What is Tokikenchuto?

Tokikenchuto is a Japanese Kampo herb formula. It mixes seven herbs and is taken as a warm drink or as a powder. People use it for pain low in the belly, such as period pain or pain after giving birth.

It is the older formula Shokenchuto with one more herb added: Japanese angelica (toki). Kampo doctors pick it for people who look pale, feel cold and tire fast. In Kampo it is used as a single drug, meaning one formula on its own.

Good human trials are missing, so we cannot say that it works. Long use in a tradition is not proof of effect, and that caution applies to every claim on this page.

It also holds licorice. Licorice can raise blood pressure and pull potassium down, so this is not a formula to take without care.

How does Tokikenchuto work?

No one has shown how Tokikenchuto works in the body. The idea below comes from Kampo theory and from lab work, not from human proof.

In Kampo terms, the formula is meant to warm the belly, ease cramping and "build blood" in people who run low and cold. Warmth and rest of the gut muscle are the stated aims.

Lab work on single herbs offers hints. Peony root holds paeoniflorin, which relaxed gut and womb muscle in animal tests. Licorice and cinnamon have also calmed muscle spasm in dishes and animals.

Those findings do not tell you what happens when a person drinks the full mix. Treat the mechanism as a theory, not a fact.

What forms does Tokikenchuto come in?

The most common form in Japan is a dried extract granule or fine powder, sold in sachets and stirred into hot water. Tsumura's TJ-123 is the best known of these.

Other forms include a home-made decoction (herbs simmered in water and strained), tablets and capsules.

Strength differs a lot between makers and between granules and raw herb. Always dose by the product label rather than by a number you read elsewhere.

Where it comes from:

The formula comes from the Chinese classic Jingui Yaolue, written by Zhang Zhongjing around the third century, where it is called Danggui Jianzhong Tang.

Japanese doctors took it into Kampo practice and renamed it Tokikenchuto. It appears in Japan's approved Kampo list and is prescribed there today, mainly for belly pain after childbirth, period pain and pain from an anal fissure (a small tear in the skin of the back passage).

What does Tokikenchuto help with?

• Pain low in the belly: This is the main traditional use, and Kampo texts have used it this way for centuries. Doctors pick it when the pain is dull and cramping, eases with warmth and light pressure, and comes with tiredness and cold. We found no controlled human trial testing it against a dummy treatment for this pain.
• Period pain: Widely used in Japan for cramping period pain in people who feel cold and run down. Evidence is limited to tradition, doctor reports and small case series. We cannot tell you how it compares with a painkiller, because that study does not seem to exist.
• Belly pain and weakness after childbirth: This is the classical use named in the source text: pain and exhaustion in the weeks after birth. There is no trial evidence we can point to. If you are breastfeeding, ask a doctor before you use it, because the herbs pass into the body and licorice has its own risks.
• Tiredness with a pale, easily chilled build: Kampo calls this an "anaemic constitution": a pale, thin, easily tired and easily chilled build, often with a soft, tender belly wall. That is a Kampo pattern, not a blood test result. If you feel tired and pale, ask for a blood test. True anaemia (low red blood cells) has causes that need finding and treating.
• Pain from an anal fissure: Japanese doctors sometimes give it for the pain of an anal fissure, a small tear in the skin of the back passage. This use rests on clinical custom and case reports rather than on trials we can cite. Bleeding from the back passage always needs a doctor's look first.
• Cold hands and feet: Warming cold hands and feet is a stated aim of the formula in Kampo practice. We found no human trial that measured this. Cold hands and feet can also come from thyroid problems, poor circulation or low iron, so get checked if it is new or one-sided.

Which foods are rich in Tokikenchuto?

1. Licorice sweets and licorice tea: they add to the licorice already in the formula
2. Ginger: a food and a herb in this mix
3. Cinnamon: a food and a herb in this mix
4. Jujube (red dates): eaten as a dried fruit and used in the mix

Practical Tips:

While taking this formula, skip licorice sweets and licorice tea, because the licorice dose adds up.

What are the side effects of Tokikenchuto?

• Nausea or an upset stomach
• Loss of appetite
• Loose stools or diarrhoea
• Skin rash or itching
• Swollen ankles or puffy face from holding fluid
• Weight gain from fluid, not fat
• Raised blood pressure
• Muscle weakness, cramps or twitching from low potassium
• Uneven or racing heartbeat (rare, linked to low potassium)
• Rare liver problems, seen as yellow skin or eyes, dark urine or deep tiredness

Good to know:

Most people take it without trouble, and mild stomach upset is the most common complaint.

The effect to watch comes from licorice. Too much licorice can drop your potassium and push your blood pressure up, which can swell your ankles, weaken your muscles and, rarely, upset your heart rhythm.

Doctors call this pseudoaldosteronism (a false hormone-like effect from licorice). It is more likely at higher doses, over longer use, and in older people.

Stop taking it and call a doctor if your ankles swell, your muscles go weak, or your heart feels uneven.

How much Tokikenchuto should you take?

• Recommended daily: No dose has been set by trials. The numbers below come from Japanese prescribing practice. A common adult dose of the extract granules is about 7.5 g a day, split into two or three doses. Home-made decoctions vary with the recipe. Follow the label on your product, or the dose a trained practitioner gives you. Do not raise the dose on your own, because more licorice means more risk.
• Best time of day: Kampo practice is to take it two or three times a day, spread evenly. Many people take it before breakfast, before the evening meal and at bedtime.
• With or without food: Kampo tradition is to take it on an empty stomach, about 30 minutes before a meal or between meals, in warm water. If it upsets your stomach, take it with a little food instead.
• Time to effect: There is no trial answer to this. Japanese practitioners often expect some change in days to two weeks, and judge the formula unhelpful if nothing shifts by about four weeks.
• How long to take it: Short courses are the safer choice. Give it two to four weeks, then judge whether anything has changed. If you take it for more than about a month, ask your doctor to check your blood pressure and your blood potassium (a mineral your muscles and heart need). Stop and reassess if nothing has improved. Ongoing belly pain that does not settle needs a diagnosis, not a longer course of herbs.