it herself; one attempt will hit the mark.

[Fetal Formation]
Danxi said: Distinguishing male and female based on the sequence of essence and blood in fetal formation is Chu Cheng's theory. I privately doubted it. Later, I read in Dongyuan's prescriptions: One or two days after menstruation stops, the Blood Sea is just cleared. If essence overcomes blood, conception results in a male. Four or five days later, blood vessels are vigorous, essence cannot overcome blood, conception results in a female. This argument is also not thorough. Why? *Yi Jing* (Book of Changes) says: The Way of Heaven forms males; the Way of Earth forms females. Heaven and Earth are the nature of Yin and Yang. Left and Right are the paths of Yin and Yang. Male and Female are the images of Yin and Yang. Father's essence and Mother's blood meet due to mutual attraction. The emission of essence is the action of Yang; the ability of blood to capture it is the transformation of Yin. Essence forms bone; this is where all things begin with Heavenly Origin (Qian Yuan). Blood forms the womb; this is where all things are born from Earthly Origin (Kun Yuan). When Yin and Yang intersect, pregnancy condenses. The place where the fetus resides is called the Zi Gong (Uterus). It has one root below and two branches above, one reaching left and one reaching right. If essence overcomes blood, and conception occurs on a Yang day/hour, Yang dominates. Receiving Qi in the Left Uterus forms a male. If essence does not overcome blood, and conception occurs on a Yin day/hour, Yin dominates. Receiving Qi in the Right Uterus forms a female. Someone asks: I understand distinguishing male and female, but what about twins? Answer: If essence is abundant, it splits, and blood captures it accordingly. As for simultaneous male and female pregnancy, if conception occurs on a Yang day/hour and a Yin day/hour, Yin and Yang mix. It does not belong to the left or right, but receives Qi between the two branches. There are also triplets, quadruplets, quintuplets, sextuplets, following the same principle. Someone asks: What about males who cannot be fathers, females who cannot be mothers, and intersex individuals? How are they distinguished? I say: Males who cannot be fathers suffer from deficiency of the Yang Path. Females who cannot be mothers suffer from obstruction of the Yin Path. Intersex conditions arise because Yin is invaded by mixed Qi, resulting in various forms. There are two types of females with male characteristics: one acts as a wife to men and a husband to women; the other can be a wife but not a husband. Another type has a female lower body but complete male upper features, which is a severe case of mixed Qi. Someone asks: Is invasion by mixed Qi seen only in Yin, yet the resulting forms differ so much? I say: The Yin body is deficient, making it easy for mixed Qi to invade. Invaded by mixed Qi, Yin and Yang mix, lacking a dominant force, unable to belong to left or right, receiving Qi between the two branches. Forms develop according to the severity of the mixed Qi received, hence the varied combined forms.
Lou Quanshan said: Danxi's argument is extremely subtle, revealing what predecessors did not. Thus, the distinction between male and female is determined at the moment of Heavenly Origin initiating all things, during Yin-Yang intersection. Ignorant people do not understand this principle and foolishly propose methods to turn females into males; this is confusing. All things begin with Heavenly Origin; does the distinction between male and female not begin with Heavenly Origin? Mr. Yuan stated: Chao Shi discussed pregnancy: Month 1 is named Shi Pei (Initial Embryo), nourished by Foot Jueyin Meridian. Month 2 is named Shi Gao (Initial Paste), nourished by Foot Shaoyang Meridian. Month 3 is named Shi Tai (Initial Fetus), nourished by Hand Shaoyin Meridian (Note: Text says Xin Shou Mai, likely referring to Pericardium/Shaoxin context or typo for standard text, usually Hand Shaoyin is Heart, but embryo nourishment varies by text; sticking to text: Xin Shou Mai). Month 4 begins receiving Water Essence to circulate blood vessels, nourished by Hand Shaoyang Meridian. Month 5 begins receiving Fire Essence to form Qi, nourished by Foot Taiyin Meridian. Month 6 begins receiving Metal Essence to form sinews, nourished by Foot Yangming Meridian. Month 7 begins receiving Wood Essence to form bones, nourished by Hand Taiyin Meridian. Month 8 begins receiving Earth Essence to form skin and flesh, nourished by Hand Yangming Meridian. Month 9 begins receiving Stone Essence to form hair, nourished by Foot Shaoyin Meridian. Month 10: Viscera, joints, and Human Spirit are complete. This is the general outline. To seek details, conception in the abdomen changes every seven days, transforming sequentially, with all life phases detailed in the *Da Ji Jing*. Nowadays, women miscarry mostly in the 3rd, 5th, and 7th months, and less in the 2nd, 4th, and 6th months. Viscera are Yin, Bowels are Yang. Month 3 belongs to Heart, Month 5 to Spleen, Month 7 to Lung, all belonging to the Five Viscera meridians. Yin is easily deficient, hence miscarriages are common. If one previously miscarried in the 3rd month, the Heart meridian is injured; one must first regulate the Heart, otherwise miscarriage recurs in the 3rd month. If one previously miscarried in the 5th month, the Spleen meridian is injured; treat the Spleen first to prevent recurrence in the 5th month. Only miscarriage within the first month is unknown to people; they think they didn't conceive, not knowing they conceived and miscarried. Month 1 belongs to Liver. Anger causes miscarriage; frequent washing of the lower body opens the orifice and causes miscarriage. Once miscarried, the Liver meridian is injured, leading to future miscarriages. Most infertile people today actually experienced first-month miscarriages, not merely failure to conceive. Therefore, after initial intercourse, rest is crucial. Do not have intercourse again to disturb the uterus. Do not allow anger, labor, lifting heavy objects, or bathing. Take more liver-nourishing and Qi-calming medicine to secure the fetus.
Cheng Mingqian said: Chu Cheng stated that in male-female intercourse, if Yin blood arrives first and Yang essence follows, a male forms. If Yang essence enters first and Yin blood follows, a female forms. Believing this, why do some men emit essence first and have sons, or emit last and have daughters? Dongyuan said: One or two days after menstruation stops, the Blood Sea is just cleared; conception results in a male. Four or five days later, blood vessels are vigorous; conception results in a female. After six or seven days, even with intercourse, no fetus forms. Believing this, why do some women conceive daughters shortly after menstruation stops and sons after a long gap? Why do some conceive no pregnancy before the 4th-5th day but pregnancy after the 8th-9th day? Yu Zimu wrote *Guang Si Yao Lue*, establishing formulas and diagrams, stating that Solid Yang can enter Empty Yin, but Solid Yin cannot receive Yang, which is Dongyuan's limited view. He also stated that Weak Yang cannot shoot Yin, and Weak Yin cannot capture Yang. Believing this, why do weak husbands and timid wives conceive repeatedly despite wanting to stop? Why do vigorous, powerful men struggle to have offspring? Zhu Danxi focused treatment mainly on women's menstruation. However, in wealthy households with many concubines, surely some have regular periods? Some women frequently bore children with a former husband but fail to conceive with a new husband chosen for ease, yet quickly conceive with someone else. Can they not conceive here but conceive there? I believe parents having children is like Heaven and Earth creating things. *Yi Jing* says: The Way of Earth is compliant, following Heaven and acting in time. Knowing that Earth creates things by following Heaven, we know mothers bear children by following fathers. Knowing mothers follow fathers, is seed-production primarily about women or men? However, being primary in men means regardless of age, strength, health, or ease/difficulty of emission, the key is whether all pulses arrive simultaneously during intercourse. If all pulses arrive during intercourse, even old, weak, sick, or prone to emission can conceive. If pulses are disordered during intercourse, even young, strong, healthy, or resistant to emission find it hard to conceive. The blood constructed by women certainly comes from the gathering of all pulses, and compared to men's essence, there must be a difference in weight/importance. Confucius praised Heavenly Origin initiating as Great, and praised Earthly Origin generating...