Makyokansekito
Do not self-treat with Makyokansekito
Practitioner-prepared only. Only the doctor who prescribes it and the pharmacist who dispenses it can set an amount.
If this is an emergency
Some reactions to Makyokansekito 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 Makyokansekito?
- Do not use it if you have any heart disease, an irregular heartbeat, or high blood pressure.
- Do not use it if you have had a stroke or a heart attack.
- Do not use it if you have an overactive thyroid (hyperthyroidism).
- Do not use it if you have glaucoma (raised pressure inside the eye).
- Do not use it if you have trouble passing urine, for example from an enlarged prostate.
- Do not use it if you have low potassium (hypokalaemia), kidney disease, or liver disease.
- Never take it with an MAOI antidepressant (an older type of antidepressant).
- Never take it with digoxin (a heart drug) or theophylline (an asthma drug).
- Never combine it with any other product containing ephedra, ma huang, ephedrine or pseudoephedrine.
- Never take it alongside another Kampo formula that contains Kanzo (licorice) without your prescriber's say-so.
- Do not use it if you are pregnant, trying to conceive, or breastfeeding.
- Do not give it to a child unless a doctor has prescribed it for that child and is watching them.
- Do not use it if you are older and frail, unless a doctor has weighed the heart risk with you.
- Avoid caffeine, energy drinks and stimulant supplements while you are taking it.
- Do not go into surgery or anaesthesia without telling the team that you take this formula.
- Never buy it online, import it, or take someone else's supply.
When should you see a doctor?
Call your local emergency number or go to an emergency department straight away if you get any of these:
Chest pain or tightness. A pounding, racing or skipping heartbeat. Fainting or near-fainting.
A sudden severe headache. Weakness or drooping on one side of the face or body. Slurred speech or sudden trouble seeing. These can be signs of a stroke.
Severe shortness of breath, gasping, confusion, or a seizure. These can be signs of cyanide poisoning from the apricot kernel part.
Marked muscle weakness, bad cramps, or swelling in the legs or face. These can be signs of low potassium from the licorice part.
Take the packet or the pharmacy label with you, and tell the staff exactly what you took. Do not wait to see if it settles.
- What it is: A doctor-prescribed Kampo formula in Japan whose Ephedra content can cause a dangerous heart rhythm, a blood pressure crisis or a stroke.
- Active ingredients: Ephedrine and pseudoephedrine, from Mao (Ephedra), Amygdalin, from Kyonin (apricot kernel), a cyanide source, Glycyrrhizin, from Kanzo (licorice)
- Side effects: Racing or irregular heartbeat, blood pressure spikes, stroke, low potassium, and cyanide risk from the apricot kernel.
- Pregnancy & breastfeeding: Avoid in pregnancy and while breastfeeding.
Educational information, not medical advice — ask your doctor or midwife.
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.
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.
Is Makyokansekito legal where you live?
In Japan, Makyokansekito is an approved Kampo medicine prescribed by doctors and dispensed by a pharmacist; lower-strength versions are sold over the counter there.
In the United States, the FDA banned dietary supplements containing ephedrine alkaloids in 2004. In the United States ephedrine is a DEA List I regulated precursor, not a controlled substance; the United Kingdom, Australia and many other countries track it the same way.
In the United Kingdom and the European Union, ephedra-containing herbal products are not permitted for general sale. Importing this formula for personal use may break the law where you live.
Options to discuss with a clinician
Bring your breathing problem to a doctor first. Every option below is one to discuss with a clinician, not to try alone.
For asthma and wheeze, ask about inhaled relievers and preventers. They act in the lung, are well studied, and avoid the whole-body stimulant effect.
For a blocked nose, ask a pharmacist about saline rinses or a steroid nasal spray. These do not raise your heart rate.
For a cough from a cold, ask whether simple care is enough. Fluids, rest and time settle most of them.
If you want to stay within Kampo, ask a Kampo-trained doctor about formulas that contain no Mao and no Kanzo. A prescriber can also check your potassium and blood pressure if a licorice-containing formula is chosen.
If you are already taking this formula, do not just stop on your own. Ask the doctor who prescribed it what to do next.
Graded pages for the options named above:
- Potassium — evidence grade A, traditional tier T0
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.