There are seven aspects of the physiological development of the organism. Among these, the first concerns human conception is said to occur through both primary and secondary causes. The primary cause of conception refers to the simultaneous conjunction in the mother's womb of a consciousness inclined to rebirth, with the father's semen and the uterine blood. The secondary causes are the five elements, without which physical development would be impossible. When consciousness enters the womb, driven by its own past actions and by diverse conflicting emotions, its natural propensities and karma should conform to those of the prospective parents . The mind that animates the embryo is initially devoid of any sense of belonging to a particular sex, regardless of its status in past lives. However, if due to the predilections of past karma a boy is to be born, the consciousness dislikes the father and is attracted to the mother, while identifying itself with the father's semen , and developing into a male consciousness. When the opposite happens, the mind feels anger towards the mother and attachment towards the father, identifying itself with mother's "blood".

There are certain cases when, owing to disorders of semen and uterine blood, conception is unlikely to occur. When wind is diagnosed as the cause, both liquids have the following symptoms: rough to the touch, dark colour, and astringent taste". Alternatively when bile is the cause, the symptoms are sour taste yellow colour and vile odour . When phlegm is the cause they are pale grey, sticky, sweet and cool to touch . When blood is the cause they are putrid . When phlegm and wind are the cause they disintegrate . When blood and bile are the cause they are extremely turbid and akin to pus . When phlegm and bile are the cause they coagulatey. When wind and bile are the cause, they are dehydrated and exhausted. All these conditions are difficult to cure. However, when the cause is a combination of these, the liquids resemble faeces and urine, and are impossible to cure.

Conception is also inhibited by the absence of the five elements - earth, water, fire, air, and space - which are responsible respectively for the properties of solidity, cohesion, maturation, growth, and their underlying condition . At the moment of conception both semen and uterine blood must be flawless . Healthy sperm is a white liquid, heavy, plentiful, and both sweet and astringent in taste; while sound uterine blood is crimson like the blood of a hare, and its stains are easily washed off. This blood is produced by the nutritional essence of assimilated food between the sixteenth and thirtieth days of each month when the "solar" reproductive fluids of the female are in the ascendent and are carried from the reservoir for reproductive fluid to the womb by two channels. In the first half of each month the "descending purgative wind" discharges the blackish blood through the vagina over a three day period, making the womb ready for conception. Female menstruation begins around the age of twelve once nutritional essences arc no longer entirely consumed by the maturing organism, and ceases with the menopause around the age of fifty, due to a general weakening of the organism.

Conception itself may take place during the nine days after the end of a menstruation. If it occurs on the first, third, fifth, seventh or ninth day, a boy will be born. If it takes place on the second, fourth sixth or eighth day, a girl will be born. Twelve days after the onset of menstruation, the womb entrance closes like a lotus at sunset and conception cannot take place until the next cycle. The sex of a child is determined not only by the date of conception but also by the preponderance of either semen or uterine blood in the embryonic mixture. Should sperm prevail over blood, a boy will be born, and vice versa. Equal quantities lead to the birth of a hermaphrodite. If the embryo is divided by wind, twins, triplets and so forth will be born, their sex being determined by the same ratio between sperm and uterine blood

There are four kinds of consciousness: an ordinary person enters the womb ignorant of past and future births, and remains so in the new body; the consciousness of a "universal emperor" or of one who has entered the stream to enlightenment enters the womb aware of past and future births, but while in the womb loses this knowledge; the consciousness of a novice bodhisattva and of a self-centred buddha (pratfekabuddha) is cognizant of preceding and future births while entering the womb and being reborn, but having resided in a new body becomes ignorant; and the consciousness of the advanced bodhisattva is aware of former and future births, and does not lose this knowledge in a new body. Wishing to propagate the teaching of the Buddha, such bodhisattvas freely choose their place of rebirth entering the mouth of the future father and through his semen, reaching the womb of the mother.

In the course of conception, the semen generates bone tissue and the spinal cord, while uterine blood generates muscle tissue, blood and the viscera.

Consciousness itself gives rise to the sense organs. However, for the embryo to develop into a sound organism, the secondary causes known as the five elements are also essential since they combine with each of the three primary causes to produce tissue, viscera and sense organs. During the formative period, the embryo receives nutritional essences from the mother via the reservoir for reproductive fluid and the umbilical cord. Over a period of thirty eight weeks following conception, the development of the embryo and the foetus follows a series of well defined stages, after which it turns upside down and leaves the womb. Pregnancy may be protracted usually when the mother has lost a lot of blood, which slows down the development of the embryo, or if she over-ate, causing steatosis of the womb, or if the passage of the baby has been blocked by a dysfunction or stagnation of wind. In these exceptional circumstances pregnancy may last for ten to twelve months, or longer. On the other hand Rahula, the son of Sakyamuni Buddha is also said to have stayed in his mother's womb for six years without sign of defect. When birth is imminent the position of the foetus within the womb will indicate its sex. The actual procedures for childbirth and maternity care require the presence of a woman who has experienced childbirth.

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