Toki-shigyakuto is a seven-herb Kampo formula first recorded in the Shang Han Lun (Treatise on Cold Damage Disorders), a foundational Chinese medical text from around 220 CE. In Japan, it became a cornerstone of Kampo practice and is still used today in hospitals and clinics as an approved prescription formula. The name translates roughly as 'Angelica Decoction for Frigid Extremities,' capturing its central purpose: restoring warmth and blood flow to cold, numb limbs.

The formula works by combining herbs that warm the interior and move blood (like cinnamon twig and Angelica) with herbs that nourish the blood (Peony root) and open circulatory channels (Akebia stem, Asarum). Together, they are thought to relieve what traditional medicine calls 'blood deficiency with internal cold' — a state where the body can't push enough warmth and nourishment to the extremities. Modern research suggests the formula may improve peripheral blood flow, modulate pain signaling, and support vascular smooth muscle function.

In Japan, Toki-shigyakuto is most commonly dispensed as standardized granule extracts (Tsumura Kampo formulas are the best-known brand), making it easy to take dissolved in warm water. Traditional practitioners may still prepare it as a decocted tea. Tablets and powders exist but are less common. The granule form is the standard used in clinical research and hospital settings in Japan.

• Cold hands and feet (Raynaud's / poor circulation)
• Menstrual pain and cramps
• Chilblains (frostbite-like skin reactions to cold)
• Lower back and leg pain made worse by cold
• Headaches linked to cold or poor circulation
• Numbness or tingling in the limbs
• Painful periods with cold sensation in the abdomen
• Endometriosis-related pain
• Circulation problems in older adults
• Tension and pain from blood deficiency pattern (Kampo)

• Recurrence of chilblains with regular winter use
• Worsening of cold-related Raynaud's episodes during cold seasons

Toki-shigyakuto is a multi-herb formula with no direct food equivalent. To support the same goals — warming the body, nourishing blood, and improving circulation — focus on warm, cooked, blood-building foods. Dark leafy greens (spinach, kale), beets, liver, grass-fed beef, black sesame seeds, and red dates (jujube) all support blood nourishment in the same spirit as this formula. Warming spices like cinnamon, ginger, and turmeric in daily cooking support peripheral circulation. Avoid raw, cold, or icy foods and drinks if you tend to run cold, as these can worsen the very pattern this formula addresses. Adequate iron and B12 intake through food is also important, since blood deficiency in Kampo often overlaps with mild nutritional anemia.

• Digestive upset, nausea, or loose stools (most common, especially on an empty stomach)
• Skin flushing or a feeling of excess warmth (if used in the wrong constitutional type)
• Allergic skin reactions in rare cases
• Menstrual flow may temporarily increase due to Angelica's blood-moving effect
• Not recommended during pregnancy without professional supervision
• Long-term use of formulas containing Akebia requires monitoring for kidney function in sensitive individuals

• Recommended daily: Standard Kampo granule extract (e.g., Tsumura #38): 7.5 g of granules per day divided into 2–3 doses (equivalent to the traditional decoction). Traditional decoction: one packet of raw herbs simmered in water, taken in 2 divided doses. Always follow licensed Kampo prescriber guidance, as dose is adjusted to the individual.
• Best time of day: Take 30 minutes before meals or between meals on an empty stomach, as is standard for Kampo formulas (enhances absorption of herbal constituents).
• With or without food: Traditionally taken away from food. If stomach upset occurs, taking with or shortly after a light meal is acceptable.
• Time to effect: Cold extremities and chilblains may show improvement within 2–4 weeks. Menstrual pain typically improves after 2–3 menstrual cycles. Full benefit for chronic conditions may take 8–12 weeks.
• How long to take it: In Japanese clinical practice, Kampo formulas are often used for several months for chronic conditions. For seasonal use (e.g., winter chilblain prevention), begin 4–6 weeks before cold season and continue through it. Always re-evaluate with a practitioner every 2–3 months, as the formula may need to be adjusted as your constitution changes.