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KAIM Special Edition - Current Kampo Medicine | November 2006

Table of Contents

Foreword
What is Kampo Medicine
Shuji Goto

History of Kampo Medicine

Features of each period, prominent persons, individual theories, celebrated books
Hiromichi Yasui, Japan Institute of TCM
The Japanese Kampo medicine has its origins in China and belongs to a group of TCM forms spreading throughout East Asia. Originally this traditional form of medicine started as an imitation of the Chinese model and finally reached in the 16th century a level equivalent to that in China. In rapid succession Japan then developed over several centuries its own unique forms. During this period politics, economics, ideology, culture and similar factors have greatly influenced medicine, so that currently the form of Kampo in Japan differs considerably from that prevailing in China
Here we would like to follow the historical course of Kampomedicine classified into the following topics and explain briefly some of the factors that have influenced this form of medicine
Introduction and imitation of Chinese Medicine
Early development
Creative Period
Eclectic Period
Decline and Revival
Application medical insurance to specific Kampo medical extra
ct

Distinctive Features of Kampo Medicine

Theory, Clinical Style, Research, Application in the Modern Medical System
Hiromichi Yasui
Kampo medicine has assumed a form considerably different from the TCM of China. These changes were initiated when Yoshimasu Todo in the 18th century revoked the theoretical basis of traditional Chinese medicine and proposed an extremely pragmatic system that subsequently started to find widespread acceptance. Modern Kampo medicine has been strongly influenced by its concepts that state that “for every etiologic factor the real nature of the disease is based on the form of the physical response” and thus assigns greater importance to symptomatology than pathology, using preparations that are prescribed for the patient’s symptoms.
Frequently used concepts within this framework include Qi, Blood, Water (Liquid) and the 6-channel classification of the “Shan Han Lun”.
Here we would like to give a general outline of how these concepts are used.

148 Prescriptions of Kampo Medicine in Medical Insurance

Explaining the Contents and Inidcations of the 148 Prescriptions of Kampo Medicine
approved for Medical Insurance

Kampo extract preparations have been developed in Japan in the 1950s. Following their widespread use as general medications people started to focus their interest on the clinical efficacy of these drugs and since 1976 they are covered under the National Health Care scheme. Medical insurance applies to a total of 148 preparations, more than 50% of which are prescriptions described in the "Shan Han Lun (Treatise on cold- induced diseases)" or the “Jin Kui Yao Lue (Synopsis of the Golden Chamber)”, reflecting the abundance of experiences in Japan with these frequently used preparations. The extensive research pertaining to Kampo that has been conducted in Japan (case series studies or controlled trials) suggests the presence and usage of these preparations. Below we would like to describe some of the characteristics of these preparations.

Manufacturing Process for the Prescriptions of Kampo Medical Prescriptions
Introduction of the Production Process of Kampo Prescriptions illustrated with photographs

It explains the manufacturing process of Chinese herbal (in Japanese Kampo) extract preparation of Japan with figure. As for them, a good quality raw material (herbal medicine) is manufactured by the advanced technique in state-of-the-art plant facilities. Therefore, it is very high-quality. You will learn a state-of-the-art, rational manufacturing factory that sees the published article and suits the GMP standard well.

Quality Evaluation of Kampo Medical Extracts

Analytical Evaluation of Crude Drugs, Residual Agricultural Chemical Examinations, Extract Quality Evaluation

Kampo extract preparations are from the stage of the crude drugs to the final products subject of rigorous examinations. The concentration of the active principles as a matter of course, but also heavy metals, agricultural chemicals, microorganisms etc. are subject of strict controls and not used, unless they meet the required standards. The status of the components contained in the finished products can later clearly be viewed with the help of 3-dimensional graphical representations.

Herbs covered by Health Insurance in Japan

Tables, Explanation of 160 Different Herbs, Common Name/Botanical Name/Chinese Name/
Chinese Characters/Japanese Name
Yoshiro Sahashi
In Japan approximately 200 types of crude drugs are covered by the health insurance plan. Some physicians use almost exclusively galenicals. The majority of the used crude drugs is imported from China. According to the standards provided in the Japanese Pharmacopoeia not necessarily all products from China are of the same quality. For the past several hundred years the same crude drugs than in China have been harvested and cultivated in Japan. When some crude drugs can be derived from several original species, the regulations specify that only certain varieties are used. For example, great care has to be taken that as sinomeni caulis et rhizome not the nephrotoxic variety Aristorocea is used, but the Stephania genus and as Asiasarum root not the aristrocic acid containing aerial part is used, but only the subterranean stems. Below follows a list of the crude drugs that can be used under the provisions of the health care services provided by health insurance.

Societies for Kampo Medicine
Now we would like to introduce some of the characteristics and activities of Kampo medicine related academic societies in Japan. Currently, concentrating mostly on the clinical aspects of Kampo medicine, is the Japanese Society for Oriental Medicine, while the Medical and Pharmaceutical Society for WAKAN-YAKU conducts outstanding pharmacologic and basic research. The Association of East-Asian Medicine provides not only academic, but also a wide spectrum of other information.

Education for Kampo Medicine
Education for Kampo Medicine in Medical Schools, Seminars, Educational Lectures of
the Japan Society for Oriental Medicine
The medical health care system in Japan is unified, meaning that there are no medical universities teaching Kampo medicine only. In this respect Japan differs greatly from its neighbors Korea and China. However, based on its clinical importance, this form of medicine has been integrated into the regular medical education. In medical colleges and universities Kampo medicine is taught in form of lectures ranging from 8 to 30 hours (the actual curriculum varies depending on the policy of the particular university), so that even students studying only western medicine may learn and acquire the minimal required knowledge. Let’s outline the curriculum of the Toyama Medical and Pharmaceutical University as an example

Journals of Kampo Medicine

Kampo Medicine, Journal of Traditional Medicine, Journal of Kampo Medicine, Journal of the Japan Society of Medical History, Clinical Journal of Traditional Chinese Medicine, Φυτο, The Kampo Medicine,
Phil Kampo, and others
Magazines dealing with this topic include a variety of organs of academic societies like the "Kampo Medicine" or the "Journal of Traditional Medicine" or else publications of pharmaceutical companies like "Kampo Igaku" of "Phil Kampo". Together with small private magazines there are probably over 50 different periodicals. Here we will introduce some of the general magazines circulating nationwide in Japan. They are almost entirely published in Japanese and only a few offer English texts.

Medical Insurance in Japan
Naoya Ono, Kyoto University
History and the present state of Medical Insurance in Japan and Kampo Prescriptions in this system
The practice of Kampo medicine in Japan is sustained by the country’s medical system. The reason that Kampo medicine is so widely used for medical purposes is due to its acceptance by medical insurance. The medical system in Japan is not the same as that in other countries. With a unique Japanese framework, and operated through the political support of the Health, Labor and Welfare Ministry; the Japanese medical system has sustained the health of the Japanese people. When considering the role played by Kampo medicine in Japanese healthcare, it is extremely important to look at how Kampo medicine is managed within the medical system.
As noted in other parts of this journal, the reasons that physicians educated in Western medicine can practice Kampo medicine are (1) drugs used in Kampo medicine can be dispensed easily, and (2) the existence of 148 types of these drugs which have a high level of compliance in their use. After learning a certain degree of traditional medical concepts, physicians introduce these drugs into their own clinical practice. Utilizing these drugs, and the insurance system that sustains their operation, they perform clinical tests and independent research, including research based on the accumulation of case studies and comparative studies
Meanwhile, there are medical institutions, though not many, which provide medical treatment based on Kampo medicine, at their own expense. In particular, there are many places that use herbal medicine as therapeutic drugs. While more than 160 types of herbal medicine are accepted by healthcare insurance, it is financially difficult for herbal medicine to be used with health insurance treatment. This is due to such problems as their excessively low cost, the fact that they require a great deal of manpower and shelf space, and the difficulty in securing pharmacists who posses a high degree of knowledge in this area. While providing medical treatment at one’s own expense is much simpler than providing health insurance treatment, it is another form of Kampo medicine practiced in Japan. This article, written by Ono, explains the medical system in Japan. The overall theme is much larger than Kampo medicine, and has very little to do with clinical Kampo medicine. Nevertheless, we have included it to let readers know that medical treatment is based on this system. This article also contains information that will be useful to people who intend to study about the Japanese medical system

Appendix - Composition and Indications of 148 Ethical Prescriptions
The composition of the preparations is characterized by uniquely Japanese amounts of the individual crude drugs that are derived from the history of this form of medicine in this country. Indications too are based on past experiences but also include many recent developments. Below is a list of the 148 ethical Kampo preparations used in Japan showing their composition, dosing and indications.

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