Bai Shi Zhi

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Kaolinite (Al₂Si₂O₅(OH)₄)

Not yet clinically reviewed

Genus: Kaolinite Pinyin: Bai Shi Zhi
White Kaolinite白石脂

Traditionally used for

  • Cough & breathing
  • Bowel health
  • Menstrual & women's health
  • Skin

Cautions & contraindications

  • Toxic — professional use only
Strong evidence · 8 studies

☯ TCM Properties

Category: astringent
Temperature: neutral
Taste: sweet, sour
Meridians: lung, stomach, large intestine
Functions:

Astringes the Intestines and Stops Diarrhea; Astringes and Stops Bleeding; Absorbs Dampness and Heals Sores; Tonifies Lung Qi; Dries Dampness in the Intestines

Traditional Chinese Uses

Bai Shi Zhi (kaolin or white halloysite clay) is a warm, astringent mineral substance used to stop chronic diarrhea, restrain excessive vaginal discharge, and stop bleeding from the lower body. Similar to Chi Shi Zhi (red halloysite), it works by consolidating and astringent the lower burner for deficiency-type leakage patterns. Its warm nature makes it especially appropriate when the underlying condition involves cold deficiency of the Spleen and Kidney.

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Botanical Description

Bai Shi Zhi is kaolinite, a hydrated aluminium silicate clay mineral of idealised composition Al2Si2O5(OH)4, occurring as fine-grained, soft, earthy white to greyish-white masses formed by the weathering of feldspar-rich rocks such as granite. The medicinal grade is collected from kaolin clay deposits in southern and eastern China, then washed, levigated to remove sand and iron impurities, dried and reduced to a uniform powder. The finished mineral is dull white, sometimes faintly pink or yellow, very soft (Mohs about 2), opaque, with an earthy fracture and a smooth, slightly greasy feel; it adheres lightly to the tongue, has no odour and a mild, faintly clay-like taste. It is insoluble in water but disperses to form a smooth suspension, and is chemically inert to dilute acids and alkalis at room temperature.

Active Constituents

Kaolin-group hydrous aluminium silicate

Phyllosilicate clay mineral (1:1 dioctahedral layer silicate)

Concentration: The composition quoted for this drug in the Chinese literature is SiO2 46.5 percent, Al2O3 39.5 percent, water 14.0 percent. Those are the stoichiometric proportions of ideal kaolinite Al2Si2O5(OH)4 to within a rounding error, so the published figure is a mineral-species ideal restated rather than an assay of medicinal material. Chinese pharmacognosy identifies the drug as polyhydrous kaolinite, that is halloysite (Halloysitum album), rather than kaolinite sensu stricto, so the binomial and the trade identity do not fully agree.

The 1:1 aluminosilicate layer presents a large hydrated surface with pH-dependent edge charge. That surface is the basis of both the traditional astringent and drying action and of the drug-binding problem: what takes up water, bile acids and bacterial toxins in the lumen also takes up co-administered drug molecules.

Aluminium

Major structural element (ICP-MS assay of medicinal material)

Concentration: 11 012 to 123 220 mg/kg across 26 commercial batches from nine Chinese provinces, and the most abundant element measured (Zhu et al., China Pharmacy 2019).

Aluminium locked in an intact clay lattice is poorly bioavailable, but the eleven-fold spread between batches is a direct measure of how variable the mineral purity of market material is.

Iron

Accessory transition metal (ICP-MS assay)

Concentration: 357 to 15 205 mg/kg across the same 26 batches.

Accessory iron oxide produces the pink, red and brown streaking recorded in most nominally white batches, and the forty-fold spread shows that Bai Shi Zhi and Chi Shi Zhi grade into one another in the marketplace rather than being cleanly separated colours.

Arsenic

Metalloid contaminant

Concentration: 4.16 to 29.63 mg/kg. All 26 batches exceeded the 2 mg/kg ceiling that the Chinese Pharmacopoeia applies to plant-derived materials (Zhu et al. 2019).

This is the single most safety-relevant number published for the drug. No arsenic limit test exists for Bai Shi Zhi in any pharmacopoeia or provincial standard, so nothing in routine quality control would detect it.

Lead

Heavy metal contaminant

Concentration: 3.97 to 64.24 mg/kg; 25 of 26 batches above the 5 mg/kg plant-material ceiling (Zhu et al. 2019).

Lead is inherited from the weathering-crust clay deposits the drug is dug from, and is not removed by the ordinary cleaning and grinding the drug receives.

Cadmium

Heavy metal contaminant

Concentration: Mostly below 0.3 mg/kg, but three of 26 batches measured 1.24, 2.71 and 16.45 mg/kg (Zhu et al. 2019).

Usually low and occasionally extreme, which is the characteristic contaminant pattern of a dug mineral. A typical value protects nobody here; only batch testing does.

Chromium

Heavy metal contaminant

Concentration: 1.85 to 34.92 mg/kg; 25 of 26 batches above the 2 mg/kg reference limit (Zhu et al. 2019).

Speciation was not determined, so the fraction present as chromium(VI) rather than the far less toxic chromium(III) is unknown for this drug.

Copper

Trace metal

Concentration: Up to 98.29 mg/kg; 10 of 26 batches above the 20 mg/kg reference limit (Zhu et al. 2019).

Relevant mainly as a further index of ore impurity rather than as a toxicity concern at customary doses.

Mercury

Heavy metal contaminant (not assayed)

Concentration: Not measured. Mercury was not among the 27 elements in the only published multi-element survey of this drug, so no mercury figure for Bai Shi Zhi exists in the accessible literature.

Recorded as an explicit gap. Absence of an assay is not evidence of absence, and no pharmacopoeial mercury limit applies to this drug.

⚠ Drug Interactions

Digoxin

Major Evidence: Probable

Kaolin-group clay adsorbs digoxin in the gut lumen. In a Latin-square single-dose study in 10 volunteers, cumulative six-day urinary recovery of a 0.75 mg digoxin dose fell from 40.1 percent (control) to 23.4 percent with kaolin-pectin. A crossover study of dose separation found that co-administration cut the amount absorbed by 62 percent and more than doubled between-subject variability; kaolin-pectin given two hours before digoxin still reduced the extent of absorption by about 20 percent, while giving it two hours after had no measurable effect. Both studies used pharmaceutical kaolin-pectin suspension, not Bai Shi Zhi, so this is an extrapolation from the mineral class rather than a direct measurement of the Chinese drug.

Clinical note: Do not co-administer. Separate by at least two hours and give the clay after the digoxin, not before. Check digoxin levels when the mineral is started or stopped.

Phenytoin

Moderate Evidence: Possible

In an everted rat intestine model, light kaolin reduced phenytoin absorption by 60.2 percent (McElnay, D'Arcy and Throne, International Journal of Pharmaceutics 1980); calcium citrate in the same model reduced it by 77.2 percent. The proposed mechanism is a physical coating barrier plus surface adsorption of a poorly soluble drug. This is a preclinical tissue model with pharmaceutical kaolin, not a human study and not Bai Shi Zhi.

Clinical note: Avoid concurrent dosing in any patient on phenytoin; separate by at least two hours and check plasma levels if the mineral is used for more than a few days.

Chloroquine

Moderate Evidence: Possible

The chloroquine-kaolin absorption interaction was characterised using a buccal partitioning model (McElnay, Sidahmed and D'Arcy, Journal of Clinical Pharmacy and Therapeutics 1982). Chloroquine is a dibasic amine that is strongly cationic at gut pH and binds readily to the negatively charged clay surface. Pharmaceutical kaolin was the adsorbent studied.

Clinical note: Separate clay and chloroquine by at least two hours; this matters most where chloroquine is being used for treatment rather than intermittent prophylaxis.

Propranolol

Moderate Evidence: Possible

Kaolin was among the agents shown to reduce propranolol absorption by McElnay, D'Arcy and Leonard (Experientia 1982). Propranolol is a lipophilic base that adsorbs to clay surfaces. Preclinical and pharmaceutical-kaolin evidence, not a study of Bai Shi Zhi.

Clinical note: Separate doses by at least two hours; watch for loss of rate control if a patient takes the mineral repeatedly through the day.

Tetracyclines and other adsorbable oral antibacterials

Moderate Evidence: Possible

Light kaolin adsorbed a series of antibacterial substances in vitro (Fulayyeh and colleagues, Journal of Pharmacy and Pharmacology 1981). No human study pairs Bai Shi Zhi with any antibiotic, so the magnitude in a patient is unknown.

Clinical note: Separate from oral antibiotics by at least two hours, and prefer to suspend the mineral for the duration of a short antibiotic course.

Aspirin

Minor Evidence: Probable

In 10 fasting volunteers given 975 mg of aspirin, mean 48-hour urinary salicylate recovery was 98.6 percent with water and 90.6, 94.6 and 95.3 percent with 30, 60 and 90 mL of kaolin-pectin; the 30 and 60 mL treatments differed significantly from water, and absorption was not delayed. Activated charcoal in the same study gave 69.5 percent, showing that clay is a far weaker adsorbent than charcoal.

Clinical note: No action needed for occasional analgesic use. The same study concluded kaolin-pectin is not an adequate treatment for aspirin poisoning, so do not substitute the clay for activated charcoal in overdose.

Orally administered drugs in general

Moderate Evidence: Established

Adsorption onto the clay surface is a physical and largely non-selective process, and its extent varies with the ionisation of the drug and with the electrolyte content and dielectric constant of the luminal fluid (Armstrong and Clarke, Journal of Pharmaceutical Sciences 1973). That variability is why a single in vitro figure cannot be read as a clinical effect size, and why the interaction should be assumed for drugs that have never been studied with clay.

Clinical note: Separate the clay from every other oral medicine by at least two hours, and give the clay after the other drug where the schedule allows; in the digoxin work, dosing the clay two hours after the glycoside abolished the effect while dosing it two hours before did not.

Chelation therapy and heavy-metal exposure workup

Theoretical Evidence: Theoretical

Mineral drugs are dug ores, and the Chinese Pharmacopoeia limits for lead, cadmium, arsenic, mercury and copper are written for plant-derived materials and decoction pieces, not for the mineral monographs. A patient taking one of these minerals long term is therefore on an uncharacterised source of arsenic and lead, which will confuse the interpretation of a blood lead, a urine arsenic or a response to chelation.

Clinical note: If a patient on a mineral drug has an unexplained raised blood lead or urinary arsenic, treat the herb itself as a candidate source and have the actual batch assayed rather than assuming an occupational or dietary cause.

Dosage

Form Amount Frequency Duration Population Notes
topical Appropriate amount — external use mainly Daily — — No ChP 一部 monograph (compare 赤石脂, which is in ChP). Kaolinite. Used chiefly externally as an absorbent and astringent powder for sores and weeping lesions. No pharmacopoeial internal dose is established here.

Evidence Tier

Strong evidence · 8 studies

Recorded studies by study design, strongest design at the top. This is a study-design tier only, not a GRADE rating: it does not weigh risk of bias, consistency or precision.

Verified: design read from PubMed for a DOI that resolves to the cited paper Unverified: taken from the study's recorded description

Clinical Studies

Decreased Bioavailability of Digoxin Due to Antacids and Kaolin-Pectin

Brown DD; Juhl RP; Lewis K; Schrott M; Bartels B (1976) New England Journal of Medicine RCT

Latin-square single-dose crossover in 10 normal volunteers. Cumulative six-day urinary recovery of a 0.75 mg digoxin dose was 40.1 percent under control and 23.4 percent with kaolin-pectin, with aluminium hydroxide, magnesium hydroxide and magnesium trisilicate intermediate; every treatment differed significantly from control. The investigators attributed the fall to reduced absorption rather than to altered gut transit. The material was pharmaceutical kaolin-pectin suspension, not a Chinese medicinal clay.

Influence of Kaolin–Pectin Suspension on Digoxin Bioavailability

Albert KS; Ayres JW; DiSanto AR; Weidler DJ; Sakmar E; Hallmark MR; Stoll RG; DeSante KA; Wagner JG (1978) Journal of Pharmaceutical Sciences RCT

Crossover study of dose separation in volunteers. Given together, kaolin-pectin delayed digoxin absorption, reduced the amount absorbed by 62 percent and more than doubled between-subject variability. Given two hours before digoxin it still reduced the extent of absorption by about 20 percent; given two hours after, neither rate nor extent was affected. This asymmetry is the evidential basis for dosing a clay after rather than before a critical drug.

Comparison of kaolin-pectin and activated charcoal for inhibition of aspirin absorption

Juhl RP (1979) American Journal of Health-System Pharmacy RCT

Five-way crossover in 10 fasting volunteers taking three 325 mg aspirin tablets. Mean 48-hour urinary salicylate recovery was 98.6 percent with water, 90.6 to 95.3 percent across three kaolin-pectin volumes and 69.5 percent with 10 g activated charcoal. Kaolin-pectin reduced aspirin absorption significantly but modestly and did not delay it, and was judged inadequate for treating aspirin poisoning.

Effect of antacid constituents, kaolin and calcium citrate on phenytoin absorption

McElnay JC; D'Arcy PF; Throne O (1980) International Journal of Pharmaceutics in vitro

Everted rat intestine model. Light kaolin reduced phenytoin absorption by 60.2 percent and calcium citrate by 77.2 percent, both significant. The authors proposed that a kaolin coating of the mucosa acts as a physical barrier to absorption in addition to adsorbing drug in solution. Preclinical tissue model with pharmaceutical kaolin.

EXAMINATION OF THE CHLOROQUINE-KAOLIN DRUG ABSORPTION INTERACTION USING THE BUCCAL PARTITIONING MODEL

McElnay JC; Sidahmed AM; D'Arcy PF (1982) Journal of Clinical Pharmacy and Therapeutics in vitro

Uses the buccal partitioning model to characterise the interaction between chloroquine and kaolin, confirming that clay reduces the fraction of chloroquine available for absorption. A partitioning model rather than a systemic pharmacokinetic study, so it establishes the mechanism but not the clinical effect size.

The effect of activated dimethicone, other antacid constituents, and kaolin on the absorption of propranolol

McElnay JC; D'Arcy PF; Leonard JK (1982) Experientia in vitro Verified: In vitro / animal

Screens antacid constituents and kaolin for effects on propranolol absorption, placing kaolin among the agents that reduce it. Preclinical; the clay tested was pharmaceutical kaolin.

Adsorption of Antibacterial Substances on Attapulgite and Light Kaolin

Fulayyeh IYM; McBride RJ; Murray JB; Qawas A; Smith G (1981) Journal of Pharmacy and Pharmacology in vitro

In vitro adsorption of a range of antibacterial substances onto light kaolin and attapulgite, establishing that medicinal clays take up antibacterial drug molecules from solution. No clinical endpoint and no Chinese medicinal material was used.

Influence of Solution Electrolyte Content and Dielectric Constant on Drug Adsorption by Kaolin

Armstrong N.A.; Clarke C.D. (1973) Journal of Pharmaceutical Sciences in vitro

Shows that how much drug kaolin adsorbs depends on the electrolyte content and dielectric constant of the surrounding solution. The practical consequence is that the size of a clay-drug interaction differs between gastric and intestinal conditions and between a fasted and a fed patient.

Historical Texts

Shen Nong Ben Cao Jing

Eastern Han, c. 200 CE
Enters the materia medica not as a drug in its own right but as one of the wu se shi zhi, the five-coloured shi zhi (green, red, yellow, white, black), listed in the upper grade. Bai Shi Zhi is the white member of that set, so its identity has been defined by colour from the beginning rather than by mineralogy, which is why the modern binomial sits uneasily on it.

Ben Cao Jing Ji Zhu (Tao Hongjing)

Southern and Northern Dynasties, c. 500 CE
Records that of the five shi zhi only the red and the white remained in ordinary use. This is why Chi Shi Zhi and Bai Shi Zhi are the two members of the set that survive in the modern materia medica while the other three do not.

Gansu Provincial Standard for Chinese Medicinal Materials

2009 edition
Not a classical text, but the only current official standard for this drug and worth recording because of what it lacks. Bai Shi Zhi has never been included in any edition of the Chinese Pharmacopoeia; the Gansu standard carries description and physicochemical identification only, with no assay and no heavy-metal or arsenic limit test.

References

  1. Zhu Renyuan; Ji Liangliang; Zhang Xiaoping; Qiu Guoyu; Ma Xiao. Simultaneous Determination of 27 Kinds of Heavy Metals and Trace Elements in Halloysitum album by ICP-MS . China Pharmacy (2019)
  2. Wang Xiaofei; Wang Youshao; Chen Daihong; Sun Shuyuan; Cao Yan; Zheng Guohua; Li Juan. Herbal Textual Research, Quality Evaluation and Phase Analysis of Halloysitum Rubrum . Chinese Journal of Experimental Traditional Medical Formulae (2024)
  3. Carretero MI. Clay minerals and their beneficial effects upon human health. A review . Applied Clay Science (2002) [DOI]
  4. Young SL; Miller JD. Medicine Beneath Your Feet: A Biocultural Examination of the Risks and Benefits of Geophagy . Clays and Clay Minerals (2019) [DOI]
  5. Brindley GW; Goodyear J. X-ray studies of halloysite and metahalloysite . Mineralogical Magazine and Journal of the Mineralogical Society (1948) [DOI]
  6. Salgado-Campos VMJ; Bertolino LC; Silva FJ da; Mendes JC. Mineralogical characterization of clay mineral assemblages from Rio de Janeiro pegmatites to identify kaolinite and/or halloysite deposits . Ceramica (2020) [DOI]
  7. Han X; Luo JY; Liu QT; Li YJ; Xie YJ; Yang SH; Yang MH. Study on species and valence state of heavy metals and deleterious elements of mineral medicine . China Journal of Chinese Materia Medica (2015) [DOI]

This information is for educational purposes only and is not intended to replace professional medical advice. Always consult a qualified healthcare provider before using any herbal remedy, especially if you are pregnant, nursing, or taking medications.

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