Nyoshinsan

What is Nyoshinsan?

Nyoshinsan is a Japanese herbal mix, or Kampo formula. It blends about 13 dried herbs, including licorice root, ginseng, cinnamon bark and Japanese angelica root. The name is often read as "woman's spirit powder".

It is used mostly for women. Kampo doctors give it for hot flushes, sweating, headache, dizziness, poor sleep and low mood around menopause (the time when monthly periods stop). It is also given after childbirth for tiredness, worry and mood swings.

Japan's health ministry (MHLW) lists Nyoshinsan as one of 148 Kampo formulas. Those formulas are covered by Japan's national health insurance, so doctors there can prescribe it like a drug.

Here is the short verdict. Nyoshinsan has a long record of use in Japan, but we could not find good human trials of it. A long history of use is not proof that a remedy works, and that holds for everything on this page.

How does Nyoshinsan work?

No one has shown how Nyoshinsan works in the body. What follows is theory, not proven fact.

Kampo thinking says the formula moves "blood" that has become stuck, and cools "heat" that has risen to the head. In plain words, it is aimed at flushing, throbbing headache and a racing mind.

Lab work gives some clues, but not answers. Some herbs in it act on blood vessels or on nerve signals in test tubes and animals. That kind of work cannot tell you what happens in a person who swallows the whole mix.

One effect is well understood, and it is not a wanted one. Licorice root in the formula can make the body hold salt and water, which can push blood pressure up and potassium down.

What forms does Nyoshinsan come in?

The common form in Japan is a dried extract. It comes as fine granules or powder in single-dose sachets.

You can also find it as small tablets or capsules. Some Kampo clinics still boil the raw herbs into a tea, called a decoction.

Strength varies a lot between makers and between the granules and the raw herb tea. Check the label and do not swap forms without asking a pharmacist.

Where it comes from:

Nyoshinsan comes from Japan, not from classical China. It is a Kampo formula, also known by the name Anei-to.

Story has it that the mix was first given to soldiers under stress in the Edo period (1600s-1800s). Later Japanese doctors, including Asada Sohaku in the 1800s, used it mainly for women.

It has stayed in steady use in Japan ever since. Today it sits on the MHLW list of 148 insured Kampo formulas.

What does Nyoshinsan help with?

• Hot flushes and sweating around menopause: This is the main use in Japan. Kampo doctors pick it when flushing comes with a hot head and cold feet. We found no controlled human trial that tested it against a dummy pill for this.
• Headache and dizziness linked to menopause: Old Kampo texts name headache, a heavy head and dizzy spells as target signs. This use rests on practice records, not on trial data. New or severe headache needs a doctor first.
• Low mood, worry and short temper around menopause: Kampo treats mood and body signs as one picture, so this is a classic fit. There is no trial evidence that it lifts mood better than a dummy pill. It is not a treatment for depression.
• Poor sleep during the menopause years: Doctors may choose it when broken sleep comes with flushing and a restless mind. Support here is traditional only. Long-term sleep trouble has many causes and should be checked.
• Tiredness and mood swings after childbirth: The formula has a long record of use in the weeks after birth. Do not use it while breastfeeding unless your doctor agrees, because safety for the baby is not known. Strong low mood after birth needs medical care, not a herb.
• Mood and body symptoms before a period (PMS): Some Kampo doctors use it when the days before a period bring flushing, headache and a short fuse. This is an extension of the menopause use. No human trial supports it.

Which foods are rich in Nyoshinsan?

1. Licorice sweets and licorice tea: they add to the licorice already in the formula
2. Salty foods: extra salt worsens the water held by licorice
3. Bananas, potatoes and leafy greens: good sources of potassium, the salt licorice can drain

Practical Tips:

Nyoshinsan is a medicine, not a food. Keep other licorice products off the menu while you take it.

What are the side effects of Nyoshinsan?

• Upset stomach, nausea or loss of appetite
• Loose stools, or cramping if your version contains rhubarb root
• Rash, itching or redness of the skin
• Puffy ankles, face or hands from held water
• Quick weight gain from held water
• A rise in blood pressure
• Muscle weakness, cramp or aching
• Low potassium (a salt your muscles and heart need to work)
• Uneven or fast heartbeat, which can follow low potassium
• Rare liver injury, with yellow skin or eyes, dark urine and deep tiredness
• Rare lung inflammation, with a dry cough, fever and breathlessness

Good to know:

Most people who take it get no side effects, and mild stomach upset is the most common one. The serious problems are rare but real.

The main one comes from licorice root. Licorice can cause pseudoaldosteronism (a state where the body holds salt and water, so blood pressure goes up and potassium falls). Signs are swelling, weight gain, muscle weakness and cramp.

Two other rare harms are worth knowing. Kampo formulas that contain scutellaria root have been linked to liver injury and to lung inflammation. Both need urgent medical care.

Risk rises with higher doses, longer use, older age and any other licorice product.

How much Nyoshinsan should you take?

• Recommended daily: In Japan the usual adult dose of the dried extract is about 7.5 g a day. That is split into two or three doses. Follow the label on the pack you own, since makers differ. Raw herb teas are made and dosed by a practitioner. No safe dose has been set for children, for pregnancy or for breastfeeding. There is also no set dose outside Japan, where the product is sold as a supplement.
• Best time of day: Take it two or three times a day, spread evenly. Many people take it in the morning, at midday and in the early evening.
• With or without food: Kampo granules are taken on an empty stomach. Aim for about 30 minutes before a meal, or between meals, with warm water. If it upsets your stomach, take it with food instead.
• Time to effect: Some people notice a change in one to two weeks. Two to four weeks is more usual. If eight weeks bring nothing, it is unlikely to help you.
• How long to take it: Give it two to four weeks, then take stock. Ask yourself if flushes, headache or mood have really changed. If nothing has shifted by eight weeks, stop and see your doctor. Long unbroken use raises the risk from licorice, so ask for a check on your blood pressure and potassium if you keep taking it past two or three months.