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Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 2  |  Issue : 1  |  Page : 36-43

Historical evolution of traditional medicine in Japan


International Education College, Shanghai University of Traditional Chinese Medicine, Shanghai, China

Date of Web Publication18-Mar-2019

Correspondence Address:
Prof. Gensheng Zhu
International Education College, Shanghai University of Traditional Chinese Medicine, Shanghai
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CMAC.CMAC_10_19

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  Abstract 


Traditional Japanese Medicine originated from traditional Chinese medicine and was first introduced to Japan directly from the mainland of China or the Korean Peninsula. After its dissemination, integration, adaption, and development in Japan for generations, it had evolved into Kampo medicine with Japanese characteristics and taken a leading role in Japanese medical practice. In history, there appeared successively schools such as Followers of Later Developments in Medicine, Followers of Classic Methods, Integrated School, and School of Textual Research. After Meiji Restoration, Kampo medicine experienced a tremendous impact by western medicine. However after World War II, with unremitting endeavors from learned scholars, traditional Japanese medicine was revived again.

Keywords: Integrated school, Kampo medicine (汉方医学), school of classic methods, school of later developments, school of textual research


How to cite this article:
Zhu G, Yan H, Chen L, Ren Y, Chu G. Historical evolution of traditional medicine in Japan. Chin Med Cult 2019;2:36-43

How to cite this URL:
Zhu G, Yan H, Chen L, Ren Y, Chu G. Historical evolution of traditional medicine in Japan. Chin Med Cult [serial online] 2019 [cited 2019 Sep 22];2:36-43. Available from: http://www.cmaconweb.org/text.asp?2019/2/1/36/254373






  Introduction Top


Japan lies adjacent to China geographically, and thus shares common cultural features with China. After its introduction to Japan, traditional Chinese medicine integrated itself with indigenous Japanese customs and lifestyles, and gradually evolved into Kampo medicine (汉方医学) of Japanese characteristics, which yet reflects its Chinese origin. Throughout its development history, traditional Japanese medicine has experienced the following six periods.


  Preliminary Stage (15Th Century) Top


Xu Fu (徐福),[1],[2] a learned Chinese scholar, who was expert at medicine, astronomy, and sailing, was sent by the First Emperor of Qin (秦始皇) in 210 B. C. to the east to search for the elixir of immortality, leading groups of pure youth and maiden, technicians, warriors, and doctors. They eventually arrived in Japan and still found nothing. They would be killed because of the failure if they returned to China, they decided to stay there instead, and disseminated Chinese medicine, agriculture, spinning and forging techniques around Japan, which promoted its social development. Moreover, he was thus respected as God of medicine and agriculture. Nowadays, there exist many temples, tombs, and parks named after Xv Fu in Japan [Figure 1] and [Figure 2].
Figure 1: Xufu Park

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Figure 2: Statue of Xu Fu

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In the early 5th century, traditional Chinese medicine and mainland Chinese culture[2],[3] were introduced to Japan through the Korean Peninsula. In 414 A.D., Korean physician of De Lai (德来) went to Japan to teach TCM. In 562 A.D., Zhao Yuan (照渊), (King of Wu)'s grandson-Zhi Cong (智聪) went to Japan through the Korean Peninsula and brought with him medicine processing tools and TCM books, to teach processing of medical herbs. Due to his prominent contributions in teaching, he was awarded the honor of “Mater of Pharmacy (和药使主)” by the Japanese Emperor at that time.

In the 7th century, the Japanese government dispatched many envoys to the Sui and Tang China to learn humanities, culture, medicine, agriculture and religion. In 608, Ono no Imoko (小野妹子) arrived in Tang China and returned to Japan with Si Hai LeiJu Fang (《四海类聚方》 Assembly of Formulas of Four Seas). The pharmacist of Namba Huiri (难波惠日) went to China in 623, 630, and 654, learned a large amount of TCM books and put them into practice back in Japan, thus honored as the “Great Benevolent Pharmacist (大仁药师)” by the Japanese Emperor at that time. In 701, based on the Yong Hui Laws (《永徽律》) of Tang (唐) China, Japan issued its first law of Taihō Code (《大宝律令》). The articles concerning medicalsystem and education were basically the same with the Tang file. For instance, technical positions such as physician, medical expert, doctor, acupuncturist, acupuncture expert, masseur, and massage expert were set according to different specialties. Doctors and acupuncture students should be taught separately, with the former learning subjects of Jia Yi Jing (《甲乙经》 The A-B Classic), Mai Jing (《脉经》 Classic of Pulse), Xiao Pin Fang (《小品方》 Excerpts of Prescriptions) and Ji Yan Fang (《集验方》 Collection of Effective Formulas), and the latter learning Su Wen (《素问》 Plain Questions), Zhen Jing (《针经》 Classic of Acupuncture), Ming Tang (《明堂》), Mai Jue (《脉决》 Secrets of Pulse) and Liu Zhu Jing (《流注经》 Classic of Ebb and Flow).

During the Tang period, not only were batches of envoys sent to China but also many experts from various specialties went to Japan to teach TCM. The most representative figure should be the distinguished monk and physician of Jian Zhen. He was well-versed in both Buddhism and TCM.[4] On invitation by Japanese monks of Rong Rui(荣睿) and Pu Zhao(普照), Jian Zhen was determined to take the trip to Japan to teach commandments in 742. Against all hardships and adversities and after five failed attempts, he succeeded in landing Japan leading a team at the end of December of 753. He then began to teach Chinese culture and medicine throughout the country, which significantly promoted the achievements and development of Japanese Buddhism and medicine. It was said that 36 kinds of herbs were brought into Japan by Jian Zhen(鉴真) from China, such as Ma Huang (麻黄Herba Ephedrae), Xi Xin (细辛 Herba Asari), Shao Yao (芍药Radix Paeoniae), Fu Zi (附子 Radix Aconiti Carmichaeli), Yuan Zhi (远志 Radix Polygalae), Huang Qi (黄芪 Radix Astragali), Gan Cao (甘草 Radix liquiritiae), Ku Shen (苦参 Radix Sophorae Flavescentis), Dang Gui (当归 Radix Angelicae Sinensis), Chai Hu (柴胡 Radix Bupleuri), Chuan Xiong (川芎 Rhizoma Chuanxiong), Xuan Shen (玄参 Radix Scrophulariae), Di Huang (地黄 Rehmannia glutinosa), Zi Su (紫苏Perilla frutescens), Dan Shen (丹参Radix Salviae Miltiorrhizae), Huang Qin (黄芩 Radix Scutellariae), Jie Geng (桔梗 Platycodon grandiflorus), Xuan Fu Hua (旋覆花 Flos lnuJae), Cang Zhu (苍术 Rhizoma Atractylodis), Zhi Mu (知母 Rhizoma Anemarrhenae), Ban Xia (半夏 Rhizoma Pinelliae), Yuan Hua (芫花 Flos Genkwa), Zhi Zi (栀子 Fructus Gardeniae), Wu Wei Zi (五味子 Fructus Schisandra chinensis), Huang Bo (黄柏 Cortex Phellodendri Chinensis), Xing Ren (杏仁 Fructus Almond), Hou Po (厚朴 Cortex Magnoliae officinalis), He Hou Po (和厚朴 Magnolia Obovata), Rou Gui (肉桂 Cortex Cinnamomi), Du Zhong (杜仲 Cortex Eucommiae), Mu Gua (木瓜 Fructus Chaenomelis), Da Zao (大枣 Fructus Zizyphi), Shu Jiao (蜀椒 Sichuan Pepper), pepper and Wu Zhu Yu (吴茱萸 Fructus Evodiae). When the Japanese Empress dowager was critically ill, only Jian Zhen's prescriptions would work. He advocated actively Zhang Zhongjing(张仲景)'s Shang Han Za Bing Lun (《伤寒杂病论》 Treatise on Cold Damage and Miscellaneous Diseases and left as his legacy the book of Jian Shang Ren Mi Fang (《鉴上人秘方》Treasurable Prescriptions by Mater Jian Zhen. Until the 17th and 18th century, his image was still printed on the packing bag of medicines by many drugstores, from which we can speculate how influential Jian Zhen is on the traditional Japanese medical field. Therefore, He was honored as the ancestor of both Ritsu (律宗) and Kampo medicine.

Japan had just imitated or copied TCM in the early period, when it came to Heian Period (784–1192 A. D.), the Japanese began to emphasize on the compilation of medical works of their own with the wakening of national consciousness.

In 808, Abe Zhenzhi(安倍真直) and the royal doctors including Izumo Guangzhen(出云广贞), acted under the Emperor's order, collected comprehensively indigenous prescriptions, and compiled the 100-Volume work of Da Tong Lei Ju Fang (《大同类聚方》Da Tong Assembly of Formulas), based on Chinese medical works such as Huang Di Nei Jing (《黄帝内经》The Yellow Emperor's Inner Classic), Mai Jing, Jia Yi Jing, Xiao Pin Fang and Xin Xiu Ben Cao (《新修本草》Newly Revised Materia Medica).

In 838 A.D., Japan sent the last batch of envoys to China and then the dispatching system was abolished. According to the Catalogue of Books Present in Japan (《日本国现在书目录》) in 898, there were 166 kinds (in 1309 volumes) of Chinese medical works stored in Japan at that time, which shows how eager the country was to study TCM.

In 984, Tanba Yasuyori (丹波康赖), the 8th generation descendant of the King of E Liu(阿留王) who was offspring of the Ling Emperor (灵帝) of the Eastern Han dynasty (东汉), compiled the first Japanese medical book of Ishinpō (《医心方》) Prescriptions from the Heart of Medicine) [Figure 3], [Figure 4], [Figure 5], [Figure 6], drawing from numerous Chinese texts introduced to Japan. The book was written in 30 volumes involving nearly 200 kinds of Chinese medical literature, and in mixed Chinese and Japanese. It was a systemic summary and preservation of a large amount of medical literature before the 10th century, providing valuable data for research on Chinese medicine in the Six Dynasties and Sui-Tang periods.
Figure 3: Research on Ishinpō (Prescriptions from the Heart of Medicine)

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Figure 4: Ishinpō (Prescriptions from the Heart of Medicine)

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Figure 5: Ishinpō (Prescriptions from the Heart of Medicine)

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Figure 6: Ishinpō

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During the Kamakura Period (镰仓时期1192–1333 A. D.), plenty of Song medical books entered into Japan due to the rapid development of Chinese printing technique. Beitiao Shishi(北条实时) (1224–1276 A.D., also called Jinze Shishi (金泽实时)), built Kanazawa (神奈川) Library in Kanagawa-ken (金泽文库) to collect the Chinese books he had stored, in which there were quite a few ancient editions of medical literature. Meanwhile, there appeared a transformation in Japanese medicine from royal physicians serving the noblemen to Buddhist monks who served the folks.

During the Muromachi Period (室町时期1338-1573 A.D.), many Japanese doctors came to China to learn theories of the great Four Jin-Yuan Schools. When they returned, most of them became the leading elites of Japanese medicine at that time, including representative physicians such as Zhutian Changqing(竹田昌庆), Yue Hu (月湖), Ban Jingyun(坂净运), Banjing Mingqin(半井明亲), and Jitian Yian(吉田意安). In the middle and late 15th century, the theoretical system of Jin-Yuan Schools(金元四大家) spread widely all over Japan, of which Li Gao(李杲) and Zhu Danxi (朱丹溪) 's academic thoughts were of more influence since they were introduced much earlier.


  Period of Later Developments in Medicine (15–17Th Centuries) Top


After settlement of TCM in Japan for nearly 1000 years, the Japanese physicians, based on TCM and its integration with Japanese elements, continuously made contributions and gradually established the school of Later Developments in Medicine,[5] during the three hundred years of late Muromachi Period, Azuchi-Momoyama Period (1573-1603 A.D.), and Edo Period (1603–1868 A.D.). Leading figures include Tashiro Sanxi(田代三喜)[6] and Manase Dosan(曲直濑道三).[7]

Tiandai Sanxi [Figure 7] (1465-1544 A.D.), born in a medical family, became a monk at 15. He went to China to learn from physician monk of Yue Hu (月湖) in 1487. He was dedicated to the academic thoughts of Li Gao and Zhu Danxi's. In 1498, he returned to Japan with numerous medical works, including Quan Jiu Ji (《全九集》 Collection of Securing The Nines) and Ji Yin Fang (《济阴方》 Formulas for Benefiting Yin) by his teacher. At first, he dwelt on Kamakura(镰仓) and worked as an attendant physician. Years afterward, he returned to and practices in his hometown of Saitama. As the pioneer of the school of Later Developments, Tiandai was well-versed in profound theoretical knowledge and superb clinical skills, thus respected as the Medical Sage(医圣) and one of the originators of Japanese Chinese medicine together with Manase Dosan and Nagata Toruhon (永田徳本).
Figure 7: Tiandai Sanxi(田代三喜)

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Manase Dosan (1507-1594 A.D.), first studied on poem and calligraphy in Kyoto (关东) and began to learn medicine from Tiandai Sanxi in Kanto in 1528. He returned to Kyoto in 1546 and then focused on medicine. His fame prevailed after he treated several generals successfully. Moreover, he then set up a medical school in Kyoto. He inherited Tashiro's experience, took basis on yin-yang and five-element theories from the Inner Classic, employed Jin-Yuan and Ming(金元明) Chinese medicine as orientation, and created his own academic genre by combining excellent medical experience and flexible clinical prescriptions. His followers counted up to several hundred, spreading his art of healing among Japanese states. Until the early Edo Period, the scale of his school reached the peak, which even thrived till the middle and late Edo Period (江户中后期).


  School of Classic Methods (17–19Th Centuries) Top


Although as early as during 1492–1501 the monk physician of Ban Jingyun(坂净运) had already learned Zhang Zhongjing's academic thoughts in China, and there was Nagata Toruhon (永田德本) with the honor of “medical Sage” in later stages (1513–1630), the real formation of the School of Classic Methods began after the 17th century, when a trend of learning Shang Han Lun (《伤寒论》The Treatise on Cold Damage Diseases) appeared in Japan. The representative figures included Nagoya Gen'I (名古屋玄医), Gotō Gonza (後藤艮山), Yamawaki Tōyō (山胁东洋) and Yoshimasu Tōyō(吉益东洞).[8],[9]

Nagoya Gen'I (1628-1696) was regarded as the initiator of the School. He familiarized himself with classics in his childhood, first learned Manase Dosan's Medical School, and then dedicated himself to ancient medical classics in later life after he contacted Shang Han Shang Lun (《伤寒尚论》Elaborated Treatise on Cold Damage) by Yu Jiayan(喻嘉言) of Ming dynasty (明代). He was the first Japanese to annotate Jin Gui Yao Lue (《金匮要略》 Golden Chamber Synopsis), advocating guidance of Zhang's academic theories, treating principle of supporting yang and subduing yin, and reviving of ancient classic formulas.

Gotō Gonzan (1659–1733) held that the yin-yang and five-element theories of the Huang Di Nei Jing (《黄帝内经》Inner Classic) and Jin-Yuan medical thoughts advocated by Tiandai Sanxi's School were mostly impractical in the clinic. Hence, by referring to Treatise on Cold Damage and Nan Jing (《难经》 Classic of Questions), he invented the view of “sole qi stagnation (一气滞留),” believing qi stagnation was the root for all diseases. In practice, he was expert in using Xiongdan (熊胆 Bile bear), pungent-spicy herbs and qi-smoothing formulas, recommended medicinal diet, hot spring spa and indigenous therapies, with preference to moxibustion. As a pioneer of medical innovation, Gotō weighed practice over theories and rarely wrote his own work, and hence, his academic thoughts were inherited by his students such as Osamu Kagawa (香川修徳) and Yamawaki Tōyō.

Yamawaki Tōyō (1706–1762), was born in a generation-physician family, learned from Gotō Gonzan and advocated current use of classic formulas. He respected Wai Tai Mi Yao Fang (《外台秘要方》 Essential Formulas from the Imperial Library) greatly and once reprinted it in 1746. In practice, he often quoted formulas from the book with pattern-differentiated modifications. Yamawaki doubted the traditional human anatomy through dissecting otter, developed anatomy on prisoners with death sentence after receiving official approval in 1754, and published an illustrated book on his anatomical findings in 1759, which pointed out several errors regarding zang-fu theories in traditional Kampo medicine. Although the experiments he had carried out was strongly opposed by the ancient School of Classic Methods led by Yoshimasu Tōdō, his attempts to testify human anatomy by experimenting had a tremendous impact on the Japanese medical field, and promoted the modernization of traditional Japanese medicine.

Yoshimasu Tōdō (1702–1773) [Figure 8] was born in a Kampo-medicine family for generations and deemed as the originator of reviving modern Japanese medicine. In the early years, he learned from the medical classics, objected some points of Jin-Yuan physicians, and advocated clinical practice based on Treatise on Cold Damage. At about 30, Yoshimasu proposed the theory of “Sole Toxin for All Diseases (万病一毒说)”. He believed, on the one hand, the occurrence of diseases was closely related to toxins; on the other hand, medicines were also toxins, so treating with medicines was like eliminating toxins with toxins and the disease would be cured after the toxins were gone. In specific, he preferred to use formulas of drastic properties. He also emphasized a lot on examination of the abdomen, considering abdomen as the root of the body. On the basis of Shang Han Lun and his adaptions to formulas according to clinical indications, he compiled the work of Lei Ju Fang (《类聚方》Classified Assembly of Formulas) [Figure 9]. Although it only consisted of over 200 kinds of formulas, most of the formulas would involve sweating, vomiting and draining methods. Yoshimasu called the drastic reaction after administration as responsive vertigo quite took pride in it, and regarded his book as Yoshimasu's Shang Han. In his early practice, there were few patients, and he had to do handcrafts to earn a living. After he was appreciated by Yamawaki Tōyō when he was 44 years old, his reputation prevailed rapidly. Inundation of patients and apprentices came. He had gained a pool of over 500 apprentices, and his academic views influenced the Kampo medicine greatly. His son of Jiyi Nanya(吉益南涯) followed his career and became the apprentice of of Hanaoka Seishu(华冈青洲) later. Nanya modified the radical views of his father and initiated a theory of qi-blood-water. It is believed that Yoshimasu Tōdō had played a key role in diverting the Kampo medicine from its origin of traditional Chinese medicine.
Figure 8: Yoshimasu Tōdō (吉益东洞)

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Figure 9: Classified Assembly of of Formulas (《类聚方》)

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In summary, the academic features of the School of Classic Methods can be concluded as suspecting the Inner Classic, advocating Treatise on Cold Damage, emphasizing clinical experience, preferring compatibility between formulas and patterns, and making good use of classic formulas.


  Integrated School (18–19Th Centuries) Top


After entering the 18th century, transformation occurred among followers of the School of Classic Methods, who tended to focus on clinical efficacy and began to utilize elements of both schools. The academic field regarded physicians of this inclination as belonging to the Integrated School. This School had overlapped time span with that of the School of Classic Methods. Since the physicians of this new School held diverse academic views, and some of them could be categorized as Classic followers, it was hard to distinguish strictly the categorization of a physician's Schools. In general, Wangyue Sanying(望月三英), Hetian Dongguo(和田东郭) and Munehaku Asada (浅田宗伯) are representative figures.[10],[11]

Wangyue Sanying (1697-1769), a pioneer figure of the Integrated School, was a royal physician of General Tokugawa in middle Edo Period, studied and examined the texts of many medical books, and opposed the theory of Sole Toxin for All Diseases by Yoshimasu Tōdō, being the first to advocate integration of ancient and modern medicines.

Hetian Dongguo (1743–1803), born in a generation-physician family, whose father was a surgeon, chose the career of a physician. He learned successively from Hutian Xiushan(戸田旭山), Yoshimasu Tōdō and others. Although he did not approve all his teachers' academic views, they significantly influenced the formation of his own thoughts. He had both recognized the merits and disadvantages of classic medicine, claiming a treatment centering on classic formulas with later modifications as a supplement. In diagnosis, he not only applied the abdomen examination appreciated by followers of Classic Methods, but also employed pulse-taking with consideration of inspecting skin, tongue, deficiency or excess of eyes, and palpitation between the kidneys, termed as the six diagnoses. His medication preferred gentle treatment without inclination of warm supplement or pure draining. The harmonious method he proposed won general recognition in the medical field and has extended to impact the traditional Japanese medicine nowadays. As a leading scholar of the Integrated School, Hetian Dongguo was ont only well-versed in concise and exquisite medical skills but pursued a benevolent career.

Qiantian Zongbo (1815-1894) [Figure 10], was born in a generation-physician family and determined to become a doctor. He once went to Kyoto and Edo to learn Kampo medicine, Confucianism and history. In 1875, he took the position of a royal physician and won well-known fame after treating a French ambassador and Japanese prince (later the Emperor Taish大正天皇) at that time successfully. Qiatian absorbed the excellent experiences of different schools with abundant effective cases of critical and difficult illnesses. He also enrolled numerous apprentices and wrote over 80 books in 200 + volumes. Zongbo was not only a skillful doctor but also expert at writing, poems and calligraphy, entitling himself as physician, historian, literature, thinker and poet. As a master of Kampo medicine during late Bakufu Period (幕府末期) and early Meiji Period (明治初期), Qiantian Zongbo had constantly been an influential leader, whose clinical legacy illuminated the traditional Japanese medicine historically.
Figure 10: Figure of Qiantian Zongbo (浅田宗伯)

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In addition to the Integrated School of Classic Methods and Later Developments, there appeared the Kampo-Dutch School to integrate traditional Japanese medicine with Dutch medicine in the 18th century, with a leading figure of Hanaoka Seishu(华冈青洲).[12]

Huagang Qinghzou (1760–1835) [Figure 11] and [Figure 12] was the third generation physician of his family. In 1782, he went to Kyoto, first learned classic formulas from the son of Yoshimasu Tōdō and then studied on surgery from a German doctor of a Dutch business house. He returned home in 1785 and inherited his father's post to practice medicine. Qingzhou contended the integration of Kampo and Dutch (Japanese and western) medicines, without separating internal medicine and surgery and with emphasis on clinical treatment. To relieve patients' suffering from operations, he began to develop anesthetic and tried the anesthetic efficacy on herbs such as Mantuoluo (曼陀罗 Datura stramonium), Caowutou (草乌头 Radix Aconiti Kusnezoffii), Baizhi (白芷 Radix Angelicae Dahuricae), Danggui (当归 Radix Angelicae Sinensis), and Chuanxiong (川芎 Rhizoma Chuanxiong). After animal experiments for several times, he tested the medicine on his family, and at the cost of his mother's life and blindness of his wife, he invented a general anesthetic of Tong Xian San (通仙散Powder for Communicating with the Immortal), which was also named as Ma Fei San(麻沸散). In 1804, he performed a successful mastectomy on a 60-year-old female patient with mammary carcinoma aided with his anesthetic. Although according to the Chinese literature, Hua Tuo in the Three Kingdoms Period (三国时期220–280 A.D.) once operated on patients with Ma Fei San, the composition of the formula was unknown. Afterward, Huagang became a nation known and carried on operations concerning bladder stone, hemorrhoids and carcinomas in succession, incurring inundation of patients and apprentices. He established a private medical school of Chunlin Xuan(春林轩), which had cultivated over 1000 students. To keep secrets his medical experience and recipes, Qingzhou seldom wrote books and instructed nobody except his own apprentices. Once someone made one of his recipes public without his consent and was then deported from his teaching. The medicines developed by Huagang such as Ten-ingredient Toxin-eliminating Decoction(十味败毒散), Zhong Huang Paste(中黄膏), and Ziyun Paste(紫云膏), etc., which are still in use in Japan at present, reflecting Huagang's influence on the traditional Japanese medicine.
Figure 11: Anesthesia Figure of Hua Gang(华冈麻醉图)

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Figure 12: Figure of Huagang Qingzhou(华冈青洲)

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Figure 13: Figure of Sen Daobo (森道伯)

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  School of Textual Research Top


During the late Edo Period(江户后期), after learning form Chinese textual research methods, the Japanese scholars began to apply them to the study on Kampo medicine. Besides sorting and exploring ancient classic literature, they would annotate the texts appropriately. The dedicated research institutions and groups were mainly lodged in the Edo Medical Institute, involving prominent scholars such as Duoji Yuanjian(多纪元简), Sejiang Chouzhai(涩江抽斋) and Sen Lizhi(森立之),[13],[14] etc.

Duoji Yuanjian (1755-1810), learned medicine from his father when he was young, and studied Confucianism from Jingshang Jin'e(井上金峨). In 1777, he began to work in the Tokugawa General House and became a royal physician later. In 1791, he acted as a teaching assistant in the official medical school his father took charge in. When his father retired in 1799, he succeeded the post. Except for his life-long dedication to his work, he was an expert at textual research, including proofreading and reprinting of ancient books, deemed as one of the initiators of textual research medicine together with Yize Lanxuan(伊沢兰轩), Duoji Yuanjian, Sejiang Chouzhai, and Sen Lizhi. The textual monographs he authored incorporated Shang Han Lun Ji Yi(《伤寒论辑义》Editing of Intentions from Treatise on Cold Damage), Su Men Shi(《素问识》Editing of Intentions from Golden Chamber Synopsis), Understanding of Plain Questions and Ling Shu Shi(《灵枢识》Understanding of Miraculous Pivot). Among all his offspring, Duoji Yuanyin(多纪元胤, the third son) and Duoji Yuanjian (多纪元坚, the fifth son) also contributed significantly to the textual research of medical classics.

Sejiang Chouzhai (1805-1858), born in a generation-physician family, learned from several famous scholars on textual research, made friends with learned figures both in the Confucian and medical field, and acquired the academic essence deeply. He had achieved excellent accomplishments in his research, and became the academic authority of textual research in Japan. Among all his works, the Jing Ji Fang Gu Zhi(《经籍访古志》Record of Ancient Classic Literature) coauthored with Sen Lizhi (森立之) was a time-honored masterpiece. Furthermore, he was one of the major proofreaders of Ishimpo.

Sen Lizhi (1807-1885), was a distinguished physician and scholar on textual research in the late Edo Period. He learned from Sejiang Chouzhai (two years older than him) when he was only 11 years old. At 16, he became an apprentice of the top scholar of Yize Lanxuan who was Chouzhai's teacher as well. In 1837, he went to Sagami and lived a recluse life for 12 years, studying dedicatedly on medical works such as Shennong's Classic of Herbs, the Yellow Emperor's Inner Classic, Treatise on Cold Damage Diseases, and Jin Gui Yao Lue (《金匮要略》Golden Chamber Synopsis), etc., He returned to Edo in 1848. In 1854, he published his work of Shen Nong Ben Cao Jing Kao Zhu (《神农本草经考注》Textual Annotation of Shennong's Classic of Herbs), appointed as a lecturer of a medical school, and participated in the proofreading work of Ishimpo at the end of the same year. Sen Lizhi's prominent academic achievements could be reflected by the publishment of Textual Annotation of Shennong's Classic of Herbs and Record of Ancient Classic Literature, etc.

With the development of the School of Textual Research, there came forth a generation of prestigious scholars who had compiled numerous monographs of high-academic values. These research achievements were introduced into Qing China after the Meiji Restoration, which influenced on the Chinese medicine of the day properly.


  Declination and Revival Periods Top


Declination period (late 19th century to middle 20th century)

Although it was introduced into Japan in the late 16th century, the scale of influence of western medicine was far inferior to traditional Japanese medicine at that time. Since the 18th century, western medicine began to develop gradually. Jie Ti Xin Shu (《解体新书》The New Book of Human Anatomy) by Shantian Xuanbai(杉田玄白) in 1774 and Excerpts of Western Internal Medicine(《西说内科选药》) by Yutian Chuanxuan(宇田川玄) in 1793 impacted massively on the development of Kampo medicine. The western medicine based on surgery grew rapidly before the Meiji Restoration(明治维新) when trends of integration of Kampo and western (Dutch) medicines emerged, and some even pursued Dutch medicine and abandoned traditional medicine. After the Meiji Restoration, driven by economic and military needs to catch up with European countries, the government put into force a medical system of promoting western medicine and eliminating traditional medicine. In 1883, it was regulated that only those who had received western medical education and passed national examination could be qualified medical practitioners. This changed the destiny of Kampo medicine decisively. Some learned scholars initiated petition but failed, which led to a dramatic decrease in the number of practitioners in Kampo medicine. Physician who chose to stay were forced to practice privately or among the folks. Meanwhile, though licensed western doctors were allowed to practice Kampo medicine, on the one hand, they were lack of theoretical knowledge and clinical experience; on the other hand, against the context of restrict and obstruction toward Kampo medicine by the government, few would like to consider studying it. The Kampo medicine then fell declined, and various terms appeared to avoid suspicion, such as Imperial Formula, Imperial Kampo Formula, Yamato Formula, Yamato Kampo Formula, and Toyo (Oriental) Medicine.[15],[16]

In 1875 (early Meiji Period), there were 22527 Kampo doctors, taking 81.5% of the total number of 27650 in Japan. After the Meiji Restoration, the situation went downhill. To survive the fierce and brutal competition with western medicine, the imperial physician of Qiantian Zongbo, together with other learned scholars, established a Kampo institute in 1879, called Wenzhi She(温知社), to carry on academic activities and cultivate students. They set up the Wenzhi Hospital in 1884, with about 30 relevant Kampo clinics around the country. However after the death of the pioneer Kampo physicians such as Sen Lizhi, the Wenzhi She, had unfortunately come to an end too in 1887. As the last master of Kampo medicine and Kampo physician of the Japanese royalty, Qiantian's death signaled a complete failure of traditional Japanese medicine in a fight against western medicine, and also the declination of Kampo medicine. In 1895, the Japanese parliament rejected the amendment proposed by Kampo doctord by 105 votes to 78 votes, which was the last straw to Kampo medicine and left hopeful practitioners of Kampo medicine in desperation. Ever since the Kampo medicine with a time-honored history exited from the once glamorous stage, its clinical treatment and academic research had also been heavily wounded.

Revival period (since the middle 20th century)

Despite the governmental inhibition and attack of western medicine, the Kampo medicine still survived in the folk because of its historical influence and actual effectiveness. Some firm believers chose to practice maong the folks as well, especially prestigious Kampo physicians from generation-physician families. They inherited the tradition of Kampo medicine and stored the seed for its revival. Kampo medicine, which almost perished in the late Meiji Period, began to revive in early Showa Period(昭和初期). Moreover, Sen Daobo(森道伯) played a leading role in the process.

Sen Daobo (1867-1931), once learned from the famous Kampo physician of Qingshui Liangqi(清水良斉). When he was 35 years old, his teacher suddenly went out and never returned, so he had to succeed his teacheran to revive in early Yi Guan Tang(一貫堂) Hospital, and dedicated to Kampo treatment. Many people admired his exquisite medical skill and noble character, and went to him for medical attention and experience, even including some licensed western doctors. Since Sen Daobo did not take systemic western medical education and acquire licensing, his attempts encountered opposition and rejection by the Japan Medical Association and relevant government departments. On November 26, 1926, the Medical Conference of Reviving Kampo Medicine was held in Nagano-ken, when Sen Daobo claimed in a speech that the legal position of Kampo medicine should be restored, and whoever intended to extinguish Kampo medicine must perish him first. It had been nearly 30 years since the salvation movement of Kampo medicine failed in 1895. This time Sen Daobo was a representative figure to ignite the fire of its revival. He not only took the lead himself in the fight but also cultivated generations of successors loyal to the Kampo cause, including many distinguished scholars in the traditional medical field.

During early Showa Period, academic institutions and groups dedicated to the revival of Kampo medicine and traditional Japanese medicine emerged in succession, involving Kampo physicians like Sen Daobo, and western medicine doctors who took great interest in it such asShishu Daoming(矢数道明), Dazhong Jingjie(大塚敬节), and Teng Pingjian(藤平健), etc. They were young and vigorous, participated actively in the revival movement, carried out various kinds of academic activities, and set up Kampo medical organizations and journals, such as Japan Kampo Medicine Association and East Asian Medical Association, etc.

In the meantime, the Kampo medical field carried on the protest to win back its legal position. According to the scale and impact of the petitions, the notable ones were the petition by Shishu Ge(矢数格) of Yi Guan Tang and one thousand more in March of 1934, and the petition launched by Japan Kampo Medical Association and Japan Medical Research Association in November of 1940. After World War II, the Kampo practitioners intended to restore the Kampo organization, yet were mocked by the staff of Ministry of Welfare when they handed in the application. In view of the sensitive meaning of the word of “漢 (Kampo)” and the official inhibition of the word in government files, they considered to establish the organization of Japan Society for Oriental Medicine, which was approved and officially set up in March of 1950. It only enrolled 98 members at the beginning, but now incorporates nearly 10000 registered members, of whom physicians take the majority of proportion, with dentists, pharmacists, and acupuncturists included.

Since 1976 when many Kampo formulas and crude medicine were incorporated into Japanese national medical insurance, increasing number of people is turning to use Kampo medicine. Research organizations, societies, and clinics of Kampo medicine have been founded by some universities and national research institutes, and even in the folks. After the 1980s, with the Chinese economic reform and opening up, Japan and China have reached a new level of exchanges and cooperation. The word “Chinese medicine” has been recognized by traditional Japanese medical field, and there has existed a compatible situation of Kampo, Oriental and Chinese medicines in Japan. Except Kampo and Oriental medical institutes existing, some institutions, organizations, and clinics of Chinese medicine have also sprung up. According to recent statistics, there are about 85% of Japanese western doctors who will employ Kampo formulas every year.

Translator: Yingshuai Duan (段英帅)

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13]



 

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