Ling Gui Zhu Gan Tang (茯苓桂枝白术甘草汤) — Poria, Cinnamon & Atractylodes

On this page

1. Overview
2. TCM pattern
3. Key herbs
4. Formula actions
5. Conditions treated
6. How it works
7. Dosage and forms
8. Cautions and contraindications
9. Treatment at my Wokingham clinic
10. Frequently asked questions
11. References

What is Ling Gui Zhu Gan Tang?

Ling Gui Zhu Gan Tang — Poria, Cinnamon Twig, Atractylodes and Liquorice Decoction — is a classical Jin Gui Yao Lue formula by Zhang Zhongjing for Spleen-Yang deficiency with thin phlegm-fluid accumulation. In Chinese herbal medicine it is one of the most useful formulas for dizziness^[22], palpitations, postural lightheadedness and clear watery sputum where the patient's pulse is deep and weak.

I prescribe Ling Gui Zhu Gan Tang as part of bespoke herbal formulas from pharmaceutical-grade granules sourced from Sun Ten in Taiwan.

Ling Gui Zhu Gan Tang TCM pattern

Prescribed for Spleen-Yang deficiency with thin-fluid retention: dizziness on standing, palpitations, chest oppression, watery clear sputum, mild oedema, sensation of cold fluid sloshing in the epigastrium, a pale tongue with a moist white coat and a deep, slippery or wiry pulse.

Key herbs

1. Fu Ling (Poria, 6-15g) — drains Damp, transforms thin-fluid, quietens Heart
2. Gui Zhi (Ram. Cinnamomi, 4-10g) — warms Yang and unblocks the channels
3. Bai Zhu (Rz. Atractylodis Macrocephalae, 3-12g) — tonifies Spleen Qi and dries Damp
4. Zhi Gan Cao (Rx. Glycyrrhizae Preparata, 2-6g) — harmonises and protects the middle

Formula actions

1. Warms and tonifies Spleen Yang
2. Drains thin phlegm-fluid (tan yin)
3. Resolves Damp and harmonises the middle Burner

Conditions treated

1. Vestibular dizziness and Meniere’s-pattern presentations with Spleen-Yang deficiency
2. Postural hypotension with clear watery sputum and fatigue^[9]
3. Chronic productive cough^[10] with watery clear sputum in deficient constitutions
4. Functional dyspepsia with sloshing fluids and a cold middle
5. Selected presentations of glaucoma, congestive heart failure and migraine with phlegm-fluid features (under joint medical care)

How does this formula work?

The four-herb composition works through complementary pathways to resolve the underlying Spleen-Yang deficiency that allows thin-fluid accumulation:

1. Damp-draining and Heart-calming — Fu Ling is the principal drainer of Damp and thin-fluid through the urinary system. It also has a documented calming action on the Heart Shen, addressing the palpitations that accompany fluid disturbance affecting the pericardium
2. Yang-warming and channel-opening — Gui Zhi (cinnamon twig) warms the Yang, opens the channels and supports the transformative function of the Heart-Yang. This warming action is what converts pooled fluid into mobile fluid that can be excreted
3. Spleen-tonifying and Damp-drying — Bai Zhu directly addresses the root: Spleen-Yang weakness that fails to transform-and-transport fluids properly. Without rebuilding this foundation, the fluid will simply re-accumulate
4. Harmonising and protective — Zhi Gan Cao binds the formula, moderates the warming herbs and protects the middle Jiao from depletion during the diuretic action of Fu Ling

Pharmacological research has documented diuretic activity from poria saponins, cardiotonic and circulatory effects from cinnamaldehyde in Gui Zhi, and gastroprotective and Spleen-supportive effects from atractylenolide constituents in Bai Zhu. The combination produces measurable improvement in inner-ear fluid balance (relevant to Meniere's disease and vestibular dizziness), gastric motility and mild cardiovascular function.

Dosage and forms

• Pharmaceutical-grade granules — 4–6 g/day in 2–3 divided doses, dissolved in warm water. The most potent and individualised form. Typical course 6–12 weeks for dizziness; longer for chronic phlegm-fluid presentations
• Traditional decoction — rarely used in modern UK practice
• Patent pills — available but lower potency; useful as maintenance dose

I prescribe pharmaceutical-grade granules from Sun Ten in Taiwan, individualised within a bespoke prescription. Sun Ten granules are tested to international quality and safety standards.

Cautions and contraindications

• Yin deficiency with dryness — the formula is warming and diuretic; in marked Yin deficiency it can aggravate the underlying dryness
• Heat patterns — contraindicated where there is yellow phlegm, wiry-full pulse, rapid pulse or yellow tongue coat
• Pregnancy — use only under specialist supervision; Gui Zhi has some Blood-moving action that warrants caution in early pregnancy
• Continuous diuretic medication — combination with prescription diuretics (furosemide, bendroflumethiazide) can theoretically increase electrolyte loss; coordinate with prescriber
• Long-term Zhi Gan Cao exposure — monitor blood pressure and serum potassium with use beyond 3 months

Always consult a qualified Chinese herbalist registered with the Register of Chinese Herbal Medicine (RCHM). Never self-prescribe. Online herbal consultations are available. See the prices page for costs.

Treatment at my Wokingham clinic

I prescribe this Poria-Cinnamon formula at my clinic at 49 Denmark Street, Wokingham, RG40 2AY for patients with vestibular dizziness on the Spleen-Yang deficient pattern, recurrent Meniere's flares with the classical clear-sputum picture, postural hypotension with fluid retention, and certain functional dyspepsia presentations with sloshing-fluid sensation. Patients travel from across Berkshire — Reading, Bracknell, Twyford, Crowthorne, Sandhurst and the wider Thames Valley.

The initial 90-minute consultation reviews your full medical history, current medications, the specific quality and timing of your dizziness or fluid-related symptoms, dietary habits (raw and cold food intake), and digestive function. Tongue and pulse diagnosis confirms the thin-fluid pattern (deep slippery pulse, moist white-coated pale tongue with possible scallop marks at the edges). The first session usually includes acupuncture treatment to immediately reduce the acute dizziness so you experience the technique alongside the herbal prescription. Follow-up sessions are 60 minutes; the typical course is 6–12 weeks of daily herbal formula combined with weekly acupuncture, then monthly maintenance.

Online Chinese herbal medicine consultations are available throughout the UK and worldwide. After a full video consultation, the bespoke prescription is posted directly to your door. I am a member of the British Acupuncture Council (BAcC) and the Register of Chinese Herbal Medicine (RCHM) with over 25 years of clinical experience.

Frequently asked questions

What is the difference between this formula and Ban Xia Bai Zhu Tian Ma Tang for dizziness?

Both formulas address dizziness from a phlegm-fluid disturbance pattern, but the underlying mechanism differs. Ban Xia Bai Zhu Tian Ma Tang targets thick Phlegm-Damp rising to obstruct the head, with a thick greasy tongue coating and head-heavy sensation. The Poria-Cinnamon formula targets thin-watery-fluid (Tan Yin) from Spleen-Yang deficiency, with a moist (not greasy) white coating and a sloshing or postural quality to the dizziness. They are sometimes combined when both patterns coexist, but selection depends on careful pattern differentiation.

How quickly does this Poria-Cinnamon formula work for dizziness?

Most patients with Spleen-Yang-deficient vestibular dizziness notice improvement within 2–4 weeks of daily granule treatment. Substantial relief from postural lightheadedness and Meniere's-pattern attacks typically develops over 6–12 weeks. For chronic dizziness of multi-year duration, treatment often continues for 3–6 months with progressive deepening of effect.

Can this formula help Meniere's disease?

Yes — Meniere's disease, in the TCM thin-fluid retention pattern, is one of the classical indications. The formula targets the inner-ear fluid imbalance from Spleen-Yang deficiency that drives recurrent vertigo attacks, tinnitus and aural fullness. Modern Chinese clinical practice routinely combines this formula with acupuncture (BL 20, BL 23, SP 9, GB 20) for substantial reduction in attack frequency over 3–6 months. Severe acute Meniere's still requires conventional vestibular suppressants alongside the herbal treatment.

Is this formula safe with vestibular suppressant medication?

Yes — no clinically significant interactions have been reported with prochlorperazine, betahistine, cinnarizine or other vestibular suppressants commonly prescribed for Meniere's or vestibular dizziness. The herbal formula is often used alongside these medications, with the medication tapered under your GP's supervision as the herbal effect develops. Always disclose all medications to your prescribing doctor.

Can this formula be taken long-term?

For appropriate Spleen-Yang-deficient patients, the formula can be taken daily for 3–6 months without typical accumulation issues. For continuous use beyond 6 months, periodic review with a qualified herbalist confirms the pattern still fits. Monitor blood pressure and serum potassium with continuous Zhi Gan Cao exposure beyond 3 months. The formula is then typically converted to a maintenance protocol (5 days per week with weekends off, or alternating with related Spleen-tonifying formulas).

What lifestyle changes complement the formula?

The thin-fluid pattern responds well to avoiding raw cold food and ice-cold drinks (which deplete the Spleen Yang and aggravate fluid retention), reducing dairy and sweet foods (which generate Damp), eating warm cooked food (especially congee and warming soups), avoiding eating late at night, gentle exercise (Qi Gong or walking) to support the Yang transformation of fluids, and applying warmth to the lower abdomen and lower back to support Kidney-Spleen Yang. Combining these dietary measures with the herbal formula typically produces faster and more sustained improvement.

Prefer to be treated from home? Chinese herbal medicine online consultations are available throughout the UK and worldwide.

References

[9] Wang YY, Li XX, Liu JP, Luo H, Ma LX, Alraek T. Traditional Chinese medicine for chronic fatigue syndrome: a systematic review of randomized clinical trials. Complement Ther Med. 2014 Aug;22(4):826-33. https://doi.org/10.1016/j.ctim.2014.06.004. PMID: 25146086.

[10] Lee B, Kwon CY, Suh HW, Kim YJ, Kim KI, Lee BJ, Lee JH. Herbal medicine for the treatment of chronic cough: a systematic review and meta-analysis. Front Pharmacol. 2023 Oct 17;14:1230604. https://doi.org/10.3389/fphar.2023.1230604. PMID: 37920213.

[22] Guo Z, Su Z, Wang Z, Luo X, Lai R. The effect of Chinese herbal medicine Banxia Baizhu Tianma Decoction for the treatment of vertebrobasilar insufficiency vertigo: A systematic review and meta-analysis of randomized controlled trials. Complement Ther Med. 2017 Apr;31:27-38. https://doi.org/10.1016/j.ctim.2017.01.004. PMID: 28434468.