A centuries-old formula steps into modern trials
Imagine a heart failure pill built from 11 different plants — including Huang Qi (astragalus), Ren Shen (ginseng), and Dan Shen (red sage).
That's Qiliqiangxin (QLQX), a traditional Chinese medicine formulation developed from principles dating back centuries.
For years, it was used mostly in China. Now, researchers are putting it through the same statistical tests Western drugs face — and the results are drawing international attention.
Heart failure with reduced ejection fraction, or HFrEF (heart failure with reduced pumping), affects millions of people worldwide.
Modern treatments — ACE inhibitors, beta blockers, SGLT2 inhibitors, sacubitril/valsartan — have made a real difference. But many patients still decline, get hospitalized, or die earlier than hoped.
So researchers keep looking for additions, not replacements. That's where adjunctive (add-on) therapies come in.
Old view vs. the more careful look
For a long time, Western cardiologists viewed traditional Chinese medicines with skepticism — often fairly, given that few had been tested in rigorous randomized trials.
What's changing: Chinese research teams are increasingly running well-designed randomized controlled trials on traditional formulas.
This new meta-analysis pooled 24 such trials on QLQX, covering 5,580 patients, and asked a simple question: does adding this capsule to standard heart failure care actually help?
How it works, in simple terms
Qiliqiangxin's name roughly translates to "strengthening the heart with qi."
In traditional Chinese medicine terms, it aims to tonify qi, activate blood circulation, and promote diuresis.
In modern biological terms, researchers have identified several possible effects: reducing heart muscle stress, calming inflammation, improving how heart cells use energy, and helping the body shed excess fluid.
Think of it as trying to support the heart from several angles at once — similar in philosophy to combination therapy in modern medicine.
The study at a glance
The authors searched seven research databases through February 2025 for randomized controlled trials of QLQX in HFrEF patients.
Two independent reviewers screened the studies and rated their quality using the standard Cochrane RoB 2.0 tool. They used the GRADE system to assess how trustworthy the combined evidence was.
Twenty-four trials — nearly all conducted in China — met inclusion criteria.
The headline numbers were meaningful.
Compared to standard treatment alone, adding QLQX reduced the risk of cardiovascular death by about 18%, hospitalization for heart failure by about 22%, and combined cardiovascular events by 18%. Evidence quality was rated as moderate by GRADE.
Heart function measures also improved: the left ventricular ejection fraction rose, chamber size shrank slightly, NT-proBNP (a blood marker of heart strain) fell, and patients walked further in a standard 6-minute walk test.
These are promising numbers — but they come with important caveats.
A re-engagement moment
Here's where it gets delicate.
A formula rooted in centuries of traditional practice, backed by moderate-quality modern data, but with almost all trials done in a single country — that's an unusual mix.
The question isn't whether QLQX deserves dismissal (it doesn't) or whether it's proven beyond doubt (it isn't). It's whether the evidence is strong enough for wider adoption outside China.
QLQX is already included in China's national heart failure guidelines as an adjunctive option.
Elsewhere, cardiologists tend to take a more cautious view. They respect the tradition and welcome the growing evidence base, but want to see large multicenter trials in diverse populations — including long-term safety data and head-to-head comparisons with modern guideline-directed medications.
This is how integration typically unfolds: promising regional data, followed by international trials, followed by gradual acceptance if results hold.
If you live in a region where QLQX is available and prescribed by a qualified cardiologist, discuss with that doctor whether it's appropriate for your case.
If you live outside China, QLQX is generally not part of standard treatment. Don't order it online or use it to replace proven therapies.
Do not stop or replace your current heart failure medications based on early research. Modern HFrEF drugs have decades of evidence behind them, and changes should always involve your cardiologist.
Honest limitations
The meta-analysis has real weaknesses to respect.
Nearly all trials came from China, which raises concerns about whether results will replicate in other populations and health systems. Individual trial quality varied. Blinding — a key feature of rigorous trials — was inconsistent.
Follow-up times were relatively short, so effects over many years remain unclear. Interactions with newer heart failure drugs, like SGLT2 inhibitors, weren't well studied.
Large, multicenter, international randomized controlled trials are needed to confirm these findings.
Some are already being planned. Studies using standardized outcomes, long-term follow-up, and more diverse populations would help move QLQX from regional acceptance to global consideration.
In the meantime, this analysis supports respecting traditional knowledge while also insisting on modern standards of proof — a balance medicine will keep navigating as more traditional therapies meet rigorous testing.
