Welcome to a Kampo UK’s ongoing exciting project, “Ask a Kampo Doctor!”! In this project, a number of great Kampo doctors and Kampo specialists from different countries are interviewed about their first hand experiences of Kampo medicine in their clinical practices. Hoping that this will be a great space to learn and be inspired about traditional Japanese medicine, Kampo Igaku 漢方医学.
Our Today’s guest is a Kampo doctor and a specialist in Internal Medicine in Tachikawa Medical Centre in Niigata, Japan, Dr. Akira Takasaki. He is also known as a “Tenor Doctor” because of his passion for music.
Kampo UK: What was the inspiration for you to start using Kampo in your practice?
Dr. Takasaki: My family has been in medical practice for the last seven generations, and my father was a physician of Internal Medicine. In fact, I grew up in a house where both modern medicine and Kampo extracts were always around in our medicine cabinet.
In Japan, when a physician prescribes Kampo extracts under the national health insurance program, a name(s) of the disease(s) has to be specified for it. Therefore, each Kampo extract has specified diseases for which it should be used.
When I was a medical student, I sometimes took Kampo extracts for the disease/conditions for which those Kampo extracts were specified. For example, I took Kakkonto (葛根湯) because I had tight shoulders and Hangekobokuto (半夏厚朴湯) when I was feeling anxious. I even took two packets of Kakkonto (葛根湯) during practical training at Accident & Emergency Centre to stay up through the night. (I heard later that some of the physicians of Haematology in the university hospital were taking 2 packets of Kakkonto (葛根湯) when they were doing research staying up all night!)
My father had taken Kampo medicine for his own sake following a modern way of prescribing medicine (without diagnosing the patients’ Sho*), but did not prescribe Kampo medicine to his patients. I remember that my father was reading some Kampo books written by then known to be a great Kampo doctor (Dr. Katsutoshi Terasawa) at a time when education of Kampo medicine wasn’t included in medical schools yet. As a physician of modern medicine, my father did not have a conceptual knowledge of Kampo medicine to use it in his own practice. At that time (about 20 years ago), the Renaissance of Kampo had not arrived in Japan yet, and no comprehensive Kampo textbooks were yet to be published.
In those days, some people say that there was a tacit understanding of different knowledge of Kampo among Kampo doctors. I believe that Kampo medicine was being practiced rather discreetly between Kampo doctors and a small number of patients who wished to have Kampo treatments. Unfortunately, even now, there are some arguments among Japanese Kampo doctors (belonging to a number of different schools of Kampo, such as Chinese medicine way and Koho-ha), which is unfortunate indeed.
Speaking of the schools of Kampo, my mentor is Dr. Yoshihide Yakazu; his grandfather was Dr. Domei Yakazu (1905 ~ 2002); and his mentor was Dr. Dohaku Mori (1867 ~ 1931) who was a founder of “Ikkando Medicine” and was a part of Goseiho-ha (a school of Kampo, based on the texts written after Tang and Sung Dynasties). Therefore, people may say that our group belongs to Goseiho-ha. However, I believe that Dr. Domei Yakazu is the first Kampo doctor who advocated a more revolutionary and liberal idea of the integrated medicine, appreciating the traditional medicine as a whole while he had been a doctor of modern medicine since the graduation from the Tokyo Medical University. He is also well known as one of the doctors who worked hard to introduce Kampo extracts to be covered by national health insurance. Because of these efforts of pioneering doctors, the current Kampo medicine exists in Japan, and it is indeed fortunate for Japanese physicians to be able to practice Kampo medicine in the manner they do now.
The recent research shows that more than 90% of Japanese physicians prescribe Kampo extracts under the national health insurance program. However, they prescribe Kampo extracts following an evidence-based (research papers) way of prescribing modern medicine, without diagnosing the patients’ Sho*.
Twelve years ago during my medical training, I met my current Kampo mentor, Dr. Yoshihide Yakazu. At the time, his teaching of prescribing Kampo medicine was based on the names of the disease/conditions. Then, upon completion of my training, I started working in general Internal Medicine Department, Haematology Department (treating leukaemia, malignant lymphoma, etc.), other departments where stroke and dementia patients were treated in the Tokyo Medical Hospital. All the patients I was seeing were elderly, suffering from incurable diseases. Inevitably, many of those patients died one by one. During those days, I was feeling troubled asking myself, “What is really good health?” Then, I reconsidered the use of Kampo medicine in my clinical practice and started studying it under Dr. Yoshihide Yakazu.
In my clinical practice, I use Kampo medicine alongside modern medicine. This integration of the two is often called, “Hybrid Treatments” in Japan.
I think that the duty of Kampo specialists like us is not about promoting how effective Kampo medicine is in medical conferences nor to patients, but to present, fist of all, more systematic clinical evidence in medical conferences. That is what Dr. Domei Yakazu was the pioneer for.
Kampo UK: What are the most common conditions/illness for which you use Kampo to treat in your practice?
Dr. Takasaki: I see patients with digestive disorders, such as poor appetite; no energy; general anxiety; anger issues; insomnia; a pain in the whole body; lower back pain; irregular menstruation; cold sensation; and others. Also I see patients who are undergoing cancer treatments.
Kampo UK: What was the most memorable case throughout your entire practice of Kampo?
Dr. Takasaki: There are too many to write in this space, so this time I would like to show a clinical case in which an unexpected improvement was observed with a quite standard treatment given for the presented complaint.
A 70 year old man was taking Juzentaihoto (十全大補湯) during his lung cancer treatment (taking Iressa – a molecular targeted drug and it is used for certain breast, lung and other cancers). During the course of the treatments, he caught a cold and developed tonsillitis. I took his Sho* and based on it, I prescribed Shosaikoto plus Kikyousekko (小柴胡湯加桔梗石膏) to him. When he attended his next appointment, he was very excited to say to me, “Doctor, the Kampo medicine you gave me is amazing! My vision has become clearer, and I can see things more clearly.” I wasn’t expecting this feedback from him. However, he told me earlier that he saw an optician because he developed a blurred vision and he could not see things clearly. These started a few years after his cataract operation. The optician then told him that nothing was wrong with his eyes.
Well, I never told him, “This Kampo will work on your vision.” Therefore, I think that it was a good example showing the benefit of Kampo medicine and not a placebo effect.
Kampo UK: Could you share one memorable experience with Kampo that it did not work as well as you would have liked?
Dr. Takasaki: There are also many to tell, but I have to say that the most serious one is of cancer treatments.
I did research of anti-cancer drugs during my doctoral program, and often gave chemotherapy for the treatment of malignant lymphoma in the university hospital. You may not know but chemotherapy medications are effective for quite a few cases of cancer of the blood, such as leukaemia and malignant lymphoma. In short, there are people who can be “cured” with chemotherapy. The famous drug is a molecular targeted drug called Imanitib used for chronic lymphatic leukaemia. This medication brought the Renaissance of a molecular targeted drug to the anti-cancer drugs. However, so called solid cancers (liver cancer, stomach cancer, oesophagus cancer, breast cancer, colon cancer, bladder cancer, etc.) have proven difficult to treat so far, although molecular targeted drugs have been developed.
As for the clinical case, a 35 year old woman was diagnosed with stomach cancer (scirrhous stomach cancer) two years prior to her visit to my office and going under a large quantity of a chemotherapy treatment (it wasn’t molecular targeted drug) in another hospital. At that time, she was wearing a wig because her hair all fell away; and she had a darkish complexion due to her skin discolouration. Based on all the information that I gathered (I took her Sho*), I prescribed her with Jyuzentaihoto (十全大補湯) in decoction but it did not show much effectiveness then. She passed away six months later. This experience triggered me to go in depth in the use of Kampo medicine for cancer treatments.
Kampo UK: What is the most important lifestyle advice you give patients to maintain good health?
Dr. Takasaki: In Kampo treatment, advice on diet and exercises is very useful as “You are what you eat” and “Exercises offer a cognitive behavioural therapy like effect.” However, I think that merely advising the patients to lead a healthy lifestyle can be a big burden for them. Therefore, I first give a piece of advice on how to have a good quality sleep at night.
Kampo UK: Thank you for the valuable stories!
* Sho = patient’s pattern or confirmation. The concept of Sho is very specific to Kampo medicine.
About Dr. Akira Takasaki MD, PhD.
Specialists in Internal Medicine, Gerontology, Dementia, Kampo, and Sports Medicine
Mar 2004 Graduated from Tokyo Medical University
Apr 2004 – Mar 2006 Resident: General Hospital • Kousei Chuo Hospital, Tokyo Japan
(I met Dr.Yakazu Yoshihide and I began to learn Kampo from him.)
Apr 2006 – Apr 2010 Doctoral Program (Anti-Cancer Drugs): Tokyo Medical University
Feb 2011 – Current Medical Director in Internal Medicine: Tachikawa Medical Centre, Niigata Japan
Jan 2013 – Dec 2016 Implemented Home Healthcare Services, Tokyo Japan
Apr 2015 Founded Kampo Department in Tachikawa Medical Centre, Niigata Japan
Dec 2011 Medical Specialist in Internal Medicine
Dec 2013 Kampo Medicine Specialist: The Japan Society for Oriental Medicine
Dec 2014 Medical Specialist in Gerontology
Dec 2016 Medical Specialist: Dementia
Translation by Atsuko Fritz
(The original in Japanese)