Immature Bitter Orange Fruit Classic Formulas … Natural Herb Library

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Breaks up stagnant qi and reduces accumulation - Zhi Shi is a strong descending citrus used when fullness, focal distention, food retention, or hard obstructive digestive stagnation is pronounced.
Transforms phlegm and disperses focal obstruction - it is classically used for chest bind, phlegm-qi congestion, and pressure or pain under the diaphragm and in the chest.
Directs qi downward and assists bowel opening - formulas use it when constipation, post-meal fullness, or even organ prolapse reflect impaired descent with excess stagnation.

Zhi Zhu Wan - classic pairing with Bai Zhu for focal distention, reduced appetite, and middle-burner blockage.
Zhi Shi Xiao Pi Wan - later formula tradition for pi fullness and severe epigastric obstruction with weak digestive transformation.
Zhi Shi Xie Bai Gui Zhi Tang or Hou Pu San Wu Tang - chest-obstruction and abdominal-fullness formula contexts where Zhi Shi's strongly descending action is central.

Official Chinese references describe Zhi Shi as bitter, pungent, sour, and slightly cold, entering the Spleen and Stomach to break qi, eliminate accumulation, transform phlegm, and dissipate focal distention.
Traditional materia medica consistently contrasts it with mature Zhi Qiao, emphasizing that Zhi Shi is harsher, more forceful, and more strongly descending.
Its classical indications include food stagnation, constipation, chest bind, and prolapse formulas where excess obstruction is prominent.