Shi Liu Pi
StarPunica granatum L.
Traditionally used for
- Bowel health
- Menstrual & women's health
Cautions & contraindications
- Pregnancy
- Young children
☯ TCM Properties
Astringes the Intestines and Stops Diarrhea; Stops Bleeding; Expels Parasites; Tonifies the Kidneys and Secures Essence; Astringes to Stop Vaginal Discharge
Traditional Chinese Uses
Shi Liu Pi (pomegranate rind) is a warm, astringent herb used in Chinese medicine to astringes the intestines and stop chronic diarrhea, to expel intestinal parasites including tapeworms and roundworms, and to stop certain types of bleeding and excessive discharge. Its astringent character is similar to that of Wu Mei and Wu Bei Zi, and it is used in formulas for chronic diarrhea, dysentery from deficiency, and parasitic infestations. It is not appropriate in the early stages of diarrhea from infectious causes.
Western Herbalism Properties
Relationships
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Botanical Description
Punica granatum, the pomegranate, is a small deciduous tree or large shrub in the family Lythraceae, native to a region stretching from Iran to northern India and cultivated since antiquity throughout the Mediterranean, Middle East, and subtropical Asia. It typically grows 3-8 meters tall, with slender, often thorny branches and reddish-brown bark. The opposite or sub-opposite, narrowly oblong, glossy leaves are 3-7 cm long with entire margins. Showy, tubular, bright red-orange flowers with crumpled, crepe-like petals and a thick fleshy calyx open in late spring. The fruit is a distinctive globose, leathery-skinned berry (balausta), 5-12 cm across, crowned by the persistent calyx and containing many juicy, ruby-red arils each enclosing a hard seed. Shi Liu Pi is the dried fruit rind.
Active Constituents
Punicalagin
Ellagitannin (hydrolysable tannin)Concentration: the dominant ellagitannin of the fruit peel
Punicalagin is the principal marker and probably the principal active of the rind. It is a large, strongly astringent hydrolysable tannin that precipitates gut-luminal protein, which is the chemical basis of the drug's intestine-astringing and haemostatic actions, and it hydrolyses to ellagic acid in the gut.
Total hydrolysable tannins
Hydrolysable tanninConcentration: classical pharmacopoeial sources put the tannin content of the rind at roughly 22-28%
The very high tannin load is what makes Shi Liu Pi an effective astringent and also what makes it irritating to the stomach and constipating on prolonged use. It is also the source of the drug's chelating and protein-binding interactions.
Ellagic acid
Polyphenol (ellagitannin hydrolysis product)Released from punicalagin and punicalin by hydrolysis in the gut, and the compound most often measured in downstream pharmacology. Reported alongside punicalagin as a major peel phenolic.
Punicalin
Ellagitannin (hydrolysable tannin)A companion ellagitannin of punicalagin in the peel, sharing its astringent and antioxidant behaviour.
Gallic acid
Phenolic acid (hydroxybenzoic acid)A free phenolic acid of the peel, identified as one of the major compounds in antibacterial peel extracts together with ellagic acid and punicalagin.
Isopelletierine, pseudopelletierine and N-methylisopelletierine
Piperidine alkaloidConcentration: concentrated in the root, stem and branch bark, reported at over 3% in root bark and roughly 0.35-0.6% in stem bark; the fruit rind carries far less and some analyses of fruit rind report none at all
These are the taenicidal alkaloids of pomegranate: they paralyse tapeworms so the worm releases its grip on the gut wall. They are also the drug's real toxicity. Absorbed pelletierine produces dizziness, visual disturbance, weakness, calf cramp, tremor and formication; large doses cause mydriasis, severe headache, vertigo, vomiting, diarrhoea and prostration, and in animals a curare-like neuromuscular block ending in respiratory arrest. Large doses of the rind are recorded as capable of causing coma and death.
Flavonoids including quercetin, rutin and catechin, with anthocyanins
FlavonoidThe secondary polyphenol fraction of the peel, contributing to its antioxidant and anti-inflammatory activity in the intestinal models below.
⚠ Drug Interactions
Shi Liu Gen Pi (Cortex Granati, pomegranate root or stem bark) substituted for, or mixed into, the fruit rind
Pomegranate root and stem bark and pomegranate fruit rind are separate drugs with very different alkaloid loads. Pelletierine-type alkaloids have been reported at over 3% in root bark and around 0.35-0.6% in stem and branch bark, while the fruit rind contains far less and in some analyses none is detectable. Bark supplied as, or blended into, rind therefore delivers many times the alkaloid the prescriber intended, and it is the alkaloid, not the tannin, that carries the neurotoxicity: dizziness, visual disturbance and mydriasis, muscle weakness and calf cramp, progressing in overdose to curare-like neuromuscular block and respiratory arrest in animals.
Clinical note: Confirm the material is the dried fruit rind, not root or stem bark. Keep to the conventional 3-10 g decocted, do not extend courses, and stop immediately at the first dizziness, visual disturbance or leg cramp. Avoid entirely in pregnancy and in children.
Warfarin, and to a lesser extent other CYP3A4 and CYP2C9 substrates
Case reports describe unstable anticoagulation in patients on previously stable warfarin who were drinking pomegranate juice regularly, in one report at least 480 mL a day. Pomegranate ellagitannins inhibit CYP2C9 and CYP3A4 in vitro and increase tolbutamide bioavailability in rats, and S-warfarin is a CYP2C9 substrate. Against this, a controlled human study found pomegranate juice did not alter oral or intravenous midazolam clearance, and controlled human data show no significant effect on CYP2C9 activity, so the human relevance is not established. The rind is much richer in the same ellagitannins than the juice, but no interaction study has ever been done on Shi Liu Pi itself.
Clinical note: Check the INR within one to two weeks of starting or stopping Shi Liu Pi in a warfarinised patient. Treat as unresolved rather than dismissed.
Oral iron salts, alkaloidal drugs and other tannin-precipitable oral medicines
Hydrolysable tannins at the 22-28% level reported for the rind precipitate alkaloids, proteins and polyvalent metal ions in the gut lumen. This is straightforward chemistry rather than a metabolic interaction, and it applies to any strongly astringent tannin-rich decoction.
Clinical note: Separate Shi Liu Pi from oral iron, and from alkaloidal or protein drugs, by at least two hours.
Praziquantel, albendazole and other conventional anthelmintics
Pomegranate peel extract has shown anthelmintic activity in vivo in ruminants and against Trichinella spiralis in rodents, in the latter case with greater effect when combined with a standard anthelmintic. No human data exist, and the traditional parasite indication for Shi Liu Pi rests on its pelletierine content rather than on its tannins.
Clinical note: There is no reason to add Shi Liu Pi to an effective conventional anthelmintic regimen, and doing so adds alkaloid exposure without demonstrated benefit.
Dosage
| Form | Amount | Frequency | Duration | Population | Notes |
|---|---|---|---|---|---|
| decoction | 3–9 g | Daily | — | — | 中国药典 2020 【用法与用量】3～9g。 【性味与归经】酸、涩，温。归大肠经。 — Chinese Pharmacopoeia 2020, quoted verbatim; route and cautions preserved. Replaces a cleared category-filler value. |
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
2
2 verified · 0 unverified
Show 2 studies
- Efficacy of the Punica granatum peels aqueous extract for symptom management in ulcerative colitis patients. A randomized, placebo-controlled, clinical trial
- Pomegranate (Punica granatum L.) peel extract ameliorates metabolic syndrome risk factors in patients with non-alcoholic fatty liver disease: a randomized double-blind clinical trial
Other clinical trial
0
Observational / case report
0
In vitro / animal
2
2 verified · 0 unverified
Show 2 studies
- Pomegranate Peel Extract Mitigates Diarrhea-Predominant Irritable Bowel Syndromes via MAPK and NF-κB Pathway Modulation in Rats
- Anthelmintic activity of pomegranate peel extract (Punica granatum) and synthetic anthelmintics against gastrointestinal nematodes in cattle, sheep, goats, and buffalos: in vivo study
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
Efficacy of the Punica granatum peels aqueous extract for symptom management in ulcerative colitis patients. A randomized, placebo-controlled, clinical trial
Patients with ulcerative colitis received 6 g/day of dried pomegranate peel as an aqueous extract, or placebo, for four weeks alongside standard medication, assessed by the Lichtiger Colitis Activity Index. Both arms improved and the between-group difference was modest: clinical response at week 4 was 41.4% with peel against 18.2% with placebo (P = 0.055), and the gap had closed by week 10 (48.3% against 36.4%, P = 0.441). Incontinence and the need for antidiarrhoeal drugs improved only in the peel arm, and side effects were few and mild. This is the closest evidence to the traditional intestine-astringing indication, and it is suggestive rather than conclusive.
Pomegranate (Punica granatum L.) peel extract ameliorates metabolic syndrome risk factors in patients with non-alcoholic fatty liver disease: a randomized double-blind clinical trial
Seventy-eight adults with non-alcoholic fatty liver disease took 1500 mg/day of pomegranate peel capsules or placebo for eight weeks, both arms on a 500 kcal deficit Mediterranean-style diet. The peel arm showed greater reductions in body weight, waist circumference, total cholesterol, triglycerides, LDL and blood pressure, higher HDL, and lower liver steatosis and stiffness; fasting insulin and HOMA-IR did not differ between groups. The indication is unrelated to the traditional TCM use, but it is the best-powered human safety experience with the rind.
Pomegranate Peel Extract Mitigates Diarrhea-Predominant Irritable Bowel Syndromes via MAPK and NF-κB Pathway Modulation in Rats
Pomegranate peel extract reduced diarrhoea-predominant irritable bowel syndrome signs in rats, with inhibition of MAPK and NF-kappaB inflammatory signalling and strengthening of the intestinal barrier. It gives a plausible mechanism beyond simple tannin astringency for the drug's use in chronic diarrhoea, in a rodent model.
Anthelmintic activity of pomegranate peel extract (Punica granatum) and synthetic anthelmintics against gastrointestinal nematodes in cattle, sheep, goats, and buffalos: in vivo study
Pomegranate peel extract was compared with synthetic anthelmintics against gastrointestinal nematodes in cattle, sheep, goats and buffalo, and produced large reductions in faecal egg counts approaching those of the conventional drugs. This supports the classical parasite-expelling indication, though in livestock nematodes rather than the human tapeworm the Chinese texts describe.
⚠ Safety & Contraindications
- Pregnancy
- Young children
Contraindications
Dosage should be not too large since it has some toxicity.
Source: Xi S, Gong Y. Essentials of Chinese Materia Medica and Medical Formulas. Academic Press/Elsevier, 2017, p. 386.
Historical Texts
Ming Yi Bie Lu
Southern Dynasties, c. 500 CE, compiled by Tao HongjingReferences
- Mansoor K, Bardees R, Alkhawaja B, Mallah E, AbuQatouseh L, Schmidt M, Matalka K. Impact of Pomegranate Juice on the Pharmacokinetics of CYP3A4- and CYP2C9-Mediated Drugs Metabolism: A Preclinical and Clinical Review . Molecules (2023) [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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