Volume 2, Number 1 | Spring 2007

Medical History in Japan

Ashikaga school was introduced to the world in 1550

Dosan Manase and his Medicine (1)by Francisco de Xavier as the "largest and mostHiromichi Yasui
Japan Institute of TCM Research

According to one man who contributed greatly tothe revival of Kampo medicine in the current age,
Keisetu Otsuka (1900-1982), "The 'Japanization' ofChinese

medicine

beganwith

DosanManase(1507-1594) and was completed by Yoshimasu Todo(1702-1773)." [1] This is an accurate summary of what
happened in Japan between the last half of the 16thCentury, when Manase began his work with Chinese
traditionalmedicine,

which

had

been

imported

virtually unchanged into Japan, and the mid-18thCentury, when Chinese medicine was modified into asignificantly

differentanduniquely

Japanesetreatment modality by Yoshimasu Todo. In the next
two issues I will introduce the work of Manase, whobuilt the foundation for Kampo medicine in Japan.
Dosan Manase's life story, and the context of his workin Japanese medicine
Chinese medicine first entered Japan in the 5thcentury, and after many generations of imitation,
began to evolve into an independent medical traditionin the 15th Century. This was due to the genius of
Dosan Manase. During the first half of the century, theAshikaga Shogunate formally opened trade with Ming
China. Communication flowed freely and trading ships
imported large quantities of goods into Japan. Some of
the most important imports were medical texts andmedicinal ingredients. This was the situation when
Dosan Manase entered the scene.

Koga, located close to this school, was the seatof the Ashikaga Shogunate regional government inEast Japan. In its vicinity lived excellent physicians
together with many intellectuals. Manase studied
first under physicians in charge of important
government officials, as well as priests who had
returned from studying medicine in China and later
the most contemporaneous advanced medicine of
the Ming period. Because he was exceedingly
sagacious he understood almost all of the material.
As a result he acquired a level of medical learningand skills that matched the physicians of the Ming
dynasty.
Following his return to Kyoto in 1545, heapplied this knowledge, referring to a large numberof 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 from diagnosis to therapy
basedontraditional

medicaltheories.

This

structure resembles very closely the current form ofTCM. A school building, the "Keiteki In", waserected in which the medical system he had founded
was taught to students gathering there from all overthe country. This system became the Japanese
medical standard of the day and spread throughout
the country.
Approximately

sixty-fourreferences

werequoted by Manase in Keiteki-shu which were clearlyinfluenced by the ideas of Zhu Danxin, one of theDosan Manase (1507-1594) was born in Kyoto.
After studying in a Buddhist temple, he headed forthe seat of learning in east Japan, the Ashikaga
Gakko (Ashikaga school) for further studies (the30

famous general university in Japan").

four great physicians in the Yuan period in China. A
great many of Manase's references refer to Zhu
Danxin, and this suggests that Manase belonged tothe Danxin school.

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

Volume 2, Number 1 | Spring 2007

Manase's Theoretical Approachexamination

1. The Physiological and Pathological Theory

asking, and touching), Manase attaches most(looking,listeningandsmelling,

At the beginning of each chapter of Keiteki-shu,

importance of taking the pulse. This is apparent

the pathological appearance of each disease isfrom how Manase explains the relationship between

described. The theories of yin and yang and the fivepulse patterns and the condition of diseases, andphases are put to full use and the theory of how

devotes a section of a chapter to pulse patterns fordiseases develop through ataxia of the viscera andevery group of diseases, and gives directions forbowels, and an imbalance of Qi, blood, and fluids aretreatment.

fully described. These theories are based on theManase divides the pu1se condition into sixclassics Hangdi-Neijing Suwen and Lingshu . In

pulse positions. His diagnoses give a detailed

many cases he also tried to explain symptoms based

account of each of them. In Kirigami he says, “Inon the ideas expressed in this classical text,

order to cure a deficient kidney, I take the pu1se on

althoughboth cubits (a pulse position) and distinguish３)

herefrains

fromdirect

quotations.

However, none of Manase's works are limited towhether water or fire should be supplied.”

physiological and pathological theory.

The causes of a coating on the tongue and its
treatment are briefly mentioned in the chapter on

2. Theory of Disease Causation

Shanghan in the Keitehi- shu under “Patterns andSince Sanyinfang(l174) is one of the texts

Treatments of the Coating of the Tongue,” however

quoted by Manase, we can assume that he had athis problem is rarely mentioned in the chapters on

good understanding of its general ideas, including

general disease groups. It seems that Manase paid

postulated internal factors, external factors, andlittle attention to an examination of the tongue“way of life” in disease causation. Moreover, in a

except in cases of Shang Han (Cold Injury). In

compilation of Manase's notes, Kirigami, a collection

contrast to later practice, in Chinese medical textsof his lectures, there is a chapter describing theof that time, only a few descriptions of tongue

threeexamination and its significance are mentioned,elements,Qi,blood,andmucus.

Theimportance of these three elements had alreadyalthoughbeen pointed out by his master, Sanki Tashiro, andundoubtedly carried out in some form or another.

it is thought that this later exerted a major

Shanghanshejian by Zhang Deng, written in 1688,influence upon Nangai Yoshimasu in his work The

first mentions tongue diagnosis in detai1.

Theory of Qi, Blood, and Fluids.
It is fully explained in the chapter on Qi, thechapter on blood, and the chapter on phlegm inexaminationsofthetonguewere

Abdominal diagnosis, commonly regarded as
one of the characteristics of Kampo Medicine, is not
mentioned at all in the writings of Manase

Keiteki-shu how Qi, blood, and fluids can exert aharmful influence and cause disease when they

4. Pharmacological Theory

become abnormal.

Manase wrote a book on pharmacology entitled,

Nodoku (Efficacy and Side Effects). It was heavily
influenced by descriptions in the classical Chinese

3. Diagnosis
Of the four traditional methods of diagnostic

text

entitled

Yixuezhengchuan such

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

asthe31Volume 2, Number 1 | Spring 2007

following：“Each medication brings about positive

it is an aid to understanding what is happening

effects and unwanted side effects. If the medicine is

inside the patient. Treatment is based upon theseeffective against a disease, the patient will be cured,observations. The method is almost the same as theif not, it becomes worse.” The original Chinese bookdistinguishing of symptom patterns and treatments

is simply a kind of memo in which the nature andadopted in modern traditional Chinese medicine.

taste of each medicine are itemized and described,

Manase changed his method for distinguishingand only those diseases against which the medicine

symptom patterns depending on the type of disease,is effective are described. In contrast, in Keiteki-shu

and adopted specific measures according to the, Manase puts his great wealth of knowledge ofcircumstances. For example, in the chapter on

medicines to full use. He seems to have developed aedemas, he describes how it is caused by ahuge pharmacological system, though this is not

malfunctioning of the spleen and kidney, and he also

included in Keiteki-shu. However, as a compendium

mentions the influence of the lung. Treatment isfor everyday treatment, Nitiyo Yakusei Nodoku isbased on these observations. In other words,

quite convenient, and the physicians of those days

distinguishing patterns of the viscera and bowels

apparently used it and added various addendum.

are most important. In addition, he made use of the８)Its wide use is also suggested by the fact that in“analysis of the eight principles”1l) (including the1603 Manase's adopted son, Gensaku９), reissued anconcepts of yin and yang), and he integrated these

en1arged version of the text, referring to the mostprinciples into the ideal case presented in therecently

Shokan-ron12), where the progression of shokan13)

importedbookonpharmacology,

through six stages is described.

Bencaogangmu(1578).
information

The concepts of Qi and blood are foundnecessary is described in idiomatic phrases, which

throughout his writing and are also made use of inmust have been widely known if we are to assume

the Keiteki-shu. In “Fifty-seven articles” whichthat each concept was readily understood. Manase

appear at the beginning of Kirigami15), Manase

did not mention the medicines by their original

mentions the importance of distinguishing patterns

names, but adopted a method designed to simplify

of Qi and blood, stating, “It is most important firstthe description by creating a single character for

to discern whether Qi and blood are in excess oreach medicine, which he called “a single-character

deficient in diagnosing various symptoms.”

InNodoku,

theminimumname.” He might have intended to protect his ownAt the very beginning of each disease group

school by the adoption of such a method since rival

mentioned in Keiteki-shu, the causes of the diseaseschools would not know exactly what medication

are explained, and the various influences leading towas

the disease are described. Moreover, as mentioned

beingprescribed.

Thisisoneof

thecharacteristics of the Dosan Manase school.

above, the idea that Qi, blood, and fluids can exert abad influence once they lose their normal condition
was well accepted. With Manase's work, the method

5. Treatment Theory
It was mentioned above that Keiteki-shu is atext designed to aid in observing symptom patterns
and in making treatment decisions. In other words,
32of distinguishing symptom patterns and relatingthem to the causes of diseases was perfected.
From the above, and considering the time that

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

Volume 2, Number 1 | Spring 2007

Dosan lived, it seems that he was in almost perfect

However,command of the concepts and theories which we use

contribution,

now in kampo. However, it was impossible for him

created in China to become well known and suitableto know Xue Ji (1488-1558), Zhao Xianke

andfor use in Japan. His contribution due to his own

ideas (Zhang Jingyue disagreed

initiative is remarkable. In addition, he was wellwith the theory of superfluous yang and insufficientable to grasp the differences between Japanese andyin〔which is used by some people today). On theChinese

other hand, he mentioned a disease which indicates

impossibility of simply adopting Chinese methods ofinsufficiency of genuine yang, which is considered totreatment in Japan, stating, “It is desirable to givebe one of the fundamental ideas of present day

different kinds of treatment depending upon the

traditional Chinese medicine. These ideas appearedcountry.” He also made an attempt to establish andafter Xue Ji and the same thing could be said for thewrite a chapter on the subject of gerontology in thetheory which appeared

Keiteki-shu, a topic which had not been consideredmuch later, indicating the foresight of Manase andin China, where he described the pathology of old

his master Tashiro.

people and indicated some methods of treatment.

１)Zhang Jingyue's

３)epidemic febrile disease４)

２)

overandManase's

medicalideas.

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

above

hiswork

allowedHepointedtheoreticaltheories

outthe33