Traditionally used for
- Digestion
Cautions & contraindications
- Before surgery
☯ TCM Properties
Directs Rebellious Qi Downward and Stops Hiccup; Directs Stomach Qi downward
Traditional Chinese Uses
Shi Di (persimmon calyx) is a neutral, bitter herb used in Chinese medicine primarily to redirect rebellious Stomach Qi downward — treating hiccup, belching, and nausea from Stomach Qi rising upward. It addresses hiccup from various causes including Stomach cold, Stomach Heat, and deficiency, making it one of the most targeted herbs specifically for intractable hiccup. Combined with other herbs, it appears in classical formulas for post-illness persistent hiccup and gastroparesis-type conditions.
Western Herbalism Properties
Relationships
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Botanical Description
Diospyros kaki is a medium-sized deciduous tree in the Ebenaceae family reaching 8-15 m tall, native to East Asia and widely cultivated for its sweet edible persimmon fruit. The bark is dark grey and fissured into rectangular plates; leaves are simple, alternate, broadly ovate to elliptic, 8-18 cm long, glossy dark green turning vivid orange to scarlet in autumn. Trees are typically dioecious or polygamous, bearing creamy four-lobed bell-shaped flowers in spring. The fruit is a large smooth-skinned berry 4-10 cm wide ripening yellow-orange to deep red, topped by a persistent four-lobed leathery calyx that remains firmly attached as the fruit matures and is shed with it. Shi Di is specifically this dried calyx — a flat brown cross-shaped structure with a short central pedicel, collected from fallen or harvested fruit.
Active Constituents
Condensed tannins (proanthocyanidins)
PolyphenolConcentration: total tannin content of the calyx rises significantly as the fruit matures, so harvest timing changes the tannin load of the drug
Condensed tannins dominate the polyphenol fraction of the calyx and were confirmed by carbon NMR with the molecular weight estimated by gel permeation chromatography. They give the drug its astringency and are the constituents most likely to interfere with the absorption of co-administered drugs and minerals.
Ursolic acid
Pentacyclic triterpenoid (ursane type)Concentration: quantified in the calyx and falls as the fruit ripens, alongside oleanolic acid
One of the quantified triterpenoids of the calyx. Its content moves in the opposite direction to betulinic and pomolic acid during maturation, so the triterpenoid profile of the drug depends on when the calyx was collected.
Betulinic acid
Pentacyclic triterpenoid (lupane type)Concentration: quantified in the calyx and increases during fruit maturation
A quantified triterpenoid of the calyx whose content rises through ripening. The pharmacopoeial drug is taken from the calyx of mature fruit, which is the point at which this compound is highest.
Pomolic acid
Pentacyclic triterpenoidConcentration: quantified in the calyx and increases during fruit maturation
One of the triterpene acids that accumulate as the fruit ripens, contributing to the chemical distinctiveness of calyx taken from mature rather than immature fruit.
Rotungenic acid and barbinervic acid
Pentacyclic triterpenoidsConcentration: both increase during maturation; both were isolated from persimmon calyx for the first time in the 2020 quantification study
Two triterpene acids newly reported from the calyx. They are markers of the mature-fruit calyx rather than established actives; no mechanism for the antiemetic effect has been assigned to them.
Lupeol
Triterpene alcoholConcentration: isolated from persimmon calyx for the first time in the 2020 quantification study
A lupane triterpene alcohol of the calyx, reported here for the first time from this drug.
Catechin and gallocatechin
Flavan-3-olsThe monomeric flavan-3-ols that make up the condensed tannin polymers of the calyx and contribute to its astringency and antioxidant capacity.
Beta-sitosterol
PhytosterolA common plant sterol identified among the calyx constituents; not implicated in the antihiccup action.
⚠ Drug Interactions
Oral iron salts (ferrous sulfate, ferrous fumarate)
The calyx is a tannin-rich drug and its total tannin content has been shown to rise as the fruit matures, so the pharmacopoeial mature-fruit calyx is the most tannin-laden form. Condensed tannins bind non-haem iron in the gut lumen and form insoluble complexes; this is a well-characterised property of tannins generally rather than an interaction measured with this specific drug.
Clinical note: Separate a Shi Di decoction from oral iron by at least two hours. Where iron deficiency is being actively treated, check the response rather than assuming it is unaffected.
Alkaloidal drugs and other protein-binding or basic oral medicines
Condensed tannins precipitate alkaloids and proteins in vitro, which is standard tannin chemistry and the reason tannin-rich decoctions are traditionally separated from alkaloid-containing drugs. No pharmacokinetic study exists for the persimmon calyx specifically, so this is a chemistry-based caution rather than an observed clinical interaction.
Clinical note: Where an alkaloidal medicine matters clinically, stagger dosing. This does not warrant withholding the herb.
Chlorpromazine, metoclopramide, baclofen and other drugs used for intractable hiccups
Persimmon calyx and the Kampo formula built on it, Shitei-to, are given for the same indication as these drugs. A five-year single-centre Japanese hospital audit of shitei extract in 149 admitted patients recorded no adverse events attributable to it, so the practical risk of adding it is low, but no pharmacokinetic or pharmacodynamic interaction study has been done with any of these agents.
Clinical note: Reasonable to use alongside conventional antihiccup drugs; the effect of the herb should be judged on the hiccup response rather than assumed to be additive.
Unripe persimmon fruit and persimmon-fruit preparations (diospyrobezoar risk)
Shibuol and related soluble tannins in unripe persimmon fruit polymerise in gastric acid and can aggregate into a diospyrobezoar. Shi Di is the persistent calyx of the mature fruit, a separate and much smaller plant part used at decoction doses, and it is not the source of that hazard. The entry is recorded here because the two are routinely conflated under the same plant name and a practitioner meeting a persimmon-related bezoar needs to know the calyx is not the culprit.
Clinical note: No restriction on the calyx. Advise patients with delayed gastric emptying or prior gastric surgery against eating large amounts of unripe persimmon fruit, which is a different matter entirely.
Dosage
| Form | Amount | Frequency | Duration | Population | Notes |
|---|---|---|---|---|---|
| decoction | 5–10 g | Daily | — | — | 中国药典 2020 【用法与用量】5～10g。 【性味与归经】苦、涩，平。归胃经。 — Chinese Pharmacopoeia 2020, quoted verbatim; route and cautions preserved. Replaces a cleared category-filler value. |
Dui Yao — Herb Pairs
The classical two-herb combinations this herb appears in, each with an action neither herb has alone.
Together they warm the middle and descend stomach qi to stop hiccups from stomach cold.
Core pair of a classical formula — Shi Di Tang, Ji Sheng Fang (Yan Yonghe)
Evidence Tier
Moderate evidence · 4 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
0
Randomized controlled trial
0
Other clinical trial
0
Observational / case report
1
0 verified · 1 unverified
In vitro / animal
3
1 verified · 2 unverified
Show 3 studies
- Diospyros kaki calyx inhibits immediate-type hypersensitivity via the reduction of mast cell activation
- Identification of Phenolic Constituents and Inhibitory Activity of Persimmon Calyx and Shiteito against Tumor Cell Proliferation
- Anti-inflammatory activities of astringent persimmons (Diospyros kaki Thunb.) stalks of various cultivar types based on the stages of maturity in the Gyeongnam province
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
Clinical Studies
Investigation into the Effect of Shitei Extract, a Traditional Chinese Medicine Formulation, on Hiccups
A retrospective single-centre review of shitei (persimmon calyx) extract prescribing at a Japanese hospital between October 2011 and May 2016. Of 149 patients, 107 (71.8 percent) had hiccups; incidence was significantly higher with brain disease, with cancer chemotherapy and where a gastric tube was in place. Among the chemotherapy patients, shitei extract was judged effective against hiccups in 45 of 55 (82.0 percent), and four patients received it prophylactically after chemotherapy. No adverse events were attributed to the extract. This is an uncontrolled audit, not a trial, and the article is published in Japanese; it is nonetheless the largest clinical dataset for this drug in its classical indication.
Diospyros kaki calyx inhibits immediate-type hypersensitivity via the reduction of mast cell activation
An aqueous extract of Diospyros kaki calyx was tested in mouse models of systemic and local anaphylaxis and in cultured mast cells. It reduced the fall in body temperature and the rise in histamine in the anaphylaxis models, with the higher doses comparable to dexamethasone, and dose-dependently suppressed histamine and beta-hexosaminidase release by lowering intracellular calcium. TNF-alpha and IL-4 were reduced through decreased NF-kappa B activation. This is an activity of the calyx unrelated to its classical antiemetic use and has not been tested in humans.
Identification of Phenolic Constituents and Inhibitory Activity of Persimmon Calyx and Shiteito against Tumor Cell Proliferation
A new compound and twenty-six known phenolics were characterised from a 70 percent acetone extract of persimmon calyx, and condensed tannins were confirmed by carbon NMR with molecular weight estimated by gel permeation chromatography. HPLC of the Kampo formula Shiteito showed its main ingredient derives from clove rather than from the calyx, an important point for anyone attributing formula effects to Shi Di. Shiteito itself only weakly inhibited Hep3B hepatocellular carcinoma proliferation, while the ethyl acetate fraction of the calyx extract inhibited Caco-2 and AGS proliferation and was strongly cytotoxic to Hep3B.
Anti-inflammatory activities of astringent persimmons (Diospyros kaki Thunb.) stalks of various cultivar types based on the stages of maturity in the Gyeongnam province
Stalk and calyx extracts from several astringent Diospyros kaki cultivars, harvested at different maturity stages, were tested in lipopolysaccharide-stimulated RAW 264.7 macrophages. The extracts reduced nitric oxide production and inducible nitric oxide synthase transcription and protein expression, and reduced phospho-p65 and nuclear translocation of p65, indicating suppression of NF-kappa B signalling. Activity varied by cultivar and by harvest stage, reinforcing that the potency of this drug is not uniform across sources.
Historical Texts
Ben Cao Shi Yi
Tang dynasty, 739, by Chen CangqiJi Sheng Fang
Southern Song dynasty, 1253, by Yan YongheBen Cao Gang Mu
Ming dynasty, 1596Ben Cao Qiu Zhen
Qing dynasty, 1769, by Huang GongxiuReferences
- Katsumi E, Oshima N, Kagawa N, Ohara H, Hada N. Changes in the extracted amounts and seasonally variable constituents of Diospyros kaki at different growth stages . Journal of Natural Medicines (2020) [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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