Zhi Gan Cao Tang (Honey Fried Licorice Decoction)

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Indications

Western Uses:

• How is Zhi Gan Cao Tang framed in modern practice?

  In modern practice Zhi Gan Cao Tang is used as a reference formula for deficiency-type presentations that overlap with functional cardiac complaints — the pattern of palpitations with an irregular pulse that classical texts describe. Chinese clinical reports most often study it in the setting of premature ventricular contractions and other arrhythmias in weak, deficient patients.

  This is a framing note, not a treatment claim:

  • Pattern-first — it is selected for the TCM pattern (qi/blood/yin deficiency with an arrhythmic pulse), not for any biomedical diagnosis.
  • Overlap terms — the reviewed literature discusses premature ventricular contractions and supraventricular arrhythmia in deficiency patterns.

  Source: reviewed clinical literature (see Research). Reference framing only; palpitations and any irregular heartbeat need evaluation by a licensed clinician — not medical advice.

Originally Appeared In:

• On Cold Damage (Shang Han Lun)

Notes:

• How does Zhi Gan Cao Tang compare with related formulas, and how is it modified?

  Zhi Gan Cao Tang is distinguished by nourishing yin and blood strongly enough to fill the vessels and restore an irregular pulse — a focus its neighbors do not share. It is also known as Fu Mai Tang (Restore the Pulse Decoction).

  • vs Sheng Mai San — both address qi-and-yin deficiency of the Heart, but Sheng Mai San (Ren Shen, Mai Men Dong, Wu Wei Zi) targets qi-and-yin collapse with profuse sweating; Zhi Gan Cao Tang more richly nourishes blood and yin and specifically restores a knotted/intermittent pulse.
  • vs Gui Pi Tang — Gui Pi Tang tonifies qi and blood via the Spleen and Heart for palpitations from Spleen–Heart deficiency, but it does not nourish yin or aim at an arrhythmic pulse.

  Common modifications: for marked palpitations, anxiety, and restlessness, spirit-settling substances such as Long Gu, Mu Li, Zhen Zhu (pearl), or Hu Po are added.

  Source: owner’s Five Branches / Bensky formula notes (comparison & modification set); Bensky, Formulas & Strategies.

Clinical Studies & Research:

• Is there modern research on Zhi Gan Cao Tang?

  Yes — mostly Chinese-language randomized trials in arrhythmia, with encouraging results but consistently low methodological quality. A systematic review of Zhigancao Decoction for premature ventricular contractions pooled 25 randomized controlled trials in 2,441 patients and found improvement in total effectiveness and a reduction in ventricular premature beats, but rated the trials as generally low quality and judged safety uncertain (only 13 of 25 reported adverse events).

  A later meta-analysis of Zhigancao Decoction combined with metoprolol versus metoprolol alone pooled 39 RCTs in 4,260 patients and reported a higher total effective rate (OR 4.74) with fewer adverse reactions — but the authors caution that all trials were Chinese-language and of low quality, only 11 of 39 used proper randomization, none were blinded, and a moderate risk of publication bias was present, so the results “must be cautiously evaluated.” Network-pharmacology work has also modeled its effects on atrial fibrillation and myocardial fibrosis.

  Sources: PubMed 25637158 (Complement Ther Med, 2015, systematic review, 25 RCTs / 2,441 patients, PVCs); PubMed 35282353 (Front Cardiovasc Med, 2022, meta-analysis, 39 RCTs / 4,260 patients, Zhigancao Decoction + metoprolol); PMC 9203184 (network-pharmacology study, atrial fibrillation / myocardial fibrosis). Research context, not a therapeutic claim.