This chapter is concerned with the effects of sexual disorders in the context of fertility treatment. On the one hand, such disorders can be regarded as a priori, that is, they impede the success of fertility treatment from the start. On the other hand, these disorders also arise in the course of fertility treatment. Most commonly, we differentiate these disturbances by means of the wu xing (five phases) and zang fu (viscera and bowels) theories.

Regardless of the fact that we now deal with problems of sexuality much more openly and liberally than in the past (for example, the use of Viagra), it is probably still true most of the time that we fail to consciously reflect on either sexuality or fertility. In both of these subject areas, we do not ask “Why?” but assume that they are a given from the start. Just like the topic of childbearing, the desire for and performance of sexual intercourse “is simply one of those things…” Problems with sex quickly lead to bafflement, self-doubt, and intense crises of identity, for both women and men. In view of the technological possibilities in biomedicine, sexual disorders appear to have been pushed into the background when we are dealing with insemination, ICSI, IVF etc. It is fatal, however, that only one side—the reproductive dimension—is taken into consideration. The reason for this is that sexuality has at least three different dimensions that are intimately connected to each other:

• the communicative, social dimension
  
• the reproductive dimension
  
• the pleasure dimension

First, there is the communicative, social dimension. This covers the need for emotional and physical closeness, for love and reciprocation of love, as well as for deep social relations; it goes far beyond the time of pure reproductivity. Because Confucian thought, which is socially minded as well, has left a clear mark on the attitudes of Chinese medical philosophy, we find aspects of this social level, for example, in all five phases of correlative thinking:

• compassion (wood)
  
• honesty (metal)
  
• ritual (fire)
  
• wisdom (water)
  
• trust (earth)

Yin and yang—these are the two fundamental and original aspects in the worldview of the ancient Chinese that determine and define the entire existence, in all its dimensions of the macro- and microcosm. The duality of heaven and earth, day and night, sun and moon, are mirrored on earth in the duality of man and woman. On the basis of the division of labor, in society as well as in the home, and extending to the shape of the sexual organs and the most commonly practiced form of sexual intercourse, the man is yang, oriented outward, giving, and moving. The woman, on the other hand, is yin, oriented inward, taking and receiving—whereby any yang contains the root of yin and any yin contains dynamic yang. When these two come together, when yin and yang unite, new life is created. He yin yang—the union of yin and yang—is the Chinese term for sexual intercourse. Both unite in yin, and the new qi is formed from the dynamism of the movements during sexual intercourse. Without this qi—the movements of both man and woman—new life is possible only with difficulty.

The difference in the energetics of both partners in this creative play also results in a difference in their susceptibility to disturbances. While kidney energy in the broadest sense can become exhausted in both partners, this affects primarily kidney yin in the man and kidney yang in the woman. Wood, or the liver, manifests in the man decisively in the erection of the penis, in accordance with the male attributes of activity, movement, and extroversion. The spleen and lung as levels of the emotions and introversion, on the other hand, are in the foreground for the woman. Regardless of all possible disharmonies and especially of individual differences—which in the context of sexual intercourse can certainly also lead to a complete reversal of these initial “roles”—the goal is for yin and yang to come together and thereby complement or support each other. The differences and mutual support of yin and yang also become clear when we look at the reactions in the union of man and woman: the man is yang and agitates during sex with his yin; this is where he wants to be approached. The woman is yin and acts during sex initially with the yang, with the head—she initially wants to be touched with the eyes and with language. Then, the woman’s yang sinks into yin and thus causes the fluids to move. The man’s yin, on the other hand, is lifted up by the woman’s yang and starts moving.

Fear creates blockage—especially men who are very achievement-oriented are blocked in their sexuality by their expectations and fear of failure. We also find erectile dysfunctions as a sort of self-fulfilling prophecy in the context of certain basic disorders like diabetes or as a described side-effect of medications. These fears—as an expression of weakness in the kidney—often multiply in the course of fertility treatment. Associated with this fear is the pressure to perform and also the fulfillment of the so-called “mythical” assumption: men can and want to do it at any time. Satisfying and above all pleasurable sex then becomes very difficult, especially in the context of fertility treatment when the sexual myths—which still control many men—are compounded by time pressure and the narrow medical framework.

In men, it is mostly the pressure to perform and fear of failure that cause problems in sexuality. In women, on the other hand, corresponding fear of reaction plays an important role: the fear of not being able to react appropriately, also due to individual experiences like feelings of guilt, self-sacrifice, or possibly even experiences of abuse. For women, the fear of failure multiplies in fertility treatment with every failed attempt at fertilization and can lead to a striking loss of identity as a woman. This means, while the field of tension in men is located in the area kidney-liver (fear and pressure), in women it is located in the area lung-kidney (emotion and fear). The following disease patterns can occur:

• liver qi congestion
  
• weakness of spleen qi
  
• dampness/damp-heat
  
• additional blockages
  
• kidney vacuity
  
• weakness of kidney yang
  
• weakness of kidney qi
  
• weakness of lung qi
  
• weakness of heart yang

Zheng—the regular, targeted flow of energies—from the TCM perspective, this is the responsibility of the liver. Qi, the life force, is directed outward for the development of the person, the fulfillment of the inborn potential and destiny. In terms of qi, sexuality means that the male or female partner is “conquered,” in accordance with one’s own wishes and expectations, but also with one’s “urges” that seek this goal. Pressure builds, which seeks release and fulfillment. If this is not achieved, qi becomes blocked, especially if the liver is unable to provide for the necessary flexibility and adaptability.

Pressure from the outside or inside or exaggerated demands on oneself greatly strain the function of the liver. The pressure can also be overwhelming from the outside, for example, the pressure in the context of fertility treatment, which manifests monthly during the time of ovulation, or which can result from personal and professional planning. The pregnancy is supposed to be planned, after all. Every plan, however, can strain our adaptability—which, according to TCM, is guaranteed by the liver—to the breaking point. The risk of obstacles, of areas of life that are incalculable because they are beyond human control, is too great. Trusting in the coincidences of creation collides with the constraints of biomedicine and life, such as, for example, the termination of human, especially female, fertility, but also the reimbursement practices of medical insurances in attempted artificial fertilization. The liver regulates the relationship between human desires and the adversities of life. In this function, it should resemble—a very beautiful image—bamboo, which is hard, solid, and stable, single-mindedly growing upward, bending in the storm without breaking. The liver should not—to stay with this image—be like an oak, which is solid and has strong roots, but breaks in the storm.

If there is no open communication between the partners in the relationship, hidden feelings can frequently also lead to blockages and thereby to sexual disturbances. When they fail to communicate about their wishes, aversions, and expectations, this can lead to blockages of the qi flow, and from there also of the flow of the fluids and blood, in either the man or the woman.

Consequently, the blood fails to move from the liver into the sexual organs, and likewise, on the microscopic level, the sperm cells are unable to move correctly. Alternatively, the woman’s menstrual blood congeals, causing cramping and pain. To resolve this pressure, TCM regards the social component of liver-wood as key: ren—benevolence. Helpful for resolving blockages are open discussions and putting oneself in the partner’s place.

The penis is the “sinew of the liver.” Its much-mentioned strength and “steadfastness” demonstrate the strengths and weaknesses of wood. The liver channel, its muscle channel, and its luo network vessels supply the penis in the man, but also the external genitals and the uterus in the woman, with blood and qi.

The liver’s yang aspect is represented in the function of the gallbladder, which is responsible for doing the right thing in the decisive and correct moment.

When liver qi stagnates, we can see this in blockages of all kinds—emotional, spiritual, and physical. The pressure manifests in a pronounced tendency to irascibility, on the muscular level in tension, and in the inability to express one’s emotions, opinions, and desires.

All liver disorders improve with movement and worsen under (time) pressure—this is a key symptom! This means that love play that is not limited in time can resolve these blockages, especially also playful engagement with different sexual techniques. According to TCM, we can recognize any involvement of the gallbladder in problems with putting ideas and expectations into practice. Fear and despondency as well as high spirits and the related tendency to infringe on others are signs of disharmony in this bowel.

Tongue: tense, dark, also with red margins (ascending liver yang)

Pulse: tight

Regulate and soothe liver qi.

Rx. Xiao Yao San (Free Wanderer Powder); Modification for the Treatment of Infertility and Sexual Disorders:

• chai hu (Bupleuri radix), 4–6 g—strongly raises qi, soothes liver qi
  
• dang gui (Angelicae sinensis radix), 4–6 g—supplements and quickens blood, quiets the shen, moistens the intestine
  
• bai shao yao (Paeoniae radix alba), 9–12 g—nourishes liver blood, quiets the liver
  
• bai zhu (Atractylodis macrocephalae rhizoma), 6–9 g—supplements the spleen, strengthens qi, dries dampness, stabilizes wei (defense)
  
• fu ling (Poria), 6–9 g—strengthens the spleen, harmonizes the center, eliminates dampness, quiets the spirit
  
• sheng jiang (Zingiberis rhizoma recens), three slices—warms the spleen and stomach
  
• da zao (Jujubae fructus), three pieces—supplements the center, strengthens the spleen and stomach, supplements blood, quiets the spirit, harmonizes the formula
  
• du zhong (Eucommiae cortex), 6–9 g—supplements the liver, kidney, and essence, downbears ascending liver yang
  
• tu si zi (Cuscutae semen), 6–9 g—supplements kidney yang, contains essence, supplements liver yin
  
• bo he (Menthae herba), 2–3 g—regulates liver qi, circulates qi (lung qi by downbearing, liver qi by upbearing)

Modifications:

• for heat: mu dan pi (Moutan cortex), 6–9 g; zhi zi (Gardeniae fructus), 3–5 g
  
• for fear or depressive mood: he huan pi (Albizziae cortex), 4–6 g; suan zao ren (Ziziphi spinosi semen), 6–9 g
  
• for constipation or flatulence: da fu pi (Arecae pericarpium), 6–9 g; bing lang (Arecae semen), 6–9 g
  
• for phlegm stagnation in polycystic ovaries (PCO): ban xia (Pinelliae rhizoma), 4–6 g; zao jia ci (Gleditsiae spina), 4–6 g
  
• for blood stasis, qi or phlegm stagnation in myomas or polycystic ovaries (PCO): tu bie chong (Eupolyphaga seu steleophaga), 3–5 g; e zhu (Curcumae rhizoma), 4–6 g
  
• for sperm antibodies, add blood-moving substances: dan shen (Salviae miltiorrhizae radix), 6–9 g; tao ren (Persicae semen), 6–9 g; hong hua (Carthami flos), 3–6 g
  
• for reduced sperm motility: wang bu liu xing (Vaccariae semen), 4–6 g; lu lu tong (Liquidambaris fructus), 4–6 g

The spleen supplies the kidney—which serves as the reservoir of both congenital and acquired essence (jing)—with all those energies that the person can absorb from the environment and digest. This can take place on the material, spiritual, and emotional level. The spleen has the function of absorbing qi from the environment in its various forms and transforming it into the body’s own substrate. Diet and metabolism: these are the sources of the energy qi (in addition to the lung)—on the physical, spiritual, and mental level. By consuming fast food and junk food, we miss paying the necessary attention to what is good for the body and what it truly needs. The results are nutritional deficits, metabolic disorders, states of deficiency, and accumulations of dampness due to non-transformed substances.

Human qi is fed from three sources:

• from the inborn potential of the kidney
  
• from respiration (lung) and
  
• from the diet (spleen)

The functions of the kidney, spleen, and lung in turn consume qi. Chronic diseases or stress lead to excessive strain on these sources of energy and thereby ultimately to the exhaustion of the fundamental reserves and potentials of the person. These elemental potentials are, however, stored in the kidney—the basis for reproduction and sexuality.

Empathy is an essential function of the spleen. If the two partners are unable during sexual intercourse to be responsive to each other or to put themselves in each other’s place, sexual satisfaction is impossible.

The spleen reflects the earth phase in the human body and therefore also our ability to remain in the middle, that is, in our own center. This also concerns the physical level because one of the important functions of the spleen is to lift the organs and tissues and keep them in their place. In spleen vacuity, we see sagging of the organs, especially of the pelvic organs. An absence of the spleen’s uplifting power can also affect the ability to get an erection.

Soft-liquid stools, possibly containing pieces of undigested food. The abdomen is distended, in conjunction with generalized cold sensations. We can also find a tendency to hernias. Drooping manifests in varicosis, uterine or bladder prolapse, and possibly dribbling after urination.

Tongue: pale, swollen

Pulse: vacuous, fine

Strengthen spleen qi, supplement the lung and yang in the kidney.

Rx. Bu Zhong Yi Qi Tang (Center-supplementing Qi-boosting Decoction); Modification for the Treatment of Infertility and Sexual Disorders:

• huang qi (Astragali radix), 9–12 g—supplements and lifts spleen qi, strengthens qi and wei (defense)
  
• ren shen (Ginseng radix), 4–6 g—strengthens original qi, strengthens the spleen and stomach, quiets the spirit
  
• bai zhu, 9–12 g—supplements the spleen, strengthens qi, dries dampness, stabilizes wei (defense)
  
• zhi gan cao (Glycyrrhizae radix cum liquido fricta), 3–6 g—supplements the spleen, strengthens qi, harmonizes the formula
  
• dang gui, 4–6 g—supplements and quickens blood, quiets the spirit, moistens the intestine
  
• chen pi (Citri reticulatae pericarpium), 3–5 g—moves and regulates qi, strengthens the spleen, downbears qi, transforms dampness
  
• sheng ma (Cimicifugae rhizoma), 3–5 g—strongly upbears qi, frees the surface
  
• chai hu, 3–5 g—strongly upbears qi, soothes liver qi
  
• du zhong, 6–9 g—supplements liver and kidneys, contains the essence, downbears ascending liver yang
  
• tu si zi, 6–9 g—supplements kidney yang, contains essence, supplements liver yin

Modifications:

• for leucorrhea: cang zhu (Atractylodis rhizoma), 4–6 g; huang bai (Phellodendri cortex), 2–3 g
  
• for fullness in the abdomen: zhi ke (Aurantii fructus), 4–6 g; hou po (Magnoliae officinalis cortex), 4–6 g; mu xiang (Aucklandiae radix), 4–6 g; sha ren (Amomi fructus), 3–5 g

The spleen transforms the energies absorbed from the diet into bodily substances. This ability (which consumes qi and yang) is strained considerably when we assimilate very solid, heavy, and simply hard to digest or fluid components of the diet. Fluids must be reabsorbed adequately from the intestine and either incorporated into tissue, flesh, or blood, or eliminated via the intestine and bladder. If the spleen does not receive sufficient qi or requires too much qi for digesting, fluids begin to collect in the body: the tissue becomes edematous, both in the extremities and, for example, in the abdomen. The sweat becomes damp and sticky, and all other fluids eliminated by the person become turbid and possibly malodorous. Unprocessed thoughts, the continuously turning merry-go-round of thoughts, and the tendency to pondering are manifestations of this dampness on the spiritual-mental level.

In men, this pattern manifests in prostate disorders, but also in disorders of sexuality as erectile dysfunctions; in women, in vaginal discharge or formation of cysts.

Note. The fact that dampness can sink downward always indicates the simultaneous existence of an energetic deficit in this part of the body. The reason is that the kidney—especially kidney yang—is also an uplifting force. When kidney yang is exhausted, an “energetic vacuum” results, into which dampness can sink in accordance with its heavy nature. Furthermore, the warming function of kidney yang is essential for the spleen’s metabolic function.

Feelings of heaviness, sluggishness, reluctance to move, frequent and possibly frustrated urge to urinate to the point of incontinence, damp and itchy genitals, vaginal discharge, soft stools, possibly hemorrhoids.

When the liver is unable to distribute qi evenly, becomes congested, and forms heat, this heat can collect together with the dampness in the lower burner. As a result, we see symptoms of dampheat especially along the course of the liver channel and its network vessels.

Feelings of heaviness and drooping in the lower abdomen, continuous frequent and possibly frustrated urge to urinate to the point of incontinence, tendency to damp-inflammatory changes in the penis, vagina, and urethra, also genital herpes, soft unformed stools, sweating and itching in the genital area.

Tongue: thick, white or yellow, with sticky fur, especially on the root of the tongue

Pulse: thin and slippery with internal disorders; replete, stringlike, and slippery with invasion of external factors; in heat patterns, rapid; in cold patterns, slow

Transform and eliminate dampness, strengthen the qi of the spleen and kidney, clear heat.

Rx. Xiang Sha Liu Jun Zi Tang (Costusroot and Amomum Six Gentlemen Decoction); Modification for the Treatment of Infertility and Sexual Disorders:

• ren shen, 4–6 g—strengthens yuan qi, strengthens the spleen and stomach, quiets the spirit
  
• bai zhu, 6–9 g—supplements the spleen, strengthens qi, dries dampness, stabilizes wei (defense)
  
• fu ling, 6–9 g—strengthens the spleen, harmonizes the center, eliminates dampness, quiets the spirit
  
• zhi gan cao, 3–5 g—supplements the spleen, strengthens qi, harmonizes the formula
  
• ban xia, 6–9 g—dries dampness, downbears lung and stomach qi
  
• chen pi, 4–6 g—moves and regulates qi, strengthens the spleen, downbears qi, transforms dampness
  
• sha ren, 3–5 g—moves qi and supplements the spleen and stomach, transforms dampness
  
• mu xiang, 4–6 g—moves qi, regulates qi in the intestine, supplements spleen qi
  
• zhi cang zhu (Atractylodis rhizoma praeparatum), 4–6 g—dries dampness, strengthens the spleen, clears dampness in the lower burner
  
• ai ye (Artemisiae argyi folium), 3–5 g—warms, supplements, and dries the uterus
  
• chao qian shi (Euryales semen frictum) 6–9 g—absorbs dampness, strengthens the spleen and checks diarrhea, secures the kidney and essence
  
• chao shan yao (Dioscoreae rhizoma frictum), 6–9 g—supplements and supports the spleen, stomach, and lung, nourishes the kidney; when processed, checks vaginal discharge
  
• chao lian zi (Nelumbinis semen frictum), 6–9 g—astringes, strengthens the spleen and checks diarrhea, clears heart heat, nourishes the kidney

or:

Rx. Er Miao San (Mysterious Two Powder); Modification for the Treatment of Infertility and Sexual Disorders:

This formula clears damp-heat:

• zhi cang zhu, 6–9 g—dries dampness, supplements the spleen
  
• huang bai, 4–6 g—eliminates damp-heat, cools vacuity heat in the kidney
  
• che qian zi (Plantaginis semen), 6–9 g—clears heat, promotes urination
  
• shi wei (Pyrrosiae folium), 4–6 g—clears heat, stanches bleeding
  
• fu ling, 6–9 g—strengthens the spleen, harmonizes the center, eliminates dampness, quiets the spirit
  
• shan yao (Dioscoreae rhizoma), 6–9 g—supplements the spleen and stomach, promotes fluid production, supplements kidney qi and yin
  
• ze xie (Alismatis rhizoma), 4–6 g—eliminates dampness, cools vacuity heat in the kidney, clears damp-heat
  
• bi xie (Dioscoreae hypoglaucae seu semptemlobae rhizoma), 4–6 g—separates the turbid from the clear, eliminates dampness
  
• zhu ling (Polyporus), 4–6 g—promotes urination, eliminates dampness
  
• yi yi ren (Coicis semen), 9–12 g—eliminates dampness, treats damp-heat
  
• tong cao (Tetrapanacis medulla), 1–2 g—eliminates dampness, clears heat, functions as courier

or:

Rx. Bi Xie Fen Qing Yin (Fish Poison Yam Clear–Turbid Separation Beverage); Modification for the Treatment of Infertility and Sexual Disorders:

• bi xie, 9–12 g—access to the bladder, liver, and stomach, separates the turbid from the clear, bitter, also clears damp-heat in the skin
  
• shi chang pu (Acori tatarinowii rhizoma), 4–6 g—opens the senses and dissolves phlegm, transforms turbid dampness, harmonizes the center burner, heart, spleen, and liver
  
• yi zhi ren (Alpiniae oxyphyllae fructus), 6–9 g—supplements yang, warms the kidney and spleen
  
• wu yao (Linderae radix), 4–9 g—moves the qi in the lower burner, warms the kidneys, spleen, stomach, and lung

Modifications:

• for ejaculate with reduced viscosity and prolonged liquefaction time: huang bai, 4–6 g; zhi mu (Anemarrhenae rhizoma), 6–9 g
  
• for sperm agglutination: wang bu liu xing, 6–9 g; mu gua (Chaenomelis fructus), 6–9 g; wan can sha (Bombycis feces), 4–6 g

Rx. Long Dan Xie Gan Tang (Gentian Liver-draining Decoction); Modification for the Treatment of Infertility and Sexual Disorders:

• chao long dan cao (Gentianae radix fricta): 4–6 g—drains damp-heat from the liver and gallbladder channels, clears liver-fire

• jiao shan zhi zi (Gardeniae fructus ustum), 3–5 g—clears heat and drains damp-heat in the triple burner

• sheng di huang (Rehmanniae radix exsiccata seu recens), 4–6 g—nourishes kidney yin, cools the blood and yang
  
• mu tong (Akebiae trifoliatae caulis), 3–5 g
  
• ze xie, 6–9 g—eliminates dampness, cools vacuity heat in the kidney, clears damp-heat
  
• shan yao, 6–9 g—supplements and supports the spleen, stomach, and lung, and nourishes the kidney
  
• chao jing jie (Schizonepetae flos frictus), 4–6 g—access to the liver, qi, and blood levels, relieves itching, when processed, less effective for freeing the surface
  
• che qian zi, 6–9 g—clears heat, promotes urination
  
• zhi cang zhu, 4–6 g—dries dampness, supplements the spleen
  
• chao bai zhu (Atractylodis macrocephalae rhizoma frictum), 3–5 g—supplements the spleen, strengthens qi, dries dampness, stabilizes wei (defense)
  
• chao chai hu (Bupleuri radix fricta), 3–5 g—strongly upbears qi, soothes liver qi
  
• chao qing pi (Citri reticulatae pericarpium viride frictum), 3–5 g—regulates liver qi, dries and transforms phlegm
  
• huang bai, 3–5 g—eliminates damp-heat, cools vacuity heat in the kidney, diuretic
  
• yi yi ren, 9–12 g—eliminates dampness, treats damp-heat
  
• chuan niu xi (Cyathulae radix), 6–9 g—access to the liver and kidney, moves the blood and drains dampness
  
• bi xie, 4–6 g—separates the turbid from the clear, eliminates dampness

Modifications:

• For prostate hypertrophy after acute inflammation in younger men two to three of the following softening substances: xia ku cao (Prunellae spica), 6–9 g; mu li (Ostreae concha), 9–12 g; zhe bei mu (Fritillariae thunbergii bulbus), 6–9 g; xuan shen (Scrophulariae radix), 6–9 g

According to TCM, the kidney is the central reservoir of the energies that are significant for maintaining life, for reproduction, and therefore also for sexuality. This pool is emptied both by emotional and physical overexertion, but also by chronic tension—that is, due to liver qi congestion. The inborn potential of essence inevitably decreases during the course of human life. We can slow down this loss only by leading a moderate life, by avoiding overexertion and excess. In any case, the kidney depends on being refilled by receiving postnatal potential (jing). Otherwise, the result is kidney yin or jing vacuity.

Vacuity of the kidney and hence also of sexuality is often influenced by an insecure future and the resulting existential fear. Unemployment, involuntary mobility, and the loss of professional, biographical identity show that the social safety net has become coarse-meshed and that life security is disappearing. All this can cause profound insecurity. Other mechanisms that “get under the skin” also affect this fundamental level, such as any experience of trauma in the sexual realm, violence, or humiliation.

Physical overexertion—this includes, for example, childbirth, pregnancies, and serious hormonal strain such as after attempted artificial fertilization—most commonly results in an exhaustion of kidney yang, but can also result in a weakness of kidney yin, which in turn cause disorders in other viscera and bowels. This weakness of kidney yin appears mostly in men or in overexertion of the mental capacities (see spleen weakness). In kidney vacuity, we will often find a vicious cycle in men: weakness of kidney yin leads to vacuity fire with an increased sex drive, whose expression in excessive sexuality in turn further aggravates the yin vacuity.

Fear and insecurity, feelings of panic and heat, increased libido, insomnia, disquietude, dizziness, heat symptoms (e. g., a red face, hot palms and soles), pain in the lower back, exhaustion, “steaming bones,” tinnitus, “light” feeling in the head, impaired hearing, all symptoms aggravated by lack of sleep or after sexual activity because of the exertion of yin, a gaunt appearance, constipation in cases of insufficient fluids.

Tongue: thin, reddish, dry

Pulse: thin to the point of disappearing, rather superficial and rapid

Strengthen the spleen, stomach, and kidney.

Rx. Da Bu Yin Wan (Major Yin-Supplementing Pill); Modification for the Treatment of Infertility and Sexual Disorders:

• zhi gui ban (testudinis carapax et plastrum cum liquido fricti), 9–12 g—nourishes yin, anchors yang, cools and nourishes blood, supplements the heart
  
• zhi mu, 6–9 g—clears heat, supplements yin, and moistens dryness in the lung, stomach, and kidney
  
• huang bai, 3–5 g—eliminates damp-heat, cools vacuity heat in the kidney, has a diuretic effect
  
• shu di huang (Rehmanniae radix praeparata), 6–9 g—supplements blood, nourishes kidney and liver yin, strengthens essence

Modifications:

• for vacuity heat or internal heat: di gu pi (Lycii cortex), 6–9 g; mu dan pi, 4–6 g; bai wei (Cynanchi atrati radix), 4–6 g
  
• for disquietude and insomnia: long chi (Mastodi dentis fossilia calcinata), 6–9 g; suan zao ren, 9–12 g
  
• for night sweating: fu xiao mai (Tritici fructus levis), 6–9 g; wu wei zi (Schisandrae fructus), 4–6 g; nuo dao gen (Oryzae glutinosae radix), 6–9 g
  
• for exaggerated libido to cool the ministerial fire: ci shi (Magnetitum), 9–12 g; zhi mu, 9–12 g; huang bai, 6–9 g
  
• for reduced sperm count: gou qi zi (Lycii fructus), 6–9 g; nü zhen zi (Ligustri lucidi fructus), 6–9 g; tu si zi, 6–9 g
  
• for an increased number of abdnormal sperm cells: dan shen, 6–9 g; tao ren, 6–9 g; hong hua, 0.2–0.3 g; added after decocting

Exhaustion of kidney yang also has a lasting effect on the qi and yang of the spleen. At the same time, dampness accumulates and therefore we see the pattern of “repletion cold-damp”—or in other words, a “damp uterus”. Here, pregnancy will rarely be possible, even by means of in vitro fertilization.

In female patients, we see cold sensations in the lower abdomen, legs, and vagina, with greater cold at night (midnight), rising from the uterus so strongly that the patient wakes from her sleep, watery vaginal discharge, aggravation of symptoms by rain and cold, a pale swollen face, edema, lack of appetite but overweight, diarrhea or soft or sticky stools, frequent urination, clear urine, and severe exhaustion. In male patients, watery fluid is discharged from the penis during bowel movements, there is a feeling of cold and dampness at the dam (CV-1), as well as possibly incontinence.

Tongue: swollen, with tooth marks, moist slimy fur that can be white, grey, or even black

Pulse: sunken, slow, and slippery, especially in the spleen position

Strengthen kidney yang, warm, transform dampness.

Rx. Zan Yu Dan (Procreation Elixir); Modification for the Treatment of Infertility and Sexual Disorders: