About dementia and Yokukansan
- H.Kitaoka
- Dec 23, 2025
- 3 min read
Introduction
Japan's population is aging at an unprecedented rate, and the number of dementia patients is increasing year by year. While dementia tends to focus on forgetfulness and memory impairment, behavioral and psychological symptoms of dementia (BPSD) pose a significant challenge in clinical and care settings.
Irritability, verbal abuse/violence, wandering, hallucinations, delusions, insomnia, anxiety, and restlessness—these symptoms significantly increase the burden not only on the individual but also on their family and caregivers, making it difficult to continue providing care at home.
Western medical treatments for BPSD include antipsychotics, anxiolytics, and sleeping pills, but they often pose significant problems, such as side effects, oversedation, and an increased risk of falls. Against this backdrop, the herbal medicine Yokukansan has recently attracted renewed attention.
What kind of herbal medicine is Yokukansan?
Yokukansan is a herbal medicine based on the Edo period medical book "Baoing Shayo." It was originally used to treat children's nighttime crying and colic. It consists of the following seven herbal ingredients:
Bupleurum Root
Angelica Officinalis
Szechuan Lovage Rhizome
Atractylodes Root
Poria Cocos
Diao Teng Kang
Licorice Root
In traditional Chinese medicine, Yokukansan is believed to suppress excitement in the "liver" and soothe mental tension and excitement. The "liver" is deeply connected to the balance of emotions and the autonomic nervous system, and has been associated with symptoms such as anger, anxiety, impatience, and irritability.
BPSD in Dementia and Yokukansan
BPSD in dementia patients occurs frequently, regardless of the type of dementia (Alzheimer's disease, Lewy body disease, vascular dementia, etc.). In particular, symptoms such as
irritability
agitation
aggression
insomnia
hallucinations and delusions
are often targeted for drug treatment.
Yokukansan has been praised for its relatively mild effect on these symptoms and its lack of excessive sedation. It has been introduced in many clinical settings, particularly for the hallucinations and agitation that are problematic in Lewy body dementia, as it may be safer than antipsychotics.
Current Scientific Evidence
Several clinical studies and randomized controlled trials have reported on the effectiveness of yokukansan.
These studies have shown significant improvements in overall BPSD scores, reductions in agitation, irritability, and hallucinations, and little evidence of adverse effects on cognitive function (e.g., MMSE).
Suggested mechanisms of action include:
suppression of glutamate overexcitation,
regulation of serotonin receptors,
suppression of neuroinflammation, etc.
This suggests that a certain degree of explanation is possible from a Western medical perspective.
Patient Profiles Suitable for Yokukansan
Yokukansan is not a panacea, but it is particularly useful in the following cases:
Irritability and agitation over trivial matters
Symptoms worsen in the evening and at night
Insomnia and nocturnal delirium are prominent
Concerns about the side effects of antipsychotics
Elderly people with relatively reduced physical strength
However, because it contains licorice, caution is needed regarding hypokalemia and pseudoaldosteronism, and regular monitoring is important.
Implications for Family and Caregivers
When the patient's symptoms improve even slightly with the introduction of Yokukansan, the psychological burden on caregivers is greatly reduced.
"They no longer yell," "They can sleep better at night," "Their facial expression has become calmer."
These changes are difficult to quantify, but are so significant that they can determine whether or not home care can be continued.
The idea of "regulating" rather than "suppressing" symptoms with medication is consistent with the direction of medical care in a super-aging society.
Bridging the Gap Between Western and Kampo Medicine
Yokukansan is not a cure for dementia itself. However, it plays a significant role as part of environmental adjustments that help individuals maintain their individuality.
The perspective of "integrated medicine," which utilizes the strengths of both Western and Kampo medicine rather than viewing them as opposing forces, will become increasingly important in the future.
If pharmacies and medical institutions can listen to not only patients but also their families and caregivers and present Yokukansan as an appropriate option, it will help improve the quality of community-based comprehensive care.
Conclusion
In dementia care, the goal is not just to achieve a complete cure.
It is also important to transform daily life, often filled with anxiety, anger, and confusion, into something even slightly more peaceful.
Yokukansan has a strong presence as one option for achieving this.
The role that the Kampo medicine Yokukansan plays in providing a little relief to everyone—seniors, their families, and medical and caregivers—will continue to attract attention.
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