The Journal of International Medical Research

2006; 34: 231 – 239

Traditional Chinese Medicine and

Kampo: A Review from the Distant
Past for the Future
F YU1,4, T TAKAHASHI1, J MORIYA1, K KAWAURA1, J YAMAKAWA1, K KUSAKA1,
T ITOH1, S MORIMOTO2, N YAMAGUCHI3 AND T KANDA1
1
Department of General Medicine, 2Department of Geriatric Medicine, and 3Department of
Serology, Kanazawa Medical University, Ishikawa, Japan; 4Department of Traditional
Chinese Medicine, Second Affiliated Hospital of China Medical University, Liaoning, China

Traditional Chinese medicine (TCM) is a integrated into the modern health-care

complete system of healing that developed system. Kampo is based on TCM but has
in China about 3000 years ago, and been adapted to Japanese culture. In this
includes herbal medicine, acupuncture, paper we review the history and
moxibustion and massage, etc. In recent characteristics of TCM and traditional
decades the use of TCM has become more Japanese medicine, i.e. the selection of
popular in China and throughout the traditional Chinese herbal medicine
world. Traditional Japanese medicine treatments based on differential diagnosis,
has been used for 1500 years and and treatment formulations specific for the
includes Kampo-yaku (herbal medicine), ‘Sho’ (the patient’s symptoms at a given
acupuncture and acupressure. Kampo is moment) of Japanese Kampo – and look at
now widely practised in Japan and is fully the prospects for these forms of medicine.

KEY WORDS: TRADITIONAL CHINESE MEDICINE; KAMPO; SELECTION OF TREATMENT BASED ON THE
DIFFERENTIAL DIAGNOSIS; FORMULATION CORRESPONDING TO SHO

Introduction October 1998, re-categorized traditional

According to the definition given by the medicine as complementary and alternative
World Health Organization, traditional medicine.
medicine includes a diversity of health Traditional Chinese medicine (TCM), one
practices, approaches, knowledge and beliefs of the oldest continuously surviving
and incorporates plant, animal and/or traditions, originated as a means of
mineral-based medicines, spiritual therapies, maintaining good health and treating
manual techniques and exercises, which are diseases in Chinese communities and has
applied singly or in combination to maintain been adopted recently by other ethnic groups
well-being and to treat or prevent illness.1 worldwide.2 TCM is a complete system of
The National Center for Complementary healing that developed in China about 3000
and Alternative Medicine, established at the years ago and reached a coherent, codified
National Institutes of Health in the USA in form about 2000 years ago. It includes

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Traditional Chinese medicine and Kampo

herbal medicine, acupuncture, moxibustion meanings of ‘disease’ and ‘symptom’ are

and massage, etc. In recent decades, the use similar to those in Western medicine. Zheng,
of TCM has become more popular in its own which can generally be translated as
right and also as a complement to Western ‘syndrome’, is the basic unit and the key term
medicine throughout the world.3 TCM has in TCM theory, with a unique meaning. Zheng
been adopted in modified form in Far is the clinical outcome of the disease at any
Eastern countries, such as Korea and Japan.4 moment, and it generally encompasses the
Traditional Japanese medicine has been aetiology, pathology and disease location.
used for 1500 years and includes Kampo, After analysing the patient’s history and all
acupuncture and acupressure (Shiatsu). The the symptoms and signs, doctors using TCM
word ‘Kampo’ (also written ‘Kanpo’) refers to recognize not only the disease, but also the
the herbal system used in China that more important Zheng. The same disease may
developed during the Han dynasty (between have many different Zheng because of
206 BC and AD 220); today the word is also differences in symptoms and signs at different
used to describe a unique system of Japanese stages of the disease. On the other hand,
herbal medicine. Kampo is widely practised different diseases may have the same Zheng,
in Japan, where it is fully integrated into the so that in TCM different diseases can
modern health-care system. sometimes be treated with the same
Throughout the history of TCM and formulation. The analysis of the patient’s
Kampo, the basic theories and the methods history and all the symptoms and signs is
of diagnosis and treatment have differed referred to as the ‘differentiation of Zheng’. All
considerably from those of Western treatments in TCM are based on the
medicine. Western medicine uses disease- differentiation of Zheng and all formulae used
based diagnosis, while TCM and Kampo for treatment are based upon this ‘treatment
emphasize patient-based diagnosis. principle’ (for an example, see Fig. 1).
Kampo is based on TCM but is adapted to The concept of ‘Sho’ comes from the
Japanese culture. It can be characterized as a Zheng of TCM, but is simpler because of the
simplified, positivistic and pragmatic version simplified Kampo theory. Sho is the patient’s
of Chinese herbal medicine.5 The process of symptoms at any moment, recognized in
diagnosis and treatment differs between terms of Qi (well-being, energy, illness,
TCM and Kampo. In TCM the treatment is vigour), Blood and Water; the eight
according to the differential diagnosis, categories (Yin–Yang, hypofunction and
whereas Kampo uses a treatment ‘formulation hyperfunction, heat and cold, superficies
corresponding to Sho’; Sho is the patient’s and interior); the five parenchymatous
symptoms at a given moment. In this paper viscera; and the six stages of the disease
we review these two forms of traditional (Taiyang, Shaoyang, Yangming, Taiyin,
medicine. Shaoyin, Jueyin).6,7 Sho is broadly defined as
Kampo diagnosis in the epistemic framework
Zheng and Sho of the Kampo view of illness, and provides
‘Sho’ and ‘Zheng’ in Japanese and Chinese are information on which to base the
derived from the same word, but over time treatment.6,7 Recently there has been a trend
they have come to acquire different meanings. to name the Sho in terms of a formula, such
The disease, the symptom and the as ‘Kakkonto Sho’, which denotes treatment
syndrome are the basic ideas of TCM. The of the patient’s symptoms with Kakkonto.

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Traditional Chinese medicine and Kampo

Traditional Chinese medicine: Kampo:

‘selection of treatment based on the ‘formulation corresponding to Sho’
differential diagnosis’

The symptoms, signs and the patient’s history by using the four diagnostic methods of
observation – hearing and smelling, enquiry and palpation
Sudden onset, sore throat, fever, chilliness, headache, nasal discharge and/or slight cough
Tongue: thin, yellow
Pulse: floating

Aetiology: wind heat Qi, Blood, Water

Eight categories:
hyperfunction/cold/superficies

Disease location: lung and superficial area Five parenchymatous viscera: lung
Six stages of the disease: Taiyang

Pathology:
wind heat impairs lung descending function

Traditional Chinese medicine disease:

Gan Mao

Zheng: superficial wind heat Zheng Sho: Taiyang-Maoto Sho

Treatment principle: promote lung

function, expel wind heat and relieve
superficial area

Formula: Yin Qiao San, Sang Ju Yin Formula: Maoto, Kakkonto

FIGURE 1: Example of the process of diagnosis and treatment in traditional Chinese

medicine and Kampo: the common cold

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Traditional Chinese medicine and Kampo

‘Selection of treatment 2000 years ago TCM had been codified into
based on the differential a system; the major classic medical
manuscripts and drug books were completed
diagnosis’ and the at this time, and these are still used today.
‘formulation corresponding In the sixth century AD Japan imported
to Sho’ the culture of Chinese medicine, mainly via
In TCM, after having recognized the the Korean Peninsula. During the period
particular Zheng, the Chinese practitioner between the seventh century and the Edo
then confirms the ‘treatment principle’. Period (1603 – 1867), the latest medicine
According to this principle, it is possible to from China was always taken up eagerly in
choose formulae for treatment and adjust Japan; it was accepted immediately and
the herbs used in the formula, or make a used virtually without modification.8 This
new formulation adapted to the patient’s imported Chinese medicine was modified to
particular condition. This step is called the meet local needs and became known as
‘selection of treatment’ in TCM. The process Kampo. In the Meiji period (1868 – 1912) the
from diagnosis to treatment in TCM is called government adopted Western medicine, and
the ‘selection of treatment based on the during this period of repression Kampo
differential diagnosis’ (Fig. 1). medicine became divided into three parts:
In Kampo medicine, the process of herbal medicine; acupuncture and
diagnosis and treatment is called ‘formulation acupressure. Today ‘Kampo’ refers only to
corresponding to Sho’. When treating a herbal medicine.8
patient, Japanese practitioners recognize the TCM has never stopped developing.
Kampo diagnosis (Sho) and choose the most However, the new theory of TCM that
suitable formula. The relationship between developed after the Meiji period was not
these steps is regarded as similar to that of accepted in Japan because of the policies of
lock and key. Each pathological condition is the Meiji government. The idea of activating
thus related to its prescription.6,7 Japanese the circulation of the blood and clearing
practitioners generally tend to check the away static blood was promoted by Wang
symptoms and name of the disease, and Qing-ren (1768 – 1831) in the Qing dynasty
choose Kampo drugs (Fig. 1).8 (1644 – 1911). The theory of Wen Bing Xue
We will now explain the development of (meaning ‘Warm Disease’ [febrile disease]),
the different methods of diagnosis and the most modern of the four areas of
treatment in TCM and Kampo. classical study, is regarded as the most
important development in TCM since the
Origin and development of theory described in the book Shang Han Za
Bing Lun (AD 190).
traditional Chinese After World War II, Kampo medicine
medicine and Kampo ushered in a new age in Japan. In 1967, the
During the development of TCM, ancient health insurance authorities began reim-
authorities, well-known doctors, researchers bursement for four Kampo drug formulae
and philosophers inherited their predecessor’s prescribed by doctors. Reimbursement was
writings, tested their techniques, and in turn available for 147 formulae in 19878 and
added their own experience and knowledge, about 200 formulae in 2000. Thereafter,
which they handed on to posterity.8 By about Kampo spread steadily and rapidly.

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Traditional Chinese medicine and Kampo

Basic theory Formulae

TCM has developed over 3000 years. The Most of the formulae used in Japan come
tradition has been well conserved and the from Shang Han Za Bing Lun. In China there is
system of recognition/healing has become a broader range of sources, including medical
comprehensive. TCM can be characterized as manuscripts and well-known formulae.
holistic, with emphasis on the integrity of the In TCM there is a large number of
human body and the close relationship excellent classic formulae. Herb formulae
between the human body and its social and (typically 10 – 15 herbs) are prescribed in
natural environment. It focuses on health such a way that each herb is used to its
maintenance, and in the treatment of greatest advantage, which improves the
disease it emphasizes the enhancement of results of the treatment and reduces any
the body’s resistance to disease.9 The adverse effects of the other herbs. Doctors
theoretical basis of TCM originates from the usually change the formulae according to
ancient Chinese philosophy of Yin–Yang and changes in the patient’s condition and the
the five elements. The major TCM theories treatment principle. This makes it possible to
are covered systematically, including Qi, treat complicated diseases and to carry out
Blood, Body Fluids, Essence, Shen, the Zang Fu patient-based treatment, in which the doctor
internal organ theory (Zangxiang), aetiology thinks about the patient’s particular
and pathogenesis, as well as the principles of characteristics, such as their age, general
the prevention and treatment of diseases. health and constitution, and the social and
As mentioned above, the theory of TCM natural setting. It also contributes to the
was unified in China. However, a unified making of entirely new formulations.
theory of Japanese traditional medicine has The herb formulae prescribed by the doctor
not been established in Japan.8 Kampo may take different forms in China. Many of
medicine is simpler and more informal than them are decoctions, while others are
TCM and emphasizes practice rather than powdered herbs, pills and tablets, and so on.
theory.10 The main theories of Kampo are the There is also the ready-to-use form, which is
three substances (Qi, Blood, Water), the eight different from that used in Japan. It is based
categories, the five parenchymatous viscera on a single herb rather than a fixed formula,
and the six stages of disease. Among the and the doctor can adjust the formula easily.
reasons for the simplification of Kampo may The Shang Han Lun and Jin Gui Yao Lue
be the policies of the Meiji government. (both are part of Shang Han Za Bing Lun)
Theories such as the Wen Bing Xue theory formulae are among the principal focal
and the idea of activating the blood points of Kampo medicine. Today, many
circulation and clearing away static blood Kampo practitioners use these books and
were not accepted after this period in Japan. prescribe their formulae. The herbs in these
Another reason is that a theory based on formulae (typically five to nine herbs) are
the treatment theory of Shang Han categorized mainly in modern texts as
Lun (included in the book Shang Han Za Bing surface-relieving herbs, heat-clearing herbs,
Lun, called Sho Kan Ron in Japanese) was moisture-draining herbs and tonics.
followed by the classical school that gained Formal recognition by the Japanese
power in the Edo era, a school that still Ministry of Health has strongly influenced
constitutes the mainstream in Japanese the practice of Kampo during the past 30
Kampo medicine.8 years. As a result, Japanese practitioners

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focus their attention on about 200 formulae. and safety of TCM using the RCT method are
Most of the modern formulae are of the increasing in number in China.
ready-to-use type produced in factories. In the 1970s, departments of oriental
medicine were established in teaching
Education hospitals for the training of physicians. In
According to the Chinese State Administration these institutions, clinical research was
of TCM, there were 34 universities or colleges undertaken on how to use traditional Kampo
for TCM and pharmacology in 2003. These formulae for the treatment of various health
universities or colleges provide 14 professional problems.10 The research models used in
programmes for undergraduates. Twenty- Japan for studying Kampo are all Western,
three of the schools provide programmes for and the approach is based on conventional
master’s degrees and 13 provide doctorate Western disease nosology and on
10
programmes. In China, every Western medical conventional immunology. The results of
school contains a department of TCM. various clinical and laboratory studies have
On the other hand, in Japan there is no led to expansion of the use of traditional
systematic programme exclusively teaching formulae in doctors’ offices and hospitals in
Kampo medicine and no special license the mainstream of Japanese medicine.10
course for Kampo physicians. Under the laws
governing medical practitioners, only Discussion
allopathic (conventional) physicians may Some ideas have penetrated deeply during
practise medicine, including Kampo the formation and development of TCM. The
medicine.1 However, there are no restrictions first is the idea of the ‘whole’, which focuses
on the types of medical procedure allopathic on the integrity of the human body and the
physicians may use in their practice.1 A close relationship between the human body
national survey in 1998 reported that 18 and its social and natural environment. The
medical schools had either an elective or a second is the idea of ‘dynamic balance’,
required class on complementary and which emphasizes movement in the integrity
alternative medicine – mainly Kampo and changeability of the Zheng.9 The third,
medicine and/or acupuncture.11 Recently, and most important, idea is the ‘selection of
more medical universities have begun to treatment based on the differential diagnosis’.
provide education in Kampo medicine along Kampo medicine accepts the ‘whole’ idea
with Western medicine. taken from TCM, and emphasizes the
relationship between the human body and
Evidence-based medicine its social and natural environment. It
The clinical efficacies of Western medicine regards the disease state as an imbalanced
and TCM have been assessed in widely state, and the process of Kampo treatment is
different ways in the past.3 Evidence-based intended to correct this imbalance or to help
medicine is the integration of the best the individual patient return to the
research evidence with clinical expertise and equilibrium state. The Zheng is changeable
patient values. Large randomized, controlled during the disease process.6,7 These ideas are
trials (RCTs) are generally accepted as the similar to those of TCM. The symptom–
gold standard. Although it is difficult to formula correspondence is regarded as
carry out RCTs because of the changeability another characteristic in which Kampo
of Zheng, scientific studies on the efficacy medicine12 differs from TCM (Table 1).

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Traditional Chinese medicine and Kampo

TABLE 1:
Characteristics of traditional Chinese medicine and Kampo

Traditional Chinese medicine Kampo

Characteristics System codified and complete Simplified and pragmatic
Characteristics of ideas Ideas of the ‘whole’ and the ‘dynamic balance’
‘Selection of treatment based ‘Formulation corresponding
on the differential diagnosis’ to Sho’
Focal point Syndrome (Zheng) Disease and symptom
Basic theory Yin–Yang and the five elements Three substances
Qi, Blood, Body fluids, Essence, Shen (Qi, Blood, Water)
The Zang Fu internal organ theory Eight categories
Aetiology and pathogenesis Five parenchymatous viscera
Prevention and treatment Six stages of disease
principles for diseases
Formulae Many classic formulae Limited formulae
Typically 10 – 15 herbs Typically 5 – 9 herbs
Decoctions and ready-to-use Ready-to-use formulae
herbs (easy to adjust) (relative fixation, i.e. relative
adjustment to the Sho)
Education Systematic traditional Chinese Western medicine
medicine programme programme
Evidence-based medicine Emphasizes experience in Emphasizes evidence from
combination with evidence clinical and laboratory studies

As drugs covered by the National Health and laboratory studies. However, all the
Insurance System (NHIS) in Japan can only clinical and laboratory studies are carried
be prescribed by medical doctors trained in out on the basis of the disease alone.
Western medicine, there is a tendency for Whereas the Zheng is changeable and the
them to use Kampo formulae without same disease may have different Zheng, it is
paying much attention to the TCM impossible to reveal the entire Zheng from
interpretations of the symptoms of the the results of the clinical and laboratory
patient.12 Therefore, the mainstream of studies. Sometimes the doctor cannot find a
Kampo relies not so much on the rigorous suitable key to the particular lock because of
interpretation of the disease state in terms of the limited number of formulae covered by
the basic TCM concepts as on the direct the NHIS.
practical effects of the formula itself.12 In the West, the practice of Chinese
Terasawa pointed out that ‘In Japan, it is herbal medicine has been strongly
not possible for a physician to use TCM’s influenced by Kampo. One reason is that
system of three elements/eight categories in Kampo was introduced before the licensing
order for his or her Kampo formulae to be of acupuncture was established, and a
covered by NHIS’.12 Kampo medicine places second reason is the convenience of the
more emphasis on the results of clinical ready-to-use formulae. A third reason may

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Traditional Chinese medicine and Kampo

be that the idea of the symptom–formula demonstration of statistically significant

correspondence in Kampo is easier to master effects seems necessary for the improvement
than TCM’s idea of the ‘selection of and acceptance of TCM.13 Modern drugs are
treatment based on the differential good for curing diseases with a clear cause
diagnosis’. Another reason, in our opinion, is and pathology but not for curing diseases due
that Kampo used with evidence-based to multiple factors, and these have become
medicine is easily accepted in the West more common.9 TCM is not a perfect way
because the research models and methods of identifying specific pathogens and
used in Japan for studying Kampo are pathological changes. It seeks disturbances in
thoroughly Western10. The practice of TCM the human body by analysing all symptoms
with evidence-based medicine in China is and signs,9 and this make it possible to treat
more difficult than in Japan because of the diseases due to multiple pathogenic factors
large number of formulae used and the and some diseases that are not very well
individualization of treatment. understood. This is the advantage and unique
Traditional medicine has faced the crisis appeal of TCM and Kampo.
and challenge of historical continuity and The third approach is the establishment of
modernization. Its practitioners in China an animal model that has the Zheng of the
and Japan have worked hard to find the best human condition in addition to showing a
approach. One approach is to combine the model form of the disease. In TCM and
Zheng with the disease. In some diseases, Kampo practice, it sometimes happens that
such as fatty liver, the patient has no special a formula that has been shown to be
symptoms and signs. In other conditions, effective in animal experiments or RCTs
such as early cancer, there are also no special does not achieve the desired effect in
symptoms and signs – or there may be only humans, and sometimes even produces the
general discomfort – and the therapeutic converse effect. One important reason for
result will differ according to whether the this is the existence of Zheng. Therefore, the
Zheng or the disease is considered. On the establishment of a model with the Zheng
other hand, if the emphasis is placed heavily seems to be necessary and important in TCM
upon the disease, it will be difficult to tailor and Kampo studies.
the treatment to the particular patient. This We need to keep alive the history of TCM
makes a TCM or Kampo medicine merely a and Kampo and at the same time make
kind of combined herb drug, like any advances in the practice of these forms of
Western drug, and TCM will have no appeal. medicine. Although the practice of Kampo in
Combining the differentiation of Zheng with Japan is different from that of TCM in China,
the diagnosis of the disease would achieve all efforts that we can make will aid the
the best therapeutic effect.9 development of TCM and Kampo.
A second approach is to combine
traditional experience with modern evidence. Acknowledgements
In TCM, there is a history of more than 3000 The authors were supported in part by a
years of unique experience and there are grant for Promoted Research from Kanazawa
hundreds of excellent classic formulae. Medical University (S2005-5), a grant for
Because of its unique system and the methods Project Research from the High-Technology
it uses for diagnosis and treatment, TCM does Center of Kanazawa Medical University
not find ready acceptance in the West. The (H2004-7), and a research grant from

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Traditional Chinese medicine and Kampo

Grant-in-Aid for Scientific Research (C) from Conflicts of interest

the Ministry of Education, Science, Sports, No conflicts of interest were declared in
and Culture of Japan (No. 17590767). relation to this article.

• Received for publication 13 December 2005 • Accepted subject to revision 6 January 2006
• Revised accepted 24 January 2006
Copyright  2006 Cambridge Medical Publications

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Address for correspondence

Dr T Kanda
Department of General Medicine, Kanazawa Medical University, 1-1 Daigaku,
Uchinada-machi, Kahoku-gun, Ishikawa 920-0293, Japan.
E-mail: kandat@kanazawa-med.ac.jp

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