The way of thinking of Chinese medicine

 What is a diagnostic system for prescribing Chinese herbs?

 The question for doctors who are about to start Kampo treatment is what kind of clues should be used to prescribe Kampo preparations to actual patients.

 

 The author believes that there are approximately nine areas of clues for prescribing Chinese herbs. The important thing is that it contains almost all the elements needed for the clinical practice of traditional medicine.

 

 The decision to apply or not to a patient can be made by one of the following nine clues, or by making a combined judgment. The author named these systems "Chinese diagnostic system".

"Kanpo Diagnostic System" consists of the following 9 items.

1) Source text = symptom group

2) Abdominal examination findings

3) Qi, blood, water

4) Six illnesses

5) Pulse diagnosis, tongue diagnosis

6) Rule of thumb = Gugyeol

7) Western medical disease name

8) Pharmacology of traditional herbal medicine (Honzogaku)

9) Yin-Yang Five Elements Theory

 According to this, it can be seen that Yoshimasu Todo (1702-1773), who was active in the Edo period, focused on diagnostic systems 1) and 2) for diagnostic treatment. It is clear that many Japanese clinicians today use 1), 2), 3), 4), and 7) as clues. Traditional Chinese medicine people attach great importance to 1), 5), 8) and 9).

 

 The feature of this system is that it is designed so that doctors practicing Western medicine can perform medical treatment based on the idea of ​​Kampo according to the accumulation of Kampo knowledge, consistent with Western medicine.

 

 If you are not confident in Kampo treatment, you should refer to the clinical evidence in 7) to determine what kind of medicine should be applied to the patient in front of you. We will examine the contents of existing research reports and prescribe the Chinese medicine if it is determined to be applicable. If it is determined that there is a lack of reliable data, do not hesitate to choose a Western medical treatment with clear epidemiological data. This is the reality of the Western-Korean integrated prescription.

1) Source text = symptom group

 Every Chinese medicine has a prescription creator (often unknown), and the reason for the idea is specifically stated in the book. Knowing the purpose for which a drug was created is a great clue when administering it.

 

 For example, Daikenchuto is a prescription derived from the Han dynasty's "Kinpo Kyosho" about 1800 years ago, but there are cases where the chest and abdomen are extremely cold and abdominal pain occurs, and food cannot be eaten. The administration target according to specific symptoms is written, such as that Daikenchuto should be used.

 

 In both the West and the East, from ancient times to the present day, therapeutic drugs always have administration conditions and specific medical conditions are set. This can be said to be a common universal condition for therapeutic agents.

 

 The first administration clues are the specific symptoms and symptoms of the drug listed in the source.

2) Abdominal examination findings

 A diagnostic technique called abdominal examination was developed by a Japanese ancestor in the Edo period, who criticized Chinese medicine and was aware of the anatomy of Western medicine that had flowed in at that time. (The ideological criticism of Chinese medicine is described in the history of medicine in the first half of this book.)

 

 Abdominal examination is a diagnostic technique that has never been developed in China, although the hint is given in the ancient Chinese literature called "Difficulty".

 

 It was a technique originally used by acupuncture and moxibustion workers in Japan. It was the most widely practiced Chinese medicine house that used hot water since the Edo period in the 17th century, especially the school that later became known as the Kohō school.

 

For reference, medicine in the Edo period is roughly classified into four academic schools.

The first is a school of the same quality as medicine, which was introduced about 100 years ago in the Edo period and was practiced in mainland China at the same time. This school was later called the posterity school after the establishment of the Kohō school. Although it is old, it is contradictory to call it the posterity, but while the Kohō school constructed the theory based on the text of the Han dynasty (AD 2-3C), China after the Song dynasty (AD 10-12C). By constructing medical logic with the text of.

The second is European medicine brought about by missionaries in the 16th century. It was called Nanban medicine at the beginning of the Edo period, and later called red hair medicine because it flowed in from the Dutch trading house. The impact of Dutch medicine on Kampo medicine has traditionally tended to be underestimated.

The third is Kohō school medicine, which is a medicine that ideologically denies the Yin-Yang wu line theory that underlies Chinese medicine, and has spread rapidly throughout the country since the mid-18th century. They respected the Han dynasty texts "Shanghan Lun" and "Kin 匱 Summary" and developed abdominal examination as an important diagnostic technique.

The fourth was an eclectic school that was an eclectic mix of these.

 Note that, as mentioned in the Kohō school commentary, the diagnostic technique of abdominal symptom was a diagnostic technique for using the prescriptions written in "Shanghan Lun" and "Jingui Yaolü", which were respected by the Kohō school. please. These prescriptions are called Ancient prescription, which was written in Shang han lun and Jin kui yao lue.

 

 Therefore, please note that in principle, it does not apply to the medicines of the later era (called posterity) made after the Han dynasty. In the old days, Daisaikoto, Saikokaryukotsuboi-to, Sho-saiko-to, Saikokeishi-to, Saikokeishi-to, Tokaku-joki-to, Daio-botan-ki-to, Keishibukuryogan, Tokishakuyakusan, Includes famous prescriptions that are frequently used in daily life, such as Ryokei Sokanto and Hachimijiogan.

 

 However, in recent years, there has been a tendency for both ancient and posterity to be confused, and there are some agents such as Yokukansankachimpi, where abdominal examination findings are more important than in the Edo period, even in posterity. .. Please note that the following description is based on that.

Abdominal examination chart

Abdominal examination chart

Judgment of abdominal strength is the most important for abdominal examination

The following items should be considered in the abdominal examination.

1. Abdominal strength

2. Mind itch (or itch)

3. Chest armpit discomfort

4. Blood stasis (Oketsu) tender points

5. Rectus abdominis muscle constriction

6. Supra-umbilicus and sub-umbilicus

7. Stomach shaking sound

8. Navel subumbilical

9. Skin properties

10. Limits of abdominal symptoms

1. Abdominal strength

 Abdominal examination is a diagnostic technique in which the patient is laid on the examination table with his limbs extended and his whole body weakened, and then palpated using the examiner's fingers and palms to obtain the information necessary for Chinese medicine.

 

 The most important information in abdominal examination is abdominal strength.

 

 Abdominal strength is the degree of tension in the abdominal wall at the time of abdominal examination. The most tense abdominal strength that can be experienced is "strong", the least tense abdominal strength is "soft", and it is strong (grade 5), slightly strong (4), moderate (3), and slightly soft (2). , It is practical to classify into five stages of softness (1). If you need a finer nuance, you can say 3-4, or 3+.

 

 It is empirically known that the applicable medicines can be roughly divided into three groups according to the strength of the abdominal strength. Let's list only a part of the specific medicine.

 

 

Figure 1 Relationship between abdominal strength and administered drug (some belong to both)

Degree of abdominal strength

Applicable agent

Strong abdomen

(3, 4, 5 stages)

Most of the preparations containing rhubarb and the preparations containing cold medicines such as Coptis chinensis and Gardenia are included here.

Daisaikoto, Saikokaryukotsuboi-to, Sho-saiko-to, Rhubarb peony-skin-to, Tokaku-joki-to, Keishibukuryogan, etc.

Moderate abdominal strength

(2, 3, 4 stages)

Saikokaryukotsuboi-to, Sho-saiko-to, Saikokeishi-to, Saikokeishi-to, Ginger-to

Keishibukuryogan, Kamiyo Harukasan, Chotosan, Hochuekkito, Juzendaihoto, etc.

Weak abdomen

(1, 2, 3 stages)

Saiko Keishi Inui-to, Hochu-ekki-to, Choto-san, Tokishakuyaku-san,

It is a prescription centered on warm medicines such as Sijunzi-to.

[Reference: Ken Fujihira, "Handbook of Chinese Prescriptions," Linne, 1982]

 

 

 * These three groups are sometimes called "demonstration medicine", "fake medicine", and "fake medicine", but it is a misunderstanding from the original meaning of the truth. So you shouldn't use it. Regarding the definition of falsehood, in this paper, as described in the "question", the state where the evil spirit is active is called the real, and the state where the spirit is lost is called the falsehood. In addition, please note that truth may be synonymous with physical fitness.

 

 * There are also medicines that are widely used regardless of abdominal strength, and there are many medicines such as Anchusan, Shakuyakukanzoto, and Sokei-Katsuto. In addition, experienced doctors treat intractable diseases with very common medicines and skillfully use medicines based on their own experience. In many cases, the abdominal strength is ignored and used.

 

 * Abdominal symptoms are established as a diagnostic system on the premise of long-term administration in chronic diseases, and do not apply to acute phase or short-term application. In the acute phase, the symptoms (called external evidence) and signs that appear on the body surface are the most important.

2. Heartbreak

 The patient's fossa is lightly pressed upward with the fingers aligned, and the resistance felt by the examiner's fingertips is called "ko", and the feeling of squeezing felt by the subject is called "itch". When the ko is positive and the ko is positive, it is called a subhearted ko. In some cases, one of the itch and the ko is positive, and the other is negative.

 

 This finding is closely associated with modern medical upper gastrointestinal and intrathoracic lesions, as evidenced by abdominal examination. It is probably related to heart failure.

 

 If Kou is proved, in Chinese medicine, we will apply 瀉 shinto, thorowax root, ginseng-containing pills, Kibo-mi-to, etc.

3. Chest armpit discomfort

 Chest armpit discomfort refers to abnormal tension in the abdominal wall along the costal arch, and is demonstrated by lightly pressing the abdominal wall along the costal arch with the examiner's fingertips toward the nipple cavity during the abdominal examination. increase. In modern medicine, it is understood to reflect lesions in the thorax and abdominal cavity that sandwich the diaphragm. This finding, called hepatic depression, is said to include changes resulting from inflammatory diseases such as hepatitis and changes resulting from certain pathological changes in the psyche such as depression.

 

 As a Chinese-style coping method, in order to improve hepatic depression, a herbal medicine called Saiko is used in anticipation of the effect of communicating hepatic qi. It is thought that the action of Saiko has anti-inflammatory action and relaxation action of mental tension and improves those conditions.

 

 There is a so-called classic saikokeishito that is prescribed for this purpose. Considering the degree of liver depression and other medical conditions, daisaikoto, saikokaryukotsuboi-to, shosaikoto, and shiba Kokei-to, Saikokeishi-to, etc. are selected. At this time, you can roughly narrow down the possible medicines by focusing on the abdominal strength mentioned above. (→ Abdominal strength and medicine)

4. Blood stasis tender points

 Blood stasis is a term that indicates the presence of medical microcirculatory disorders or unhealthy and inadequately functioning blood, and can be diagnosed through interviews, inspections, and abdominal examinations.

 

 Knowing the blood stasis condition by abdominal examination depends on its peculiar tender point. Typical tender points that suggest the presence of blood stasis include paraumbilical tender points, ileocecal tender points, and sigmoid colon tender points. When an attempt is made to compress with the fingertip, the subject feels tenderness by touching the resistance peculiar to the examiner's finger.

 

 Rhubarb peony bark, Tokakujokito, Keishibukuryogan, Tokishakuyakusan, etc. are the drugs that are administered with the goal of tender points of blood stasis. Will be done. (→ Figure)

 

5. Constriction of the straight abdominal muscle (abdominal skin constriction)

 Strong tension in the rectus abdominis muscle is thought to indicate morbid mental tension. It may be seen with strong abdominal strength, but it is surprisingly common for lean body shapes. In this case, the abdominal wall is often thin, and it is difficult to grasp the abdominal strength itself. At that time, if the angle formed by the costal arch is 90 degrees or less and you are thin, the trick is to keep the abdominal strength at about two-fifths. In other words, it is considered to be more empty.

 

 Tension above the navel is usually observed, but morbidity is when it is tight below the navel. Full-length tension is thought to indicate the presence of pathological mental tension with some debilitation. This is the case for children with strong tantrums, such as when Xiaojianzhong-to is applied.

 

 The usual method for relieving the constriction of the straight abdominal muscle is to relieve it with peony, and Shigyakusan, Xiaojianzhongto, Keishikashakuyakuto, etc. are selected. It is interesting to see that the morbid tension of the rectus abdominis muscle gradually relaxes as the treatment improves the desired symptoms.

..

6. Supra-umbilicus and sub-umbilicus

 Supra-umbilicus is more common than sub-umbilicus.

 

 Umbilical excitement is thought to indicate the presence of a kind of mental excitement, while at the same time showing some kind of debilitating state. There are two ways to deal with cases of umbilical ulcers, one is to select a drug that is dispensed with dragon bones and oysters (Saikokaryukotsuboi-to, Saikokaryukotsuboi-to, and Keishi-karyukotsuboi-to). In some cases, you may choose a water-related drug such as Ryokei Sokanto or Yokukansankachimpi. The latter is derived from the historical interpretation of the navel swelling as "moisture swelling".

7. Stomach shaking sound

It is a symptom that suggests the existence of "drinking" excessive accumulation of fluids and the so-called gastrointestinal weakness.

 

 For patients with shaking noise, it is wise to avoid medicines containing Ephedra, Rehmannia glutinosa, etc., which tend to burden the digestive system, as the first choice.

 

 For cases with a positive gastric shaking sound, Ryokei Sokanto, Bukuryoin, Tokishakuyakusan, etc. are indicated.

 

 Gastric shaking sound is a medical examination method that uses resonance when the abdominal wall is shaken at a unique frequency. Please note that some tips are required and it is easy to get false negatives if you are not used to it. If you are suspicious, such as a young woman, but negative, ask the patient if there is a water noise in her stomach. If there is a reply, the author treats it as a positive finding.

8. Navel subumbilical

 Abdominal findings, also known as subumbilical softness and abdominal insufficiency, are used to diagnose "renal deficiency" by abdominal examination. The abdominal wall in the middle of the navel may be less tense and softer, or the skin in the area may be paralyzed. A significant proportion of older people have these findings.

 

 It may be better to refer to the symptoms when diagnosing renal deficiency for the purpose of actually prescribing medicine. Hachimijiogan and Rokumimaru are typical treatments for renal deficiency. If your limbs get cold during the interview, consider Hachimijiogan. If the patient is old, the former is the first choice, and if the patient is young, the latter is the first choice.

 

 I think there will be more opportunities to use these medicines in a longevity society.

 

9. Skin properties

 From the skin condition observed at the time of abdominal examination, we will grasp the condition in Chinese medicine.

 

 The soft skin, fine texture, and easy sweating are clues for choosing Ogikenchuto or Ogikenchuto.

 

 On the contrary, if the skin is dry and dry, it is necessary to moisturize it with a medicine containing shimotsuto, Rokumi-maru, Hachimijio-maru, etc.

10. Limits of abdominal symptoms

 Abdominal symptoms are one of the traditional "diagnostic systems" of Kampo treatment. Although it is common to other diagnostic systems, all of them are "theories" obtained by inductively empirical facts, so there is little logical consistency in every detail. It is wise to observe the patient's condition from various perspectives and make good use of it.

 

3) Qi, blood, water

 Qi, blood, and water are three hypothetical pathological concepts of traditional medicine, but their quality and judgment of deficiency or excess can be used to help in choosing a treatment method.

 

 If fatigue and weakness are regarded as lack of qi, that is, qi deficiency, the treatment method will be supplemental air, and Hochuekkito will be selected.

 

 Blood is reminiscent of blood circulating in the body. Unhealthy blood such as subcutaneous bleeding and impaired blood flow is treated as blood stasis with a blood stasis agent such as Keishibukuryogan. If the quantity and quality of blood decreases, blood supplements such as Shimotsuto will be applied as blood deficiency.

 

 Water is a general term for body water called "drinking" from ancient times, but if it is present in excess, it may cause edema and palpitation. ..

 

 Qi, blood, and water are regarded as one of the liquid pathological ideas common to many ancient medicines. It is well known that the ancient Greek doctor Hippocrates of Kos (5th century BC) thought that the disease was a disorder of the humor (blood, mucus, yellow bile, black bile).

 

 Empedocles, a philosopher of the same era, is said to have understood nature from the elements of fire, water, wind, and soil (four elements). It's a similar idea.

4) Six illnesses

 The ancestors have noticed that the illness that begins with acute fever progresses with a somewhat common course. Therefore, he classified acute febrile illness into 6 stages according to the degree of progression, and devised a treatment method according to each stage. The treatment principle of "Kankanron" was established in this way.

 

 The sun disease, Shoyobyo, Yomeibyo, Shoinbyo, Taiinbyo, and Kechinbyo are the diseases. There are 6 stages. This is called the six illnesses. Knowing where the patient in front of you is in the six illnesses can help you solve the problem.

 

5) Pulse diagnosis, tongue diagnosis

 The findings of pulse diagnosis and tongue diagnosis were important biometric information in Kampo medicine where clinical examination was not developed. In other words, it is equivalent to a physiological test or a physical test in Western medicine. Among them, pulse diagnosis was an excellent index to know the general condition.

 

 Pulse diagnosis was once an important diagnostic technique not only in Chinese medicine but also in Western medicine. With the development of sample testing and diagnostic imaging using equipment, the importance of pulse diagnosis in Western medicine seems to have diminished. It has historically been emphasized that Western medicine diagnostic textbooks for modern medical students state that pulse is important not only for diagnosing cardiovascular disease but also as an indicator of general condition. It's a sickness.

 

 In Chinese medicine, it is important to judge the improvement and exacerbation of acute illness by pulse diagnosis. Pulse diagnosis in chronic diseases is mainly used as a reference for constitutional diagnosis.

 

 Tongue examination also presents unique findings in both acute and chronic illnesses.

 

6) Rule of thumb = Gugyeol

 Our ancestors left behind a number of sayings that could be called the secrets of treatment in short words. This is called a gugyeol, and it is probable that he did not say anything other than the school's family. In posterity, a collection of written words began to appear. A typical example is Sohaku Asada (1815-1894)'s "French Chamber Gugyeol".

 

 To give an example, Sohaku Asada accurately describes Hochuekkito as "adapting to the emptiness of Shosaikoto." It is also famous that Yokukansan (1739-1798) points out that yokukansan is effective if there is "existence of anger".

7) Western medical disease name

 A study by the performers from 2001 to 2005 revealed that Kampo medicine has a lot of credible clinical evidence, even by the criteria of Western medicine. *)

 

 It can be said that the rationale for prescribing some Chinese herbal medicines has been clarified based on the name of the Western medical diagnosis disease. It will be possible for the therapist to decide to some extent whether to treat the patient in front of him with Kampo treatment, Western medical treatment, or a combination of both, and the first step toward true Western-Chinese integrative medicine has been taken. I did.

 

 *) Evidence Report of Kampo Treatment, Japan Society for Oriental Medicine Vol. 56 Suppl., 2005

 

8) Pharmacology of traditional herbal medicine (Honzogaku)

 The oldest drug science book in Kampo medicine is "Shennong Ben Cao Jing", which seems to have been established around the Eastern Han (AD2). Here, 357 kinds of crude drugs are listed along with their medicinal properties. The properties of crude drugs such as warming, cooling, supplementing, and lagooning are traditional medical effects called the medicinal properties of crude drugs that are directly linked to treatment.

 

 Traditional herbal pharmacology, which is completely different from pharmacology in Western pharmacy, is also a system that can estimate drug efficacy at the level of the five human officials.

 

 Historically, many of the therapeutic drugs in Western medicine have owed much to the herbal medicine itself or an extract of the herbal medicine. It is a well-known fact that aspirin and digitalis are of plant origin.

9) Yin-Yang Five Elements Theory

 The last of the diagnostic system is the Yin-Yang Five Elements theory. The Yin-Yang Five Elements Theory is said to have been created by fusing the Yin-Yang Theory (Yin-Yang Theory) and the Five Elements Theory (Theory) in BC. These were originally theories for understanding and predicting natural phenomena such as climate change and volcanic activity. Later, the idea of ​​"heavenly union" was born, and after it was said that heaven and humans were based on the same principle, it was applied to the physiology of the human body and understanding of diseases. (This overlaps with the perception of modern Europe that humans are microcosmos)

 

 For example, the yang is the heaven and the yin is the earth, so "water, rain, steam, clouds" move back and forth between them, so the heavens and the earth, that is, the yin and yang, are connected to each other. The five elements (wood, fire, earth, gold and water) born from yin and yang are the everyday five materials, and because of the relationship between the burning of wood and the fire, the liver and gall bladder diseases that represent wood immediately become the heart and small intestine that represent fire. Causes the disease. In other words, it is rooted here that you can see the liver disease and cure it while the heart disease is not sick.

 

 Now let's get into a little more detailed explanation.

 

 The Yin-Yang Five Elements theory and the way of thinking based on it often appear in the traditional studies of the Orient. Many people will be fascinated by the Yin-Yang dualism and the oriental way of thinking that tries to understand the nature and the human body in the circulation and transition of the five primitive elements of the natural world: wood, fire, earth, gold, and water. However, it is also an area that is difficult to handle scientifically.

a. Yin and yang

 A long time ago, when the heavens and the earth of this world were still undivided, the yang and yin, which are said to have arisen from the rush of chaos, subsequently established themselves as a symbol of dualism. In the beginning, the yang qi first went up and became heaven, and the heavy and muddy yin qi went down and became a solidified ground.

 

 And yin and yang were represented by two contradictory elements: heat and cold, heat and cold, day and night, light and dark, men and women, and sun and moon. However, since yin and yang are originally the same, there is an intimate exchange between them, and they mix with each other. It is the same as rain nurturing the life of all things while going back and forth between the heavens and the earth.

 

 The ancestors, who realized that the human body had something in common with the natural phenomena of the universe, tried to find a life phenomenon in the phase of interaction between the positive and the negative inherent in the human body.

 

 In traditional medicine, it may be understood that the yang is heat and the yin is cold, the yang is qi and the yin means body fluid, and the yang is a parenchymal organ and the yin is a hollow organ.

b. Five lines = Thursday, Tuesday, Saturday, Friday, Wednesday

 For ancient people, the natural world was an awe-inspiring object of fear and grace. A series of natural phenomena exceeded people's expectations and sometimes caused immense disasters. People must have somehow found a law in nature, anticipating what was to come, and hopefully avoiding it.

 

 In this way, people come up with the idea that five substances existing in nature change each other and create one model system from the fact that they interact with each other, and inferring by analogy with it can explain the successful experience accumulated so far. I did. That is the five-element theory.

c. Aioi

 Wood, fire, earth, gold and water are the five elemental substances. First, when the wood is rubbed together, it creates a fire, and when the wood is burned, the flame burns vigorously. In other words, wood will produce fire.

 

 The fire burns vigorously, but gradually declines to form ash. Since ash is soil, fire produces soil.

 

 Most of the minerals and metals are in the soil, so it can be said that Toke produces gold.

 

 The relationship between gold and water is a little difficult to understand, but it seems that gold produces water because shiny metal produces water droplets due to humidity and easily rusts when water is obtained.

 

 Finally, it is clear that water grows trees, so it was said that water would produce trees. This is the cycle that is generated, which is called the relationship of Aioi.

 

d. Sokoku

 Next, let's try a combination with one space between them.

 

 Trees grow by depriving the soil of nutrients, so the wood has a negative effect on the soil. This is called a mutual relationship.

 

 Similarly, the soil dams up the water, so the soil is moist.

 

 AlsoWater extinguishes the fire, so water is a fire.

 

 Fire melts metal, so fire is gold.

 

 Since metal becomes a knife and is used to cut down and process wood, Kinki is a woodki.

 

 The cycle established in this way is called a mutual relationship.

e. Five Pillars of Islam and Five Pillars of Islam

 This circulation and interrelationship of the five elements was applied mutatis mutandis to the understanding of the structure of the human body and diseases. In other words, wood, fire, soil, gold, and water are distributed to the liver, heart, spleen, lungs, kidneys, and the gallbladder, small intestine, stomach, large intestine, and bladder San Jiao. A cure was sought. Please note that the traditional medicine Zang-fu is a kind of virtual internal organ system and does not match today's anatomical organs.

 

 It is a hypothesis that it is too bold to say that what is happening between the five elements also applies to the five viscera and six halves, but the therapeutic experience of the ancestors accumulated over decades is 2000 according to the five elements theory. The historical fact that it was systematized and unfolded during the year needs to be faced. It should contain many facts to capture and many possibilities that may develop in the future.

 

 Historically, there have been multiple arrangements of the five elements of the Five Elements theory, and it is inferred that there was a long process of controversy over which one was valid in the light of past experience. In other words, in "Shunjui Genmeiho" (one volume called Genmeiho in Shunjui, a prophecy about spring and autumn that happened in the Han dynasty), the five lines are Assuming that it starts with water, "Shosho Kohanhen" also has five lines that start with water, and in "Kanjo Ritsurekishi", it is called Mizuki, Thu, Fri, and Sat. Also, in "Roshi Shunju", the five lines are preached in the order of civil engineering, gold, fire, and water.

 

 What is being done today is the order of wood, fire, earth, gold and water, as described in "Huangdi Neijing Question". The strengths and weaknesses of a very human-like philosophical theory, in which the theory of five elements is not absolute and the urgent desire to find the law in the harsh nature that flows and does not stop, has come to fruition. prize.

f. Five elements theory and clinical

 From experience, the five elements theory gives us various useful clues, so let me introduce a few of them.

 

 The five organs are closely related to a specific body part and provide an opportunity to select a therapeutic drug for the disease that occurred there. (1) The liver is said to be closely related to the eye, and yokukansan, which treats ataxia in the liver, is indicated for eye diseases. It is written in the name of the person such as Senkoku Meimeto.

 

 The heart is associated with the tongue, and Hangeshashinto, which aims to cool the heart fire, may be used to treat recurrent aftertaste of the tongue.

  The kidney is said to be closely related to ear function. Therefore, Hachimijiogan may be effective for hearing loss and tinnitus associated with decreased renal function of the five organs. (2) Since the five viscera that are adjacent to each other are influenced by each other, strengthening the mother may be a hint for treatment, especially between mothers and children who have a symbiotic relationship.

 

 One example is the treatment of cataract, which is an eye disease, with Hachimijiogan, a renal supplement.

Transition of Chinese medicine diagnostic system

1. Medicine and medical care in the Edo period

 The medicine practiced in the early Edo period was established by Tashiro Sanki at the end of the 15th century, when he introduced the continental medicine. Therefore, it focuses on diagnostic systems 1 (classical description), 5 (pulse diagnosis, tongue diagnosis), 8 (honzogaku knowledge), 9 (yin-yang wu theory), etc.

 

 In 1609, the emerging European country of the Netherlands set up a factory in Hirado. The resident doctor of the Dutch trading house brought European medicine of the same era, and people welcomed it. In 1637, before the Shimabara Rebellion, it is recorded in the diary of the director of the factory that Nagasaki Daikan Suetsugu Heizo was the doctor in charge of the factory. According to the diary, it can be seen that patients in various positions, from high-ranking shogunate officials to monks, are receiving medical treatment.

 

 The reason why Dr. Shokan was welcomed was that medical information from overseas was medical by medical experts, compared to the convenient nature of the means of Christian missions such as missionaries. Furthermore, it is not the old European medicine called Nanban medicine by the predecessor Portugal and Ispania, but the new era of medicine based on the anatomy of Vesalius and so on.

2. The impact of Dutch medicine on Kampo medicine

 Not only high-ranking shogunate officials welcomed Dutch medicine. In the middle of the 17th century, 50 years after the inauguration of the Shogunate, a medical school called "Red Hair Surgery" was born who had already learned Dutch medicine from a factory doctor and practiced medical practice in the city. There was also a doctor who changed the signboard from the previous Nanban medicine to the red hair style.

 

 Goto Konzan (1659-1733) is one of the most renowned Chinese medicine doctors who has shown a keen interest in the anatomy of Dutch medicine. According to the preface to "Kurashi" by Toyo Yamawaki (1706-1762), Gonzan exudes a strong academic passion for anatomy to the Orient. They have to assume a fictitious cause because the traditional five viscera and six halves do not reflect the true structure of the human body, and the future development of Japanese medicine is difficult without understanding the anatomy. I realized that the point was the biggest weakness of Chinese medicine derived from ancient China.

 

 Yamawaki Toyo was a high-ranking old-fashioned doctor named Houmei, but as promised by Gonzan, he carried out the first publicly licensed anatomy in Japan in 1754, and his achievements that should be noted in the history of medicine in Japan. I left.

 

 It is speculated that the anatomical emphasis of the two Gonzan and Oriental Chinese practitioners was a common concern of many contemporary Chinese practitioners.

3. Chinese medicine envisioned by Todo Yoshimasu

 Yoshimasu Todo (1702-1773) was a doctor who was found in Yamawaki Toyo and came out into the world. He is the person who established the basic medical practice style of Kampo medicine in Japan, which emphasizes the description and abdominal examination of two medical books, "Shanghan Lun" and "Kimpo Summary".

 

 If you try to verify the medical theory advocated by Todo with a diagnostic system, there are two, 1 (classical description) and 2 (abdominal examination). 3 (Qi-Blood Water), 4 (Six Diseases), 5 (Pulse Diagnosis / Tongue Diagnosis) are all discarded. It should be noted that it does not adopt 8 (Honzogaku) ​​and 9 (Yin-Yang Five Elements theory), which were the core of ancient Chinese medicine. These are clearly stated in "Medical Decision" by the disciple Tsurumoto Itsu, which can be said to be a challenge to existing medicine in Dongdong.

 

 How did you come up with such an extreme medical theory? The author speculates that the answer is that Toyo Yamawaki, who sent Todo to the world, emphasized anatomy and agreed with Toyo himself. This is because no material has been found to show it until now, so I have no choice but to speculate, but the Chinese medicine that Dongdong envisioned contains all the elements that could be denied by the anatomy of Dutch medicine. The first reason is that there is no such thing. In other words, the work done by Dongdong was to balance Dutch medicine, which was becoming popular at that time, with Kampo medicine in Japan. Since the Yin-Yang Five Elements theory is directly linked to the Five Viscera and Six 腑 theory, it had to be denied and abandoned in the first place.

 

 One of the most interesting medical theories in Dongdong is the "Everything Poisonous Theory". From the standpoint of Todo, who believes only in what can be seen and grasped, the poisonous theory seems to be very different. But the reason for this can be understood by considering why Gonzan and Toyo were keenly aware of the need for anatomy. Already at that time, where and how the disease was sick was of great concern not only to doctors but also to patients. It was a great attraction that the red-haired surgeon gained the support of people, even if it was rudimentary, that he could explain the cause and the existence of the disease with his knowledge of anatomy. Both Gonzan and the Orient wanted to know the cause of the illness. Todo tried to put an end to the cause controversy and make the need for anatomy meaningless by claiming that the "one poison" that was supposed to exist in the abdomen was the cause of all illnesses.

4. The spread and rise of Western medicine

 The year after the death of Todo, in 1774, "Kaitai Shinsho" by Genpaku Sugita and Ryotaku Maeno was published, and a new era began in the history of medicine in Japan. It can be said that the period of about 100 years until the Meiji era was a time when Dutch medicine (hereinafter referred to as Western medicine) gradually gained momentum, although there were some fluctuations.

 

 What impressed people with the strengths of Western medicine was the success of vaccination, the epidemic of cholera and other epidemics, and the remarkable performance of surgeons on the battlefield.

 

 Smallpox has been a disease that has plagued humankind since ancient times. In 18th century Europe, Jenner informed the medical community that cowpox can prevent smallpox. When the cowpox method began in Japan in 1849, it spread rapidly. The benefits of Western medicine left a strong impression on the general public, who knew that smallpox could actually be overcome.

 

 At the end of the Tokugawa shogunate, epidemics often spread at ports where foreign ships entered. The cholera epidemic that began in Nagasaki in 1858 is well known. Cholera spread to Osaka and Tokyo a month or two later, scaring people. It is said that 30,000 people died in Edo alone. Kampo medicine, which was good at treating individual patients, was powerless against these epidemics because it did not have a public health perspective. People were hoping for the sedation of the epidemic by Western medicine, even with the treatment of blocking people's movements, isolating patients, and spraying lime.

 

 At that time, armed conflicts broke out here and there over whether the country was opened or not. Many people were injured by gunshot wounds and bombs, and the demand for surgery surged. It was clear to everyone that anatomy-based Western medicine was superior in surgery.

 

 In 1857, at the invitation of the Shogunate, the Dutch Navy Surgeon Pompe was assigned to the Nagasaki Naval Training Center to educate many human resources, including Taizen Sato, who later attracted the medical community in Japan. Willis, an English doctor who came to Japan in 1861, worked hard to treat the injured in the Boshin War.

 

 In Keio 4 (1868), before it was changed to the Meiji era, it was decided by the government and military side such as Satsumacho that Western medicine should be used as Japanese medicine instead of Kampo medicine promoted by the Tokugawa family in the coming era. It is said that it was.

5. Promulgation of medical system and Kampo survival movement

 In 1874, the Meiji government established a medical system that is the basis of medical administration, and it was implemented on a trial basis in Tokyo, Kyoto, and Osaka prefectures and spread throughout the country. The medical system consisted of 76 articles, including the establishment of a sanitary administration system, medical education based on Western medicine, a doctor's practice license system, a modern drugstore system, and a pharmaceutical division of labor system. For the first time, it was stipulated what kind of academic skills doctors should have, and the experience of seeing the systems of Western countries with Tomomi Iwakura as the plenipotentiary ambassador was utilized here.

 

 Since the medical education shown in the medical system was only Western medicine, and Kampo medicine was not the target, the Kampo doctors formed Onchisha and developed a nationwide movement to continue Kampo medicine. The center of the movement was Shirohiro Yamada, Sohaku Asada, Tatsuyuki Mori, and others, who were based on the Edo Medical School, a medical school maintained by the Tokugawa Shogunate. However, Sohaku Asada died in 1894, and the bill to revise the doctor's license rules submitted by Kampo doctors was rejected by 78 votes out of 183 votes and 105 votes to reject it at the 8th Congress the following year. Then, the Kampo reconstruction movement came to an end here.

6. Revived East Cave's medical theory, its new role

 Even after Kampo medicine was no longer recognized as official medicine, the government did not prohibit doctors from practicing Kampo medicine at their own discretion. Therefore, among those who learned Western medicine and became doctors after the promulgation of the medical system, some doctors practiced Kampo medicine.

 

 Already at the end of the Tokugawa shogunate, a composition was born in which Western medicine supporters and Kampo medicine supporters were in conflict with each other. The confrontation became decisive with the enforcement of the Meiji government's medical system, creating an atmosphere that still remains, with Western medicine despising Chinese medicine and Chinese medicine having a strong hostility toward Western medicine.

 

 Keijuro Wada (1872-1916) studied Western medicine under the new system of the Meiji government and became a doctor. I appealed to the world's intellectuals that a certain Chinese medicine should not be destroyed. The Chinese medicine he insisted was the ancient medicine advocated by Yoshimasu Todo in the 18th century during the Edo period. In other words, the emphasis is on the two classics of "Shanghan Lun" and "Kinpou Koujou", and the medical treatment technology developed in Japan during the Edo period, called abdominal examination, is pushed to the fore.

 

 For Kampo doctors who learned Western medicine and became doctors, the medical theory of Dongdong was easy to accept because there were few inconsistencies with Western medicine. The number of people who understand it has increased. Yumoto Koma (1876-1941) was inspired by Wada's claim and awakened to Kampo, and is a representative person who played a major role in the spread of Kampo medicine in the Taisho and early Showa periods.

 

 There are two reasons why the medical theory of Todo Yoshimasu became popular. First, because Dongdong dismissed the Yin-Yang Five Elements theory and the idea of ​​five viscera and six palpations, it was easy for Western medicine doctors to understand, and it was easy to apply their own knowledge of Western medicine pathology and bacteriology as a cause. Secondly, diagnostic techniques centered on abdominal examinations were easy for ordinary doctors, and palpation of the abdomen was a daily medical practice technique that was easy to incorporate. Zang-fu is a functional system that is virtualized in the body for the purpose of knowing the cause of the disease, so it was a troublesome subject that was difficult for doctors who know the actual anatomy to understand.

7. Insurance medical treatment and Chinese medicine treatment

 The health insurance system is a medical system that Japan is proud of in the world. The so-called universal health insurance system, which allows all citizens to enjoy the benefits of medical care at a low cost, was realized in 1961, but from the beginning it was included in the list of medicines covered by crude drugs. It was possible to have medical treatment in Chinese medicine with insurance. This can be understood as a manifestation of the fact that the Japanese government envisioned Kampo medicine as well as Western medicine as a therapeutic medicine for the people.

 

 When 42 Chinese herbal extract preparations were listed in the NHI price standard in 1976, Chinese herbal medicine spread rapidly. In addition, many clinical studies have been conducted by Western medicine experts, and clinical data have been accumulated for about 30 years to date. It is said that this formed the evidence for prescribing Chinese medicine preparations based on the diagnostic disease name of Western medicine in Diagnostic System 7, and played a major role in establishing EBM (evidence-based medicine) for Chinese medicine treatment. Not even.

 

 This is a characteristic of Kampo medicine in Japan that is not found in other East Asian countries, and is directly related to the single doctor license system. Japan has the potential for the fusion and development of Western medicine and traditional medicine at a high level.

8. University education and Chinese medicine

 In 2001, medical students were required to learn about Japanese and Chinese medicine. The background to this is that more than 70% of clinicians are using Chinese medicine, and the public is becoming more interested in Chinese medicine.

 

 Japanese and Chinese herbal medicine is a combination of herbal medicine called Japanese herbal medicine, which has been used as a folk medicine in Japan for a long time, such as Geranium thunbergii, and herbal medicine used for traditional Chinese medicine treatment. It goes without saying that knowledge of Japanese and Chinese medicine is not limited to knowledge of medicine, but also arouses interest in traditional medicine itself and requires knowledge. Thinking in this way, we can see that the historic shift in medical policy since the Meiji era has taken place. Similar curriculum revisions have been made in pharmacy education, laying the groundwork for further utilization of traditional medicine.