Mogami, S., & Hattori, T. (2014). Beneficial effects of Rikkunshito, a Japanese Kampo medicine, on gastrointestinal dysfunction and anorexia in combination with western drug: A systematic review. Evidence-Based Complementary and Alternative Medicine, 2014, 519035. 

• FINAL NUMBER STUDIES INCLUDED = 60 
• TOTAL PATIENTS INCLUDED IN REVIEW: Not able to determine the total number of patient is this review
• KEY SAMPLE CHARACTERISTICS: Characteristics spanned a wide variety of diagnoses that included cancer, dyspepsia, and gastroesophageal reflux disease. 

Twelve studies looked at rikkunshito’s effects on anorexia in subjects with cancer. Three studies utilized human subjects. These studies looked at patients receiving cisplatin for unresectable/relapsed gastric cancer and gemcitabine for pancreatic cancer with ascites. The results showed that rikkunshito improved anorexia in 19 patients receiving docetaxel/5-FU/cisplatin. When evaluated for nausea, mood, and activities of daily living, scores in these metrics were significantly lower in the rikkunshito group compared to controls. In a crossover design, the effects of rikkunshito on cisplatin-induced anorexia were studied, which demonstrated an increase in oral intake, no decrease in ghrelin levels, and a lower grade of anorexia in patients taking rikkunshito compared to when those patients were not taking rikkunshito. In a retrospective study of 39 patients who were treated with gemcitabine, improvement in anorexia was noted as well as increased survival. In the studies of anorexia, models utilizing animals revealed improved food intake with increased ghrelin levels that were noted along with improved survival. Rikkunshito was combined with various western agents in these studies and was shown to improve gastrointestinal side effects/symptoms and not affect the effects of the agents (e.g., SSRIs, antimicrobial agents, antiparkinson agents). There was no indication for any effect on CYP isoenzymes or P-gp.

Rikkunshito combined with western anticancer medicines has been shown to improve appetite by increasing ghrelin levels, thereby reducing anorexia.

All studies were conducted in Japan where Kampo medicine is used frequently and is readily available for use. There were very few human studies conducted; the majority of studies utilized animal subjects.

Rikkunshito appears to be a promising medication to improve anorexia, but there is inadequate data to recommend this agent at this time. Additional studies utilizing human subjects and a variety of anticancer medications as well as cancer diagnoses need to be conducted. In addition, studies are needed to evaluate the use of rikkunshito for the management of gastrointestinal symptoms in other diagnoses (e.g., depression, Parkinson’s, gastroesophageal reflux disease).