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The traditional Chinese herbal medicine Sho‐saiko‐to is a mixture of seven herbal preparations that has long been used in the treatment of chronic liver disease. Various clinical trials have shown that Sho‐saiko‐to protects against the development of hepatocellular carcinoma in cirrhotic patients. However, the mechanism by which Sho‐saiko‐to protects hepatocytes against hepatic fibrosis and carcinoma is not yet known. Basic science studies have demonstrated that Sho‐saiko‐to reduces hepatocyte necrosis and enhances liver function. Sho‐saiko‐to significantly inhibits hepatic fibrosis by inhibiting the activation of stellate cells, the major producers of collagen in the liver, as well as by inhibiting hepatic lipid peroxidation, promoting matrix degradation, and suppressing extracellular matrix (ECM) accumulation. Furthermore, clinical trials have shown that Sho‐saiko‐to lowers the rate of hepatocellular carcinoma (HCC) development in patients with cirrhosis and increases the survival of patients with HCC. Unfortunately, some case reports have shown the side effects of Sho‐saiko‐to. Most of the side effects were interstitial pneumonia and acute respiratory failure induced by Sho‐saiko‐to in Japan. As a result of analyzing these case reports, the incidence and risk are increased by co‐administration of interferon, duration of medication, and, high in an elderly population. This review discusses the properties of Sho‐saiko‐to with regards to the treatment of chronic liver diseases and suggests the side effects of Sho‐saiko‐to