by Carmen Altomonte
The word kampo is the Japanese pronunciation for the combination of the Chinese characters Kan (han) meaning “from China” and po (ho) meaning the “way”. Thus, kampo is the Japanese version of traditional Chinese medicine, dating back several thousands of years. To understand kampo, one must first look to China.
According to Chinese legend, Shen Nung, the god of husbandry, established herbal medicine. The principles of herbal medicine were first recorded as a conversation between the yellow emperor and his minister, Chi Po. They discussed medical philosophy in a book known as the Su Wen (Basic Questions), and medical practice in a book later named The Magic Pivot. These writings became the world’s first known medical textbook, The Yellow Emperor’s Canon of Internal Medicine (Huang ti nei ching su wen). Although this book was perhaps the earliest book listing herbal remedies, it was mainly concerned with acupuncture. It listed only 28 herbs, combined into 12 formulas categorized by taste.
In 168 BC, shortly after The Yellow Emperors Canon appeared, the first book dealing mainly with herbal healing was written. This work, Formulas for 52 Ailments (Wu shi er bing fang), contained magical formulas in the form of pills, potions, teas, etc., to fight the evil influences thought to cause various forms of illness. This medicinal/magical combination later became known as Fang ji and incorporated astrology, geomancy and other quasi-sciences into its practice.
Understandably, Fang ji proved inadequate for certain needs. Herbalist Zhang Zhanjing, after losing much of his family to the plague in AD190, decided to replace magic with medicine. He studied all of the old medical classics, developed and collected many prescriptions, and finally compiled the Shang han a bing lun (Discussion of cold induced disorders and miscellaneous diseases). This book later became known in Japan as the Sho Kan Ron, the forerunner of all kampo manuals.
Zhang had unique ideas concerning medical treatment. He taught that herbal medicine should conform to people — it should be customized for the individual. Zhang’s main precept was that if the disharmonies within the diseased individual could be discerned, then the correct combinations of herbs that would correct the imbalances would naturally follow. If physicians thoroughly understood herbs and their effects on the body and the body’s energy, they could precisely match the herbal combination with the affliction. Zhang’s idea was tremendously successful. In fact, it became so reliable that in time the name of the formula used for treatment became synonymous with the diagnosis.
Invaluable as it may be, the Sho Kan Ron was not the only work to prove itself useful even into modern times. The third century herbalist Ge Hong took Zhang’s principle a step further. He wrote the Bei ji zhou hou fang (Emergency Formulas to Keep Up One’s Sleeve). This book is the source of most of the asthma treatments kampo has to offer.
Other works of this period, including the Wai tai bi yao (Arcane Essentials from the Imperial Library), contain many formulas still in widespread use.
As time progressed, herbal texts became increasingly voluminous and disorganized. The Tai ping hui min he ji ju fang (Imperial Grace Formulary of the Tai Ping Era), written around AD 990, contained almost 17,000 formulas. It became difficult for physicians to determine which treatment to use for a given condition — especially so since many manuals began to use substitutes for original ingredients. Attempts to organize this vast wealth of herbal knowledge were largely unsuccessful.
The 12th century scholar Cheng Wu-ji wrote the Shang han ming li lun (A Clarification of the Theory of Cold-induced Disorders). He attempted to streamline the system by categorizing all herbal formulas into seven basic categories. Cheng also made some advances by discussing the location of disease in the body, the strength of the disease itself, the constitution of the patient and the correct timing of the herbal treatment. On the other hand, his system of classification was rather inconsistent and some of his observations had no logical basis whatsoever. For instance, one of his precepts still quoted today states, “To induce sweating do not use an even number of herbs. To drain downward do not use an odd number of herbs.”
The logical inconsistencies and organizational problems troubled many practitioners.
It was the Japanese who found that they could simplify the enormous volume of herbal information and knowledge into a system that would be more efficient. This uniquely Japanese system of medicine became known as kampo.
The Japanese, like the Chinese, once relied on magic and prayer to address their medical needs. Sometime after AD 593, the Empress Suiko sent her armies to invade Korea, where Chinese medicine was already in use. Reports of the Chinese medical practices so impressed the Empress that she sent two emissaries to China to study. Knowledge of kampo spread to the Buddhist monasteries of Japan during the Nara period (AD 710 – 794) when a Japanese monk fell ill while traveling in China and recovered after being treated with kampo. Other emissaries were soon sent to bring back more of the Chinese herbal healing formulas. During the Heian period (794-1192) a scholar by the name of Yasuyori Tamba revised the oldest Japanese medical text, the Issinho (The Way of Medicine) to include all the herbal formulas discovered in China. The rewritten work was hand copied into thirty volumes.
This enormous amount of information posed the same problem for the Japanese as it did for the Chinese, so, over the years, the Japanese began their process of simplification. Kampo practioniers dropped the 17,000 formulas of the Imperial Grace Formulary in favor of the more ancient Shen nung pen ts’ao. (Pharmacopoeia of Heavenly Husbandry). The pool of available herbal combinations was cut down to 365 herbal formulas, one for each day of the year. There were 120 joyaku (upper class medicine) formulas designed to increase safely vitality and longevity when taken regularly, 120 chuyaku (middle class medicine) and 125 shimoyaku (lower class medicine). The last category, the shimoyaku, is intended as treatment for serious ailments, and usually produces negative side effects. Kampo practioners tried to heal as gently as possible, with the fewest possible side effects.
Another important reason for the simplification was the fact many original ingredients were simply unavailabile. Early on, Japan was open to trade with foreign countries, but during the Tokugawa period (1603 – 1867), all trade with foreign countries was cut off and Japan became an isolated nation. This eliminated foreign herbal sources.
The religious motivations of the Buddhist monks also became a reason for simplification. For centuries, monks were the only source of kampo medicine for the commoners. The only other practioners were court scholars who would not administer to anyone outside the imperial court. The Chinese used a vast array of animal products in their preparations, such as rhinoceros horn, whole wasps and tiger bone. Since Buddhist doctrine forbade the taking of life, the Japanese had a general distaste for animal by-products, and the pool of materials was necessarily reduced.
Except for the use of shells and fossilized bone, Japanese medicine became almost entirely plant-based.
At one point, the simplification process reached its limit. Todo Yoshimasu (1702 – 1773) stated that all diseases stem from the presence of toxins, and, once the toxin was removed, the cure would follow. Yoshimasu invented a treatment called meigen, a belief that “like cures like” using very high concentrations of toxins. However, since most of his patients died, this method was quickly discarded.
One school of Kampo, composed of followers of the 16th century master Dosan Manase, held on to the five elements and energy-circuit ideas of ancient China. The Koho School of kampo, however, rejected these concepts in favor of their own, uniquely Japanese method. The practitioners of the Koho School returned to the Sho Kan Ron, and proceeded to simplify even this quite basic text. They then identified five basic causes of disease: wind, cold, heat, dampness and improper diet and/or overwork. Elaborate theories of the interplay of yin and yang were discarded and subsequently used only as diagnostic indicators. Kampo, as it is practiced today, is largely a result of the reforms of the Koho School.
After looking at the history of kampo, one can see that the theories behind diagnoses and treatments are considerably different than those of conventional western medicine. Western medicine utilizes disease-based diagnosis, in which the physician tries to isolate a specific case of the illness. Eastern medicine utilizes patient-based diagnosis, in which the doctor looks for recognizable patterns of disharmony within the patient. To more thourghly understand kampo, you must first have a general understanding of this “patient-based” theory of medicine.
The underlying premise behind Asian medical theory is that all forms of life are animated by an essential life force called chi in Chinese (ki in Japanese). It is the quantity, quality, flow and balance of chi that ultimately determines one’s state of health. Important factors affecting chi are the air we breathe and the food we consume. Thus, the stomach and lungs play vital roles in the absorbing chi from the environment. If these organs are not functioning properly, the physician must correct the condition by prescribing proper diet, exercise, breathing, etc. If the imbalance has progressed to the point that a vital organ or system is affected, the physician may prescribe an herbal formula to correct the imbalance. The chi of the herb, in theory, goes straight to the target organ.
The concepts of yin and yang (Japanese in and yo) are central to herbal medicine. The precarious balance between the two must be maintained in order for life to thrive. Yin represents the negative, passive, female force and yang represents the positive, active, male force. The balance is often disturbed, throughout one’s life. For example, during winter, the cold yin influences dominate and might need to be counteracted by warming, yang herbs. Usually, the body can adjust this balance automatically. Only when it does not must a physician intervene.
To explain the interdependence of the various organs, the ancient Chinese used the theory of the five elements. Wood represents the liver; fire, the heart; earth, the spleen; metal, the lungs and water, the kidneys. Wood burns to generate fire, fire produces ashes, which generates earth, earth produces metal which, when molten, becomes like water, and water promotes the growth of plants, which produces wood. Since each vital organ corresponds to an element, the interplay of the elements creates analogs by which physicians can understand bodily systems and functions.
Japanese historical chronicles abound with accounts of kampo being used by the samurai. The Bonsen Shukai has two recipes for pills, one to combat hunger and the other for thirst. The Zohyo Monogatari has an entire section devoted to medical care, offering proof that the wounded were cared for and not just left to die. Umeboshi (pickled plums) were considered great if one was having difficulty breathing, and pepper grains were taken on campaign to encourage warmth. Shikimi (star anise oil) was taken to help alleviate frostbite.
As far as wounds were concerned, there were several herbal remedies available, including narcissus root and wheat flour paste. Pulverized leeks were said to help heal gunshot wounds and burns were treated with a mixture of tannin and ink. If such herbal remedies were unavailable, one might mix horse dung in water and apply it to the wound, or urinate in a copper hat and wash with it.
In light of the alternative remedies, you can easily see why the samurai sang the praises of kampo herbs.
Dunn, Charles J. Everyday Life in Traditional Japan. Charles E. Tuttle Company, Inc., 1969.
Reid, Daniel. The Complete Book of Chinese Health and Healing. Shambhala Publications, Inc., 1994.
Rister, Robert. Japanese Herbal Medicine. Avery Publishing Group, 1999.
Tsumura, Akira. Kampo. Japan Publications, Inc., 1991.
Turnbull, Stephen. The Samurai Sourcebook. Arms and Armor Press, 1998.
Ziyin, Shen and Zelin, Chen. The Basis of Traditional Chinese Medicine. Shambhala Publications Inc., 1996.