University of Munich, Dept. of Internal Medicine, Research Unit for Japanese Phytotherapy
Integration of Japanese Phytotherapy (Kampō) into modern Medicine
Remedies origination in the herbal sphere may still play an important role in future therapeutics, and this despite an apparent predominance of synthetic drugs in modern pharmacotherapy. Two factors account for this. First, in recent years a renewed interest has emerged to subject plants to a scientific evaluation in regard of their chemical ingredients. Obviously it is assumed that some plants may promise therapeutic potentials that have remained unknown so far. Second, plants have played an essential role in the medical systems of all cultures of the world since ancient times. The therapeutic efficacy of such medical plants has been established empirically, and it is to be asked whether an approach exists to evaluate such efficacy scientifically. One of the issues involved here touches on the question how empirically effective methods that have originated in a traditional therapeutic context, and that are closely tried to culture-specific notions of diagnosis and illness, can be integrated into cosmopolitan, i.e. modern scientific medicine. In Japan, Kampō therapy (lit. 'method from Han-period China'), defined by the administration of crude drug formulae mainly of plant origin on a rather pragmatic clinical basis, hat been the established medicine for centuries until it was replace by Western medicine towards the end of the 19th century. Recent decades saw a revival of Kampō which took place within a context completely dominated by Western medicine. The majority of Kampō specialists consider integration into modern medicine as the only way to preserve its role within the modern health care system. Main indications today are disease patterns caused by modern industrial society, such as chronic and degenerative diseases, functional and psychosomatic disorders and the multiple diseases of the elderly. The gradual integration of Kampō into modern medicine has already caused significant changes within the traditional therapeutic approach which are characterized by the following main features:
- In contrast to other Asian countries, in Japan only examined physicians are allowed to prescribe traditional medication. In most cases Kampō drugs are applied in addition to a modern medical regimen.
- Practitioners who during the early years of Kampō revival created the image of Kampō as an alternative treatment and claimed equal recognition with modern medicine have become a minority. Modern specialists regard Kampō as an additional therapeutic option to enhance the quality of modern health care in defined areas.
- Recent textbooks reveal the trend to standardize traditional diagnostic procedures, to modernize the Kampō terminology and to clearly determine indications, benefits, and risks from the viewpoint of Western medicine.
- For the past forty years, extensive research has been conducted in Japan both to identify the chemical structure of herbal drugs and the pharmacology of active ingredients of complex prescriptions, and to elucidate the dynamics of traditional therapies in general. Research interests include quality control of herbal preparations, standardizing of active ingredients within crude extracts and toxicity control. These efforts let to an acknowledgement by the Japanese National Health Insurance, covering Kampō-prescriptions since 1976. The initial pharmacological research has increasingly been followed up by clinical trials conducted in research centers of Kampō medicine as well as in university hospitals, applying established methodology of clinical research.
Integration into modern medicine is a precondition for the internationalization of Kampō therapy. Traditional experience gives valuable hints for the possible medical significance of a herbal prescription, but it cannot replace scientific evaluation and proof of efficacy. Respecting tradition means to raise the quality of herbal preparations and the level of scientific evaluation of medicinal plants with the aim that this form of therapy may preserve ist place in modern medicine and may survive economically and scientifically in times of growing competition.