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By Yi-Li Wu[caption id="attachment_13767" align="aligncenter" width="1477"] Figure 1. Depictions of boys at play were a popular Chinese decorative motif during the sixteenth century, imbued with auspicious meaning and conveying hopes for male offspring. This porcelain bowl was made in Jindezhen during the Jiajing reign period (1522–66). From the collection of the Metropolitan Museum of Art, New York, NY. Gift of Denise and Andrew Saul, 2001. Accession number 2001.738. On-line at https://www.metmuseum.org/art/collection/search/64484[/caption]Throughout imperial China, a family’s well-being and longevity required the birth of sons. [Fig. 1]  Sons performed the ancestral rites, inherited land, and were responsible for supporting aged parents. And only men could take the examinations for government office which conferred elite socio-economic status. But at age 40, Liu Xiaoting was still sonless (wu zi). He appealed to the physician Gong Tingxian (15`38-1635), promising him rich recompense if he could help. As Gong recorded in his influential treatise, Curing the Myriad Diseases (Wanbing huichun, preface dated 1587), Liu’s “male member was weak, and his semen was icy cold.” Furthermore, his pulses were flooding when felt at the first position (cun) at the wrist, but deep and faint at the third position (chi). Gong’s diagnosis: a profound deficiency of primordial qi (yuan qi), the source of all the body’s vitalities and material manifestations. This was caused, he explained, by excessive drinking and sexual indulgence.Depletion from debauchery was a common diagnosis for upper-class men of the time, those who had the means to own concubines and patronize courtesans. Doctors agreed that such carousing exhausted the body’s vitalities, not least because male semen was produced from “essence” (jing), the vitality that enabled growth, generation, and reproduction. Besides depleting the body, excessive outflows of semen harmed the kidneys, the organs that produced, stored, and transformed essence.  To cure Liu, Gong prescribed a 16-ingredient formula called “Elixir to Solidify the Root and Strengthen Yang” (Guben jianyang dan) (see below).  After taking one recipe’s worth, Liu felt that his nether parts were warm again.  After an additional half-recipe, he felt recovered. To his great joy, he then begat a son. Liu subsequently shared the formula with a Liu Boting and a Liu Min’an (probably kinsmen) who also used it successfully. [Figs. 2 and 3][caption id="attachment_13772" align="aligncenter" width="1200"] Figs. 2 and 3: The recto and verso of a page from a seventeenth-century edition of Gong Tingxian’s Curing the Myriad Diseases, showing his recipe for Elixir to Solidify the Root and Strengthen Yang (Fig. 2, recto) and explaining how he used it to cure Liu Xiaoting (Fig. 3, verso). Note that Chinese books were read from right to left. From Expanded edition of “A Collection on Curing the Myriad Diseases” by Mr. Gong Yunlin, Confucian doctor (Zengbu ruyi Gong Yunlin xianshen Wanbing huichun ji), Renren shushe woodblock edition, 1641. Yulin was Gong Tingxian’s sobriquet (hao). In the collection of the Berlin State Library, Germany. Digitized and on-line at the Staatsbibliothek zu Berlin-PK digitalisierte Sammlungen, permanent URL: http://resolver.staatsbibliothek-berlin.de/SBB000160F000000000.[/caption]Gong Tingxian placed Liu Xiaoting’s case in his discussion of “seeking descendants” (qiu si), which was part of a larger section on “women’s diseases” (fu ke).  “Descendants” here referred specifically to sons.  Although Chinese medical writings on childbearing focused primarily on the female body, people had also long recognized that male ailments could impede conception. These concerns were especially salient in Gong and Liu’s time, when population pressure, urbanization, and commercialization were creating new forms of socio-economic mobility and instability.  As Charlotte Furth has shown, this inspired a proliferation of writings on male self-cultivation and producing sons. Such material appeared in various textual genres, and it was not uncommon to find the reproductive illnesses of men discussed in chapters on women. These discussions assumed, furthermore, that a deficient man might still be able to father daughters, but that only a properly regulated male body would create sons. The question was how best to achieve that regulation.In medical discussions of infertility, cold could refer to somatic sensations of chillness, as well as to a sense of deficiency and absence of vitality.  Writings on women were primarily concerned with ensuring the ample and free flow of female blood, which constituted the female seed, nourished the fetus, and later transformed into breast milk.  But doctors also worried about coldness in the womb, whether from an invading wind, or arising from internal depletion. Cold would cause female blood to stagnate and become corrupt.  But concerns about female cold were also expressed in terms of agricultural metaphors which portrayed the womb as a field that needed to be warm and nurturing to receive the male seed.Women with cold wombs would simply not produce children. But when couples produced only girls, this suggested deficiencies in the man, who played a key role in determining the child’s sex. The various theories of sex selection might differ as to details, but they agreed that a man could produce boys by shooting (she) his seed into the woman on certain days, in a certain manner, at a certain point in the copulatory act.  Particularly important was the belief that both men and women released reproductive seed during orgasm, and that the fetus’ sex was determined by the seed that came last.  A man who wanted sons thus needed to bring his female partner to climax before releasing his own seminal essence. His semen also needed to be sufficiently “dense” (mi), lest it dribble uselessly out of the womb.Coldness in men was thus associated with impaired copulatory function, manifesting as cold and watery seed and as a weak penis unable to control its emissions. Gong Tingxian’s fertility formula echoed this understanding, relying heavily on substances that were classified as “principal drugs for treating spermatorrhea” and/or as “principal drugs for treating impotence” in Li Shizhen’s authoritative  and encyclopedic Compendium of Materia Medica (Bencao gangmu,preface dated 1590).  At the same time, Gong’s formula implicitly rebuked those who would treat male coldness with heating drugs.  This objection was rooted in a particular understanding of how cosmological yin and yang forces expressed themselves in the male body.To simplify enormously: yang referred to things that were external, active, and hot, while yin was internal, receptive, and cool. Men were the yang of humankind, and male potency and fertility were understood as expressions of bodily yang. As a result, people routinely tried to treat sonlessness with heating drugs. But some doctors warned that too much heat would damage and consume yin, harming the kidneys (yin) and consuming its essence (yin). Excessive heat would sicken the man, and even if he managed to conceive a son, the heat would remain as a latent poison in the fetal body and the boy would die young. Instead, they argued that the proper way to regulate yang was to address the underlying deficiency of yin.  Gong Tingxian shared this viewpoint, and the key drugs in his prescription acted by nourishing bodily yin and the kidneys.  As Liu Xiaoting swallowed the dozens of pills that Gong prescribed, he may have had initial doubts about their efficacy. But the birth of his son would have convinced him that, at least in this instance, Gong’s approach to male coldness was the correct one.~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~Elixir to Solidify the Root and Build Yang (Guben jianyang dan)Dodder seed (tu si zi) cooked in wine, one and a half taels[1]White poria, root end (bai fu shen), skin and woody bits removedDioscorea (shan yao), steamed with wineAchyranthes root (niu xi), stems removed, washed in wineEucommia bark (du zhong), washed in wine, skin removed, roasted until crispAngelica root, main body (dang gui shen), washed in wineCistanche (rou cong rong), soaked in wineSchisandra fruit (wu wei zi), washed in wineBlack cardamom (yi zhi ren), stir-fried in salt waterTender deer antler (nen lu rong), roasted until crispOne tael each of the abovePrepared rehmannia (shu di), steamed in wineDogwood fruit (shan zhu yu), steamed in wine, the pit removedThree taels each of the aboveSichuanese morinda (chuan ba ji), soaked in wine, the heart removed, two taelsTeasel (xu duan), soaked in wineMilkwort (yuan zhi), processedCnidium seeds (she chuang zi), stir fried, the husks removedOne and a half taels each of the aboveAdd:Ginseng (ren shen), two taelsGoji berries (go ji zi), two taelsGrind the above into a fine powder, and mix with honey to form pills as large as the seeds of the parasol tree. For each dose, take 50 to 70 pills on an empty stomach, washed down with salt water. With wine is also fine. Before bedtime, take another dose. If the woman’s monthly affair is already concluded, then this is the time for planting sons, and if one takes three doses a day, that is no problem.  If essence is not stable, then add dragon bone (long gu) and oyster shell (mu li), heated in fire and quenched in salted wine three to five times. Use one tael, three mace of each. Moreover, add five taels of tender deer horn.[1] The weight of the tael (Ch. liang) has varied over time, but during Gong Tingxian’s lifetime would have been equivalent to approximately 37 grams.  A mace (Ch. qian) is one-tenth of a tael.~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~Yi-Li Wu is a Center Associate of the Lieberthal-Rogel Center for Chinese Studies at the University of Michigan, Ann Arbor (US).  She earned a Ph.D. in history from Yale University and was previously a history professor at Albion College (USA) for 13 years.  Her publications include Reproducing Women: Medicine, Metaphor, and Childbirth in Late Imperial China (University of California Press, 2010) and articles on gender and the body; medical illustration; forensic medicine, and Chinese views of Western anatomical science.  She is currently completing a book manuscript on the history of wound medicine in China.