Kanpouyaku An Herbal Alternative in a Modern Health Care System

This report will encompass Kanpouyaku’s widely-rooted origin, the full legislative history, and societal impacts and influences. In addition to a list of the most popular Kanpouyaku including their benefits and usages. Kanpouyaku (漢方薬 lit. Chinese Alternative Medicine) or rather more commonly known as Kampo-medicine, is a unique blend of traditional Chinese-Japanese herbs and methodologies. Japanese medicine has gone through multiple phases and forms to get to where it is today. That is why presently, 148 different formulations (mainly herbal extracts) can be prescribed within the Japanese National Health Insurance System. Although, over the centuries the study of medicine has borne witness to many epochs around the world. It can’t be forgotten that medicine first took its roots in the soils of eastern Asia, over two-thousand years ago.

Early years of kanpouyaku

Origin of Kampo-medicine. In Imperial China, herbal medicine flourished under the Han Dynasty (206 BCE – 220 CE). During this period, the first Chinese Emperor, Qin Shi Huang is rumored to have sent envoys to what would later become Japan in an attempt to search for elixirs of immortality; this is the first record of the island of Japan existing aside from native-Japanese records. During Japan’s Asuka-period, in 608 CE Japan would send envoys of scholars (and physicians) to China, in hopes of them returning with new found knowledge of this rather foreign land. After training in this new land for years these scholars would return to Japan with new religious and medical practices; also establishing lines of communication with the Sui and Tang China governments.

Often recognized for the introduction of Buddhism to Japan, these scholars also returned with thousands of crude-drug samples, practices, and applications. With the induction of thousands of new formulae it was impossible to discernibly say which crude-drug would have which effects for whom. Japanese physicians of the time would begin to blend traditional Chinese medicine with those of native Japan

Edo-period changes in Kampo-medicine. The controlling powers of Japan shifted with Ieyasu Tokugawa establishing the position of Shogunate in March of 1603. Soon after the start of the Edo-period (1603 – 1868), Japan experienced a state of “Sakoku” (鎖国 lit. closed country) or better known as isolationism. It was during this time in which physicians would begin to break away from the predominantly Chinese concepts making up Kampo-medicine. Moving forward specific Japanese characteristics of Kampo-medicine would take shape; beginning with the reduction of the number of crude-drug formulae from thousands down to approximately three-hundred. Despite Japan’s period of isolationism, the Dutch were not affected by the embargo and were allowed to trade through ports in Hirado. Thus the Dutch East India Company was formed and an influx of exotic Asian goods such as spices, textiles, porcelain, and silk were traded.

With material goods also came the introduction to Western-medicine, in the form of pills, elixirs, and extracts. This new method of medical practice named Rampo-medicine (consequently gave name to Kampo-medicine to distinguish) shook the foundations of Kampo-medicine for years to come. In the mid-18th century the strongest critique of traditional practices came from the physician Yoshimasu Toudou, in his pursuit to combine Kampo-medicine and Rampo-medicine into a practical form. He developed a technique that allowed one to find the sole root to a patient’s illness through a series of abdominal palpation techniques known as Fukushin. Simultaneously, Yoshimasu completely dismissed the many traditional concepts of medicine adopted from China especially yin-yang etiology. Relying heavily on what was visible before him, he believed that “in clinical medicine, we should only rely on what we actually have observed by examination of the patient”(Watanabe). The results of the abdominal palpation should give additional clinical information in order to select the most appropriate herbal prescription for the patient. As time passed under the Tokugawa rule, Rampo-medicine grew in popularity while Kampo-medicine stayed stagnant. As the Edo-period came to an end so did Sakoku; it remained effective until 1853 when the Perry Expedition forcibly opened Japan to Western trade. Kampo-medicine would fall under strict legislation as Japan’s government is restructured by Emperor Meiji during the Meiji Restoration.

Legislation of kanpouyaku

Effects of Westernization on Kampo-medicine during the Meiji period. Due to the desire to westernize Japan; under the Meiji government, Kampo-medicine found itself subject to scrutiny. In an effort to compete with the industrialized world the Japanese solidified their stance on Rampo-medicine and in 1883 passed a law which retracted the licenses of any existing traditional practitioners. This act forced many public practices to go bankrupt and face foreclosure. In an attempt to keep Kampo-medicine alive private practices began to open. Unfortunately, the amount which did form proved insufficient in keeping the system alive and Kampo-medicine quickly began to fall out of the public’s eye.

By 1885, new doctors were being trained only in Rampo-medicine. To coincide with this the government was publicly endorsing Rampo over Kampo-medicine. Noting the fact that Kampo-medicine while not favorable at the time was still beneficial; the Pharmaceuticals and Medical Devices Agency under the authority of the Ministry of Health, Labour and Welfare published the first edition of the Japanese Pharmacopoeia in 1886. The Japanese Pharmacopoeia first included 468 crude-drug formulae, adapted in combination with Asuka and Edo-period Kampo-medicines.

Effects of Westernization on Kampo-medicine during the post-war period. The practice of Kampo-medicine was nearly halted with the continuing rise of Rampo-medicine. As Japan moved into the 20th century the practice of Kampo-medicine had been so disesteemed that only about 100 physicians in the country were engaging in it. This trend continued until the end of World War II; when in 1945 the Japan Society For Oriental Medicine (8000< members) lobbied Kampo-medicine as a healthier alternative to Rampo-medicine. This dissent from modern medicine was predominantly due to the treatment received during WWII. Skeptical of further interaction with western nations, Japan decided to return to their roots, and resume practice of Kampo-medicine.

With the Japanese Ministry of Health and Welfare under pressure to supply Kampo-medicine; that in 1967, it could be prescribed yet again. However, it was not until 1971 that Kampo-medicine would be recognized in the Japanese National Health Insurance drug list. This would allow citizens to once again receive regulated and lab-tested herbal prescriptions for all forms of ailments. In the following years from 1972 to 1974, the Japanese Ministry of Health and Welfare narrowed the accumulated Kampo-medicine from approximately 700 down to 210 crude-drug formulae. It should be noted that the factors considered were: the ratio of crude-drug component, dosage and administration, and indication for each formula. After years of debate the Japanese Ministry of Health and Welfare would publish a formal report titled “210 OTC Kampo Formulae” which encompassed all available over-the-counter Kampo-medicines.