PEP Topic 

Hangeshashinto, a traditional Japanese medicine, contains seven herbal crude drugs: pinelliae tuber, Scutellariae Radix, Glycyrrhizae Radix, Zizyphi fructus, Ginseng Radix, Zingiberis Processum Rhizoma, and Coptidis Rhizoma. It reduces prostaglandin E2 levels and affects cyclooxygenase activity. Hangeshashinto is used in Japan to treat gastritis, stomatitis, and inflammatory diarrhea and has been studied in patients with cancer as a treatment for chemotherapy-induced oral mucositis.

Effectiveness Not Established

Research Evidence Summaries

Kono, T., Satomi, M., Chisato, N., Ebisawa, Y., Suno, M., Asama, T., . . . Furukawa, H. (2010). Topical application of hangeshashinto (TJ-14) in the treatment of chemotherapy-induced oral mucositis. World Journal of Oncology, 1, 232–235.

doi: 10.4021/wjon263w

Study Purpose:

To determine if hangeshashinto (TJ-14) is an effective treatment for oral mucositis

Intervention Characteristics/Basic Study Process:

Patients with oral lesions 7–10 days after chemotherapy were given a 50 ml oral rinse with 2.5 g of TJ-14 and tap water three times per day for 7 days. Patients held the solution in their mouth for 10 seconds and spit it out. TJ-14 also was applied to the lesions with a cotton pellet as soon as the lesion appeared. Patients could not eat or drink 30 minutes before or after treatment. No other mucosal treatments were used during the study. Two blinded physicians graded mucositis.

Sample Characteristics:

  • N = 14  
  • MEAN AGE: 62 years
  • AGE RANGE: 34–80 years
  • MALES: 43%, FEMALES: 57%


  • SITE: Single site   
  • SETTING TYPE: Outpatient   
  • LOCATION: Japan

Phase of Care and Clinical Applications:

  • PHASE OF CARE: Active antitumor treatment

Study Design:

  • Non-randomized trial

Measurement Instruments/Methods:

  • Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 mucositis scale


In this study, 92.8% of patients had improvements in oral mucositis. There was a significant reduction in CTCAE grades of mucositis for all participants from 2.4 ± 0.8 to 1.1 ± 0.8 (p = 0.0012). No adverse events or side effects from NJ-14 were reported.


NJ-14 was effective at improving oral mucositis and did not have any reported side effects in this small sample. However, caution must be used in interpreting this data due to the limitations of the study.


  • Small sample (< 30)
  • Risk of bias (no control group)
  • Risk of bias (no random assignment)
  • Risk of bias (no appropriate attentional control condition)


Nursing Implications:

NJ-14 is a promising intervention to treat chemotherapy-induced oral mucositis; however, more research is needed from large RCTs.