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Tuesday, April 17, 2012
Medicinal direction from both the East and West
By TOMOKO OTAKE
Once shunned as outdated and unproven, kanpō (Chinese herbal therapy) is currently making a vibrant comeback in Japan.
The original aim of using Chinese herbal treatments, which arrived in Japan around the 5th or 6th century, was to strengthen the body's defences against diseases. The practice not only miraculously survived in the face of modern Western medicine following the 1868 Meiji Restoration, but in the preceding Edo Period (1602-1867), before Japan opened itself to the West, it had also developed some uniquely Japanese techniques, such as fukushin (abdominal diagnosis for herbal treatment).
Now, more and more mainstream hospitals and clinics are taking an interest in the preventive and complementary role kanpō can play in treating patients.
A 2011 survey commissioned by the Japan Kampo Medicines Manufacturers Association showed that 89 percent of 627 doctors polled said they had some experience of prescribing kanpō for a wide range of complaints that included colds, constipation and menopausal difficulties. Many university hospitals have recently opened kanpō gairai, outpatient kanpō clinics, some of which have become so popular that patients have to wait for weeks to get an appointment.
So what's behind this kanpō renaissance?
Doctors say that, on top of mounting patient demand for milder and less drastic approaches to ailments, the 2001 revisions to the "core curriculum" for the nation's medical schools have changed doctors' attitude to herbal treatments. The revised medical curriculum mandates that basic theories of kanpō medicine be taught to all medical students, which means that younger generations of Japanese doctors — all of whom must also be trained in Western medicine to practice medicine of any kind — are comfortable prescribing kanpō on a routine basis.
This is all good news for people seeking the best of Western and Oriental medicine — but it's even better news that many kanpō treatments are covered by Japan's national health insurance.
The national government currently allows 148 kanpō "formulas" to be covered by the public health-insurance scheme, specifying the herbal components of each formula and their ratios. Most formulas, such as kakkontō (prescribed for the common cold) and maōtō (for influenza), come as standardized, freeze-dried powders, but some institutions supply bags of crushed herbal mixtures that need to be decocted.
There are, of course, other specialist hospitals and clinics that offer tailor-made kanpō treatments, which are not covered by public insurance. Doctors at these clinics are trained to recognize a patient's sho — the condition of a patient according to kanpō-specific diagnostic methods. This can include checking the abdominal region and the tongue, and then altering treatments accordingly by tweaking the herbs used and their ratios.
Dr. Yoko Kimura, associate professor at the Institute of Oriental Medicine of Tokyo Women's Medical University, says the time-honored philosophy of yōjō (recuperation care) is also an important part of kanpō treatment, and it works well for today's patients with hectic and stressful lifestyles.
"Kanpō is not just about taking drugs; its teachings include how to look after yourself during times of illness," Kimura says. "When you take kakkontō (known to be effective if taken when the early symptoms of a cold emerge), for example, you also need to curl up in your futon to warm up, avoid cold foods and then (after a while) start eating something hot, like porridge. This whole process is called yōjō, and it's all part of your treatment."
Kanpō specialists, however, do not rule out Western medicine. Patients with acute needs are better treated by modern medicine, Kimura says, noting that she prescribes both Western and kanpō drugs and refers patients to non-kanpō doctors when necessary.
Many general practictioners, meanwhile, diagnose a patient for kanpō the same way they do for pharmaceutical drugs.
"While kanpō-specialist doctors use sho, we general practitioners can only diagnose and prescribe by listening to the complaints of patients," says Dr. Jun Saito, deputy director of Saito Family Clinic in Shinagawa Ward, Tokyo. "For us, the more weapons we have to use, the better. Some patients who do not get better with Western drugs do improve with kanpō."
As the use of kanpō has become widespread in recent years, so have efforts to re-evaluate the medicinal herbs in a modern context. In 2010, a special Japan Society for Oriental Medicine committee for evidence-based medicine published a 430-page report listing the results of 345 randomized clinical trials (RCTs) on kanpō.
In reality, however, such Westernization of kanpō medicine has its limits, argues Dr. Hiroshi Odaguchi, vice-director general of the Kitasato University Oriental Medicine Research Center, one of the oldest kanpō clinics in Japan. He says some of the RCTs in the report didn't produce the best "evidence," partly because kanpō is based on the idea that patients' conditions should be examined holistically, not by specific symptoms.
"Western drugs target and treat specific organs, so it's relatively easy to find out the efficacy of a drug for headaches, for example — it's either effective or not effective," Odaguchi says. "But with kanpō, one formula can be effective for those suffering headaches and stomach pains at the same time, but not so effective for those who have headaches without stomach pains. This makes it very difficult to test kanpō's efficacy (from Western perspectives)."
Even so, Odaguchi believes such evidence-gathering efforts are important to convince the skeptics.
"Kanpō has survived because it's effective," he says. "(But) there are still people who say kanpō merely produces a placebo effect. It's not a placebo, and we need to show it's effective as a medical therapy."