Related Terms

• Asarum, bai shao, ban xia, cinnamon twig, ephedra, gen cao, ginger root, gu zhi, Kampo, licorice root, ma huang schizandra fruit, minor blue dragon, peony root, pinella, qi, So cheong ryong tang (Korean), TCM, TJ-19, Traditional Chinese Medicine, we wei zhi, xi xin, Xiao qing long tang (Chinese), yang.

Background

• Sho seiryu to, also known as TJ-19, is a Japanese herbal formula often used for short periods of time to ward off and help speed recovery from colds in the absence of fever. In Chinese, this same herbal formula is known as xiao qing long tang, and the indications for use are identical to that of sho seiryu to. Though these formulas have different spellings and pronunciations, they contain the same ingredients. The ingredients are equal proportions of licorice root, schizandra fruit, ephedra, cinnamon twig, ginger root, peony root, asarum herb, and pinella. Traditionally, eachdose of sho seiryu to contains 9g of each ingredient.

• The origins of sho seiryu to and xiao qing long tang are in the traditional medical practices of Japan and China, respectively. This formula was first written about by Zhang Zhong Jing, known as the Chinese Hippocrates, in the Traditional Chinese Medicine (TCM) classic text Shang Han Lun (On Cold Damage) about 1,800 years ago. Traditional Japanese medicine developed a similar but separate tradition called Kampo. Kampo developed when the texts and medical theories were brought to the island from mainland China. In TCM, xiao qing long tang is usually prescribed after an acupuncture treatment. In Kampo, sho seiryu to may be used without an acupuncture treatment. This formula is generally not recommended for long-term use in Kampo or TCM.

• The use of sho seiryu to and Xiao qing long tang are indicated in Kampo and TCM as a treatment for illness with symptoms of lethargy, aching muscles, swelling, coughing, aversion to cold, and excessive phlegm. It is a primary treatment for colds in China and Japan, as well as among practitioners in the Kampo and TCM traditions outside of the United States.

• Western-style clinical trials on animals have shown that sho seiryu to may improve immune function and counteract the effects of asthma. Sho seiryu to has been the subject of many clinical trials, although high-quality studies in humans are lacking.

• The Japanese government regulates the production of sho seiryu to, or TJ-19. In the United States, sho seiryu to is not available from a pharmacy or via a doctor's prescription because this formula includes ephedra, an illegal herb known to cause cardiovascular problems. Because of an exception in the Food and Drug Administration law, only registered practitioners of TCM or Kampo may obtain this formula for distribution to patients.

Practice

• Traditionally, the formula is taken as a tea, which has an unpleasant taste and odor. Most Westerners take xiao qing long tang by mouth in the form of capsules or tablets, a method of administration that somewhat diminishes the odor and taste. Dosages are usually larger than most Western medicines, usually about 72g.

• In the United States, acquisition of this formula is limited to licensed acupuncturists and herbalists. Sho seiryu to contains ephedra, which, as of February 6, 2004, was banned for sale by the Food and Drug Administration (FDA) to most patients and health care professionals. Distributors may not sell ephedra or any product containing ephedra to any person without a license to practice TCM. This ban extends to medical doctors. Only registered practitioners of TCM may purchase any formula containing ephedra, and these medical professionals may only give the formula to patients for medical indications as dictated in the TCM medical worldview. Patients in the United States may only obtain sho seiryu from a registered practitioner of TCM. There is no licensure process for Kampo in the United States, and Kampo practitioners without a license to practice TCM may not obtain sho seiryu to.

• Before recommending a prescription, a practitioner typically performs an assessment of the patient. This assessment includes a medical history and an often lengthy discussion of the presenting problem. The patient's abdomen, pulses, and face may be examined for subtleties that are not considered important in Western medicine.

• Based on the assessment, the practitioner may recommend a formula, usually in the form of what is known as a "patent." Such formulas are sold by companies in pre-mixed quantities. In most Asian countries, the patent is mixed with a cup of hot water and consumed as a tea. In the United States, these patents are usually taken in pill form.

• Sho seiryu to may not be purchased at a pharmacy. The patient usually obtains the formula from the practitioner's private in-office stock. However, many herbal companies which manufacture sho seiryu to now allow practitioners to fax or email permission for a patient to purchase the product from their company. Individuals without a license to practice TCM may not purchase sho seiryu to from any herbal manufacturer or distributor.

• The prescription of sho seiryu to usually accompanies directions to avoid certain foods and stressful situations. The patient immediately typically begins taking the sho seiryu to from one to five times a day, and should expect symptoms to slowly resolve.

• A follow-up treatment with the practitioner is usually scheduled within one week of the initial assessment regardless of prognosis. The patient usually receives acupuncture, which in the Kampo and TCM medical worldview supports the actions of the herbs on the body to aid recovery. If the patient has not improved by the follow up appointment, the patient may receive a different herbal formula or an increased dose of sho seiryu to.

• Sho seiryu to contains equal proportions of eight ingredients. One treatment is usually comprised of 9g of each:

• Asarum herb (xi xin): Xi xin is often used to clear nasal obstruction and resolve dull or throbbing headaches. This herb should be used in moderation. Asarum's Latin name is Asarum arifolium.

• Cinnamon twig (gui zhi): In TCM, cinnamon twig is used to treat dysmenorrheal, tight muscles and joints, swelling, and skin eruptions. This herb may be familiar to Westerners as a spice for cooking. Its Latin name is Cinnamomum zeylanicum.

• Ephedra (ma huang): Ephedra is banned in the United States because of a number of deaths attributed to its use as a weight loss and athletic supplement. In TCM, ephedra is only used for very short periods of time to ward off illness. Its Latin name is Ephedra sinica. This herb is known to "release the exterior," a phrase that refers to the induction of heavy sweating in order to expel what is conceptualized as an external pathogen that does not belong in the body, and therefore causes illness when it enters the body. It may also induce coughing.

• Ginger root (gan jiang): This herb is often used by itself in Western medicine to control vomiting. The Latin name of ginger root is Zingiber officinale. The root of this plant is thought to enhance appetite, control diarrhea, and warm the body. It is also reputed to possess antibacterial qualities.

• Licorice root (gan cao): The Latin name of this herb is Glycyrrhiza glabra. This root grows as a shrub, and is native to areas of Asia and Europe. The root is thought to contain both anti-inflammatory and antioxidant properties. In TCM, this herb is primarily used to promote longevity. Licorice root possesses a variety of active compounds, including glycyrrhizin, coumarins, flavonoids, volatile oils, and plant sterols. For purposes of this TCM formula, the licorice root is fried in honey before being added to the formula. This herb may moderate the effects of other herbs.

• Pinella (ban xia): Ban xia halts intestinal spasms and may resolve diarrhea, vomiting, and upset stomach. This herb is frequently used as an appetite enhancer. Pinella's Latin name is Pinellia tubifera.

• Peony root (bai shao): In TCM and Kampo, this herb is used to invigorate moving energy (yang) in order to move what are known as vital substances, which may be likened to nutrients and chemical messengers. It is said to alleviate pain and may act as a sedative. This herb is sometimes used to treat hypertension (high blood pressure). Bai shao is sometimes used to induce childbirth because of its supposed properties to move energy. In Latin, peony root is known as Paeoniae laciflorae.

• Schizandra fruit (we wei zhi): Native to China and Russia, this fruit grows on a woody vine, and is also known as the Wood of Five Flavors. This herb is said to nourish the defensive energy of the body in order to ward off sickness. Schizandra is known by two interchangeable Latin names, Schisandra fructus and Schisandra chinensi.

Theory/Evidence

• In TCM or Kampo a diagnosis is made on the basis of what treatment needs to be performed. The assessment tells the practitioner the pattern of illness, and each pattern of illness has specific treatment protocol for return to wellness.

• This formula has been the subject of at least 40 Western-style clinical trials. These trials have evaluated sho seiryu to in treating stress, asthma, and rhinitis. It has also been tested for its anti-inflammatory and immune boosting qualities.

• Although the results of these studies are promising, sho seiryu to is now illegal in the United States because it contains ephedra.

• Research on Kampo in Japan and on TCM in China is conducted according to a different system of proof and evidence than in Western-style randomized control trials. Japanese and Chinese-style research focuses on the predicament of people with particular "constitutions," and often separates trial groups by a series of signs and symptoms for which there is no correlate in Western medicine. Based on these methods, sho seiryu to has been proven as an effective treatment for resolving colds.

• A 2001 study found that oral administration of sho seiryu to reduced bronchial inflammation in the lungs of mice sensitized to allergens. The inflammation that occurred in the mice treated with sho seiryu to decreased at a faster rate after the removal of the allergen from the environment than placebo in mice.

• A 1998 study induced influenza in mice. The animals treated with sho seiryu to displayed increased antibody activity and decreased airway inflammation in comparison to the placebo group.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

• Ephedra, an herb in sho seiryu to, is illegal in the United States because of its potentially fatal effects when taken in extremely high doses.

• In TCM and Kampo, the use of this formula is contraindicated when the patient has a high fever.

• Sho seiryu to should not be taken for longer than two weeks at a time. In one reported case, a man died from interstitial pneumonitis after taking high doses of this formula for an extended period of time.

• The side effects of sho seiryu to are not well known or documented in the current available literature.

Author Information

• This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

1. Food and Drug Administration. Questions and Answers about FDA's Actions on Dietary Supplements Containing Ephedrine Alkaloids. 24 June 2006. www.fda.gov

2. Hasegawa A, Yoshino M, Nakamura H, et al. Identification of inhibitory component in cinnamon--O-methoxycinnamaldehyde inhibits CYP1A2 and CYP2E1. Drug Metab Pharmacokinet. 2002;17(3):229-36. View Abstract

3. Japanese Ministry of Health, Labour and Welfare. 23 June 2006. www.mhlw.go.jp/English/index.html

4. Murayama T, Yamaguchi N, Iwamoto K, et al. Inhibition of ganciclovir-resistant human cytomegalovirus replication by Kampo (Japanese herbal medicine). Antivir Chem Chemother. 2006;17(1):11-6. View Abstract

5. Nagai T, Arai Y, Emori M, et al. Anti-allergic activity of a Kampo (Japanese herbal) medicine "Sho-seiryu-to (Xiao-Qing-Long-Tang)" on airway inflammation in a mouse model. Int Immunopharmacol. 2004 Oct;4(10-11):1353-65. View Abstract

6. Tong Y, Zhang NX, et al. [Protective and therapeutic effects of Shugan Lifei Recipe on rats with asthma under stress and the mechanisms] Zhong Xi Yi Jie He Xue Bao. 2005 Sep;3(5):391-6. Chinese. View Abstract

7. Yafune A, Cyong JC. Population pharmacokinetic analysis of ephedrine in Kampo prescriptions: a study in healthy volunteers and clinical use of the pharmacokinetic results. Int J Clin Pharmacol Res. 2001;21(2):95-102. View Abstract

8. Yamada H, Nagai T. In vivo antiinfluenza virus activity of Kampo medicine Sho-seiryu-to through mucosal immune system. Methods Find Exp Clin Pharmacol. 1998 Apr;20(3):185-92. View Abstract

9. Yamasaki K, Kajimura K, Nakano M, et al. Effects of preparations of Chinese medicinal prescriptions on digestive enzymes in vitro and in vivo. Biol Pharm Bull. 1998 Feb;21(2):133-9. View Abstract

10. Yamashiki M, Asakawa M, Kayaba Y, et al. Herbal medicine "sho-saiko-to" induces in vitro granulocyte colony-stimulating factor production on peripheral blood mononuclear cells. J Clin Lab Immunol. 1992;37(2):83-90. View Abstract