What is Choreito?

Choreito is a herbal mix used in Kampo, the herb system of Japan. It has five parts. Two are mushrooms, one is a marsh plant root, one is a soft mineral called talc, and one is gelatin made from hide.

People take it for burning or painful urination. It is also used when urine is dark, scant, or has a trace of blood in it.

Choreito sits on Japan's list of 148 Kampo formulas that the national health plan will pay for. A doctor there can write it on a script. In other countries you can buy it as a powder or in tablets.

Long use in a tradition is not proof that a remedy works. The human trial base for Choreito is thin. Most of what we know comes from small Japanese reports and from lab work.

How does Choreito work?

No one has shown how Choreito works in the body. What follows is the idea behind the mix, not proven fact.

Three of the five parts act as mild water pills, which means they make you pass more urine. The hope is that more urine flushes the bladder and eases the sting.

Gelatin is said to soothe raw tissue and to slow light bleeding. Talc was used in old texts to cool heat in the lower body. In Kampo terms, the mix treats heat and damp held in the bladder.

Some lab work hints that parts of the mix may calm swelling. That work was done in cells and in mice, not in people.

What forms does Choreito come in?

Granules are the main form. They come in a sachet of powder that you tip into warm water and drink. This is what most Japanese doctors hand out.

You can also find tablets and capsules. Some clinics still boil the raw parts into a tea, which is the old way.

Granule strength differs by brand, so check the label each time you switch.

Where it comes from:

Choreito first appears in the Shanghan Lun, a Chinese medical text from about 200 CE. Its Chinese name is Zhu Ling Tang.

Japanese doctors took up the formula long ago and kept it under the name Choreito. It is now a set item in Kampo practice and one of the 148 formulas Japan's health ministry has approved for insurance cover.

What does Choreito help with?

• Burning or painful urination: This is the main use in Kampo. Doctors in Japan reach for Choreito when passing urine stings and the urine is scant. Good trials in people are lacking. If the burning comes from a bladder infection, you still need germ-killing drugs (antibiotics). Herbs do not replace them.
• Passing urine often, with little coming out: Tradition puts this at the heart of the formula. The mix is said to shift stuck fluid so the bladder empties better. We found no solid human trial for this use. Frequent urination can also come from diabetes or a prostate problem, so get a check first.
• A trace of blood in the urine: Old texts use Choreito when urine is pink or faintly red. The gelatin part was thought to slow light bleeding. This claim has not been tested well in people. Blood in urine can be a sign of something serious. See a doctor before you treat it yourself.
• Pain from small stones in the urinary tract: Japanese clinics sometimes add Choreito while a small stone passes. The thinking is that more urine helps move it along. The evidence is weak and mostly comes from small reports. Stone pain is often severe and needs proper care.
• Bladder pain after radiation therapy: Some Japanese cancer clinics use Choreito for a sore, bleeding bladder after radiation. This use is reported in case notes, not in large trials. Never start it during cancer care without telling your cancer team first.
• Thirst with scant, dark urine: In Kampo, thirst plus low urine output is the classic sign that points to this formula. It is a pattern, not a modern diagnosis. There is no trial evidence for it. Strong thirst with little urine can mean you are dry inside or have a blood sugar problem, so get it checked.

Which foods are rich in Choreito?

1. Poria (bukuryo): this mushroom is cooked into soups and steamed cakes in China and Japan
2. Gelatin: the same protein is found in jelly, gummy sweets and stock made from bones

Practical Tips:

Choreito itself is a made-up medicine mix, not a food, so you cannot get it from your diet.

What are the side effects of Choreito?

• Nausea or an upset stomach
• Loose stools
• Loss of appetite
• Skin rash or itching
• Allergic reaction to the gelatin part, which can be severe
• Rare reports of liver injury with Kampo formulas in general

Good to know:

Most people who take Choreito have no trouble with it, and stomach upset is the most common complaint. It usually settles when you stop.

Serious problems are rare, but they do happen. Stop the herb and get medical help if you get a spreading rash, swelling of the face or mouth, yellow skin or eyes, or dark urine that starts after you begin taking it.

How much Choreito should you take?

• Recommended daily: In Japan the usual adult dose of the granule form is 7.5 g a day, split into two or three doses. Some brands use 6 g a day. Follow the label on your pack, or your doctor's word. No dose has been set by trials outside Japan. Doses for children are set by a doctor, by weight.
• Best time of day: Spread the doses through the day, such as morning, noon and evening. Take the last dose a few hours before bed so you are not up all night passing urine.
• With or without food: Kampo practice is to take it on an empty stomach, about 30 minutes before a meal or between meals. If it upsets your stomach, take it with food instead. Drink plenty of water with it.
• Time to effect: Japanese sources say relief often starts within a few days. This has not been tested well in trials, so treat it as a rough guide.
• How long to take it: Kampo practice expects some change within two to five days. If your urinary symptoms have not eased in three days, see a doctor rather than taking more. Do not take it for more than two weeks on your own. Longer use should be checked by a doctor who knows Kampo.