By Eric Brand

I had the good fortune to spend the past few days in Tokyo, and, in true herb nerd fashion, naturally one of my first stops was a pharmacy to scope out the local range of Kampo granule products. In Japan, granule products are covered by national insurance and most products are only available by prescription from an MD or a licensed pharmacist. However, a number of Kampo remedies are available over the counter, and today’s blog will focus on the selection of OTC products that can be found on the street in a typical pharmacy.

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Historically, Japan and China shared a common cultural foundation back in the Tang dynasty, but the two cultures branched into different directions by the time of China’s Song dynasty (about 1000+ years ago). Many of the formulas used in Japan today date back to the Han dynasty, with a particular emphasis on formulas from Zhang Zhong-Jing’s Shang Han Za Bing Lun. While a number of later generation formulas can also be found in Japan, including famous recipes such as Li Dong-Yuan’s Bu Zhong Yi Qi Tang and warm disease formulas such as Yin Qiao San, many of the most obvious formulas on the shelves date back to the early foundations of Chinese medicine.

Many OTC granule products in Japan are somewhat different than the granule products widely seen in Taiwan, the U.S., and mainland China in terms of their consistency and excipients. One could say that OTC products such as the Ge Gen Tang packets shown above have characteristics that are similar to both the granules of Taiwan and mainland China, yet they have notable differences when compared to either the mainland Chinese or Taiwanese products. Notably, key differences and similarities exist in terms of the dissolvability, packaging, excipients, and particle size.

In mainland China, it is common for granules to be packaged in single-dose foil packs. Notably, granules in mainland China are largely foil packs of single herb extracts, while compound formulas are comparatively rare. By contrast, in Taiwan many products are compound formulas (though single extracts are also present). In Taiwan, granule formulas tend to be packaged in 200g bottles and singles tend to be packaged in 100g bottles. In Japan, foil packs and capsules are widely seen on the OTC market, but most products are compound formulas rather than single herb extracts.

In terms of excipients, there are interesting differences between the regions. In mainland China, granules are usually first made into a pure extract powder with no excipient and then they are formed into large-particle granules with or without the addition of dextrin. In Taiwan, granules usually have starch added during the granulation process, and the particle size is very small (i.e., the product is a fine powder rather than large kernels). Interestingly, the OTC granules in Japan are an intermediate size, with a larger particular size than the Taiwanese product but with smaller kernels than the typical mainland Chinese product. Another key difference is that the Japanese granules use lactose as an excipient. Lactose adds a nice sweet flavor while still allowing for high dissolvability. As a consumer, the Japanese product is extremely smooth when taken by mouth: it melts in the mouth without either the starchy residue of the Taiwanese products or the intensely concentrated but harsh flavor of the mainland Chinese products. The taste is richly herbal yet slightly sweet and smooth, perfect for OTC products for the mainstream consumer market. However, I can’t even imagine the reaction to a lactose-based granule on the allergen-sensitive U.S. market!

Another interesting feature of the Asian markets is that the raw herb equivalence of the granule products is clearly stated on all granule products, whereas granules products in the West rarely publish their concentration ratios. In Japan, boxes of multiple single-dose foil packets are sold with a clear description of the raw herb equivalence of each herb within the formula. In Taiwan, every bottle has a label that describes the raw herb equivalence per gram of finished product. In mainland China, each packet of granules states its raw herb equivalence. Ideally, such data would also be available in the West, yet it seems that most companies prefer not to reveal this information because the market doesn’t request or require it. In reality, the actual concentration often varies slightly from batch to batch, yet nevertheless a case can be made for the inclusion of data on concentration ratios based on the model used in Asian markets.

The product pictured above is Ge Gen Tang. The taste was exceptional; very distinctive flavors such as that of ephedra and cinnamon could be readily distinguished, and the dissolvability was excellent. It was slightly sweet due to the addition of lactose, and 10 packets were sold OTC for about $6. Herbal tourism at its best!

(Please note: The vast majority of my personal education is rooted in Chinese medicine rather than Japanese medicine, so I apologize in advance for any inadvertent errors derived from my imperfect understanding of Japanese medicine. I welcome any corrections and contributions, so readers please write a comment if you have corrections or contributions in this regard.)