Saireito (Kampo)

What is Saireito (Kampo)?

Saireito is a classical Kampo (Japanese herbal medicine) formula made up of twelve individual herbs. It is the combination of two well-known Kampo prescriptions: Sho-saiko-to (a liver and immune-modulating formula) and Gorei-san (a water-metabolism formula). This dual action makes it uniquely suited to conditions involving both inflammation and abnormal fluid handling in the body.

How does Saireito (Kampo) work?

Saireito works through several overlapping pathways — it helps calm overactive immune responses, reduce protein loss through the kidneys, and regulate how the body distributes and eliminates fluid. The Bupleurum-based herbs are thought to dampen inflammation, while the Alisma and Polyporus components act like gentle natural diuretics, helping the kidneys manage fluid more efficiently. Together, the formula also appears to support the adrenal system, which is important for patients taking corticosteroids.

What forms does Saireito (Kampo) come in?

In Japan, Saireito is overwhelmingly prescribed as standardized granules (most commonly Tsumura brand, extract granule TJ-114) that dissolve in warm water. This is the form used in virtually all clinical research. Traditional decoction (boiling raw herbs) is less common today. Tablet forms exist but are less widely studied.

Where it comes from:

Saireito's roots trace back to classical Chinese medicine texts, where the parent formulas Xiao Chai Hu Tang and Wu Ling San were described over 1,800 years ago in the Shang Han Lun (Treatise on Cold Damage Disorders) by Zhang Zhongjing. Japanese Kampo physicians later combined these into Saireito (Chai Ling Tang in Chinese) to address conditions involving both inflammatory heat and fluid stagnation. In modern Japan, Saireito is a government-approved prescription drug covered by national health insurance, reflecting its established role in clinical nephrology and hepatology.

What does Saireito (Kampo) help with?

• Nephrotic syndrome: Saireito has been used alongside corticosteroids to help reduce the amount of protein leaking into urine and to lower relapse rates. It appears to help stabilize the kidney's filtering barrier and may allow doctors to taper steroid doses more successfully over time.
• Chronic kidney disease (proteinuria): In patients with chronic kidney disease, Saireito has shown the ability to reduce urinary protein loss, which is one of the key markers of kidney damage progression. Keeping protein in the blood rather than losing it through urine helps protect kidneys long-term.
• Steroid-dependent conditions (to reduce steroid dose): One of the most clinically relevant uses of Saireito is as a steroid-sparing agent. Studies in nephrotic syndrome patients show it can help maintain remission while allowing the corticosteroid dose to be gradually reduced, lowering the side-effect burden of long-term steroid use.
• Chronic hepatitis B and C: Japanese clinical research has investigated Saireito's parent formula Sho-saiko-to as well as Saireito itself in chronic viral hepatitis. The formula appears to reduce liver enzyme elevations and may slow fibrosis, though it should not replace antiviral therapy.
• IgA nephropathy: IgA nephropathy is an autoimmune kidney condition marked by protein and blood in the urine. Saireito has been studied as a supportive treatment to reduce proteinuria and urinary red blood cells, likely by dampening the immune-driven inflammation that drives the condition.
• Autoimmune inflammation: The Bupleurum and Scutellaria components in Saireito help calm the type of chronic, low-grade immune activation seen in many autoimmune conditions. This makes it a broadly applicable anti-inflammatory tool in integrative Japanese clinical medicine.
• Fluid retention and edema: The Gorei-san component of Saireito (Alisma, Polyporus, Poria, Atractylodes, Cinnamon) is a classical formula for correcting fluid imbalances. It is used for edema — particularly the kind tied to kidney or metabolic dysfunction — rather than simple dehydration or heat-related fluid loss.
• Frequent relapse of minimal change nephropathy: Children and adults with frequently relapsing minimal change disease are a group where Saireito has specific research interest in Japan. It has been used to extend remission and reduce the number of relapses per year when added to standard steroid protocols.

What can Saireito (Kampo) help prevent?

• Relapse of nephrotic syndrome (in steroid-sensitive patients on maintenance therapy)
• Progression of proteinuria in early-stage chronic kidney disease

Which foods are rich in Saireito (Kampo)?

Saireito is a multi-herb prescription formula with no direct food equivalent. However, the dietary pattern that most closely supports its goals — reducing kidney inflammation and protecting fluid balance — is a low-sodium, plant-forward diet rich in anti-inflammatory foods. Emphasize: omega-3-rich fish (salmon, sardines) to reduce kidney inflammation; leafy greens and beets for nitrate-based kidney support; shiitake and maitake mushrooms for immune modulation; green tea for its anti-inflammatory polyphenols; and ginger root, which mirrors one of Saireito's own ingredients. Minimize processed sodium (the single most harmful dietary factor for proteinuria and fluid retention), red meat, and high-sugar foods that worsen systemic inflammation.

What are the side effects of Saireito (Kampo)?

• Nausea or mild stomach upset (usually transient)
• Diarrhea or loose stools
• Elevated liver enzymes (rare: monitor in hepatitis patients)
• Interstitial pneumonia (rare but serious: watch for dry cough and breathlessness)
• High blood pressure (from Glycyrrhiza/licorice content with long-term use)
• Pseudohyperaldosteronism (sodium retention, low potassium from licorice — rare with standard doses)
• Skin rash or allergic reaction (uncommon)

Good to know:

Saireito is generally well tolerated when used as prescribed. Serious adverse effects are uncommon but real — the most clinically important risks are drug-induced liver injury and interstitial pneumonia, both of which have been reported with Bupleurum-containing Kampo formulas. Any new cough, shortness of breath, or yellowing of skin should prompt immediate medical evaluation.

How much Saireito (Kampo) should you take?

• Recommended daily: 7.5 g/day of standardized extract granules (e.g. Tsumura TJ-114), typically divided into 2–3 doses — this is the standard dose used in Japanese clinical practice and research. Raw decoction dosing varies and should be guided by a Kampo practitioner.
• Best time of day: Traditionally taken before meals — approximately 30 minutes before breakfast, lunch, and/or dinner. This is the standard Kampo administration timing.
• With or without food: Take on an empty stomach or just before meals. Dissolve granules in warm (not boiling) water and drink as a warm tea. Avoid taking with cold drinks or cold food immediately after, per traditional Kampo guidance.
• Time to effect: 2–4 weeks for initial changes in inflammatory markers or urinary protein; 8–12 weeks for full clinical assessment in chronic kidney conditions.
• How long to take it: For chronic conditions like nephrotic syndrome or IgA nephropathy, Saireito is often used for months to years under physician supervision. It is not intended as a short-cycle supplement — long-term use should include periodic liver function monitoring and blood pressure checks due to the Glycyrrhiza content.