Glycyrrhiza uralensis

Known Contraindications

• • Yin-deficiency with heat signs
• • Acute febrile disease
• • Pregnancy
• • Kidney Yin deficiency without damp-heat (formula is strongly draining)
• • Pregnancy (Da Huang and diuretics)
• • Qi deficiency with profuse clear urination (wrong pattern)
• • Monitor renal function in patients with pre-existing kidney disease
• • Mu Tong species caution: use Akebia trifoliata, NOT Aristolochia manshuriensis (nephrotoxic aristolochic acid)
• • Hypertension
• • Hypokalemia
• • Prolonged use > 6 weeks without monitoring
• • Kapha-predominant edema (sweet taste increases Kapha)
• • Long-term use without monitoring (pseudoaldosteronism risk from Kanzo)
• • Concurrent aldosterone-affecting drugs
• • Pure exterior pattern (Hyō-Shō — use diaphoretic instead)
• • Pure interior excess (Ri-Jitsu-Shō — use purgative instead)
• • Caution in interferon therapy (historical adverse events with combination)
• • Monitor for interstitial pneumonia (rare but serious — identified through Japanese pharmacovigilance)
• • Kyo-Kan (deficiency-cold) pattern without heat signs
• • Severe Kidney Yang deficiency (use warming formula instead)
• • Severe renal impairment (monitor electrolytes)
• • Prolonged high-dose use (pseudoaldosteronism)
• • Concurrent diuretics or cardiac glycosides