The Allure of Kampo Medicine (Part 1)
Chiharu Kobayashi, MD., Ph.D.
Navitas Clinic Kawasaki, Internal Medicine, Tetsuikai Medical Corporation
Graduated from Oin High School in 2001 and from the Faculty of Medicine at the University of Tokyo in 2007. Engaged in clinical and research work on hematologic malignancies at the University of Tokyo Hospital, Department of Developmental Biology at Keio University (as a special research fellow of the Japan Society for the Promotion of Science), and the National Cancer Center East Hospital. Since 2014, encountered Kampo medicine while involved in primary care at Navitas Clinic Kawasaki. After receiving training at Kitasato University's Oriental MedicineResearch Center, she assumed an additional position at the Koganei Tsurukame Clinic's Kampo outpatient clinic in 2023. She aims to practice medicine that balances Western and Eastern medicine.
She is a certified specialist of the Japanese Society of Internal Medicine, a certified Kampo physician of the Japan Society for Oriental Medicine, a certified Kampo family doctor of the Japan Clinical Kampo Medicine Association, and holds a Doctor of Philosophy degree. She is also a mother of three, actively engaged in child-rearing.
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The Allure of Kampo Medicine (Part 1)
My journey into the study of Kampo (known as 漢方 in Chinese characters) medicine began when I encountered "Lessons in Kampo Medicine", a book recommended to me by Dr. Eiji Kusumi. Following my training at the Kitasato University Oriental Medicine Research Center, I am now striving to deliver a balanced integration of Western and Kampo medicine in my practice.
What is the allure of Kampo medicine?
It's a natural question for a healthcare provider trained in Western medicine: Where does the value lie in integrating a traditional practice, rooted in classical texts, within the rapidly advancing sphere of Western medical treatment? Without a doubt, the sharp precision of Western medical treatments, when the target (diagnosis) is clear, is something I've personally experienced. Yet, in daily clinical practice, not all patient complaints align neatly with a distinct diagnosis. There are also instances where a diagnosis exists, but Western medicine lacks a suitable treatment. Kampo medicine proves potent in these situations, providing an effective therapeutic approach.
One of the most distinctive features of Kampo medicine is its ability to tailor treatments to each patient's condition. Take 'coldness', for instance. In Kampo medicine, this is categorized into types such as extremity, whole-body, or a complex mixture of hot and cold. There are numerous remedies available, from warming treatments containing 'Aconite' or 'Dried Ginger' to promote heat production, to therapies that balance 'Qi (気, the energy that moves all life activities), Blood (血, which carries nutrition throughout the body), and Water (水, the balance of body fluids)' to alleviate coldness. For fever associated with acute upper respiratory infections, general analgesics and antipyretics are typically prescribed. However, Kampo medicine responds more delicately, with treatments such as Maoto (麻黄湯), Kakkonto (葛根湯), Keishito (桂枝湯), Keimakakuhannto (桂麻各半湯), Keishinieppiitto (桂枝二越婢一湯), and Kososan (香蘇散), chosen according to the patient's 'Sho' (証, a measure of the patient's condition in Kampo medicine and an indicator for treatment).
Furthermore, Kampo medicines are used in a wide variety of conditions, from gynecological issues such as menstrual disorders and menopausal symptoms, to pain disorders including headaches, backaches, and joint pain. They're used to treat mental illnesses like insomnia and depression, gastrointestinal disorders like diarrhea, constipation, and irritable bowel syndrome, skin diseases like atopic dermatitis and urticaria, otolaryngological conditions like vertigo and allergic rhinitis, respiratory diseases like bronchial asthma, and cardiovascular disorders like hypertension, palpitations, and postural tachycardia syndrome. Recently, they have even been used to improve symptoms of 'Long COVID', a lingering effect of COVID-19.
When selecting Kampo medicines, understanding the benefits of the included herbal ingredients is crucial. For instance, 'Licorice' has the ability to retain water and mitigate acute symptoms (a property often referred to as 'curing urgency'). When elderly individuals suffer leg cramps during sleep, Shakuyakukanzoto (芍薬甘草湯) is used, which aptly addresses sudden symptoms caused by dehydration. Prescriptions with a high content of licorice, such as Kikyoto (桔梗湯), are used for sudden throat pain, and Kanbakutaisoto (甘麦大棗湯) is used for panic attacks – both effective for sudden symptoms. Understanding the benefits of each individual herb enhances comprehension of Kampo medicines, which are combinations of these ingredients, and can bring a sense of excitement as you see how they can be applied in various situations.
In the field of Kampo medicine, two concepts prevail: "Dōbyō-Ichi (同病異治)" and "Ibyō-Dōchi (異病同治)" ."Dōbyō-Ichi" translates to "different treatments for the same disease". For instance, in the treatment of atopic dermatitis, if the skin presents with pronounced erythema, dampness, and itching, the Kampo formulation Orengedokuto (黄連解毒湯) is chosen. However, if the skin is characterized by dryness and lichenification, and the patient exhibits diminished vitality and strength (a condition referred to as 'Qi-blood deficiency', 気血両虚 in Chinese characters), then the prescription shifts to Juzentaihoto (十全大補湯). This illustrates that within the same disease, different medicinal strategies can be adopted depending on the patient's condition.
On the other hand, "Ibyō-Dōchi" corresponds to "same treatment for different diseases". For instance, when Tōkishakuyakusan (当帰芍薬散) is administered for dysmenorrhea, it can concurrently improve headache symptoms. The Kampo feature of being able to provide the "same treatment for different diseases" is revealed in the fact that many applicable disease names are listed in the attached documents of Kampo medicines.
Considering the possibilities and applications of Kampo medicine, its scope is not limited to treating individual organs. Instead, it adopts a holistic approach, responding to the entire person — a concept known as 'shinshin-ichinyo' (心身一如), or the 'unity of mind and body'.
It has the potential to reduce polypharmacy in elderly patients and contribute to cost reductions in healthcare. For example, when treating a septuagenarian male patient with diabetes accompanied by nerve damage, prostate hypertrophy, and lower back pain, if approached from a Western medical perspective, the patient would visit various specialists for each condition and receive numerous prescriptions. On the contrary, from a Kampo perspective, these symptoms could be interpreted as 'Kidney deficiency' (腎虚), a decline in function centering on the adrenal gland, urinary system, and reproductive system that often occurs with aging. They could be treated with a single formulation, Hachimijiogan (八味地黄丸), thereby potentially reducing the number of Western medications required.
Moreover, Kampo medicine has been increasingly employed to alleviate the side effects of anticancer treatments. For instance, Daikenchuto (大建中湯) is used to prevent intestinal obstruction following colorectal cancer surgery. Hangeshoshinto (半夏瀉心湯) addresses oral mucositis resulting from chemotherapy, and Goshajinkigan (牛車腎気丸) is employed to treat peripheral neuropathy. Additionally, Rikkunshito (六君子湯) and Hochuekkito (補中益気湯) are used for loss of appetite. Evidence supporting these applications continues to accumulate.
Kampo medicine not only focuses on patients already displaying symptoms but also emphasizes the importance of 'mibyo' (未病) — a state where subtle changes in the body's condition are detected before disease symptoms appear, prompting early intervention measures.
Adhering to the principle of 'Ishoku-Dogen' (医食同源), which posits that medicine and diet are of the same origin, Kampo medicine places a high priority on dietary nourishment. During Kampo consultation, aspects of lifestyle such as sugar consumption, which could cool the body, are checked. Those interested in dietary nourishment and Kampo medicine might find the comic "Watashi wa Kampo Bijin", supervised by Kampo pharmacist Toshiya Ejima, quite informative and easy to understand.
The Foundations and History of Kampo Medicine
Kampo Medicine, with a history spanning thousands of years, is a derivative of traditional Chinese medicine. It's plausible to believe that people in ancient times might have experimented with consuming various substances, in the process discovering potential medicinal properties. These substances were combined based on empirical observations, creating the foundation of Kampo prescriptions.
The esteemed text, 'Shang Han Lun' (傷寒論), also known as the Treatise on Cold Injury, is widely recognized as the cornerstone of Kampo Medicine. This pivotal work was written during the Later Han Dynasty, around the year 200 AD. The mind behind this invaluable resource was Zhang Zhongjing (張仲景), a governor in Changsha, China. Moved by the unfortunate passing of numerous family members due to a prevailing illness known as 'shanghan' (傷寒)—a condition similar to modern-day influenza—Zhang devoted himself to writing this treatise.
Over time, the 'Shang Han Lun' was divided into two distinct parts. The first part retained the original title and primarily concentrates on the management of infectious diseases. The second part, named 'Jin Gui Yao Lue' (金匱要略), or Synopsis of Prescriptions of the Golden Chamber, shifted its focus towards chronic diseases. It's worth noting that many Kampo treatments frequently administered today, such as Kakkonto (葛根湯, Ge Gen Tang in Chinese, or Kudzu Root Decoction), and Tokishakuyakusan (当帰芍薬散, Danggui Shaoyao San in Chinese, or Tongi and Peony Powder), are mentioned in these texts.
Chinese medicine was introduced to Japan through envoys to the Sui and Tang dynasties and flourished from the Heian to the Edo periods. This led to the birth of various schools of thought, such as the Gosei school (後世派) and Koho school (古方派). However, with the prioritization of Western medicine after the Meiji Restoration, in 1895, a petition for the continuation of Kampo was rejected in the national parliament. Yet, Kampo Medicine was preserved by a group of Kampo practitioners.
In 1950, the Japan Society for Oriental Medicine was established, and in 1972, the Kitasato University Oriental Medicine Comprehensive Research Institute was inaugurated as Japan's first research institution for Oriental medicine and designated as the WHO Traditional Medicine Cooperation Center in 1986. In 1976, a large number of Kampo extract preparations were included in the drug pricing standard. Then in 1979, starting with Toyama Medical and Pharmaceutical University, Kampo treatment departments began to be established in various universities. Moreover, in 2002, the ability to 'summarize Japanese Kampo medicine' became a required part of the medical school core curriculum, marking a significant milestone in the history of Kampo.
The term 'Kampo', used to refer to ancient Chinese medicine, was coined in the 16th century to differentiate it from the newly introduced Western medicine, referred to as 'Ranpo' (蘭方). However, it's important to note that contemporary Japanese Kampo (also known as Wakkan和漢) is distinct from traditional Chinese medicine as it's practiced in modern China, particularly in terms of perspectives, prescriptions, and terminologies. (To be continued in the next part)