Evidence Explorer · MS-N231 · Japanese Kampo multi-herb medicine · Supportive care · Appraised November 4, 2026
A small randomized crossover pilot found a smaller drop in calorie intake during rikkunshito courses, but the per-protocol analysis and crossover design leave substantial uncertainty.
Evidence at a glance
Benefit signal: Modest short-term calorie-intake signal
Certainty: Very low; 40 enrolled, 31 analyzed, short crossover pilot
Risk context: Multi-herb product containing licorice, ginseng and ginger; interaction and electrolyte risks require review
What was studied
Forty people with lung cancer receiving cisplatin-based chemotherapy were randomized to treatment sequence. Rikkunshito 7.5 g/day was taken for 14 days during one course and omitted during the comparison course; standard antiemetics were used in both.
Among 31 people completing the protocol, calorie intake fell 18% during rikkunshito courses versus 25% during control courses (P=.025). Acylated ghrelin fell in both groups by day 3 and recovered by day 5 only during rikkunshito exposure.
What this evidence cannot establish
The 7-percentage-point intake difference has uncertain clinical importance, and a per-protocol crossover result may be influenced by attrition, treatment order and carryover.
The study did not show durable weight gain, improved treatment tolerance, tumor response or survival.
Practical safety context
The short trial did not identify clinically significant adverse events, but this does not establish safety. Licorice can cause hypertension, low potassium and fluid retention; ginger and ginseng may add interaction risks.
Appetite loss during cisplatin treatment also requires optimized antiemetics, hydration, constipation management, oral care and dietitian support.
Questions for the care team
- Is the product composition equivalent to the studied Japanese formulation?
- Could licorice or other ingredients interact with antiemetics, anticoagulants or blood-pressure medicines?
- Is calorie intake, weight and muscle function being monitored?
- Are nausea, constipation, mucositis or depression driving the appetite loss?
Funding and conflicts
Funding and manufacturer influence were not fully verified from the accessible abstract. The 2026 review found incomplete safety and product-characterization reporting.
Sources
- Randomized crossover pilot (PMID 31428894)
- 2026 systematic review of oral herbal preparations in supportive cancer care (PMID 42930516)
Sources and publication status checked November 4, 2026. Last literature search: November 4, 2026; record appraisal: November 4, 2026.
For education, not personal medical advice. Research regimens are not personal prescriptions. Symptom, laboratory or biomarker changes do not establish tumor response, recurrence prevention or longer survival.
