Kampo - Japanese Herbal Medicine

Kampo medicine (æ¼¢æ–¹åŒ»å¦, KanpÅ igaku), often known simply as KanpÅ (æ¼¢æ–¹, Chinese [medicine]), is the study of traditional Chinese medicine in Japan following its introduction, beginning in the 7th century. Since then, the Japanese have created their own unique system of diagnosis and therapy. Japanese traditional medicine uses most of the Chinese therapies including acupuncture and moxibustion, but KampÅ in its present-day sense is primarily concerned with the study of herbs.

History

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Origins

According to Chinese mythology, the origins of traditional Chinese medicine are traced back to the three legendary sovereigns Fuxi, Shennong and Yellow Emperor. Shennong is believed to have tasted hundreds of herbs to ascertain their medicinal value and effects on the human body and help relieve people of their sufferings. The oldest written record focussing solely on the medicinal use of plants was the Shennong Ben Cao Jing which was compiled around the end of the first century B.C. and is said to have classified 365 species of herbs or medicinal plants.

Chinese medical practices were introduced to Japan during the 6th century A.D. In 608 Empress Suiko dispatched E-Nichi, Fuku-In and other young physicians to China. It is said that they studied medicine there for 15 years. Until 838 Japan sent 19 missions to Tang China. While the officials studied Chinese government structures, physicians and many of the Japanese monks absorbed Chinese medical knowledge.

Early Japanese adaptation

In 702 A.D., the TaihÅ Code was promulgated as an adaptation of the governmental system of China's Tang Dynasty. One section called for the establishment of a university (daigaku) including a medical school with an elaborate training program, but due to incessant civil war this program never became effective. Empress KÅmyÅ (701â€"760) established the Hidenin and Seyakuin in the KÅfuku-Temple (KÅfuku-ji) in Nara, being two Buddhist institutions that provided free healthcare and medicine for the needy. For centuries to come Japanese Buddhist monks were essential to convey Chinese medical know how to Japan and to provide health care for both the elite and the general population.

In 753 A.D., the Chinese priest Jianzhen (in Japanese Ganjin) who was well-versed in medicine arrived in Japan after five failed attempts in 12 years to cross the East China Sea. As he was blind he used his sense of smell to identify herbs. He brought medical texts and a large collection of materia medica to the imperial palace in Nara, which he dedicated to the Emperor ShÅmu in 756, 49 days after the emperorâ€™s death. They are kept in a log-cabin style treasure house of the TÅdai-Temple (TÅdai-ji) known as ShÅsÅin.

In 787 A.D., the "Newly Revised Materia Medica" (Xinxiu Bencao, 659 A.D.), which had been sponsored by the Tang Imperial Court, became an obligatory text in the study of medicine at the Japanese Health Ministry, but many of the 844 medicinal substances described in this book were not available in Japan at the time. Around 918 A.D., a Japanese medical dictionary entitled "Japanese names of (Chinese) Materia Medica" (HonzÅ-wamyÅ) was compiled, quoting from 60 Chinese medical works.

During the Heian Period, Tanba Yasuyori (912â€"995) compiled the first Japanese medical book, IshinpÅ ("Prescriptions from the Heart of Medicine"), drawing from numerous Chinese texts some of which have perished later. During the period from 1200 to 1600, medicine in Japan became more practical. Most of the physicians were Buddhist monks who continued to use the formulas, theories and practices that had been introduced by the early envoys from Tang China.

Early revision

During the 15th and 16th century, Japanese physicians began to achieve a more independent view on Chinese medicine. After 12 years of studies in China TashirÅ Sanki (1465â€"1537) became the leading figure of a movement called "Followers of Later Developments in Medicine" (Gosei-ha). This school propagated the teachings of Li Dongyuan and Zhu Tanxi that gradually superseded the older doctrines from the Song dynasty. Manase DÅsan, one of his disciples, adapted Tashiro's teachings to Japanese conditions. Based on own observation and experience he compiled a book on internal medicine in 8 volumes (Keiteki-shÅ«) and established an influential private medical school (Keiteki-in) in KyÅto. His son Gensaku wrote a book of case studies (Igaku tenshÅ-ki) and developed a considerable number of new herb formulas.

Since the second half of the 17th century a new movement, the "Followers of Classic Methods" (KohÅ-ha) evolved, that emphasized the teachings and formulas of the Chinese classic "Treatise on Cold Damage Disorders" (Shanghan Lun, in Japanese ShÅkan-ron). While the etiological concepts of this school were as speculative as those of the Gosei-ha, the therapeutic approaches were based on empirical observations and practical experience. This return to "classic methods" was initiated by Nagoya Gen'i (1628â€"1696), and advocated by influential proponents such as GotÅ Gonzan (1659â€"1733), Yamawaki TÅyÅ (1705â€"1762), and Yoshimasu TÅdÅ (1702â€"1773). Yoshimasu is considered to be the most influential figure. He accepted any effective technique, regardless of its particular philosophical background. Yoshimasu's abdominal diagnostics are commonly credited with differentiating early modern Traditional Japanese medicine (TJM) from Traditional Chinese medicine (TCM).

During the later part of the Edo period, many Japanese practitioners began to utilize elements of both schools. Some, such as Ogino Gengai (1737â€"1806), Ishizaka SÅtetsu (1770â€"1841), or Honma SÅken (1804â€"1872) even tried to incorporate Western concepts and therapies, that had made their way into the country through physicians at the Dutch trading-post Dejima (Nagasaki). Although Western medicine gained some ground in the field of surgery, there was not much competition between "Eastern" and "Western" schools until the 19th century, because even adherents of "Dutch-Studies" (Rangaku) were very eclectic in their actual practice.

Traditional medicine never lost its popularity throughout the Edo period, but it entered a period of rapid decline shortly after the Meiji Restoration. In 1871, the new government decided to modernize medical education based on the German medical system. Starting in 1875, new medical examinations focused on natural sciences and Western medical disciplines. In October 1883, a law retracted the licenses of any existing traditional practitioner. Despite losing legal standing, a small number of traditional physicians continued to practice privately. Some of them, such as Yamada GyÅkÅ (1808â€"1881), Asada SÅhaku (1813â€"1894), and Mori Risshi (1807â€"1885), organized an "Association to Preserve [Traditional] Knowledge" (Onchi-sha) and started to set up small hospitals. However, by 1887, the organization was disbanded due to internal policy dissent and the death of leading figures. The "Imperial Medical Association" (Teikoku Ikai) founded in 1894, was short-lived too. In 1895, the 8th National Assembly of the Diet vetoed a request to continue the practice of KampÅ. When Azai Kokkan (1848â€"1903), one of the main activists, died, the KampÅ-movement was almost stamped out.

Era of Western influence

Any further attempt to save traditional practices had to take into account Western concepts and therapies. Therefore, it was graduates from medical faculties, trained in Western medicine, who began to set out to revive traditional knowledge. In 1910 Wada KeijÅ«rÅ (1872â€1916) published "The Iron Hammer of the Medical World" (Ikai no tettsui). Yumoto KyÅ«shin (1876â€"1942), a graduate from Kanazawa Medical School, was so impressed by this book that he became a student of Dr. Wada. His "Japanese-Chinese Medicine" (KÅkan igaku) published in 1927 was the first book on KampÅ medicine in which Western medical findings were used to interpret classical Chinese texts. In 1927 Nakayama Tadanao (1895â€"1957) presented his "New Research on KampÅ-Medicine" (KampÅ-igaku no shin kenkyÅ«). Another "convert" was ÅŒtsuka Keisetsu (1900â€"1980), who became one of the most famous KampÅ practitioners of the 20th century.

This gradual revival was supported by the modernization of the dosage form of herbal medicine. During the 1920s, the Nagakura Pharmaceutical Company in Osaka began developing dried decoctions in a granular form. At about the same time, Tsumura JuntendÅ, a company founded by Tsumura JÅ«sha (1871â€"1941) in 1893, established a research institute to promote the development of standardized KampÅ medicine. Gradually these "Japanese-Chinese remedies" (wakan-yaku) became a standard method of KampÅ medicine administration.

In 1937, new researchers such as Yakazu DÅmei (1905â€"2002) started to promote KampÅ at the so-called â€œTakushoku University Kampo Seminarâ€. More than 700 people attended these seminars that continued after the war. In 1938, following a proposal of Yakazu, the "Asia Medicine Association" was established. In 1941, Takeyama ShinichirÅ published his "Theories on the Restoration of KampÅ Medicine" (KampÅ-ijutsu fukkÅ no riron, 1941). In that same year, Yakazu, ÅŒtsuka, Kimura Nagahisa, and Shimizu FujitarÅ (1886â€"1976) completed a book entitled "The Actual Practice of KampÅ Medicine" (KampÅ shinryÅ no jissai). By including the Western medical disease names he greatly expanded the usage of KampÅ formulas. A new version of this influential manual was printed in 1954. This book was also translated into Chinese. A completely revised version was published in 1969 under the title "Medical Dictionary of KampÅ Practice" (KampÅ ShinryÅ Iten).

In 1950 ÅŒtsuka Keisetsu, Yakazu DÅmei, Hosono ShirÅ (1899â€"1989), Okuda KenzÅ (1884â€"1961), and other leaders of the pre- and postwar KampÅ revival movement established the "Japan Society for Oriental Medicine" (Nippon TÅyÅ Igakkai) with 89 members (2014: more than 9000 members). In 1960, raw materials for crude drugs listed in the Japanese Pharmacopoeia (Nippon Yakkyoku-hÅ) received official drug prices under the National Health Insurance (NHI, Kokumin kenkÅ hoken).

Approved KampÅ medicines

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Today in Japan, KampÅ is integrated into the Japanese national health care system. In 1967, the Ministry of Health, Labour and Welfare approved four KampÅ medicines for reimbursement under the National Health Insurance (NHI) program. In 1976, 82 kampo medicines were approved by the Ministry of Health, Labour and Welfare. This number has increased to 148 Kampo formulation extracts, 241 crude drugs, and 5 crude drug preparations.

Rather than modifying formulae as in Traditional Chinese medicine, the Japanese KampÅ tradition uses fixed combinations of herbs in standardized proportions according to the classical literature of Chinese medicine. KampÅ medicines are produced by various manufacturers. However, each medicine is composed of exactly the same ingredients under the Ministry's standardization methodology. The medicines are therefore prepared under strict manufacturing conditions that rival pharmaceutical companies. In October 2000, a nationwide study reported that 72% of registered physicians prescribe KampÅ medicines. New KampÅ medicines are being evaluated using modern techniques to evaluate their mechanism of action.

Regulations, and likewise safety precautions, are much stronger and tighter for Japanese KampÅ than Chinese traditional medicine due to strict enforcement of laws and standardization.

Herbs

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The 14th edition of the Japanese Pharmacopoeia (JP, Nihon yakkyokuhÅ) lists 165 herbal ingredients that are used in KampÅ medicines. Lots of the KampÅ products are routinely tested for heavy metals, purity, and microbial content to eliminate any contamination. KampÅ medicines are tested for the levels of key chemical constituents as markers for quality control on every formula. This is carried out from the blending of the raw herbs to the end product according to the Ministryâ€™s pharmaceutical standards.

Medicinal mushrooms like Reishi and Shiitake are herbal products with a long history of use. In Japan, the Agaricus blazei mushroom is a highly popular herb, which is used by close to 500,000 people. In Japan, Agaricus blazei is also the most popular herb used by cancer patients. The second most used herb, is an isolate from the Shiitake mushroom, known as Active Hexose Correlated Compound.

KampÅ outside Japan

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In the United States, KampÅ is practiced mostly by acupuncturists, Chinese medicine practitioners, naturopath physicians, and other alternative medicine professionals. KampÅ herbal formulae are studied under clinical trials, such as the clinical study of Honso Sho-saiko-to (H09) for treatment of hepatitis C at the New York Memorial Sloan-Kettering Cancer Center, and liver cirrhosis caused by hepatitis C at the UCSD Liver Center. Both clinical trials are sponsored by Honso USA, Inc., a branch of Honso Pharmaceutical Co., Ltd., Nagoya, Japan.

Differences from traditional Chinese medicine and Western medicine

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Herbal medicines in Japan are regulated as pharmaceutical preparations; their ingredients are exactly measured and standardized, unlike the United States where most herbal preparations are regulated as dietary supplements (technically foods, not medicines). Furthermore, Kampo does not incorporate any human body parts nor animal parts, thus avoiding issues with animal cruelty prevalent in Traditional Chinese Medicine. Both the industry and the government conduct extensive monitoring of agricultural and manufacturing processes as well as postmarketing surveillance to guarantee the safety of these preparations. Furthermore, access to KampÅ herbal medicines is guaranteed as part of Japanâ€™s national health plan for each of its citizens. KampÅ, like the traditional medicines of modern China, Vietnam, and Korea, has roots that extend back to ancient Chinaâ€™s Han Dynasty (200 BC to 220 AD). The term Kampo itself incorporates two characters: æ¼¢ (kan) an adjectival modifier for things Chinese and æ–¹ (hÅ/-pÅ) denoting "method" or "prescription". Thus, KampÅ means "Chinese-style medicine". The term came up during the late Edo period to draw a line against the growing influence of Western medicine, which was called RampÅ (Dutch-style medicine) by its adherents.

References

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External links

International Society for Japanese Kampo Medicine (in English)
Japan Society for Oriental Medicine (in English)
Current Kampo Medicine (Special Edition) (PDF). International Institute of Health and Human Services, Berkeley. November 2005. ISSNÂ 1559-033X.Â
Center for Kampo Medicine at the Keio University School of Medicine (in English)

Kampo - Japanese Herbal Medicine

Sabtu, 26 Agustus 2017