Japanese Kampo OTC: A Pharmacist's Beginner Guide to Kakkonto, Shoseiryuto, Goreisan & More

"I saw a 'Kampo' shelf at a Japanese drugstore but had no idea what to pick."

"A pharmacist suggested 'Kakkonto' when I felt a cold coming on. What exactly is that?"

"Is kampo the same as traditional Chinese medicine?"

These are some of the most common questions about kampo from international visitors and residents in Japan.

Japanese drugstores carry a dedicated section of kampo — traditional herbal medicines that have been integrated into modern Japanese pharmacy practice. Even a small convenience-store-sized pharmacy will usually have a full shelf of kampo formulas, and several are recommended at the counter for everyday complaints like an early cold, a runny nose, or a hangover.

From a non-Japanese perspective, however, several questions tend to surface immediately: What is kampo, exactly? Is it the same as traditional Chinese medicine (TCM)? Is it safe for international visitors to try? This guide, written by a Japanese pharmacist who regularly fields kampo questions at the counter, walks through seven representative OTC kampo formulas that travelers and residents are most likely to encounter.

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Before we start: this is general information, not medical advice

Product classifications, approved indications, and safety information below are accurate as of May 2026 but can change. Kampo OTC products are regulated medicines in Japan with approved indications — but "natural-origin" does not mean "side-effect free." Always confirm with a Japanese pharmacist or doctor before taking any product, especially if you are pregnant, breastfeeding, taking prescription drugs, or buying multiple kampo formulas at once. Full disclaimer at the end.

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1. Kampo and traditional Chinese medicine — related, but not the same

Kampo (漢方) and traditional Chinese medicine (TCM, 中医学) share a common origin in classical Chinese medical texts. Many of the formulas you'll see in a Japanese drugstore appear, with slight variations, in the Chinese pharmacopoeia. From the outside they can look interchangeable.

In practice, however, kampo developed its own distinct identity in Japan over several centuries, and the two systems differ in how formulas are selected, how patients are assessed, and how the medicines are regulated.

	Kampo (Japan)	TCM (China)
Origin	Introduced from China in the 5th–6th century	Classical Chinese medicine
Subsequent development	Reorganized and codified in Japan from the Edo period onward	Continuous development on the Chinese mainland
Formula focus	Classical formulas from texts such as the Shang Han Lun and Jin Gui Yao Lue	Broader repertoire, including modern adaptations
Diagnostic approach	Emphasis on the patient's overall constitution, or "sho" (証)	Pattern differentiation (bian zheng) is more formally codified
Regulatory status	Prescription kampo is covered by national health insurance; OTC kampo is regulated as licensed medicine	Varies by country

A short note on "sho" — the constitutional view

In kampo, even the same symptom (a cough, say, or diarrhea) can call for different formulas depending on the patient's overall constitution and current state — their sho. A robust, sweat-free person at the very start of a cold might be steered toward Kakkonto, while someone running cold and weak with a thin, watery runny nose might receive Shoseiryuto.

Self-diagnosing your own sho is harder than it sounds, especially from outside the tradition. This guide does not try to teach formal sho assessment. Ask a pharmacist if you are unsure which formula fits you.

A note on the kampo/TCM distinction: while the theoretical frameworks differ, the clinical concepts behind sho and bian zheng overlap significantly in practice, and the two systems should not be viewed as wholly separate. Modern kampo has also been shaped by the introduction of Western medicine, the development of standardized extract preparations (notably by Tsumura), and ongoing pharmacological research.

Is kampo available outside Japan?

In the U.S., U.K., and most other English-speaking countries, kampo formulas are not generally sold as OTC medicines. A handful of formulas may appear under TCM names in Asian-American grocery stores, herbalist shops, or naturopathic clinics, but they are usually marketed as dietary supplements rather than as approved medicines. The Japanese drugstore experience — formulas with approved medicinal indications, sold next to ibuprofen and antihistamines — is hard to replicate abroad.

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2. Kampo OTC essentials: where to find them and how to take them

Reading the shelf: Tsumura and Kracie

Two manufacturers dominate the OTC kampo shelf:

Manufacturer	Position	Numbering
Tsumura & Co.	The largest prescription kampo maker in Japan, with a more limited OTC range	OTC products follow Tsumura's prescription-kampo numbering (Kakkonto = 1, Goreisan = 17, and so on)
Kracie Pharma	A larger OTC kampo lineup, with more tablet and capsule options	Uses its own numbering, but the formula names are identical

Tsumura's OTC kampo broadly follows the same numbering as its prescription line for the formulas it has made available OTC. If a box from Tsumura says "No. 1" or "1番," it is the OTC version of the same Kakkonto formula used in hospitals. Kracie uses different internal numbers, but because the formula names are standardized (Kakkonto is always Kakkonto), you can switch brands as long as you check the formula name.

That said, "same number" or "same formula name" does not mean a completely identical preparation. Extract amounts, excipients, and binders can vary between prescription and OTC versions, and between manufacturers. If that matters for you, ask the pharmacist about the differences.

Granules, tablets, and liquids

Most kampo OTCs come in three formats:

• Extract granules — the modern, freeze-dried version of the traditional decoction. Designed to be dissolved in hot water before drinking. Often described as "closer to the traditional decoction experience," but clear pharmacokinetic differences from tablets have not been established in published evidence. The taste is a barrier for some users.
• Tablets or capsules — easier for travel or for users who dislike the bitter taste.
• Liquids and tonics — common in the jiyo-kyoso ("nourishing and strengthening") category.

When to take kampo

The traditional instruction is 30 minutes before meals or roughly two hours after meals (food-gap, shokukan). The rationale is to avoid interactions with food components and because some kampo constituents are thought to involve intestinal flora in their activation (this applies to specific components rather than kampo as a whole).

If you have a sensitive stomach, taking kampo with food is acceptable; absorption may be slightly reduced but the formula will still work.

Watch for overlap with Western OTC drugs

The single biggest safety issue with kampo OTC is unintended overlap with Western medicines:

• Kakkonto plus a Japanese cold medicine: Kakkonto contains ephedra (mao), which contains pseudoephedrine-type alkaloids. Many Japanese combination cold medicines also contain dl-methylephedrine or pseudoephedrine. Taking both can cause palpitations, raised blood pressure, and difficulty sleeping.
• Two or more kampo formulas together: Many kampo formulas contain licorice (kanzo), which contains glycyrrhizin. Stacking formulas can push the total licorice dose into a range that may trigger pseudoaldosteronism (see Section 4).
• If you take blood-pressure or diuretic medication: Formulas containing licorice or ephedra can interact with these treatments. Talk to a doctor before starting any kampo.

When buying a Japanese cold or pain medicine alongside kampo, ask the pharmacist directly: "Is it safe to take this with [formula name]?" For background on the Japanese pharmacy landscape, see our guide to types of pharmacies in Japan.

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3. Seven representative kampo OTC formulas, by symptom

At-a-glance: formulas by symptom — and whether they contain mao or kanzo

Symptom	Formula	Ephedra (mao)	Licorice (kanzo)	Main precaution
Earliest stage of a cold (chills, stiff neck)	Kakkonto	✓	✓	Do not combine with Japanese combination cold medicines; use with caution if hypertensive
Runny nose, hay fever	Shoseiryuto	✓	✓	Same as above
Dry, lingering cough	Bakumondoto	−	✓	Watch for cumulative licorice exposure
Hangover, edema	Goreisan	−	−	Relatively flexible to combine; stay hydrated
Cold, bloated abdomen	Daikenchuto	−	−	Contains malt sugar — caution if diabetic
Fatigue, summer-heat exhaustion	Hochuekkito	−	✓	Watch licorice exposure with long-term use
PMS, menstrual symptoms	Keishi-bukuryo-gan	−	−	Contraindicated in pregnancy

Each formula is covered in detail below.

① Kakkonto (葛根湯) — for the earliest stage of a cold

When it's used: Chills, stiff neck and shoulders, no sweating yet, at the very first sign of a cold.

Key ingredients: Pueraria root (kakkon), ephedra (mao), cinnamon bark (keihi), peony root (shakuyaku), licorice (kanzo), ginger (shokyo), jujube (taiso).

Approved indications (Tsumura OTC Kampo No.1): Initial stage of common cold without sweating in patients of average or higher physical strength; nasal cold; rhinitis; headache; shoulder stiffness; muscle pain; pain in arms and shoulders.

Practical note: Best taken at the first hint of a cold — chills, neck stiffness, that "uh-oh, here it comes" feeling. Once fever and active sweating have set in, other formulas may be more appropriate.

Cautions: Contains ephedra. Use with caution and check with a doctor if you have high blood pressure, heart disease, diabetes, or thyroid issues. Do not combine with Japanese combination cold medicines.

→ For a wider view of Japanese cold OTCs, see our Japanese cold medicine guide.

② Shoseiryuto (小青竜湯) — for runny nose and hay fever

When it's used: Continuous sneezing, thin and watery nasal discharge, thin sputum with cough. Early-stage hay fever or cold-season allergic rhinitis.

Key ingredients: Ephedra, peony, dried ginger (kankyo), licorice, cinnamon bark, asarum (saishin), schisandra (gomishi), pinellia (hange).

Approved indications: Bronchitis, bronchial asthma, rhinitis, allergic rhinitis, edema, common cold, hay fever — in patients of average or somewhat weaker constitution who have cough or runny nose with thin watery sputum.

Practical note: The main difference from Western antihistamines (cetirizine, fexofenadine, etc.) is that Shoseiryuto is generally considered less likely to cause drowsiness, though individual responses vary and the ephedra content can occasionally produce restlessness or palpitations.

Cautions: Contains both ephedra and licorice — same precautions as Kakkonto apply.

→ For a wider view, see our hay fever medicine guide in Japan.

③ Bakumondoto (麦門冬湯) — for a dry, lingering cough

When it's used: Sputum that doesn't clear easily, a tickly dry cough that keeps coming back, hoarseness, throat dryness.

Key ingredients: Ophiopogon root (bakumondo), pinellia, ginseng (ninjin), licorice, non-glutinous rice (kobei), jujube.

Approved indications: Dry cough, bronchitis, bronchial asthma, pharyngitis, hoarseness — in patients of average or weaker constitution with difficult-to-clear sputum, intermittent severe coughing, or sensation of pharyngeal dryness.

Practical note: A reasonable option for the dry, persistent cough that lingers after a cold or in air-conditioned environments. A loose, productive cough usually calls for a different formula.

Cautions: No ephedra, so safer to combine with Western cold medicines than Kakkonto or Shoseiryuto — but still contains licorice, so watch for cumulative licorice exposure.

④ Goreisan (五苓散) — for hangover, edema, and water-related symptoms

When it's used: Hangover headache, mild edema, dizziness, watery diarrhea, heatstroke-related malaise.

Key ingredients: Alisma (takusha), polyporus (chorei), poria (bukuryo), atractylodes (byakujutsu), cinnamon bark.

Approved indications: Watery diarrhea, acute gastroenteritis, heatstroke, headache, edema, hangover — applicable across constitutional types when accompanied by thirst with reduced urinary output, dizziness, nausea, vomiting, abdominal pain, headache, or edema.

Practical note: Goreisan is one of the few kampo formulas with "hangover" explicitly listed in its approved labeling. Because it contains neither ephedra nor licorice, it is generally more flexible to combine with other medicines — but stay alert for dehydration, since the formula's mechanism involves regulating water distribution.

→ See our hangover, motion sickness, and jet lag OTC guide for a fuller treatment.

⑤ Daikenchuto (大建中湯) — for a cold, distended abdomen

When it's used: Cold, painful abdomen with bloating; abdominal discomfort in people with lower physical reserves.

Key ingredients: Japanese pepper (sansho), ginseng, dried ginger, malt sugar (koi).

Approved indications: Cold-type abdominal pain with bloating in patients of weaker constitution.

Practical note: Daikenchuto is one of the more clinically studied kampo formulas, with a relatively strong contemporary evidence base by kampo standards. As an OTC, it is a reasonable choice for a cold, bloated abdomen — for instance, abdominal discomfort after sitting too long in an air-conditioned room in summer.

Cautions: Contains malt sugar, so users with diabetes should consult their doctor.

→ See our Japanese stomach medicine guide.

⑥ Hochuekkito (補中益気湯) — for fatigue and summer-heat exhaustion

When it's used: Persistent fatigue, low appetite, summer-heat exhaustion, recovery after illness.

Key ingredients: Ginseng, atractylodes, astragalus (ogi), Japanese angelica (toki), citrus peel (chinpi), jujube, bupleurum (saiko), licorice, ginger, cimicifuga (shoma).

Approved indications: Frail constitution, fatigue and lassitude, post-illness or postoperative weakness, loss of appetite, night sweats, common cold — in patients of weaker constitution with low energy and reduced gastrointestinal function.

Practical note: A classic "tonifying the qi" formula. Not a fast-acting medicine — expect to evaluate effects over several weeks of continued use rather than the same day.

Cautions: Contains licorice — watch for cumulative exposure if taking other licorice-containing formulas.

⑦ Keishi-bukuryo-gan (桂枝茯苓丸) — for menstrual and circulation-related symptoms

When it's used: Menstrual pain, irregular menstruation, premenstrual syndrome (PMS), menopausal symptoms, lower abdominal pain, accompanying shoulder stiffness or hot flushes with cold feet.

Key ingredients: Cinnamon bark, poria, moutan bark (botanpi), peach kernel (tonin), peony.

Approved indications: Irregular menstruation, menstrual abnormalities, menstrual pain, menopausal symptoms, "blood-related disorders" (chi-no-michi-sho), shoulder stiffness, dizziness, heavy-headedness, bruises, chilblains, dark skin spots, eczema/dermatitis, acne — in patients with relatively robust physical strength who experience lower abdominal pain, shoulder stiffness, heavy-headedness, dizziness, or hot flushes with cold feet.

Practical note: A leading kampo formula for "oketsu" (stagnant blood circulation) patterns. The approved indications list includes skin-related conditions (eczema/dermatitis, acne, dark skin spots), but some OTC products omit these skin-related indications from the package labeling — always check the box.

Cautions: Do not use during pregnancy or if pregnancy is possible. Severe menstrual symptoms should prompt a gynecology consultation rather than long-term self-medication.

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4. Important safety considerations

Licorice and pseudoaldosteronism — the biggest concern when stacking formulas

The most clinically important kampo side effect is pseudoaldosteronism caused by licorice (glycyrrhizin).

Mechanism: Glycyrrhizin disrupts mineral balance, which can lead to fluid retention, raised blood pressure, and low blood potassium. Severe cases can progress to muscle weakness and, rarely, cardiac arrhythmia.

Dose thresholds (general reference): Japanese regulatory warnings cite glycyrrhizin intake of ≥40 mg/day, or licorice intake of ≥2.5 g/day, as thresholds where pseudoaldosteronism risk increases with continued use. These thresholds can be exceeded surprisingly easily when stacking multiple licorice-containing formulas.

When the risk goes up:

• Combining multiple kampo formulas that both contain licorice (e.g., Kakkonto plus Bakumondoto)
• Long continuous use
• Older adults and people with lower body weight
• Concurrent use of thiazide or loop diuretics (potassium-wasting interaction)

Warning signs: Swelling in hands or feet, sudden weight gain, fatigue, limb weakness, palpitations or irregular heartbeat.

If you are taking — or might combine — several kampo formulas, or if you are on antihypertensive or diuretic medication, confirm the licorice exposure with a pharmacist before continuing.

Pregnancy and breastfeeding

Do not self-medicate with kampo during pregnancy or breastfeeding. Several formulas are explicitly contraindicated:

• Keishi-bukuryo-gan is contraindicated in pregnancy
• Formulas containing rhubarb (daio), such as Bofu-tsusho-san, are contraindicated in pregnancy
• Ephedra-containing formulas (Kakkonto, Shoseiryuto, etc.) are not generally recommended without medical advice

→ For background, see our guide to OTC medicines during pregnancy and breastfeeding in Japan.

Children

Most kampo OTCs have age-specific dosing or age restrictions, and the rules vary by product. Always check the package age table and confirm with a pharmacist.

→ See our children's OTC guide in Japan.

When to stop self-medicating and see a doctor

A reasonable trial period depends on what you're treating:

• Acute symptoms (cold, hay fever, hangover, etc.): review at around 5 days — see a doctor if there is no improvement
• Chronic symptoms (fatigue, menstrual issues, etc.): a trial of several weeks to a month is reasonable before re-evaluating

In any case, see a doctor immediately — without waiting for the trial period — if any of the following appear:

• Fever above 38 °C lasting three days or longer
• Severe abdominal pain, bloody stools, or persistent vomiting
• Menstrual pain severe enough to interfere with daily life
• New shortness of breath, palpitations, or sudden swelling

→ See our guide to seeing a doctor in Japan.

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5. Summary — kampo as a complement, not a shortcut

Kampo OTCs are a distinctive feature of Japanese drugstores, with formulas backed by approved indications that can be a useful self-care option for travelers and residents. They are not, however, the "natural and therefore safe" category many international shoppers assume.

A quick reference:

• Kakkonto, Shoseiryuto — early cold and hay fever
• Bakumondoto — dry, persistent cough
• Goreisan — hangover and edema
• Daikenchuto — cold, bloated abdomen
• Hochuekkito — fatigue and summer-heat exhaustion
• Keishi-bukuryo-gan — menstrual and PMS-related symptoms

Within the indications on the package, these formulas can be a reasonable option to try. Outside of those indications, or when combined with Western OTC drugs or other kampo formulas, the safety margin shrinks quickly — especially because of ephedra, licorice, and rhubarb-related risks.

When in doubt, the simplest move is to ask a pharmacist: at the drugstore counter, the formula's name on the box is enough information for them to advise you. The pharmacist–technician distinction matters here: kampo combination questions are best directed to a licensed pharmacist (yakuzaishi), not a registered seller (toroku-hanbaisha). See our guide to types of pharmacies in Japan for more on the distinction.

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Sources

• Tsumura & Co. — Medical Professional Information and General Kampo Preparations (official product information)
• Kracie Pharma — General Kampo Preparations product information
• Pharmaceuticals and Medical Devices Agency (PMDA) — Package Insert Database for OTC Medicines
• Japan Society for Oriental Medicine — Background materials on kampo
• Ministry of Health, Labour and Welfare (MHLW) — Pharmaceuticals and Medical Devices Safety Information (licorice / pseudoaldosteronism series)

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Disclaimer

This article is provided for general informational purposes based on information available as of May 2026. It does not constitute medical advice tailored to your specific constitution, medical history, or concurrent medications.

The effects and safety of kampo OTC products vary between individuals, and "natural-origin" does not mean "free of side effects." For any combination of multiple kampo formulas, combination with Western medicines, or long-term use, please consult a licensed pharmacist or physician.

If you are pregnant, breastfeeding, have an underlying medical condition, or are buying a kampo OTC for a child, do not rely on this article alone — please seek advice from a qualified medical professional.

If you experience new symptoms during use — swelling, blood pressure changes, fatigue, rash, or any other unusual change — stop taking the medicine and see a doctor.