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Moderate evidenceGut health

Rikkunshito

A Japanese Kampo formula of eight herbs, widely prescribed in Japan for functional dyspepsia. Meta-analyses find a modest benefit for upper gastrointestinal symptoms, though most trials come from one country and are of moderate quality.

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What the science says

  • Functional dyspepsia symptoms Moderate evidence

    A systematic review and meta-analysis of 52 RCTs (5,475 patients) concluded that rikkunshito, alone or as add-on therapy, can be considered for functional dyspepsia, with better symptom scores than conventional treatment.

  • Upper gastrointestinal symptoms more broadly Moderate evidence

    A separate systematic review and meta-analysis found rikkunshito improved upper gastrointestinal symptoms across varied populations, while flagging heterogeneity and generally moderate methodological quality.

  • Dyspepsia accompanied by anxiety Moderate evidence

    The multicentre randomized DREAM study found rikkunshito improved dyspeptic symptoms together with correlated anxiety scores in patients with functional dyspepsia.

Dosage & safety

Studied doseThe Japanese standard is 7.5 g/day of extract granules, divided into two or three doses taken before meals.
SafetyGenerally well tolerated. It contains liquorice, so prolonged use can cause pseudoaldosteronism — low potassium, oedema and raised blood pressure — especially at higher doses or alongside diuretics. The ginseng component may matter for people on warfarin.

How to take it

TimingBefore meals, two or three times daily, as the Japanese protocols specify.
With food?Before food, dissolved in warm water — this is how the granules are meant to be taken.
Worth knowingIf your ankles swell or your blood pressure creeps up over weeks of use, suspect the liquorice and get your potassium checked.

Interactions

With medications

  • thiazide and loop diuretics

    The liquorice component drives potassium loss on top of the diuretic, risking marked hypokalaemia. do not combine without potassium monitoring

  • digoxin

    Liquorice-induced low potassium increases the risk of digoxin toxicity. do not combine without medical supervision

  • corticosteroids

    Additive sodium retention, oedema and raised blood pressure. talk to your doctor before combining

  • warfarin

    The ginseng component has been reported to alter warfarin response. monitor your INR more closely when starting or stopping

With other supplements

  • liquorice, DGL and other kampo formulas

    Liquorice appears in a great many formulas; stacking them multiplies the pseudoaldosteronism risk. add up the liquorice across everything you take

Well-established interactions only — this is not a complete list. Always tell your doctor and pharmacist what you take.

Frequently asked questions

Does rikkunshito work for functional dyspepsia?

Rikkunshito has moderate evidence for functional dyspepsia: a meta-analysis of 52 RCTs (5,475 patients) found better symptom scores than conventional treatment, alone or as add-on therapy. Most trials come from Japan and are of moderate quality.

How do I take rikkunshito?

The Japanese standard for rikkunshito is 7.5 g/day of extract granules, divided into two or three doses dissolved in warm water before meals.

What are the side effects of rikkunshito?

Rikkunshito contains liquorice, so prolonged use can cause pseudoaldosteronism with low potassium, oedema and raised blood pressure, especially at higher doses or with diuretics. If your ankles swell or blood pressure creeps up, get your potassium checked.

Can I take rikkunshito with warfarin or diuretics?

Do not combine rikkunshito with thiazide or loop diuretics or with digoxin without potassium monitoring, because its liquorice drives potassium loss. Its ginseng component may alter warfarin response, so monitor your INR more closely when starting or stopping.

Scientific references

Related in Gut health

Herbal medicines: what the evidence says (335)