Nichinto
Quick Facts
- What it is: A nine-hundred-year-old Kampo herbal preparation of five herbs, taken for a phlegmy cough, nausea and a heavy stomach.
- Main uses: Wet cough with phlegm, Nausea and vomiting, Indigestion and stomach fullness
- Best for: Short-term phlegmy cough, Queasiness with a full, heavy stomach
- Active ingredients: Glycyrrhizin (from licorice), Hesperidin (from citrus peel), Gingerols (from ginger), Pinellia alkaloids, Pachymic acid (from poria)
- Forms: Granulated extract (ekisu), Tablets, Powder, Traditional decoction
- Time to effect: Hours to two days for nausea; up to two weeks for cough.
- Side effects: Usually mild stomach upset; the licorice can raise blood pressure and lower potassium.
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What is Nichinto?
Nichinto is a traditional Japanese Kampo herbal preparation taken for a wet, phlegmy cough and for nausea, queasiness and a heavy, full feeling in the stomach. Its name means "two aged decoction", after two ingredients that were traditionally aged before use.
It is catalogued here as one single Kampo entry, because it is sold as one named preparation. It is not one plant. It combines five herbs: hange (processed pinellia root), chinpi (aged citrus peel), bukuryo (poria fungus), kanzo (licorice root) and shokyo (ginger).
The evidence verdict in one line: Nichinto has centuries of standing in East Asian medicine, but almost no modern human trials test the formula itself, and long traditional use is not proof that a remedy works.
One point matters more than any other for safety. Nichinto contains licorice, which in regular or high doses can raise blood pressure, cause swelling and push your potassium too low.
How does Nichinto work?
Kampo practice explains Nichinto in its own terms, not in modern biological ones. In that system it is said to move and dry "damp phlegm" that has settled in the stomach and chest, and to settle stomach energy that is rising the wrong way.
In modern terms, several plausible ideas have been studied in the laboratory rather than in people. Ginger and citrus peel are thought to speed stomach emptying and calm nausea signals. Pinellia has shown anti-nausea and cough-quieting effects in animal work.
Licorice is the best-understood part, and it is understood mainly through its harms. Glycyrrhizin, its main compound, can act like the hormone aldosterone in your body, holding on to salt and water and flushing out potassium.
None of this has been confirmed as the way Nichinto works in a person. Treat these as reasonable ideas that are still unproven.
What forms does Nichinto come in?
Granulated dried extract (ekisu) is the usual modern form in Japan. It comes in single-dose sachets, is prescribed by doctors and is covered by Japanese national health insurance.
Tablets and fine powders of the same extract are sold over the counter in Japan and by Kampo suppliers elsewhere.
The classical form is a decoction: the raw sliced herbs simmered in water and strained. This is now uncommon outside specialist practice.
Home-blended loose herbs are not recommended. Getting the licorice and pinellia amounts right matters, and raw unprocessed pinellia is harmful.
Where it comes from:
Nichinto is the Japanese reading of Er Chen Tang, a formula recorded in the Chinese Song dynasty imperial formulary Taiping Huimin Heji Jufang, around 1107 CE.
It passed into Japanese Kampo practice and into Korean medicine, and has stayed in continuous use in all three for roughly nine hundred years. It is one of the base formulas that many later phlegm formulas were built from.
Today it is an officially approved Kampo prescription in Japan with a standardised extract, which is unusual standing for a herbal preparation.
Who should avoid Nichinto?
- Do not use if you have hypokalaemia (too little potassium in your blood).
- Do not use if you have aldosteronism (a hormone disorder that raises blood pressure and lowers potassium).
- Do not use if you have myopathy (a muscle disease causing weakness), including any past episode of rhabdomyolysis (serious muscle breakdown).
- Do not use if you are pregnant or trying to become pregnant, unless a doctor trained in Kampo has told you to, because pinellia (hange) is not established as safe in pregnancy.
- Do not use if you are breastfeeding without asking your doctor first.
- Do not use if you are already taking another product containing licorice, kanzo or glycyrrhizin, including other Kampo formulas, licorice sweets or licorice tea.
- Do not use if you take digoxin (a heart drug) or a diuretic (water tablet) unless your doctor is checking your blood potassium.
- Do not use if you have heart failure, uncontrolled high blood pressure, or kidney or liver disease, without a doctor's approval.
- Never take raw, unprocessed pinellia root; only the prepared form used in the finished formula is safe to swallow.
- Do not give it to a child without a doctor's advice and a reduced dose.
When should you see a doctor?
Stop taking it and see a doctor promptly if your ankles, hands or face start to swell, your blood pressure rises, or you feel unusual muscle weakness, cramping or tiredness. These are the early signs of the licorice pushing your potassium too low.
Get urgent medical help if you have severe muscle pain with dark brown urine, an irregular or racing heartbeat, or yellowing of your skin or eyes.
Also see a doctor rather than continuing on your own if your cough lasts more than two to three weeks, brings up blood or green phlegm, or comes with fever or breathlessness, or if vomiting stops you keeping fluids down.
Evidence grades and traditional-use labels are explained in our methodology. Nothing here is medical advice.
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