Zhi Shi Xie Bai Gui Zhi Tang (枳实薤白桂枝汤) — Decoction for Chest Bi

Zhi Shi Xie Bai Gui Zhi Tang is a classical Chinese herbal formula used primarily for stable angina pectoris with cold-phlegm pattern. It is prescribed for chest Yang deficiency with Phlegm-Qi obstruction:

On this page

1. Overview
2. TCM pattern
3. Key herbs
4. Formula actions
5. Conditions treated
6. Cautions
7. Frequently asked questions

Overview

Zhi Shi Xie Bai Gui Zhi Tang is from Zhang Zhongjing’s Jin Gui Yao Lue. It addresses chest Bi syndrome from Yang deficiency with Phlegm-Qi obstruction — the classical TCM picture of angina-pectoris-like chest pain with cold pattern, Phlegm signs and Qi stagnation. In modern terms it covers many presentations of stable angina, post-MI recovery, and chronic chest tightness from a mixed pattern.

The chief pair Xie Bai (Chinese garlic, Allium macrostemon) and Gua Lou is the classical “open the chest Yang” combination. Adding Zhi Shi, Hou Po and Gui Zhi gives the formula its distinctive Qi-moving and Yang-warming action.

I prescribe Zhi Shi Xie Bai Gui Zhi Tang as part of bespoke herbal formulas from pharmaceutical-grade granules sourced from Sun Ten in Taiwan.

TCM pattern

Zhi Shi Xie Bai Gui Zhi Tang is prescribed for chest Yang deficiency with Phlegm-Qi obstruction:

• Chest pain, tightness or oppression — central or with arm/jaw radiation
• Worse with cold, exertion, emotional stress
• Shortness of breath
• Palpitations
• Cold extremities
• Fatigue
• Sticky mouth
• Tongue — pale or slightly purplish, white or slippery coat
• Pulse — wiry, possibly tight or slow

Key herbs

1. Zhi Shi (Fr. Aurantii Immaturus, 12g) — moves Qi in the chest
2. Xie Bai (Chinese garlic, Allium macrostemon, 9-12g) — opens chest Yang; key “heart formula” herb
3. Gua Lou (Fr. Trichosanthis, 12-24g) — resolves Phlegm and opens the chest
4. Gui Zhi (Ram. Cinnamomi, 3-6g) — warms Yang and harmonises
5. Hou Po (Cx. Magnoliae Officinalis, 12g) — moves Qi and transforms Damp

Formula actions

1. Opens chest Yang
2. Transforms Phlegm in the chest
3. Moves stagnant Qi
4. Relieves chest pain and tightness

Conditions treated

1. Stable angina pectoris with cold-Phlegm pattern (alongside cardiology care)
2. Post-MI recovery with chronic chest oppression
3. Atypical chest pain from Phlegm-Qi stagnation
4. Costochondritis
5. Chronic obstructive pulmonary disease (COPD) with chest tightness
6. Hiatus hernia symptoms with chest pressure
7. Esophageal motility disorders
8. Anxiety[4] with chest tightness

Cautions

Acute severe chest pain or new-onset chest pain needs emergency cardiology assessment — call 999 if chest pain is acute, severe or with sweating, breathlessness or radiation. This formula is for chronic stable chest Bi only.

Not appropriate for Heat-pattern chest pain (sticky yellow phlegm, red tongue with yellow coat).

Use cautiously in pregnancy.

Always consult a qualified Chinese herbalist registered with the RCHM.

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

Frequently asked questions about Zhi Shi Xie Bai Gui Zhi Tang

What is Zhi Shi Xie Bai Gui Zhi Tang used for?

Zhi Shi Xie Bai Gui Zhi Tang is used for stable angina pectoris with cold-phlegm pattern (alongside cardiology care), post-mi recovery with chronic chest oppression, atypical chest pain from phlegm-qi stagnation, costochondritis, chronic obstructive pulmonary disease (copd) with chest tightness. The formula targets the underlying TCM pattern producing these symptoms rather than the symptom in isolation, which is why pattern diagnosis by a qualified herbalist is essential.

How does Zhi Shi Xie Bai Gui Zhi Tang work?

The herbs in Zhi Shi Xie Bai Gui Zhi Tang work together: Xie Bai (Chinese garlic, Allium macrostemon, 9 12g) — opens chest yang; key “heart formula” herb; Gua Lou (Fr. Trichosanthis, 12 24g) — resolves phlegm and opens the chest; Gui Zhi (Ram. Cinnamomi, 3 6g) — warms yang and harmonises. The synergy of these actions addresses the underlying TCM pattern.

How long does Zhi Shi Xie Bai Gui Zhi Tang take to work?

For most patients, an improvement is typically noticed within 2–4 weeks of daily granule treatment. Full benefit usually requires 6–12 weeks, depending on how long-standing the underlying pattern is. Zhi Shi Xie Bai Gui Zhi Tang is typically prescribed as part of an individualised treatment plan that may include other herbs or adjustments over time.

Is Zhi Shi Xie Bai Gui Zhi Tang safe in pregnancy?

Use cautiously in pregnancy. As with any Chinese herbal formula, prescription in pregnancy should only be by a qualified RCHM herbalist with pregnancy training.

Who should not take Zhi Shi Xie Bai Gui Zhi Tang?

Acute severe chest pain or new-onset chest pain needs emergency cardiology assessment — call 999 if chest pain is acute, severe or with sweating, breathlessness or radiation. This formula is for chronic stable chest Bi only. Not appropriate for Heat-pattern chest pain (sticky yellow phlegm, red tongue with yellow coat). Use cautiously in pregnancy. Always consult a qualified Chinese herbalist registered with the RCHM. Prefer to be treated from home? Chinese herbal medicine online consultations are available throughout the UK and worldwide. Zhi Shi Xie Bai Gui Zhi Tang must be prescribed only after full pattern diagnosis by a qualified RCHM herbalist; self-prescription is not appropriate.

References

[4] Lin Y, Cai S, Wang T, Zhuang T, Huang T, Yu X, et al. Evaluation of the Safety and Efficacy of Xiao Yao San as a Treatment for Anxiety: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med. 2022;2022:1319592. https://doi.org/10.1155/2022/1319592. PMID: 35432568.