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).
