HH3002 SHORTHAND

By Pei Qi, Phyllis, Yih Ching

NAVIGATING TRADITIONAL MEDICINE IN CONTEMPORARY SOCIETY

A story about how traditional East Asian medicine find its place in society today

Introduction

Traditional medicine has come a long way from its initial form. In today’s fast pace society, it is easy to dismiss traditional medicine and make sweeping statements or uninformed criticism about its validity based on personal bias. The tendency to put definite labels on traditional medicine and western biomedicine also often results in the situation where both medicines are pit against each other.

Much of this contestation stems from binary thinking - western versus non-western and tradition versus modernity. Such a dichotomous thinking holds little regard to the actual implication of these terms.

How can we think beyond dichotomy?

This research presents a story about how traditional medicine finds its place in contemporary society by investigating the possibility of coexistence of western and traditional medicine, focusing on traditional medicine in the three East Asian countries - China, Korea and Japan. This article will present some background information of each of the three traditional medicine in focus and look at a case study of how these traditional medicines are applied to the treatment of cancer.

TRADITIONAL CHINESE MEDICINE

The origins of Traditional Chinese Medicine (TCM) date back at least 2,000 years. The enduring system of Chinese medicine primarily centres around the philosophical concepts of qi, yinyang, five phases (wuxing).

With tremendous influence on TCM, the three philosophical thoughts have already infiltrated into every field of TCM and become its philosophical foundation.

Binded by these concepts as well as the methodologies of the four diagnostic methods (si zhen) and pattern discrimination (bian zheng), the theoretical framework of TCM is rooted to naturalistic philosophies of ancient China. (Lozano, 2014)

Since the human being is perceived to share an intimate relationship with its natural environment, health problems are seen as “a deviation from natural conditions”, which have direct relations to the changes in the natural environment. (Lozano, 2014)

For instance, diseases are often described to be a result of wind, dampness, heat etc. As such, all TCM treatment emphasises on alteration of function and seeks to restore the body’s balance and harmony between the natural opposing forces of yin and yang. (Lozano, 2014)

Pattern Discrimination
(bianzheng lunzhi 辨证论治)

The distinct hallmark of TCM is certainly its emphasis on treatment based on pattern discrimination (bianzheng lunzhi 辨证论治).

Pattern discrimination is an essential part of the pathological treatment process where TCM physicians analyse data derived from the four diagnostic methods - observation, listening/ smelling, inquiring and pulse-checking. Beyond diagnosis, TCM physicians seek to identify the underlying process or disease mechanism of the disease. This is otherwise more popularly known as the pattern of disharmony.

(Lozano, 2014)

For example, in a common medical case of an ordinary flu, the underlying pattern can vary from being identified as an invasion by wind-cold, wind-heat or to any other possible patterns. The identified pattern of disharmony would determine the therapeutic principle and the treatment that will be prescribed to the patient. Correctly identifying the pattern that led to the manifestation of a disease is essential for the effectiveness of a TCM treatment. (Lozano, 2014)

On this note, patient information retrieved during TCM treatment are also vastly similar to the diagnosis processes and the clinical records of Western medicine.

How can we look beyond the stereotypical dichotomies of TCM and western biomedicine? What are the instances where both medicines co-existed?

Through different historical periods, TCM underwent a series of evolution in conjunction to the development of science and technology as well as the emergence of modern medicine from the west. This is especially the case in mid-20th century China, after the establishment of the People’s Republic and the rise of the Communist Party (CCP) to power. (Liu, 2018)

Under the leadership of Mao Zedong, the fusion of tradition and modern science/ TCM and Western medicine was projected as the trajectory that China ought to take in its development of Chinese medicine. (Scheid, 2014)

Mao’s idealistic vision of creating a “new medicine (xinyi 新医)” where there is not division between the two medicines is best exemplified through the slogan which he coined in the 1950s -
“Unify Chinese and Western medicine
(zhongxiyi tuanjie 中西医团结)”. (Scheid, 2014)

Here, the emphasis of integrating Chinese and Western medicine is heavily projected and the unification of both medicines remains the ultimate goal of all CCP healthcare related policies in the 1950s.

“中医要科学化，西医要中国化"

“Chinese medicine must become scientific, Western medicine must become Chinese”

In the first and second National Health Conference in 1950 and 1951, “four great guiding principles” were established to anchor all efforts and policies that are rolled out to strengthen the structure of China’s health care system. (Scheid, 2014)
The four principles are:

The purpose of medicine is to serve and treat the working people
Preventive medicine programs take precedence over curative treatments
The unification of Chinese medicine and Western medicine
Health care initiatives have to be tied to mass movements.

A non-exhaustive list of CCP policies and initiatives that were enforced during the mid-20th century (Scheid, 2014)

1952:
The establishment of a new licensing examination which tested mainly western biomedical knowledge

1952:
The large-scale re-education of Chinese medicine practitioners at the newly established “Chinese Medicine Improvement Schools (zhongyi jinxiu xuexiao 中医进修学校)

1955:
The re-education of Western medicine doctors studying Chinese medicine in the first experimental class
(diyijie xiyi xuexi zhongyi yanjiu ban 第一届西医学习中医研究班)

Mao Zedong shaking hands with the experimental class's (医学习中医研究班) director.

Mao Zedong shaking hands with the experimental class's (医学习中医研究班) director.

1956:
The founding of four Chinese medicine colleges
(zhongyi xueyuan 中医学院)

1957:
New national textbooks and teaching materials were compiled under the supervision of the Ministry of Health to minimise idiosyncratic interpretations in classes

Although the initiatives may differ in terms of scale and target audience, the shared commonality lies in “the simplification, regularisation and systematization of traditional modes of practice”.

The timeline also serves to give some level of understanding about the extent of institutionalising Chinese medicine in an attempt to uphold CCP’s principled stance of unifying both medicines.

Such a political stance and the above mentioned policies definitely paved the way for the institutionalisation of traditional Chinese medicine in China. It is without a doubt that this provided Chinese medicine with an institutional infrastructure and framework of clinical practice that still stand today.

Driven by political goals, Chinese medicine was also utilized as a means for the CCP to garner the support of the rural population, where there were little to no access to health care and technological resources.

In conjunction to the establishment of the three-tier health care network (sanji weisheng baojian wang 三级医疗卫生保健网), there was an increased recognition to bring effective health care needs to the rural regions. This led to the establishment of rural communes (大队医疗站) and barefoot doctors (chijiao yisheng 赤脚医生), which formed the lowest tier of the three-tier health care network. (Wei, 2013)

Barefoot Doctors -
A Peasant Medical Force

Also known as “half peasants, half physicians” (bannong banyi 半农半医), barefoot doctors are young adult peasants who take on dual roles in the rural community. They are qualified healthcare providers who are able to provide basic medical and paramedical services in rural regions in China. However, when they are not engaged to treat others medically, these barefoot doctors carry out agricultural activities, just like the rest of the rural community. (Wei, 2013)

These rural healthcare providers are part of a nation wide movement where over thousands of them were mass recruited to receive basic medical training in both Chinese and Western medicine. Each training is designed to be brief, such that the barefoot doctors will be able to pick up knowledge of anatomy, bacteriology, acupuncture, prescribing both tradition and western medicine within a short frame of time. (Wei, 2013)

Barefoot doctors roam around the countryside treating common illnesses and even promote preventive healthcare and family planning. (Wei, 2013)

Specifically with regards to diagnosis and prescription, biomedical pharmaceuticals are used, and Chinese herbal formula is prescribed based on symptoms instead of the usual TCM way of pattern discrimination. (Wei, 2013)

For patients with medical conditions that are out of the purview of barefoot doctors, they will be referred to the commune clinics or larger county hospitals depending on the complexity of the condition. (Wei, 2013)

The integration of barefoot doctors and the three-tier health care network is significant for several reasons. Firstly, it signified a shift of medical resources to the countryside. Such a new radical health care system ensures the accessibility and affordability of medical treatment in the rural region. For the very first time, an inclusive network of health care was established on a national level. Secondly, risks of infectious and parasitic diseases, which are the main causes of death in the countryside, along with the morbidity rate were greatly reduced. Thirdly, since the barefoot doctors utilise both Chinese and western medical knowledge, it projected a clear image that was aligned to the ones that CCP was trying to put forth - the integration of both medical fields. (Wei, 2013)

The Chinese Barefoot Doctors

In this video titled, The Chinese Barefoot Doctors, the intimate relationship shared between the barefoot doctor and the community that he or she resides in is portrayed. The video also provides an insight into the recruitment process of barefoot doctors as well as the mobilisation of these medical forces to curb infectious and parasitic diseases. (Wei, 2013)

The later half of 20th century witnessed the deepened inter-relationship between TCM and Western Medicine (traditional medicine and modern medicine). Although some initiatives such as the three tier health care system, fell apart eventually, the coexistence of these medicine not only paved the route to the later development of TCM, it also created a new unique kind of medicine - one that has its own unique set of distinctive features and competitive advantages.

Visual representation of the three-tier health care network (sanji weisheng baojian wang 三级医疗卫生保健网)

Propaganda Poster, Barefoot Doctor 1974

Propaganda Poster - Barefoot Doctor at Rural Communes, 1975

Brigade Clinic/ Rural Communes, Early 1970s

Barefoot Doctor at Rural Communes, n.d.

Propaganda Poster - Barefoot Doctor at Rural Communes, n.d.

TKM Background & Dual Medical system

Often mistaken and associated with Traditional Chinese medicine (TCM), Traditional Korean Medicine (TKM) has developed its own distinctive features that separates it from the former.

Koreans were first introduced to Oriental medicine through their interaction with the Chinese residents of Nangnang (Baker, 2003) Official medicine perform in Joseon Korea was based mostly on “canonical texts of Chinese medicine”. However, although the China was the primary sources of medical concepts and practices in TKM, there was also influence from other sources as well. Arab merchants that traded with the Goryeo ports may have brought medicinal material from other places like southeast Asia or even further available to Korea. (Baker, 2003)

TKM has tried to prevent the association with TCM by changing its name. Originally called Hanui and written with Sino-Korean characters, the first Han syllable was later changed with a homophone that meant Korea. This change was due to how the original spelling could be literally rendered to mean Chinese medicine. (Baker, 2003) In addition to this, TKM has modified some of the medical practices they adopted from China to the Korean environment such as providing local counterparts for Chinese ingredients. The Dongui bogam (A treasury of Eastern Medicine) published in 1613 by the revered physician Heo Jun (1539-1615) incorporated native ingredients and folk remedies and rewrote Chinese prescription to replace expensive Chinese ingredients with local Korean equivalents. (Baker, 2003) Diagnosing patients using the “Four Constitutions” By Lee Je-ma (1838-1900) was also popularised in Korea due to Koreans wanting to create traditional medicine with Korean roots. (Baker, 2003)

Korea's Dual Medical System

In present day Korea, TKM thrives alongside western biomedicine. Koreans often use western medicine for acute medical problems and surgery and TKM for chronic pain and fatigue. (Baker, 2003) The roles of TKM doctors can be divided as planners and executors of public health. TKM medicine is used to enhance the quality of healthcare and health of Koreans. Citizens trust and have satisfaction in TKM and it is also seen as a national characteristic of Korean medicine. (Kim et al., 2016)

TKM has an important role in the public health system of Korea. TKM has an official educational system and its professional status is comparable to Western medicine in other countries. In present day, TKM is used by 20,000 certified clinicians and uses 8% of Korea’s National Health Insurance. Unlike TCM and traditional medicine in Japan, TKM is not allowed to combine its techniques with Western medicine, but TKM and western medicine have an equal status. (Han et al., 2016)

Interest in TKM was first revived during Korea’s liberation in 1945. The Medicine for citizen Act (1951) started the structure for the Korean healthcare system. This Act would start the basis for higher education of TKM, as seen in Kyunghee University’s 6-year course in TKM. These modern traditional medicine universities had instructors, subject specific classes, and clinical education in hospitals. This was not like previous ways of learning TKM in traditional apprenticeships with medical classics. Western Biomedical knowledge was also incorporated to support TKM practices. During the 1980s to 1990s, the public developed an interest in TKM services and thus it claimed back its role in public healthcare. (Han et al., 2016)

The flow of TKM’s educational system was similar to Western medicine in Korea. In 2013, there were twelve TKM universities in Korea . (Han et al., 2016) TKM courses would focus on internal medicine, obstetrics, paediatrics, and others. Students were also sent to hospitals for clinical apprenticeship and specialised training programmes. Thus, TKM has modernised and developed its own independent educational system while maintaining its originality. (Han et al., 2016)

TKM use of modern medical device

Medical devices are instruments that are used for the purpose of giving a diagnosis and treating of diseases. The global medical device market is expected to grow from 4.8% from 2010-2014 to 6.1% from 2015-2020 due to the increase of aging. (Sung et al., 2018)

The medical device market of Korea has also sustained an annual growth of 10.4% in 2011-2015 and in 2015 and the cost of producing medical devices was $4.5 billion.

Doctors used modern medical devices to gain an edge in technology and increase professionalisation. Medical devices are also useful for improving the quality of healthcare.

The medical industry in Korea elevated the use of medical devices to greater heights in development of biomaterial. (Sung et al., 2018)

Traditional medicine also uses tools such as acupuncture, cupping therapy, and herbal medicine. TKM practitioners used to make diagnosis by using traditional methods of observing, touching, and smelling. (Sung et al., 2018) TKM doctors now have started to use electroacupuncture devices and pulse wave analysers. Additionally, TKM doctors also started to use modern biomedicine devices like X-ray machines and CT scanners along with traditional medicine tools. In 2012-2016, the most used medical devices of TKM practitioners were MRI and CT scanners and X-ray machines. (Sung et al., 2018) These modern medical devices are helpful in giving objective information for healthcare practitioners. (Sung et al., 2018) However, these devices are not permitted for TKM practitioners to use. This contrasts with China, TCM uses conventional medicine and modern biomedicine devices alike licensed medical doctors. (Sung et al., 2018) There are also no laws preventing the use of modern medical devices and western biomedicine by TCM practitioners. Due to this, studies have been made using both TCM with medical imaging devices. (Sung et al., 2018)

The dual medical system that exists in Korea had many disputes. One such dispute was the claim by biomedicine that TKM was appropriating their technology. This dispute arose from a TKM clinic using CT scanners to diagnose patients. (Ma & Lynch, 2014)

Biomedicine physicians claimed that this technology were exclusive products of modern medical science” and TKM physicians did not have the proper training and skill to use to use them. (Ma & Lynch, 2014) TKM physicians have also criticised the biomedicine physicians’ use of herbal remedies, as they claimed that the knowledge and meanings of the herbal remedies are not able to be translated into biomedical terms. (Ma & Lynch, 2014) This shows the rivalry between the two medical systems.

Translating TKM to bioscience

A frequent argument use against TKM is that it is unscientific and TKM physicians are usually marginalised and discriminated in the medical and science community. (Kim, 2007) This led to TKM physicians’ interest in trying to scientifically validate TKM by reconstructing and translating it to laboratory science. (Kim, 2007) Director Ho-Cheol Kim supported the scientisation of TKM and wanted to oppose the discrimination and use science to further develop TKM. (Kim, 2007) Thus, Dr. Kim led the research on TKM experimentation on the condition of Joong-Poong, roughly be described as brain ischaemia. The research focused on verifying the neuroprotective effects of herbal medicine. (Kim, 2007) However, the lab faced many difficulties such as the ambiguous causes of Joong-Poong were too hard to test. One example is that they were scientifically unable to test ‘Internal wind’. Joong-Poong was later equated to cerebral ischaemia, but this conclusion would then transform the meaning of Joong-Poong that was described in TKM classics. (Kim, 2007)

Another challenge was publishing TKM lab results in the Science Citation Index (SCI) to make western scientist recognise TKM. However, as TKM practices do not follow the epistemology and methodology that SCI journals used, TKM manuscripts are often rejected. To avoid this rejection, lab members removed the traditional concepts used to publish their findings. (Kim, 2007) Therefore, the Scientisation of TKM would mean discarding concepts and reinterpreting TKM. TKM concepts and principles would then follow the western scientific standards resulting in identity loss despite its effort to legitimise itself. (Kim, 2007)

Kampo medicine
漢方医学

Traditional Japan herbal medicine, also known as Kampo medicine (漢方医学) originated from China about 1,500 years ago (Fuyuno, 2011). The term, Kampo (漢方), which meant ‘method from the Han period of ancient China’(Fuyuno, 2011) was coined during the Tokugawa era to distinguish traditional Japanese medicine from Rampo, which was the then Dutch-style medicine (Terasawa, 2014).

In the midst of the Tokugawa era, a cultural renaissance initiated by literature started in Japan (Terasawa, 2014). As new ideas on ancient classical textbooks such as the Shokanron (傷寒論) were introduced to Japan, a countermovement emerged (Tsumura & Co, n.d). Scholar began advocating for a more Japanese form of traditional medicine and rejected neo-confucianistic doctrines which eventually lead to the subsequent difference in Kampo medicine and traditional Chinese medicine (Tsumura & Co, n.d). This form of nationalistic movement emerged to oppose the non-critical use of Chinese culture (Terasawa, 2014). The Edo period was seen as a period of growth and crucial developments of Kampo.

Currently, Kampo medicine is substantially different from how traditional medicine was practiced in other East Asian countries such as China and Korea. Unlike China and Korea where physicians of western medicine are not allowed to prescribe traditional Chinese or Korean medications, Kampo medicine has been greatly integrated into the system where physicians are allowed to prescribe both Kampo medications as well as western medications to patients. The integration of Kampo medicine was facilitated by the ‘pragmatic and reductive approach of restricting Kampo therapy to clinically meaningful components.’

Kampo is now used by more than 90% of the doctors in Japan in their daily practices (Yakubo et al, 2014). Other than being used by University hospitals with high-technology techniques such as robotic surgery, Kampo medicine is also used for treatments of cancer alongside with chemotherapy or radiation therapy. These examples demonstration the integration of Kampo and Western biomedicine in Japan.

However, after the Meiji restoration, the government imposed a requirement for all physicians to study Western medicine due to the adoption of German system of medical regulations (Terasawa, 2014). The practice of Kampo gradually declined as only physicians who were trained in Western medicine were certified as medical doctors, leaving physicians who practiced Kampo uncertified professionals (Mootoo et al., 2011). It was only at the grass-roots level where Kampo was kept alive by committed physicians, pharmacists, and vendors of traditional medicines which enabled the revival of Kampo in the early 20^th century (Tsumura & Co, n.d). In 1967, the coverage of Kampo by national health insurance started and since then, Kampo has been recognized as an important medical approach in modern medicine (Motoo et al., 2011).

Even though Kampo has a strong public support, it is still overshadowed by western medicine which takes up a major 98% of the total pharmaceutical production in Japan. Growing acceptance of traditional Chinese medicine as well as the lack in support from the government in promoting Kampo also poses a threat to Kampo. Just in autumn 2009, government tried to eliminate Kampo from the health insurance, but the plan was met with strong objection from the public. The Japan Society for Oriental Medicine in Tokyo collected an estimated number of 920,000 Japanese citizens’ voluntary signatures on a petition in less than a month and this petition eventually stopped the government from carrying out its plans (Motoo et al., 2011).

Even though Kampo is based on the traditional Chinese herbal medicine, it has developed into its own unique form in Japan (Terasawa, 2014). The original form has evolved into a system that is compatible with the ‘environment and climate of Japan as well as the physical constitution and lifestyle of the Japanese population’ (Wang et al., 2018).

A short clip on what Kampo is.

Kampo is not a ‘monolithic ideological system’.

It is a broad system of medical practice and thinking which evolved over the years.

Integrating traditional and western medicine in cancer care

Case Study -
Traditional Chinese Medicine

Oncology (a branch of medicine that deals with the prevention, diagnosis and treatment of cancer) has a long history in TCM. Studies of cancer treatment are included in The Yellow Emperor’s Inner Canon (huangdi neijing) and The Classic of Medical Problems - two key classical works that TCM is based on. (Liu, et al., 2015)

Treatment strategies, which centres around the key philosophical concepts of TCM place strong emphasis on the goal of “the combination of partial and systemic therapy, strengthening body resistance and eliminating pathogens, treatment of the body, and the regulation of emotion”. Through the various research conducted especially since the founding of the People's Republic of China, it has been proven that TCM is highly compatible with modern cancer treatment. The combination of treatment boosts the chance of patient recovery through alleviating side-effects of western treatment, which in turn enhances the quality of life, prevents the relapse of cancer. (Liu, et al., 2015)

(Liu, et al., 2015)

(Liu, et al., 2015)

As reflected in the visual representation, TCM treatment is said to be a viable option for all patients and capable of producing desired results for cancer of different stages. For patients who are deemed physically unsuited for radiotherapy and chemotherapy such as advanced cancer patients and elderly patients, TCM treatment could be the silver lining for them. (Liu, et al., 2015)

For example, radiotherapy and chemotherapy can harm “the qi and blood, essence and fluid, and the function of the five viscera and six bowels”. The weakened body is prone to symptoms such as fatigue, nausea, vomiting, loss of hair etc. To curb these symptoms, TCM treatment focuses on “tonifying qi and producing blood, strengthening the spleen and stomach, nourishing the liver and kidney and removing heat from blood and toxic material from the body.” (Liu, et al., 2015)

Case Study: TKM on Cancer

There is an increased amount of research on traditional medicine’s effect against cancer. Traditional medicine has been used for cancer treatment for thousands of years and many herbs and plants are known to prevent cancer. It is reported that during 11986 to 2006, 70% of cancer treatment drugs were made from natural products or were similar to it. Medicinal herbs from eastern countries have been recognised to suppress the process of carcinogenesis. The comprehensive approach of traditional medicine is now being use with modern medicine to support the shortfalls of the current medical system. The use of medicinal herbs, acupuncture and traditional exercise are now part of the treatments used against tumours . (Yoon, Jeong, Kim, & Aggarwal, 2014)

The internal condition of the body plays an important role in the onset of cancer, this means that external factors can cause cancer when the body’s defence system is weak. In TKM when the body is unable to revert to its normal state due to chronic inflammation, it is attributed to the lack of Qi. Reviving the patient’s Qi while getting rid of external factors according to the physical condition of the patient, are the foundation of cancer prevention and treatment. Modern biomedicine treats cancer by focusing on eliminating the tumour, but this approach may make the patient weak. This increase the potential of cancer to return due to the patient’s weakened immune system. Whereas TKM focuses on balancing between reviving the patient’s Qi and expelling the tumour. Thus, not only does it respond to the tumour, but it also keeps the body’s immune system in mind. This approach can benefit patients in later stages of the disease. TKM believes that an aggressive approach to treating the disease should only be used to the halfway point as overuse can weaken the body’s Qi and cause the tumour to return. Reviving of Qi should also only be used to a halfway point as overuse can result in stagnation of Qi which may lead to the return of the tumour. The diagnosis and treatment of the patient should be designed according to their symptom pattern and constitution. Using these methods help TKM in preventing cancer and treatment. (Yoon, Jeong, Kim, & Aggarwal, 2014)

In modern biomedicine, cancer is seen as “a set of clonal cells that have outgrown their environmental constraints and control mechanisms ”. (Yoon, Jeong, Kim, & Aggarwal, 2014) The abnormal cells are foreign to the body and have to be removed through aggressive therapies. Modern biomedicine sees disease as a substance and focuses on it. (Yoon, Jeong, Kim, & Aggarwal, 2014) This way of treating cancer differs greatly from traditional medicine. TKM views disease as a circumstance occurring in the body . (Yoon, Jeong, Kim, & Aggarwal, 2014) Cancer in TKM is viewed together with the body and seen as a “imbalance of the body-mind-spirit network as a whole”. This shows that cancer is a systemic disease, and the treatment of the body should be considered as well, rather than just focusing on the tumour. Through nourishing the body and bringing back its balance, the body’s normal pattern will be reinstated and thus, cancer will be resolved . (Yoon, Jeong, Kim, & Aggarwal, 2014)

TKM is useful in controlling the common symptoms of cancer like fatigue and anorexia. Recent studies have shown that using TKM in cancer treatment helps to increase the patient’s chances of survival. Thus, in terms of cancer treatment, TKM can be integrated with modern biomedicine. (Yoon, Jeong, Kim, & Aggarwal, 2014)

Case Study- Kampo Medicine
Sho (証)

In order to understand the use of Kampo, it is important to look at how Kampo practitioners diagnose patients and factors influencing their decision to administer a certain Kampo prescription to their patients.

Kampo prescriptions are determined based on the overall condition and constitution of the patient. Many of these formulations are only effective when they match the physical constitution and symptoms of the patient. Therefore, physicians often use Kampo diagnosis, also known as ‘sho’ (証)  or ‘pattern’, a measure used in Kampo medicine to determine the constitution of a patient.

‘Sho’ is used along with other subjective remarks made by the patients and symptoms observed by the physicians to decide on the prescription that is the most suitable for the patients (Melby et al.,2019). This is also known as ‘shi-shin’ which represents the four diagnostic approaches of visual observation, listening of sounds from patient’s body, smelling and touching of the patient’s body and listening to their thoughts (Terasawa, 2014).

According to Professor Terasawa (2014), the central concept of Kampo is thought to be the concept of ‘Sho’. ‘Sho’ can be translated as symptoms or ‘patterns’ which form the basis of the prescription of kampo medicine where a physician would select formulations for patients based on the ‘pattern’ identified (Terasawa, 2014). Standard patterns include ‘vaculty’, ‘repletion’, ‘ki’ (vital energy), ‘ketsu’ (blood) and ‘sui’ (body fluid) (Wang et al., 2018).

‘Vaculty’ and ‘repletion’ is used in relation to a person’s physical strength and resistance. One with sufficient physical strength and resistance is said to have a ‘repletion’ pattern and on the contrary, one with little physical strength is said to have a ‘vaculty’ pattern (Wang et al., 2018).

‘Ki’, ‘ketsu’ and ‘sui’ are elements that indicate the disharmony in the body and are examined to locate the problem in the body (Wang et al., 2018). Harmony in the body is maintained when all three factors are in proper circulation (Wang et al., 2018). On the other hand, inbalance, stagnant or insufficient in any of the three factors is thought to cause disease or disorder in the body (Wang et al., 2018).

Based on observations of the different patterns, a physician is able to determine the cause of a disease or pain and provide suitable kampo formulations to help patients.

One of the leading causes of death in Japan is cancer and as many as one in two people develop cancer (Nagata et al.,2016). Cancer therapies such as surgical procedures, anticancer agents and radiation therapy often cause severe adverse implications which may prevent some patients from completing treatments (Nagata et al.,2016). Hence, practitioners have been looking for a more effective therapy which is safer for patients. Herbal preparations such as traditional Chinese medicine and Kampo medicine are used in cancer treatment alongside other therapies to ‘enhance the immunity of patients, improve pre and post-operative conditions of the patients and mitigate adverse drug reactions’ (Nagata et al.,2016). Even though there have been observations made regarding the effectiveness of the use of such traditional medicine in improving therapeutic outcomes, there have been no evidence on the antitumor effectiveness of traditional medicine when used on its own (Nagata et al.,2016).

In contrast to the ‘direct and powerful therapies’ of Western medicine, Kampo medicine provides a milder therapy to correct the imbalance of the entire body using critical observation of the patient’s body and constitution (Nagata et al.,2016). It places more ‘emphasis on natural healing potential and the host’s defense system’ (Nagata et al.,2016).

There is a general preference among cancer patients to opt for the use of Kampo medicine, due to the perception that Kampo medicine may be ‘less toxic for their body than conventional medicine’. Data from a research suggests that patients with cancer conditions chose Kampo as part of their treatment alongside biomedicine, such as chemotherapy (Melby et al.,2019). There are also instances where patients turn to Kampo after the experiencing the ineffectiveness of biomedical treatments (Melby et al.,2019).

Doctor’s preference in administering Kampo medication for patients are also influenced by reports which ‘showed the effectiveness of Kampo medicine for the control’ of the toxic side effects of cancer chemotherapy. In this sense, the use of Kampo medicine in cancer treatments is influenced by two main factors which is the preference of the doctors as well as the patients which may have stemmed from their trust of the effectiveness of the medicine. Doctors may have a more aware view of the effectiveness through professional reports but for the patients, their preference stemmed from their own perception of Kampo medicine as well as doctor’s advice. We can see from this that there is a generally good perception on the effectiveness of Kampo medicine which may be an explanation for its popularity.

(Takeda et al., 2012)

A research on the Kampo preparation Daikenchuto (DKT) which is commonly used to improve intestinal functions shows that it provides antitumor effect against various cancer cells such as esohageal, breast, gastric and colon cancer cells (Nagata et al.,2016). DKT is made with ginseng, Japanese Zantoxylum peel, processed dried ginger and malt sugar. According to the research, Japanese Zantoxylum peel contains antitumour factor (Nagata et al.,2016). ‘This formula is known for its prokinetic action or clinical efficacy against intestinal obstruction subsequent to laparotomy or radiation therapy’. Other than DKT, another Kampo preparation, Ninjinyoeito has also been proven to provide effective treatment for ‘myeolosuppression during gynecological cancer treatment.’ (Takeda et al., 2012)

Conclusion

Each country has its own unique system of traditional medicine and faces different sets of challenges in implementing and preserving it. Despite the challenges, traditional medicine manages to stay relevant and prove its usefulness in today’s world.

Thinking beyond the stereotypical labels, the case study on cancer highlights the advantages when these two forms medicine converge. We can see how traditional medicine is effective in treating an acute illness like cancer and even complements biomedical treatment, which greatly increases the survival rate of patients. Attempts to use traditional medicine with western biomedicine also encourages innovative ways to treat illnesses and alleviate patient pain.

Thus, rather than thinking of one as better than the other, we can look at it through another perspective - that both are tools of equal value which can be used to advance healthcare.