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Peng Deqi, a private practitioner in Zhangming Town, Jiangyou City, Sichuan Province

Gardenia and Fermented Soybean Decoction is seen in the "Treatise on Cold Damage Diseases," composed of Gardenia and Fermented Soybean. It is primarily used to treat cold damage diseases, "after sweating, vomiting, and purging, leading to restlessness and insomnia, and in severe cases, causing frequent tossing and turning, restlessness and stifling," as well as symptoms such as "stuffiness in the chest," "severe epigastric pain," and "softness below the heart" that occur after sweating, vomiting, and purging in cold damage diseases. If accurately diagnosed, the treatment is quite effective.

Historical commentators have generally interpreted Gardenia and Fermented Soybean Decoction in two main ways: one considers it an emetic, while the other views it as a heat-clearing and dispersing agent. The divergence in these interpretations lies in the understanding of the efficacy of Fermented Soybean (also known as Xiangchi or Fermented Soybean). The former view holds that Fermented Soybean is an emetic, as Ke Yun-bo stated: "Fermented Soybean resembles the kidneys in shape, and when processed into chi, it floats upward, enabling the expulsion of pathogenic factors from the heart and abdomen through the mouth, thus relieving the chest and abdomen." The latter view considers Fermented Soybean a dispersing agent, as stated in the "Treatise on Cold Damage Diseases" edited by the Hubei College of Chinese Medicine: "Fermented Soybean disperses and relieves stagnation in the chest." Although these interpretations differ, they share a common view, such as "expelling pathogenic factors and relieving restlessness," though the methods of expelling pathogenic factors vary. This theory of expelling pathogenic factors and relieving restlessness is somewhat difficult to reconcile, as it mentions "deficiency restlessness," yet advocates the use of emetic formulas or dispersing powders that may further deplete the deficiency. Hence, there are theories like "sudden deficiency of healthy qi, not a true deficiency from chronic illness" and "yangming deficiency differs from Taiyang (EX-HN5) deficiency," but these arguments are somewhat akin to sophistry, such as "a white horse is not a horse," and seem inadequate. For instance, if "sudden deficiency is not true deficiency," then Newly Supplemented Cinnamon Twig Decoction should not include Ginseng. If "yangming deficiency differs from Taiyang (EX-HN5) deficiency," how should White Tiger Decoction with Ginseng be explained?

The author believes that Gardenia and Fermented Soybean Decoction neither induces vomiting nor disperses. Its efficacy is similar to Coptis and Ass Hide Glue Decoction, both capable of clearing heat and nourishing yin, restoring the coordination between the heart and kidneys. The only difference is that Gardenia and Fermented Soybean Decoction has a shaoyin-nourishing effect compared to Coptis and Ass Hide Glue Decoction. To clarify this issue, it is essential to understand the efficacy of Fermented Soybean. Historically, many physicians have regarded Fermented Soybean as a drug that disperses wind-heat or induces vomiting to expel diaphragm heat, as mentioned above. Although the "Bielu" mentions its ability to treat "deficiency fatigue and panting," the "Yaoxing Lun" states that "roasted, it can stop night sweats and relieve restlessness," and the "Huiyue Medical Mirror" claims it "treats steaming bone fever," these have not garnered much attention in the medical community. The first two interpretations have become customary, especially the theory of "dispersing wind-heat," which firmly holds a dominant position.

The author personally believes that Fermented Soybean is sweet and cool in nature, capable of nourishing the kidneys, calming the heart, and stimulating appetite in cases of middle consumptive thirst. Although its yin-enriching power is not as strong as Rehmannia or Ophiopogon Tuber, it does not have the side effects of causing stagnation or impairing the stomach like wheat or Rehmannia. When used for cases where internal heat is still strong and yin is not yet deficient, it pairs well with Gardenia; for cases where external heat is still strong and slight yin deficiency is observed, it is also very suitable when combined with Fistular Onion Stalk and honeysuckle and forsythia. The basis for this is modern reports that Fermented Soybean contains a large amount of fat, protein, and enzymes, so this product not only nourishes but also aids digestion. Therefore, the Qianjin Fang states: "Gardenia and Fermented Soybean Decoction can treat shortness of breath in young men due to excessive sexual activity," which refers to its ability to treat yin deficiency with internal heat. Zhang Zhongjing in the "Treatise on Cold Damage Diseases" uses Gardenia and Fermented Soybean Decoction in several instances, but always in cases where deficiency and excess coexist after sweating, vomiting, purging, or excessive labor during recovery. If Fermented Soybean were indeed a medicine for dispersing wind-heat, it would not be used in cases with internal deficiency; if it were a medicine for inducing vomiting, it would certainly not be used in cases with internal deficiency. Moreover, Article 78 of the "Treatise on Cold Damage Diseases" clearly states that for cases with Gardenia and Fermented Soybean Decoction syndrome accompanied by vomiting, Fresh Ginger Rhizome should be added to downbear counterflow and stop vomiting, clearly indicating that it is not a vomiting-inducing agent.

Fistular Onion Stalk, Fermented Soybean Decoction is used for Fistular Onion Stalk and Fermented Soybean, originally intended for nourishing yin and releasing the exterior. For example, the use of Unprocessed Rehmannia Root in Nine-lngredient Notopterygium Decoction and Peony Root in Cinnamon Twig Decoction do not assist the main drug in inducing sweating, but rather constrain the excessive dispersing power of the main drug. The method of antagonism and mutual enhancement in formulation is common in both ancient and modern formulas, not unique to Fistular Onion Stalk, Fermented Soybean Decoction. Folk remedies use single herbs like ginger and onion to induce sweating and release the exterior, but there is no example of using single Fermented Soybean to induce sweating and release the exterior, which sufficiently illustrates that Fermented Soybean does not have the function of inducing sweating. In the preparation of Fermented Soybean, although there is a method of soaking soybeans in a decoction of Ephedra and cultivated purple perilla leaf before steaming and fermenting, the dispersing substances on the surface of the soybeans are mostly lost after this process of steaming and fermenting, and they no longer possess the power to release the exterior. Wei Yi-lin in Shiyi Dexiao Fang records: using a pinch of this product (more than 30 grams), decocted and taken can treat hematuria. If it were a dispersing or emetic drug, how could it be used in such large quantities? And how could it stop bleeding without inducing sweating or vomiting? The reason it can stop bleeding is likely because increasing water can counteract fire. The author has used Gardenia and Fermented Soybean Decoction with modifications to treat chronic debilitating diseases such as visceral agitation and insomnia of the deficient heat type, often with good results. Are these conditions sudden deficiencies? Should the medication used be emetic or dispersing? This is what is being discussed.