Goshakusan

Do not self-treat with Goshakusan

Practitioner-prepared only. If a clinician has prescribed it, follow their instructions and no one else's.

If this is an emergency

Some reactions to Goshakusan need urgent care. Call your local emergency number or go to an emergency department straight away — do not wait to see whether it passes.

Who should avoid Goshakusan?

Never self-treat with this formula; it is a prescription medicine in Japan and its ephedra content is banned from supplements in the United States.
Do not use if you have any heart disease, including angina (chest pain from the heart) or a past heart attack.
Do not use if you have high blood pressure.
Do not use if you have an irregular or fast heartbeat.
Do not use if you have had a stroke or a mini-stroke.
Do not use if you have hyperthyroidism (an overactive thyroid).
Do not use if you have an enlarged prostate or any trouble passing urine.
Do not use if you have glaucoma (raised pressure inside the eye).
Do not use if you have hypokalaemia (low potassium) or take drugs that lower potassium.
Do not use if you have kidney or liver disease.
Do not use if you have diabetes, unless a prescriber says otherwise and checks you.
Never take it with an MAOI (an older mood drug), or within two weeks of stopping one.
Do not take it with decongestants, diet pills, or other stimulant drugs.
Do not use if you are pregnant or breastfeeding.
Do not give it to a child.
Avoid it if you are older and have not had your heart and blood pressure checked.
Do not use it before surgery or an anaesthetic without telling your surgeon.
Never buy ephedra-containing products online to treat yourself.

When should you see a doctor?

When to see a doctor

Call emergency services now if you or someone else has:

- Chest pain, pressure or tightness - A pounding, racing or very irregular heartbeat - A sudden severe headache - Weakness or drooping on one side of the face or body - Slurred speech, confusion or sudden loss of vision - Fainting or collapse - A seizure (a fit) - Severe shortness of breath or swelling of the lips or throat - No urine at all, with pain in the lower belly

Do not wait to see if it passes. Say clearly that the person has taken a herbal medicine containing ephedra and licorice, and bring the package if you can.

Book a same-week appointment for muscle weakness, cramps, ankle swelling, or blood pressure readings that are higher than usual.

What it is: A doctor-prescribed Japanese Kampo formula that contains Ephedra herb (mao), whose ephedrine alkaloids are banned from dietary supplements in the United States.
Active ingredients: Ephedrine and pseudoephedrine from Ephedra herb (mao), Glycyrrhizin from licorice root
Side effects: Can cause a racing heart, high blood pressure, urinary trouble, low potassium and, rarely, stroke or seizures.
Pregnancy & breastfeeding: Avoid in pregnancy and while breastfeeding.

Educational information, not medical advice — ask your doctor or midwife.

What is Goshakusan?

What is Goshakusan, and why is it restricted?

Goshakusan is a Japanese Kampo formula that contains Ephedra herb (mao). Mao holds ephedrine-type alkaloids. These act on the body much like adrenaline.

That is the core hazard. Ephedrine alkaloids have been linked to high blood pressure, fast or odd heartbeats, stroke, and trouble passing urine.

The formula blends 17 to 18 herbs. One more matters here: licorice (Glycyrrhiza). Licorice can lower potassium, a mineral your heart needs, which makes rhythm problems worse.

In Japan, Goshakusan is a prescription Kampo product (Tsumura 63). A doctor or pharmacist decides if it is suitable and dispenses it. In the United States, ephedrine alkaloids are banned from dietary supplements.

Evidence verdict: the formula has a long place in practice, but good human trials are missing. Long use in a tradition is not proof that a remedy works or that it is safe. That point is made once here and not repeated below.

How does Goshakusan work?

How does Goshakusan act in the body?

The main driver of harm is ephedrine and pseudoephedrine from mao. These are sympathomimetic drugs, meaning they mimic adrenaline.

They raise heart rate and blood pressure in people. That effect is well established in humans, not just in lab work. They can also tighten the bladder outlet, so passing urine gets harder.

In traditional terms, the formula was said to warm the body and move "cold" and "damp" blockage. That is the language of a practice model. It is not a test of biology.

Licorice adds a second, separate problem. Its glycyrrhizin makes the body hold salt and water and lose potassium. Doctors call this pseudoaldosteronism (a false aldosterone effect), and it is well documented in people.

Now put the two together. A sped-up heart plus low potassium is a known recipe for a dangerous heart rhythm. This is why the combination worries clinicians.

Cinnamon and the remaining herbs have mostly been studied in cell and animal work. In test tubes, some show mild effects on inflammation and on blood vessels. Whether any of that happens in a person taking this formula is not established.

What forms does Goshakusan come in?

In Japan it is sold as a licensed prescription Kampo medicine. The usual form is a dried granule or fine powder in single sachets. Some makers also supply tablets.

The best known product is Tsumura 63. A doctor prescribes it and a pharmacist dispenses it.

Raw herb versions exist in some clinics. This page gives no method for handling, cooking or measuring any form, and no place to buy one.

Imported or online products are a special worry. Labels may not match the contents. Ephedra-containing goods are blocked or restricted in many countries, so grey-market stock is common and unchecked.

Where it comes from:

Where does Goshakusan come from?

The formula began in China as Wu Ji San, or Five Accumulations Powder. It appears in a Song dynasty official formulary from around the 1100s.

Practitioners of that era used it for what they called cold and damp blocking the body. Reported targets were chills, aches, cramping belly pain and stalled digestion.

Japanese Kampo doctors took up the formula and kept it in use. In the modern era it was standardised and approved as a prescription medicine in Japan.

That history shows the formula is a genuine, core part of the tradition. It does not show that the formula is safe for you to take on your own.

What does Goshakusan help with?

Low back and hip pain linked to cold: Kampo doctors used it for aching that felt worse in cold, damp weather. Human trial data for this use is thin. No good controlled study shows the formula beats standard care.
Period pain with cold hands and feet: Tradition matched the formula to women who felt cold and had cramping pain. Modern support is limited to case notes and small reports. There is no reliable trial evidence of benefit.
Cramping belly pain with poor appetite: The blend was chosen for a "cold stomach" picture with bloating and low appetite. Evidence is traditional, not trial-based. Belly pain also has many causes that need a proper check.
Cold-weather joint and muscle pain: Older texts describe use for stiff, achy limbs in winter. Lab work on some of the single herbs suggests mild anti-inflammatory action. Whether that helps joints in people taking this formula is not known.

What are the side effects of Goshakusan?

High blood pressure, sometimes a sharp rise
Fast, pounding or irregular heartbeat
Chest pain
Stroke or bleeding in the brain, reported with ephedrine alkaloids
Seizures (fits)
Trouble starting or passing urine, more likely with an enlarged prostate
Restlessness, anxiety, shaking and trouble sleeping
Headache, sweating and nausea
Low potassium from licorice, causing muscle weakness, cramps or tiredness
Swelling in the legs and face from salt and water retention
Raised blood sugar
Allergic rash or, rarely, breathing trouble

Good to know:

How serious is this, and how fast?

Some effects come on within hours. A racing heart, a jump in blood pressure, or a bad headache can start the same day.

Other effects build quietly over weeks. Low potassium from licorice is the classic slow one, and it can end in muscle weakness or a dangerous heart rhythm.

Serious harm is not just theoretical. Strokes, heart attacks, seizures and deaths have been reported with ephedrine-alkaloid products. Treat any chest pain, fainting or one-sided weakness as an emergency.

Is Goshakusan legal where you live?

In Japan, Goshakusan is an approved prescription Kampo medicine, dispensed by a physician or pharmacist; lower-strength versions are sold over the counter there. In the United States, the FDA's 2004 rule bans ephedrine-alkaloid dietary supplements, and ephedrine is a DEA List I regulated precursor, not a controlled substance. Ephedra-containing products are also restricted or prescribed by doctors in the UK, the EU, Canada and Australia.

Options to discuss with a clinician

What could you consider instead?

Start with the problem, not the herb. Take your symptom to a doctor, pharmacist or qualified Kampo physician, and ask what fits you.

Options they may raise include:

- Kampo formulas that contain no ephedra and no licorice, chosen and prescribed for you. - Plain heat, gentle movement and physiotherapy for cold-weather aches and low back pain. - Standard pain relief for period pain, with a check for causes such as endometriosis (tissue like the womb lining growing outside it). - A proper work-up for cramping belly pain, since ulcers, gallstones and other causes need different care. - A blood pressure and heart check, which is wise before any stimulant-type remedy is even discussed.

Each of these should be discussed with a clinician who knows your health history and your medicines. Do not swap one restricted herb for another on your own.

Review status

This page has not been signed off by a pharmacist and is not published. It is shown here for a policy decision only.