Kampo medicine, a traditional Japanese herbal system, is increasingly demonstrating its efficacy for functional gastrointestinal disorders (FGIDs) through randomized controlled trials (RCTs), complementing its classic use based on patient pattern (sho) diagnosis. This review synthesizes current clinical evidence and mechanisms of key Kampo formulas. For functional dyspepsia, Rikkunshito is the first-line treatment, proven to enhance ghrelin signaling and improve gastric motility. In cases of PPI-refractory GERD, Hangeshashinto offers significant therapeutic benefit. For irritable bowel syndrome (IBS), treatments are tailored to subtypes: Keishikashakuyakuto for mixed-type, Ninjinto for diarrhea-predominant, and Daikenchuto for constipation with bloating. Furthermore, Daikenchuto is effective for postoperative ileus and functional constipation by promoting intestinal motility and blood flow. Unlike single-target Western pharmaceuticals, these multicomponent medicines modulate integrated regulatory systems via prokinetic, antiinflammatory, and psychotropic actions. This evidence confirms that Kampo medicine provides a valuable, multitarget therapeutic strategy for the complex pathophysiology of FGIDs, offering effective options where conventional treatments are limited.