Goreisan for Heart Failure

Despite remarkable advances in guideline-directed medical therapy, congestion remains a major determinant of hospitalization and mortality in patients with heart failure. Loop diuretics are indispensable for symptom relief; however, prolonged or high-dose use may induce neurohormonal activation, renal dysfunction, electrolyte imbalance, and diuretic resistance, highlighting the need for alternative decongestive strategies. Goreisan, a traditional Japanese Kampo medicine, has recently attracted attention as an adjunctive approach for heart failure because of its unique ability to regulate body water homeostasis. Unlike conventional diuretics that promote forced diuresis, Goreisan appears to "modulate" aquaporin-mediated water transport, facilitating physiological water balance while minimizing excessive intravascular volume depletion. Emerging experimental studies also suggest anti-inflammatory and cardio-protective effects. Clinical evidence has generated increasing interest in its potential role for managing refractory congestion. This review summarizes the pathophysiological basis of congestion in heart failure, the limitations of current diuretic therapy, the pharmacological mechanisms of Goreisan, and the available clinical evidence supporting its use. Although current evidence remains limited, Goreisan may represent a promising adjunctive strategy for optimizing congestion management alongside contemporary guideline-directed medical therapy.