Volume 1, Special Edition | Current Kampo Medicine 2005

History of Kampo Medicine
Hiromichi Yasui, Japan Institute of TCM
Kampo medicine is the descriptive term used inJapan for TCM (in a broad sense Kampo medicine refers
to the entirety of traditional Chinese medicine practiced
in Japan, and in a narrow sense specifically to herbal
medicine). This form of medicine differs from the Chinese
form of TCM and is characterized by many uniquetheories and therapies. It is necessary to review the1500-year history since the introduction of this system
into Japan and thereby illuminate the characteristics ofKampo medicine.
Introduction and imitation of Chinese medicine
Traditional Chinese medicine was brought to Japanin the 5th century via the Korean peninsula. At that time
Japan maintained an extensive exchange with the
Korean peninsula and immigrants from the peninsula(some Korean physicians had been invited to Japan) had
provided the people of the ruling class in Japan with acertain degree of insight into Chinese medicine. From theend of the 6th century direct exchange with China started
and by the 7th century the Japanese government sentscholars for foreign studies with their ambassadors to
China in the Sui and Tang periods. Some studied theChinese medicine before their return to Japan.
In 701 the government enacted laws (including items
related to the medical system) modeled according to theChinese system used in the Tang period. For the purposeof medical education a curriculum was established, where
the textbooks included classics like the "Huang-Di
Nei-Jing" (Yellow Emperors Classic of Internal Medicine),
medical encyclopedias, textbooks of pharmacology, pulse
diagnosis and the like. The duration required for the
study of medicine was set at 6 years. This was a period ofimitation during which almost no original contributions
introduced by Japanese were observed, but in 984 theoldest Japanese medical encyclopedia, the "Ishinpo" wascompiled (the contents of which are, however, mostly
citations from Chinese medical textbooks).
This system of medical affairs served the ruling classof the government and functioned as long as thearistocracy controlled the government until the end of the
12th century. After the warrior class seized politicalpower and moved the capital from Kyoto to Kamakura
the system was perfunctorily handed down (thisgovernment is called the Kamakura Shogunate).
Medicine was handed down in specialized families and in
extremely confined conditions. Yet, during this period,
Buddhism, concentrating on salvatational activities,
suddenly flourished and people involved were looking for
a new medicine, breaking free of the Kyoto medical
community. The representative priest and physician of
the time was Shozen Kajiwara (1266-1337), who wrote
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two large medical encyclopedias between 1302 and 1327.
In these works an enormous amount of Chinese medical
books are cited as references.
Early development
In the 15th century the second government of thewarrior class, the Ashikaga Shogunate, placed great
importance on trade with China of the Ming period anddispatched many trading vessels. Beside these there wasa significant number of private vessels scuttling between
China and Japan. While this led to the import of many
Chinese articles, it simultaneously also increased thenumber of people visiting Japan. Moreover, since
Buddhist priests and intellectuals had found an interestin medicine, the merchant vessels imported large
quantities of medical references and drugs. Yet, duringthat time the trade partners of the Japanese were
Chinese merchants and information pertaining to thecapital, Beijing, was scarce. The imported medical books
tended to be slightly biased. They did not represent themost advanced medicine of the Ming period, but the
majority of the books were rather of the preceding Sung
period. For this reason Japanese medicine adapted itself
to that period.
This situation was changed by Dosan Manase(1507-1594) who was born in Kyoto. After studying in a
Buddhist temple, he headed for the seat of learning ineast Japan, the Ashikaga Gakko (Ashikaga school) for
further studies (the Ashikaga school was introduced to
the world in 1550 by Francisco de Xavier as the "largest
and most famous general university in Japan").
Koga, located close to this school, was the seat of the
Ashikaga Shogunate regional government in East Japan.
In its vicinity lived excellent physicians together withmany intellectuals. Manase studied first underphysicians in charge of important government officials aswell as priests who had returned from studying medicine
in China and later the contemporarily most advanced
medicine of the Ming period. Because he was exceedingly
sagacious he understood almost all of the material. As aresult he acquired a level of medical learning and skills
that matched the physicians of the Ming dynasty.
Following his return to Kyoto in 1545 he applied thisknowledge, referring to a large number of books, to create
his own unique medical system. The fruit of his labor
culminated in his main work, the "Keiteki Shu". The
purpose of this compilation was to unify the process fromdiagnosis to therapy based on traditional medical
theories. This structure resembles very closely thecurrent form of TCM. A school building, the "Keiteki In",
was erected in which the medical system he had founded
was taught to students gathering there from all over thecountry. This system became the Japanese medical
standard of the day and spread throughout the country.
During the latter half of the 16th century the powerof the Ashikaga Shogunate declined, and in the course of

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multiple civil wars over a period of several decades, theTokugawa Shogunate was established in 1603. This
government transferred the capital to Edo (present day
Tokyo) in order to govern the country, divided the country
into more than 200 small feudal domains and appointed
feudal lords (daimyo) to rule those particular domains,while the shogun maintained a central authorative
government. The government of the Emperor in Kyoto
continued to exist as a government without any real
powers to which perfunctory government officials wereappointed. The same situation applied to medicine.
Each feudal domain had an administrative
organization resembling that of the central government.
Initially the medical system was not exceptional. Duringthat period there had not yet been any attempts at state
regulated educational systems, so that people who
studied in private medical schools were free to open
offices in the cities and establish their practice there. The
leaders of the private schools had studied in Manase's
school and most were excellent physicians.
Many of the private schools were found in Kyoto andEdo (present day Tokyo), so that students intending tostudy medicine gathered in these two cities. The
publication of medical books gradually increased, and in
addition, the classics and books of the Ming period,
reprints and commentaries trying to render difficult
medical issues easier to understand circulated. Thesevarious commentaries became very important for the
tradition of Japanese Kampo medicine.
Following the late 16th century new situations arose
between Japan and the continent. One of those eventswas the attempt of Hideyoshi Toyotomi, for a short period
the supreme ruler of Japan, to invade the Korean
peninsula. The invaders plundered cultural artifacts
including medical books and technical experts (including
physicians) throughout the various parts of the peninsulaand brought them back to Japan. In particular, theexperts on wood block printing made important
contributions to the Japanese publishing business.
Publication of medical books relied largely on thetechnical expertise of these people.
Another event occurring a little later was thedownfall of the Ming dynasty. People being attacked by
the Manchurians (of the later Qing period) fled to thesouth and a small minority of these people(approximately 20-30,000) sought refuge in Japan. Herethey were accepted by the Tokugawa Shogunate newly
formed in 1603. Among these people were excellent
physicians who taught the Japanese the newest level ofChinese medicine of the day.
These two events greatly promoted during the 17th
century the introduction and spread of the latest medical
knowledge from China and the Korean peninsula to
Japan.
As stated above, the conceptual world of Japan at thetime regarded Confucian studies to be of highest priority

and studies of Neo-Confucianism, as the conceptual basisof the Tokugawa Shogunate, were promoted (serious
introduction of Neo-Confucianism to Japan occurred
during the latter half of the 16th century). Yet, by thelatter half of the 17th century, new trends were observedin this branch of learning. Some of the progressive
scholars denied Neo-Confucianism and attempted toreturn to the original Confucian views. Thus, the classicsof the Confucian area were no longer interpreted along
the Neo-Confucian lines of thought, but the trend among
these scholars was to interpret the classics according totheir own views. This also influenced the practice of
medicine, which always stood under the strong influenceof conceptual Confucianism. That is why the medical
original classic "Sho Kan Ron" (Shang han lun) wasinterpreted according to the views of the medical scholars
and not according to the interpretations prevailing during
the Ming period in the same way that the Confucianists
emphasized Confucius's original texts. This led to the
spread of a movement, placing the utmost importance on
clinical applications.
One cannot disregard the extensive studies of theChinese "Shang han lun". In China the "Zhung-Jing's
Encyclopedia" of 1599 (this included the "Shang han lun"and "Jin gui yao liu") was published. Around this time
research on the "Shang han lun" started. This boom sooncaught fire in Japan and in 1659 the Japanese re-print of"Zhung-Jing's Encyclopedia" and a number of otherclassic texts were published. Moreover, during this period
research scriptures dealing with the Chinese "Shang hanlun" were brought to Japan, immediately receiving muchattention and motivated many people to study this world.
The second trend motivated the Japanese physicians
to emphasize the original medical text of the "Shang hanlun". This was a characteristic Japanese event and thisschool of thought later was designated the "classic school"(Koho Ha). The origin of the classic school was the revivalof ancient medical saints (medical arts) in modern times,
but the actual manifestation varied with each individual
and through the different periods.
Creative Period
While the physicians of the classic school studied the"Shang han lun", they criticized at the same time
traditional medical theories. Later, these concepts formed
the characteristics of this school. During the early period
there were influential people among the members of thisschool, their problem awareness was based on the "Riki
Nigen
Ron"
(Two
Principle
theory)ofthe
Neo-Confucianism. They considered "qi" (spirit) to be
more important than "li" (reason) and thus establishedtheories emphasizing "yang qi" or the "movement of qi".
These concepts received much attention as new
hypotheses of physiology and pathology, but did not
develop beyond that, so that there was little hope, as will
be stated later, for the appearance of new theories.

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The "Shang han lun" may have been considered bythis school of thought as the one and only classic and gave
rise to an enormous number of research books. The mostoutstanding methodologic characteristic of their study
was that they tried to explain this classic through therules it provided itself. Todo Yoshimasu (1702-1773) was
the one person who promoted this methodology to its
extreme limits. His appearance on the scene abruptly
changed the form of Japanese Kampo medicine.
Yoshimasu gave his own experiences and the entries
in the classic a lot of thought and came up with theconcept that "all diseases arise from a single toxin"(Manbyo Ichidoku Setsu = single toxin hypothesis of
diseases) and thus arrived at a view of pathology entirely
new and different from the common one. Drugs were
supposed to expel this toxin and he set forth that theprescriptions listed in "Shang han lun" and "Jin gui yao
liu" were highly effective for this purpose. Although there
was only one toxin, it could reach various different places,
causing a multitude of different symptoms. Abdominal
examination was given great importance as the one
diagnostic method of choice to determine the location of
the toxin. Abdominal examination is a uniquely Japaneseexamination procedure. Its origin reaches back to the16th century and Todo Yoshimasu inheriting its
tradition, relied for his use available prescriptions.
Moreover, he insisted that "prescriptions were the mostimportant thing in medicine" and studied how individual
prescriptions could be used for the expulsion of the toxin.
For this purpose he temporarily broke up the "Shang
han lun" and "Jin gui yao liu", reassembled themclassified by drugs and termed this work "Ruiju Ho" or"Lei Shu Fang" (in Chinese). In this book the individual
paragraphs are arranged according to prescriptions,which served to facilitate clear comprehension of theindications for each drug. This arrangement does notdepend on traditional theories, but allowed one toadminister appropriate treatment provided a set ofsymptoms could be identified. This "treatment system of
specific prescriptions for specific symptom complexes" iscalled "prescription-symptom relation". Later this system
continued to play an important role in the Japanese
Kampo medical system.
Yoshimasu also tried to deduce a posteriori the actionof the individual drugs from the entry text in the "Shang
han lun". When regarding prescriptions containing
several crude drugs he searched for shared meanings in
the text pertaining to the indications, identified theactions of the individual drugs and detailed them in his
book "Yakuchou" or "Yao Chang" (in Chinese). In this way
he supported his theories with pharmacology.
The "single toxin hypothesis of diseases" hypothesis
did not worry about the right qi, but concentrated solely
on the presence of evil forces and his treatment wascharacterized by dispelling this evil. Yoshimasu's
4

concepts gave rise to extensive discussion and quickly
spread throughout Japan. This resulted after a shortwhile in the collapse of the Manase school of medicine.
However, while the single toxin hypothesis was one of thedefining characteristics of Yoshimasu's medicine, it too
gradually fell into disuse after his death and only the"prescription-symptom relation" was passed down tofuture generations.
The classic school of medicine was, as stated above,
not uniform, but had several other special characteristics
such as emphasizing the "Shang han lun", rejecting the
traditional medical theories, and attempt to findtreatment principles out of the "Shang han lun".
Eclectic Period
Until the early 18th century the theories of
traditional medicine formed the roots of medicine,including the Manase school of basic theories, but were
rejected by the advocates of the classic school. Instead
speculation was given up and therapies that could bebased entirely on directly verifiable things became themainstream. Symptoms were minutely examined,
symptompatterns
identified
andtreatments
administered matching those patterns. The physicians of
the time founded their practices under thesecircumstances on their own personal experiences,
experience based personal hypotheses and the integrationof therapeutic methods from other fields (like folk
medicines and blood letting) and practiced their own
individual eclectic styles. The result was that from thelater half of the 18th century until the early 19th century
an abundance of experiences was accumulated using thismethod. These people were called eclectics.
During this time the completely rejected traditional
medical concepts by Todo Yoshimasu again came into use
because of their clinical necessity. The eight principles of
yin-yang, exterior-interior, cold-heat, deficiency-excess, orgreater yang disease, brighter yang disease and similarterms revived the six channel concepts of the "Shang hanlun". Also, a child of Todo Yoshimasu, Nangai Yoshimasu,
proposed the hypothesis that although there is only one
toxin, this may superimpose on qi, blood or water andthereby cause the symptoms of disease. These technicalterms appear on first sight to be the traditional medical
terms used previously, but actually refer to completely
different things. They possess almost no meaning related
to physiology or pathology, but are instead characterized
in that they are used simply as indices of classifications.
Also, during this period academic conflicts arose
between Kyoto and the capital Edo (present day Tokyo).
The physicians of Kyoto placed their greatestemphasis on the epoch of the "Shang han lun" andfrequently used prescriptions listed in this classic. A
representative figure of the contemporary eclectics was
Tokaku Wada (1742-1803) from Kyoto. He acquired the

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skill to use a relatively small number of prescriptions (afew dozen) for their respective indications throughexperience and was very skillful in applying theseprescriptions to various different pathologic conditions.
Kinkei Nakagami (1744-1833) also came from Kyoto andclassified therapies most suitable for individual diseases,
not restricting himself to Chinese herbal medicine, butalso successfully used folk medicines, acupuncture andmoxibustion, blood letting, affusions, and the like, for thetreatment of diseases.
Conversely, Kakuryo Katakura (1751-1822) from Edo
had referred to Chinese medicine up to the Sung dynasty,
fitting specific prescriptions to the various conditions,thus achieving excellent results. He is known to have
performed in 1794 the world's first resection of a nasal
polyp with a snare.
In the latter half of the 18th century new trends
appeared in Confuscianism and the study of historicalartifacts flourishing in China of the Qing period wasintroduced to Japan. Medicine too came under the
influence of this trend and the study of historical artifacts
began to flourish in Japan. Classic texts like the"Huang-Di Nei-Jing" and "Shang han lun" were subject tostrict criticism, which led to the preparation andpublication of the correct texts. These movements were
initially propagated by individual persons, but later also
acknowledged by the Tokugawa Shogunate that
established a national medical research institute (EdoMedical House). Here research and education were
performed simultaneously. The third director of theinstitute, Genkan Taki (1754-1810), has left the world
many great achievements. Among these his comments on
the most important classic texts of traditional Chinese
medicine "Huang-Di Nei-Jing", "Shang han lun" and "Jingui yao liu" are of particular excellence. Later, while theinstitute was responsible for a portion of medical
administration, the Taki family made remarkableachievements in the study of historical artifacts. The
result was that the study of historical artifacts became
the mainstream academic trend in Edo.
The serious introduction of western scientificmedicine presented in Dutch to Japan began in the 19th
century. In the middle part of the 18th century, during
the period of Yoshimasu's activity, the gradualintroduction of western medicine had already begun.
While few in number, some medical books of highly
advanced content had been imported and progressively
minded physicians studied and translated these. The firsttranslation of such a book was the "Ontleedkundige
Tafelen" by the German Johan Adam Kulmus. This
edition expanded the view of the Japanese, who had
previously known only traditional Chinese medicine. Allof a sudden a view of European trends was available.
Initially only anatomy and surgery in western
medicine were introduced and started to gain ground, but

soon internal medicine and other clinical applications
started to spread. In particular a form of integrative
medicine was practiced in the field of surgery. The
representative person of this era, Hanaoka Seishu,
resected in 1805 a breast cancer under the world's first
general anaesthesia. Moreover, nearing the end of the
Shogunate, western scientific medicine gained a lot more
momentum, so that a western medical doctor was
assigned as the physician responsible for the Shogun. A
demonstration of this medicine's effectiveness in form ofsmallpox vaccinations made clear that Kampo medicine
was not necessarily any longer the only form of medicine.
The Meiji government later succeeded in adopting
German medicine, because Japan had shown that it had
been able to assimilate and apply western medicine of thehighest level worldwide.
The ranks of Kampo physicians working in the fieldof internal medicine having difficulties in integrating
both medical systems according to Hanaoka's approach,assumed a hostile attitude toward western medicine andtried to reject it. But their attempt at opposing the trendsof the time failed and western medicine spread still
further, leading to the feared decline of Kampo medicine.
Under these circumstances, many physiciansbelieving in the superiority of Kampo medicine, appeared
and tried to develop it further. At that time many
physicians conducted their clinical practice along thelines of Yoshimasu's concepts and among these Yodo Odai
(1799-1870) practiced a consequent Yoshimasu style
medicine and became renowned for his excellent
treatment. He added his personal experiences in the formof comments to Yoshimasu's "Ruiju Ho" and published his
own book "Ruiju Ho Kogi". His book detailed explicitly
how the prescriptions of the "Shang han lun" should beapplied to the various pathologic conditions (The "Ruiju
Ho Kogi" was a popular piece of reading during therenaissance of Kampo medicine in the 1930s anddeveloped into a clinical guide. Its influence continues tothe present day).
Gyoko Yamada (1808-1881) was one of the clinicians
contributing to actual clinical practice. He was an
outstanding personality who also had an academic sidethat led to his assignment as a teacher at the Edo medical
research institute. He integrated the study of historicalartifacts in clinical practice and applied past clinicaldescriptions and case reports into present clinicalpractice.
Another remarkable person was Sohaku Asada(1815-1894). He established a unique system based
mainly on the "Shang han lun" and the medical theoriesof the Sung period. He was entrusted with important
posts by the Tokugawa Shogunate and the new Meiji
government. He is also known for having treated many
important government officials and ministers of many
foreign countries. His medical system was a broad-based

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system combining the Kyoto and Edo schools and he isalso well known for episodes describing his dealing with asciatica attack in the French envoy, Leon Roche; or
inducing recovery in the Taisho Emperor during a critical
illness in his infancy.
While Kampo medicine developed, it divided into
various coexisting schools by the middle of the 19th
century. The study of historical documents achieved an
unprecedented development. Before this backgroundclinical experiences were accumulated in a preparatory
step for further development. Yet, these trends came to asudden standstill, as outlined in further detail below,
because of changes in the political environment.
Decline and Revival
Until the middle of the 19th century Kampo medicine
made enormous contributions to the health of ordinary
people. During this time there was both technicalprogress and academic development. Yet, when the new
Meiji government (where the emperor again assumed thehighest position in a constitutional monarchy) replaced
the Tokugawa Shogunate in 1868, the circumstances
relevant to medicine changed completely.
The new government was modeled after the politicalsystems of America and various other countries,
establishing guidelines that westernized politics,
economy, education, military and various otherinstitutions. While it suffered from unequal treaties with
America and various other countries, it initiated abuild-up of national strength according to the motto“national prosperity and defense”.
Regarding medicine, there was a need for military
medicine and for that purpose it was decided to adopt themost advanced German medical system. German medical
educators were invited and highly advanced, specialized
education started at the universities. All medical
facilities of the former government were requisitioned by
the new government or else abolished. After that, allpracticing Kampo physicians had to terminate theirprofession in one generation (the profession of a physician
was often hereditary) and regardless of how zealously
their children or disciples practiced, they were not able tobecome physicians any longer.
People aspiring to become physicians were obliged to
study western medicine at universities or specializedorganizations and then pass an examination forpracticing physicians. Although the curriculum did notinclude Kampo medicine, the people in charge of therelevant department at that time, did not reject Kampo
medicine in itself. There was still room left to study
traditional medicine after formally becoming a physician.
This measure later led to the revival of Kampo medicine.
Kampo medicine was considered not to be proper
medicine and as such banished from any official capacity.
Social survival was permitted only for acupuncture and6moxibustion with permission of the regional government(refer to the special edition of "Japanese Acupuncture" forfurther details). The research of the constituent crude
drugs of Kampo prescriptions (pharmacognosy) was at
the time the most advanced academic subject andenthusiastically conducted in pharmacologic faculties ofuniversities. The isolation of ephedrine from the ephedra
herb by Nagayoshi Nagai is just one such example. In thisway the traditional Japanese pharmacology wasinherited and led to modern scientific research in Kampo
medicine.
Having received a major blow from the government,
Kampo medicine was now completely removed from themainstream of medicine. In spite of the opposing
movement of actual Kampo medicine practitioners (thismovement is in terms of medical history very intriguing),
there was almost no reflection on this situation at all
during the 1900s. However, the small number ofphysicians who studied by the end of the Tokugawa
Shogunate under the few remaining Kampo physicians(most of which had degrees in western medicine) started
new research into Kampo medicine and applied thisclinically.
During this period the Kampo physicians could
grossly be divided into three different groups.
The first group was the successors of Shuhaku Asada,
who practiced by the end of the preceding century. They
handed the medical teaching of their master down while
practicing in Tokyo, Osaka, and Kyoto and these disciples
in turn trained their own students in their devotion forfurther development. This school belonged to the so-called
eclectics.
The second group were followers of Wada Keijuro,
who himself still being a young boy, saw his sisterradically improve through Kampo medicine and thus
decided to become a Kampo physician himself, later
making great efforts in his attempt at facilitating thedevelopment in this field of learning. In 1910 hepublished the book "Ikai no Tettsui" (The Iron Hammer ofthe Medical World) wherein he used western medicine as
academic background. The book provides an outstanding
description of Kampo medicine as a form of clinicalmedicine and by which he pioneered the social revival of
Kampo medicine. The basic style of the book was thesame as that of Todo Yoshimasu and based mainly on the"Shang han lun" and "Jin gui yao liu". He and his
successors formed a group of people belonging to theclassic school.
Third, was the group of followers of Dohaku Mori,
who was also a religious figure with his disciples. Mori
entered into an apprenticeship with a not famous, but avery capable Kampo physician, where he acquired his
medical skills. Adding his own personal ideas he createda unique classification of physical constitutions and later
instructed younger generations. His treatment was

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outstanding and in 1918, during the so-called Spain
influenza epidemic, he classified this disease into three
types, assigned different prescriptions to these types andthereby achieved great therapeutic success. His school
belonged to the Gosei Ha (new world school).
Second generation followers of these schools
cooperated later in the 1930s to establish the Japanese
Kampo medical system. The results of these efforts foundtheir common expression in the book "Practice of ClinicalKampo Medicine" (1941). This book was prepared for the
purpose of offering the "busy clinician the possibility ofacquiring Kampo medical skills without any backgroundknowledge". It later became the archetype of literature on
Japanese Kampo medicine.
The methodology outlined in this book closely
resembles that put forward by Todo Yoshimasu. Specificprescriptions were assigned for specific symptom
complexes and the concept therefore followed the
tradition of the "prescription-symptom relation" (fangzheng xiang dui) where the prescription matches the
Kampo diagnosis. It may be said to have developed basedon the hypothesis that "prescriptions are the mostimportant thing in medicine".
The revived Kampo medicine followed the lines of
medicine as it had been practiced during the Edo period.
It promoted a form of treatment that put little emphasison the pathologic factors and mechanisms at work in thepatients and therefore facilitated its application within
the framework of western medicine. Later thiscontributed both positively and negatively to the future
development of Kampo medicine. Put in another way, thisform of medicine could be put to practical use from thattime onward, provided there was a basic backgroundknowledge in western medicine. Doubtlessly this wasvery convenient for physicians who had received only awestern medical education but would like to give the useof Kampo medicine a try.
Actually, the application of health insurance to theprescription of Kampo medical formulas was introduced
in 1976 on this basis and later saw a surprising growth,thus supporting this methodology. Conversely, the loss of
traditional ways of thinking obstructed theoreticaldevelopments. This became a major obstacle in academic
exchanges with China and Korea and various othercountries with the similar traditional medical systems(and theoretical systems) by creating major systematicdifferences.
Application of medical insurance to specific Kampo
medical extracts
Currently, even though Kampo medicine is nottaught in medical school, herbal medicines are sold in
pharmacies and traditional prescriptions in use (many ofwhich are manufactured by small scale, by familybusiness type companies) are in use. Their constituentsare actively studied as materials for new drugs.
Furthermore, since the establishment of the Japanese
health insurance system, health insurance currently
covers more than 160 herbal formulas. While the policy of
the Meiji government superficially had abolished Kampo
medicine, it had survived among the people.
In 1976 the Ministry of Health and Welfare adapted
the opinions from the chairman of the Japanese Medical
Association, Taro Takemi who had a deep understandingof Kampo medicine, demonstrated strong politicalleadership, and made remarkable contributions to the
medical administrative management of the Japanese
government, which led to the approval of healthinsurance for Kampo medical prescriptions.
A number of pharmaceutical companies have started
to manufacture these formulas. The sales strategies forthese companies at the time were to use Kampo
medicines based on names of diseases. Thus, while
yin-yan, deficiency-excess and similar pathologic factors
and mechanisms were largely neglected, identification of
the symptom patterns called "Sho" was the only concept
barely being accepted and used. This resulted in the useor large quantities of Chinese herbal extracts covered byhealth insurance in the clinical setting and a quick
spread of these in the medical world.
These circumstances led to the appearance of a small
number of physicians using Kampo medicine in adisorderly manner, yet did not entirely drive thedevelopment of Kampo medicine into an undesirable
direction. A substantial amount of clinical research(including
DB-RCT
cumulative
research)
andpharmacologic research was conducted, also developing
new applications and indications like relief of side effectsof radiation therapy or chemotherapy. In this way a
number of applications for a number of fields have beendeveloped.
At the same time, limitations of this kind of
application became evident. Already in the 1980s anumber of problems had emerged. The first of which was
the efficacy of Kampo medicine (extracts) for medical use.
While the dose of Japanese Kampo prescriptions is quite
small, the amount of extract contained in the extracts iseven smaller. Regarding efficacy, this was reason why
these formulas were thought of as possibly not being
sufficiently effective. Following communication of thisfact to the Ministry of Health and Welfare in 1985, thesituation improved. However, the fact that the used doses
were small, remained unchanged.
The second problem was that ready-made formulas
could not be individually adjusted, preventing theprescriptions made to order for individual patients. To
circumvent this problem a number of extracts werecombined to provide a limited amount of freedom, yet thisdid not constitute a fundamental solution.

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For the solution of this second problem a significant
number of physicians adopted the original application
form of these drugs, namely decoctions.
Thirdly, and this is the most important problem,
limitations became clear, when Kampo medicines wereprescribed according to western medical diagnoses anddisease names instead of the original Kampo medical
concepts.
A number of solutions to these problems haveemerged.
The first of which was the reintroduction of a system
similar to that used by the Japanese 400 years ago inmodern traditional Chinese medicine (TCM). Because thetraditional body concepts (anatomy, physiology, etc.)
similar to those originally adopted by the Chinese andlater used by the Japanese, had been replaced in a little
over a century by western medical body concepts,
comprehension of traditional TCM theories based on said
traditional body concepts became almost impossible. This
resulted in the necessity for physicians to relearn the
TCM theories. A rather difficult undertaking. Even
though identical Chinese characters are used in both
systems, correct comprehension is currently quitedifficult. A large number of relevant textbooks andreferences have been published.
Even though TCM has again become a subject of
research among Japanese physicians, the Japanese havedifficulties in grasping the abstract TCM theories, whichmakes a complete mastering of the subject difficult.
Recently, Yoichiro Ebe developed a theory integratingthese abstract theories with practical elements tofacilitate their explanation. This theory is called "Keiho
Igaku" (Classical formulation (jing fang) medicine) andassigns particular importance to the attempt at obtaining
a detailed and concrete understanding of the functions of"qi" within the body.
Another problem is the adoption of modern medical
research methods. In order to enable various practicalclinical applications of Kampo medical extracts coveredby the health insurance, cumulative research, including
DB-RCT, have been performed and the formulations
applied clinically based on these studies.
In this field the research into clinical epidemiology isparticularly noteworthy. The research group of Hajime
Haimoto examined more than 100 conditions for which
patients received Kampo medicines, analyzed this datawith a computer and calculated the odds ratio. One of thefindings of their research particularly well known is thatthe use of Poria Powder with Five Herbs for headaches
associated with a drop in atmospheric pressure carries aprobability of being effective of more than 90% (see thisjournal, Vol. 1, No. 1).
In Japan, the study of galenicals has been a family
tradition for more than 100 years. Application of modern
methods in this field has led to further developments and8now similar studies performed for Kampo medicines haveyielded corresponding results. Studies trying to identify
the components of crude drugs or formulas are in thelimelight of recent attention. However, the newtechniques trying to identify "compounds in serum",following the intake of Kampo herbal formulas, are themost significant with application of this so-called serum,
Kampo pharmacology attempts to clarify thepharmacodynamics of the crude drug components in the
body. It gradually becomes clear that the enteric bacterial
flora apparently plays an important role in the absorptionof these components.
In Japan, there is another research area that thecountry can pride itself with before the world, and this isresearch into medical history, classical texts andbibliography. In the first half of the 19th century the Edo
Gakko (Edo Medical House) led research efforts in thisarea to a culmination point, but after the adoption ofGerman medicine, it lost its necessity and rapidly
declined. Yet, this area of research has in recent years
seen a renaissance and Hiroshi Kosoto, et al. of the
Department of Medical History Research at the Oriental
Medicine Research Center of the Kitasato Institute havepublished a series of new research results. The research
into medical history on first view does not appear to haveany direct bearing on clinical practice, but it plays animportant role in the establishment of the foundation of
Kampo medicine. Also, critical text analysis often
provides hints for new clinical applications.
From a clinical point of view, the most importantfeature of Japanese Kampo medicine is the extensive
accumulation of experiences in the use of "Shang han lun"prescriptions (including the "Jin gui yao liu"). In the past,
Japanese physicians have been using these for conditions
that are basically indications for different prescriptions.
This successfully contributed to the demonstration of theinherently great potential of these drugs, indicated newforms of clinical applications and has thus also provided
material for further studies. Researchers of Japanese
Kampo medicine work with the above described various
different research methods and clinical applications, but
agree with each other regarding the importance placed onthe "Shang han lun" prescriptions. The achievements
associated with this accumulation of experiences are both
Japan's pride and asset.
In modern Japan, highly diverse forms of Kampo
medicine coexist and their presence has a historicalbackground.
Yet, this diversity represents the real nature ofJapanese Kampo medicine and comprises new researchmethodologies and applications found only in Japan.
Even though the future worldwide development of TCM islargely influenced by the prevailing trends in its birthplace, China; Japanese Kampo medicine will contributesignificantly to that development.

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