Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodis Macrocephalae, and Licorice Decoction)

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Indications

Western Uses:

• What is Ling Gui Zhu Gan Tang used for in modern practice?

  In modern practice Ling Gui Zhu Gan Tang is referenced for conditions Western medicine associates with fluid or motion disturbance — peripheral vertigo (including Menière’s disease), chronic bronchitis or airway conditions with copious thin sputum, functional dyspepsia with an epigastric splashing sound, and as an adjunct alongside standard care for chronic heart failure with palpitations, reduced gastric motility, or premature contractions.

  These biomedical correlates are offered as a reference to the formula’s traditional use, not as a claim that it treats any disease. Clinical evidence is strongest for the cardiovascular-adjunct indications (see research); trials for vertigo remain at the registered-protocol stage with no pooled results yet. Any use for a diagnosed condition belongs with a qualified practitioner and appropriate medical care.

  Source: traditional-use correlates summarized from Bensky & Barolet, Formulas & Strategies, cross-checked against PubMed clinical literature (see research); reference only, not a treatment claim.

Originally Appeared In:

• On Cold Damage (Shang Han Lun)

Notes:

• How is Ling Gui Zhu Gan Tang different from Wu Ling San, Zhen Wu Tang, and Xiao Qing Long Tang?

  All four formulas warm and move water, but they target fluid retention at different depths and locations. Ling Gui Zhu Gan Tang addresses fluid pooled in the chest and epigastrium from Spleen-yang deficiency, without a severe cold collapse or an unresolved exterior pattern.

  • vs Wu Ling San: Wu Ling San adds stronger diuretics (Ze Xie, Zhu Ling) and Rou Gui to transform Bladder qi; choose it when an unresolved exterior pattern accompanies scanty urination and thirst with an inability to transform fluids.
  • vs Zhen Wu Tang: Zhen Wu Tang treats deeper Kidney-yang deficiency with more pronounced edema and cold limbs, using Fu Zi to warm at a stronger, more foundational level.
  • vs Xiao Qing Long Tang: Xiao Qing Long Tang addresses external cold combined with internal cold-fluid in the Lung (wheezing and copious thin sputum with an unresolved exterior), adding Ma Huang and Xi Xin to release the exterior and warm the Lung.

  Common modification: Ze Xie is often added when dizziness from fluid retention is especially prominent.

  Source: Bensky & Barolet, Formulas & Strategies (comparison of water/fluid-regulating formulas).

Clinical Studies & Research:

• Is there modern research on Ling Gui Zhu Gan Tang?

  Yes — the strongest clinical evidence is as an adjunct in cardiovascular care, alongside a growing body of preclinical mechanism studies. A systematic review and meta-analysis of 14 randomized controlled trials (1,236 patients) found Linggui Zhugan decoction added to standard antiarrhythmic therapy improved clinical effectiveness and reduced 24-hour premature beats in coronary heart disease, though the included trials carried a high overall risk of bias. A separate clinical study reported efficacy for decreased gastric motility caused by chronic heart failure.

  • Coronary heart disease / arrhythmia (clinical synthesis): meta-analysis of 14 RCTs, 1,236 patients, found higher clinical effectiveness and fewer premature beats vs. antiarrhythmic drugs alone, with no significant increase in adverse events (PMID 36407468).
  • Chronic heart failure, gastric motility (clinical): reported clinical efficacy for decreased gastric motility caused by chronic heart failure (PMID 34269552).
  • Chronic heart failure, mechanism (preclinical, rat): activation of the SIRT1/AMPK/PGC-1α pathway improved myocardial antioxidant capacity and mitochondrial function after induced infarction (PMID 37089931).
  • Nonalcoholic fatty liver disease (preclinical, mouse): improved hepatic function and reshaped gut-microbiota/bile-acid metabolism in a high-fat-diet model (PMID 38647315).

  Registered systematic-review protocols also exist for peripheral vertigo and for chronic heart failure with Yang deficiency, but as of this writing report no pooled results yet.

  Sources: PubMed 36407468; PubMed 34269552; PubMed 37089931; PubMed 38647315. Research context, not a therapeutic claim; direct clinical trial evidence remains limited and concentrated in cardiovascular indications.