What Is Bofutsushosan? Effects, Side Effects, How to Take It, and a Comparison with GLP-1/SGLT2 Inhibitors

What Is Bofutsushosan? A Kampo Diet Medicine Combining 18 Crude Drugs

Bofutsushosan is a traditional Kampo formula described in the medical text “Xuanming Lun” written by Liu Wansu, a physician of China’s Jin-Yuan period. In Japan it is approved as a prescription Kampo preparation, and several manufacturers—Tsumura, Kracie, Kotaro, JPS, and others—produce and sell it.

Bofutsushosan is a formula built on the idea of expelling the “heat,” “water,” and “waste” trapped inside the body in three directions—through perspiration, diuresis, and bowel movement. It mainly targets men and women of medium build or stronger who have abundant abdominal subcutaneous fat and a tendency toward constipation, swelling, flushing, and high blood pressure, making it a Kampo medicine well suited to addressing metabolic syndrome in men.

• Classification: Kampo preparation (a Class-2 drug as an OTC product).
• Main component: An extract obtained from 18 crude drugs.
• Forms: Granules and tablets (varies by manufacturer).
• Indications (package insert): In people with abundant abdominal subcutaneous fat who tend toward constipation—palpitations, stiff shoulders, flushing, swelling, and constipation associated with high blood pressure or obesity; sinusitis; eczema; dermatitis; skin eruptions; and obesity.
• Common prescribing situations: Visceral-fat obesity, metabolic syndrome, and constipation-type obesity.

History and Insurance Coverage of Bofutsushosan: An Obesity Kampo Used for Over 800 Years

Bofutsushosan is a formula that originated in 12th-century China and was introduced to Japan in the Edo period. In Japan it was added to the drug tariff as a prescription Kampo preparation in 1976, and today it can be prescribed under insurance coverage for conditions such as “obesity” and “palpitations, stiff shoulders, and flushing associated with high blood pressure” (at the physician’s discretion).

It is also classified as a “Class-2 drug” available for purchase at pharmacies and drugstores as an OTC product, and is widely sold under brand names such as Naishitoru (Kobayashi Pharmaceutical), Coccoapo (Kracie), and Rohto Bofutsushosan (Rohto). The biggest differences between OTC products and a clinic prescription are the “daily amount of crude-drug extract” and whether “side-effect monitoring by a physician” is provided.

Bofutsushosan is called an “obesity Kampo” because it is one of the few Kampo medicines whose package-insert indications clearly list “obesity.” Among insurance-covered Kampo medicines that list obesity as an indication, three are representative—Bofutsushosan, Daisaikoto, and Boiogito: Bofutsushosan is chosen for men’s metabolic-type obesity, Boiogito for women’s water-retention-type obesity, and Daisaikoto for stress-type or dyslipidemia-type cases.

Its Place Among Kampo Medicines: A Medicine That Works When the “Sho” Matches

In Kampo medicine, each patient’s constitution and how symptoms manifest is called the ‘sho’ (pattern), and prescribing a medicine matched to the sho is emphasized. Bofutsushosan’s sho is expressed by keywords such as “excess pattern (jissho),” “interior heat (rinetsu),” and “constipation,” and specifically, people with the following characteristics are candidates.

• Medium build or stronger, with a solid, sturdy physique.
• Abundant subcutaneous fat around the belly—the so-called “potbelly” or “beer belly.”
• Tends toward constipation, with a bowel movement only once every 2–3 days.
• Prone to flushing, facial redness, and sweating.
• Has a hearty appetite and tends to overeat.

Conversely, Bofutsushosan does not suit people who are frail, have a weak stomach and intestines, are sensitive to cold, or tend toward diarrhea. A Kampo medicine works gently when the sho matches, but when it does not, only side effects tend to appear—so caution is needed. Having a physician assess your sho during an examination is the first step toward using Bofutsushosan safely.

A Thorough Look at the 18 Crude Drugs: The Actions of Ephedra, Rhubarb, and Mirabilite

The greatest characteristic of Bofutsushosan is that it combines as many as 18 crude drugs in a single formula. Since common Kampo medicines often contain 5–10 crude drugs, 18 is an exceptionally large composition. This is thought to be the composition needed to simultaneously achieve “perspiration, diuresis, bowel movement, fever reduction, and improved circulation.”

The following three crude drugs are the lead players in Bofutsushosan. Understanding their actions reveals the mechanisms behind both the effects and the side effects.

• Ephedra (mao): Contains ephedrine; stimulates the sympathetic nervous system and promotes fat burning.
• Rhubarb (daio): Contains sennosides; stimulates the intestines and promotes bowel movement.
• Mirabilite (bosho): Sodium sulfate; raises intestinal osmotic pressure and softens stool.

List of the 18 Crude Drugs and Their Roles

The 18 crude drugs contained in Bofutsushosan, organized by role, are as follows.

*The blending ratios of the crude drugs differ slightly by manufacturer, but the composition of 18 crude drugs itself is common to all.

The Fat-Burning Mechanism of Ephedra (Ephedrine)

At the center of the scientific basis for Bofutsushosan’s reputed diet effect are the ephedrine alkaloids contained in ephedra. Ephedrine acts on the sympathetic β3-adrenergic receptors and activates hormone-sensitive lipase inside fat cells, thereby breaking down triglycerides into glycerol and free fatty acids. It also promotes the activity of brown adipose tissue, which leads to heat production (a boost in metabolism).

For this reason, taking Bofutsushosan tends to produce changes such as body temperature rising by about 0.3–0.5°C, mild sweating, and increased post-meal energy expenditure (diet-induced thermogenesis). Several clinical studies report that groups who continued taking Bofutsushosan showed a significant reduction in visceral fat area compared with placebo groups.

However, ephedrine also has effects such as palpitations, insomnia, and elevated blood pressure, so people with heart disease, high blood pressure, or hyperthyroidism need to use it with caution.

The Bowel-Movement Mechanism of Rhubarb and Mirabilite: Why It Works for Constipation-Type Obesity

The sennosides in rhubarb are broken down by intestinal bacteria into active forms that directly stimulate the motility of the large intestine. This shortens stool transit time and promotes natural bowel movement. Mirabilite (sodium sulfate), acting as an osmotic laxative, draws water into the intestine and softens the stool, supporting bowel movement.

In the type of obesity called “constipation-type obesity“—in which waste building up in the intestines lowers metabolism and increases weight—improving bowel movement itself can lead to weight loss. As constipation is resolved, abdominal bloating eases, and quite a few people feel their waistline has slimmed by 2–4 cm in appearance.

However, using rhubarb-containing medicines for a long time risks making intestinal peristalsis dependent on the drug, leading to “atonic constipation” in which you cannot pass stool without the medicine. It is important to proceed with continuous use beyond three months while consulting a physician.

The Effects of Bofutsushosan: Fat Burning, Improved Bowel Movement, Reduced Swelling

The greatest concern of those searching for “Bofutsushosan effect” or “lost weight with Bofutsushosan” is likely “how much weight will I actually lose?” and “when will it start working?” To state the conclusion first, one guideline for Bofutsushosan is a loss of 1–3 kg in weight and 1–3 cm in waist circumference with three months of continuous use.

The effects of Bofutsushosan appear broadly from four directions.

• Fat burning: A metabolic boost and visceral-fat reduction from ephedra’s ephedrine.
• Improved bowel movement: Promoted defecation and a better intestinal environment from rhubarb and mirabilite.
• Reduced swelling: Diuretic action and improved water metabolism from talc and atractylodes.
• Accompanying effects: High-blood-pressure prevention, relief of stiff shoulders, and improvement of eczema and skin eruptions.

Guideline for Weight and Waist Changes by Treatment Period

Changes in weight and waist circumference from Bofutsushosan generally progress gradually over several months from the start. Clinical-trial data and real-world reports suggest the following guidelines.

*Weight and waist reduction vary by individual, and results change greatly with food intake, exercise level, baseline weight, and lifestyle. The table is a “guideline for Bofutsushosan alone” and does not guarantee results.

What many people tend to overlook is that Bofutsushosan is not a fast-acting drug; its effects appear gradually over half a month to more than a month. If you judge it “ineffective” and stop after 1–2 weeks, you may end up never experiencing its true effect.

Does Bofutsushosan Work on Visceral Fat or Subcutaneous Fat?

Bofutsushosan acts on both visceral and subcutaneous fat, but several clinical studies report that the reduction rate is greater for visceral fat. This is thought to be because ephedra’s ephedrine stimulates the sympathetic nervous system, activating the β3 receptors of visceral fat cells and promoting lipolysis.

Men’s obesity is often the visceral-fat type called the “apple shape,” with the belly alone protruding—the so-called beer belly or potbelly pattern. Men of this type are good candidates for Bofutsushosan. On the other hand, the “pear shape” (more common in women), in which fat accumulates in the lower body, is the subcutaneous-fat type, for which Boiogito may be more suitable than Bofutsushosan.

In the diagnostic criteria for metabolic syndrome in men, a waist circumference of 85 cm or more is regarded as the caution line. A man with a waist of 85 cm or more who tends toward constipation can be said to fit the typical profile for Bofutsushosan.

Who Bofutsushosan Suits and Who It Does Not

Bofutsushosan is not “a medicine anyone with obesity can take.” Because a Kampo medicine’s effects and side effects change greatly with how it suits one’s constitution, whether the ‘sho’ matches is the key.

In our physicians’ clinical experience, the more of the following characteristics a man has, the more readily he tends to feel the effects of Bofutsushosan.

Characteristics of People Bofutsushosan Suits

• Physique: Medium build or stronger; solid, sturdy, with a protruding belly.
• Belly type: Visceral-fat-type protruding belly (beer belly, potbelly).
• Bowel movements: Tends toward constipation (once every 2–3 days or less), with hard stool.
• Appetite: Hearty appetite with a tendency to overeat; frequent stress eating.
• Sensations: Prone to flushing, sweats easily, severe stiff shoulders.
• BMI: Mild-to-moderate obesity, around 25–30.
• Blood pressure: A mild-to-moderate tendency toward high blood pressure.
• Age: Prescribing experience is greatest for men from their late 30s to their 60s.

A man who matches three or four or more of these can be said to fit the typical profile for Bofutsushosan. In particular, those who have the three-point set of “constipation + protruding belly + hearty appetite” tend to see effects more readily.

People Bofutsushosan Does Not Suit or Who Cannot Take It

People to whom the following applies should not take Bofutsushosan, or require careful administration. When purchasing an OTC product as well, be sure to consult a pharmacist.

• Frail people with a weak stomach and intestines: Prone to diarrhea and abdominal pain from the stimulation of rhubarb and mirabilite.
• People sensitive to cold or prone to diarrhea: For a “deficiency pattern” constitution, the effect is weak and side effects are likely.
• People with a history of angina or myocardial infarction: Ephedra’s ephedrine burdens the heart.
• People with (severe) high blood pressure or hyperthyroidism: Ephedrine may worsen symptoms.
• People with urinary difficulty or prostatic hyperplasia: Ephedrine may worsen symptoms.
• People with diabetes taking other medications: Caution is needed regarding interactions.
• Pregnant or breastfeeding people: The laxative action of rhubarb and mirabilite affects the mother and fetus.
• Children under 15: Safety has not been established.
• People who have had allergic symptoms from Bofutsushosan in the past.

If any item applies to you, be sure to inform your physician or pharmacist. Avoid using an OTC product continuously over the long term on your own judgment, and if the effect is poor after taking it for three months or more, you should consider switching to another medical weight-loss drug.

How to Take Bofutsushosan Correctly and When

The basics of taking Bofutsushosan are “2–3 times a day, before meals or between meals, with water or lukewarm water.” Most Kampo medicines are considered to be better absorbed on an empty stomach, so it is common to take it 30 minutes before a meal or between meals (between meals, about two hours after eating).

If you forget a dose, take one dose when you remember. Never take two doses at once. If you cannot leave at least five hours before the next dose, skip that dose and resume at the next scheduled time.

Differences in Dose and Daily Extract Amount Between Prescription and OTC Products

Bofutsushosan comes as a prescription Kampo preparation (physician-prescribed) and a general-use Kampo preparation (OTC), and the daily amount of crude-drug extract differs.

*A “full-dose formula” contains the maximum amount in the package insert as the daily dose. “2/3-dose” and “1/2-dose” formulas are reduced versions. Because the content differs greatly by product even for the same “Bofutsushosan,” always check the “daily amount” on the package when buying.

Time Until Effects Appear: A Guideline of Half a Month to a Month

The effects of Bofutsushosan appear in stages. Listed in order of how readily they are felt, they are as follows.

• 1–3 days: Improved bowel movement (the earliest effect to appear).
• 3–7 days: Reduced swelling and less facial puffiness.
• 2–4 weeks: A felt sense of bodily warmth and a metabolic boost.
• 1–3 months: Weight and waist reduction begin to appear as numbers.
• 3–6 months: A significant reduction in visceral fat (verifiable by CT measurement).

It is too early to judge it “ineffective” in 1–2 weeks. Continuing for at least a month, and preferably three months, is the guideline for assessing the effect. Conversely, if there is neither improved bowel movement nor weight change after three months of continued use, the ‘sho’ likely does not match, so consult a physician and consider switching to another Kampo medicine or medical weight-loss drug.

Side Effects and Cautions for Bofutsushosan: Liver Dysfunction and Pseudoaldosteronism

The image that “Kampo medicines have no side effects” is a misconception. Bofutsushosan contains potent crude drugs such as ephedra, rhubarb, and licorice, and various side effects—from mild to serious—have been reported.

The package insert clearly lists five serious side effects requiring particular attention.

• Interstitial pneumonia: Fever, dry cough, shortness of breath (early detection is important).
• Liver dysfunction and jaundice: Fatigue, yellowing of the skin or whites of the eyes, loss of appetite.
• Pseudoaldosteronism: Numbness and weakness in the limbs, swelling, elevated blood pressure (occurs with long-term licorice use).
• Myopathy: Weakness in the limbs, muscle pain, a feeling of tightness.
• Mesenteric phlebosclerosis: Recurring abdominal pain, constipation, and diarrhea (caution with long-term use of 5 years or more).

Mild-to-Moderate Side Effects: A List of Frequent Symptoms

The side effects that are relatively frequent and that many people may experience are as follows.

• Gastrointestinal symptoms: Loss of appetite, stomach discomfort, nausea, abdominal pain, loose stool, diarrhea (especially common in the first week of use).
• Skin symptoms: Rash, itching, hives (allergic reactions).
• Cardiovascular and nervous system: Palpitations, a faster pulse, insomnia, an agitated state (the ephedrine action of ephedra).
• Other: Excessive sweating, urinary difficulty, dry mouth.

If these symptoms appear, first stop taking the medicine and watch for changes. If mild, they often improve within a few days, but if symptoms persist or are strong, see a physician.

The one to watch especially is “diarrhea.” Quite a few people get diarrhea because the action of rhubarb and mirabilite improves bowel movement too much. If you pass watery stool many times a day or have accompanying abdominal pain, reduce the dose or consult a physician about changing the medicine.

Risk of Liver Dysfunction: The Importance of Regular Blood Tests

Liver dysfunction from Bofutsushosan is an important side effect that, although low in frequency, has been reported with fatal cases in the past. Its onset mechanism is thought to be an immunological idiosyncratic reaction (a type of drug allergy), and its characteristic is that it can happen to anyone.

The early symptoms of liver dysfunction are as follows.

• General symptoms: Strong fatigue, fever, loss of appetite.
• Skin: Yellowing of the skin or whites of the eyes (jaundice).
• Urine: Urine turns dark brown (bilirubinuria).
• Itching: Whole-body itching.

If these symptoms appear, stop taking the medicine immediately and see a medical institution. With a clinic prescription, it can be checked with liver-function blood tests every 3–6 months (AST, ALT, γ-GTP, ALP, bilirubin). If you use an OTC product continuously over the long term, we recommend regularly checking liver function through your municipality’s specific health checkup or similar.

Pseudoaldosteronism: Hypokalemia Caused by Licorice

Bofutsushosan contains licorice (kanzo). The glycyrrhizic acid in licorice can cause pseudoaldosteronism through excessive intake or long-term continuous use.

Pseudoaldosteronism is a condition in which an action resembling that of the adrenal hormone (aldosterone) causes a drop in blood potassium and retention of sodium and water. Specifically, the following symptoms appear.

• Numbness and weakness in the limbs (worsening especially from evening to night).
• Muscle pain and leg cramps.
• Swelling of the face and limbs.
• Elevated blood pressure.
• Headache and nausea.

Because the risk of pseudoaldosteronism rises when combined with other licorice-containing Kampo medicines (such as Shakuyakukanzoto), anyone taking multiple Kampo medicines must inform their physician. If detected early, it improves with discontinuation and correction, but left unattended it can lead to serious arrhythmia.

Bofutsushosan vs. GLP-1 and SGLT2 Inhibitors: Where It Fits in Medical Weight Loss

In recent years, the options for medical weight loss have expanded greatly. In addition to the Kampo medicine Bofutsushosan, drugs with various approaches are prescribed, such as the GLP-1 receptor agonists Mounjaro and Rybelsus, the SGLT2 inhibitor Jardiance, and the appetite suppressant Sanorex.

Because each has a different mechanism of action and magnitude of effect, it is important to choose according to your constitution, lifestyle, and budget.

Comparison Table of Medical Weight-Loss Drugs: Effect, Side Effects, Cost

Comparing the major medical weight-loss drugs reveals the following differences in characteristics.

*Costs are self-pay guidelines as of May 2026 and vary by clinic.

As the table shows, Bofutsushosan is the lowest-cost and easiest medical weight-loss option to start with, and it is an excellent entry point for those with mild-to-moderate obesity who want to “try Kampo first.” On the other hand, for moderate-to-severe obesity with a BMI of 30 or more, or when accompanied by diabetes or high blood pressure, GLP-1 or SGLT2 inhibitors can be expected to have a greater effect.

Can Bofutsushosan Be Combined with GLP-1 or SGLT2 Inhibitors?

Combining Bofutsushosan with GLP-1 (Rybelsus, Mounjaro) is done in some cases under a physician’s judgment. The combination—aiming for appetite suppression and glycemic improvement with GLP-1, and improved bowel movement and visceral-fat reduction with Bofutsushosan—works complementarily, so a synergistic effect can be expected.

On the other hand, combining Bofutsushosan with an SGLT2 inhibitor (Jardiance) requires caution. Because both have diuretic action, the risk of dehydration rises. If combined, you must thoroughly maintain a fluid intake of at least 1.5–2 L per day and receive physician follow-up.

For any combination, the rule of thumb is to do it under a physician’s prescription, not on your own judgment. Absolutely avoid combining OTC Bofutsushosan with clinic-prescribed GLP-1 on your own.

The Difference from Naishitoru, Coccoapo, and OTC Products

Many people have seen the names “Naishitoru” (Kobayashi Pharmaceutical) and “Coccoapo” (Kracie) at drugstores. These are all Class-2 drugs that use the same formula as Bofutsushosan, and their active ingredient is Bofutsushosan extract itself.

So why are the product names different? The biggest reasons are marketing branding and differences in the daily extract amount. It is important to understand that even for the same “Bofutsushosan,” the daily extract amount differs greatly among each company’s products.

Comparison of Extract Amounts for Naishitoru, Coccoapo, etc.

Comparing the daily extract amounts of major manufacturers’ representative products gives the following.

*Extract amounts may change by package or period. Check the labeling at the time of purchase for the latest information.

The point is that the larger the extract amount, the more readily effects appear—but the risk of side effects also rises. When choosing an OTC product, the safe approach is to start with the 2/3-dose type, confirm there are no side effects, and then move to the full-dose formula.

Three Differences Between OTC Products and a Clinic Prescription

There are three major differences between OTC products and a prescription at a medical institution.

• (1) Assessment of constitutional fit: At a clinic, the physician assesses the ‘sho’ before prescribing, so there is less wasted effort. With OTC products, because it is self-judged, there are cases where people for whom it does not suit keep taking it and only get side effects.
• (2) Side-effect monitoring: At a clinic, liver- and kidney-function blood tests can be performed regularly. With OTC products, side effects are hard to notice.
• (3) Cost: Under insurance coverage, a prescription at a medical institution is often cheaper than OTC products (about 1,000–3,000 yen a month at 30% co-payment).

If it is just “I’m a bit concerned about my waistline,” starting with an OTC product is fine, but if you want to seriously tackle weight loss, continue for three months or more, or are also taking other medications, we recommend a prescription at a medical institution. Men’s Care Clinic offers both insured and self-pay care and proposes the best option to match each patient’s constitution and wishes.

Bofutsushosan as a Measure for Men’s Metabolic Syndrome and Visceral Fat

Metabolic syndrome in men refers to a state, based on visceral-fat obesity, of also having two or more of high blood pressure, dyslipidemia, and high blood sugar. It is estimated that about one in two Japanese men aged 40–74 has metabolic syndrome or is a reserve case, and it is known that, left unattended, the risk of myocardial infarction and cerebral infarction rises 2–3 fold.

Bofutsushosan is a Kampo medicine positioned as a “first step” in such measures for men’s metabolic syndrome.

Metabolic Syndrome Criteria and the Timing of Bofutsushosan Intervention

Japan’s diagnostic criteria for metabolic syndrome are as follows.

• Required item: Waist circumference of 85 cm or more for men / 90 cm or more for women.
• Selective items (diagnosed with two or more):
  • Systolic blood pressure 130 mmHg or higher, or diastolic blood pressure 85 mmHg or higher.
  • Triglycerides 150 mg/dL or higher, or HDL cholesterol below 40 mg/dL.
  • Fasting blood glucose 110 mg/dL or higher.

At the stage of being diagnosed as a “metabolic syndrome reserve case” with a waist of 85 cm or more, it is worth considering Bofutsushosan intervention. Reducing visceral fat early raises the likelihood of preventing the onset of diabetes and high blood pressure.

In a clinical study that prescribed Bofutsushosan to men diagnosed with metabolic syndrome at the Ministry of Health, Labour and Welfare’s specific health checkup (metabolic checkup), it was reported that waist circumference decreased by an average of 2–3 cm in six months, and improvements in triglycerides, HbA1c, and blood pressure were also observed.

Diet, Exercise, and Lifestyle to Maximize the Effect of Bofutsushosan

Bofutsushosan is not “a medicine that makes you lose weight just by taking it.” Its effect is maximized by combining it with appropriate diet and exercise. The combined approach our physicians recommend is as follows.

• Diet: Adjust daily calorie intake down by 300–500 kcal. Be mindful of dietary fiber (vegetables, seaweed, mushrooms) at every meal, and keep fried foods, sweets, and sugary drinks to no more than three times a week.
• Exercise: Aerobic exercise 3–4 times a week (about 30 minutes of brisk walking) plus strength training twice a week. A synergistic effect with ephedra’s fat-burning action can be expected.
• Fluids: A fluid intake of 1.5–2 L a day. Because the medicine is diuretic, this is important for preventing dehydration.
• Sleep: Seven or more hours of sleep. Sleep deprivation increases the appetite hormone (ghrelin) and decreases the satiety hormone (leptin).
• Abstaining from or moderating alcohol: Bofutsushosan plus excessive drinking burdens the liver. Set two alcohol-free days a week.
• Recording weight and waist: Record your weight and waist daily after waking and using the toilet. Visualizing the numbers becomes motivation to continue.

By practicing these, you can expect 1.5–2 times the weight-loss effect of Bofutsushosan alone. Not forgetting the stance that “the medicine is a supplement; the lead role is lifestyle improvement” is the key to dieting success.

Bofutsushosan Prescription at Men’s Care Clinic

Men’s Care Clinic offers, as options for men’s metabolic-syndrome measures and medical weight loss, prescriptions for Bofutsushosan, GLP-1 (Mounjaro, Rybelsus), SGLT2 inhibitors (Jardiance), and Sanorex. Based on each patient’s constitution, BMI, medical history, and budget, our physicians propose the optimal drug.

At the first visit, the examination proceeds as follows.

• (1) Interview: Check physique, dietary and exercise habits, bowel movements, sleep, medical history, and current medications.
• (2) Measurement: Height, weight, BMI, waist circumference, blood pressure.
• (3) Blood test: Measure liver function, kidney function, lipids, blood glucose, and HbA1c (as needed).
• (4) Kampo-medical assessment: Determine the ‘sho’ from stamina, sensitivity to cold, swelling, and constipation.
• (5) Prescription proposal: The physician decides on Bofutsushosan alone or in combination with other drugs.
• (6) Follow-up: Check effects and side effects at follow-up visits at 1 and 3 months.

Because online consultations are also available, even those far away or busy can complete everything from examination to prescription to delivery from home. “I want to start with a Kampo medicine, but I don’t know which one suits me”—if that’s you, please feel free to start with a free consultation.

Frequently Asked Questions (FAQ)

This article was created under the supervision of the Men’s Care Clinic medical team, based on package inserts, domestic and international clinical-trial data, and the guidelines of the Japan Society for Oriental Medicine. The content is information as of May 2026; always check the latest package inserts and guidelines. Actual prescriptions differ according to each patient’s individual condition (sho, medical history, concomitant medications).

{
“@context”: “https://schema.org”,
“@type”: “MedicalWebPage”,
“name”: “What Is Bofutsushosan? Effects, Side Effects, How to Take It, and a Comparison with GLP-1/SGLT2 Inhibitors”,
“url”: “https://mens-care-clinic.com/medical_column/article_059/”,
“description”: “Bofutsushosan is a Kampo diet medicine combining 18 crude drugs. The Men’s Care Clinic medical team explains its effects, side effects, how to take it, a comparison with GLP-1 and SGLT2 inhibitors, and the difference from Naishitoru.”,
“about”: {
“@type”: “Drug”,
“name”: “Bofutsushosan”,
“alternateName”: “Boufutsushosan”,
“drugClass”: “Kampo preparation”
},
“audience”: {“@type”:”MedicalAudience”,”audienceType”:”Patient”},
“author”: {“@type”:”Organization”,”name”:”Men’s Care Clinic”},
“publisher”: {“@type”:”Organization”,”name”:”Men’s Care Clinic”,”url”:”https://mens-care-clinic.com/”},
“dateModified”: “2026-05-09”
}

{
“@context”: “https://schema.org”,
“@type”: “FAQPage”,
“mainEntity”: [
{“@type”:”Question”,”name”:”Does Bofutsushosan really cause weight loss?”,”acceptedAnswer”:{“@type”:”Answer”,”text”:”For people who fit the indication, one guideline is a loss of 1–3 kg in weight and 1–3 cm in waist with three months of continuous use. Several clinical studies report, in particular, a reduction in visceral fat area. However, for those whose ‘sho’ does not match, effects are hard to see, and combining diet and exercise is a prerequisite.”}},
{“@type”:”Question”,”name”:”When is the correct time to take Bofutsushosan?”,”acceptedAnswer”:{“@type”:”Answer”,”text”:”The basics are to take it 2–3 times a day, 30 minutes before a meal or between meals (two hours after eating), with water or lukewarm water. Kampo medicines are considered to be better absorbed on an empty stomach. If you forget a dose, take one dose when you remember, and avoid taking two doses at once.”}},
{“@type”:”Question”,”name”:”Are the side effects of Bofutsushosan frightening?”,”acceptedAnswer”:{“@type”:”Answer”,”text”:”As mild side effects, diarrhea, palpitations, insomnia, and rash are seen relatively frequently. As serious side effects, liver dysfunction, pseudoaldosteronism, and interstitial pneumonia have rarely been reported, and liver-function blood tests every 3–6 months are recommended.”}},
{“@type”:”Question”,”name”:”Are Bofutsushosan and Naishitoru/Coccoapo different medicines?”,”acceptedAnswer”:{“@type”:”Answer”,”text”:”The active ingredient is the same ‘Bofutsushosan extract’. Naishitoru (Kobayashi Pharmaceutical) and Coccoapo (Kracie) are brand names, and the formula itself is identical. The differences are the daily extract amount and the brand price.”}},
{“@type”:”Question”,”name”:”Which causes more weight loss, Bofutsushosan or GLP-1 (Rybelsus, Mounjaro)?”,”acceptedAnswer”:{“@type”:”Answer”,”text”:”Speaking only of the magnitude of weight loss, GLP-1 (especially Mounjaro) is greater, at about 8–15 kg over six months. Bofutsushosan is a guideline of 2–4 kg, but it has its own strengths—low cost, improved bowel movement, and reduced swelling—and is excellent as a first option for mild obesity or constipation-type obesity.”}},
{“@type”:”Question”,”name”:”Does Bofutsushosan work for men too?”,”acceptedAnswer”:{“@type”:”Answer”,”text”:”Yes. Men of medium build or stronger with a protruding belly fit the typical profile for Bofutsushosan. For visceral-fat obesity (apple shape), common in men, ephedra’s fat-burning action and rhubarb’s bowel-movement action work complementarily and are considered effective for tightening the waistline.”}},
{“@type”:”Question”,”name”:”Will I rebound if I stop taking Bofutsushosan?”,”acceptedAnswer”:{“@type”:”Answer”,”text”:”If diet and exercise stay as they were before, weight tends to return. At the time you finish, having your dietary and exercise habits in order is the key to preventing rebound. Rather than stopping abruptly, it is recommended to taper off gradually while consulting your physician.”}},
{“@type”:”Question”,”name”:”Is Bofutsushosan covered by insurance?”,”acceptedAnswer”:{“@type”:”Answer”,”text”:”If a diagnosis such as ‘obesity’, ‘palpitations, stiff shoulders, and flushing associated with high blood pressure’, or ‘constipation’ is made, a prescription at a medical institution is covered by insurance. At 30% co-payment, a guideline is about 1,000–3,000 yen a month. OTC products are entirely self-pay and cost 3,000–8,000 yen a month.”}},
{“@type”:”Question”,”name”:”Is it okay to take Bofutsushosan with alcohol?”,”acceptedAnswer”:{“@type”:”Answer”,”text”:”A small amount of alcohol poses no immediate problem, but excessive drinking burdens the liver and raises the risk of liver dysfunction, so avoid it. The combination of ephedra’s ephedrine and alcohol also greatly burdens the cardiovascular system. Set two or more alcohol-free days a week.”}},
{“@type”:”Question”,”name”:”How many months do I need to continue Bofutsushosan?”,”acceptedAnswer”:{“@type”:”Answer”,”text”:”For assessing the effect, a guideline is continuing for at least a month, and preferably three months. If there is no change after three months, the ‘sho’ likely does not match, so consult a physician. Because long-term continuous use (5 years or more) carries a risk of mesenteric phlebosclerosis, avoid aimless use.”}},
{“@type”:”Question”,”name”:”Can Bofutsushosan be combined with other Kampo medicines?”,”acceptedAnswer”:{“@type”:”Answer”,”text”:”Combining with other licorice-containing Kampo medicines (such as Shakuyakukanzoto and Shoseiryuto) raises the risk of pseudoaldosteronism and should be avoided. Combining with other ephedra-containing Kampo medicines also causes palpitations and insomnia. Be sure to inform your physician or pharmacist.”}},
{“@type”:”Question”,”name”:”Can Bofutsushosan be bought by personal import or online?”,”acceptedAnswer”:{“@type”:”Answer”,”text”:”It can be purchased as a Class-2 drug at domestic drugstores and online stores. Overseas personal-import sites carry a risk of counterfeits and inferior products with different ingredient amounts and should be avoided. To obtain it safely, we recommend choosing a domestic drugstore or a prescription at a medical institution.”}}
]
}