Volume 2, Number 4 | Winter 2007

Medical History in Japan
Todo Yoshimasu and his Medicine (2)CASE 2: Dysphasia

Hiromichi Yasui
Japan Institute of TCM Research

In the last issue, I introduced the biography
and the medical theory of Todo Yoshimasu whoradically changed Japanese Kampo medicine.
His theory replaced the pathophysiological parts
needing elucidation — which is the mostimportant aspect of TCM — with a black box
that quickly spread across the country and hassince become the tradition of Japanese Kampo
medicine. In this issue, I will introduce how headministered treatment using case reports fromhis book, “Kenjyuroku” (1763).

An old man, aged over 90, never believed in
medicine, thinking that it was useless. But hecame to admire our master's medicine recently,
saying to his family members that when he got
ill, the only doctor who could be relied on was
Yoshimasu. A few years later, he began sufferingfrom exogenous febrile disease. He began to feelmalaise and heat in his chest, and to talk indelirium. There was no urination, he lost hisappetite for 6 days. His family members askedtoexamine

him.

There

werestuffiness in the chest, and his limbs were a littleswollen. Yoshimasu made bukuryoin to give him.
After vomiting much water, the patient wascured.
Since he was 60, he used to wear thick clothes
even in summer time. Nevertheless he felt chilly.
He thought it was necessary to wear thickclothes because of his age. But after thattreatment, the old man was able to wear thinclothes an when he was younger. So the case was
not due to senility, but disease.

was suffering from dysphagia for 2 years. Every 5
or 10 days, it occurred. He came to feel turgor in
his chest and abdomen and his physical condition
was getting worse. No doctor could cure him.
Hearing of Yoshimasu 's reputation, he decided toask his treatment, saying: life and death aredecided by destiny. If I have to die, I would like todieby

Yoshimasu'streatment.

Yoshimasu

provided daihangeto, which made him vomit.
Everytime he vomited, there was sputum. After 8
or 9 days, the medicine began to work, letting thebowels loose, and his vomiting stopped. Within 2months, he was cured completely.
CASE 3: Hematemesis

CASE 1: Cold Injury (Shang han)Yoshimasu

A servant to the lord of a clan, 20 years old,A merchant of Karasuma in Kyoto, Ihei
lzumiya was suffering from hematemesis for 20years Almost every 10 days, he vomited blood. In
autumn of one year he was very sick and almost
unable to breathe. No doctor could do anything tocurehim.

Familymembers,crying,werepreparing his funeral. Yoshimasu happened tocome and examine him. The patient was not deadyet, for when our master put a thread in front of
his nose, the thread moved, although themerchant was motionless. When Yoshimasu
touched his abdomen, it moved a little. judging
that Qi was not dead yet, he made san’oshashinto
in haste. Then, after taking the medicine, thepatient began to have loose his bowels and after
10 times, then stopped. Within 20 days, he wascompletely cured. Since then, almost 10 years
passed, and there was no recurrence.
CASE 4: Tuberculosis
A daughter of a merchant, Denbei Masuya of
Kawara-machi in Kyoto got ill, and all the doctorsdiagnosed her symptoms as tuberculosis. No

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

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Volume 2, Number 4 | Winter 2007

treatment worked. She got thinner day by day,

CASE 6: Pain of the heel

and almost died. From the beginning, theA medical student, aged about 20, suffered

merchant was afraid of the treatment of Koho

from pain of the heel. The pain was like being(ancient prescription in “Shang han lun”). He

pierced by an awl or the blade of a sword,

could not bring himself to Yoshimasu to examine

unbearable to the touch. Many doctors tried but

her. Yoshimasu, learning that the merchant did

could not cure him. A surgeon thought that there

not believe in Yoshimasu's intention, just left

was pus, so he cut out that part. But that was notthem alone. A few months later, this girl died.
Two years later, a sister of the girl got ill. Themerchant said: “I have 5 children, and 4 among
them have died due to tuberculosis. In the year
when they turned 17 years old, in spring, theygot ill, and in August, they died. Now theyoungest girl is 17 years old, and infected withtuberculosis. Although I know the efficacy ofKoho, I am afraid that very-strong laxative
medicines

areused.

But

prescriptionofslow-acting and reinforcement could not work forthis disease, as far as I remember. So please cureher disease. If she would die, I will not regret it.”
Our master examined her. For enervation,dullness in limbs, alternate spells of fever andchills, and cough, he made shoseiryuto andkontangan, which he used in mixed form. Before
August, she was cured completely.
CASE 5: Edema

effective. Yoshimasu was called to see him.
There was a contracture of the abdominal wall.
There was no softness felt by his hand on
abdominalpalpitation.

Hemadeshakuyakukanzoto to give him. With one dosage,
the pains disappeared.
CASE 7 : Soliloquy
An ambitious, poor student studied very hard
and read a lot of books without sleeping for 7 days.
He started to talk to himself in delirium, laughing,rebuking his master. Everybody thought that hehad become insane. Yoshimasu examined him.
There was swelling in the sternocostal, a fast
throbbing of heart and ki went up and could notcome down. He made saikokeishikankyoto to givethis patient, sometimes attacking poison by shien.
Within a few days, the student was completelycured.
CASE 8 : Eruption on the head

A chief Buddhist monk of the Kosai-Temple in

A merchant in Kyoto, Kichigoro Yamatoya,

Bungo suffered from swelling of his body. He

every spring had a fever in his head and face. On

could not urinate. Stuffiness in his chest made it

his head, he had a sore, which was very itchy. Ifalmost unable to breathe. His feet became very

he scratched it, it became infected. When autumn

weak. For him, a doctor made eppikajutsubuto

came, the symptoms disappeared, without any

which did not work at all. Yoshimasu examinedtreatment. He wanted to be completely curedhim. As there was unconsolidation in the lower

though. Yoshimasu examined him. There wasabdomen, for which to correspond, he madeslight palpitation, fullness in the chest andhachimijiogan. With one dos-age, the stuffinesshypochondrium, and an abnormal rising of Qi. Toin his chest disappeared. With a second dosage,correspondhe was able to urinate. With less than ten

saikokeishikankyoto and kyuosan . In a month,dosages, he was cured completely

all symptoms disappeared. Since then, there wastotheheprepared６)

no recurrence.
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symptoms

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

Volume 2, Number 4 | Winter 2007

CASE 9 : Dumbness and convulsive fit

adorns the first page of “Kenjuroku”, I will add

A soldier of the Yamashiro-yodo clan, named

some explanation from the standing of ModernHeizaemon Yamashita met Yoshimasu, andTCM. The 5-year-old patient mentioned in thesaid. “I have a 5 year old boy. He cannot speak,book must now be considered to be about 3 years

and he has convulsive fits once or twice a day.

old when various factors relevant at that time are

His body has become very thin, he seems to betaken into account. From the modern medical

very exhausted, and close to death. His agony

point

seems to increase day by day. As his parents,

developmental disorder, although the cause is not

we cannot bear to see him in pain. We would bevery much obliged if you could treat him. If
fortune favors us, and if we will be able to see
him well again, even if it will be only once, wewill never regret it. ”Accepting their wish,
Yoshimasu examined the boy. He recognized an
abdominal symptom of stuffiness in the gastricregion, which was soft when he palpated it. He
made daio’orenshashinto , which he provided
for 100 days. The stuffiness in the gastricregion disappeared, and convu1sive fits also
stopped. Nevertheless, there was still swellingin the sternocostal, fullness is the upper
abdomen, and dumbness. He made shosaikoto,and together with san’ogan, he continued histreatment. Sometimes he provided deikankyogan
to treat those symptoms. In this way, about 6
months passed. One day, his nurse was leaningofview,

thediagnosis

might

bea

known.
Todo,

however,administereddaio’orenshashinto, targeting a “distressed andsoft epigastrium.” Epigastric distress abated inabout 100 days and rib-side distension, andhypochondrium fullness,” with occasional useof daikankyogan, which achieved the desired
effect.
From the present traditional medical pointof view, what Todo tried to clear out of the bodywas primarily “retained phlegm” accumulated
in the chest, diaphragm, and epigastrium, andsecondarily, retained qi in the epigastrium.
There is no way to tell from the foregoing if hewas

awareofpathologicalproducts

andpathological phenomena, and if he thought
they were toxins or a kind of toxin as heasserted. It is conceivable that, depending onthepathologicalcondition,targetedandagainst the entrance gate with this child in her

accurate administration of the four foumulaearms. Someone passed in front of them, leading(daioorenshashinto , shosaikoto, san’ogan, anda horse. Suddenly the child uttered “uma.”daikankyogan)

Being overjoyed to know this, his parents took

non-physical afflictions and improved the flow

the child with them to Yoshimasu to tell himof qi and body fluids.

dispelled

physicalandthis. And when Yoshimasu showed a piece ofThis is a brief study of Yoshimasu's methods ofsweets to the child, he said “uma” again. (Intreatment, citing from his book Kenju-roku. We canJapanese, “uma” means “a horse” and “sweetsee that his methods of treatment were based on histaste.” It is a homonym.) The parents were very

own medical theory, and at the same time he was aglad. So he continued with the prescriptions

very efficient clinical doctor with keen insight.

mentioned above. Within a few months, theboy's language ability became normal.
Since the last case is interesting, one thatAnyway, what he said and what he did put themedical world of that time into great turmoil.

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Volume 2, Number 4 | Winter 2007

Maintaining his motto of relating symptoms tomedication, he denied all theories of traditional
medicine. He insisted upon the administration oftreatments to expel poison, sometimes using very
intense laxatives and mercurial medicine. It willcontinue to be one of our important themes toknow how to grasp the meaning of Yoshimasu,
and how to make the most of his ideas andmethods of treatment in current medicine.

Prescription (Japanese, Chinese Character, Pinyin)bukuryoin 茯苓飲 Fulingyin
daihangeto 大半夏湯 Dabanshatang
san’oshashinto 三黄瀉心湯 Sanhuangxiexintang
shoseiryuto 小青竜湯 xiaoqinglongtan
kontangan 滖痰丸
eppikajutsubuto 越婢加朮附湯hachimijiogan 八味地黄丸 Baweidihuanwan
shakuyakukanzoto 芍薬甘草湯 Shaoyaoganzaotang
saikokeishikankyoto 柴胡桂枝乾姜湯 Chaihuguizhiganjiantang
shien 紫円
kyuosan 芎黄散
daio’orenshashinto 大黄黄連瀉心湯 Dahuanhuanglienxiexintang
daio’orento 大黄黄連湯 Dahuanghuanglientang
shosaikoto 小柴胡湯 Xiaochaihutang
san’ogan 三黄丸 Sanhuantang
daikankyogan 大陥胸丸 Daxianxiongwan

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