Volume 2, Number 3 | Fall 2007

Medical History in Japan
Todo Yoshimasu and His Medicine (1)yin-yang five phase metaphysics, and in his 30s heHiromichi Yasui
Japan Institute of TCM Research

In KAIM Vol. 2 No. 2, we looked at the medicineof Dosan Manase (1507-1594), and I described someclinical cases. Dosan took the latest available
medical technology from Ming China and arranged
it in ways suited to Japanese life and society, in theprocess creating a structure that closely resembles
modern-day Traditional Chinese Medicine (TCM).
In the mid-18th century Todo Yoshimasu advocateda very different and unique medical system, andDosan's system fell from favor. The differences
betweenJapaneseKampo

medicine

andthetraditional forms of medicine in China and Korea
are primarily due to the changes that were
implemented at that time by Todo Yoshimasu, who
effectively constructed the basis for modern Kampo
medicine in Japan. I would like to introduce his
medical perspective in two parts.

the Shang Han Lun (On Cold Damage) and the Jin

Gui Yao Lue (Synopsis of Prescriptions of theGolden Chamber). In 1738 at the relatively young
age of 38, he expressed the aspiration of "curing thephysicians of the world" (in other words, to bring hisown system to other physicians so that they could
cure their patients more effectively). To do this, he
set off for Kyoto, which was then the cultural capitalof Japan. At first, things did not go according to his
expectations, and he was hard-pressed to survive.
He made dolls, fired clay pots, and in general led a
hand-to-mouth existence. Presently, however, hebegan to be recommended by the Emperor's head
physician, Toyo Yamawaki, and the name of Todo
Yoshimasu began to be widely known. His medical
work flourished, and he attracted a large number ofstudents.
In 1759, one of his students published acollection of Todo Yoshimasu's medical treatises
under the title "Idan" (roughly translated as"medical diagnostics"), and this publication became

1. Biography
Todo Yoshimasu was born the son of a physician
in the city of Hiroshima, which in later years would
become famous as Ground Zero for an atomic bombat the end of World War II. He descended from aprestigious samurai family. However, in the 17th
Century after a long and devastating civil war, theJapanese nation entered into the generally peaceful
Tokugawa period. Since there was less demand forwarriors at that point, his family followed the adviceof the old Japanese proverb, "If you cannot be a goodruler, then be a good doctor." Todo himself began thestudy of medicine at the age of 19. The Yoshimasu
family traditionally practiced surgery, but Todo
Yoshimasu involved himself in the study of internal
medicine.
He questioned the medical theories based on30

put together a unique system of medicine based onquite influential. Todo also collected each of theformulations described in the chapters on the 220
formulations in the Shang Han Lun and Jin Gui Yao

Lue, added his own opinions, and published theresulting manuscript under the title Ruijuho topresent the standards for "Koho" or traditional
methods of treating patients. In addition, hecollected information on the indications for various
herbaldrug

formulationsandpublishedamanuscript called Yakucho, in which he describedanalogous pharmacologic effects for the individual
drug substances contained in those prescriptions.
At the end of his life, Todo was happily
surrounded by his children and grandchildren. He
died of a stroke on September 25, 1773, at 72 yearsof age. His medical writings, in addition to thethree-volume set of Ruijuho, Hokyoku, and Yakucho,

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Volume 2, Number 3 | Fall 2007

also included titles such as Hoki, Ijiwakumon

Yoshimasu refused to include the traditionally(medical questions and answers), Kenjuoku, andaccepted concept of original vital energy15) into hisKoshoigen (a collection of medical expressions fromconcept of diseases. He believed that the originalthe ancient texts).

vital energy was given by the heaven, and although
it waxed and waned according to time's flow, Qi16)

2. Medical Views

itself did not suffer disease.

Todo Yoshimasu's biography, his medical views,

Yoshimasu also criticized the theories of Yin andand the process by which he formulated those views

Yang and the five phases, the basic principles of thehave been widely discussed [1, 2, 3, 4, 5, 6, 7, 8, 9, 10,

Manase School. His point was that, as Yin and Yang

11, 12]. We can see the main points of his medical

was the Qi of heaven and earth, it was wrong totheory in “Idan 医 断 ”, compiled by his disciple,

apply the concept of yin and yang to a human body.

Tsuruta and in his “Iji Wakumon 医事或問”, written

As a clinical physician, he did not accept thein question and answer style. Here I am going totheories of Zhu Danxi 朱丹溪, and Zhang Jing-yue 張

summarize some important points, which can be景岳, And he ignored the theory of five phases, as

found in these books.

well as the concept of the Rotating Qi. He also did
not accept the concept of viscera and channels.

(1) The theory that all diseases are caused by one
poison, and Kampo sho relativity(3) Etiology and pathogenesis

Todo's medical theory was based on two points:

As we have seen above, his medical principle was"All disease comes from a single poison," and "Never“relating symptoms to medication,” based on a

speak of what you cannot see with your eyes." [13]complete

Because he was unable to see with his own eyesprescription.

what occurred within the body, he refused to say

the causes of diseases. The important thing for him

anything about that. Since he could not analyze thewas to know in which part of the body there wasmechanisms of etiologic pathogenesis, he refused topoison, and not to research the cause of disease. He

accept the theories of traditional medicine.

thought that this type of research could not help in

He also held that disease was caused by toxins

understandingoftheindicationofFor that reason, he did not question

clinical treatment.

developing within the body, and that those toxins

Todo Yoshimasu did not rule out the existence ofcame from food, drink, and other external sources.

pathogenic mechanisms, but instead held that

He considered the important question to be not how

theories

the toxins were formed, but rather how to heal thehypotheses, and that they were unnecessary for

person by removing the toxins from the body.

treatment. According to his position, the mostThe location of the toxin is confirmed by"fukushin" (abdominal diagnosis), and the patient isabout

thesemechanisms

wereonly

central tenets of Chinese traditional medicine wereactually unnecessary.

treated with a prescription that accurately targets
the patient's symptoms. This method is called(4) Diagnostics

For Todo, the purpose of diagnosis was to"Kampo shou relativity."

determine the location where the poison was(2) Criticism of yin-yang five phase metaphysics

present, and the method upon which he placed hisand "zofu riron" (literally "entrails theory")

greatest emphasis for such diagnosis was fukushin.

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Volume 2, Number 3 | Fall 2007

He attached importance to the abdominal diagnosis,
based on his idea that the “Abdomen is the origin of(6) Dosimetry

Todo made extensive use of formulations fromthe Shang Han Lun (On Cold Damage). In thelife and also of all diseases.”reports, the reader realizes the extreme importanceRuijuho, he compiled lists of the individual
prescriptions in the Shang Han Lun and the Jin Gui
Yao Lue (Synopsis of Prescriptions of the Golden
Chamber), and he used those prescriptions in ways

he attached to abdominal shou.

that were unrelated to their context within theFukushin was not at all theoretical, but had aspecific rationale for clinically based confident
diagnosis. Looking through his numerous caseHe did not think much of the pu1se diagnosis. He

Shang Han Lun.

thought that pulses differed from one person to

Yoashimasu's frequent use of Zhang Zhong-jinganother. If he could know the usual pulse condition

張仲景 prescriptions was based on his belief thatof a patient, he could then know how it differed wasthey were used and effective in the old times. He

when a patient was ill. But it was very rare, 10-20%

used not only the prescriptions of Zhang Zhong-jing,

possibility in general, that certain qualities of thebut also other prescriptions, if they were effective.

４)

pulse, such as floating or deep , slow or rapid ,His attitude toward “Shang Han Lun” was veryslippery or uneven , could be diagnosed. Yoshimasu

different from others of the Koho School. Yoshimasu

also thought little of Qi of the five parenchymatous

put his emphasis on grasping the indication ofviscera.

prescription, and tried to ignore the contexts which(5) Drugs (herbal medications)were related to “Shang Han Lun”. Concerning the３)５)

As for medications, he had ideas far different
fromthecontemporarytheories.

Concerning

descriptions in “Shen-Nung Ben-Zao-Jing”19) andchose ideas which agreed with the principle oftheory of six pairs of channels27), he said he used it
only as a way of classification, that the more
important thing was Sho (a symptom-complex).
His

attitudes

werealsoexpressedin

hisZhang Zhong-jing 張仲景 20) With his concept ofcompilation, “Ruiju Ho 類聚方”. In the book, for each

medicine as poison, and with his principle ofprescription he described extracts from the texts oftreatment, in which poison could be eliminated only

“Shang Han Lun”, “Jin Gui Yao Lue”, and theby poison, he did not accept the idea of moderating

indication of each prescription in a style that closely

the efficacy of medicine.

related symptoms to medications. Some phrases,

He wrote the book, “Yakucho 薬徴” about theput in square brackets, meant that he had not

efficacy of medicines. A prototype of the bookinvestigated them himself, and perhaps, he thought

seemed to exist in 1740. In 1771 it was completed.

of those as being in the category of “should not”. ForThroughout

hiswritings,

Todo

criticizedYoshimasu, concepts such as Yin and Yang,conventional pharmacology based on the Shen Nong

Tai-Yang-Bing30),

Ben Cao Jing, a Chinese book on agriculture andmedicinal plants, and insisted that the Shang HanLun (On Cold Damage) should be used instead.

necessary.

In the book, he said that ginseng cured stuffinessHis

Yang-Ming-Bing

werenot(7) Treatment

treatments

weremadeofvariousand rigidity of the epigastric region22), and did not

combinations of prescriptions from “Shang Han

replenish the original vital energy. For that purpose,Lun”, and strong laxatives such as croton seed23),

ginseng produced in China was not effective, only

kansui root24）, rhubarb25) etc pills which contained

the Japanese one should be used.

mercury, as well as. The basic idea behind his32

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

Volume 2, Number 3 | Fall 2007

treatment was the elimination of poison.
Yoshimasu

had4

therapeutic

was their fate. However, others said that they didmethodsof

not understand Todo's protocols.

treatment: diaphoresis, emesis, purgation andmediation１) which he used according to the region
which was poisoned. And he thought that in the3. Medical Theories and TCM
Accordingtotraditional

Chinesemedicine,

medical arts, only a method of attack existed, adiagnosis clarifies the condition's etiology andmethodHe

pathogenesis, and this is an inseparable part ofemphasized that attacking poison meant everything.

treatment. In contrast, Kampo medicine in Japanofreplenishment

didnotexist.

It was Ming-Xuan 瞑眩, a medical reaction which
one felt when attacked by medicine.
Concerning the concept of deficiency and excess
he also had a unique idea. Citing “the excess(symptom-complex) results when the invading
pathogens is exuberant, exhaustion of vital essence
brings on insufficiency (symptom-complex from
“Huan-Di Nei-Jing” he said that what attacked
excess was poisonous medicine, and what nourisheddeficiency were foods such as rice or meat. He
maintained his theory that diseases were caused bypoison, so treatment should be geared toward
driving poison away from in the body by medicine
which was itself poison.

He said that as a physician he always tried his best
to cure diseases, but that had nothing to do with thepatient's life and death. Only destiny could decidehemeant

was

that

when

headministered his treatments based on his methods,
he could nothing but await the judgment of destiny.
This issue elicited strong reactions within theJapanese

medicalestablishment

in

the18thCentury, and became a major area of controversy atthe time. In his Ijiwakumon, Todo spent many pages
explaining

hisposition,"black box" that they did not try to explain. Todo
Yoshimasu started the tradition that the mostimportant tenets of traditional Chinese medicine
were the very points that should be deemphasized.
The new Meiji government, which took control ofJapan in 1868, adopted a German medical model,
andKampo

medicineceasedtobeinthemainstream of Japanese medical practice. However,Kampo continued to be popular among the common
people, and even experienced a certain level ofrevival. Since that process of revival was based onJapan closely resembles his teachings. However,

Yoshimasu had a unique concept of life and death.

Whatand doctors put etiology and pathogenesis into a

Yoshimasu's theories, modern Kampo medicine in(8) Views on life and deaththat.

provided treatment in direct response to symptoms,

which

was

that histreatment was based on a kind of protocol. Today wemight consider it "textbook-standard treatment." He
believed that if people were treated according to theappropriate protocol, and they were not healed, that

there are some differences. For example, althoughthe "black-boxing" of etiology and pathogenesis
remains unchanged, modern methods differ from
Yoshimasu's in that they utilize a number ofetiologicalcategories.

However,modernpractitioners continue to avoid analyzing etiology
and pathogenesis during the diagnostic process, justas Yoshimasu taught.
By any measure, Todo Yoshimasu exercised
tremendous influence on Japanese Kampo medicine.
Yoshimasu's denial of the central tenet of Chinese
TCM, a position that has been continued inJapanese Kampo medicine, makes it difficult for thetwo traditions to have a conversation about
theoretical points that they hold in common. Clearly
Yoshimasu's tradition continues to live on in Japan
today.

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References
1) Yoshimasu N. Todo Sensei Gyojoki (Conduct8) Huang Huang, 徐 霊 胎 (Joreitai) and Todo

Report on Dr. Todo), Collected works of Todo,

Yoshimasu, Journal of the Japan Society of551-558 Shibunkaku Co., Ltd., 1918

Medical History No. 2, Vol. 47, 229-260, 2001

2) Kure S. Dr. Todo Yoshimasu, Collected Works of9) Wada M. Todo Yoshimasu, a revolutionary,Todo, 1-138, Shibunkaku Co., Ltd., 1918
3) Oka S. Biography of Todo Yoshimasu,extraordinary physician, Journal of Kampo

Medicine, special issue commemorating 100thedition, **-** 1963

Joranshawa, Vol. 354) Otsuka K. Todo Yoshimasu, Kinsei Kampo

10) Yamamoto I. Todo Yoshimasu and his medical

Igakusho Shusei (Collection of Modern Kampo
Medical Texts) 10, 7-38, Meicho Shuppan, 1979

methods, Toui Zatsuroku (1), 19-33 Ryogen,5) Yasui H. Todo Yoshimasu and his medical art,Kinsei Kampo Chiken Senshu 6, Meicho

198311) Yamamoto I. Speaking of Todo Yoshimasu, TouiZatsuroku (3), 1-57, Ryogen, 1983
12) Yamamoto I. On Japanese Kampo and the Koho

Shuppan, 1985
6) Tateno M, Oyama M. Todo Yoshimasu and Taoist

School, Toui Zatsuroku (2), 1-104, Ryogen, 1981

Philosophy, Journal of the Japan Society of13) Otsuka K. Medicine in the First Half of Modern

Medical History, No. 4, Vol. 47 P 855-857, 2001
7) Tateno M. A study of “Kosho Igen” by TodoYoshimasu, Kyuko Shoin, 2004

Times, Modern Scientific Thought (2nd volume),

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Nihon Shiso Taikei (A Compendium ofJapanese Thought) 535, Iwanami Shoten, 1979

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