Hai Piao Shao
StarSepiella maindroni de Rochebrune; Sepia esculenta Hoyle
Traditionally used for
- Cough & breathing
- Digestion
- Menstrual & women's health
- Skin
☯ TCM Properties
Astringes and Stops Bleeding; Secures Essence and Stops Leakage; Controls Acidity and Stops Pain; Absorbs Dampness and Heals Sores
Traditional Chinese Uses
Hai Piao Shao (cuttlefish bone, sepia) is a warm, astringent substance used to restrain and bind — stopping excessive bleeding, excessive vaginal discharge, acid reflux, and spermatorrhea. Its antacid properties make it effective for stomach pain from hyperacidity. It also softens hardened masses and nodules when combined with other Phlegm-dissolving herbs. Applied externally, it assists wound healing, dries weeping sores, and controls bleeding from lacerations.
Relationships
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Botanical Description
Hai Piao Xiao (also written Hai Piao Shao) is the dried internal shell — the cuttlebone — of the cuttlefish, principally Sepiella maindroni or Sepia esculenta (Cephalopoda, Sepiidae), harvested from coastal waters of the East and South China Seas. The cuttlebone is a porous chambered structure of aragonite (calcium carbonate) with a thin organic chitinous matrix; it serves as a buoyancy organ in the living animal and is collected from beached or fished specimens, then cleaned of soft tissue, sun-dried, and used whole or powdered. In traditional Chinese medicine the cuttlebone is salty, astringent, slightly warm, and acts on the Liver and Kidney channels: it restrains acidity and relieves epigastric pain (a classical TCM antacid), stops bleeding from uterine, gastric, and traumatic sources, secures the lower jiao for vaginal discharge, and is applied topically as a drying powder for damp sores and ulcers.
Active Constituents
Calcium carbonate (aragonite)
Inorganic carbonate biomineralConcentration: roughly 87-94% of the dried cuttlebone
The overwhelming bulk of the drug and the source of almost everything it does. As an alkaline calcium salt it neutralises gastric acid, which is the pharmacological content of the classical function of controlling acidity and stopping pain, and it binds dietary phosphate in the gut. It is laid down as aragonite in superposed chambers separated by calcified pillars, which gives the powdered drug a very large surface area for its mass.
beta-Chitin
Polysaccharide (N-acetylglucosamine polymer)Concentration: roughly 3-4% of the dried cuttlebone
The organic scaffold interleaved with the aragonite. It is the starting material for the beta-chitosan of cuttlebone, which has documented biomedical interest, and it is the part of the drug most plausibly behind the traditional topical use for absorbing damp and healing sores.
Organic matrix proteins
Structural proteinsConcentration: roughly 3-7% of the dried cuttlebone
Together with beta-chitin these make up the organic membranes of the chambered structure. Cuttlebone preparations have shown antioxidant activity in vivo that the pure mineral would not explain, and the organic fraction is the likely carrier of it.
⚠ Drug Interactions
Tetracyclines and fluoroquinolones (doxycycline, minocycline, ciprofloxacin, levofloxacin, moxifloxacin)
Cuttlebone is close to 90% calcium carbonate. Divalent calcium chelates the beta-diketone of tetracyclines and the 3-carboxyl-4-oxo group of quinolones to form non-absorbable complexes in the gut lumen; this is the same, well-characterised interaction that calcium supplements, dairy and calcium-containing antacids produce.
Clinical note: Separate the decoction or powder from the antibiotic by at least two hours before or four to six hours after the dose. In a short antibiotic course it is simpler to suspend Hai Piao Shao.
Levothyroxine
Calcium carbonate is documented to reduce levothyroxine absorption by adsorption and by raising intragastric pH, and the effect is large enough to have been reported as clinically evident hypothyroidism in patients whose calcium was taken at the same time as their thyroxine.
Clinical note: Give levothyroxine on waking and keep the herbal preparation at least four hours away. Check TSH if the patient is on a long course.
Oral bisphosphonates (alendronate, risedronate, ibandronate)
Bisphosphonates already have very low oral bioavailability and chelate avidly with calcium. Any calcium-containing preparation taken at the same time effectively abolishes absorption of the dose.
Clinical note: The bisphosphonate must be taken on an empty stomach with plain water and nothing else, including this herb, for at least 30 to 60 minutes.
Oral iron salts (ferrous sulfate, ferrous fumarate)
Calcium competes with iron at the enterocyte and the alkalinising effect of the carbonate reduces the solubility of ferrous iron, which needs an acid environment to stay absorbable.
Clinical note: Space the iron dose two hours from the herbal preparation. This matters especially where Hai Piao Shao has been prescribed for chronic uterine bleeding, since the patient is likely to be on iron for that same bleeding.
Acid-dependent drugs (atazanavir, itraconazole capsules, ketoconazole, oral erlotinib)
These drugs need an acidic stomach to dissolve. Cuttlebone works as an antacid, and its whole classical indication of controlling acidity implies exactly the rise in gastric pH that impairs their dissolution.
Clinical note: Where the antacid effect of the herb is the point of the prescription, this interaction cannot be dosed around by simple separation in every case; discuss with the prescribing physician.
Calcium-based phosphate binders, calcium supplements and activated vitamin D analogues in dialysis patients
The meta-analysis of nine randomised trials in end-stage renal disease found cuttlebone lowered serum phosphate more than conventional binders, in a dose-dependent way, and also lowered intact parathyroid hormone and the calcium-phosphorus product; serum calcium did not differ between groups and rates of raised blood calcium were similar. But the drug is being used as a calcium-based binder, so adding it on top of calcium acetate or carbonate plus alfacalcidol stacks three calcium-raising interventions, and the pooled trials had very high heterogeneity.
Clinical note: This is a drug to substitute for a calcium-based binder under nephrology supervision, not to add to one. Monitor serum calcium, phosphate and PTH.
Dosage
| Form | Amount | Frequency | Duration | Population | Notes |
|---|---|---|---|---|---|
| decoction, or powder/pills | 5–10 g | Daily | — | — | 中国药典 2020 【用法与用量】5～10g。外用适量，研末敷患处。 【性味与归经】咸、涩，温。归脾、肾经。 — Chinese Pharmacopoeia 2020, quoted verbatim; route and cautions preserved. Replaces a cleared category-filler value. |
Evidence Tier
Strong evidence · 2 studiesRecorded 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.
Systematic review / meta-analysis
1
1 verified · 0 unverified
Randomized controlled trial
0
Other clinical trial
0
Observational / case report
0
In vitro / animal
1
0 verified · 1 unverified
Other / unclassified
0
Verified: design read from PubMed for a DOI that resolves to the cited paper Unverified: taken from the study's recorded description
Some DOIs on this page have not been checked against the registries yet; their studies count as unverified until they are.
Clinical Studies
The efficacy and safety of cuttlebone for lowering serum phosphate in patients with end-stage renal disease: a meta-analysis of randomized controlled trials
Nine randomised controlled trials published between 2000 and 2019, 726 participants, mostly from Chinese-language databases. Cuttlebone lowered circulating phosphate compared with conventional phosphate binders (mean difference -0.23, 95% CI -0.39 to -0.06, p = 0.006) with a dose-dependent effect, and reduced intact PTH and the calcium-phosphorus product; serum calcium was unchanged and there was no difference in constipation, gastrointestinal discomfort or raised blood calcium. Heterogeneity was very high (I2 = 94% for the primary outcome) and the authors call for further investigation. Registered as PROSPERO CRD42023396300.
Effect of Cuttlebone on Healing of Indomethacin-Induced Acute Gastric Mucosal Lesions in Rats
Cuttlebone isolated specifically from Sepiella maindroni de Rochebrune was given at 750, 1500 and 3000 mg/kg to rats with indomethacin-induced gastric ulcers, against omeprazole 4 mg/kg. It reduced lesion index and inflammation score in a dose-dependent way, lowered malondialdehyde and raised epidermal growth factor, prostaglandin E2 and superoxide dismutase. The doses are large and the model acute, but this is the most direct experimental support for the classical use in acid-related epigastric pain.
Historical Texts
Shen Nong Ben Cao Jing
Han dynastyReferences
- Palaveniene A, Harkavenko V, Kharchenko V, Daugela P, Pranskunas M, Juodzbalys G, Babenko N, Liesiene J. Cuttlebone as a Marine-Derived Material for Preparing Bone Grafts . Marine Biotechnology (2018) [DOI]
- Krishnan S, Chakraborty K, Dhara S. Biomedical potential of β-chitosan from cuttlebone of cephalopods . Carbohydrate Polymers (2021) [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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