6 Patient Support

23 Inviting the “Heavenly Spark”—Shen in the Support of Couples in Fertility Treatment
Ruthild Schulze, Gudrun Kotte

“[…] a person’s shen is an active and initiating power, tied to individuation, that is bestowed by Heaven shortly before birth, … enters the person as he or she comes into being, resides there throughout the entire life—as the person’s individual physical disposition, temperament, personality, consciousness, and mental power… Seen from this perspective, shen is a cosmic power that envelops the person, but simultaneously constitutes a particularly subtle form of qi within the person and gives him or her individuality for the duration of life.”9

Shen has at least as many different meanings as the English term “spirit.” Shen can be understood as divine power, as individual personality, as life force, as consciousness, and also as divine-cosmic efficacy. In this chapter, we address those aspects of shen that are particularly relevant to the practical support of a couple during fertility treatment. This includes, in particular, the following levels of meaning:

• shen as consciousness and mindfulness of the practitioner
  
• shen as power of the heart and spiritual connection of the couple
  
• shen as heavenly spark during conception of the child

While this chapter focuses on statements about shen in Chinese medical literature, we will depart from the theoretical level in some instances, to show what kind of living and practical help the concept of shen can offer to contemporary TCM practitioners. These practical tips can only be approximations and recommendations, not a guideline for standard therapy, because in that case we would miss the immediate potential of the present moment and therefore shen. Which competences, emotions, and experiences we include in a therapeutic approach that is oriented towards shen depends, above all, on one thing: on our own shen!

Shen as Consciousness and Mindfulness of the Practitioner

The ancient Chinese medical texts provided clear notions on the ethics and personality of an excellent physician. Thus, for example, the gist of statements in the first and 55th chapters of the Ling Shu (Magic Pivot) in the Huang Di Nei Jing ( The Yellow Emperor’s Inner Classic^* is that a physician with a good shen should be able to diagnose a beginning disharmony on the basis of small changes before it has manifested in symptoms. A practitioner’s shen is expressed not only in his or her professional skills, but also in the presence, attentiveness, and intuition, in the consciousness, warm heart, and clarity and intelligence. Shen resides in the heart and inspires all highly developed mental functions that make us human:

^* The Huang Di Nei Jing is regarded as the oldest and most commonly quoted medical text in China’s medicine of systematic correspondences. It consists of a systematic collection of treatises by unknown authors that were compiled around the 1st to 3 rd centuries CE. The currently known division of the text into two parts of 81 chapters each, called the Su Wen (Elementary Questions) and Ling Shu (Magic Pivot), did not always exist as such. Originally, there appear to have been two additional parts in the Nei Jing corpus, namely the Tai Su and the Ming Tang. Both were supposedly lost in the later Song period. Compare Unschuld 200314.

• sensitivity
  
• inspiration
  
• spiritual aspirations
  
• the ability to express thoughts, feelings, and emotions

A strong shen radiates outward from the forehead and eyes.

Shen as Self-knowledge

Self-reflection, not only at this point, gives the treatment clarity and therefore shen. Thus, it is said in Chapter 13 of the Su Wen ():

“You would then very easily realize that those who carry shen and energy within them awaken to a flowering life and lead a good life compared to those whose shen and energy have been lost.”^*

Under certain circumstances, a good shen can involve the insight that you personally may not be the ideal provider of fertility treatment right at that moment due to your personal concerns. In most cases, though, just the realization of your own sensitivities will already clear up unconscious blockages. Because shen stands for consciousness and mindfulness, it is subject to change depending on the situation and must be acquired anew again and again. Regarding this topic, Chapter 73 of the Ling Shu states:

“It is absolutely necessary to model yourself after the physicians of antiquity, to learn from them and to show the validity of their teachings also in the present, to pay attention to the most subtle and also the most insignificant conditions of any prevailing state of qi within the body, and to also transmit this again and again to future generations. A physician with only minor qualifications will pay no heed to such subtleties; the highly-qualified physician, however, will greatly value these details. The reason for this is that the states of qi inside the body are so inconspicuous and formless that they are really as mysterious as the spirits.”

It is therefore advisable to foster our concentration and presence and thereby cultivate our shen by means of personal reflection, mindfulness exercises, and self-questioning.

Shen as Clarity between Practitioner and Patient

• Do I know both partners?
  
• How is the contact between myself and the woman and between myself and the man?
  
• How do I rate the mental state of the couple?
  
• What is my attitude towards them as a couple? Am I moved by certain thoughts or feelings? With whom? When?
  
• What do I expect from them? What do they expect from me?

^* The quotations from the Huang Di Nei Jing Su Wen and Ling Shu are based in particular on Schmidt12, but have been slightly modified in some places, following Henry C. Lu¹⁰ and Fu Baotai².

If the relationship between the practitioner and the couple is disturbed, this also affects the shen of both sides negatively, which will have consequences for the quality and success of the treatment.

General signs of a shen disturbance include:

• diffuse or lacking eye contact
  
• vague or unclear language
  
• incoherent talking, as well as disconnected thoughts and speech

In this context, it is also indicative if a person repeatedly evades questions or contradicts him- or herself in their statements. If you are unable to achieve free-flowing communication even after repeated attempts at clarification, a fundamental requirement for any successful treatment is lacking. The Chinese classics also describe treatment circumstances that make success impossible. A clear shen allows us to recognize such cases and to let go without judgment. Thus, for example, Chapter 9 of the Ling Shu lists a number of circumstances or patient characteristics under which an experienced physician refuses to treat. Every treatment and every patient is an individual case and requires new sensitivity, as is summarized, for example, in the 29th chapter of the Ling Shu:

“When coming to an unfamiliar land, you first have to familiarize yourself with its customs and habits; when visiting the households of unfamiliar families, you have to familiarize yourself with their likes and dislikes; when participating in a celebration, you have to concern yourself with its basic meaning and ritual configuration; and when visiting a patient, you have to grapple with the therapeutic approach that is appropriate in each particular case.”

The process of clarification at the beginning of treatment must also always include the general framework such as treatment place, time, and costs, as well as information on the particular situation on the basis of which the couple has entered into TCM treatment. For the treatment to succeed, it is important to know what the couple has experienced and learned in the time since attempting to conceive a child. The effects of an unfulfilled wish for a child on the couple’s lifestyle and sexual intercourse are part of this initial clarification process as well.

Shen in the Treatment Situation

Translated into modern clinical practice, this means a consistent discussion of the couple’s positive as well as negative beliefs. Fixations like “We will never succeed in this,” “We do not deserve this,” or “This is the punishment for previous abortions” present obstacles for treatment. A clear shen in the practitioner includes the ability to clearly and consistently press ahead with the investigation of obstacles. The practitioner does not share the couple’s “blind spots,” but uncovers them with kindness. The following principle applies: you may address anything, including lack of connectedness and hopelessness. Opening up to reality with all its consequences strengthens the shen of the couple and of the practitioner and is an ideal starting point for successful patient care. You should turn to any physical treatment only after these essential questions have been resolved. Chapter 25 of the Su Wen also stresses that acupuncture cannot have much effect if the shen level is not cleared:

“To obtain full efficacy in the treatment with acupuncture, you must first heal the shen. Afterwards, you must determine the state of the five viscera by taking the pulse … Only then can you apply the needle.”

According to the “Yellow Emperor,” every practitioner should pay special attention to the shen. With regard to acupuncture, striving for the shen means the greatest possible attentiveness and concentration. Additionally, we can invite the shen by selecting special acupuncture points and by the method of needle manipulation. In the framework of this chapter, it is impossible to discuss shen in relation to needling techniques in more detail. As an example, let me briefly introduce the supplementing needling technique as it is explained in Chapter 73 of the Ling Shu:

“[…] for this purpose, the physician’s attitude must be sincere, calm, persistent, and confidence-building; the needle must not be removed immediately after introducing it … and the hole of the puncture site on the skin must be closed afterwards … All in all, we can thus say that you must never disregard the importance of restoring the balance of shen when needling.”

Both during conversation and during needle contact, it is essential to be completely present and to devote your undivided attention to the event. In this way, the unclear background situation of the couple’s childlessness can reveal itself more easily.

Similar to shen in the contact with oneself and in communication with others, the shen aspect in a treatment situation also facilitates a sharpened perception of irritations or confusions. By this, we mean disturbances in the clinical process that are normally ignored or appear to be inconspicuous or accidental. This can include, for example, recurring problems with scheduling a visit for the couple, but also “accidents” during a session such as dropping a tea cup. An irritated contact or a shen disturbance can express itself in a needle that cannot be inserted by means of the usual routine or a mix-up of acupuncture points during needling. If irritations or conflicts in the contact with the couple persist in spite of the greatest possible openness and presence of the practitioner, you should reconsider the continuation of treatment.

Shen as Power of the Heart and Spiritual Connection of the Couple

Shen as Expression of a Shared Will

“In couples with identical changes, identical thinking, identical magnanimity, identical humbleness, with complete likeness of heart, a fruit will arrive in the mother’s womb … With the same convictions and activities, the same loftiness and lowliness, a child is bound to spring forth, the parents encounter the spirit shen, and a child must come into being.”5

Here, shen contains the meaning of expressing a corresponding mental attitude and individual personality. According to the Fo Shuo Bao Tai Jing, to invite the heavenly spark, the couple’s mode of thinking must be identical. The question of identical conviction means in this context to inquire about the couple’s shared efforts to produce a child. Couples who have a clear shen level will also tend to be congruent in their efforts to invite the child. The likeness of heart, the identical magnanimity manifests here as the expression of a shared wish, a shared sense of purpose. It is only under these conditions that the shen of the child will meet the parents, the Sutra states. It is therefore advantageous to get to know both partners personally in at least one appointment. This also applies when it is a lesbian or gay couple who are undergoing fertility treatment, in which case only the fertility of one partner appears to be relevant.

The Shen Contact between the Partners during Treatment

“To invite the child enthusiastically to come to this world, the mother is allowed to express the deepest and most heartfelt love. You should tell the little being: Your mother and your father love you more than anything; they wish that you grow soundly and arrive at your parents’ side by a good birth.”17

Shen as Heavenly Spark during Conception

In this quotation, shen stands for a cosmic or even divine power that is both within us and surrounding us and that we can only realize if we “look very closely” and “have an open and sensitive heart.” Shen is communicated via the consciousness and the heart. Shen works as if the sky were cloudless, as if the world were bathed in radiating brightness as a result. This cosmic side of shen is what we mean when we speak of the heavenly spark. The heavenly spark shen must be present in the woman’s body before a child can be created. The place where shen is active, the place of change, lies inside the woman, in her yin. The waiting period when we are uncertain about the success of conception invites us to feel into the invisible, but also allows just as much room for negative projections, pessimistic expectations, or fears. Even where early ultrasound examinations facilitate the visualization at an early point in time, the couple is never spared this phase of waiting. As a result, even artificially supported conceptions are accompanied by a certain small period of introspection. Directing confident hope and visionary power to this time span are creative inspirations on the basis of the wood phase. Because wood gives rise to fire, we can hereby invite the heavenly spark. Thus Zita West and Birgit Zart, for example, as Western authors promote visualizing cellular processes during conception in this phase of fertility treatment.16,18

In the following paragraphs, we use selections from the Chinese medical literature of different periods to investigate which additional constellations are most favorable for the arrival of shen. For this purpose, we quote primarily texts from the Han, Ming, and Song periods, without being able to discuss the particularities and background of each dynasty in more detail here (see Riegel¹¹).

Correct Timing

“Thunder will quickly raise its voice if there is somebody who acts carelessly because such a person will engender children who are imperfect.”11

While the climatic rules are interesting, they are less relevant to the question of the shen aspect than the following popular recommendations. As necessary preconditions for the fertile encounter of man and woman, Chinese texts emphasize mainly the self-cultivation of both the man and the woman, the observance of natural cycles and laws, and erotic passion, depending on the predominant philosophical-religious influence. Among these, the last one is most important from the Western perspective for inviting the shen.

Internal Self-cultivation

“it is necessary to [preserve] a heart that is free from the desire to harm others. Reverence towards the elderly, concern for children, compassion for orphans, sympathy for widows, help for others in distress, rescuing others from danger … to the point where my heart becomes one with the heart of heaven, one with its principle. In this way, how could one end up in the miserable position of being unable to engender children?”11

In this ancient Chinese text, the benevolence of the heart is described as a guarantee for conception. Numerous texts regard virtue and harmony in the parents’ nature as an important requirement for inviting the heavenly spark. Even though fertility treatment cannot concern itself with calling on the man and woman to engage in charity, cultivating mindfulness as a quality of the heart is certainly linked to a considerable strengthening of the shen and therefore a helpful support of fertility treatment.

Acceptance of Natural Cycles and Laws

“There is in fact no need to employ artificial methods or prescribe supplementing medicinals … The success of farmers and simple folk who act with no intention lies in the fact that they conform to the rules of nature. They have internalized the laws of nature.”11

These texts are written with the basic assumption that it is simply the way of nature to produce descendants. They say that if people succeed in cultivating themselves in such a way that their actions are unintentional, impartial, and wasteful like nature herself, they are bound to produce a child. In the Chinese worldview, humans cannot be perceived as separate from cosmic and natural rhythms. Inviting the heavenly spark thus depends on the quality of the heart and on the human approximation to the characteristics and cycles of heaven and earth. A convincing proponent of this view was the pharmacologist Yuan Huang () from the Ming period (1533–1606). From a Daoist priest, he had received the prophecy that he would die young and without descendants. His Zen master recommended that he should follow the Buddhist path of accumulating merits. Yuan Huang took this advice to heart. As a result, he not only became a father but also a resolute advocate of believing in the human ability to change one’s predestined fate by striving for harmony with nature and cultivating compassion and love in the heart. His work Qi Si Zhen Quan ( True Notes on Praying for Descendants) therefore is directly addressed to men who—like himself in the past—were hoping for descendants in vain.¹¹

The significance of this approach to fertility treatment lies in the space for personal assessment and in the respective openness of the participants. The faith in a kind of predestiny or a deeper justification for “unjust strokes of fate” can imply relief and acceptance for both sides. For the patient and the practitioner, this attitude facilitates strength and confidence in spite of adverse starting conditions, holding out in treatment periods without visible success, or under certain circumstances, dealing with frustration and defeat.

Erotic Passion

Another essential aspect of inviting the heavenly spark is joyful passion. The very early literature on childbirth, but especially texts on the topic of guang si (increasing descendants) from the 15th and 16th centuries on devote much attention to the relationship between fertility and the emotional state of the woman.4 Daoist texts in particular stress the need for mutual pleasure and passion during the act of conception. In this context, the Daoists were not necessarily only concerned with creating descendants. Joyful, conscious sexual intercourse was also seen as a guarantee for longevity and health, in the nei dan school even as an alchemistic path to initiation. The Daoists not only teach an “art of the bedchamber” that is entertaining and satisfying for both sides, but even assume that conception cannot succeed without the woman’s orgasm. Sexual passion in man and woman is seen as the manifestation of heaven and earth, as universal and individual erotic pleasure, in the words of a Daoist master:

“Of all the things that benefit humans, none can be compared to sexual intercourse. It is fashioned in the image of heaven and receives its form from the earth, it balances yin and rules over yang … In this way, the seasons follow each other, the man gives, the woman receives; above is action, below receptivity.”¹

According to the above-mentioned Yuan Huang, conception occurs when the sexual union is joyful, spontaneous, and without knowledge or thoughts. Neither yin nor yang are able to conceive a child on their own, therefore the sexes have to meet in harmony:

“[…] when wives are happy and in harmony, children will come—just as the manifestations of springtime are the result of harmony between heaven and earth.”³

This is the moment when the heavenly spark (literally: the heavenly qi) descends and jing begins to lead the new vital processes.

With regard to fertility treatment, this information means most importantly that we should encourage the couple to show more equanimity and pleasure in their sexuality. The following questions are illuminating here:

• When do you feel attracted to your partner?
  
• Do you act on and express your erotic feelings in these situations?
  
• How much value do you place on the stimulation and fulfillment of the orgiastic needs of your partner?
  
• In your sexual intercourse, how do you invite the child?
  
• How has your sexuality changed since your wish for a child?

Generally speaking, couples who desire a child tend to leap to the topic of sexuality. The problematic of “sex by the clock” has by now been discussed sufficiently in public that there is little shyness in speaking about it. As such, the decline of erotic passion in couples undergoing fertility treatment is no longer a stigma, but nevertheless must still be overcome as a fact. Discussing erotic passion and sexual intercourse is important in the context of fertility treatment even in cases where the couple is completely dependent on invasive medicine in its desire for a child.

At this point, we invite the couple to connect with the fire and shen aspect of sexuality: from fire, earth is engendered. Due to the problems with becoming pregnant, sexuality is in danger of becoming too controlled. If metal conquers fire, the pleasure, spontaneity, and passion around conception can be pushed too far into the background. Directing attention to the level of the heart and shen usually offers a very welcome change in the couple’s love life. When man and woman (yin and yang) are able to meet with their shen, they share the highest pleasure and mirror the creative spontaneity of nature. To share the highest pleasure means to invite the highest. To allow the intimacy, passion, and fullness of love to return and to meet each other in sexual intercourse truly heart to heart is an invitation to the heavenly spark that could not be more powerful. In Chinese, to open the heart (kai xin ) is an expression for “to be happy.” The expression “to have joy” (you le ), on the other hand, stands for being pregnant.

Shen and Jing

Discussion

Pregnancies can also occur under forced circumstances. This refers not only to sexual rape; here we can certainly also consider, for example, the view of the author Theresia Maria de Jong6 who describes invasive methods like IVF and ICSI as “rape of the egg and sperm.” We do not know yet what the results are when a child has been created in this way. The known historical Chinese texts apparently do not consider such cases; in these texts, conception does not happen without the heavenly spark. They do warn, however, against unfavorable conditions and an unlucky moment of conception because they fear negative results for the constitution of the child. We can likewise assume consequences for the constitution of those children who have been created by means of invasive fertility treatments. The practitioner should be able to recognize and name clear signs of overexertion in the couple, such as after repeated IVF or other treatments. If these invasions, from the diagnostic perspective, constitute too great a strain and limitation for physical and mental health, you should address the possibilities of treatment breaks, Godparenthood, adoption, and fosterparenting.

Concluding Remarks