Sepiae Endoconcha (hai piao xiao) (also called cuttlefish bone) is a very popular medicinal for reducing stomach acid - thereby reducing stomach pain, the sensation of burning or acid, and even healing ulcers. Consequently, it is often added to formulas and even given alone as an effective remedy. However, it can be used in the wrong situations—situations that might seem perfectly logical, but may actually cause harm. In fact, is not much different than over-the-counter antacids such as TUMS and Rolaids.
Let’s explore when to use this medicinal, when not to use this medicinal, and how it works.
Chinese medicine explains Sepiae Endoconcha’s (hai piao xiao) function as: controlling acidity, harmonizing the stomach, and alleviating pain. It is used for symptoms such as stomach or epigastric pain, distasteful belching, or acid regurgitation. Up to 30 grams at a time can be used for this function.
Biochemical analysis shows that Sepiae Endoconcha’s (hai piao xiao) key ingredient is calcium carbonate. It also contains sodium chloride, calcium phosphate, and magnesium chloride. Calcium carbonate is also the active ingredient in TUMS and Rolaids. This works very well at neutralizing stomach acid. Of note, other Chinese medicinals that are used to control stomach acid work in a similar manner, such as Arcae Concha (wa leng zi) and calcined Meretricis/Cyclinae Concha (duan hai ge qiao).
However, merely controlling the symptoms does not come without a price.
- Inhibits digestive enzymes. For example, it inhibits the release of pepsin.
- Binds with other minerals in the gut.
- Can cause constipation.
- Causes rebound acid effects.
- It is theorized by some that it can cause long-term systemic pH imbalances and possibly cause Kidney damage.
In general, we do not want to lower stomach acid unless absolutely necessary! Stomach acid is essential for the digestion of foods (especially proteins), absorption of nutrients (e.g. B12), and inhibiting the growth of organisms such as pathological bacteria (H. Pylori), yeast, and the proliferation of parasites. For example, if the pH is too high (low stomach acid), then the proper release of bile and pancreatic enzymes does not occur. Thus, a higher pH sets up a cascade of events that can lead to a general weakening of the body’s vitality (such as, the adrenals) and immune system (potentially causing, for example, systemic viral proliferation).
As we age, our ability to produce stomach acid declines. In addition, when we are under stress (such as, weakened adrenals), our stomach acid production will also decline.
When to use Sepiae Endoconcha (hai piao xiao) or similar medicinals:
1. Too much stomach acid production. This usually occurs in people with excess constitutions (think about a high powered-business man with a red face). This will quell the acid, allowing you to use other methods to treat the root. It can also be used symptomatically, on its own, on an as-needed basis.
2. When there are ulcers. No matter what the constitution, reducing the acid can allow the ulcer to heal.
When not to use Sepiae Endoconcha (hai piao xiao):
1. For deficient constitutions or the elderly.
2. Hypochlorhydria (low stomach acid), even if there is burning and acid sensation.
Various sources cite that 50-70% of people that suffer from GERD, acid regurgitation, burning, etc., suffer from hypochlorhydria, not excess stomach acid. In these people, hyperacidity is caused from hypochlorhydria that has progressed and the stomach lining has suffered observable damage. Thus, they simultaneously have both conditions of hypochlorhydria and hyperacidity. The simple explanation is that proteins are not properly digested (because of low stomach acid), and then secondary putrefaction occurs (creating an acid). Thus, the proper treatment of their acid symptoms is not to reduce stomach acid, but just the opposite: to increase their stomach acid!
Thus, if there is low stomach acid, one does not want to use Sepiae Endoconcha (hai piao xiao) and other similar medicinals, even for symptomatic relief (unless there is an ulcer). In contrast, one should strive to find the root cause and also consider actually adding medicinals to increase stomach acid, such as Mume Fructus (wu mei), Chaenomelis Fructus (mu gua), and Crataegi Fructus (shan zha) as suggested by Chen Ze-Lin and Hu Jian-Hua. Notice that they are all sour.
HCL Challenge: How to know if there is actually hypochlorhydria
Gas and bloating are the most typical signs of low hydrochloric acid. Bad breath also occurs when proteins putrefy. A fairly reliable test for gauging the status of stomach acid production is a hydrochloric acid (HCL) challenge:
Take one betaine HCL (200mg) with a solid protein meal. If there is no warmth, discomfort, burning, or cramping, then increase the number of HCL pills by one on each subsequent day and with a similar solid protein meal. Do not exceed seven pills. When discomfort appears, you have overstepped how much additional HCL is needed.
It should be noted that some people who present with both hypochlorhydria and hyperacidity will experience increased symptoms with the introduction of HCL. These people may already have some ulcerous condition. One must therefore first heal the lining of the stomach, before increasing their HCL production.
To accomplish this, expert doctors such as Zhang Xiaoping recommend adding the treatment principle of moistening the Stomach and nourishing yin to one’s core treatment, regardless of the tongue. However, if there is a greasy coat he will add Artemisiae scopariae Herba (yin chen) and Poria rubra (chi fu ling). However, the medicinals he likes for moistening the Stomach and nourishing yin are Paeoniae Radix alba (bai shao), Mume Fructus (wu mei), Schisandrae Fructus (wu wei zi), and Crataegi Fructus (shan zha). These medicinals can have the potential for being too rich and cloying, so if there is abdominal distention, hiccup etc. he will usually combine these medicinals with Citri sarcodactylis Fructus (fo shou), Caryophylli Flos (ding xiang), Perillae Fructus (zi su zi) / Perillae Caulis (zi su geng). Therefore he is able to moisten dryness while not being too rich and greasy and regulate qi without being too acrid and dry. Chen Zelin likes a base of Four-Gentlemen Decoction (si jun zi tang) plus Dendrobii Herba (shi hu), Ophiopogonis Radix (mai men dong), Rehmanniae Radix (sheng di huang), and Dioscoreae Rhizoma (shan yao) - unless there is a yellow greasy coat. A full differential diagnosis should be undertaken, to arrive at the proper root treatment.
Other ideas to increase your stomach acid:
Patients can take betaine HCL tablets with their meals, at a dose that is slightly lower than where they maxed out with the HCL challenge. With larger meals they can take more, and with smaller meals, less. Typically, protein meals are the only ones that need HCL supplementation.
- Homemade bone marrow broth. Here is a recipe I recommend to my patients, click here.
- Add cabbage, sauerkraut, and other fermented foods and drinks to your diet.
- Acidic foods, such as lemon and vinegars. For example, apple cider vinegar acts similarly to betaine HCL tablets. However, this does not usually lower the pH as much.
- Coffee (even decaffeinated) and alcohol
- Milk and other dairy products
- Other basic healthy choices can also help, such as eliminating sugars and processed foods.
- Anything to reduce the stress in your life, such as acupuncture.
- Eat slowly and chew your food.
Please feel free to post any comments, questions, or corrections.
The Wu Mei and Shan Zha have modern research demonstrating their ability to increase Stomach acid. I would bet Wu Wei Zi does also. Bai Shao may also have this effect, but I think it is just an excellent herb for stomach pain, relaxing the middle.
Jason thanks for the info. I’m writing on behalf of a small group of PCOM SD students. We’ve been discussing and we can’t exactly understand Dr. Zhang Xiaoping’s herb selections for Nourishing Yin and Moistening the Stomach. We recognize that all 4 herbs are Sour. Amongst them Bai Shao nourishes yin directly(mainly Liver but enters the Spleen Channel), Wu Mei nourishes fluids, Shan Zha aids digestion, and Wu Wei Zi astringes yin and fluids. We aren’t sure though why these sour herbs and not more straightforward yin tonics as Dr. Zelin chose (mai men dong, etc.). Are these sour herbs to be mixed with sweet herbs. Any insight you can share would be helpful to expanding our understanding of herbs.
Just wanted to mention that its not necessary to consume the cabbage in saurekraut to get the benefit of its increasing stomach acidity. For people with gut sensitivity I recommend simply drinking the juice ( about 2 tabs on an empty stomach in the morning) .This has repeatedly proven to be an excellent way to improve digestion and relieve acute food stasis..particularly when it causes insomnia
A simple test is to ingest 1 Tbsp of apple cider vinegar mixed with 4 -5 oz of water on an empty stomach. If there is no sensation of burning, acid regurgitation, etc. then the person has hypocholorhydria and should supplement his or her stomach acid. If there is a burning, acid reflux or other discomfort, then the person has hyperchlorhydria and should use something to reduce the acid. At least that’s what the nutritional experts have said in my CEUs.