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Kanpo - Ancient Art, Modern Medicine

Nigel Dawes

Kanpo - A Brief History

Kanpo, sometimes written Kampo, literally means "the way of the (Han) Chinese." It is a term coined in 19th C. Japan referring to the classical methods of prescribing herbs developed during the Han dynasty (200 BCE - 220 AD). This early herbal knowledge began reaching Japan by the 6th century, via Korea, initiating a period of fertile medical exchange between China and Japan, which lasted until the beginning of the 11th c. The period was dominated by influence of the Han Dynasty works of Zhang Zhong Jing (c.150-220 AD), including the Shang Han Lun and the Jing Gui Yao Lue, as well as those of the Sui (589-618 AD) and Tang (618-907 AD) dynasties, including a revision of the Shennong Bencao Jing (Divine Farmer's compendium) by Tao Hongjing (452-536 AD) and the Qianjin Yaofang and Qianjin Yifang by Sun Simiao (581-682 AD).

If there was a single founder of the Kanpo tradition, it was Jian Zhen (690-760 AD), a Buddhist priest who introduced Chinese medicine into Japan in 753 whilst the earliest surviving Japanese Kanpo text, the Ishimpo, was written in 984 AD by Yasuyor Tamba, and is considered the seminal work on the subject. Soon after its publication, Japan essentially entered a period of cultural isolation lasting until the end of the 15th C, broken eventually by Sanki Tashiro's (1465-1537) visit to China from 1486-1498. A Buddhist priest and physician, he introduced some of the Jin Yuan period (1127-1359) teaching into Japan, notably those of Li Dongyuan (1180-1251) and Zhu Danxi (1281-1358). His work lay the foundation for the Gosei-ha (Reformation) school, established by Dosan Manase (1549-1594) which espoused in particular the theory of the 5-Phases and the center-tonifying principles of Li Dongyuan (aka. Li Gao), which remain strong features of Kanpo practice to this day.

The so-called "golden age" of Japanese medicine followed in the Edo period (1600-1868), during which time many of the unique features of Kanpo were developed, including the practice of Fukushin (abdominal diagnosis), first mentioned in the test "Essentials of Abdominal Diagnosis" by Saramata Takera (1573-1614) and later developed practically by Todo Yoshimasu (1702-1773). This period was marked by the emergence of the Koho-ha (classical) school, founded by Geni Nagoya (1628-1696) and developed by Gonzan Goto (1659-1733). Its main feature was a rejection of the neo-classical revivalist medicine of the Gosei-ha in favor of a return to the simplicity and practicality of the classical teachings, in particular the Shang Han Lun. This emphasis on practical, often palpation-based approaches to diagnosis and practice has remained a feature of Kanpo to this day.

Kanpo when into decline with the advent of Western influences in medicine and was all but relegated to folklore by the Meiji period (1868-1902). It was only revived in the first half of the 20th c. by enthusiastic Western-trained doctors, such as Kenzo Okumura, Jusha Tsumura, Tadanao Nakayama and others who were interested in returning to their classical roots in medicine. Among them, perhaps the most well-known, often called the "father of modern Kanpo," was Keisastu Otsuka (1900-1980), who is widely published, helped set up the Kiasato Research Institute for Kanpo studies in Tokyo and was perhaps the best-known modern Kanpo practitioner in Japan. His legacy, continued by his son and other he influenced, such as Hong Yen Hsu (1917-1991), has helped re-establish the practice of Kanpo in Japan and elsewhere embodied in contemporary practitioners such as Takahide Kuwaki, Toyohiko Kikutani, Katsutoshi Terasawa and others.

Kanpo Today

Along with recognition in the medical world came validation of the herbs by rigorous research and clinical trials, mostly funded by the large drug companies who maintain a majority share of the Kanpo market to this day in Japan. Their legacy has been the delivery system of granular herbal extracts (Wakan-yaku in Japanese), a convenient and mass-produced method of taking the herbs with a high rate of patient compliance very popular in Japan. In addition, the Japanese health ministry official recognizes more than 220 Kanpo formulas, and more than 150 of these are covered by the national health insurance. It is currently estimated that as many as 50% of all doctors in Japan use some form of Kanpo medicine and that there are in excess of 10,000 pharmacies dispensing Kanpo preparations. Kanpo in Japan is taught in the traditional academic and clinical setting to M.D.s and pharmacists wishing to specialize in herbal medicine. These are the only professions licensed to practiced and prescribe herbal medic ine in Japan today. However, there are large numbers of specialist Kanpo doctors who have usually studied in the formal apprenticeship tradition and who generally practice under the license of a collaborative physician. These individuals often have far superior knowledge and training in the medicine and are sought out by patients all over Japan. It is common for a patient to seek a prescription for herbal medicine over the counter at their local pharmacy or to visit their physician for such. Equally, it is also commonplace for hospital inpatients to receive Kanpo medicines in place of or alongside their orthodox medication regime.

With the sanction of the orthodox medical community, the future of Kanpo in Japan and worldwide is therefore assured by the increasing interest among the public and professionals alike. This position is strengthened by the quality assurance of the products and of their research-based validation, financed in large part by several of the leading pharmaceutical companies. At a time when the Food and Drug Administration in this country is getting increasingly interested in safety and toxicity issues with regard to the raw and prepared herbal materials being imported, it is comforting to note that the prepared formula format employed by most Kanpo practitioners has already passed stringent quality control testing and is generally accepted as meeting U.S. GMP standards.

Kanpo Practice

Kanpo carries the trade-marks of all traditional Japanese therapeutic systems.

An emphasis on palpation (primary abdominal in the case of Kanpo).

A diagnostic framework based on early theories from the classics (such as the Nei Jing Su Wen and Ling Shu "Yellow Emperor's Classic of Internal Medicine" and the Nan Jing "Classic of Difficult Questions") focusing on Yin Yang; 5-Phase; and Qi, blood and fluid theory).

The prescribing of classical formulae primarily derived from the Shang Han Lun ("Treatise on febrile diseases caused by cold") and its sister text, the Jing Gui Yao Lue ("Prescriptions from the Gold Cabinet"), both written in the later Han Dynasty.

The unique features of this classical system include:

Prescription and dosages are small in comparison to modern Chinese herbal formulas (typically one-third), rendering a narrow therapeutic target.

Herbs are never re-boiled.

Primarily plant material used (very few animal parts).

Knowledge of the clinical application of the formulas is emphasized over and above detailed memorization of the materia medica.

Formulas are prescribed for short periods (usually one week or less) prior to re-evaluation.

Herbs are often delivered as concentrated granular extracts that can be modified, or as traditional raw-herb decoctions.

Diagnosis employs the Sho, Yin Yang, 5-Phase and Qi, blood and fluid differentiation (instead of 8-principals).

Pulse diagnosis is derived from the Nan Jing ("Classic of Difficulties").

Fukushin (Abdominal diagnosis) is a unique and important hallmark of Kanpo.

Formula synergy - classical formulas are valued for their uninterrupted clinical efficacy of almost 2000 years. A major emphasis on Kanpo is therefore to respect the synergy of each formula by using it according to its exact classic dimensions and proportions. Modification or subtraction is rarely, if even considered; rather, an alternative formula may be prescribed instead.

Formula matching - the practice of composing a formula based on the perceived individual action of each herb was not discussed in the early classical texts. Prescribing was done on the basis of "matching" an existing formula to a patient conformation, called the Sho in Japanese. The Sho differs from the modern TCM concept of a pathological "syndrome" in that it includes not only a collection of identifiable signs and symptoms but also pays attention to the patient's subjective complaints, the constitution, the state of the digestive function and diagnostic specialties, such as Fukushin. In Kanpo terms, each formula is therefore said to have its own unique Sho, and the practitioner's job is to successfully "match" this Sho with that of the patient. This process requires a direct application of clinical knowledge of the formulas to a deep understanding of the patient without reference to abstract theoretical constructs or theories.

Summary

Kanpo, Sino-Japanese herbal medicine, is widely practiced in Japan today and has successfully been transplanted to Taiwan and thence to Europe and the U.S. It is a system seeking to remain faithful to the earliest classics of Chinese herbalism whilst integrating the latest in modern pharmaceutical research into the herbs. While many of its hallmarks are recognizably Chinese in origin, others are uniquely Japanese. As such, it is earning an important place in the growing popularity of herbal medicine traditions from Asia.

I will be offering a workshop on "Fukushin - the role of abdominal diagnosis in Kanpo" at the 2003 Pacific Symposium in November. It will provide a practical introduction to the use of abdominal palpation in diagnosis and treatment in herbal medicine. My own interest in Kanpo began at acupuncture school in Japan in the early 1980's. After almost 20 years of practice, I am still in awe of the relevance of classical Chinese literature in the modern clinic as well as the innovative and highly pragmatic approaches of the Japanese in diagnosis and treatment methods.

As interest in Kanpo continues to grow in this country, I believe there will be a need for education at the post-graduate level, which can incorporate the practical, clinical approaches to herbal medicine espoused by this tradition. Anticipating such a need would, in my view, be an intelligent step toward ensuring diversity in our medicine..