What patterns does Shi Gao address?

Shi Gao addresses these TCM patterns of disharmony: Qi Level Heat, Lung Heat, Stomach Fire Blazing.

What conditions is Shi Gao used for?

Shi Gao is commonly used for: High Fever, Pneumonia, Toothache, Gingivitis, Asthma, Diabetes, Mouth Ulcers, Heat Stroke, Eczema, Skin Burns, Acne. A TCM practitioner would consider this herb when these conditions arise from the specific patterns it addresses.

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Ingredient Mineral (矿物 kuàng wù)

Shi Gao

Q: What are the TCM actions of Shi Gao?

The TCM actions of Shi Gao include: Clears Heat and Drains Fire, Eliminates Irritability and Relieves Thirst, Clears Lung Heat, Clears Stomach Heat, Promotes Tissue Regeneration and Heals Sores.

Gypsum · 石膏

CaSO₄·2H₂O (hydrous calcium sulfate) · Gypsum Fibrosum

Also known as: Bái Hǔ (白虎, White Tiger), Hán Shuǐ Shí (寒水石), Xì Lǐ Shí (细理石), Ruǎn Shí Gāo (软石膏), Bīng Shí (冰石), Yù Dà Shí (玉大石), Fibrous Gypsum

Images shown are for educational purposes only

Shi Gao (gypsum) is a mineral-based substance and one of the most powerful cooling herbs in Chinese medicine. It is primarily used for high fevers, intense thirst, and inflammatory Heat conditions affecting the Lungs and Stomach. For centuries it has been a cornerstone ingredient in formulas for serious febrile illnesses, dental inflammation, and respiratory infections with Heat.

Category Heat-clearing herbs Herbs that clear Heat and drain Fire (清热泻火药)

Therapeutic focus Fever Management Respiratory Health Oral and Dental Health Inflammation Support

TCM Properties

Temperature

Cold

Taste

Acrid / Pungent (辛 xīn), Sweet (甘 gān)

Channels entered

Lungs, Stomach

Parts used

Mineral (矿物 kuàng wù)

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What This Ingredient Does

Every ingredient has a specific set of actions — here's what Shi Gao does in the body, explained in both everyday and TCM terms

Therapeutic focus

In practical terms, Shi Gao is primarily used to support these areas of health:

Fever Management Respiratory Health Oral and Dental Health Inflammation Support

TCM Actions

In TCM terminology, these are the specific therapeutic actions that Shi Gao performs to restore balance in the body:

Clears Heat and Drains Fire Eliminates Irritability and Relieves Thirst Clears Lung Heat Clears Stomach Heat Promotes Tissue Regeneration and Heals Sores

How these actions work

'Clears Heat and drains Fire' is Shi Gao's primary action and the reason it has been called the most important herb for clearing internal Heat at the Qi level. When a high fever enters deep into the body (past the surface layer), the Lung and Stomach channels become filled with intense Heat. Shi Gao, being extremely cold in temperature and heavy in nature, powerfully descends and clears this Heat. This is the action showcased in the famous Bai Hu Tang (White Tiger Decoction), used for high fever, strong thirst, profuse sweating, and a forceful, flooding pulse. Unlike bitter-cold herbs that can dry out body fluids and damage the Stomach, Shi Gao's sweet taste helps protect fluids while clearing Heat.

'Eliminates irritability and relieves thirst' means Shi Gao addresses the restlessness, agitation, and intense thirst that accompany high fevers. When Heat blazes in the Qi level, it consumes fluids and disturbs the spirit, making a person extremely restless and desperate for cold drinks. The sweet and cold nature of Shi Gao quenches this internal 'fire' and helps restore fluids.

'Clears Lung Heat' refers to its ability to clear Heat that has lodged in the Lungs, causing cough, wheezing, rapid breathing, and thick yellow phlegm. By entering the Lung channel, Shi Gao can cool the Lungs and restore their normal descending function. This action is featured in the formula Ma Xing Shi Gan Tang, where it pairs with Ma Huang to treat Lung Heat cough and asthma.

'Clears blazing Stomach Fire' means Shi Gao can drain excessive Heat from the Stomach channel. Since the Stomach channel passes through the gums and teeth, Stomach Fire often manifests as severe toothache, swollen and bleeding gums, headache, and mouth sores. Shi Gao is the primary herb for these Stomach Fire symptoms.

'Generates flesh and heals sores' applies only to the calcined (roasted) form, Duan Shi Gao. After calcining, Shi Gao loses most of its cold nature and gains astringent properties. In this processed form it is ground into powder and applied externally to wounds, burns, eczema, and ulcers that will not heal, helping to dry dampness and promote tissue regeneration.

Patterns Addressed

In TCM, symptoms cluster into recognizable patterns of disharmony. Shi Gao is used to help correct these specific patterns.

Why Shi Gao addresses this pattern

Qi-level Heat (气分热盛) occurs when pathogenic Heat penetrates past the body's surface defence and blazes in the interior, particularly in the Lung and Stomach. This generates the classic 'four bigs': big fever, big thirst, big sweating, and a big (flooding) pulse. Shi Gao is the definitive herb for this pattern because its acrid-sweet and extremely cold nature directly targets the Lung and Stomach channels where Qi-level Heat resides. Its acrid taste helps vent Heat outward, its sweet taste protects fluids and the Stomach, and its extreme coldness powerfully quenches the blazing internal Heat. As a heavy mineral, it also has a descending quality that settles and calms the agitation caused by Heat disturbing the spirit.

A practitioner would look for one or more of these signs

High Fever

High fever that does not respond to surface-releasing treatments

Excessive Thirst

Intense thirst with desire for cold drinks

Excessive Sweating

Profuse sweating that does not reduce the fever

Restlessness

Agitation and irritability from internal Heat

Why Shi Gao addresses this pattern

When pathogenic Heat lodges in the Lungs, it disrupts their normal descending and dispersing functions, leading to cough, wheezing, and difficulty breathing. Shi Gao enters the Lung channel and, with its powerful cold nature, directly clears Heat from the Lungs. By removing the Heat that is causing the Lung Qi to rebel upward, Shi Gao restores normal Lung function. Importantly, it clears Lung Heat without excessively drying the Lungs, since its sweet taste helps preserve fluids. This makes it ideal for conditions where Heat has both impaired Lung function and begun to damage fluids.

A practitioner would look for one or more of these signs

Hypochondrial Pain That Is Worse On Coughing And Breathing

Cough with thick yellow sputum

Wheezing

Wheezing and rapid breathing from Lung Heat

High Fever

Fever accompanying respiratory infection

Why Shi Gao addresses this pattern

Stomach Fire blazing (胃火亢盛) is a condition where excessive Heat accumulates in the Stomach and flares upward along the Stomach channel, which traverses the face, gums, and teeth. This causes intense toothache, swollen and painful gums, headache, mouth ulcers, and facial swelling. Shi Gao is the premier herb for clearing Stomach Fire because it enters the Stomach channel directly and its extreme coldness powerfully drains the accumulated Fire. Its acrid quality helps disperse the congested Heat, while its sweet quality prevents the cold from harming the Stomach's digestive function.

A practitioner would look for one or more of these signs

Toothache

Severe toothache from Stomach Fire flaring upward

Swollen Gums

Red, swollen, and painful gums

Headaches

Headache along the Stomach channel (forehead and face)

Mouth Ulcers

Mouth sores and oral ulceration

Commonly Used For

These are conditions where Shi Gao is frequently used — but only when they arise from the specific patterns it addresses, not in all cases

Arises from: Qi Level Heat

TCM Interpretation

In TCM, high fever that does not respond to sweating treatments is understood as Heat that has moved past the body's surface and settled deep in the interior, particularly in the Qi level of the Lung and Stomach systems. This is not merely a temperature problem but a state where pathogenic Heat is consuming the body's fluids, disturbing the spirit (causing agitation), and forcing sweat out without relieving the Heat. The Stomach and Lungs become like a furnace, generating the 'four bigs' pattern: big fever, big thirst, big sweating, and a big pulse. If untreated, this Heat can progress deeper, potentially damaging the Blood level or causing delirium.

Why Shi Gao Helps

Shi Gao is the single most important herb in Chinese medicine for clearing intense internal Heat at the Qi level. Its extremely cold temperature directly counteracts the blazing Heat in the Lung and Stomach. Its acrid taste helps vent the Heat outward through the skin, while its sweet taste protects body fluids from further damage and prevents its cold nature from harming digestion. As a heavy mineral, it has a natural descending tendency that helps settle the agitated Qi caused by the Heat. This is why Shi Gao is used as the King herb in Bai Hu Tang (White Tiger Decoction), the classical formula for exactly this type of high fever, typically at doses of 30 to 60 grams or more.

Arises from: Lung Heat

TCM Interpretation

TCM understands pneumonia primarily as a condition where pathogenic Heat has invaded the Lungs, obstructing their normal function of descending and dispersing Qi and fluids. When Lung Qi cannot descend, it rebels upward, causing cough and wheezing. The Heat also thickens and 'cooks' the body's fluids into thick, yellow phlegm. The Lungs govern the skin and breathing, so when they are overwhelmed by Heat, the person develops fever, rapid breathing, nasal flaring, thirst, and yellow sputum. In severe cases, the Heat can further damage Lung Yin, leading to dryness and more serious complications.

Why Shi Gao Helps

Shi Gao enters the Lung channel and powerfully clears the Heat that is blocking normal Lung function. By draining the Heat, it allows the Lungs to resume their descending function, which naturally calms coughing and wheezing. In the classical formula Ma Xing Shi Gan Tang, Shi Gao works alongside Ma Huang (which opens and ventilates the Lungs) to clear Lung Heat while restoring Lung Qi circulation. Shi Gao's sweet nature also helps protect the fluids that Heat has been consuming, an important consideration since pneumonia patients are often dehydrated. Clinical reports have documented the effectiveness of Shi Gao-based formulas for pneumonia in both children and adults.

Arises from: Stomach Fire Blazing

TCM Interpretation

TCM has long recognized a condition called 'wasting-thirst' (消渴 xiāo kě) that closely parallels diabetes. It is understood as a condition where Heat, particularly Stomach Fire, consumes the body's fluids faster than they can be replenished. The 'upper wasting' type features excessive thirst, the 'middle wasting' type features excessive hunger, and the 'lower wasting' type features excessive urination. In many cases, Stomach Heat and Kidney Yin Deficiency coexist: the Stomach Fire blazes upward unchecked because the Kidney's cooling Yin is too depleted to restrain it. This dual pathology explains why diabetes patients often have both Heat signs (thirst, hunger) and Deficiency signs (fatigue, weakness).

Why Shi Gao Helps

Shi Gao directly clears the Stomach Fire that is consuming fluids and driving the excessive thirst and hunger seen in many diabetes patients. Its sweet-cold nature not only quenches the Heat but also helps generate fluids and relieve thirst. In Bai Hu Tang and its variant Bai Hu Jia Ren Shen Tang, Shi Gao addresses the Heat component, while other herbs support the Qi and fluid regeneration needed to manage diabetes. In Yu Nu Jian (Jade Woman Decoction), Shi Gao clears Stomach Fire while Shu Di Huang nourishes Kidney Yin, addressing both the excess Heat and underlying Yin Deficiency together. Modern clinical practice continues to use these Shi Gao-based formulas as part of an integrative approach to diabetes management.

Also commonly used for

Toothache

Toothache and gum inflammation from Stomach Fire

Gingivitis

Swollen, painful, and bleeding gums

Asthma

Asthma or wheezing due to Lung Heat

Mouth Ulcers

Recurrent mouth sores from Stomach Heat

Heat Stroke

Heatstroke with high fever and intense thirst

Eczema

Eczema and weeping skin lesions (calcined form applied externally)

Skin Burns

Burns and scalds (calcined form applied externally)

Acne

Acne and rosacea from Lung-Stomach Heat

Ingredient Properties

Every ingredient has an inherent temperature, taste, and affinity for specific channels — these properties determine how it interacts with the body

Temperature

Cold

Taste

Acrid / Pungent (辛 xīn), Sweet (甘 gān)

Channels Entered

Lungs Stomach

Parts Used

Mineral (矿物 kuàng wù)

Dosage & Preparation

These are general dosage guidelines for Shi Gao — always follow your practitioner's recommendation, as dosages vary based on the formula and your individual condition

Standard dosage

15-60g

Maximum dosage

Up to 250g (historically up to several jin per treatment course) for severe excess heat conditions, under experienced practitioner supervision only. Zhang Xichun routinely used 60-120g and documented cases using far larger cumulative doses.

Dosage notes

For mild heat or as a supporting herb, 15-30g is typical. For significant Yangming-level heat with high fever, thirst, and flooding pulse, 30-60g is standard. In critical cases of blazing excess heat, experienced practitioners may use 60-120g or more per dose. Shi Gao must be crushed or ground into small pieces before decocting, as its hard mineral nature means active components dissolve slowly. It should be decocted first (先煎) for 15-30 minutes before other herbs are added. Zhang Xichun recommended grinding Shi Gao to powder and taking it with the strained decoction rather than decocting the chunks, arguing this maximized efficacy. He also emphasized the principle of stopping as soon as the fever reduces to 80-90% (中病即止) to prevent over-cooling and damaging the Spleen and Stomach.

Preparation

Must be decocted first (先煎, xian jian). Because Shi Gao is a hard mineral, its active components dissolve slowly. It should be crushed into small pieces or coarse powder, then boiled for 15-30 minutes before the other herbs are added to the pot. Some classical texts recommend wrapping the crushed gypsum in cloth (绵裹) before decocting to prevent sediment in the decoction. Zhang Xichun recommended an alternative method: grinding Shi Gao into fine powder and taking it directly with the strained herbal liquid, arguing this was more effective than prolonged decoction of chunks.

Processing Methods

In TCM, the same ingredient can be prepared in different ways to change its effects — here's how processing alters what Shi Gao does

Processing method

The raw gypsum blocks are placed in a kiln or heat-resistant container and calcined at high temperature until they turn red-hot and become crumbly and opaque. After cooling, the calcined gypsum is ground into a fine powder.

How it changes properties

Calcining dramatically reduces Shi Gao's cold nature and eliminates its internal Heat-clearing ability. The calcined form gains an astringent (涩 sè) quality that the raw form does not have. It shifts from an internal medicine that clears Heat and relieves thirst into an external medicine that absorbs moisture, promotes tissue regeneration, stops bleeding, and helps close wounds. The taste adds astringency alongside the original sweet and acrid.

When to use this form

Duan Shi Gao is used exclusively for external application. It is ground into fine powder and applied to eczema, weeping skin lesions, burns, scalds, non-healing ulcers, and wounds that fail to close. It should never be substituted for raw Shi Gao in internal prescriptions, as it cannot clear Heat when taken internally and may even worsen the condition.

Common Ingredient Pairs

These ingredients are traditionally combined with Shi Gao for enhanced therapeutic effect

Zhi Mu Shi Gao 30g : Zhi Mu 9g (roughly 3:1, following Bai Hu Tang proportions)

Shi Gao and Zhi Mu are one of the most famous herb pairs in Chinese medicine. Shi Gao powerfully clears Qi-level Heat in the Lung and Stomach, while Zhi Mu's bitter-cold and moist nature assists the Heat-clearing and adds a fluid-nourishing, Yin-protecting dimension that Shi Gao alone does not provide. Together they clear Heat far more effectively than either herb alone and simultaneously protect the body's fluids from Heat damage.

When to use: For Qi-level Heat with the 'four bigs': high fever, intense thirst, profuse sweating, and a flooding pulse. This is the core pair in Bai Hu Tang.

Ma Huang Shi Gao 24g : Ma Huang 12g (Shi Gao double the amount of Ma Huang)

Shi Gao clears interior Lung Heat while Ma Huang opens the Lungs and ventilates Lung Qi outward. Despite their opposite thermal natures (Ma Huang is warm, Shi Gao is very cold), their combination achieves what neither can do alone: Ma Huang unblocks the Lungs and prevents Heat from being trapped, while Shi Gao ensures that Ma Huang's warmth does not worsen the Heat. The result is clear Lung ventilation with simultaneous Heat-clearing.

When to use: For Lung Heat patterns with cough, wheezing, fever, and thick yellow sputum. This is the core mechanism of Ma Xing Shi Gan Tang.

Huang Lian Shi Gao 15–30g : Huang Lian 3–6g

Shi Gao clears Qi-level Heat from the Lung and Stomach, while Huang Lian drains Fire from the Heart and Stomach with its intensely bitter-cold nature. Together they provide a powerful combined assault on Heat and Fire affecting both the Qi level and the Heart, addressing irritability, insomnia, delirium, and Stomach Fire symptoms more effectively than either herb alone.

When to use: For Heart Fire and Stomach Fire blazing together, with symptoms such as high fever, delirium, severe irritability, insomnia, mouth ulcers, and swollen painful gums.

Shu Di Huang Shi Gao 15g : Shu Di Huang 15–30g (1:1 to 1:2)

Shi Gao clears Stomach Fire while Shu Di Huang (prepared Rehmannia) nourishes Kidney Yin. This pairing addresses the common clinical scenario where Stomach Fire is blazing because depleted Kidney Yin can no longer restrain it. Shi Gao drains the excess Heat above while Shu Di Huang replenishes the Yin below, tackling both the root (Yin Deficiency) and the branch (Stomach Fire).

When to use: For Stomach Heat with underlying Kidney Yin Deficiency, as seen in diabetes with thirst and hunger, or toothache with loose teeth and gum recession. This is the core pair in Yu Nu Jian.

Key Formulas

These well-known formulas feature Shi Gao in a prominent role

Bai Hu Tang 白虎湯 King

Bai Hu Tang (White Tiger Decoction) from the Shang Han Lun is the definitive showcase of Shi Gao's core action. Shi Gao serves as King at a heavy dose (originally one jin, approximately 250g) to clear Yangming Qi-level Heat. The formula treats the 'four bigs' of high fever, great thirst, profuse sweating, and flooding pulse. It is the single formula most associated with Shi Gao in the entire tradition.

Zhu Ye Shi Gao Tang 竹葉石膏湯 King

Zhu Ye Shi Gao Tang (Lophatherus and Gypsum Decoction) from the Shang Han Lun demonstrates Shi Gao's use for lingering Heat after a febrile illness, combined with Qi and Yin Deficiency. Shi Gao clears residual Heat from the Lungs and Stomach while the other herbs (Ren Shen, Mai Dong, Ban Xia) address the depleted Qi and fluids and counteract nausea.

Yu Nu Jian 玉女煎 King

Yu Nu Jian (Jade Woman Decoction) from the Jing Yue Quan Shu showcases Shi Gao's ability to clear Stomach Fire when combined with Yin-nourishing herbs. Shi Gao serves as King to drain Stomach Heat, while Shu Di Huang nourishes Kidney Yin, addressing the common clinical pattern of Stomach Heat with Yin Deficiency seen in toothache, diabetes, and chronic thirst.

Ma Xing Shi Gan Tang 麻杏石甘湯 Deputy

Ma Xing Shi Gan Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) from the Shang Han Lun showcases Shi Gao's Lung Heat-clearing action. Here Shi Gao works as Deputy alongside King herb Ma Huang: Ma Huang ventilates and opens the Lungs while Shi Gao clears the Heat trapped within them. This formula is the go-to prescription for Lung Heat causing cough, wheezing, and fever.

Comparable Ingredients

These ingredients have overlapping uses — here's how to tell them apart

Shi Gao vs Zhi Mu

Both Shi Gao and Zhi Mu clear Lung and Stomach Heat and are often used together. The key difference is that Shi Gao is a mineral with a powerful, fast-acting Heat-clearing force and is the primary choice for acute, intense Qi-level Heat with high fever. Zhi Mu is milder in its Heat-clearing but adds significant Yin-nourishing and fluid-generating properties that Shi Gao lacks. Zhi Mu can also address Kidney Fire and Yin Deficiency Heat, while Shi Gao should only be used for excess Heat patterns, never for deficiency Heat.

Shi Gao vs Han Shui Shi

Han Shui Shi (Calcitum/Glauberitum) is another mineral that clears Heat and drains Fire, and its functions overlap significantly with Shi Gao. However, Shi Gao is far more commonly used, better studied, and considered more effective for clearing Qi-level Heat. Han Shui Shi enters the Stomach and Kidney channels and has a salty taste, giving it a slight ability to soften hardness that Shi Gao does not have. In practice, Han Shui Shi is sometimes combined with Shi Gao to reinforce Heat-clearing but is rarely used as the primary Heat-clearing mineral.

Shi Gao vs Zhi Zi

Both Shi Gao and Zhi Zi (Gardenia fruit) clear Heat and relieve irritability. However, Shi Gao specializes in clearing Qi-level Heat from the Lung and Stomach with its acrid-sweet-cold nature, making it ideal for high fever and intense thirst. Zhi Zi is bitter-cold and enters the Heart, Lung, and San Jiao, making it better for clearing Heat from all three burners simultaneously, draining Damp-Heat downward through the urine, and cooling the Blood. Zhi Zi is preferred for irritability with chest tightness and for jaundice, while Shi Gao is preferred for the classic high fever, great thirst, and flooding pulse of Yangming Heat.

Common Substitutes & Adulterants

Related species and common adulterations to be aware of when sourcing Shi Gao

Shi Gao has historically been confused with several related minerals. Han Shui Shi (寒水石) is the most common source of confusion: the original Ben Cao texts described Han Shui Shi as a natural crystalline form of mirabilite (sodium sulfate), but in modern commerce, "Han Shui Shi" is often sold as either a form of red gypsum (in northern China) or calcite/calcium carbonate (in southern China). These substitutes have different chemical compositions and therapeutic effects. Ying Shi Gao (硬石膏, anhydrite) is another related mineral that lacks the crystal water of true gypsum and has different medicinal properties. Fang Jie Shi (方解石, calcite/calcium carbonate) can also be mistaken for gypsum. Authentic Shi Gao can be distinguished by its characteristic fibrous crystal structure, silky lustre, softness (scratched by fingernail), and the presence of crystal water (shown by weight loss on heating). A key concern is the substitution of calcined gypsum (煅石膏) for raw gypsum (生石膏) in prepared decoctions, which can be dangerous if the preparation is intended for internal use. Zhang Xichun advised purchasing whole blocks of bright, clearly fibrous gypsum and grinding them oneself to ensure authenticity.

Educational content — always consult a qualified healthcare provider or TCM practitioner before using any ingredient.

Toxicity Classification

Classical Chinese pharmacopoeia toxicity rating for Shi Gao

Non-toxic

Shi Gao is classified as having very little toxicity (毒性甚小) in classical sources and is considered non-toxic in standard pharmacopoeial use. Its main component, hydrous calcium sulfate, is chemically inert and generally safe. However, there are reports that natural gypsum specimens containing high levels of arsenic impurities can cause toxic reactions. The Chinese Pharmacopoeia sets limits: arsenic content must not exceed 2 parts per million, and heavy metals must not exceed 10 parts per million. The most important safety distinction is between raw (生石膏) and calcined (煅石膏) forms: calcined gypsum must NEVER be taken internally. Zhang Xichun specifically warned that ingesting even a few qian of calcined gypsum could congeal phlegm and blood, producing symptoms ranging from irregular heartbeat (结代脉) to chest oppression, speech difficulty, and limb weakness.

Contraindications

Situations where Shi Gao should not be used or requires extra caution

Avoid

Spleen and Stomach deficiency-cold patterns (脾胃虚寒). Shi Gao is very cold in nature and will further damage weakened digestive function, worsening symptoms like poor appetite, loose stools, and abdominal cold pain.

Avoid

Yin deficiency with internal heat but no excess (true deficiency, false heat). Shi Gao clears excess heat from the Qi level. Using it for deficiency-heat (such as tidal fever from Yin deficiency with bone-steaming) will injure Yin and Yang further without addressing the root cause.

Caution

Febrile disease where the exterior has not yet been resolved. If pathogenic factors are still at the surface level (exterior pattern), using a heavy interior-clearing mineral like Shi Gao prematurely may trap the pathogen inward.

Caution

Patients with blood deficiency or general Qi deficiency without clear signs of excess heat. The strongly cold and heavy nature of Shi Gao can further deplete Qi and damage Blood production.

Caution

Before the start of summer (立夏前) or in cold climates, excessive use should be cautioned. Li Dongyuan warned that overusing Bai Hu Tang (containing Shi Gao) before summer could cause urinary incontinence from excessive descending of Qi.

Avoid

Do not use calcined Shi Gao (煅石膏) internally. Calcined gypsum loses its heat-clearing properties and can congeal blood, block phlegm, and cause serious harm including chest oppression and limb weakness. Internal use must be raw (生石膏) only.

Special Populations

Important considerations for pregnancy, breastfeeding, and pediatric use

Pregnancy

Generally considered safe at standard doses during pregnancy when prescribed for appropriate heat conditions. Shi Gao is not classified as a pregnancy-prohibited or pregnancy-cautionary herb in standard TCM references. However, its strongly cold nature means it should only be used when genuine excess heat is present. Unnecessary use of this very cold mineral could potentially damage the Spleen and Stomach Yang of a pregnant woman, impairing digestion and nutrient absorption needed during pregnancy. Use should be under practitioner guidance with careful pattern differentiation.

Breastfeeding

No specific contraindications for breastfeeding have been recorded in standard TCM references. Traditionally, Shi Gao was even noted in the Shen Nong Ben Cao Jing as being able to promote lactation (产乳). Its primary constituent, calcium sulfate, is a simple inorganic salt unlikely to produce harmful metabolites in breast milk. However, its cold nature means prolonged or excessive use could weaken the mother's Spleen and Stomach, potentially reducing milk quality or quantity. Use should be limited to genuine heat presentations and discontinued once the heat has resolved.

Children

Shi Gao is frequently used in pediatric TCM for high fever, particularly in formulas like Ma Xing Shi Gan Tang for childhood pneumonia and lung heat. The classical formula Yu Lu San (玉露散) specifically targets childhood heat patterns with vomiting and diarrhoea. Dosage should be reduced proportionally according to the child's age and body weight, typically one-third to one-half of the adult dose for young children. As with adults, it should only be used for confirmed excess heat patterns, and the principle of stopping once the heat resolves (中病即止) is especially important in children, whose Spleen and Stomach are inherently more delicate and easily damaged by cold medicines.

Drug Interactions

If you are taking pharmaceutical medications, be aware of these potential interactions with Shi Gao

Cardiac glycosides (digoxin, digitoxin) and calcium channel blockers (nifedipine, prenylamine): Shi Gao releases calcium ions during digestion. Elevated blood calcium can affect cardiac conduction and potentiate the toxicity of digitalis-type drugs, increasing the risk of arrhythmias and conduction block. Co-administration should be avoided.

Tetracycline and macrolide antibiotics: Calcium ions can chelate with tetracycline and certain macrolide antibiotics in the gastrointestinal tract, forming insoluble complexes that reduce the absorption and efficacy of these drugs.

Sulfonamide antibiotics: Co-administration may increase the adverse effects of sulfonamides, possibly through altered renal handling of the drug in the presence of excess calcium and sulfate.

Phosphate and sulfate medications: Taking Shi Gao with phosphate-containing or additional sulfate-containing preparations can produce insoluble precipitates in the gut, reducing the therapeutic effect of both substances.

Dietary Advice

Foods and dietary considerations when taking Shi Gao

While taking Shi Gao for heat conditions, avoid greasy, fried, spicy, and warming foods (such as lamb, chilli peppers, ginger, and alcohol) that can generate additional internal heat and counteract the cooling effect. Cold and raw foods in excess should also be avoided because, while Shi Gao is used for heat, it is itself very cold and combining it with cold foods can overwhelm the digestive system. Light, easily digestible foods like congee (rice porridge) and clear soups are ideal. Classically, rice congee or rice (粳米) is included directly in the formula (as in Bai Hu Tang) to protect the Stomach from the cold nature of the mineral.

Botanical Description

Physical characteristics and morphology of the Shi Gao source mineral

Shi Gao (石膏, Gypsum Fibrosum) is not a plant but a naturally occurring mineral. It is a hydrous calcium sulfate (CaSO₄·2H₂O) belonging to the sulfate mineral group of the monoclinic crystal system. In its natural state, gypsum forms as fibrous crystalline aggregates in sedimentary rock deposits, typically associated with evaporite environments such as ancient inland lakes and marine basins where water evaporation concentrated mineral salts.

The crystals commonly appear as plate-like or blade-like formations, and the aggregate structure is characteristically fibrous or leaf-like. The colour is usually white, greyish-white, or pale yellow, though impurities can produce grey, flesh-pink, honey-yellow, or even black tones. The mineral has a silky or pearly lustre on its cleavage surfaces and fibrous faces, is translucent to semi-transparent, and is notably soft (hardness 1.5 to 2 on the Mohs scale, easily scratched with a fingernail). It has a specific gravity of approximately 2.3 and exhibits both flexibility and slight elasticity.

Sourcing & Harvesting

Where Shi Gao is sourced, when it's harvested or collected, and how to assess quality

Harvesting season

Gypsum can be mined year-round, though winter is the traditional harvesting season.

Primary growing regions

Shi Gao is widely distributed across China, with deposits found in Hubei, Anhui, Shandong, Henan, Sichuan, Hunan, Guangxi, Guangdong, Yunnan, Xinjiang, Inner Mongolia, Shanxi, Shaanxi, Ningxia, Gansu, Qinghai, and Tibet. The recognized dao di (道地) production regions are Hubei, Anhui, and Shandong provinces, with the gypsum from Yingcheng (应城) in Hubei province traditionally regarded as the finest quality. Gypsum forms primarily through chemical sedimentation in arid-climate inland lakes and marine basins where intense evaporation concentrates mineral salts.

Quality indicators

Good quality Shi Gao appears as large, intact blocks that are white or greyish-white in colour, with a silky (绢丝样) lustre visible on the longitudinal fibrous surface. The upper and lower faces should be relatively flat, while the side surfaces show clear longitudinal fibrous striations. Good specimens are semi-transparent, heavy in weight, soft enough to be scratched by a fingernail, and have a faint smell with a bland taste. The best quality is described as: blocks large, colour white, longitudinal surface fibrous with lustre, texture loose (not overly dense), and free from impurity stones or dirt. According to the Chinese Pharmacopoeia, the hydrous calcium sulfate (CaSO4·2H2O) content should be no less than 95%.

Classical Texts

Key passages from the classical Chinese medical texts that describe Shi Gao and its therapeutic uses

Shen Nong Ben Cao Jing (《神农本草经》)

「主中风寒热，心下逆气，惊喘，口干舌焦，不能息，腹中坚痛，产乳，金疮。」

"Governs wind-strike with cold and heat, counterflow Qi below the heart, fright and panting, dry mouth and parched tongue, inability to breathe, firm pain in the abdomen, [promotes] birthing and lactation, and [treats] metal sores."

Ming Yi Bie Lu (《名医别录》)

「除时气头痛身热，三焦大热，皮肤热，肠胃中膈热，解肌发汗，止消渴烦逆，腹胀暴气喘息，咽热。」

"Eliminates seasonal headache and body heat, great heat in the Three Burners, skin heat, heat in the intestines and stomach, resolves the muscles and promotes sweating, stops wasting-thirst and vexation with counterflow, abdominal distension with sudden panting and dyspnoea, and throat heat."

Yong Yao Xin Fa (《用药心法》, Li Dongyuan)

「胃经大寒药，润肺除热，发散阴邪，缓脾益气。」

"A greatly cold medicinal of the Stomach channel. It moistens the Lung and eliminates heat, disperses Yin-type pathogens, and relaxes the Spleen to benefit Qi."

Ben Cao Xin Bian (《本草新编》)

「乃降火之神剂，泻热之圣药。」

"It is the divine agent for lowering fire, the holy medicine for draining heat."

Historical Context

The history and evolution of Shi Gao's use in Chinese medicine over the centuries

Shi Gao is one of the oldest medicinal minerals in the Chinese pharmacopoeia, first recorded in the Shen Nong Ben Cao Jing (circa 1st-2nd century CE), where it was classified as an upper-grade medicine with a "slightly cold" nature. It bears several classical aliases including Xi Shi (细石), Xi Li Shi (细理石), Ruan Shi Gao (软石膏), Han Shui Shi (寒水石), and Bai Hu (白虎, "White Tiger"), the last reflecting its association with the famous Bai Hu Tang formula and the fierce, cooling power it represents.

A significant historical debate surrounds the thermal nature of Shi Gao. The Ben Cao Jing Ji Zhu by Tao Hongjing first classified it as "greatly cold" (大寒), a view adopted by most subsequent texts. However, the Jin Dynasty physician Zhang Yuansu's warning that it was "a greatly cold medicine of the Yangming channel" that could "make people unable to eat" led many later physicians to use it timidly. Li Shizhen, in the Ben Cao Gang Mu, reverted to the Shen Nong Ben Cao Jing's original classification of "slightly cold." The modern physician Zhang Xichun (张锡纯, 1860-1933) was the most influential advocate for bold use of Shi Gao. In his Yi Xue Zhong Zhong Can Xi Lu, he argued that Shi Gao's cold nature was far milder than Huang Lian or Huang Bai, and he routinely used it in large doses (sometimes several jin per course of treatment) for febrile diseases. He documented 38 detailed case studies involving conditions from pneumonia to scarlet fever. In 1954, Chinese physicians applied Zhang Xichun's experience of heavy Shi Gao dosing to treat an epidemic of Japanese B encephalitis in Shijiazhuang with remarkable success, and the Ministry of Health promoted this approach nationwide.

Beijing's famous physician Kong Bohua (孔伯华, one of the "Four Great Physicians of Beijing") also championed the use of Shi Gao, insisting that the "greatly cold" label was a post-Tang and Song misconception that had caused generations of physicians to fear this excellent medicine unnecessarily.

Modern Research

4 published studies investigating the pharmacological effects or clinical outcomes of Shi Gao

Evaluation of the antipyretic activity of Gypsum Fibrosum and its constituents (Preclinical study, 2009)

Wang HD, Wang MW, Li XB. Asian Journal of Traditional Medicines, 2009, 4(3): 82-84.

This rat study compared raw Gypsum Fibrosum extract, calcined gypsum, and pure calcium sulfate against LPS-induced fever. Raw gypsum extract significantly reduced fever, but neither calcined gypsum nor pure CaSO4 showed antipyretic activity. The researchers concluded that the heat-clearing effect of raw gypsum likely comes from its trace inorganic elements (iron, potassium, aluminium), not from calcium sulfate itself. This helps explain why calcined gypsum, which loses many trace elements during heating, lacks the antipyretic effect of the raw form.

Gypsum fibrosum and its major component CaSO4 increase cutaneous aquaporin-3 expression levels (Preclinical study, 2012)

Ikarashi N, Mizukami N, Pei C, et al. Journal of Ethnopharmacology, 2012, 139(2): 409-413.

Using diabetic KKAy mice fed a diet containing Gypsum Fibrosum extract, researchers found that gypsum significantly increased the expression of aquaporin-3 (AQP3) protein in the skin by approximately 3.2-fold compared to controls. AQP3 is a water channel protein critical for maintaining skin hydration. The effect was attributed to increased calcium content in the skin from CaSO4 absorption. This provides a scientific rationale for gypsum's traditional use in Bai Hu Jia Ren Shen Tang for thirst and skin dryness.

PubMed

Research progress in pharmacological effects of Gypsum Fibrosum and material basis for its heat-clearing effect (Review, 2024)

Wang TT, Yang DL, Han N, Yin J. Zhongguo Zhong Yao Za Zhi, 2024, 49(4): 853-857.

This review summarized recent research on how Shi Gao clears heat. The proposed mechanism involves calcium ions regulating the Na+/Ca2+ ratio in the brain's thermoregulatory center, thereby inhibiting the upward shift of the temperature set point. Trace elements in natural gypsum may also contribute by modulating the immune system, promoting calcium absorption, and affecting synthesis of prostaglandin E2 (PGE2), a key mediator of fever.

Research Progress on Main Symptoms of Novel Coronavirus Pneumonia Improved by Traditional Chinese Medicine (Review, 2020)

Yang C, et al. Frontiers in Pharmacology, 2020, 11: 556885.

This review discussed the role of TCM in treating COVID-19 symptoms. Gypsum Fibrosum was highlighted as a key antipyretic component. When absorbed through the intestines after interaction with gastric acid, part of the calcium in gypsum enters the bloodstream and may regulate the temperature centre to relieve fever. Combined with Zhi Mu (Anemarrhena), it enhances calcium ion dissolution and strengthens the antipyretic effect, as in the classical Bai Hu Tang formula.

Research on individual TCM herbs is growing but still limited by Western clinical trial standards. These studies provide emerging evidence and should be considered alongside practitioner expertise.