What Ling Gui Zhu Gan Tang is for
The skin here is cool, clammy and puffy rather than red or dry: tissue that holds fluid, weeps a clear ooze and heals slowly, on a surface that feels cool to the touch and looks pale or dusky. The explanation is Yang too weak to move the fluid, so it collects in the tissue, and the formula warms the Yang while draining what has gathered.
The tissue looks waterlogged. It is cool and clammy under the hand, puffy or boggy where fluid has settled, and it may weep a clear or pale ooze rather than a yellow one. Weeping eczema of this type sits on a pale or dusky base, and the lesions dry slowly and heal slowly. The area feels cold rather than hot, and there is no angry redness about it. Dampness of this kind is heavy and inert, so the skin looks burdened rather than inflamed.
The tradition reads the puffiness as fluid that has collected because the Yang cannot move it. Yang is the warming and moving side of the body, and when it is low the fluids gather in the tissue instead of circulating. Fu Ling drains what has collected, Gui Zhi warms the Yang so the fluid can move again, Bai Zhu strengthens the Spleen so fluid is transformed rather than stored, and Gan Cao holds the middle. The warmth is what makes the draining work: without it the fluid would be shifted but not transformed, and without the draining the warmth alone would not clear what has already settled.
It is not for the opposite picture. Yin deficiency with dryness, where the skin is thin, dry and finely cracked, is excluded, because warming would consume the little moisture left. Damp-Heat is excluded too: where the skin is red, hot and weeping yellow, or the tongue carries a yellow greasy coat, the warmth would feed the Heat rather than clear it. The formula is given for one to four weeks and then reassessed.
Actions
- Warms Yang and transforms fluid
- Drains Dampness
- Strengthens the Spleen
- Settles dizziness and palpitations
Properties
- Taste and temperature: Predominantly sweet and pungent with a bland quality. Sweet supports the middle, pungent warms and moves, bland drains fluid.
- Organs: Spleen, Heart, Lungs
- Channels: Spleen, Heart, Lung
The pattern behind it
The root is Yang deficiency that leaves the body unable to transform and move fluid, so it collects in the chest and tissues. That produces the dizziness, the heavy chest and the palpitations, and on the skin the cool clammy puffiness. Warming the Yang and draining the fluid addresses both the cause and what has accumulated.
Composition
The herbs in Ling Gui Zhu Gan Tang, with their role and dose.
| Role | Herb | Dose | Properties | Why it is there |
|---|---|---|---|---|
| Deputy | Fu Ling | 12 to 20 g | Neutral, Sweet, bland | Drains the accumulated fluid out through the urine and supports the Spleen. |
| Assistant | Gui Zhi | 9 to 15 g | Warm, Pungent, sweet | Warms Yang and helps the fluid move, which is the key to transforming rather than simply draining it. |
| Envoy | Bai Zhu | 6 to 10 g | Warm, Bitter, sweet | Strengthens the Spleen so fluid is transformed properly in future. |
| Gan Cao | 6 g | Neutral, Sweet | Supports the middle and harmonises the formula. |
Patterns it treats
Damp-Phlegm
Cool, clammy and puffy skin that holds fluid, weeps a clear ooze and heals slowly on a pale or dusky base. The fluid has collected because the Yang cannot move it, so the tissue looks waterlogged rather than inflamed.
How the formula is built
Two herbs drain and warm, one strengthens the source, one holds the middle. Gui Zhi is the essential addition: without warmth the fluid does not move, and without the draining herbs the warmth alone would not clear what has collected. That is why the formula is effective for both the internal dizziness and the skin's cool puffiness.
Skin conditions it is used for
Where this formula appears in the skin conditions of the library.
Preparation and use
Decocted in water and taken warm, in two or three divided doses.
Modifications
- If the dizziness dominates, a herb to settle the head is added.
- If the Cold is marked, warming herbs are increased.
- If the digestion is very weak, Spleen support is increased.
- Where Heat is present, the warming herbs are reduced and cooling added.
Timing
Taken warm in two or three divided doses.
Duration
One to four weeks for acute fluid retention, reassessed; longer for chronic recurrent dizziness or palpitations with periodic review.
Diet while taking it
Avoid cold, raw and greasy food, and reduce salt if there is puffiness.
Safety
Contraindications
Avoid in Yin deficiency with Heat signs such as a dry mouth and red tongue with little coating. Avoid in Damp-Heat with a yellow greasy coat, because the warming herbs would aggravate it.
Interactions
The draining herb can add to diuretic medication. Gan Cao may interact with diuretics, digoxin and corticosteroids.
Pregnancy
Use with caution in pregnancy. Gui Zhi is warming and promotes circulation, which is generally acceptable in moderate doses but needs professional guidance.
Breastfeeding
Considered acceptable under professional guidance.
Children
Used in children with reduced dose for fluid retention with dizziness.
Before you use it
Recorded from the classical record and rewritten in this project's own words. Educational only: not a prescription, and persistent dizziness or palpitations needs medical assessment.
General safety references
General references for herbal hepatotoxicity and herb-drug interactions; they are not specific to this formula.
- Review article: Herbal hepatotoxicity - an update on traditional Chinese medicine preparations. Alimentary Pharmacology & Therapeutics, 2014. PMID: 24844799.
- Interactions between herbal medicines and prescribed drugs: an updated systematic review. Drugs, 2009. PMID: 19719333.
- Warfarin and food, herbal or dietary supplement interactions: a systematic review. British Journal of Clinical Pharmacology, 2021. PMID: 32478963.
Origin and history
Shang Han Lun (伤寒论, Treatise on Cold Damage) by Zhang Zhongjing, Eastern Han dynasty, around 220 CE.
The formula comes from Zhang Zhongjing's Treatise on Cold Damage, one of the oldest clinical texts in the tradition, where it treats fluid that collects because Yang is deficient. Its four herbs remain unchanged, and its use for dizziness and palpitations of the fluid-retention type is one of the most durable prescriptions in the tradition.
Evidence note
No controlled trial of this treatment in skin conditions was identified for this entry. What is described here rests on the classical and later materia medica record and on traditional clinical use, not on controlled trial evidence, and it is not a prediction of benefit. Where skin-specific research does exist it is linked above.
Common questions
Why does a cold formula contain a warming herb?
Because fluid only moves when it is warmed. Gui Zhi warms the Yang so the fluid can be transformed, while Fu Ling drains what has already collected.
Can it help weeping eczema?
Only the cool, clammy, puffy kind on a cold base. Hot weeping eczema needs cooling and drying instead.
Is it used for dizziness?
Yes, the dizziness of fluid retention with a heavy chest and a wet pale tongue. Dizziness has many other causes and needs medical assessment.
How long is it taken?
One to four weeks for an acute episode, longer for chronic patterns with review.