Zhi Shi Xiao Pi Wan, Immature Bitter Orange Pill to Reduce Focal Distension, is Zhi Shi, Hou Po, Huang Lian, Ban Xia, Ren Shen, Bai Zhu, Fu Ling, Mai Ya, Gan Jiang and Zhi Gan Cao. The catalogue classes it among the formulas that reduce food stagnation.

Herb

Amount

15 g

12 g

15 g

9 g

9 g

6 g

6 g

6 g

3 g

6 g

Actions and indications

Moves Qi, reduces focal distension and eliminates fullness

Spleen deficiency with Qi stagnation and both Cold and Heat, producing focal distension (pi)
Fullness and distension in the upper epigastrium, sometimes also a focal distension of the chest and abdomen, possibly with distending pain
The fullness is uncomfortable but not painful on firm pressure, which sets it apart from a solid Excess accumulation

Strengthens the Spleen and harmonises the Stomach

Poor appetite and weak digestion, often with undigested food, and no thirst
Fatigue, lethargy and weakness with a wan complexion
Bowels that alternate between loose and hard
Tongue normal with a greasy coat that may be yellow; pulse wiry, especially at the right middle position

Modern uses

Indigestion
Functional dyspepsia
Functional gastrointestinal disorders
Diabetic gastroparesis
Chronic gastritis
Chronic atrophic gastritis
Intestinal obstruction
Cholecystitis
Cholelithiasis
Cushing's syndrome
Anorexia
Fatigue
Weakness

Modifications

Marked Cold with pain: + huang lian, + gan jiang, + gao liang jiang, + rou gui

Chronic productive cough and wheezing with a full, distended feeling in the chest and diaphragm: + chen pi, + sha ren, − huang lian

Accumulation of parasites: + shi jun zi, + bing lang

Alternative to the entry above: + chen pi, + sha ren, + jie geng

Food stagnation more prominent: + shan zha, + shen qu

Qi stagnation more prominent, with pain: + mu xiang, + chen pi

Damp more prominent: + cang zhu

Chronic gastritis from Liver Qi invading the Stomach: + chai hu, + chen pi, + dan shen, − gan jiang

Chronic gastritis from Deficiency Cold of the Spleen and Stomach: + pao jiang, + gui zhi, − huang lian

Chronic gastritis from Damp-Heat in the Spleen and Stomach: + mu dan pi, + zhi zi

Atrophic gastritis, chronic, of Excess Heat type: + gan jiang, + huang lian

Atrophic gastritis, chronic, of Excess Cold type: + huang lian, + gan jiang

Show all 31 modifications

Chronic atrophic gastritis with a lot of belching: + xuan fu hua
Indigestion from Stomach Yin deficiency: + yu zhu, + shi hu, − zhi ban xia, − sheng jiang
Indigestion with constipation: + da huang, + gua lou
Indigestion with pain in the upper abdomen: + mu xiang, + yan hu suo
Indigestion with acid reflux and a burning feeling in the Stomach (combined with Zuo Jin Wan)
Indigestion where the tongue coat is thick and greasy: + cang zhu, + bai dou kou, − bai zhu
Intestinal obstruction: + xi yang shen, − ren shen
Intestinal obstruction, abdominal pain severe: + chuan lian zi, + yan hu suo
Intestinal obstruction with marked food stagnation: + shen qu, + shan zha
Intestinal obstruction with fluids badly damaged: + shi hu, + tian hua fen
Cholecystitis or gallstones with Excess Heat: + da huang
Cholecystitis or gallstones with stabbing pain under the ribs: + chai hu, + yu jin
Cholecystitis or gallstones with nausea and vomiting: + zhu ru
Cholecystitis or gallstones with dry stools and constipation: + da huang, + gua lou
Cholecystitis or gallstones with jaundice: + yin chen hao, + zhi zi
Cushing's syndrome: + shan zha, + han fang ji, + lai fu zi, + bai jie zi, + ze xie, − huang lian, − zhi ban xia, − mai ya, − gan jiang
Cushing's syndrome with headache and dizziness: + shan zha, + han fang ji, + lai fu zi, + bai jie zi, + ze xie, + ju hua, + chuan xiong, − huang lian, − zhi ban xia, − mai ya, − gan jiang
Constipation in Cushing's syndrome: + shan zha, + han fang ji, + lai fu zi, + bai jie zi, + ze xie, + mang xiao, + da huang, − huang lian, − zhi ban xia, − mai ya, − gan jiang
Kidney Yang deficiency in Cushing's syndrome: + shan zha, + han fang ji, + lai fu zi, + bai jie zi, + ze xie, + zhi fu zi, + gan jiang, − huang lian, − zhi ban xia, − mai ya, − gan jiang

Cautions

caution Take care where Qi deficiency is severe

contraindication Not suited to a simple Excess pattern, or to a picture that is purely Hot or purely Cold; match it to the mixed deficiency-stagnation, Cold-Heat pattern rather than using it for any epigastric discomfort

caution Because it combines warming Gan Jiang with cooling Huang Lian, it is best used under the supervision of a qualified practitioner

Pinyin

zhi shi xiao pi wan

English Name

Immature Bitter Orange Pill to Reduce Focal Distention

zhi shi xiao pi wan

About zhi shi xiao pi wan

Ingredients

Actions and indications

Moves Qi, reduces focal distension and eliminates fullness

Strengthens the Spleen and harmonises the Stomach

Modern uses

Symptoms

Modifications

Cautions

Preparation

Names

Classification

Support