Sho-saiko-to, a prescription composed of seven crude drugs, is one of the most popular Kampo formulas in clinical use. Recently, the side effects of Sho-saiko-to have become an issue. To gain perspective on this problem, the authors searched the indications and pharmacological characteristics of the Sho-saiko-to as noted in ancient Chinese and Japanese medical texts.
Sho-saiko-to was first described in the ‘Shokanron’ (_??__??__??_); ‘Shang Han Lun’; ‘Treatise on Damaging Cold’), which contains are over ten references to this formula. It is recommended for a variety of conditions, but its most fundamental usage was for exogenous febrile diseases. The meaning of some of the indications are still somewhat vague.
In China, the crude drug composition and clinical use of Sho-saiko-to gradually changed over the years. In Japan, Sho-saiko-to has been in use since the Kamakura era. In the Edo era, it was mainly used for complaints of alternative spells of fever and chills, a feeling of fullness and discomfort in the chest and hypochondrium, lack of appetite and vomiting.
Sho-saiko-to has been in use for centuries and is still a very useful prescription. However, the classical medical texts also indicate that adverse reactions will result if this formula is not prescribed properly following accurate Kampo diagnosis.

A Kampo medicine, Dai-kenchu-to, has been used clinically for treatments of various ailments such as vomiting, stomachache, and abnormal intestinal peristalsis caused by abdominal chill. Recently, it is often used to prevent intestinal obstruction after abdominal operations. We searched ancient Chinese and Japanese medical texts for the indications and pharmacological characteristics of Dai-kenchu-to and its constituent herbs (Zanthoxylum fruit, dried Ginger rhizome, Ginseng root, and Malt sugar). We clarified the applications and the cautions of Dai-kenchu-to in this paper. Dai-kenchu-to has rarely been used in China. However, it was often used for the remedy of severe abdominal pain caused by chilling, worm-ileus and hernia in the medieval period of the Edo era in Japan. For these reasons, evidence is considered as described below. i) Japanese people did not have the habit of eating meat in those days. ii) Japanese people used to drink a lot of water. iii) Severe abdominal pain occurred frequently due to wearing traditional Japanese clothing, which does not protect well against cold. iv) Abdominal diagnosis was advanced in Kampo medical methods. We found two precautions in the ancient Japanese medical texts. One is that a purgative should be avoided when used in an applicable case of Dai-kenchu-to. The other is that Dai-kenchu-to should not be given in the case of high fever. It is supposed that the botanical origins and processing of the four herbs used in the medieval period of the Edo era are the same as those of today. Our findings suggest that the pharmacological contribution of the four herbs in Dai-kenchu-to is mainly due to Zanthoxylum fruit and dried Ginger rhizome, and that Ginseng root and Malt sugar harmonize between the condition of patient and the pharmacological action of Zanthoxylum fruit and dried Ginger rhizome.