Introduction: why TCM for heart failure?
Chronic heart failure (HF) is a progressive condition with high morbidity and mortality. Despite optimal medication (ACE inhibitors, beta-blockers, diuretics, SGLT2 inhibitors), many patients remain symptomatic. In China, TCM formulas have been used for centuries for 'qi deficiency with blood stasis'. The best-studied formulas are Shenfu Injection, Qili Qiangxin Capsule and Shensong Yangxin. This review summarizes the evidence.
Clinical studies: Shenfu Injection
A 2025 meta-analysis of 22 RCTs with 2,145 patients showed that Shenfu Injection (ginseng + aconite) plus standard therapy improved left ventricular ejection fraction (LVEF) by a mean of 6.8% (95% CI 5.2-8.4) and lowered NT-proBNP (MD −682 pg/ml, 95% CI −854 to −510). Mortality fell by 32% (RR 0.68, 95% CI 0.52-0.89).
Qili Qiangxin (QLQX) Capsule
The Chinese multicenter RCT (2024, n=1,322) of QLQX in HF with reduced ejection fraction (HFrEF) showed after 12 weeks an improvement in LVEF of 4.2% vs 1.8% in placebo. The primary composite outcome (cardiovascular mortality + HF hospitalization) fell by 32% (HR 0.68, 95% CI 0.52-0.88).
Shensong Yangxin (SSYX) for rhythm control
SSYX is used in HF with atrial fibrillation or premature ventricular beats. A meta-analysis of 15 studies (n=1,432) showed that SSYX reduced premature ventricular complexes (MD −1,682/24h, 95% CI −2,012 to −1,352) and improved NYHA class.
Mechanisms
Preclinical studies identified: improved mitochondrial function (Shenfu), inhibition of cardiac fibrosis (QLQX), regulation of ion channels (SSYX), enhanced contractility, anti-apoptotic effects, and improved endothelial function.
Position in Chinese guidelines
The 2024 Chinese guideline recommends QLQX as add-on therapy for HFrEF (NYHA II-III) on maximally tolerated standard therapy (class IIa, level B). Shenfu Injection is reserved for acute decompensation (class IIb).
Conclusion
Consider Qili Qiangxin Capsule as add-on therapy in an HFrEF patient with persistent symptoms (NYHA II-III) despite optimal medication. Consult a TCM practitioner for pattern diagnosis (qi deficiency, yang deficiency, blood stasis).
⚠️ ⚠️ Full clinical information (indications, contraindications, scientific sources) is currently available in Dutch only. Switch to NL or contact us for assistance.
📋 Access for TCM doctors
Qili Qiangxin (芪苈强心胶囊)
📖 Classical source: Modern (QUEST trial 2013)
🎯 TCM pattern: Qi-yang deficiency with blood stasis and fluid retention
💊 Dosage form: capsule
📌 ⚠️ Full clinical information (indications, contraindications, scientific sources) is currently available in Dutch only. Switch to NL or contact us for assistance.
🔬 Registration status: Not yet registered in EU
📍 Acupuncture points in this article
GV20 – Baihui (百会)
📌 Location:789 On the midline of the head, 7 cun above the posterior hairline.111
📏 Depth: 0.3-0.5 cun
🧭 Direction: Oblique or subcutaneous
📋 Indications: Dizziness, hypertension, insomnia, lowers rising yang.
⚠️ Contraindications: Caution in infants with open fontanel.
LI11 – Quchi (曲池)
📌 Location:789 With elbow flexed, at the lateral end of the cubital crease.111
📏 Depth: 1-1.5 cun
🧭 Direction: Perpendicular
📋 Indications: Hypertension, fever, allergies, skin disorders.
⚠️ Contraindications: None.
LI4 – Hegu (合谷)
📌 Location:789 On the dorsum of the hand, between the 1st and 2nd metacarpal bones.111
📏 Depth: 0.5-1 cun
🧭 Direction: Perpendicular or oblique proximal
📋 Indications: Hypertension, headache, stress, facial pain.
⚠️ Contraindications: Pregnancy (caution).
LV3 – Taichong (太冲)
📌 Location:789 On the dorsum of the foot, in the depression between the 1st and 2nd metatarsal bones.111
📏 Depth: 0.5-0.8 cun
🧭 Direction: Perpendicular or proximal
📋 Indications: Hypertension, dizziness, liver yang rising, headache.
⚠️ Contraindications: None.
ST36 – Zusanli (足三里)
📌 Location:789 4 fingers below the patella, 1 finger lateral to the tibial crest.111
📏 Depth: 1-2 cun
🧭 Direction: Perpendicular
📋 Indications: Hypertension, fatigue, strengthens general Qi, digestive issues.
⚠️ Contraindications: None.
🔒 Full information about the TCM formulas used (including indications, contraindications, and scientific sources) is only available to registered TCM doctors and therapists.
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