From the Japanese Association of Medical Sciences
The Japan Society for Oriental Medicine
Current Situation of Kampo Medicine in Japan
JMAJ 56(2): 112–114, 2013
Tomoaki ISHIKAWA*1
After ancient Chinese medicine was introduced In some Asian and African nations, for example, to Japan about 1,500 years ago, it was combined 80% of the population uses traditional medicine with the natural features and culture of Japan, in primary care. traced a unique course of development that was Under these circumstances, a variety of inter- free of interference from other countries, and national issues have rapidly emerged. WHO became accepted among the people of Japan as and other organizations have begun studies Kampo medicine (Japanese oriental medicine). concerning the international standardization of This medical approach has been systematized traditional medicine around the world, based for the treatment of infectious diseases. The on considerations such as the following: host-parasite relationship is an important factor 1) Traditional medicine has the potential to under the treatment of infectious diseases. But handle a significant portion of health care, in the age when parasites were unknown, con- and there are global commonalities. cepts systematizing diverse symptoms exhibited 2) The present medical information systems con by the host in terms of disease stages and the cerning traditional medicine are inadequate. host’s biological reactions were used to deter- 3) Individual countries have outstanding knowl- mine the methods of treatment in contraposition edge concerning traditional medicine, but to the right treatment drugs. This host-centered there is a lack of international coordination. approach is characterized by the ability to treat 4) There is a need for information on traditional maladies ranging from acute infectious diseases medicine based on international standards. to chronic conditions. 5) Efficiency would be improved by the inte- A unique kind of integrated medicine has gration of traditional medicine with existing been developed in Japan since the Meiji era, using information systems. Kampo medicine in combination with Western 6) The digitization of medical information is an medicine under the contemporary medical edu- opportunity for traditional medicine. cation. At present in Japan, Kampo medicine Because the Japanese government had no is covered under the national health insurance office in charge of traditional medicine, the Japan system. More than 148 Kampo herbal extracts Liaison of Oriental Medicine (JLOM) was estab- are utilized in daily medical practices, and the lished in 2005 by four academic associations International Classification Diseases (ICD) is (the Japan Society for Oriental Medicine, the used for disease classification as well as claim Japanese Society of Pharmacognosy, the Medical for medical treatment fees in both Western and and Pharmaceutical Society for Wakan-Yaku, Kampo medicine. and the Japan Society of Acupuncture and Mox- The Alma-Ata Declaration on primary care ibustion) and two WHO Collaborating Centers proposed that the national governments of the for Traditional Medicine (Kitasato University’s world should incorporate traditional medicine Oriental Medicine Research Center and Univer- as a part of primary health care. Now, more than sity of Toyama’s Department of Japanese Orien- 30 years later, traditional medicine is widely tal Medicine), for the purpose of developing a available in Africa, Asia, and Latin America, and cooperative framework for involvement in the it is generally accessible in terms of costs as well. WHO project for the international standardiza-
*1 President, the Japan Society for Oriental Medicine, Tokyo, Japan ([email protected]).
112 JMAJ, March / April 2013 — Vol. 56, No. 2 CURRENT SITUATION OF KAMPO MEDICINE IN JAPAN
tion terminologies on traditional medicine. medical care not only in Japan but worldwide. The area of international standardization China has been pursuing every means for the of traditional medicine includes not only ter- international standardization of TCM. Many of minology, but also standardization of natural the issues raised by China will have a significant pharmacological materials. Even when the same impact on traditional medicine in other countries, herbal medicine is used in the pharmacopoeia and there is an urgent need to develop a response of different countries, it is problematic that the concerning these matters. Caution is needed ingredients may differ in some countries although as these issues of international standardization the same name is used. In Japan, JLOM is play- will affect even the health care systems of other ing a leading role in promoting mutual under- countries. Their scope is beyond the capacity of standing across national borders. In addition, the Japan Society for Oriental Medicine and regarding the domestic situation of traditional JLOM to handle on their own, and the entire medicine, the Ministry of Health, Labour and Japanese medical field must cooperate to address Welfare of Japan has established a project team this critical situation. This has the potential to on integrated medicine, and this team has com- become a global problem. menced studies to understand the current situa- Additionally, there are problems with the sup- tion of integrated medicine in Japan and develop ply of raw materials for herbal medicines, which policies for future efforts. is becoming more challenging every year. Most Meanwhile, studies of the international stan- herbal medicines used in Japan are imported dardization of traditional medicine have begun from China, but a large proportion of China’s under the Standards for Traditional Chinese rural population has been moving to urban Medicine (TC249) of the International Organiza- regions because of differences in economic tion for Standardization (ISO), and the Chinese opportunities. The volume of herbal medicine government is the key player behind a move to production has been declining, while domestic promote Chinese medicine as the international demand has grown rapidly as treatment with standard. It is reported that China has issued herbal medicines is now covered by health proposals under ISO/TC249 concerning matters insurance in China. Because the overall supply such as education in traditional medicine and is falling short of demand, problems such as physician licensing issues. If an international limited shipment quantities and soaring prices standard is adopted for practitioners of tradi- have begun to emerge. tional Chinese medicine (international TCM The Japanese national health insurance physicians), it is possible that Japanese practi- system includes drug price standards which tioners who became licensed as international determine the prices of medicines, and herbal TCM physicians would be able to perform med- medicines cannot be used when their import ical procedures in other countries without getting prices are higher than these standards. This will medical education in Japan and obtaining physi- make it essentially impossible to use Kampo cian’s license. There is concern that international treatment under the national health insurance, standardization in this area could have a major and this is the most serious problem. If the prices impact not only on Kampo medicine but also covered by insurance diverge too widely from on Japan’s physician licensing and health care the actual costs of herbal medicines, distributors systems. This problem affects not only Japan, will naturally be unwilling to sell them at a loss. but Korea as well. However, clinical practitioners of Kampo medi- In China, there appears to be a desire for cine will be unable to treat patients as prescribed international standardization of overall TCM, if even one herbal medicine is unavailable. Prac- including medical institutions where traditional titioners of Kampo medicine in Japan have medicine is practiced as well as medical instru- requested the government to improve this situa- ments, terminology, and education. On the other tion, but there are no prospects for easy realization hand, Japan, especially JLOM, takes adequate of a system that would ensure a stable supply. and deliberate approaches, which include the If practitioners use only inexpensive herbal advocacy of standards in which Japan’s outstand- medicine, there will be quality problems. Medic- ing traditional medicine, such as Kampo, acu- inal effect worsens as quality declines, and the puncture, and moxibustion, can contribute to effectiveness of treatment will be impacted as
JMAJ, March / April 2013 — Vol. 56, No. 2 113 Ishikawa T
well. As a result, it could become impossible to question of how to grow herbal medicines for maintain an adequate level of treatment with domestic production in Japan will be an impor- herbal medicines for the people of Japan. The tant future issue.
114 JMAJ, March / April 2013 — Vol. 56, No. 2