Volume 2, Number 2 | Summer 2007

Medical History in Japan
Dosan Manase and his Medicine (2)definitionofayang

minor

channelintheShokan-ron16).

Hiromichi Yasui

What is of great interest is that Manase not only

Japan Institute of TCM Researchdetails every symptom and pu1se pattern, but also theappropriate medicine. That is, he used a method in

In the last issue I talked about the writings andwhich he analyzed each symptom, and prescribed an

medical theories of Dosan Manase (1507-1594), whoappropriate medicine, instead of first taking a known

introduced state-of-the-art Chinese medicine to Japanprescription and more or less fitting it to the disease.

in the 16th Century. In this issue I will discuss theThis method can only be carried out by someone who isactual therapeutic methods used, based on specificconfident of his ability to understand the condition ofcases described by Dosan in his writings.

the disease. In this particular case, the following
process of relating symptoms to medication was

Dosan Manase wrote few case studies. He left only
a few examples of his clinical work in a book entitledestablished:
Pain in chest and side: Scutellariae Radix, Bupleuri

Shussho Haizai. Among them, however, a considerable

Radix

number can be regarded as suitable data from which toDeafness:

analyze his ideas and actual treatment methods.
Several cases are presented below.

BupleuriRadix,

PeucedaniRadix,

Glycyrrhizae Radix
Bitterness in mouth: Bupleuri Radix
Dry tongue: Paeoniae Radix, Scutellariae Radix,

Case 1：Shang han (Cold Injury)

Glycyrrhizae Radix

A male, aged 40, suffering from Shang han (ColdInjury) for four days. A problem of the “yang minorchannel”8)wasdiagnosed

bythepu1seandAlternating sensations of hot and cold: Bupleuri Radix,

Peucedani Radix
Vomiting: Citri Unshiu Pericarpium, Pinellia Tuber

accompanying symptoms: pain in the chest and side,

Taut and rapid pulse at both the inch and cubit:

deafness, bitterness in the mouth, a dry tongue, hot

Scutellariae Radix, Paeoniae Radix, Peucedaniand cold sensations, vomiting, a taut and rapid pulse

Radix, Bupleuri Radix.

taken both at the “inch” and “cubit.”
Prescription (Seven herbs):

There is no indication from his writings thatBupleuri Radix

Manase had read the Shang han lun4), but it is likely

Scutellariae Radix

that he knew its outline through reading other books,

Pinelliae Tuberand was aware of its applications. Therefore, he is

Citri Unshiu Pericarpium

likely to have thought of a prescription which includes

Paeoniae Radix

saiko (bupleurum root) as main herb when symptoms

Peucedani Radixof Shang han were apparent for a number of days.

Glycyrrhizae Radix 15)

What is remarkable about Manase is that he could
think of complex prescriptions such as those listed inThis case was not cured until four days after thethe Shang han lun, while he analyzed each symptom

onset of the disease. In cases of Shang han (Coldand composed individual prescriptions, taking intoInjury), the fourth day is usually considered to beconsideration each separate ingredient. This resulted

when the syndrome changes from a “yang major

in selecting a prescription which was similar tochannel” to either a “splendid yang channel” or a “yangdaisaikoto6). And this particular case reveals Manase's

minor channel.” In fact Manase mentions that both theknowledge of Shang han very well.

pulse and symptoms he describes are in accord with a
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 2, Number 2 | Summer 2007

cases where it affects the bowels, it is necessary toCase 2: Palsy
A male, aged 50, viscera affected by “wind,” slack

expel the ‘pernicious wind influence’ using diaphoretic

lips, no voice, nasal congestion, blindness, deafness,

recipes such as shozokumeito. This will cure it quite

constipation, has normal urination, and a “forceful”

easily. In cases where it hits the meridians, it isand “slippery” pulse.

necessary to supply the blood and nourish the muscles

The first four kinds of medicines work to make trappedwith tonifying recipes such as daijingyoto, which canwind circulate:also dispel pathogenic wind from the exterior of theNotopterygii Rhizoma

body. And in cases where it affects the viscera, we must

Magnoliae Cortex

first get rid of any stagnation with sankato, and thenRhei Rhizoma

adopt additional prescriptions with juzentaihoto andAurantii Fructus Immaturus

shimotsuto, However, cases such as this last one areThe next eleven normalize qi and blood and smooth thevery difficult to cure.”“meridians”:

Angelicae Radix

Palsy caused by wind affecting the viscera indicates

Paeoniae Radix

serious apoplexy, including, at times, bouts of fainting,

Cinnamomi Cortex

hence it is extremely difficult to cure. Although theRehmanniae Radix

name of the prescribed medicine is not described inGinseng Radix

this case study, sankato was adopted as a prescription.

Citri Unshiu Pericarpium

It consists of four kinds of medicines which function toArmeniacae SemenexpelNotopterygii Rhizoma

Notopterygii Rhizoma

Arecae Semen

dispelled from the exterior of the body, after having aAstragali Radix

bowel movement with the help of sankato. (At theFour moxibustion points

same

trappedtime,thewind.

shojyokito

Using),

fainting

pathogenic

would

wind

probablyplus
washave

Bai-hui(Du20)

subsided.) Manase continued treating the patient thisQu-chi(LI11),

way. The medicines he used served to invigorate blood

Jian-Jing(GB21),

circulation, replenish “vital essence,” dispel pathogenic

Zu-San-li(ST36)

wind from the exterior of the body, and stimulate
circulation in the meridians.

This case is one of Chung-feng, in other words,

Manase also gave detailed advice on his treatment

stroke. Chung-feng means “to be affected by wind”,

methods, including descriptions of palsy such as “oneand is thought to be caused by a harmful windshould not use Aconiti Radix

invading the body. In such cases, the patient shows

Processa ) without first smoothing the flow of vital

signs of being upset by a harmful wind influence.

energy and curing phlegm, and one should not depend

Clearly, Manase was well aware of pathogenic factors

only on medicine for dispelling pathogenic wind fromand internal injury. He determined how to drive away

the exterior of the body, and neglect the need tothe pernicious influence, and regulate the internal

invigorate blood circulation.”(Keiteki-shu))

and Aconiti Radix

condition in his treatment.
Manase also used moxibustion treatment for
Manase states in the chapter on apoplexy in theapoplexy. The moxibustion points used are exactly theKeiteki-shu:“Symptoms change depending on whether

same as those used in modern acupuncture andthe wind affects the bowels, meridians, or viscera. Inmoxibustion.

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

Volume 2, Number 2 | Summer 2007

This suggests Manase's self-confidence in treating

moisturizing the lung” would be expected to be adopted

apoplexy which, in those days when there were noas the treatment.

mannitol, steroids, activation drugs for cerebral

In this case, Manase's thought processes and themetabolism, and no hypotensive drugs, is impressive.

linking of symptoms to medication were as follows:

Case 3: CoughCough habitually gets heavier in the afternoon:

When the patient's cough remains uncured and

Bupleuri Radix, Moutan Cortex

usually gets heavier in the afternoon, he has a

Deficiency of yin, slight fever：Chinese angelica root,

deficiency of yin, a slight fever, rushes of blood to theRehmanniae Radix, Paeoniae Radix 18), Moutanhead, a hoarse voice, is thirsty, has bloody phlegm,

Cortexcopious night sweats, weight loss, loss of taste, slight
difficulty with bowel movements and urination, pain in

Rush of blood to the head: Phellodendri Cortex,

Pogostemi Herba

the sides accompanied by a cough, a “taut, fine,

Hoarse voice: Fritillariae Bulbus, Asini Corii Collas

sinking, hesitant pulse,” and “five beats in a breath.

Thirst: Trichosanthis Radix, Ophiopogonis Radix

Sixteen tastes：

Bloody phlegm: Asteris Radix, Fritillariae Bulbus

Asteris Radix

Night sweats: Trichosanthis Radix, Ophiopogonis

Moutan Cortex

Radix, Paeoniae Radix, Cinnamomi Cortex

Bupleuri Radix

Loss of taste: Scrophulariae Radix, Cinnamomi Cortex,

Angelicae Radix

Angelicae Radix

Paeoniae Radix

Slight difficulty with bowel movements and urination:

Phellodendri Cortex

Angelicae Radix, Moutan Cortex, Paeoniae Radix,

Fritillariae Bulbus

Ophiopogonis Radix, Pogostemi Herba

Asini Corii Collas

Chest pain: Bupleuri Radix

Trichosanthis Radix
Ophiopogonis Radix

As shown above, Manase logically chose andCinnamomi Cortex

prescribed medicines which facilitated a supply of yin

Scrophulariae Radixand cooled the extra heat stored in the lung. It is easy

Gentianae Scabrae Radix

to understand Manase's basic method if we consider

Polygoni Tinctorii Folium

this prescription to be removing something from, andPogostemi Herba

thenRehmanniae Radix

hyakugokokinto.

This case can be regarded as a disease which isCase 4: Sterility

addingsomethingto,

theprescriptionofsimilar to chronic bronchitis or bronchiectasia. It can

A female in her early thirties. Qi in the liver andbe considered fundamentally to be a deficiency of lunggallbladder is excessive, she is irritable, and therefore

yin, where the cough has stimulated the lung over a

her blood “stagnates,” and is unable to nourish thelong period of time, causing an excess of yang, or heat,

meridians and their collaterals. Because of a uterinein the lung. At the same time, the symptoms of ahypoplasia and a lack of “sex-stimulating essence” indeficiency of kidney and lung yin, such as a slight fever,

the kidney, she is unable to conceive. She has ana rush of blood to the head, night sweats, and thirst

oppressed feeling in the chest, an angry look,were present, and “the method of tonifying yin anddysmenorrhea, tennesmus, and her pulse is slightly

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)33

Volume 2, Number 2 | Summer 2007

I have investigated Manase's treatment methods by“taut and hesitant.”
compoundexamining a few cases recorded by him. This has

medicines, with some additions and subtractions

brought to light his own characteristic methods, which

depending upon the symptom variation over time, theformed the roots of the Gosei school13). However,patient was able to become pregnant.

Manase's method disappeared due to the sudden riseAfteradministeringtenkindsofBupleuri Radixof the Koho school14) in the middle of the Edo period.

Cyperi Rhizoma

Nevertheless, it remains important because it isRehmanniae Radix

remarkably similar to modern traditional Chinese

Cnidii Rhizoma

medicine, and so it is essential that we understand it if

Citri Unshiu Pericarpium

we aspire to a synthesis of Japanese Kampo Medicine

Moutan Cortexand TCM.

Arecae Semen

Prescriptions: Pinyin - Chinese Character - Japanese

Glycyrrhizae Radix

daisaikoto ・Da-Chai-Hu-Tang・大柴胡湯Angelicae Dahuricae Radix

shozokumeito ・Xiao-Xu-Ming-Tang・小続命湯For this case of sterility, Manase analyzed thesymptoms and prepared a prescription to counteract
the deficiency of liver blood and the stagnant liver qi,
which was the original condition of the patient. The
name of the prescription is not clear, however, it wasprobably

acombinationofkyukichoketuin andshoyosan, with some variations. Even today similar

daijingyoto ・Da-Qin-Qiu-Tang・大秦艽湯
shojokito ・Xiao-Cheng-Qi-Tang・小承気湯
sankato ・San-Hua-Tang・三化湯
juzentaihoto ・Shi-Quan-Da-Bu-Tang・十全大補湯shimotsuto・Si-Wu-Tang・四物湯hyakugokokinto・Bai-He-Gu-Jing-Tang・ 合固金湯kyukichoketuin・Xiong-Gui-Tao-Xue-yin・芎帰調血飲
shoyosan ・Xiao-Yao-San・逍遥散prescriptions are sometimes used.

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