Zhi Ke (Qiao)枳壳

Fructus AurantiiBitter Orange

Category: Herbs that regulate Qi
Nature: slightly cold
Taste: bitter, pungent
Channels entered: Spleen, Stomach, Large Intestine
Secondary channels: Liver
Dosage: 3–10 g

Usual doses

Dosage: 3–10 g
Tincture: 1–3 ml

Actions & indications

Promotes the movement of Qi, reduces distention and pressure and resolves hardenings: Qi Stagnation and accumulation (especially in weak or deficient patients)
Removes stagnated food: Food Stagnation

Contraindications

Use with caution during pregnancy.
Use with caution in those with a weak Spleen and Stomach.
Use with caution in those with gastric or duodenal ulcers.

Interactions

Use with caution in patients taking anticoagulants such as heparin, warfarin (Coumadin), or enoxaparin (Lovenox), or antiplatelet drugs such as aspirin, dipyridamole (Persantine), or clopidogrel (Plavix), since it may potentiate their effects.

Combinations

- Chai Hu
- Bo He
For surface Heat problems in the Upper Jiao.
- Gui Zhi
For stabbing pain in the chest and flanks.
- Jie Geng
Regulates Qi flow in the chest and aids Phlegm transformation, for chest congestion.
- Sheng Ma
Relaxes the bowels and promotes the downward movement of turbid Yin.
- Yu Jin
For Liver Qi Stagnation with chest stuffiness and epigastric/abdominal fullness accompanied by Heat signs, and for stabbing pain in the chest, flanks, and abdomen from Blood Stagnation.
- Jing Jie
- Fang Feng
- Hong Hua
- Chi Shao
For itching of the skin.

Notes

For constipation, this herb is less effective than Fr. Aurantii Immaturus Zhi Shi.
Its action is milder than Zhi Shi's, making it better suited for clearing Food Stagnation and treating Spleen and Stomach Qi Deficiency.
It is used for indigestion, constipation, abdominal distention, chest stuffiness, thick yellow sputum, and prolapse of the uterus, rectum, or stomach.
Per. Citri Reticulatae Chen Pi and Exocarpium Citri Reticulatae Rubra Ju Hong are chosen for Spleen and Stomach disturbance and cough; Fr. Aurantii Immaturus Zhi Shi is favored for Gallbladder congestion and constipation; and Zhi Ke is favored where there is surface Heat, such as sore throat, skin eruptions, or hot flashes.
It works best for Liver Qi Stagnation, particularly flank pain.
It helps relieve chest stuffiness and belching.
For postpartum uterine prolapse, prolonged soaking in a Zhi Ke decoction will cause it to recede.
Zhi Ke and Fr. Aurantii Immaturus Zhi Shi come from the same fruit at different stages of ripening — Zhi Shi unripe, Zhi Ke nearly ripe — and both break up Qi, disperse clumps and Phlegm, and reduce focal distention. Zhi Ke acts on the upper trunk, covering the chest, diaphragm, skin, and body hair, while Zhi Shi acts on the lower trunk, covering the Heart, abdomen, Spleen, and Stomach; Zhi Shi's nature is forceful and excels at driving downward, whereas Zhi Ke moves Qi more gently and gradually through the chest, diaphragm, Lungs, Stomach, and Large Intestine.
Dry-fried Bitter Orange Chao Zhi Ke has a gentler action than the unprepared herb and suits elderly or weak patients better, or inclusion in tonifying formulas to support digestion.
Charred Bitter Orange Zhi Ke Tan is far less cold, entering the Blood level to stop bleeding, and is also used for Qi blockage disorders accompanied by bleeding, such as Intestinal Wind.