OTHER ARTICLE

AMDA accepts healers of traditional medicine as members. This provides chances for cooperation among modern medicine and alternative medicine and also facing the challenges that goes with it. It is not an easy task as based on the author's personal experience in traditional medicines in China, Thailand and India. AMDA should ponder realistic ways for constructive communication among members from different backgrounds.

At present, herbal medicine is practiced to a considerabie degree within framework of modern medicine in Japan. To the author's knowiedge, Japan is the only country where traditional medicines are being used in harmonywithmodernmedicine. Scientific research is also being carried out intensively. The situation is so unique that it needs a comprehensive explanation to be understood by foreigners.

It is a fact, that there are only few other nations where traditional medicine coexists with modem medicine. There are however, traditional remedies which are separated from modern and practiced mainly by the traditional healers who are not medical doctors of modem medicine. In China or India for example, their own traditional medicines are highly protected. There exists two separate medical systems (schools, Ikenses, clinics, etc.) = one for traditional medicine and another for modern medicine.

In general, traditional doctors use solely traditional methods, while modern doctors apply modern therapies independently. As both sides compete for patients, there seems to be more confrontations than cooperation between the two parties. The totally different mode of theory on which both medicines abide hinders mutual understanding. Graduates from traditionai medicai schods usuaily have a disadvantage due to the lack of education in the scientific objectivity. Such factas sometimes even lead to apparent mutual condemnations.

Japan is an exception. There are modern doctors and pharmacists with scientific background who practice Japanese herbal medicine called Kampo. Thus Kampo is fully exposed to modern science and less disturbed by vain socio-political conflicts as seen in some other countries.

To understand how and why this condition has emerged, it is best to look back on the history. The Chinese medicine was introduced into Japan around the 7th to 8th century; the original meaning of Kampo is 'Chinese Method'. Since then, this Kampo medicine had been the nationally authorized medical system until it was replaced by the Western Medicine.

In late 19th century, the hen Meiji government decided to adopt German medicine and abandoned the Japanese traditional medicine. This transformation was an integral part of the camprehensive policy for westernization or modernization, under the slogan of "Fukoku-Kyohei" (enrich country and strengthen army), and was fulfilled completely. Kampo declined literally to the edge of extinction. A small number af traditionai practitioners and a few medical doctors who noticed its significance hardly succeeded in keeping this tradition and because of the profound inherited popularity of Kampo among common people this was made possible. Though in the mainstream of medicine, Kampo had been totally looked down and neglected since then.

Then came the trend in reappreciation of Kampo after World War II, as some weak points of modern medicine began to realized; such as hazardous side effects and relative lack of potency for chronic aging - related diseases. The Japan Society for Oriental Medicine was established in 1950, and a modern research institute of oriental medicine was opened in 1972. The most important event for adoption in the governmental health insurance system. In 1976, several kinds of Kampo extract prescriptions were admitted to be covered by the government insurance. Only processed powder form of herbal drugs under strict quality control was approved.

The newly developed technology of processing at several leading companies made the quality control possible and compliance of intake by patients became higher. The strict orthodox pharmacdogic assessments required for any other newly adopted modern drug, however, saved on the special allowance that the long history of clinical use itself was equivalent to such assessments.
This decision owed much to the enthusiasm of Dr. Takemi, the then president of the Japan Doctors' Society. Actually it is not a great proportion of medical doctors who realized the significance of Kampo at that time, though an established trend toward reappreciation was already seen. Thus this turning-point was set, in a sense, that by chance they have this politically powerful president who happened to befamiliarwith Kampo.

As processed drugs of kampo were made readily available for any doctor with the rationally economical arrangement, more doctors began to try herbs; first by chance, at patient's request, stimulated by a colleague doctor, suggested by advertisements of Kampo pharmaceutic companies and so on. Through such direct opportunities to experience efficacy of Kampo, more doctors began to appreciate it for themselves.

A survey (1) shows the dramatic increase in ratio of medical doctors who use herbs. The percentage of medical doctors who answered to have had an experience in prescribing Kampo increased from 19.2% in 1976 to 78.9% in 1991, and that of those who use Kampo constantly from 28.0% in 1979 to 69.0% in 1991. The doctors member of the Sodety for Oriental medicine have increased dramatically, especially since the start of the Kampo specialist registration system = 700 in 1979, 1.800 in 1989, to 8.000 in 1991. (2)
In the business scene, the market of Kampo medidne has expanded from 29 bill ion in 1979 to 165 billion Japanese yen in 1990.

The unique situation of practice of herbal medicine in Japan as described, however, also has negative aspects.
First, most medical doctors have little knowledge of the original Kampo Theory, and second, the kinds of herbal prescriptions admitted under the insurance system are of processed powder form only, and limited in number (about 150 kinds).

Originally, Kampo was practiced according to the traditional Sho diagnosis, putting emphasis on the symptomatic pictures and physical constitution. This diagnostic system is different from the modern concept of disease classification. All the original guidelines for kampo application are described with Shodiagnosis. Kampo medicine is not taught at medical schools.

Thus, doctors who get interested in Kampo must study it for themselves after graduation. A survey in 1988 by the Society for Oriental medicine (3) shows, among Kampopractising doctors, 32% studied Kampo through textbooks, 19% through pamphlets of Kampo pharmaceutic companies, and only 17% under Kampo specblists. It is apparent very few has a chance to get comprehensive information of the Kampo theoretical system. Nowadays there are even few doctors who prescribe Kampo almost purely through the western medlcal knowledge, as several guidelines designed easily usable by ordinary modern doctors were published. The last type approach prompts aitidsm from more tradition-oriented specialist and might really lead to a wrong superficial application of kampo.

Processed powder drugs, each of which contains 5 to 15 kinds of herbs, have a fixed combination of herbs, and do not allow traditionally recommended precise adjustment according to each patient's specHic constitution.

In parallel to the increase in clinical use, more and more scientific basic and clinical research began to be performed, which proved significant effectiveness in various conditions. Widely recognized fields for kampo at present are allergy, liver dysfunction, autonomic nerve dysfunction, certain skin diseases, infertility, auto-immune diseases, emaciated states due to various causes and so on. Nationwide double blind trials are planned to be held by the Ministry of Health soon. This project will be the first systematic assessment of herbal medicine in the world history.

Interestingly enough, several types of effect, which appear in mild and selfrecovery like manners, look unknown to modern medicine. For example, immuno enhancement, normalization of malignant cells, and boosting physiological body function are suspected in several scientific studies.

As each herbal prescription contains numerous number of components and is claimed to exert synergetic effects, it is difficult to apply orthodox pharmacological research methodology. whether the efficacy comes truly from such a combination of various components or from a certain number d main ingredients compatible to the orthodox modern pharmacological hypothesis is yet to be darified but suggests a very interesting theme.

Revival of herbs itself is actually not incompatible with modern medicine at all. In fact, the history reveals modern pharmacological development started with extraction of active components from herbal drugs. For example, ephedrine was isolated from epherae harba in 1885, and became synthesized in 1927 and then introduced to modern medicine. Nonetheless, this original herb is used not only for a restricted kinds of condition as ephedrine but is known to retain a broader range of efficacy.

Is there a definite advantage to use a crude material ? Does such a synergetic effect really exist or is everything understood in reductive manners eventually ? Since Kampo is proven to be more effective than available modern drugs in certain clinical conditions, the above questions will never fail to be a target of intensive scientific research.

If efficacy and safety are proven through Japan's clinical experience, other countries may become positive to introduce Kampo. Other traditional medicines, most of which are under hardship, just as Kampo was in the Meiji era or even before 1976, may be stimulated by the Kampo's success.
The resurgence of Kampo in Japan is by no means a mere revival of traditional medicine but a new frontier for modern medical development.

REFERENCES :
(1) NIKKEI MEDICAL, PAGES 31-34, 10, 1989
(2) TOYO IGAKUKAI SHINBUN, 1991
(3) NIPPON TOYO IGAKU.ZASSHI, PAGES 47-73, 38