Zhǐ Shí (枳实) — Immature Bitter Orange

On this page

1. Overview
2. Properties
3. Actions and indications
4. Modern research
5. Incompatibilities
6. Cautions and contraindications
7. Treatment at my clinic

1. Overview

Zhǐ Shí (枳实) is the immature fruit of Citrus aurantium, the bitter orange. It belongs to the category of Herbs that regulate Qi in the Chinese Materia Medica and is one of the strongest Qi-breaking herbs in Chinese herbal medicine, used for severe food stagnation, abdominal distension and stuck phlegm with constipation. The mature fruit is Zhǐ Ké, which is gentler.

I prescribe Zhǐ Shí as part of bespoke herbal formulas from pharmaceutical-grade granules sourced from Sun Ten in Taiwan.

2. Properties

3. Actions and indications

Principal actions

1. Breaks up stagnant Qi and reduces accumulation
2. Transforms phlegm and unblocks the chest
3. Drains downward to unblock the bowels

Indications

1. Severe food stagnation with abdominal fullness, distension, belching and constipation
2. Stagnant Qi with painful epigastric distension
3. Phlegm and Qi stagnation in the chest with oppression and tightness
4. Rectal prolapse and uterine prolapse with sinking Spleen Qi (paradoxically used in modern formulae)

4. Modern research

Zhi Shi contains flavonoids (hesperidin, naringin, neohesperidin) and synephrine. Pharmacological studies report a prokinetic effect on gastrointestinal smooth muscle, a mild positive inotropic action on the heart, and bronchodilator effects. Synephrine is a sympathomimetic that mildly raises blood pressure; modern Sun Ten granules are standardised and used at conventional doses.

5. Incompatibilities

Zhǐ Shí (枳实) Immature Bitter Orange is not listed in either of the two classical incompatibility texts — Shi Ba Fan (Eighteen Antagonisms) or Shi Jiu Wei (Nineteen Mutual Inhibitions). As with every Chinese herb it should be prescribed only as part of a balanced formula by a registered Chinese herbalist (RCHM), who will check for interactions with any other herbs and prescription medications you are taking.

6. Cautions and contraindications

Avoid in pregnancy. Use with caution in patients with weak constitution, low blood pressure or arrhythmias because of synephrine content. Avoid concurrent grapefruit-style juices and certain CYP3A4-metabolised drugs without herbalist supervision.

Pattern contraindications

Use cautiously in Yin and Blood deficiency — Qi-moving herbs are aromatic and drying and can deplete fluids. Avoid in pregnancy for the strongly descending Qi-movers (Zhi Shi, Qing Pi).

Modern drug interactions

Chai Hu modulates CYP enzymes. Other regulating-Qi herbs are usually well tolerated. Tell your GP about your herbal prescription if you take regular medication.

Important: Chinese herbs should always be prescribed by a fully qualified herbalist who is a member of the Register of Chinese Herbal Medicine (RCHM).

7. Treatment at my clinic

I prescribe Zhǐ Shí as part of tailored herbal formulas for stubborn epigastric and abdominal distension, food stagnation with constipation, functional dyspepsia with bloating, and post-cholecystectomy bloating with Qi stagnation. Every prescription is individually formulated following a full TCM assessment.

I see patients in person at my clinic in Wokingham, Berkshire. Online Chinese herbal medicine consultations are available.

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