Zhi Shi Xie Bai Gui Zhi Tang: A Classic TCM Formula for Chest Pain Relief
Hongji Medical- Feb 21
- 6 min read
Updated: May 7
Zhi Shi Xie Bai Gui Zhi Tang is a time-honored prescription from Jingui Yaolue, a key section of Shanghan Zabing Lun by the renowned Eastern Han Dynasty physician Zhang Zhongjing.
Noted in the text for treating “chest numbness, fullness in the heart, qi stagnation, and downward pressure on the heart,” this formula addresses chest pain and discomfort caused by weak chest Yang, phlegm stagnation, and Qi reversal.
By promoting Yang, clearing phlegm, and regulating Qi, it restores balance and alleviates symptoms like chest tightness and shortness of breath, making it a cornerstone of traditional Chinese medicine (TCM) for chest-related conditions.
Formula Composition of Zhi Shi Xie Bai Gui Zhi Tang
Zhi Shi Xie Bai Gui Zhi Tang consists of five herbs, organized according to the TCM principle of “monarch, minister, assistant, and envoy”:
Monarch Herbs:
Zhi Shi (Immature Bitter Orange): Breaks up Qi stagnation, resolves phlegm, and disperses lumps, easing chest tightness.
Xie Bai (Chinese Chive Bulb): Warm and pungent, it promotes chest Yang Qi, clears cold and phlegm, and relieves stagnation.
Minister Herb:
Hou Po (Magnolia Bark): Dries dampness, resolves phlegm, and moves Qi downward to reduce fullness and chest discomfort.
Assistant Herb:
Gua Lou (Trichosanthes Fruit): Cold in nature, it clears lung phlegm and dampness, opens the chest, and relieves cough or wheezing.
Envoy Herb:
Gui Zhi (Cinnamon Twig): Warms Yang, disperses cold, and calms upward-rushing Qi to smooth chest Qi flow.
This synergistic blend targets the root causes of chest pain—phlegm, cold, and Qi stagnation—while restoring Yang and circulation.
Pathogenesis: Understanding the Condition
The formula addresses “chest Yang deficiency with phlegm stagnation and Qi reversal,” a condition where insufficient chest Yang allows cold, phlegm, and dampness to block Qi and blood flow. This leads to:
Chest tightness, fullness, or pain, sometimes radiating to the back.
Shortness of breath, cough, or wheezing due to phlegm obstructing the lungs.
Qi rushing upward from the lower abdomen, causing discomfort in the chest or heart area.
White, greasy tongue coating and a deep, tight, or stringy pulse.
Cold Qi and phlegm disrupt the lungs’ normal function, worsening respiratory and chest symptoms. Zhi Shi Xie Bai Gui Zhi Tang restores chest Yang, clears blockages, and regulates Qi to relieve these issues.
Therapeutic Effects of Zhi Shi Xie Bai Gui Zhi Tang
Zhi Shi Xie Bai Gui Zhi Tang excels in:
Promoting Chest Yang: Gui Zhi and Xie Bai warm the chest, dispersing cold and restoring Yang Qi flow.
Clearing Phlegm and Dampness: Zhi Shi, Hou Po, and Gua Lou dissolve phlegm, easing cough, wheezing, and chest fullness.
Regulating Qi: The formula calms upward-rushing Qi, relieving heart and rib discomfort and improving circulation.
Relieving Chest Pain: By addressing stagnation and phlegm, it reduces chest tightness and pain, including severe cases radiating to the back.
These effects make it highly effective for chest and respiratory discomfort caused by cold and phlegm.
Modern Applications of Zhi Shi Xie Bai Gui Zhi Tang
In modern medicine, Zhi Shi Xie Bai Gui Zhi Tang is used for conditions linked to chest Yang deficiency and phlegm stagnation, including:
Cardiovascular issues like coronary heart disease, angina, and arrhythmias.
Respiratory conditions such as chronic bronchitis or asthma with phlegm.
Musculoskeletal pain, including intercostal neuralgia, back coldness, or trauma-related chest pain.
Other conditions like chronic nephritis, epigastric pain, or pediatric hyperrespiration syndrome.
Variants of the formula include:
Gua Lou Xie Bai Bai Jiu Tang: Used for asthma, phlegm, and chest pain with slow or tight pulses, emphasizing phlegm clearance.
Zhi Shi Xie Bai Gui Zhi Tang with Pinellia: Adds Pinellia for heavy phlegm, enhancing chest-opening and phlegm-clearing effects.
These adaptations tailor the formula to specific symptoms, broadening its clinical utility.
Precautions for Use
When using Zhi Shi Xie Bai Gui Zhi Tang, consider the following:
Yang Deficiency Caution: For patients with severe Yang or Qi deficiency, combine with Yang-tonifying herbs, as the formula alone may be insufficient.
Syndrome Differentiation: Ensure the condition matches chest Yang deficiency with phlegm and Qi stagnation (e.g., chest pain, greasy tongue coating, tight pulse) before use.
Formula Adjustments: Tailor the recipe to symptoms—add Pinellia for chest fluid, Citrus Aurantium for fullness, or extra Magnolia Bark for severe Qi reversal—under a practitioner’s guidance.
Medical Supervision: Consult a TCM practitioner to confirm suitability and avoid overuse, especially in complex cases.
Chinese Name | 枳實薤白桂枝湯 |
Phonetic | Zhi Shi Xie Bai Gui Zhi Tang |
English Name | Immature Bitter Orange, Chinese Chive and Cinnamon Twig Decoction |
Classification | Qi-regulating formulas |
Source | 《Essentials from the Golden Cabinet》Jin Gui Yao Lue《金匱要略》 |
Combination | Aurantii Fructus Immaturus (Zhi Shi) 4 pieces (12g), Magnoliae Officinalis Cortex (Hou Po) 4 liang (12g), Allii Macrostemonis Bulbus (Xie Bai) 0.5 sheng (9g), Cinnamomi Ramulus (Gui Zhi) 1 liang (6g), Trichosanthis Fructus (Gua Lou) 1 piece (12g) |
Method | Decoct zhi shi and hou po in five sheng water and reduce to two sheng then filter the residue. Add the rest of the ingredients and bring it to a boil once again. Divide the decoction into three equal parts. It is to be taken warm three times per day. (Modern administration: It can also be prepared as a decoction.) |
Action | Unblocks yang and dissipates masses, dispels phlegm and lowers qi. |
Indication | Zhi Shi Xie Bai Gui Zhi Tang is indicated for chest bi caused by chest yang weakness, phlegm obstruction, and counterflow qi. The symptoms are fullness and pain in the chest, chest pain radiating to the back, panting, cough, spitting, shortness of breath, hypochondriac qi counterflowing upward to heart and chest. The coating is white and greasy, and the pulse is deep, wiry or tight. |
Pathogenesis | This pattern is caused by chest yang weakness, fluid concentrated into phlegm, binding of qi and phlegm, and yin cold qi counterflow. Phlegm is a yin pathogen which tends to obstruct the movement of qi. When it collects in the chest, fullness and pain in the chest may occur. The pain may radiate between the chest and the back. Phlegm obstruction along with lung failing to diffuse and govern descent leads to panting, cough, spitting, and shortness of breath. When the chest yang is weak, yin cold qi counterflows and the patient can feel it rising from the hypochondria to attack the heart and chest. The root of this pattern is chest yang weakness, while the branches are phlegm obstruction and qi stagnation with counterflow qi. Therefore, the therapeutic methods are to unblock yang, dissipate masses, dispel phlegm, and lower qi. |
Application | 1. Essential pattern differentiation Zhi Shi Xie Bai Gui Zhi Tang is a commonly used formula for chest bi caused by chest yang weakness, phlegm obstruction, and counterflow qi. This clinical pattern is marked by fullness and pain in the chest, hypochondriac counterflow qi rising to attack heart and chest, white, greasy coating, deep, wiry or tight pulse. 2. Modern applications This formula may be used in the following biomedically defined disorders, when the patient shows signs of chest yang weakness, phlegm obstruction, and qi stagnation: angina pectoris, intercostal neuralgia, and non-suppurative costal cartilage inflammation. 3. Cautions and contraindications This formula is not appropriate for chest bi due to yang deficiency with weak qi. |
Additonal formulae | 1. Gua Lou Xie Bai Bai Jiu Tang (Trichosanthes, Chinese Chive and White Wine Decoction 瓜蔞薤白白酒湯) [Source]《Essentials from the Golden Cabinet》Jin Gui Yao Lue《金匱要略》 [Ingredients] Gua lou 1 piece (12g), xie bai 0.5 sheng (12g), white wine 7 sheng (as needed) [Preparation and Administration] Decoct all of the ingredients simultaneously, reduce down to two sheng of the decoction, and drink while it is warm. [Actions] Unblocks yang and dissipates masses, moves qi and dispels phlegm. [Applicable Patterns] Chest bi. Symptoms include: panting, cough, spitting, chest and back pain, shortness of breath, the cun pulse is deep and slow, and guan pulse is tight and rapid. 2. Gua Lou Xie Bai Ban Xia Tang (Trichosanthes, Chinese Chive and Pinellia Decoction 瓜蔞薤白半夏湯) [Source]《Essentials from the Golden Cabinet》Jin Gui Yao Lue《金匱要略》 [Ingredients] Gua lou (smashed) 1 piece (12g), xie bai 3 liang (9g), ban xia half sheng (12g), white wine 1 dou (as needed) [Preparation and Administration] Decoct all of the ingredients simultaneously and reduce to four sheng. Drink one sheng, warm, three times per day. [Actions] Unblock syang and dissipates masses, dispels phlegm and loosens the chest. [Applicable Patterns] Chest bi. Symptoms include: severe phlegm-turbidity chest pain radiating to the back, and unable to lie down flat. |
Remark | Officinal Magnolia (Magnolia officinalis) is listed as "Endangered" in the International Union for the Conservation of Nature and Natural Resources (IUCN) Red List of Threatened Species. |
