The International Society for Japanese Kampō Medicine (ISJKM) was founded in 2009 at the 60th Annual Congress of the Japanese Society of Oriental Medicine (JSOM). Two of the founding members at this meeting were Ann Bradford and Gretchen de Soriano, both Kampō practioners from England. It was established to further international communication among English speaking Kampo practitioners and researchers, and is ‘twinned’ with the JSOM (founded in 1950). Its second international symposium took place at Asia House in central London on the 10th April 2013.
There were about 50 participants, mainly Japanese medical doctors, medical historians, and medical researchers, with about 15 Europeans including medical doctors, practitioners, publishers and academics. Fourteen papers were scheduled, exploring the unique features of Kampō, how it is integrated into modern health care, and dealing with Kampō’s historical, anthropological and clinical findings.
Historical and Anthropological Aspects
Professor Elisabeth Hsu led the session on the historical and anthropological aspects of Kampō. She has authored many papers on the subject of “tactility” in Asian medicine, and has a particular interest in Kampō, known to have a high degree of sensitivity due to the development of the abdominal exam.
Dr. Heidrun Reissenweber-Hewel (currently the President of the ISJKM) outlined the special features of Kampō: abdominal palpation (fukushin); tongue and pulse; diagnosis through identification of a constitutional type (sho), leading to appropriate herbal prescription (ho). She then placed Kampō in the context of the Japanese medical system and discussed recent efforts to align Kampō patterns to the World Health Organisation International Classification of Diseases (ICD-11).
Gretchen de Soriano then presented a sample of her exciting PhD research at University College London under Dr Vivienne Lo, on the interpretation of illustrated Edo (1603–1867) medical documents with specific reference to fukushin and the development of the sho. It was evident from this study that the myths and lore about a classical medical text can blind us to the clinically useful attributes of the text itself.
Dr Toshihiko Hanawa discussed two prominent schools in the history of Kampō, the Gosei school of Dosan Manase (1507-1594) from the Muromachi period, and the Koho school of Todo Yoshimasu (1702-1773) in the Edo period. The main point of this talk could be summed up in a quote from Todo Yoshimasu: ”The aim of medicine is to acquire knowledge of a prescription”. He advocated a theoretical system anchored in empiricism. The unique characteristic of Kampō medicine is that the sho and the ho are not separate steps as in other herbal traditions. To this day Kampō focuses on matching disease with the herbal prescription —matching ho and sho. The constitutional type of the disease status (the symptom pattern) is the description of the characteristics of the herbal formula. This ‘one step’ method contrasts with the differentiation of syndromes found in TCM (Traditional Chinese Medicine).
Gretchen de Soriano now took the stage alongside the anthropologist Xing Wang from UCL. From the perspective of medical anthropology they had looked at GP decisions to refer migraine patients for Kampō treatment within a London NHS clinic. They examined one patient’s experience of how relief from migraine was accomplished, understood in terms of an ‘illness narrative’. The study also examined the factors contributing to a GP’s decision to refer, and compared this with the decisions of two trainee doctors on a hypothetical migraine patient who had not responded to biomedical treatment. Wang interpreted the results on a spectrum of scientificity, meaning that the further along in actual clinical work a GP travels, the least likely that GPs will seek to rely on standardized clinical trials as a guide. In short, trust in standardized science declines as clinical experience increases.
Interestingly, the Kampō practitioner found the migraine did not correspond to customary Kampo migraine patterns. the successful formula was for “water toxins”.
Ann Bradford gave an account of the Department of Health funded menopause study at Westminster University, led by Professor Volker Scheid. The aim was to investigate the potential effectiveness of Chinese medicine (including Kampō) treatment of women suffering from menopausal syndrome in the UK. It was part of a three-phase study with the ultimate goal of defining treatment protocols that might be evaluated by a placebo controlled double blind trial. 90 women completed the study, each receiving a course of 12 treatments, using herbs and/or acupuncture. Outcome measures included the Green Climacteric Scale, the Menopause Specific Quality of Life Questionnaire, a flushing diaries and GPT. Ann also highlighted the most commonly prescribed herbs and formulas.
Dr Takeshi Sakiyama, Liaison Director of the Japan Society for Oriental Medicine, discussed the merits of Kampō as an alternative to conventional cancer therapy. He presented three cases of elderly women with urinary cancer, breast tumour and breast cancer, who had asked to be treated with mainly Kampō therapy, instead of simply as a supportive therapy to standard cancer treatment. These cases suggested that the ameliorating effects of Kampō may be preferable to chemotherapy, surgery or radiotherapy especially for the elderly.
Dr Silke Cameron, head physician at the Department of Gastroenterology and Endocrinology, Gottingen University, presented a literature review of recent Kampō research. This was a richly documented presentation including the treatment of gastrointestinal tumors. In principle the ‘biomarkers’ used in conventional medicine can individualise treatment by predicting the development of the disease, help to decide treatment choices, and control response to therapy. However modern medicine could learn from Kampō, which assigned great importance to constitutional factors as a basis for an individualised approach. Also, Japanese Kampō prescriptions could help to reduce the side effects of modern chemotherapy, for example through the effect of Kampō on immunomodulation and on microcirculation.
The next presentation, authored by Yoshitaka Toriumi and presented by co-author, Tsutomu Kamei, focused on a clinical study that investigated the use of maotoh (Mahuang Combination/ mahuang tang), a formula for the taiyang fever stage which highlights the importance of pinpointing the stage of an infectious disease (within the six stages) in drawing up an effective treatment. Maotoh was compared with the use of Oseltamivir and Zanamivir in children under 15 years old. Five groups were compared: maotoh used alone, maotoh with each of the vaccines, and each of the vaccines used alone. The results were encouraging, with the conclusion that maotoh has potential as a treatment for influenza in children, especially where there is low sensitivity to oseltamivir and for very young patients for whom the use of zanamivir is difficult.
Dr Hiroshi Odaguchi presented a cross-sectional study of 567 elderly patients, with observations of tongue, pulse, abdominal findings and the presence of cold feet, and edema in the legs. Correlations were shown between the somatic observations and diseases such as osteoporosis, atrial fibrillation, hypertension, cerebral infarction, and cerebral haemorrhage. It was a far-reaching study which showed the lengths that need to be taken even to begin to show how Kampō sho relate to Western disease status.
Tetsuhiro Yoshino presented an example of data mining analysis, a study which had used the results of a computer based questionnaire (introduced at Keio university in 2008 to collect data on patients complaints and to record changes in severity) to examine features of patients with the pattern hiesho, feeling of coldness (as opposed to okan, fear of cold or wind) and to predict a priori the Kampō formulas that would be used. (Of 2,830 new patients visiting the Centre for Kampō Medicine at Keio University Hospital May 2008 to Dec 2011, 322 patients had been diagnosed with hie sho). Of all the formulas used, Tokishakuyakusan, Dang Gui and Peony Formula (Dan gui shao yao san) was the most commonly used.
Using the same questionnaire data as the above, Yuko Horiba, currently with Kenji Watanabe at Keio University, then presented a data analysis of the profile of patients who had been prescribed six formulas from the Bupleurum ‘family’: daisaikoto, Major Bupleurum Combination (da chai hu tang); shosaikoto, Minor Bupleurum Formula (xiao chai hu tang); saikokaryukotsuboreito, Bupleurum and Dragon Bone Combination (chai hu jia lang gu mu li tang); shigyakusan, Bupleurum and Chih-shih Formula (si ni san); saikokeishito, Bupleurum and Cinnamon Combination (chai hu gui zhi tang); saikokeishikankyoto, Bupleurum, Cinnamon and Ginger Combination (chai hu gui zhi gan jiang tang). The importance of fukushin, abdominal palpation, and the finding of kyokyokuman, hypochondriac tension, was the most important factor when prescribing Bupleurum based formulas. This highlights the importance of a full interpretation of abdominal findings.
Dr Kenji Watanabe gave a synopsis of his faculty’s work with regard to finding Kampō Medicine pattern codes for ICD-11 diseases. Japanese Kampō had decided to follow Western Medicine disease names, mainly because all Kampō practitioners in Japan are medical graduates, and doctors prescribing ethical Kampō formulas use Western disease names when completing the NHI (national health insurance) form for reimbursement.
The Kampō pattern coding is likely to be as follows: (1) Yin/yang (2) Deficiency/excess (3) Interior/exterior (4) Cold/heat (5) 6 stages (6) Ki/blood/body fluid (7) Abdominal diagnosis. Each of these will be differentiated along Kampō sho, for example No. 4. Cold/Heat may have 7 items including ‘upper heat and lower cold’, ‘reversal cold’, ‘vexing heat in the extremities’. These are all traditional Japanese Kampō symptoms.
The final presentation by Takuya Furukawa excited us with the potential of a Kampō ‘app’, marrying traditional knowledge with modern smart phone and tablet technology. The presenter is a graduate of St Martins School of Art and Design who produced the Kampō UK website and facebook page. His desire is to make available information on the benefits of Kampō, as practiced by his parents in rural Hokkaido, to the youth of his generation in the west, who are keen to find out about natural medicine.
It was a very successful, inspirational and engaging day. I can’t wait for the next Symposium, which is promised for 2015 in Vienna.
A thank-you to Gretchen de Soriano for her additions and help, and to Dr Yoshino and friends in Japan for helping to clarify some of the points.
Written by Ihsan Dal Din
Ihsan received a BSc (Hons) in Acupuncture from University of Westminster, and a Diploma in Qigong Tuina. He then completed an apprenticeship with Gretchen De Soriano in Kampō herbalism, handed down within the Otsuka Kohoha medical tradition. He practises in West Devon, specialising in chronic conditions, respiratory and infectious diseases.