Report Kampo Medicine as an Integrative Medicine in Japan JMAJ 52(3): 147–149, 2009 Ko NISHIMURA,*1 Gregory A. PLOTNIKOFF,*1,2 Kenji WATANABE*1,3 Whole medical systems involve “complete sys- Introduction tems of theory and practice that have evolved independently from or parallel to allopathic Worldwide, modern healthcare systems increas- (conventional) medicine.” 2 These may reflect ingly spotlight integrative healthcare modalities individual cultural systems, such as Kampo medi- that incorporate ancient wisdom. This movement cine, traditional Chinese medicine (TCM),3 tradi- started in both the United Kingdom and the tional Korean medicine (Han medicine), and United States as “alternative medicine.” As Ayurvedic medicine. Some elements common alternative healthcare modalities became more to whole medical systems are a belief that the prevalent, the descriptive term changed to body has the power to heal itself, and that healing “complementary medicine” or “complementary may involve techniques that use the mind, body, and alternative medicine” (CAM). Now, due to and spirit. the further incorporation of such practices, the more frequently used term is “integrative medi- History of Kampo Medicine cine.” Kampo medicine, or Japanese traditional medicine, is integrative as it has been used by Ancient Chinese medicine was recorded in two Western physicians in addition to conventional medical texts, the Huangdi Neijing ( ) medicine. and Shan Hang Lung ( ), during the Han Dynasty (202 BC to 220 AD). Medicines were Whole Medical Systems transmitted from ancient China to Japan via the Korean Peninsula in the 5th or 6th century. In the U.S., the National Center for Complemen- Although Japanese medicine initially fol- tary and Alternative Medicine (NCCAM) defines lowed the ancient Chinese medicine, soon Japan CAM as “a group of diverse medical and health- started to modify the Chinese medicine, mainly care systems, practices, and products that are because the materials were unique to China and not presently considered to be part of conven- needed to be adjusted to conditions in Japan. tional medicine.” 1 NCCAM interprets “comple- The first Japanese medical book (Daidoruijuhou mentary” medicine as those treatments that are ) was written in 808. Kampo medicine used together with conventional medicine, and became established during the Edo period (1603– “alternative” medicine as those treatments that 1867). At the beginning of the Edo period, the are used in place of conventional medicine. It medicine of Ming-China was introduced and classifies CAM into four categories or “domains”: widely spread. In the 17th and 18th centuries, biologically-based practices, energy therapies, Japanese doctors advocated the exclusion of manipulative and body-based methods, and Ming Chinese medicine and followed the basic mind-body medicine. A fifth domain, “alternative concept of Chinese medicine written in the medical systems,” is now referred to as whole Shan Hang Lung ( ) and Chin Gui Yao medical systems. Liu ( ) during the Han Dynasty. This *1 Lecturer, Center for Kampo Medicine, Keio University School of Medicine, Tokyo, Japan. *2 Medical Director, Penny George Institute for Health and Healing Abbott Northwestern Hospital, Minneapolis, USA. *3 Director, Associate Professor, Center for Kampo Medicine, Keio University School of Medicine, Tokyo, Japan ([email protected]). JMAJ, May/June 2009 — Vol. 52, No. 3 147 Nishimura, K, Plotnikoff GA, Watanabe K school of thought was called the KOHO school. Medicine under the KOHO School followed Use of Kampo Drugs in Daily Clinical the simple ancient Chinese formula and excluded Practice the expanded medical theory of Ming-China. Abdominal diagnosis was also established. This Because the Meiji Government adopted a one- started in the Muromachi period (14th to 15th license system for medical practitioners in Japan, century) as a treatment method and later came to there is no separate medical license for tradi- be regarded as a useful diagnostic procedure. tional medicine in Japan. This differentiates Abdominal diagnosis became a major force and Kampo from the use of traditional medicine in led to the establishment of the Japanese tradition. China and Korea, where there are two distinct With the Meiji Restoration in 1867, the new licenses. Only Western-style physicians are allowed government changed gear to follow Western to prescribe Kampo drugs, and currently more countries and adopted only Western medicine. than 70% of Japanese physicians (including Thereafter, the practice of Kampo medicine dras- nearly 100% of Japanese Ob/Gyns) use Kampo tically declined. However, it persisted in private medicine in daily practice, even in university hos- practice until finally being rediscovered by main- pitals, together with high-tech medical treatments stream medical practitioners. Kampo products such as organ transplantation and robotic opera- (mainly herbal extract formulations) were first tions.6,7 Most practitioners use extract formulas. covered under the public health insurance sys- Kampo medicines are government-regulated tem in Japan in 1976. Today, 148 kinds of Kampo prescription drugs and currently 148 formulas formulas are prescribed under the Japanese are listed under the Japanese insurance program. national health insurance system.4 Kampo practitioners are also able to use decoc- tion, selecting several herbs from among 243 kinds Characteristics of Kampo Medicine of herbs available under the insurance system.8 In 2001, the Ministry of Education, Culture, Kampo medicine differs from TCM in many Sports, Science and Technology decided to incor- respects.5 Although TCM derives its theories porate Kampo medical education into the core mainly from the Huangdi Neijing ( ), curriculum of medical schools. Although a Shennong Bencao Jing ( ), and Shan national survey in 1998 reported that only 18 Hang Lung ( ) medical texts, all of which Japanese medical schools had either elective were written during the Han Dynasty, these or required classes on Kampo medicine,9 cur- theories were expanded broadly. As mentioned rently all 80 medical schools provide Kampo above, Japan decided to follow the Shan Hang medical education. Lung ( ) faithfully. Thus, although many of the original features of TCM and Kampo Conclusion were the same, the two forms of medicine have diverged more and more over the years, espe- All Kampo medicines are made by Japanese cially after World War II. In China, TCM was pharmaceutical companies whose manufacturing molded and regulated by the government after is governed by the Pharmaceutical Affairs Law the People’s Republic of China was founded. and strictly controlled by other government There are three major differences between regulations, including Good Manufacturing Prac- TCM and Kampo. First, TCM prescription is indi- tice. As a result, product quality and safety of vidualized at the herbal level, while Kampo the highest level are assured.10 Because of the medicine is individualized at the formula level; high quality and safety of Kampo formulas, clini- second, the prescription pattern is simplified in cal studies using Kampo formulas, including Kampo medicine; and third, abdominal findings randomized controlled studies,11–15 can be orga- are important for making diagnoses in Kampo nized more easily than clinical studies using medicine. Although abdominal diagnosis was Kampo decocted from several herbs. Some may described in the Shan Hang Lung ( ), it is think there is little clinical evidence for the effec- not valued in Chinese and Korean traditional tiveness of Kampo and that the medicines are medicine. In Japan, abdominal diagnosis was based only on historical knowledge, but com- uniquely developed and used widely. pared to traditional medicines of other countries, 148 JMAJ, May/June 2009 — Vol. 52, No. 3 KAMPO MEDICINE AS AN INTEGRATIVE MEDICINE IN JAPAN Kampo medicine is a model integrative medicine system. We should make an effort to inform the in many aspects.16,17 Moreover, Kampo medicines world of our experience with Kampo medicine in are the only ancient medical products covered Japan.18,19 under the Japanese universal health insurance References 1. NCCAM. Get the FACTS—What Is Complementary and Alterna- logical symptoms of dementia. Int J Neuropsychopharmacol. tive Medicine (CAM)? Available at http://nccam.nih.gov/health/ 2008;11:1–9. whatiscam (accessed on November 22, 2005) 12. Odaguchi H, Wakasugi A, Ito H, et al. The efficacy of goshuyuto, 2. NCCAM. BACKGROUNDER: Whole Medical Systems—An a typical kampo (Japanese herbal medicine) formula, in prevent- Overview” (October 2004). page 1. Available at http://nccam.nih. ing episodes of headache. Curr Med Res Opin. 2006;8:1587– gov/health/backgrounds/wholemed.pdf (accessed on November 1597. 22, 2005) 13. Arakawa K, Saruta T, Abe K, et al. Improvement of accessory 3. NCCAM. NCCAM Funding: Appropriations History. Available at symptoms of hypertension by TSUMURA Orengedokuto Extract, http://nccam.nih.gov/about/appropriations/index.htm a four herbal drugs containing Kampo-Medicine Granules for ethi- 4. Ono N. Medical insurance in Japan. The Journal of Kampo, cal use: a double-blind, placebo-controlled study. Phytomedicine. Acupuncture and Integrative Medicine. 2005;1:70–84. 2006;3:1–10. 5. Yu F, Takahashi T, Moriya J, et al. Traditional Chinese medicine 14. Urata Y, Yoshida S, Irie Y, et al. Treatment of asthma patients and kampo: a review from the distant past for the future. 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