Ling Gui Zhu Gan Tang: Herbal Support for Warming and Fluid Balance
Health Lab- Jan 30
- 6 min read
Updated: May 3
Ling Gui Zhu Gan Tang, or Poria, Cinnamon, Atractylodes, and Licorice Decoction, is a classic Chinese herbal formula from the Golden Guide by Zhang Zhongjing. Renowned for warming yang, transforming body fluids, strengthening the spleen, and promoting diuresis, it’s a powerful remedy for phlegm and fluid retention caused by spleen yang deficiency.
With just four herbs, this formula restores warmth and balance, making it a cornerstone of traditional Chinese medicine (TCM) and a versatile tool in modern healthcare.
What’s in Ling Gui Zhu Gan Tang?
Ling Gui Zhu Gan Tang combines four herbs, structured by the TCM principle of monarch, minister, assistant, and messenger, to address fluid retention and spleen weakness. The ingredients and their roles are:
Poria (Fu Ling, 12g): Neutral and sweet, poria strengthens the spleen, promotes urination, and clears phlegm and fluid buildup, targeting the root of fluid retention.
Cinnamon Twig (Gui Zhi, 9g): Warm and pungent, cinnamon twig warms yang, transforms qi, and opens water channels, aiding fluid movement.
White Atractylodes (Bai Zhu, 6g): Warm and bitter, atractylodes strengthens the spleen, dries dampness, and enhances digestion to prevent fluid accumulation.
Roasted Licorice Root (Zhi Gan Cao, 6g): Sweet and warm, licorice harmonizes the formula, balances the warming herbs, and supports spleen qi.
Preparation
Decoct the herbs in water and drink warm as a tea. Dosages may be adjusted based on the patient’s condition.
Variations
Severe Dizziness: Add alisma (Ze Xie) to enhance diuresis.
Cough with Thin Phlegm: Include pinellia (Ban Xia) and tangerine peel (Chen Pi) to clear phlegm.
Dry Belching or Head Pain: Add dogwood (Shan Zhu Yu) to stabilize and nourish.
Cold Body: Add aconite (Fu Zi) to warm and disperse fluids.
Weak Spleen Qi: Include codonopsis (Dang Shen) and astragalus (Huang Qi) to boost qi.
How It Works
Ling Gui Zhu Gan Tang targets phlegm and fluid retention caused by spleen yang deficiency, a TCM condition where weak spleen yang fails to transform and transport fluids, leading to dampness and phlegm buildup.
The spleen, known as the “Zhongzhou” (central hub), digests food and distributes nutrients. When its yang (warmth) is deficient—often due to cold diet, overexertion, or chronic illness—fluids stagnate, forming phlegm that causes symptoms like chest fullness or dizziness.
The formula works by:
Warming Yang: Cinnamon twig restores spleen warmth, promoting fluid movement.
Transforming Fluids: Poria and atractylodes clear phlegm and dampness, enhancing spleen function.
Promoting Diuresis: Poria’s diuretic effect expels excess fluid via urine.
Harmonizing: Licorice ensures the herbs work together smoothly, preventing overly warming effects.
This restores spleen function, clears fluid retention, and alleviates symptoms, as Zhang Zhongjing noted: “For phlegm and fluid, use warming herbs.”
What Does It Treat?
Ling Gui Zhu Gan Tang is used for spleen yang deficiency with phlegm and fluid retention, with symptoms including:
Chest or abdominal fullness
Dizziness or vertigo
Palpitations or shortness of breath
Cough with thin, watery phlegm
White, slippery tongue coating
Stringy, slippery, or heavy pulse
These reflect fluid stagnation in the chest, abdomen, or head, often worsened by cold or weak digestion.
How It Differs from Wu Ling San
Both Ling Gui Zhu Gan Tang and Wu Ling San promote diuresis, but their focus differs:
Ling Gui Zhu Gan Tang: Targets spleen yang deficiency with phlegm and fluid in the chest or abdomen, causing fullness or dizziness.
Wu Ling San: Addresses bladder qi dysfunction with urinary difficulty, thirst, vomiting, or edema.
Ling Gui Zhu Gan Tang’s warming and spleen-strengthening focus makes it ideal for internal fluid retention rather than bladder issues.
Modern Applications
Modern research highlights Ling Gui Zhu Gan Tang’s diuretic, anti-inflammatory, antioxidant, and immune-regulating properties, expanding its clinical uses. Key applications include:
Respiratory Conditions: Treats chronic bronchitis and bronchial asthma by clearing phlegm and easing cough or wheezing.
Cardiovascular Issues: Manages cardiac edema, heart failure, pericarditis, or pericardial effusion by reducing fluid buildup.
Kidney Disorders: Relieves edema in chronic glomerulonephritis by promoting diuresis.
Neurological and Sensory Issues: Improves Meniere’s disease, tinnitus, vertigo (e.g., hypertensive or post-concussion), sinusitis, otitis media, and optic neuritis by clearing fluid and lifting qi.
Digestive Disorders: Treats duodenal ulcers, gastroptosis, or gastric atonia by strengthening the spleen.
Other Conditions: Supports breast lobular hyperplasia, simple obesity, night blindness, keratitis, and endocrine-related thirst, often tied to fluid retention or spleen weakness.
The formula also alleviates post-cold symptoms like nasal congestion, postnasal drip, or shortness of breath, addressing lingering dampness and yang deficiency.
Pathogenesis in TCM
In TCM, spleen yang deficiency leads to phlegm and fluid retention due to:
Weak spleen failing to transform fluids, causing dampness and phlegm.
Poor lung function, allowing fluid to accumulate in the chest (fullness, cough).
Kidney yang weakness, impairing fluid metabolism, contributing to stagnation.
Phlegm and fluid can flow with qi, causing chest fullness (in the ribs), dizziness (in the middle jiao), or palpitations and cough (affecting the heart and lungs). Ling Gui Zhu Gan Tang warms and transforms, restoring spleen and organ balance.
Precautions
Yin Deficiency or Heat: Avoid in cases of yin deficiency with excessive fire (e.g., dry mouth, red tongue) or damp-heat (yellow, greasy tongue), as warming herbs may worsen symptoms.
Expected Diuresis: Increased urination after taking the formula is a positive sign of fluid clearance, not a side effect.
Professional Guidance: Consult a TCM practitioner to ensure proper use, especially for chronic conditions or when modifying the formula.
Conclusion
Ling Gui Zhu Gan Tang is a beautifully simple yet potent Chinese herbal formula that warms yang, transforms fluids, and strengthens the spleen. With poria, cinnamon twig, white atractylodes, and licorice, it effectively treats phlegm and fluid retention, relieving chest fullness, dizziness, and cough caused by spleen yang deficiency. Its modern applications—from bronchitis to cardiac edema—highlight its versatility, backed by research on its diuretic and anti-inflammatory effects.
When used under professional guidance, Ling Gui Zhu Gan Tang restores warmth and balance, offering natural relief and vitality rooted in TCM wisdom.
Chinese Name | 苓桂朮甘湯 |
Phonetic | Ling Gui Zhu Gan Tang |
English Name | Poria, Cinnamon Twig, Atractylodes Macrocephala and Licorice Decoction |
Classification | Dampclearing formulas |
Source | 《Essentials from the Golden Cabinet》Jin Gui Yao Lue《金匱要略》 |
Combination | Poria (Fu Ling) 4 liang (12g), Cinnamomi Ramulus (Gui Zhi) 3 liang (9g), Atractylodis Macrocephalae Rhizoma (Bai Zhu) 2 liang (6g), Glycyrrhizae Radix et Rhizoma Praeparata cum Melle (Zhi Gan Cao) 2 liang (6g) |
Method | Prepare as a decoction and drink it warm. |
Action | Warms yang and dissolves rheum, fortifies the spleen and drains dampness. |
Indication | Ling Gui Zhu Gan Tang is indicated for phlegm-rheum due to deficiency of the middle-yang. The symptoms are distention and fullness of chest and rib-side, dizzy vision, palpitations, shortness of breath, and cough. The tongue coating is white and glossy. The pulse is either wiry and slippery or deep and tight. |
Pathogenesis | This formula is applied to patterns of phlegm-rheum caused by deficiency of middle-yang and the failure of the transformation and transportation of the spleen which leads to disorder of qi transformation and the retention of water and dampness. The spleen lies in the middle jiao and governs qi transformation. It acts as an axis of qi ascension and descending; therefore, when the spleen yang is deficient, its transformation and transportation is affected. The result is dampness accumulation which further develops into phlegm-rheum. Phlegm and rheum ascend and descend as qi moves. Consequently, they can exist anywhere. When they accumulate in chest and rib-side, distention and fullness of chest and rib-side may be seen. When they block the middle jiao and cause a disorder of clear yang ascension, dizziness and vertigo may be seen. When they invade the heart and lung, palpitations, shortness of breath, and cough might be seen. A white and glossy tongue coating, wiry and slippery pulse, and deep and tight pulse are all signs of retention of phlegm-rheum. Zhang Zhong-jing said that “one who suffers from phlegm-rheum should be regulated by warm medicinals” recorded in《Essentials from the Golden Cabinet》. The therapeutic methods are to warm yang and dissolve rheum, fortify the spleen and promote urination. |
Application | 1. Essential pattern differentiation This formula is the representative formula for treating phlegm-rheum due to middle yang deficiency. This clinical pattern is marked by distention and fullness of chest and rib-side, dizziness and vertigo, palpitations, white and glossy coating. 2. Modern applications This formula may be used in the following biomedically defined disorders when the patient shows signs of water and fluid retention in the middle jiao: chronic bronchitis, bronchial asthma, cardiac edema, edema in chronic glomerulonephritis, Meniere's disease, and neurosis. 3. Cautions and contraindications It is not applicable for patients with phlegm transformed into heat marked by cough with sticky sputum. |
Additonal formulae | Gan Cao Gan Jiang Fu Ling Bai Zhu Tang (Licorice, Dried Ginger, Poria and Atractylodes Macrocephalae Decoction 甘草乾薑茯苓白朮湯) [Source]《Essentials from the Golden Cabinet》Jin Gui Yao Lue《金匱要略》 [Ingredients] Gan cao 2 liang (6g), gan jiang 4 liang (12g), fu ling 4 liang (12g), bai zhu 2 liang (6g) [Preparation and Administration] Prepare it as a decoction. [Actions] Warms the spleen and overcomes dampness. [Applicable Patterns] Cold-dampness invasion in the kidney. Symptoms include: cold pain and heaviness of waist, normal appetite, absence of thirst, dysuria, a pale tongue body, a white tongue coating, and a slow and deep or deep and moderate pulse. |
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