Yi-gan san

Scientific Name(s): Angelica acutiloba Kitagawa, Atractylodes lancea De Candolle, Bupleurum falcatum Linne, Cnidium officinale Makino, Glycyrrhiza uralensis Fisher, Poria cocos Wolf, Uncaria rhynchophilla Miquel
Common Name(s): TJ-54, Tsumura, Ukgansan, Yi-gan san, Yoku-kan-san, Yokukan-san, Yokukansan

Medically reviewed by Drugs.com. Last updated on Aug 23, 2021.

Clinical Overview

Use

Yi-gan san has been used for centuries as a traditional herbal medicine to treat agitation and restlessness in children and has often been administered to both the mother and infant. In Japan, it is approved for neurosis, insomnia, night cry in children, and irritability in children. Increasingly, yi-gan san is being used for a variety of psychological and psychiatric conditions associated with dementia, personality disorder, schizophrenia, sleep disorders, traumatic brain injury, and Charles Bonnet syndrome. There is limited clinical data indicating its usefulness in chronic urticaria and tardive dyskinesia.

Dosing

According to the prescribing information for the Japanese commercial product (TJ-54), the usual adult dosage of yi-gan san formulation is 7.5 g/day given orally in 2 or 3 divided doses. The dosage may be adjusted based on patient age, body weight, and symptoms for the relief of symptoms of nervousness (ie, neurosis, insomnia, night crying in children, irritability). This dose has also been used in clinical studies for treatment of behavioral and psychological symptoms of dementia, tardive dyskinesia, aggressive dream-enacting behavior, and visual hallucinations. Doses of the yi-gan san formulation ranging from 2.5 to 7.5 g/day have been studied in females with borderline personality disorder.

Yi-gan san dosages of 2.5 g once or twice daily (evening and/or bedtime) as an adjunct to psychotropic regimens have been used to treat restless leg syndrome (RLS) and abnormal night eating behavior. A dosage of 2.5 g 3 times daily as an adjunct to antipsychotic treatment has been used to manage treatment-resistant schizophrenia.

Contraindications

Contraindications have not been identified.

Pregnancy/Lactation

Since 1555, yi-gan san has been used in breast-feeding mothers, infants, and children; however, information regarding safety and efficacy in pregnancy and lactation is lacking. According to Japanese product labeling, the safety of yi-gan san has not been established.

Interactions

Coadministration of glycyrrhiza-, glycyrrhizinic acid-, or glycyrrhizinate-containing preparations may lead to pseudoaldosteronism, hypokalemia, and myopathy.

Adverse Reactions

Reversible adverse effects reported include sedation, nausea, vomiting, diarrhea, epigastric discomfort, hypokalemia, and leg edema. Clinically important adverse reactions are interstitial pneumonia, pseudoaldosteronism, heart failure, myopathy or rhabdomyolysis, hepatic dysfunction and jaundice, and skin hypersensitivity (ie, rash, redness, pruritus). Use caution in patients with extremely weak GI tracts, as adverse effects including anorexia, nausea, vomiting, diarrhea, and epigastric distress may occur.

Toxicology

No data are available.

Scientific Family

• Compositae
• Leguminosae
• Polyporaceae
• Rubiaceae
• Umbelliferae

Botany

Yi-gan san is an herbal formulation used in traditional East Asian medicine. Yi-gan san is composed of a ratio of 4:4:3:3:3:2:1.5 of the following 7 dried medicinal herbs: Atractylodis Lanceae Rhizoma (rhizome of A. lancea De Candolle, Compositae), Poria (sclelrotium of P. cocos Wolf, Polyporaceae [also known as Hoelen]), Cnidii Rhizoma (rhizome of C. officinale Makino, Umbelliferae), Angelicae Radix (root of A. acut...