Evidence‐Based Reconstruction of Kampo Medicine: Part II—The Concept of Sho

In this lecture, I would like to focus on and discuss what I think is the central concept of Kampo: the concept of Sho. It can be roughly translated into English as, for example, symptoms, signs or evidence, and I shall try to explain (though not define) it in more detail in the second section of this article. There are several reasons why I try to represent Kampo practice as based centrally on Sho, besides the fact that I believe it is really part of the essence of Kampo. First, many Western scientists and physicians are put off from the start if they are told that it is impossible for them to understand traditional Chinese medicine (TCM) or Kampo without grasping the full complexities of its basic concepts such as Ying-Yang, five elements, five organs, Qi, etc. If Western scientists and physicians are told that the TCM paradigm is so different from modern Western medicine that they should first switch the paradigm itself, they will be hopeless when they try to come to terms with any specific Kampo or TCM remedies. In some sense this is true and it is very risky for Western physicians to pick up any Kampo or TCM formulae outside the context of Kampo's cognitive paradigm. However, since saying that the paradigm should come first may only result in shutting the door against those who genuinely wish to enter the rich field of TCM or Kampo, I would think that it is more productive to first focus on what I think is the central medical concept of Kampo without going any deeper into its paradigm, philosophical foundations or the system itself. Secondly, I have to emphasize that TCM and Kampo are not monolithic ideological systems. They are broad systems of medical practice and thinking evolved over thousands of years. Therefore, the systems themselves have a rather wide variation. There have been many schools in TCM and Kampo and disputes among them are the rule, rather than the exception. Basic concepts like Yin-You (Ying-Yang in Chinese) or Ki (Qi in Chinese) have been held invariantly among different schools, but slightly different interpretations are common, even for such central concepts as Ying-Yang, and no less common are different emphases on more peripheral concepts. In the first article of this lecture series (1), I pointed out that Kampo could be seen as a simplified or practical version of TCM. Stated differently, Kampo is a sort of school or an important variant of TCM. In that article I stated that modern Kampo in Japan can be traced back to the 18th century Renaissance (or restoration) movement of the Koho (old formula) school of, for example, Yamawaki and Yoshimasu. Western readers may be astonished to know that Yoshimasu went so far as to suggest the irrelevance of the very concept of Ying-Yang, emphasizing, in effect, that anything should go as long as it is effective, regardless of philosophy. Though I should hastily add that such attitudes did not become orthodox in Japan, it cannot be denied that Kampo is less rigorous about its philosophical or ideological basis than the orthodox TCM. Thus, if I were asked by outsiders what the central concept held as consensus among Kampo practitioners in Japan is, I would say that it is Sho. Thirdly, it is very interesting to highlight the concept of Sho in this journal, Evidence-based CAM, because the Chinese character representing Sho can be translated in English to mean evidence. Also of interest is that the same word may have been differently represented in ancient Chinese character, the meaning of which in turn could be translated in English to mean symptom. Thus, the term Sho bears very interesting medical implications, unlike Ying-Yang or Qi, which would be of interest to any Western scientist or physician who wished to acquire medical knowledge about Kampo or TCM. Finally, there is a very practical reason peculiar to the Japanese situation surrounding Kampo. This is related to the government's policy on prescriptive drugs. In Japan, it is not possible for a physician to use TCM's three elements/eight categories interpretations in order for his/her Kampo formulae to be covered by the National Health Insurance System (NHIS). Thus, a Kampo formula, if it is to be covered by the NHIS, must be prescribed for disease entities expressed in terms of modern Western medicine, such as gastritis or atopic eczema. For rigorous practitioners of TCM this would be a great insult, as their diagnostic interpretations are not recognized as official or scientific categories of diseases. Thus, nowadays it has become more common for Japanese medical doctors to prescribe Kampo formula just by saying that the patient now has a condition which requires such formula. Though it has long been legitimate in Kampo to prescribe a formula as the patient is simply in its Sho, this tendency has become more prominent these days. For example, a patient can just be said to be Rikkunshi-To-Sho, regardless of his/her diagnosis in terms of modern western medicine. As I shall explain later, this situation arises in the Kampo system itself, where any symptoms (Sho) can be taken as evidence (Sho, again) for some formulae, and very often symptoms are called Sho-for-some Kampo formulae. As drugs covered by NHIS can only be prescribed by medical doctors trained in Western medicine in Japan, there is a tendency for them to use Kampo formula without paying much attention to the TCM interpretations of the symptoms of the patient. Therefore, I think the mainstream of Kampo is Sho-oriented, meaning that it does not rely so much on the rigorous interpretation of the disease state in terms of the basic TCM concepts as on the direct practical effects of a formula itself.