Japanese herbal medicine for menopause: what Kampo actually offers, and what the evidence says

By Natsuko Shibata, pharmacist licensed in Japan · Updated 2026-09-17

In Japan, Kampo — the Japanese system of herbal medicine — is prescribed for menopausal symptoms within ordinary health insurance, by gynaecologists and general physicians. It is not an alternative scene here; it is one of the standard options. Most of that prescribing comes down to a handful of formulas, chosen by the pattern of symptoms rather than by the word "menopause".

This page explains those formulas: what they are, which pattern each is traditionally used for, what clinical trials have and haven't shown, and how you actually get them in Japan. It explains; it does not recommend. Which one, if any, fits you is a question for a practitioner who can see the whole picture.

Kampo has a long-standing way of reading this stage of life. The classical text Huangdi Neijing describes a woman's body changing on a seven-year rhythm, with the channels that govern menstruation quieting around forty-nine. In that framework, menopause is not treated as a single deficiency of hormones but as a shift in what Kampo calls the "kidney" — the root of the body's reserves — and the symptoms are read by where that shift shows.

How Kampo reads menopause

Kampo does not ask "are you menopausal?" It asks which of these patterns is loudest. Several can overlap, and the formula follows the pattern.

Yin deficiency (腎陰虚) — heat and dryness. Hot flushes, sudden sweating, night sweats, waking in the night, dry mouth, dry skin and hair, warmth in the palms and soles in the evening. In Kampo terms the body's cooling, moistening reserve is thinning, so heat rises unopposed. This is the most typical menopausal pattern.

Yang deficiency (腎陽虚) — cold and fatigue. Whole-body cold that is hard to warm, swelling, night-time urination, difficulty getting up, daytime drowsiness, heaviness in the lower back. The body's warming, moving reserve is low. Women who were already cold-prone tend to present this way at menopause.

Stagnant qi (肝気鬱結) — the emotional wave. Irritability without cause, mood swings, sudden tears, light sleep, tightness in the chest or sides, sighing. The "liver" in Kampo governs the smooth movement of qi and reacts to hormonal shifts. This pattern is common in women who have carried responsibility for a long time.

Blood stasis (瘀血) — hot above, cold below. A flushed face with cold feet, chronic stiff shoulders and headaches, dull skin, dark lips or gums. Circulation in the pelvis has slowed; heat pools above, cold settles below. Stasis accumulates with age and shows in the skin and shoulders as much as in the cycle.

The formulas

Each is listed with its Tsumura product code (the "TJ" numbers you will see on prescription granules in Japan), the pattern it is traditionally used for, its main herbs, and the cautions that matter.

Kamishoyosan (加味逍遙散, TJ-24)

Traditionally used for the stagnant-qi pattern with some heat: irritability, hot flushes, unsettled mood and light sleep occurring together. In Japan it is the formula most often prescribed first in menopause.

Main herbs: toki (Japanese angelica root), shakuyaku (peony root), byakujutsu or sojutsu (Atractylodes), bukuryo (Poria), saiko (Bupleurum), kanzo (liquorice), botanpi (moutan bark), sanshishi (gardenia fruit), shokyo (ginger), hakka (mint). The name means "to wander freely".

Cautions: contains liquorice (see below). Contains saiko; interstitial pneumonitis and liver dysfunction have been reported with saiko-containing formulas, so a persistent dry cough, fever or breathlessness while taking it should be reported to a doctor.

Keishibukuryogan (桂枝茯苓丸, TJ-25)

Traditionally used for the blood-stasis pattern in someone with reasonable strength: a flushed face with a cold lower body, stiff shoulders, headache, dull skin, painful periods.

Main herbs: keihi (cinnamon bark), bukuryo (Poria), botanpi (moutan bark), tonin (peach kernel), shakuyaku (peony root). A classical blood-moving composition. No liquorice.

Cautions: generally not chosen for someone frail or depleted. Loose stools can occur.

Tokishakuyakusan (当帰芍薬散, TJ-23)

Traditionally used for cold, swelling and easy fatigue in a slight, pale, anaemia-prone build — the blood-deficiency-with-fluid pattern. With the two above, one of the "three major women's formulas" of Japanese gynaecology.

Main herbs: toki, senkyu (Cnidium rhizome), shakuyaku, bukuryo, sojutsu, takusha (Alisma). No liquorice.

Cautions: loss of appetite or stomach discomfort in those with weak digestion.

Hachimijiogan (八味地黄丸, TJ-7)

Traditionally used for the yang-deficiency pattern: lower-body cold and heaviness, night-time urination, fatigue. It builds yin and warms yang at the same time.

Main herbs: jio (Rehmannia root), sanshuyu (Cornus fruit), sanyaku (Dioscorea rhizome), takusha, bukuryo, botanpi, keihi, bushi (processed aconite).

Cautions: contains processed aconite. Flushing, palpitations or numbness of the tongue mean stop and consult. Rehmannia can sit heavily on the stomach; taking it after meals is acceptable.

Rokumigan (六味丸, TJ-87)

Traditionally used for the yin-deficiency pattern — hot flushes, night sweats, dryness — where cold is not part of the picture. It is hachimijiogan without the cinnamon and aconite.

Main herbs: jio, sanshuyu, sanyaku, takusha, bukuryo, botanpi. No liquorice, no aconite.

Cautions: stomach heaviness, as above.

Nyoshinsan (女神散, TJ-67)

Traditionally used for what Japanese practice calls chi-no-michi-sho (血の道症): hot flushes, irritability, headache and dizziness around menstruation, childbirth and menopause. Historically a formula named for women.

Main herbs: toki, senkyu, byakujutsu, koboshi (Cyperus rhizome), keihi, ogon (Scutellaria root), ninjin (ginseng), binroji (areca seed), oren (Coptis rhizome), kanzo, choji (clove), mokko (Saussurea root), daio (rhubarb).

Cautions: contains liquorice. Contains rhubarb, a laxative — loose stools or abdominal pain can occur, and it is not a formula for someone who already tends to diarrhoea.

What the evidence shows — and doesn't

This is the part most English-language pages skip. There are placebo-controlled trials of these formulas for menopausal symptoms, and their results are more sobering than the marketing around Kampo suggests. Here they are.

Kamishoyosan, 2020. A randomised, double-blind, placebo-controlled trial in Japanese women (101 on kamishoyosan, 104 on placebo) measured hot-flush frequency, depression, anxiety, quality of life and a menopausal index over 8 weeks. Symptoms improved in both groups — and the difference between kamishoyosan and placebo was not statistically significant on any measure. The authors concluded the formula was safe and had "some effects", but not beyond placebo, and that the placebo effect in this area is large. (Takamatsu K et al., Evidence-Based Complementary and Alternative Medicine, 2020.)

Kamishoyosan, 2021 — the KOSMOS study. The same group ran a second trial designed to strip out placebo responders first: a 4-week placebo run-in, then randomisation of the non-responders (20 vs 20), with irritability as the primary outcome over 12 weeks. Again, the primary outcome did not differ significantly from placebo. Two secondary findings pointed the other way: a larger proportion of women improved by 3 or more points on kamishoyosan (70% vs 45%), and in the premenopausal subgroup irritability improved more on kamishoyosan than on placebo. Safety was good, with no serious events. (Takamatsu K et al., EBCAM, 2021.)

Keishibukuryogan, 2011. A US phase II trial (178 postmenopausal American women, 12 weeks, two doses vs placebo) measured hot-flush scores, climacteric symptoms and sleep. All three groups improved by roughly a third — 34% on placebo, 40% and 38% on the two doses — and the differences were not significant. Diarrhoea occurred in one in five women on the active formula. The authors noted this did not match Japanese clinical experience and raised questions about applying Kampo to a non-Japanese population without pattern-based selection. (Plotnikoff GA et al., Menopause, 2011.)

Clinic data. Retrospective analyses from a Tokyo menopause clinic, where the three major formulas were chosen by each woman's pattern, reported improvements in sleep, headache and blood pressure over about five to six months. These are before-and-after records without a placebo arm, so they show what practitioners see, not what the formula does independently. (Terauchi M et al., Archives of Gynecology and Obstetrics, 2011.)

The 2025 review. A narrative review of Kampo in menopausal management (Liu Y et al., Drug Discoveries & Therapeutics, 2025) summarises this literature and the laboratory work behind it — including studies showing weak oestrogen-receptor activity for several of these formulas — and frames Kampo as a complementary, individualised option rather than a replacement for hormone therapy.

The honest summary. In the three double-blind placebo-controlled trials that exist, none of these formulas beat placebo on its primary outcome. Kamishoyosan showed secondary signals — more responders, and a clearer effect on irritability before menopause — that its investigators considered worth pursuing. The trials are small, short (8–12 weeks), and mostly Japanese; none compared Kampo directly with hormone therapy; and all measured symptom scores, not hormone levels. What is not in doubt is safety at standard doses over those periods, and that in Japan these medicines are prescribed every day, chosen by pattern, by doctors who see them work in individuals. Those two facts sit side by side, and a fair page has to hold both.

How you actually get these in Japan

On prescription, through health insurance. Gynaecology or internal medicine. The doctor chooses by pattern and writes the formula on an ordinary prescription; you collect it at any pharmacy. With Japanese health insurance you pay 30% of the total cost. For example, a 30-day supply of kamishoyosan granules (7.5 g/day) carries a drug cost of roughly ¥3,400, making your out-of-pocket share for the medicine itself around ¥1,020 (as of 2026; drug prices are revised periodically under national tariff rules). Consultation, prescribing and dispensing fees are added on top.

Over the counter. The same formula names are sold at drugstores without a prescription. The herbs are largely the same, but many OTC products are made to a gentler daily dose than the prescription version, and the packaging is in Japanese. If symptoms are persistent or strong, a clinic visit is the route the Japanese system expects.

The real difficulty. For English speakers, the obstacle is rarely the medicine. It is finding a gynaecologist who will talk it through in English, knowing what to say at reception, and understanding what you were handed. That gap is what this site exists for.

Bringing it into Japan. Japan's general rule for personal use is that up to a one-month supply of an ordinary prescription medicine can be carried into the country without paperwork, and Kampo extract granules fall under that rule. This is about entering Japan. It is not about importing Japanese prescription medicine into your own country — the US and most other countries have separate and generally stricter rules on personal drug importation, so check your own before ordering anything from Japan. Larger quantities and controlled substances have their own procedures in both directions.

Who should be careful

Liquorice (kanzo). Kamishoyosan and nyoshinsan contain it, and so do many other Kampo formulas. Taking two liquorice-containing formulas together, or one for a long time, can cause swelling, raised blood pressure and low potassium — pseudoaldosteronism. This is the most common serious problem with Kampo in Japan, and it is avoidable. Tell a pharmacist everything else you take, including other Kampo.

Processed aconite (bushi) in hachimijiogan, and rhubarb (daio) in nyoshinsan: see the cautions above.

Not a self-selection situation: pregnancy or possible pregnancy, liver disease, current hormone therapy, other regular medicines.

See a doctor first if what looks like menopause comes with irregular bleeding, strong palpitations, rapid weight change or marked low mood. These sometimes have another cause behind them.

Hormone therapy and Kampo are commonly used together in Japanese clinics. They are not opposed options, and a doctor here will not think it strange to ask about both.

I am a pharmacist. I cannot diagnose you or tell you to stop a medicine your doctor has prescribed. This article explains formulas; it does not recommend any product. Decisions about treatment belong with your doctor.