Chinese Medicine in Japan: Development and Current State
Japan, China's near neighbor, was deeply influenced by Chinese culture historically. Before Western medicine arrived, Chinese medicine was always the mainstream there. With the Meiji Restoration, Western medicine entered Japan; the government decreed the abolition of TCM and the advocacy of Western, and TCM fell to its knees, nearly wiped out. In recent times, with side effects and high cost of Western drugs, people have sought natural-plant alternatives, and Chinese medicine is again valued in Japan. But can Japanese TCM truly revive? What is the present picture? A careful look at Japanese TCM's course and current state must aid our policy-making and future direction.
I. TCM's eastward transmission
1. Scattered transmission
Chinese medicine has more than 3,000 years of history. It first reached Japan about 1,500 years ago, around the 5th century, via the Korean peninsula. By record, in CE 414 a Korean named Kim Mu of Silla brought medical skill to Japan — the earliest record. In CE 459 the Goryeo physician Tokurai went to Japan and settled in Naniwa, opening a clinic and known as Naniwa Yakushi. From CE 554, herb-gatherers from Baekje came regularly, bringing Chinese-medicine knowledge eastward.
2. Formal transmission
The formal arrival of TCM came in China's Sui era. Emperor Suiko, eager to learn Chinese culture, sent four embassies to the Sui. In CE 608, the apothecary E-nichi and Yamato Aya no Atai Fuku-in went with the Ono no Imoko embassy to study Chinese medicine in earnest; they returned in CE 623, in the Tang dynasty — TCM had then formally entered Japan. In CE 753 the Tang monk Jianzhen reached Japan with a great quantity of TCM works and herbs and lectured on Buddhism and medicine at Tōdai-ji in Nara. He is said to have cured Empress Kōmyō and was honored as Daisōjō. The Qixiao Wan he made while teaching at Tōshōdai-ji is still widely used. In CE 806 Kūkai brought back from Tang studies a copy of the Shanghan Lun — the Kanpei-bon Shanghan Lun; another, brought by Saichō, is the Kōji-bon Shanghan Lun. In this period TCM in Japan was confined to the imperial court — commoners had no access.
3. The formation of Japanese TCM
In the Heian period the court physician Tanba Yasuyori wrote Ishinpō in 30 fascicles, in Chinese — covering medical ethics, general medicine, treatments of various conditions, health preservation, bedroom arts — drawing heavily on Tang-extant works; the essence of TCM at that time and the first founder of Japanese medicine. In CE 984 Tanba presented it to the court. In the late Kamakura period (1304) Kajiwara Shōzen, drawing on Sui-Tang-and-Song works, wrote Ton'ishō (50 fascicles), and in 1327 Man'anpō (50 fascicles), quoting heavily the Song Taiping Shenghui Fang and Shengji Zonglu — still of high documentary value. In 1363 the Zen monk Yū-rin wrote Fukudenpō (12 fascicles), referencing about 160 Chinese works and crediting sources — treating various disorders, materia medica, processing, acupuncture, health preservation. At that time it was regarded as the most high-level, practical medical work in Japan.
4. The forming of schools
In the Edo, Japanese medicine had four kinds: court physicians serving the imperial court; bakufu physicians serving the shogunate; han physicians under each domain; machi physicians serving the common people. Edo-era physicians had no state-recognized credentials and were trained apprentice-style.
TCM truly developed in Japan in the 16th century. Tashiro Sanki (Muromachi/Sengoku-era physician) went to Ming China at 23 in 1487; the Jin-Yuan teachings of Li Dongyuan and Zhu Danxi were then in flower. Sanki studied with the monk-physician Yue-hu, returning with works like Quanjiu Ji and Jiyin Fang. He opened a clinic to treat the people and was honored as Japan's medical sage. In 1531 he took Manase Dōsan as pupil; Dōsan, having completed his studies, founded the Keitei-in medical academy in Kyoto, taking many students. In 1574 (Tenshō 2) he wrote Keiteki-shū. He also wrote Yakusei Nōdoku, Hyakufuku Zusetsu, Seishin-shū, Shinankin Kyūshū, Benshō Haizai Itō, and others. He founded the Later-Generation School, which valued theory: on yin-yang and five-phase, clinically using formulas from Taiping Shenghui Fang and Wanbing Huichun.
The Edo-early physician Nagoya Gen'i (1628–1696) studied with Hagawa Sōjun and learned the Ming-and-early-Qing physician Yu Jiayan's Shanghan Shanglun and Yimen Falu, advocating medical reverence for the ancient, exclusive reverence for Zhang Zhongjing, and rejection of the schools. Founded the Ancient-Formula School. Then Gotō Konzan put forth all diseases arise from qi; smoothing qi is the cardinal treatment — the one-qi-stagnation theory — and held the Shanghan Lun as iron rule. He wrote Shisetsu Hikki, Tōyō Rakugo, and so on. His pupils Kagawa Shūan, Yamawaki Tōyō, and Yoshimasu Tōdō carried on; the Ancient-Formula School flourished.
5. The destruction of Japanese TCM
In 1868 Emperor Meiji set up a new government, undertook modernization, set up a constitutional monarchy. Economically: encourage industry and rear products, learn from Europe and America. Culturally: civilization and enlightenment, Europeanize, develop schooling. In medicine, the government clearly required physicians to study Western medicine and obtain Western medical credentials before they could practice — otherwise they could not be called physicians. The law is still in force. Thus pure TCM no longer exists in Japan. In 1895 the Japanese TCM world launched a protest, submitting a Physicians' Law amendment — rejected by just 28 votes. Since the law did not ban TCM study and research, those holding Western medical credentials could still use TCM. In 1910 Wada Keijūrō wrote Ikai no Tetsutsui; his pupil Yumoto Kyūshin wrote Kōkan Igaku, persisting in defense of TCM.
II. The current state of TCM in Japan
The earliest-arriving Western medicine was called ranpō ("Holland-method"); to distinguish, TCM was called kanpō ("Han-method"). Likely also because the Ancient-Formula School was then in vogue, the name kanpō stuck. There is also Oriental medicine; some today hold that kanpō refers to TCM reformed in Japan into a Japanese medicine. But by whatever name, it cannot escape TCM's root. Looking at today's kanpō or "Oriental medicine," does it have a complete medical system, can it stand alone in social medical service? The question remains.
1. Japanese kampo's mainstream
The Japanese monk Mori Dōhaku deeply studied kampo, especially the Later-Generation School; in late life he founded the Ikkan-dō, recruiting many credentialed Japanese physicians. Among them later became kampo figures Yasuyori Kaku and Yakazu Dōmei. Yakazu, meeting Ōtsuka Keisetsu, formed the Japan Kampo Medicine Society to revive kampo. In 1950 the Japan Society for Oriental Medicine was founded, to help physicians (MD, dental, pharmacist, acupuncturist) interested in kampo. It has eight regional chapters and 8,600+ members. They are Japanese kampo's mainstream.
2. The revival of Japanese kampo
In 1972 (Shōwa 47) China-Japan relations normalized; cultural exchange grew. With many physicians' work, the Ministry of Health, Labour and Welfare from 632 formulas selected 210 kampo formulas and set general-use kampo standards. The 210 are drawn from Shanghan Lun, Jinkui Yaolüe, Heji Jufang, Wanbing Huichun, Waitai Miyaofang, Qianjin Fang, with reference to Empirical Kampo Formula Dose Collection (Ōtsuka & Yakazu), Practical Kampo Diagnosis-and-Treatment (Ōtsuka, Yakazu, Shimizu Tōtarō), Kampo Diagnostic Codex (Ōtsuka, Yakazu, Shimizu), Clinical-Application Explanation of Kampo Formulas (Yakazu), Kampo Medicine (Ōtsuka), Clear Explanation of Kampo Formulas (Nishioka Kazuo), and others. In 1976 kampo granules entered medical insurance, widely used. By rough count, over 80% of Japanese physicians now use kampo. But Japan has no pure-kampo physicians; all are Western-learning kampo. Kampo products are stock items, generally no look-listen-ask-palpate needed, no clinical modification — just use per package insert. This may be a feature of Japanese kampo. Japanese TCM has in fact walked the road of abolish medicine, keep the drug — historically a road ever narrower.
III. Lessons for Chinese TCM
What can we learn from this?
1. Stop internal strife. Any science should allow many schools, contend, learn from each other, share strengths — never suppress or exclude. The Japanese TCM history shows this vividly. In Ming-Qing transition, Japanese kampo had reached a level; if not for the Ancient-Formula and Later-Generation struggle, kampo might not have fallen, or in the 1890s revival might not have been rejected by 28 votes. The current kampo would not be limited to 210 formulas.
2. Wrong policy decisions. Japanese kampo's main responsibility for its state lies with government policy. The Meiji Physicians' Law: only Western-trained physicians who pass the national exam may practice; kampo practitioners are not physicians. From then kampo went into the cold palace. To this day Japan has not one kampo higher-education institution. The fruit of millennia of forebears' labor — destroyed in a stroke, still un-recovered. This great historical lesson should make us reflect deeply. Bringing in foreign advanced science is unobjectionable; wholesale rejection of one's own culture brings unalterable result. Modern China too has heard calls to abolish TCM; in recent years certain so-called scientists have called TCM pseudo-science and called for its banning. Their learning is shallow, their motives sinister — they are criminals of the Chinese nation. By Japanese TCM's history and present state, let us rethink our policy and direction. We must redouble effort and lift Chinese medicine forward.