What is Keishikakakkonto?

Keishikakakkonto is a traditional Japanese Kampo herbal formula used at the very start of a common cold, when you feel chilled, your neck and shoulders feel stiff, and you sweat easily. Its name translates as Cinnamon Twig plus Pueraria Decoction. It is also given for plain stiffness in the nape of the neck.

In Kampo this whole formula counts as a single drug (Kampo). You take it as one fixed prescription made of six herbs together, not as separate supplements you combine yourself.

The herbs are cinnamon twig (keishi), kudzu root (kakkon), peony root (shakuyaku), licorice root (kanzo), fresh ginger (shokyo) and jujube date (taiso). It is essentially the classic formula Keishito with kudzu root added to reach the stiff neck.

Being used for centuries is not the same as being proven to work. Human trial evidence for this particular formula is very thin, and traditional standing and tested effect are two different things. We report both separately on this page, and we do not repeat that point in every section below.

How does Keishikakakkonto work?

Kampo explains this formula in its own terms, not in modern ones. The pattern it targets is an early "exterior" chill in a person whose surface is loose, so they sweat and feel cold, with tight muscles at the back of the neck.

Cinnamon twig and ginger are described as warming and pushing outward. Kudzu root is described as relaxing the tight nape and back. Peony, licorice and jujube are described as easing muscle tension and softening the effect of the warming herbs.

Modern studies of the single herbs suggest anti-inflammatory and muscle-relaxing actions in laboratory models. That is not proof that the finished decoction does the same thing in your body. No accepted modern mechanism for the whole formula has been established.

What forms does Keishikakakkonto come in?

In Japan it is most often a dry extract granule or fine powder in single-dose sachets, sold under prescription or over the counter. Tablets and capsules of the same extract also exist.

A traditional water decoction is also possible. You simmer the raw sliced herbs and drink the strained liquid warm, usually in two or three portions across the day.

Outside Japan you may find it as "Gui Zhi Jia Ge Gen Tang" granules from Chinese or Taiwanese makers. Content and strength vary between brands, so the dose on your own package is the one to follow.

Where it comes from:

The formula comes from the Shang Han Lun, a Chinese medical text compiled around the third century, in the chapter on early-stage cold patterns. It travelled to Japan and was absorbed into Kampo, the Japanese branch of that tradition.

It is a recognised, insurance-listed Kampo prescription in Japan today, though a minor one compared with its better-known relative Kakkonto. Doctors there pick between the two by how much the person sweats: Keishikakakkonto for those who sweat, Kakkonto for those who do not.

Unlike Kakkonto, this formula contains no ephedra (mao), the stimulant herb.

What does Keishikakakkonto help with?

• Early common cold with chills and a stiff neck, in people who sweat easily: This is the classic reason Kampo practitioners choose it, and the use goes back to the original third-century text. The target person feels cold, aches, sweats even with a mild fever, and has a tight nape. There are no published human trials of this formula for colds that we could find. Its close relative Kakkonto has been studied in small Japanese trials, but that is a different formula with ephedra in it, so those results do not transfer.
• Stiffness in the nape of the neck and shoulders: In Japan this is the second common reason it is prescribed, including outside of colds. Kudzu root plus peony is the pairing traditionally aimed at tight neck muscles. Evidence here is traditional use and practitioner report only. No controlled human trial supports it for neck or shoulder stiffness, and a persistent stiff neck can have causes that need a proper examination.
• Headache that comes from a tight neck: Traditional use only, and secondary to the neck stiffness rather than a separate indication. The idea is that easing the tight nape eases the head pain that follows it. No human trial has tested this. A new, severe or sudden headache is a reason to get checked rather than to self-treat.
• Mild fever with body aches at the start of a cold: Traditionally used only in the first day or two, and only in the sweating, chilled pattern described above. Kampo does not use it for a settled high fever or a cold that has moved to the chest. Untested in trials. If a fever is high, lasts more than three days, or comes with breathlessness, that needs a doctor, not a herbal formula.

Which foods are rich in Keishikakakkonto?

1. Cassia cinnamon: the same plant family as the cinnamon twig in the formula, though the twig and the bark are different parts
2. Kudzu starch (kuzu): made from the same root as kakkon, used in Japanese cooking as a thickener
3. Licorice sweets and licorice tea: the same source as kanzo, and the main reason to avoid doubling up
4. Fresh ginger: the same herb as shokyo
5. Jujube dates: the same fruit as taiso

Practical Tips:

Eating these foods is not the same as taking the formula, but heavy licorice sweet or tea habits do add to the same risk.

What are the side effects of Keishikakakkonto?

• Nausea, loss of appetite or stomach discomfort
• Rash, itching or redness of the skin
• Swelling in the face, hands, ankles or legs
• Rapid weight gain from holding water
• Rising blood pressure
• Low potassium in the blood, which can cause tiredness and cramps
• Muscle weakness, aching or cramping, sometimes with dark urine
• Irregular or pounding heartbeat
• Rarely, liver irritation with yellow skin or eyes, dark urine and deep tiredness

Good to know:

Most people who take this for a few days have no trouble at all, and mild stomach upset is the commonest complaint.

The effects worth knowing about come from the licorice root in it. Taken for weeks, or taken alongside other licorice-containing products, it can cause pseudoaldosteronism (a state where your body holds salt and water and loses potassium). That shows up as swelling, weight gain, higher blood pressure, weakness or cramps.

Rarely, low potassium leads to serious muscle breakdown or heart-rhythm problems. These are uncommon but they are real, and they are the reason this page is rated caution rather than routine.

How much Keishikakakkonto should you take?

• Recommended daily: Follow the dose printed on your own package, because brands differ in strength. Japanese extract granules are commonly 6.0 to 7.5 g of extract per day, split into two or three doses. A traditional decoction is usually made from one day's portion of raw herbs, simmered in water and drunk warm across two or three servings. There is no independently established dose. Doses for children should be set by a doctor or pharmacist, not scaled down by guesswork.
• Best time of day: Spread the daily amount over two or three doses, morning, midday and evening. For a cold, traditional practice is to take the first dose as early as possible, then rest and keep warm.
• With or without food: Kampo granules are traditionally taken before meals or between meals, with warm water. If it upsets your stomach, taking it with a little food is acceptable and is unlikely to matter much.
• Time to effect: For cold symptoms, traditional use expects a change within several hours to a day or two. For muscle stiffness, people who notice anything usually notice it within a week or two. Neither timeline has been confirmed in trials.
• How long to take it: For a cold, this is a short-term formula. Kampo practice uses it for the first few days only, and if you are no better in three to five days you stop and get advice. For ongoing neck stiffness, some people take it for a few weeks under supervision. Because it contains licorice root, longer use raises the risk of low potassium and raised blood pressure, so blood pressure and a potassium blood test should be checked if you continue past about a month.