Characteristics of Kampo
Traditional medicine that originated in ancient China, has developed in different ways in Asian countries, such as China, South Korea, and Japan, and each has unique characteristics. They are named "traditional Chinese medicine (TCM, 中医学)" in China, "Korean medicine (KM, 韓医学)" in Korea, and "Kampo（漢方）" in Japan. This paper describes the characteristics of "Kampo".
1. Integration of Kampo with modern medicine
1) Kampo in modern medicine
Kampo has continued to change under the influence of the era. In other words, it has a history of integration with Western medicine. The medical system in Japan was unified into Western medicine by the resolution of the Imperial Diet in 1895, and Kampo was nearly lost. However, after World War II, Kampo regained popularity because it compensates for the weaknesses of Western medicine when patients suffer from adverse effects of it. Currently, Kampo has been adopted in many clinical practice guidelines, and is prescribed in daily practice by more than 80% of Western medical doctors in Japan. Although there are some adverse effects of Kampo drugs, it shows excellent medical safety, and the adverse effect reports of Kampo are published every year on the website of the Ministry of Health, Labour and Welfare in the same way as for Western medical drugs.
2) Kampo in medical education
The Japanese Society of Oriental Medicine (JSOM) has published "Introduction to Kampo" and other textbooks since 2002 to clarify the content of education in the field of traditional medicine based on Western medicine. Although the JSOM's Committee on Medical Specialist System is vigorously training specialists in Kampo, the number of specialists is about 2,000 in January 2021, which is still only 0.7% of the total number of medical doctors in Japan.
As for pre-graduate education, since 2001 when the core curriculum of medicine included a section on "able to outline Kampo" for the first time, almost all medical schools have begun to offer lectures on Kampo, but the content has varied. For this reason, a unified textbook for pre-graduate education was prepared and published in 2020 by the Japan Council of Kampo Medicine (composed of medical school educators from throughout Japan).
2. Shanghan Lun (傷寒論) and Keisetsu Otsuka（大塚敬節）'s publications
The ancient Chinese classic Shanghan Lun 『傷寒論』 is a treatment book for acute febrile illness, and in Japan, the theories inspired from the description of the book have accumulated, and it has been used as a reference not only in infectious diseases but also in various chronic diseases.
Keisetsu Otsuka (1900-1989), leader of a school that gives great significance to following the theory of Shanghan Lun and Jingui Yaolü 『金匱要略』, called as Koho school (古方派), summarized the theories of Japan's predecessors with the aim of integrating modern Western medicine and Kampo. His work1-3) had a marked influence on modern Kampo medical education and practice. “Yin-yang”, “deficiency-excess”, and “qi-blood-water” in Kampo are based on the description of Shanghan Lun, influenced by the theory of the Koho school. On the other hand, the five-phase theory (五行論) and viscera theory (臓腑論) have been influenced by the theory of the Goseiho school (後世方派), that gives weight to the prescription after the Han dynasty of China and that of acupuncture and moxibustion.
3. Emphasis on abdominal examination
Todo Yoshimasu (吉益東洞, 1702-1773), one of the most famous Kampo practitioners of the Koho school in the Edo period, advocated the "Source of all illness is a poison” Theory (万病一毒説) and denied the ｙin-yang five-phase theory (陰陽五行論). He also developed an abdominal examination method (腹診法) for selecting an appropriate Kampo prescription. In short, the prescription is decided according to the findings such as resistance and tenderness in several parts of the abdomen. Abdominal diagnosis is easier to learn than pulse diagnosis and is superior in terms of skill acquisition.
4. Fixing the combination of crude drugs as a Kampo formula
There has been a tradition of using Kampo formulas without adjusting the combination of crude drugs in Japan. The purpose of using a Kampo formula is to exert sufficient clinical effects with the smallest amount of crude drugs possible. It has been pointed out that the reasons for this were that the crude drugs imported from China were expensive, the extraction efficiency was good due to the high quality of water in Japan, and it became possible to prepare frequently used Kampo formulas. The tradition of using Kampo formulas rather than prescribing crude drugs is also contributing to the current Kampo practice in Japan.
5. The role of the “acupuncturist” in Japan
In Japan, there are national licensure systems such as “acupuncturist (鍼師)” and “moxibustionist (灸師)” for those who specialize in acupuncture and moxibustion treatment, respectively. These licenses do not exist in China and South Korea, because Chinese and Korean traditional medical doctors practice acupuncture and moxibustion in these countries. In Japan, practitioners of acupuncture and moxibustion usually hold both licenses, and are called “acupuncturist (鍼灸師)” in short.
Currently, about 110,000 acupuncturists are engaged in clinical practice. On the other hand, there are 300,000 medical doctors, and acupuncture and moxibustion are legally permitted as a practice of doctors, but doctors who perform acupuncture and moxibustion are extremely rare. Therefore, acupuncture and moxibustion in Japan are practiced mainly by acupuncturists.
As an original invention in the field of acupuncture in Japan, the needling method using a guide tube (guide tube insertion method: 管鍼法) by Waichi Sugiyama (杉山和一, 1610-1694) is well-known. Using this method, needling can be performed almost painlessly, and therefore, it is now used throughout the world. Also, in recent years, the “contact acupuncture method” that does not pierce the skin has attracted attention, and is used not only for children but also adults with chronic diseases. Thus, painless needling and mild stimulation are major characteristics of Japanese acupuncture and moxibustion.
6. Contribution to the revival of traditional medicine in China
Little is known about Japan's commitment to the discovery, preservation, and research of Chinese classical medical literature, and its contribution to the revival of traditional medicine in China through the Japanese literature influenced by modern science. There was a time when traditional medicine was suppressed in China as in Japan. In the Qing dynasty in 1822, the acupuncture and moxibustion department of the court's clinic was abolished because acupuncture and moxibustion were prohibited for the emperor. Consequently, acupuncture and moxibustion were banned even for citizens.
As mentioned above, in Japan, the Imperial Diet in 1895 voted not to view Kampo as national medicine anymore, and thereafter, China (Republic of China) also ratified traditional Chinese medicine abolition in 1929. The dark ages of traditional medicine in China continued until 1937, when the traditional Chinese medicine committee was established in the Ministry of Health of China.
Chinese classics have been imported to Japan since dispatching an envoy (600-618) to the Sui dynasty, but in Japan, they have been actively preserved and analyzed to make new discoveries. By accumulating the efforts, the level of research on traditional medicine in Japan came to its peak at the end of the Edo period. Thereafter, these valuable documents have been exported back to China since the Meiji era. According to a survey in 2006, 296 kinds of Chinese medical books were returned to China, and 751 kinds of Japanese books were exported to China. There are about 4,000 old Japanese medical books and other printed material numbering more than 10,000 in China 4, 5). In addition, Japanese traditional medicine books written under the influence of modern science had a marked influence on the establishment of traditional Chinese medicine in New China (People's Republic of China). This is also exemplified by the fact that many Japanese traditional medicine books were published in China. Among those, the most influential book after the Meiji period was Kokan Igaku (皇漢医学) by Yumoto Kyuhin (湯本求真, 1876-1941), which has been reprinted nine times in China. Regarding acupuncture and moxibustion books, 16 kinds of books by Sorei Yanagiya (柳谷素霊, 1906-1959), Bunshi Shirota (代田文誌, 1900-1974), Yoshio Nagahama (長浜善夫, 1915-1961), Kobee Akabane (1895-1983), Shohaku Honma (本間祥白, 1904-1962), Yoshio Manaka (間中喜雄, 1911-1989), and others have been translated and published since the establishment of New China in 1949.
7. Inheritance and dissemination of traditional medicine in Japan
At present, education on traditional medicine in Japan is mainly centered on Kampo in 82 medical schools (in about 40% of them, acupuncture and moxibustion are both taught) and schools for acupuncture and moxibustion (11 universities and 90 special training schools). Post-graduate education and dissemination activities of Kampo are carried out mainly by the 12 full member organizations of JLOM. In the future, it will be the mission of the full members of JLOM to further enhance pre-graduate education and expand opportunities for doctors, pharmacists, and acupuncturists who have studied traditional medicine.
References
1) Otsuka K. Actual practice of Kampo treatment by symptoms. Nanzando. Tokyo. (1963) (in Japanese)
2) Otsuka K, Yakazu D, Shimizu M. Chinese medicine medical practice. Nanzando. Tokyo. (1969) (in Japanese)
3) Otsuka K. Thirty years of Chinese medicine practice. Sogensha. Osaka. (1959) (in Japanese)
4) Mayanagi M, The contribution of Japan for the formation of Japanese acupuncture and moxibustion studies to the present, Journal of the Japan Society of Acupuncture and Moxibustion. 2006; 56(4): 605-615. (in Japanese)
5) http://square.umin.ac.jp/mayanagi/paper01/MoChiAcu.html (in Japanese)
accessed on Jan. 8, 2021.
