Kampo, which translates as ‘Han Method’,  has a history of nearly 1500 years in Japan.  This holistic and elemental approach to medicine primarily relies on the prescription of herb formulas as well as encompassing acupuncture, moxibustion, and other components of the Chinese medical system. Unique aspects of Kampo include the selection of herbs prescribed and the use of palpation of the abdomen (hara) as a diagnostic tool. After a period of decline following the Meiji Restoration, Kampo is widely practiced today and the prescription of herbs integrated into the modern health care system and the National Health Insurance Scheme. My first direct exposure to Kampo, and its connection to InYo (C. Yinyang) and the Five Elements/Phases, was at the Nihondo Kampo complex in Shinagawa, Tokyo. This bought home the continuing relevance of Kampo, and the Five Chinese Elements/Phases, in contemporary Japan.

The first thing that caught my eye when I visited the Kampo Museum/Gallery was the prominence of the Yinyang symbol and the Five Chinese Elements/Phases of Earth, Water, Fire, Wood and Metal, as shown in the images below. There is almost no information available in English at the Nihondo complex in Shinagawa, although some can be found on the Nihondo website. This relates to the history of the Company and the approach it takes. The role of InYo and the Five Elements/Phases in diagnosis and treatment are not currently covered in English. Hopefully that material will be added in the future.

Elsewhere at the Nihondo Kampo Museum (see below) the elements were displayed in a pentagram. This symbol has a long history in Japan – it is said to have been derived independently, or ‘borrowed’ from Daoism, by Abe no Seimei around 1000 years ago  (for more detail see ‘Fusui, the way of Feng Shui in Japan‘). The use of the black and white Yinyang symbol in Japan largely appears to be a modern practice (for more detail see ‘Yinyang in Japan: harmonising vital energies‘). As a globally recognised symbol it was not surprising to see it had been adopted in the Museum. The symbols and images used to represent the elements in Japan is a whole other topic.

If I could read and speak Japanese my understanding is that I could have ordered a meal that was specifically related to my elemental ‘constitution’. Food and the elements is a whole other subject to write about, including Buddhist cuisine, Macrobiotics and ‘food as medicine’ (J. Ishoku dogen).

The introduction to Kampo in Shinagawa was through a modern lens with the practice adapted to modern lifestyles. Their motto ‘Health first, Kampo second‘ means, as I interpret it, that Kampo treatments are ancillary to looking after your health in the first place through good diet and exercise. It would be interesting to compare modern practices with those over traditional Kampo practitioners over its long history. One vital aspect of health that is likely to have changed over time is access to Vitamin D through exposure to sunlight.  As recently as 100 years ago Japanese people exposed more of their skin to the elements, particularly in rural areas. As I travel around now I see people covered from head to toe with protective clothing from the sun’s UV rays. Vitamin D deficiency is a serious health issue around the world. Potentially it is addressed by Kampo today through overall health assessments and that supplements are provided if required.

The Kampo of today is a distinctive system that evolved in Japan following the introduction of Chinese medicine around 600 AD.  To discover more about the history of Kampo and its connection with InYo and the Five Elements/Phases over time I turned to my growing book collection on Japan and the elements and online sources. There is more to share than I can cover now, including the history of the two Schools that flourished during the Edo period and their influence on current elemental practice. Connections and continuity between traditional and modern expressions of the elements is a theme of great interest to me. 

For those readers who are familiar with the ‘Book of Five Rings‘ by Miyamoto Musashi, the title of the book ‘Medicine of the Five Rings‘ may be confusing. Musashi’s book on martial arts, written around 1645,  is famous for using the five Buddhist elements of Earth, Water, Fire, Wind and Void to describe his methods and techniques. When I first saw Rister’s title I presumed his book would refer to the same five elements. This was not the case, as explained on the cover sleeve of the book. Rister’s ‘Five Rings’ are the five ways that Yin and Yang express themselves in human beings, creating flows of energy throughout the body and “rings of coincidence” between the body and the physical, mental, emotional and spiritual world outside it. The ‘rings’ represent the elemental qualities of Earth, Water, Wood, Fire and Metal. That makes sense in the context of Kampo.

In relation to Acupuncture, another integral component of traditional Japanese medicine, I have two comprehensive books co-written by Kiiko Matsumoto and Stephen Birch, shown below. They explain the Five (Chinese) Elements in detail and their relationship to the hara as a diagnosis tool in even greater detail.

The theory, diagnostics and practice of the Five Elements and Ten Stems, as recorded in the Nan Ching (a Chinese text generally thought to have originated in the first millennium BC) is complex and not possible to cover in detail. Drawing on the two books above, I can provide a glimpse into some of the intricacies using the Five Elements in traditional Japanese medicine. If you would like to know more I would recommend ‘Five Elements and Ten Stems‘ as a starting point.

As described in the recommended book, the Five Elements in Chinese philosophy have many correspondences, for example with the seasons, colours, parents and organs. These are derived from the cyclic inter-relationship of the Elements as shown in the pentagram above. Each of these correspondences are viewed as having potential diagnostic significance and help perceive the energy patterns of an individual. Kampo is a holistic practice so may consider facial colour, the texture of the skin on the forearm, voice qualities, and the condition of the hara in the process of forming a diagnosis.

In the book ‘Reflections on the Sea‘ the authors note that in Japan the concept of the hara is much larger than the simple idea of the abdomen. It is described as part of a pervasive social and cultural concept, rooted in the Chinese classics and the practice of meditation. The hara is seen as the source of the bodies energies, the energetic centre from which life springs. I look forward to learning more about the hara in Japanese culture and its relationship to the elements.

Another important diagnostic tool in Kampo is reading the multiple pulses in each arm. Matsumoto and Birch (1983, the red book) say “The Nan Ching gives us a series of color correspondences useful for diagnosis because they are detailed in relationship to the qualities of the pulse.” An example is the colour blue, representing Wood, that should be seen with a Wiry or Tight pulse. The colour red, representing Fire, should be seen with a Floating, Big or Scattered pulse. Where the colour and pulse match the disease can be seen as a disease within a single element. If the colour and pulse do not coordinate, the treatment may be more complex and difficult. The skills required to undertake these holistic analyses and recommend treatments take many years to acquire.

Kampo survived changes in Japan during the Meiji era where only the German medical system was recognised. One of the reasons for the recent resurgence in interest in traditional Japanese medicine has been the manufacture of high-quality extracted herbal granules based on Kampo theory, starting in 1957. 140 of the herbs were added to the the National Health Insurance Plan in Japan in 1976 and are commonly prescribed. According to a Californian website on Kampo the increased interest in Acupuncture after President Nixon visited China in 1972 also had flow on effects for Kampo. The uptake of Kampo practices internationally, which I understand occurred via Taiwan, is another piece of this complex jigsaw puzzle. 

This initial exploration of the elements in traditional Japanese medicine has highlighted the importance of InYo, the Five Chinese Elements and energy flow to the diagnosis and treatment of a patients overall health. Whether all of these factors are taken into consideration in modern diagnoses is still to be discovered. Certainly they are essential components at the Nihondo Boutique in Shinagawa. I discovered the Kampo complex there serendipitously, on my way to see the 47 Ronin, and am very pleased that I did. Several months later I discovered another Nihondo store in Kyoto. A broad range of Kampo health treatments and aids can be found there – hopefully one day they will open a restaurant. 🙂

Afterword: Early in 2021 it was drawn to my attention that Kampo has been practiced alongside a Buddhist approach to medicine in Japan for hundreds of years. While I have a few academic papers that touch on Buddhism and medicine, its importance was brought home when I bought ‘Buddhism and Medicine in Japan‘ by Katja Triplett. The book was recommended by David Ramey who is publishing a book on horse medicine in Japan in the second half of 2021.

Katja’s book refers to a set of Buddhist medical ideas and practices in Japan designed to heal the physical bodies of humans and animals with the aim of providing a path to salvation and eradicating all ills in the world. It includes chapters on treating sight-related diseases, women’s health, plant-based materia medica, medicinal gardens and equine medicine. As expected, both the Buddhist and Chinese elements/phases are referred to. The long-established pluralistic approach to medicine in Japan, where Kampo and ‘religious’ healing have been utilised and at times combined, now includes western-style techniques in the mix. Thanks goes to David for his book recommendation, and to Katja for her insights, both of which have improved this post.