What is Makyokansekito?

Makyokansekito is a prescription Kampo formula sold in Japan as Tsumura 55. It is restricted because it contains Mao (Ephedra), the plant source of ephedrine. Ephedrine can cause a racing or irregular heartbeat, a sudden spike in blood pressure, and stroke.

Two other ingredients add their own danger. Kyonin (apricot kernel) contains amygdalin, which the body can turn into cyanide. Kanzo (licorice) can push your potassium level down, and low potassium makes heart rhythm problems worse.

The four named parts are Mao (Ephedra), Kyonin (apricot kernel), Kanzo (licorice) and Sekko (gypsum). In Japan a doctor prescribes it and a pharmacist dispenses it. It is not something to self-treat with, and it is not something to buy online.

The formula has been used for centuries for wheezing and cough. That long history is not proof that it works, and it is not proof that it is safe. This page gives no dose, no amount and no method of any kind.

How does Makyokansekito work?

The airway effect comes mostly from ephedrine in Ephedra. Ephedrine opens the airways and shrinks swollen linings in the nose and chest. That drug action is well established in people.

The same action drives the harm. Ephedrine speeds the heart and tightens blood vessels. In people this can raise blood pressure sharply and set off an abnormal heart rhythm.

Amygdalin in apricot kernel is broken down in the gut into hydrogen cyanide. This chemistry is well documented, and human poisonings from apricot kernels have been reported. Cyanide blocks the way cells use oxygen.

Glycyrrhizin in licorice causes pseudoaldosteronism. That is a hormone-like effect in which the body holds on to salt and loses potassium. It is a known effect in people who take licorice-containing products.

Low potassium and a stimulant in the same formula is a bad pairing. Each one alone can disturb heart rhythm. Together the risk is higher.

Sekko (gypsum) is mineral calcium sulfate. Tradition treated it as a cooling ingredient. There is little human data on what it adds here.

What forms does Makyokansekito come in?

In Japan it is supplied as a ministry-approved extract granule or powder, dispensed by a pharmacy against a prescription. Some clinics also use raw herb mixes prepared by a pharmacist.

You may also see look-alike products sold online as "herbal asthma" or "energy" blends. These are not the regulated Japanese product. Their strength is unknown and they have been linked to serious harm.

This page does not describe how any form is made, handled or taken. That is deliberate. The whole point of the prescription rule is that a trained person decides, checks and monitors.

If a product you own lists ephedra, ma huang, mao, apricot kernel or licorice, treat it as a medicine and ask a pharmacist about it. Do not experiment with it.

Where it comes from:

Makyokansekito is the Japanese Kampo name for Ma Xing Gan Shi Tang. The formula is recorded in the Shang Han Lun, a Chinese medical text from around the third century.

Classical practice used it for noisy, laboured breathing with fever and a cough. Practitioners of the day framed the pattern as "heat" trapped in the lung. Ephedra was chosen to open the breath and gypsum to cool.

Kampo doctors in Japan carried the formula forward, and it was later given a ministry approval number. That approval set the rules for who may hand it out. It did not make the formula safe for anyone to take on their own.

It has long been given to children with wheezing in Japanese practice. That history is often quoted online as reassurance. It is not reassurance, because the prescribing doctor is the part that is missing when you self-treat.

What does Makyokansekito help with?

• Wheezing and asthma-type breathing trouble: This is the classic use, and it is why the formula still holds a place in Kampo practice. Ephedrine does open airways in people, so an effect is plausible. The human evidence for the whole formula is thin. Most reports are small or come from routine Japanese practice rather than controlled trials. Modern asthma care uses inhaled drugs that reach the lung directly. They are better studied and far easier to dose safely.
• Cough with thick phlegm and a feeling of heat: Tradition matched this formula to a hot, noisy cough rather than a dry or cold one. Practitioners judged that pattern by examining the person. There is no good trial evidence that it settles cough better than other options. Cough from a virus usually eases on its own.
• Bronchitis: Kampo doctors have used it for short-term chest infections with wheeze. Evidence in people is limited and not strong enough to guide self-use. A chest infection that brings fever, breathlessness or a cough lasting weeks needs a medical check, not a herbal one.
• Blocked or stuffy nose: Ephedrine and pseudoephedrine shrink swollen nasal lining, and that effect is real in people. It is the same reason pseudoephedrine sits behind the pharmacy counter. Using a whole stimulant herbal formula for a stuffy nose is a poor trade. The heart and blood pressure risk is the same, and safer nasal options exist.

Which foods are rich in Makyokansekito?

This is a prescription medicine, not a food. It has no place in a diet plan.

What are the side effects of Makyokansekito?

• Fast, pounding or irregular heartbeat
• Sharp rise in blood pressure
• Stroke or heart attack, in the worst cases
• Chest pain
• Anxiety, restlessness, tremor and trouble sleeping
• Headache and dizziness
• Low potassium, which brings muscle weakness and cramps
• Swelling in the legs or face from fluid held in the body
• Trouble passing urine
• Sweating, nausea and loss of appetite
• Cyanide poisoning from the apricot kernel part, which is a medical emergency
• Rash or allergic reaction

Good to know:

The serious harms here are fast, not slow. A heart rhythm problem or a blood pressure spike can happen within hours of a first dose.

The licorice harm works the other way. Potassium can fall quietly over weeks, with tiredness and weak muscles as the first hint.

A fast heart and low potassium together are more dangerous than either alone. That is the core reason this formula is kept behind a prescription.

How much Makyokansekito should you take?

• Recommended daily: This page gives no dose, and that is on purpose. The formula is a prescription medicine in Japan because the safe amount depends on your heart, your blood pressure, your thyroid, your kidneys, your age and every drug you take. Ephedrine has a narrow margin. An amount that helps one person can push another into a dangerous heart rhythm. Licorice harm builds up slowly, so a "fine so far" week tells you nothing. Only the doctor who prescribes it and the pharmacist who dispenses it can set an amount. Any number you find on a forum or a sales page is not a safe number.
• Best time of day: Not applicable. Timing is part of prescribing, and this page does not prescribe.
• With or without food: Not applicable. Any instruction on how to take it comes from the pharmacist who dispenses it, not from this page.
• Time to effect: Not applicable. We do not describe what to expect, because that invites people to test it on themselves.
• How long to take it: Not applicable. This page gives no length of use, because it gives no use at all outside a prescription. A prescriber decides how long, and watches potassium and blood pressure while you take it.