The Allure of Kampo Medicine (Part 2)
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 2)
The Process of Kampo Diagnosis
The process of a Kampo medical diagnosis can be a comprehensive field of study in its own right, but let's briefly summarize some key aspects. Kampo medicine's diagnostic methods are based on the four examinations: inspection, listening and smelling, inquiry, and palpation. Inspection involves observing the patient's appearance and demeanor, while listening and smelling focus on the sounds made by the patient. The inquiry process has similarities to Western medicine, and palpation involves checking the pulse, tongue, and abdominal findings. In Japanese Kampo practice, significant emphasis is placed on a thorough abdominal examination. However, patient consultation and feedback often hold even greater importance. For instance, even if palpable symptoms such as discomfort or distension in the hypochondriac region are absent, these conditions may still be recognized if the patient expresses feelings of heaviness in the flank. Thus, the patient's voice is a crucial component of the diagnostic process.
Kampo examinations are not strictly ritualized, so it's not necessary to gather all findings each time. However, the most crucial aspect lies in avoiding the prescription of Kampo formulas that could be harmful to the patient. The greatest mistake in Kampo practice would be prescribing a drying formula to a patient who is already experiencing dryness, considering that dehydration could have been fatal in the past. Therefore, before using Kampo formulas that contain drying herbs such as Bupleurum (柴胡) or Pinellia (半夏), it's essential to check whether a white coating is present on the tongue and to ensure that the tongue itself is not dry. This helps prevent inappropriate treatments.
After gathering the Kampo medical findings, we establish the patient's pattern (syndrome) by categorizing their condition according to concepts such as "Yin and Yang (陰陽)", "Six Stage Patterns (六病位)", "Cold and Heat (寒熱), Deficiency and Excess (虚実), Interior and Exterior (表裏)", and "Qi, Blood, and Fluids (気血水)." While the specialized Kampo terms may seem daunting to some, it is perfectly acceptable to articulate the condition in simpler terms, such as "I feel cold" (representing a Yin syndrome, 陰証), "I feel weak" (representing a deficiency syndrome, 虚証), or "I have severe menstrual pain" (indicating a Blood issue). The most important factor is selecting the appropriate Kampo formula for the patient's specific needs.
I shall elucidate some particularly significant concepts of Kampo medicine. "Yin-Yang" is a notion that bifurcates everything into two opposing aspects; "Yin" symbolizes cold, sinking, and non-activity, while "Yang" denotes heat, rising, and activity.
The 'Six Stage Patterns' concept categorizes the body into six layers, from surface to interior, indicating the depth at which a disease is situated. The 'Early Yang Stage Pattern' (太陽病) represents diseases that cause surface symptoms, such as headaches, joint pains, backaches, and neuralgia. The 'Lesser Yang Stage Pattern' (少陽病) refers to a more advanced stage of the disease that presents with gastrointestinal and respiratory symptoms. Meanwhile, the 'Middle Yang Stage Pattern' (陽明病) implies that the disease has extended to the intestines, leading to symptoms like constipation and abdominal fullness.
As the disease progresses further, it becomes a grueling battle within the human body. This is categorized into the Early Yin Stage Pattern (太陰病), Middle Yin Stage Pattern (少陰病), and Late Yin Stage Pattern (厥陰病). The Early Yin Stage Pattern is characterized by gastrointestinal symptoms accompanied by a sensation of cold. The Middle Yin Stage Pattern manifests as an escalating sense of fatigue. The Late Yin Stage Pattern is akin to a state of shock. Presently, prescriptions for the Late Yin Stage Pattern are also used for chronic diseases where extreme fatigue is a prominent symptom.
"Deficiency and Excess" indicate the strength of the body and the severity of the disease. The image is "deficiency" is like a deflated balloon, and "excess" is like an over-inflated balloon. Therefore, even thin elderly people with severe constipation are considered "excess syndrome" when choosing Kampo medicines.
"Qi, Blood, and Fluid" refer to the basic functions and substances of the body, where "Qi" is the energy that moves all life activities, "Blood" is what carries nutrition throughout the body, and "Fluid" represents the balance of body fluids. Morning discomfort, episodic symptoms with variability suggest abnormality in Qi; aggravation at night, fluctuations with menstrual cycle, pain related to surgical history suggest abnormality in Blood; symptoms that worsen with changes in weather or atmospheric pressure suggest abnormality in Fluid. These can be evaluated with the Qi-Blood-Fluid score, advocated by the famous Kampo doctor, Dr. Katsutoshi Terasawa.
Side Effects of Traditional Chinese Medicine
In contemporary clinical practice, it is noted that while over 80% of physicians utilize traditional Chinese medicine, there is often a lack of understanding of its potential side effects. For instance, interstitial pneumonia due to Shosaikoto (小柴胡湯) is well-known, but it is also important to be cognizant of not-uncommon liver dysfunction caused by medicines containing Scutellaria root (黄芩). In addition, there have been reports of eczema resulting from the use of cinnamon (桂枝), ginseng (人参), and Astragalus (黄耆); sclerosing encapsulating peritonitis caused by gardenia, an ingredient in Kamishoyosan (加味逍遙散); and symptoms of cystitis associated with the use of Bupleurum (柴胡)-containing medicines, Unseiin (温清飲), and Bofutsushosan (防風通聖散).
The Integration of Kampo and Western Medicine
Kampo medicine, as previously discussed, is not in opposition to Western medicine but works in a complementary capacity. It may be difficult for those residing in Japan to fully appreciate this, but it's a stark reality that most of the global population cannot access the expensive treatments available in developed nations.
In response to this, the World Health Organization (WHO) advocates for a strategy aiming to integrate traditional medicine, including Kampo, and modern medicine. In line with this goal, the "WHO Global Centre for Traditional Medicine" was established in India in April 2022.
According to the WHO, out of the 194 member nations, 170 have reported the use of traditional medicine. This center holds the mission to validate not only Kampo medicine but all forms of indigenous and regionally entrenched medical practices which are collectively referred to as traditional medicine. The center aims to establish the therapeutic evidence for these medical systems, some of which lack systematic evidence, using scientific methods.
Kampo medicine, with its robust tradition and comprehensive system, carries significant potential for evidence-based development in the future. Its application is not confined to East Asia and is projected to expand globally. The International Classification of Diseases (ICD-11) by the World Health Organization, approved in June 2019, now includes a chapter on traditional medicine. This chapter documents around 250 types of disorders and approximately 200 traditional medical patterns, including 'Deficiency and Excess', 'Cold and Heat', 'Qi, Blood and Fluid', and 'Six Stage Patterns'. This allows for Western disease names and traditional patterns to be referenced side by-side.
Kampo medicine, which aims to achieve a state of balance referred to as "Chuyo" (中庸), is gaining international recognition for its potential to complement Western medicine, which excels in addressing the biological mechanisms of disease.
In an endeavor to contribute to the application and further development of Kampo medicine, a legacy inherited from our ancestors, in modern healthcare, I am committed to making even the smallest contributions.