Kampo, the elements of traditional Japanese medicine

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 (YinYang) and the Five Elements, was at the Nihondo Kampo complex in Shinagawa, Tokyo. This bought home the continuing relevance of Kampo, and the Five Chinese Elements, in contemporary Japan.

The Nihondo Kampo Museum in Shinagawa is a complex of four businesses that encompass the first Kampo Museum in Japan (the Gallery), a Boutique, School and Restaurant.

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 in diagnosis and treatment are not currently covered in English. Hopefully that material will be added in the future.

Kampo theory is based on InYo (YinYang), the five Chinese elements and the flow of energy in the body. The five colours above represent the five Chinese elements of Earth, Water, Fire, Wood and Metal. Elsewhere at the Nihondo Kampo Museum (see below) the elements were displayed in a pentagram. This symbol was derived independently in Japan around 1000 years ago by Abe no Seimei so has a long history (for more detail see ‘Fusui, the way of Feng Shui in Japan). The use of the black and white YinYang symbol in Japan appears however to be a modern practice. 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.

The main display table in the Kampo Museum shows the relationship between the Five Chinese elements, the different parts of the body they are related to and the herbs that can be used to treat a range of ailments. Herbal medicines are prescribed in the Kampo Boutique based on the diagnosis of the patient.

The approach to health at Nihondo is based on herbal medicine and the mantra that “Eating = Beauty & Health’. I have had lunch at their 10 Zen restaurant twice, the second time with my sister Ruth in April 2018.  Both meals were delicious. 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’ (Ishoku Dogen).

The Five Elements formed the basis of a range of beauty and health related products sold in the Nihondo Boutique. From left to right the five coloured boxes represent Wood, Fire, Earth, Metal and Water. The five small rings used as a logo reminded me of a plum blossom, the first sign of Spring in Japan.

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. 

Robert Rister is passionate about the herbal remedies used in Kampo, which he refers to as “energy medicine”. He has written at least two books to share the approach with a wider audience, particularly in North America.

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.

These two books go into great detail about Acupuncture in Japan, the vital role of InYo and the Five Elements, and the importance of the palpations of the hara as a diagnostic tool.

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 color, the texture of the skin on the forearm, voice qualities, and the condition of the hara in the process of forming a diagnosis.

Fukushin, or abdominal (hara) diagnosis, is used as a tool for both the the prescription of herbs and the practice of Acupuncture in Kampo.  It is the latter technique that is covered in the books by Matsumoto and Birch. The relationships between the major organs and the five Chinese elements in the hara are shown here. Using the hands to touch the hara (a technique known as palpation) as a form of diagnosis is only used in Japan.

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.

Three of my other books on Kampo vary in their description of InYo (Yin and Yang) and the five elements. The book on the right does not mention them at all, the middle book briefly refers to In and Yoh  but not the five elements, and the book on the left refers to both. This author notes the correspondences between the five elements and the major organs in the body, commenting on their effectiveness in being used as code words for bodily functions. Readers will get a different impression of the importance of InYo and the Five Elements for Kampo depending on the perspectives taken in the book they read.

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 was 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.

2 thoughts on “Kampo, the elements of traditional Japanese medicine

  1. And I am pleased that you managed to fit a return visit to the Kampo complex in Shinagawa into our itinerary! It really is a fascInating place and, if you hadn’t come across it ‘by accident’, this contemporary offering of Kampo in modern Japan may have remained another missing piece of the puzzle for a while longer! I can see that you have read and researched a great deal more in the last few weeks, broadening yours and our understanding of the use of Kampo in the past and present. It’s great that you have been able to find several books on the subject written in English. I found the image used for hara diagnosis particularly interesting.

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    • I was very fortunate to come across the Kampo complex in Shinagawa as it enriched my understanding of the modern practice of traditional Japanese medicine. When I originally visited the Museum it was the first time I had seen the pentagram and the Five Chinese Elements illustrated that way in Japan. As you can imagine that was very exciting! Since then this symbol has revealed itself as part of the practice of fusui, in books written in Japanese. One of the elements of serendipity is that you don’t know what other things you are missing! I hope that through writing these blogs that people will let me know of important places/publications etc. that it would be good to know about. The other place I’ve seen a Kampo shop was in Zentsuji on Shikoku (I could tell it was Kampo because I could read the hiragana!). It looked much more like a traditional pharmacy. It’s likely that a place I stopped near Ontake-san that sold traditional Japanese herbs would also be a Kampo outlet. Now that I have read some of the history and practice of Kampo I will ask my Japanese friends more about it. I agree that the image on the book about Hara diagnosis is striking. It is from a scroll by Yoshio Manaka, depicting Shen Nung, the father of Chinese medicine. Originally I wasn’t sure if I’d find many books on Kampo in English. The fact that I did illustrates the interest in traditional Japanese medicine in the west.

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