This introductory chapter is intended to survey the meanings and problematic of the wish for a child in the context of its social and cultural environments. We have found that ethical-moral views colored by social as well as religious paradigms significantly affect reproductive and sexual behavior. Traditional Chinese Medicine (TCM) draws not only on the experiences of a complex treatment system transmitted over 2500 years, but also, a holistic view of the individual that is rooted in notions from our time and context.

TCM can be utilized in fertility consultations as an alternative as well as supplement to other medical methods. In this context, it benefits from the fact that the unusual reception of TCM in the West has integrated aspects of psychological diagnosis and care, in addition to the therapeutic application of acupuncture/moxibustion and Chinese medicinals, into a special treatment concept.

Involuntary childlessness refers to a state that is characterized by the condition of barrenness (also called infertility or sterility). In 1967, the Scientific Group on the Epidemiology of Infertility of the WHO recognized involuntary infertility (inability to fertilize or conceive) as a disease. According to the WHO definition, infertility/sterility is diagnosed when a couple is unable get pregnant against their explicit wishes after more than 24 months in spite of regular unprotected sexual intercourse (ICD-10 Diagnosis: Female sterility [N97.x], male sterility [N46]).

Sexuality is an innate power that gives humans the possibility to gain pleasure. This energy reaches its peak with the onset of sexual maturity. This does not mean, however, that it is not present before or after this time span. A child also gains pleasure, just as older people past their reproductive age can have a fulfilled sex life. In this respect, human sexuality is something that can first be lived out independently from reproduction. In our context, however, it is important that sex—irrespective of autoerotic activities—is per se directed at a partner and in this aspect acquires a social and cultural dimension.

In the recent past, the “sexual revolution” and the contraceptive pill in particular have separated sex from reproduction. “Free love” created the possibility of having sex without begetting a child, while modern biomedicine now promises a child without sex. We must apparently distinguish here between two terms—sexuality and reproduction—which in fact exist separately from each other but are nevertheless intimately interwoven.

The close connection between sexuality and reproduction was formed in our culture under the influence of Christianity. Hinduism likewise postulates “chastity in marriage,” as a result of which sexuality was shifted into the realm of extramarital activities like prostitution, a process that was and is certainly also found in the Greco-Roman-Christian cultural complex as a result of sexual asceticism.

The Christian Church proceeded from a black-and-white image of woman as holy mother or evil temptress. However, this development only occurred with the increasing institutionalization of Christianity into a church, while women enjoyed a status of fundamental equality in the early stages of this religion. In this regard, early Christianity was influenced by stoicism, whose basic premises were the absence of passion, the primacy of reason, virtue, and a lifestyle in correspondence with nature. Philon of Alexandria, for example, a Greek Jewish theologian, postulated that sexual intercourse in marriage should only take place for the purpose of producing offspring, not for the sake of pleasure.

Similarly, according to Clement of Alexandria (2nd- 3 rd century CE), marital sex should only take place for the sake of reproduction, and man and woman should live like brother and sister the rest of the time. Particularly significant for Christian moral theology was Aurelius Augustinus who branded any type of pleasure as sinful and evil (4th- 5th century CE). In early Greece of the 6th century CE, Pythagoras, as well as later Xenophon, Plato, Aristotle, and Hippocrates alike, shared the view that excessive sexual intercourse was harmful. Influenced by these Greek traditions, the apostle Paul finally relegated women to the above-mentioned roles. For centuries thereafter, the “evil” prostitute and sexual temptress on the one side, coexisted with the “holy” mother in the service of reproduction on the other.

In the course of enlightenment, which demanded in the 17th and 18th centuries, a “free man, absolved from a self-imposed immaturity” (Kant, 1724–1804), sexuality experienced a partial redefinition in the relationship between man and woman, in the sense that it stressed emotional, sensual relationships based on respect and mutuality. This development was continued by the Romanticists in the 18th century.

A very different view, however, was taken by Sigmund Freud (1856–1939). In his work and on the basis of psychoanalytic reasoning, he created new notions about sexuality that have deeply influenced our thinking even to this day. Influenced by mechanistic ideas, terms like “drive,” “suppression,” “the unconscious,” and so on, are deeply anchored in our use of language. Freud “mechanized” and (pathologized) sexuality as a source of neuroses as well as of cultural developments. Many couples in fertility treatment appear to give more priority to these aspects than to a lively sexuality; and sexual intercourse itself as well as fertilization become increasingly mechanized in the course of the various attempts, and are performed with a purposive attitude.

In China as well, issues of reproduction and sexuality have been determined significantly by the culture as a whole, which since the 5th century BCE, was shaped by the two great religious-philosophical currents, namely Confucianism and Daoism, and later, since the 1st century CE, by Buddhism.

Founded by Kongzi in the 5th century BCE, Confucianism is rooted in a worldview that defines the individual as part of society, and not only on a synchronic plane, that is, during the person’s lifetime, but also in terms of obligations towards ancestors and descendants. All individual efforts should serve first and foremost the creation and preservation of a good and just society by a system of mutual, carefully graded rights and responsibilities. The personal fulfillment of wishes and claims of the individual was secondary to this, unlike in the West, where the individual was the governing force since Plato. All human efforts, hence also sexuality, had to be subordinated to this overarching benefit to society as a whole. Reproduction assumed a central role until the modern age, especially since neo-Confucianism developed around the 12th century in the Song dynasty. Concepts of sexuality, on the other hand, were primarily developed in Daoism.

Daoism is designed much more loosely than Confucianism. We can distinguish between several developments since its creation by Laozi and Zhuangzi, most likely contemporaries of Kongzi:

• sociopolitical developments (Laozi)
  
• philosophical teachings (Zhuangzi)
  
• a religion with a particular world of deities (assimilated from popular religion, which also included the fangshi [“magicians”] widely popular until the Qing period)
  
• the ability to cultivate life (yang sheng)
  
• religious cult with sometimes sexual practices, and so on

In particular, with regard to the aspect of “cultivating life” (yang sheng), which included efforts to achieve longevity and immortality, numerous strategies were developed in the areas of sexuality and reproduction. More details on this topic and on Confucianism can be found in the contributions of Dagmar Hemm (pp.18ff).

For Buddhism, all life is suffering. This suffering has four causes, of which the second cause is desire, or thirst, that is, for the so-called “lusts of the five senses,” for existence, for becoming, and for non-existence. The goal of Buddhism is liberation from the eternal cycle of rebirth. This is achieved by practicing the “eight-fold path of right conduct”:

• right insight
  
• right intent
  
• right speech
  
• right actions
  
• right livelihood
  
• right efforts
  
• right mindfulness
  
• right concentration

In this context, Confucian ideas about descendants and ancestors are just as irrelevant as Daoist ideas about longevity and immortality. Hence, Buddhist monks are not allowed to touch women or spend time with a woman in a secret or non-public place, let alone engage in sexual intercourse. In Buddhism, sexuality is not seen as reprehensible per se, but only as part of general badness that must be overcome because it stands in the way of enlightenment.

We also need to mention that Tantric Buddhism, a school of Buddhism, consciously cultivated sexuality in “red” or “left-handed” Tantra and engaged in sexual practices to unite the polarities. But not all forms of Tantrism include real sexual intercourse, such as Buddhist and Hindu Tantrism. During the time of Kublai Khan (1216–94 CE), this school exerted considerable influence, which, however, declined afterwards and partly continued to exist in turn in Daoist communities like the Quanzhen order.

Throughout Chinese history, the combination of these three great philosophical-religious currents in a great variety of ways led to alternating sexually liberal and repressive periods, as happened for different ideological reasons in European history as well.

Since the 17th century, that is, with the end of the Confucian-influenced Ming dynasty and the beginning of the Manchu Qing dynasty, the influence of Western thought has grown, especially due to the activities of mostly Protestant missionaries. Nevertheless, their influence has remained marginal until today.

With the foundation of the socialist People’s Republic of China in 1949, and most vividly during the Cultural Revolution since the middle of the 1960s, the large family with many children was propagated as a socialist ideal. The subsequent “one-child policy” successfully slowed down population growth, sometimes with abortive methods up until the last months of pregnancy that are quite severe from a Western perspective. The continued existence of the “wish for sons” (see pp. 18 ff), however, has promoted a selective practice of abortions on the one hand, and the intensive implementation of fertility-enhancing methods from Western and Traditional Chinese Medicine, on the other.

The comments at the beginning of this chapter clearly show that modern biomedicine and complementary medicine, here referring to TCM, can both contribute to our efforts at fertility treatment. Chinese medicine offers us the chance to build bridges between the deconstructed view of the human body in the West and the fragments of ancient Chinese medicine that will have to be at least partially reconstructed. The reason for this is that it was also influenced by Confucianism, Daoism, and Buddhism, even if not always in a way that we find desirable. In this context, the deconstructed view of the human body in the West concerns on the one hand the relationship between man and woman, in the private and public realm alike, which covers innumerable different areas. On the other hand, however, it also concerns desolate notions about the functioning of a body or its individual parts with neither connection to spirit or soul nor to other parts of the organism. In general, the goal of medicine should be to restore health and thereby the unimpeded life of the organism in all aspects, internally and externally. This goal should be our first maxim, especially in a process as sensitive and affected by multilayered aspects as the creation of new life, of a new autonomous being. Interventions into this extremely complicated set of rules may be necessary, but should always be undertaken with the following quote from Goethe’s (1797) poem “The Sorcerer’s Apprentice” in the back of the mind:

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