Zhi Gan Cao Tang: Herbal Support for Heart Health and Energy

Health Lab
Jan 30
7 min read

Updated: May 3

Zhi Gan Cao Tang, or Honey-Fried Licorice Decoction, is a renowned Chinese herbal formula from Treatise on Febrile Diseases by Zhang Zhongjing. Celebrated for nourishing qi and yin, boosting yang, and restoring heart function, it’s a go-to remedy for heart-related issues like palpitations and irregular pulse caused by qi and blood deficiency.

With a blend of tonic and warming herbs, this formula bridges ancient wisdom with modern applications, offering relief for cardiovascular and other conditions.

What’s in Zhi Gan Cao Tang?

Zhi Gan Cao Tang combines a range of herbs, structured by the TCM principle of monarch, minister, assistant, and messenger for balanced effects. The key ingredients and their roles are:

Monarch Herb

Roasted Licorice Root (Zhi Gan Cao, 12g): Sweet and warm, roasted licorice strengthens heart qi, harmonizes the formula, and relieves pain. Its high dose (4 liang in ancient measures) boosts energy and supports heart rhythm, with modern studies confirming its anti-arrhythmic properties.

Minister Herbs

Raw Rehmannia (Sheng Di Huang): Sweet and cooling, rehmannia nourishes yin and blood, replenishing the heart and blood vessels to ease palpitations and fatigue.
Ginseng (Ren Shen): Warm and sweet, ginseng boosts vital energy, nourishes the spleen and heart, and calms the mind, improving qi deficiency symptoms like shortness of breath.

Assistant Herbs

Donkey-Hide Gelatin (E Jiao): Sweet and neutral, this tonic nourishes heart yin and blood, moistens dryness, and supports blood vessel health.
Ophiopogon (Mai Dong): Sweet and cooling, ophiopogon moistens the lungs and heart, relieving palpitations, insomnia, and dryness.
Hemp Seed (Huo Ma Ren): Sweet and neutral, hemp seed lubricates the intestines, promotes bowel movements, and nourishes blood to ease constipation.

Messenger Herbs

Ginger (Sheng Jiang, 3 slices): Pungent and warm, ginger warms the heart and stomach, promotes circulation, and aids digestion.
Cinnamon Twig (Gui Zhi): Warm and pungent, cinnamon twig warms the heart yang, unblocks blood vessels, and supports circulation.
Jujube (Da Zao, 3 pieces): Sweet and warm, jujube nourishes the spleen and heart, calms the mind, and boosts qi and blood.

Preparation

Traditionally, the herbs are boiled with 7 liters of sake and 8 liters of water until reduced to 3 liters. The residue is strained, donkey-hide gelatin is dissolved into the liquid, and the decoction is taken warm, 1 liter three times daily. Modernly, it’s decocted in water, with gelatin added at the end.

How It Works

Zhi Gan Cao Tang targets heart qi and blood deficiency, often caused by excessive sweating, vomiting, diarrhea, blood loss, or chronic illness. In TCM, this deficiency leads to:

Weak Heart Qi: Inability to pump blood effectively, causing irregular or weak pulse.
Low Heart Blood: Poor nourishment of the heart, leading to palpitations and restlessness.
Deficient Heart Yang: Lack of warmth in the heart, causing coldness and spontaneous sweating.
Deficient Heart Yin: Dryness in the heart vessels, resulting in dry mouth, tongue, or stools.

The formula works by:

Nourishing Qi and Yin: Licorice, ginseng, and ophiopogon boost energy and hydrate the heart and lungs.
Replenishing Blood: Rehmannia, donkey-hide gelatin, and jujube nourish blood to fill vessels and calm the heart.
Warming Yang: Ginger and cinnamon twig warm the heart and promote circulation, restoring pulse regularity.
Harmonizing: Licorice ensures smooth coordination, reducing chest tightness and enhancing overall effects.

This multi-pronged approach restores heart function, stabilizes rhythm, and alleviates symptoms of deficiency.

What Does It Treat?

Zhi Gan Cao Tang is used for conditions marked by heart qi and blood deficiency, with symptoms including:

Palpitations or irregular heartbeat
Weak, irregular, or stuttering pulse
Fatigue, shortness of breath, or weakness
Pale or sallow complexion, pale lips
Insomnia, restlessness, or vivid dreams
Dry mouth, throat, or stools
Dizziness, numbness in hands and feet
Pale tongue with minimal coating

These symptoms often arise after illness, blood loss, overexertion, or chronic stress, particularly affecting the heart and spleen.

Modern Applications

Modern research highlights Zhi Gan Cao Tang’s cardiovascular benefits, driven by active compounds like glycyrrhizic acid (licorice) and antioxidants. Its clinical uses include:

Cardiovascular Conditions: Treats functional arrhythmias, extrasystoles, coronary heart disease, rheumatic heart disease, and viral myocarditis by stabilizing heart rhythm and improving blood flow.
Respiratory Issues: Relieves dry cough or shortness of breath in qi and yin deficiency, such as in pulmonary tuberculosis.
Digestive Disorders: Manages chronic gastritis, prolonged diarrhea (especially in children), and constipation (common in the elderly) by nourishing qi and moistening dryness.
Other Conditions: Supports leukopenia, adrenal insufficiency, hypotension, and chronic fatigue by boosting immunity and energy.

The formula’s anti-inflammatory, antioxidant, and immunomodulatory effects make it a versatile remedy for heart and systemic health.

Pathogenesis in TCM

In TCM, Zhi Gan Cao Tang addresses heart qi and blood deficiency with weak yang, often triggered by:

Post-illness depletion (e.g., after typhoid fever or prolonged fever).
Excessive blood loss or fluid loss (sweating, diarrhea).
Chronic stress, overthinking, or weak spleen function, reducing qi and blood production.

This leads to underfilled blood vessels, poor circulation, and a weakened heart, causing palpitations and irregular pulse. The formula restores balance by tonifying qi, blood, yin, and yang, ensuring smooth heart function.

Precautions

Yin Deficiency with Heat: Use cautiously in cases of yin deficiency with internal heat (e.g., night sweats, red tongue), as warming herbs like ginger and cinnamon may aggravate symptoms.
Tuberculosis or Lung Conditions: Adjust dosages of warming herbs (ginger, cinnamon, wine) to avoid depleting yin fluids.
Professional Guidance: Consult a TCM practitioner to tailor the formula and ensure safe use, especially for chronic or complex conditions.

Conclusion

Zhi Gan Cao Tang is a time-honored Chinese herbal formula that nourishes qi and yin, warms yang, and supports heart health. With herbs like roasted licorice, rehmannia, ginseng, and cinnamon twig, it effectively treats palpitations, irregular pulse, and fatigue caused by heart qi and blood deficiency.

Backed by modern research, its anti-arrhythmic and tonic properties make it a valuable remedy for cardiovascular issues, respiratory conditions, and more. When used under professional guidance, Zhi Gan Cao Tang blends ancient TCM wisdom with contemporary applications, offering natural relief and renewed vitality.

Chinese Name	炙甘草湯
Phonetic	Zhi Gan Cao Tang
English Name	Honey-Fried Licorice Decoction
Classification	Tonic formulas
Source	《Treatise on Cold Damage》Shang Han Lun《傷寒論》
Combination	Glycyrrhizae Radix et Rhizoma (Zhi Gan Cao) 4 liang (12g), Zingiberis Rhizoma Recens (Sheng Jiang) 3 liang (9g), Cinnamomi Ramulus (Gui Zhi) 3 liang (9g), Ginseng Radix et Rhizoma (Ren Shen) 2 liang (6g), Rehmanniae Radix (Sheng Di Huang) 1 jin (50g), Asini Corii Colla (E Jiao) 2 liang (6g), Ophiopogonis Radix (Mai Dong) 0.5 liang (10g), Cannabis Fructus (Ma Ren) 0.5 liang (10g), Jujubae Fructus (Da Zao) 30 pieces
Method	Add all the medicinals except e jiao into seven sheng of wine and eight sheng of water. Decoct until three sheng remain. Remove the dregs, and then put e jiao in until it melts thoroughly. Take the decoction when it is warm, one sheng three times a day. (Modern preparation: Prepare as a common decoction with e jiao infused.)
Action	Boosts qi, enriches yin, unblocks yang, and restores the pulse.
Indication	1. Zhi Gan Cao Tang is indicated for patterns of yin-blood and yang-qi deficiency with malnutrition of the heart vessel. The symptoms are intermittent or knotted pulse, palpitations, weakness, emaciation, weak breathing, etc. The tongue is peeled with a scanty or dry and thin coating. 2. Zhi Gan Cao Tang is indicated for deficiency-consumption and lung atrophy. The symptoms are dry cough without expectoration, or spitting up a small amount of saliva, emaciation, shortness of breath, insomnia, vexation, spontaneous sweating or night sweat, a dry throat and tongue, dry stool, and a deficient, rapid pulse.
Pathogenesis	Zhi Gan Cao Tang is a well-known formula from《Treatise on Cold Damage》used to treat an intermittent or knotted pulse and palpitations. This pattern is always seen in one of two circumstances. The first is the mistreatment of cold-induced diseases by sweating, vomiting, or purging; or from blood loss after catching a cold-induced disease. The second is a miscellaneous disease due to yin-blood insufficiency and deficiency of yang qi. The insufficient yin-blood fails to fill in the blood vessel and deficient yang qi fails to activate or pump the blood vessel, these two leading to an intermittent or knotted pulse. Yin-blood insufficiency fails to nourish the heart mind and heart yang deficiency fails to warm the heart vessels, so the patient complains of palpitations. The treatment should be to enrich heart yin, nourish heart blood, boost heart qi, and warm heart yang in order to restore the pulse and calm palpitations.
Application	1. Essential pattern differentiation Zhi Gan Cao Tang is a formula that supplements yin, yang, qi, and blood at the same time. This clinical pattern is marked by intermittent or knotted pulse, palpitation, weakness, emaciation, weak breathing, peeled, pale tongue with a scanty coating. 2. Modern applications Zhi Gan Cao Tang is commonly, and effectively, used for functional arrhythmia and extra systole. It can be used, with appropriate modifications, for disease conditions such as coronary disease, rheumatic heart disease, viral myocarditis, hyperthyroidism, etc. that present with palpitations, shortness of breath, and an intermittent or knotted pulse. These conditions must be identified as patterns of yin-blood insufficiency and yang qi deficiency according to traditional Chinese medical differentiation. It is also applicable for deficiency-consumption and dry cough resulting from both qi and yin consumption. 3. Cautions and contraindications When Zhi Gan Cao Tang is used to treat deficiency-consumption and lung wei disease due to qi-yin deficiency, one should decrease the dosage of, or omit, the warm medicinals such as sheng jiang, gui zhi, and wine since they will cause more yin-fluids deficiency.
Additonal formulae	Jia Jian Fu Mai Tang (Pulse-Restoring Variant Decoction 加減復脈湯) [Source]《Systematic Differentiation of Warm Diseases》Wen BIng Tiao Bian《溫病條辨》 [Ingredients] Zhi gan cao 6 qian (18g), sheng di 6 qian (18g), bai shao 6 qian (18g), mai dong 5 qian (15g), e jiao 3 qian (9g), ma ren 3 qian (9g) [Preparation and Administration] Prepare it as a decoction. [Actions] Enriches yin and nourishes blood, engenders fluid, and moistens dryness. [Applicable Patterns] Yin-fluids deficiency in the late stage of warm disease due to lingering pathogenic heat.
Remark	Ginseng (Panax ginseng) is listed in the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES) Appendix II. Its trade is allowed but subject to licensing controls.