What is Goshakusan?

What is Goshakusan, and why is it restricted?

Goshakusan is a Japanese Kampo formula that contains Ephedra herb (mao). Mao holds ephedrine-type alkaloids. These act on the body much like adrenaline.

That is the core hazard. Ephedrine alkaloids have been linked to high blood pressure, fast or odd heartbeats, stroke, and trouble passing urine.

The formula blends 17 to 18 herbs. One more matters here: licorice (Glycyrrhiza). Licorice can lower potassium, a mineral your heart needs, which makes rhythm problems worse.

In Japan, Goshakusan is a prescription Kampo product (Tsumura 63). A doctor or pharmacist decides if it is suitable and dispenses it. In the United States, ephedrine alkaloids are banned from dietary supplements.

Evidence verdict: the formula has a long place in practice, but good human trials are missing. Long use in a tradition is not proof that a remedy works or that it is safe. That point is made once here and not repeated below.

How does Goshakusan work?

How does Goshakusan act in the body?

The main driver of harm is ephedrine and pseudoephedrine from mao. These are sympathomimetic drugs, meaning they mimic adrenaline.

They raise heart rate and blood pressure in people. That effect is well established in humans, not just in lab work. They can also tighten the bladder outlet, so passing urine gets harder.

In traditional terms, the formula was said to warm the body and move "cold" and "damp" blockage. That is the language of a practice model. It is not a test of biology.

Licorice adds a second, separate problem. Its glycyrrhizin makes the body hold salt and water and lose potassium. Doctors call this pseudoaldosteronism (a false aldosterone effect), and it is well documented in people.

Now put the two together. A sped-up heart plus low potassium is a known recipe for a dangerous heart rhythm. This is why the combination worries clinicians.

Cinnamon and the remaining herbs have mostly been studied in cell and animal work. In test tubes, some show mild effects on inflammation and on blood vessels. Whether any of that happens in a person taking this formula is not established.

What forms does Goshakusan come in?

What forms does Goshakusan come in?

In Japan it is sold as a licensed prescription Kampo medicine. The usual form is a dried granule or fine powder in single sachets. Some makers also supply tablets.

The best known product is Tsumura 63. A doctor prescribes it and a pharmacist dispenses it.

Raw herb versions exist in some clinics. This page gives no method for handling, cooking or measuring any form, and no place to buy one.

Imported or online products are a special worry. Labels may not match the contents. Ephedra-containing goods are blocked or restricted in many countries, so grey-market stock is common and unchecked.

Where it comes from:

Where does Goshakusan come from?

The formula began in China as Wu Ji San, or Five Accumulations Powder. It appears in a Song dynasty official formulary from around the 1100s.

Practitioners of that era used it for what they called cold and damp blocking the body. Reported targets were chills, aches, cramping belly pain and stalled digestion.

Japanese Kampo doctors took up the formula and kept it in use. In the modern era it was standardised and approved as a prescription medicine in Japan.

That history shows the formula is a genuine, core part of the tradition. It does not show that the formula is safe for you to take on your own.

What does Goshakusan help with?

• Low back and hip pain linked to cold: Kampo doctors used it for aching that felt worse in cold, damp weather. Human trial data for this use is thin. No good controlled study shows the formula beats standard care.
• Period pain with cold hands and feet: Tradition matched the formula to women who felt cold and had cramping pain. Modern support is limited to case notes and small reports. There is no reliable trial evidence of benefit.
• Cramping belly pain with poor appetite: The blend was chosen for a "cold stomach" picture with bloating and low appetite. Evidence is traditional, not trial-based. Belly pain also has many causes that need a proper check.
• Cold-weather joint and muscle pain: Older texts describe use for stiff, achy limbs in winter. Lab work on some of the single herbs suggests mild anti-inflammatory action. Whether that helps joints in people taking this formula is not known.

Which foods are rich in Goshakusan?

Goshakusan is a medicine, not a food. No food contains it. Note that licorice sweets and licorice teas add to the low-potassium risk from this formula, so tell your prescriber if you eat or drink them.

What are the side effects of Goshakusan?

• High blood pressure, sometimes a sharp rise
• Fast, pounding or irregular heartbeat
• Chest pain
• Stroke or bleeding in the brain, reported with ephedrine alkaloids
• Seizures (fits)
• Trouble starting or passing urine, more likely with an enlarged prostate
• Restlessness, anxiety, shaking and trouble sleeping
• Headache, sweating and nausea
• Low potassium from licorice, causing muscle weakness, cramps or tiredness
• Swelling in the legs and face from salt and water retention
• Raised blood sugar
• Allergic rash or, rarely, breathing trouble

Good to know:

How serious is this, and how fast?

Some effects come on within hours. A racing heart, a jump in blood pressure, or a bad headache can start the same day.

Other effects build quietly over weeks. Low potassium from licorice is the classic slow one, and it can end in muscle weakness or a dangerous heart rhythm.

Serious harm is not just theoretical. Strokes, heart attacks, seizures and deaths have been reported with ephedrine-alkaloid products. Treat any chest pain, fainting or one-sided weakness as an emergency.

How much Goshakusan should you take?

• Recommended daily: Why does this page give no dose? We give no dose, no amount and no way to prepare this formula. That is on purpose. Goshakusan contains ephedrine-type alkaloids and licorice. The gap between a working amount and a harmful one can be narrow. It also shifts with your heart, blood pressure, thyroid, prostate and other medicines. In Japan this is a prescription medicine. A doctor or pharmacist judges whether it fits you, and checks you while you take it. That judgement cannot be made by a web page. If a clinician has prescribed it, follow their instructions and no one else's.
• Best time of day: Not applicable. This page gives no timing guidance for a restricted, doctor-prescribed medicine.
• With or without food: Not applicable. Any instruction of this kind is part of a prescription and comes from the prescriber.
• Time to effect: Not applicable. We do not describe an expected effect or a time to it, because that would read as a green light to self-treat.
• How long to take it: Not applicable. Only a prescribing clinician can set how long treatment runs, and they do so while checking your blood pressure and potassium.