Volume 1, Special Edition | Current Kampo Medicine 2005

Distinctive Features of Kampo Medicine
There are varying styles of Japanese Kampo Medicine.
Each derives its inherent characteristics from the Japanese,
their culture, climate and history.
Japan began accepting Chinese Medicine in the 5 th
century. It utilized Ming-China’s therapeutical system in the
16th century, but constructed a new system based on the“Shang han lun” from the late 17th century to the early 18th
century. At this time a school providing treatment that was
not based on the theory of traditional Medicine appeared.
This school sought a principle of medicine in “Shang han lun”
and did not utilize the Ming-China’s system. From then on
there was academic controversy between the grouppracticing Ming-China’s Medicine and the group based on“Shang han lun”. In addition, a group compromising both
systems arose. Groups correcting and annotating medical
textbooks arose, and as a result, Japan developed its own
medical environment in which various views coexisted.
After the Meiji Restoration in 1868, Kampo Medicine,once ostracized politically during the reconstruction period
starting in the 1930’s, developed successfully in thisenvironment. Medicine can be divided into “study” and“skill”. One of the features of Japanese Kampo Medicine isthat it has a strong tendency to be considered as “skill” andnot “study”. This tendency is especially remarkable in viewof the compromising party which arose in the 18 th century.
Medicine is, of course, knowledge. The highest level to beachieved is mastering the skill followed by continued
improvement gained through new knowledge and experience.
It has something in common with the world of art or ‘Zen’.
Having these aspects, Kampo Medicine is applied fairly
pragmatically at bedside. For instance, Kampo medicine is
specifically prescribed for specific diseases. That is, as toapply “Minor blue dragon decoction”, of which its validness ischecked by DB-RCT, for allergic rhinitis, or the use of “TenStrong Tonic Herbs Decoction” in order to increase theimmunity, reduce the side effects, and improve the QOL for
patients who take chemotherapy, radiotherapy, or malignant
tumor surgery. These are only some of the many uses ofKampo medicine.
Even in these pragmatic methods, Kampo medicine exists
with its own unique styles of logic. These styles are various,
such as the traditions from the Edo period, the recent TCM
theory, or the utilization of clinical epidemiology.
1. Theory of Usage
Logic adopted in Kampo Medicine is varied as seen
above. While one adopts the same logic as present day
Chinese TCM, another may use prescriptions applying theresults of an experimental study in modern medicine.
Yet, the most frequently employed method is theso-called "pattern corresponding prescription" system. Thissystem was established approximately 200 years ago by Todo

Yoshimasu and is based on the concept: "Regardless of what
pathologic factors are at work, the form of body response
constitutes the real nature of the disease". Basically, thissystem assumes that reliance on minute clinical observation
allows to identify the relevant symptom complexes andthereby leads to the deduction of the required medication foreach individual patient. The most important aspect of a TCM
diagnosis, namely the disease stage (disease mechanism) is
at that time treated as a sort of black box. This is one of themost distinguishing features of Japanese Kampo medicine.
Since this system easily allows the integration of modern
medical research results, it is extremely helpful for the
spread of this medicine in Japan, where medicine is unified
according to the western medical system.
Currently, in contrast to Yoshimasu's time, theimplementation of this method employs
severalsupplementary
traditional
medicalconcepts.
Theterminology of these concepts itself is almost identical withthe relevant terms used in TCM. Yet, there are essential
differences in their application. The terms are not used to
identify the aforementioned pathologic mechanisms, butrather to classify the various diseases. This classification of
diseases in turn decisively determines the most suitableprescription for the patients. The concepts used in thisconnection include the eight principles (yin -yang,interior-exterior, cold-heat anddeficiency-excess),"Qi-Blood-Water" triad, the six channels according to the"Shang han lun" and the internal organ concept etc.
Although the same terms are used in TCM, theirrespective meaning is not necessarily the same.
Terms from the Kampo medical point of view arepresented below.
(1) Eight principles
The eight principles indicate the eight fundamental
concepts of yin-yang, interior-exterior, cold-heat anddeficiency-excess.
The terms yin and yang are used in daily life speech inJapan and thus do not have to be remembered, but some
aspects of their usage differ from that in China. Medically,
they have two different meanings. One expresses the generallevel of activity of the patient(s). Here there is no majordifference to their meaning as it is used in TCM. The otheraspect is a characteristic of Kampo medicine and serves toindicate the location of diseases based on the six channels
according to the Shang han lun, where they are divided into
greater yang, brighter yang, lesser yang disease stages orgreater yin, lesser yin or reverting yin. The former are called"yang pattern" and the latter "yin pattern". The frequent useof prescriptions from the Shang han lun has a significant
meaning. It is not necessarily common that the use yang
implies yang Qi and yin be a representative for yin fluid as it
is in TCM. Usually, a yin deficiency pattern represents a yin
pattern combined with a deficiency pattern, whereas a yangdeficiency pattern means a yang combined with a deficiency
pattern.

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

9Volume 1, Special Edition | Current Kampo Medicine 2005

The concept of interior-exterior expresses the depth ofthe disease and here there are no major differences with its
use in TCM.
Cold-heat is a scale pertaining to temperature andexpresses the true nature of the body as well as
characteristics of diseases and crude drugs or prescriptions.
Yoshimasu did not use this concept for his treatment, but
expressions like shivering or fever are cold-heat related
symptoms frequently encountered in daily clinical practice,so that in spite of Yoshimasu's intentions, they have beenused comparatively frequently and are currently still in use.
Regarding deficiency-excess, there are several aspects
and not just one concept. Usually, the terms are used to referto the conditions of true and evil Qi within the body based on
the reference in the first section of the classic "The Yellow
Emperor's Classic of Internal Medicine" given as "when theevil Qi is flourishing, the essential Qi is lost and deficiency
results". Following the introduction of TCM, the concept of
deficiency-excess has remained bound to its traditional
forms.
However, during the revival of Kampo medicine in the
1930s, researchers of the time proposed one more
deficiency-excess concept. According to this concept, there is"deficiency, the weakening of physical resistance to disease
with an excess, representing a condition of abundant
physical resistance to disease. Generally, people of strong
physical build present a state of excess, while asthenic
people of frail body build present a state of deficiency." Thatmeans that deficiency and excess indicate a state of excess of
deficiency of a certain vector and thus can be considered torepresent the difference in physical constitution andstrength. The background for this new interpretation in
Japan lies with the two different elements ascribed to thecharacteristics of right and evil Qi respectively. When
discussing the one index, "deficiency-excess", this seemed tobe paradox and may partly be explained by the logicalstructures the Japanese used in general. Currently, this is
accepted as the representative concept of deficiency-excess.
Later, Terasawa combined these two concepts in 1990 topropose a new concept of deficiency-excess. He suggested
that "deficiency pathologic conditions (deficiency patterns)
represent pathologic conditions for which only weakened Qi
and blood forces can be mobilized against any possible
distortions caused by external disruptive factors. Generally
this occurs before a background of lowered whole body levelsof Qi and blood. In excessive pathologic conditions (excess
patterns) the external disruptive factors are very strong and
the Qi and blood forces mobilized against these factors arealso very vigorous. This condition generally develops before abackground of heightened whole body levels of Qi and Blood."
In this form the concept resembles the prevailing ideas usedin TCM.

10(2) Qi-Blood-Water
The concept of Qi (in Japanese Ki) is one of thefoundations of traditional Chinese medicine. In Japan thisconcept is very important. There is a large number of
expressions in everyday language pertaining to Qi.
Yet, about 250 years ago in Japan, Todo Yoshimasu
discarded it based on the concept that it cannot be seen andthere is no way of objectively proving its real existence. Since
then a considerable number of physicians have forsaken theapplication of this concept in medicine. This trend became a
new tradition in Kampo medicine and has been handed down
to the present, but there are also schools that recognize therelevant concepts of those days and in recent times almost all
modern physicians understand the concept of Qi.
Pathologic Qi conditions include Qi deficiency, Qi stasis,Qi reversal etc. and Terasawa has assigned scoring systems
to these pathologic conditions.
Diagnostic criteria for Qi deficiency (Terasawa)◆

Qi deficiency score
Body feels heavy

10

Dull eyes and toneless voice

No energy

10

Tongue with pale white or red fur,

Tire easily

10

Drowsiness during the day

6

Weak pulse

8

Loss of appetite

4

Weak and soft abdominal wall

8

Catch cold easily

8

Symptoms of internal organ atonia １） 10

Be easily startled

4

Subumbilical insensitivity 2）

6

Tendency toward diarrhea

4

hypertrophied

68

Diagnostic criteria: A score of more than 30 points indicates Qi
deficiency. Any clear manifestations of the parameters receives a fullscore, while half the score is given to mild cases.
Note 1: Symptoms of internal organ atonia refers to gastric atonia,
kidney ptosis, uterine prolapse and anal prolapse.
Note 2: Subumbilical insensitivity refers to decreased muscle tonein the lower abdominal region.
Diagnostic criteria for Qi stasis (Terasawa)◆

Qi stasis score
Tendency toward stasis １）

18

Symptoms periodically get worse2） 8Dull headache, sense of developing

Difficulties getting up in the morning 8

a cold8

A lot of flatulence

6

Feeling of throat congestion

12

Belching

4

Feeling of thoraci oppression

8

Sensation of residual urine

4

Abdominal tympanicity

8

Feeling of stasis in the
hypochondrium

8

Abdominal distention

8

Diagnostic criteria: Any clear manifestations of the parameters
receives a full score, while half the score is given to mild cases. A
score of more than 30 points indicates Qi stasis.
Note 1: The severity of various symptoms, like a tendency towardstasis, refers to depressive moods, lack of interest, loss of appetite,food tasting unpleasantly like sand, is used for the evaluation.
Note 2: "Symptoms get worse over time" means that the chiefcomplaint fluctuates.

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Special Edition | Current Kampo Medicine 2005◆◆

Diagnostic criteria for Qi reversal (Terasawa)

Diagnostic criteria for blood stasis (Terasawa)

Qi reversal score
Feeling hot in the upper half of the
body and cold in the lower half １）14

Blood stasis score

Easily startled

6

Attacks of restlessness

8

Palpitation attacks

8

Facial flushes

10

Paroxysmal headaches

8

Epiumbilical palpitation 2）

14

Vomitting（with little nausea）

8

Feeling of cold in the lower or all four

Cough associated with anger

10

Attacks of abdominal pain

6

extremities
Palmar and plantar sweating

4
4

Diagnostic criteria: Any clear manifestations of the parameters
receives a full score, while half the score is given to mild cases. A
score of more than 30 points indicates Qi reversal.
Note 1: This refers to a condition where the patient experiences
heat in the upper half of the body and feels cold in the lower half ofthe body at the same time. The condition is triggered by entering awell air-conditioned room. This also receives 14 points.
Note 2: Epiumbilical palpitation refers to an increased pulsation of
the abdominal aorta that is felt when touching the medianabdominal wall lightly with the palm of the hand.

Pathologic conditions of blood include blood deficiency,
Oketsu syndrome (which has the same meaning as"stagnation of blood") blood heat, blood cold, hemorrhage etc.
The most important of these conditions in Japan is the
Oketsu syndrome. These pathologic conditions can beobserved in most chronic diseases and have been given
particular importance in many gynecologic diseases. For
Japanese trying to grasp all phenomena in concrete form thisconcept is extremely important, because the abdominal
examination provides comparatively easily assessable
information. Extensive basic and clinical research has been
conducted regarding the Oketsu syndrome and even an"Oketsu Academic Society" has been established. Terasawa
has created a scoring system for blood deficiency and Oketsu.
◆

Diagnostic criteria for blood deficiency (Terasawa)
Blood deficiency score

Decreasing concentration ability

6

Poor complexion

10

Insomnia, sleep disorders

6

Head hair easily falling out１）

8

Eyestrain

12

Dry skin, getting rough andDizzyness

8

Calf cramps

10

Oligomenorrhea, irregularmenstruation

6

chapped

14

MaleFemalePigmentation of
the eyelids
Pigmentation of
the face
Dermal roughness
and chapping １）
Darkening of the
lips

10

10

2

2

2

5

2

2

Darkening of thegingivae

10

5Tounge turning
dark red or
purpleFine arteries 2）
Subcutaneous
extravastion
Palmar erythema

10

10

5
2

5
10

2

5

Male

Female

5

5

10

10

5

5

5

2

5

5

5

5

10

5

Periumbilicaltenderness, left
Periumbilicaltenderness, right
Periumbilicaltenderness, center
Tenderness,
resistance of theileocecal region
Tenderness,
resistance of thesigmoid region
Tenderness,
resistance of the
hypochondrium
Hemorrhoids
Menstrual
disorders

10

Diagnostic criteria: A score of less than 20 points indicates apathology unrelated to blood stasis, a score of more than 21 points
an blood stasis pathology, more than 40 points a severe blood stasis
pathology. Any clear manifestations of the parameters receives a fullscore, while half the score is given to mild cases.
Note 1: Chapping skin, roughening, fissure formation.
Note 2:Dilatation of capillaries, arterial spiders etc.

Pathologic conditions of fluids include besides a lackthereof, an excess, asymmetrical distribution etc. also rheum
produced by excessive metabolism, dampness, phlegm andsimilar pathologic substances. In Japan, pathologic
conditions caused by excessive fluids, have theirasymmetrical distribution or pathologic substancescollectively called "water toxin (disorders of the body's fluid
metabolism)" or "water stagnation". This term implies thatstagnation of the flow of water has adverse effects on the
body through individual metabolites of water or its entirety
and as such as a very broad range of application. Terasawa
has created a scoring system for water stagnation.
◆

Diagnostic criteria for water retention (Terasawa)
Water retention score

Body feels heavy

3

Nausea, vomitting

3

Pulsating headache

6

Increased gurgling3

Dull headache

3

Morning stiffness7

Getting motion sickness easily

5

Tendency toward edema, gastricAnomalies of the nails 2）

8Disturbances of perception 3）

6

Lightheadedness, dizziness

5

Stiffness of abdominal muscles

6

Syncope5

Watery nasal discharge

3Hypersialosis

3

Epiumbilical palpitation １）

5

Foamy sputum

4

Watery diarrhea

5Diagnostic criteria: Any clear manifestations of the parameters
receives a full score, while half the score is given to mild cases.
A score of more than 30 points indicates blood deficiency.
Note 1: An abundance of dandruff would have the same meaning.
This too receives 14 points.
Note 2: This refers to symptoms like brittle, easily splitting nails,roughening of the skin around the nail beds and the development of
hangnails.
Note 3: Tingling or ticklish sensations resembling numbness,feeling like the presence of an added skin layer, loss of sensation etc.

clapotage

15

Pleural effusion, cardiac water
retention, ascites

15

Decrease urinary volume

7

Diuresis

5

Diagnostic criteria: A score of more than 13 points indicates water
retention.
Note 1: Epiumbilical palpitation refers to an increased pulsation of
the abdominal aorta that is felt during light massage of theumbilical area.

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

11

Volume 1, Special Edition | Current Kampo Medicine 2005

(3) Six channel classification of the "Shang han lun"
The "Shang han lun" has been recognized since the 18th
century as an extremely important classic of Kampo
medicine and many Japanese physicians believe that thisbook contains important treatment rules. The classification
into six channels (greater yang, brighter yang, lesser yang,greater yin, lesser yin or reverting yin disease) represents a
basic classification of disease stages, but each of the diseasestages according to the Shang Han also indicates diseases in
specific locations, so that it can also be called a classification
into disease locations. Its acknowledgment in Kampo
medicine is used to classify all diseases into disease locations
for which suitable Kampo medicines are applied from among
the prescriptions listed in the "Shang han lun". Not
restricted to acute diseases these may also be applied tochronic diseases. For example, a condition like rheumatoid
arthritis is classified as a greater yang disease location andis treated with Two-parts Cinnamon Twig Decoction and
One-part Maidservant from Yue Decoction, whereas a
disease like chronic hepatitis is classified as lesser yanglocation and thus treated with Minor Bupleurum Decoction.
(4) Concept of bowels and viscera
As with the other concepts, the concept of bowels andviscera is essential to Kampo medicine. However, Yoshimasu
maintained the point of view that he "will not discuss things
invisible". Later, discussions of pathologic conditions of thebowels and viscera ceased in Japan. Due to the influence ofthe reintroduction of TCM in recent years there has been atrend towards a revival.
2. The Clinical Practice
The medical treatment of Kampo Medicine is based on
the tradition of TCM, and begins with the comprehension of
the patients’ conditions using four diagnostic methods. Whatdiffers most from the Chinese system is that it values
abdominal diagnosis among four diagnosis methods. Thisclinical system developed gradually from the 16th century,and nearly established its present prototype in the early 18 th
century, and from then formed its present prototype by
gaining experience. Currently, this is an examination form
indispensable for the proper application of prescriptions.
Another considerable difference of Japanese Kampo
Medicine from other countries possessing various types of
TCM, is that it enables the use of medical insurance in theEuropean medicine system, and for that it uses
approximately 160 herbal materials and 148 Kampo
prescriptions for medical use. Since Kampo medicine for
medical use was approved by the Ministry of Health andWelfare in the 1976, the significance of Kampo Medicine isremarkable when considering that 90% of doctors practicing
European medicine, which once became irrelevant totraditional medicine, now include it in their practice.
Reflecting Japanese tradition, some 50% of the prescriptions
are based on “Shang han lun” and “Jin gui Yao lue”. These
two classics represent basic contributions to Kampo
medicine. The prescriptions given therein form the basis of
TCM dosimetry. In Japan these have been historically highly
valued.

12

In spite of the large number of opinions, the mostmarked characteristic of Japanese Kampo medicine is theapplication of prescriptions from the "Shang han lun" and"Jin gui Yao lue" to a variety of diseases and an extremely
large body of related experiences.
For example, the ethical Kampo drug designated as No.
1, Pueraria Decoction, is used for many different diseases.
Table 7 lists the diseases for which it has been used so far. It
goes without saying that physicians do not prescribe theindividual formulas indiscriminately to the various diseases,
but first identify the relevant pattern (Sho) for the particularprescription to be used.
In the past several hundred years, physicians havecontinued to ponder about indications for individual
prescriptions. This led to the accumulation of an enormous
body of information and is reflected in current clinicalpractice.
3. Research
Research on Kampo Medicine is actively pursued, bothbasic research and clinical trials. In the clinical field, themost significant research effort is the clinical application of
Kampo Medicine in modern medicine. Numerous researchstudies are published at many professional medical
congresses every year including the Japanese Society ofOriental Medicine. It should be noted that research resultsin some areas exceed the latest European medical research.
It is important to note that in clinical research, otherthan modern medical research, there are studies of
traditional logic. Studies are done on the treatment andcomprehension of patient conditions based on traditional
logic, the logic of present TCM, and medical treatment
methods as abdominal diagnosis. Conversely, in the field of
research, many outstanding, typical Japanese items can befound. These appear in publications of such groups as theJapanese Society of Oriental Medicine and the Association of
East-Asian Medicine.
Table 7

Indications for Pueraria Decoction

Infections: influenza, measles, scarlet fever, encephalitis,
meningitis
Respiratory tract: common cold, bronchial asthma, bronchitis,
pneumonia
Circulatory system: hypertension
Alimentary tract: infectious enterocolitis
Locomotorium: stiff shoulders, neck pain, frozen shoulder
Nervous system: headache, tetanus, trigeminal neuralgia,
myasthenia gravis, facial palsy
Otolaryngology: otitis media, otitis externa, parasinusitis,
allergic rhinitis, hypertrophic rhinitis, nasal polyps,
tonsillitis, pharyngolaryngitis, epidemic parotitis
Ophthalmology: conjunctivitis
Dermatology: urticaria, purulent dermatitis, eczema, herpes
zosterStomatology and dentistry: temporomandibular arthrosis,
dental pain
Breast: hypogalactia, mastitis
Psychiatry: narcolepsy, depressed mood
Other: common cold prevention, health maintenance, nocturnal
enuresis

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)