Introduction: History of Medicine in Japan. Before Europeans visited Japan in 1549, traditional Chinese medicine was the primary healthcare system.
Even during the period of national isolation, which began in 1639, Japan’s resilience and resourcefulness shone through despite severed diplomatic relations with the rest of the world, except the Netherlands and China. The Japanese managed to sustain their healthcare system, adapting it to their unique circumstances.
For over 200 years, American Admiral Matthew Perry compelled Japan to open its doors in 1853. Japan learned about Western medicine only from doctors in Dutch merchants’ offices or from Dutch medical books.
One of the most fascinating aspects of Japanese medicine is its transformation from spiritual healing to scientific medicine.
In earlier times, illness was attributed to divine punishment or the influence of evil spirits, and treatment and prevention were primarily based on religious practices such as prayer, glorification, and almsgiving.
However, after a slow start, Japanese medicine rapidly westernized and became more scientific, incorporating drugs and bloodletting. Let’s read more about the History of Medicine in Japan.
History of Japanese Medicine
The history of medicine in Japan is a chronicle of medical advancements and a deeply intertwined narrative of the country’s cultural and social evolution. Traditional Japanese medicine, known as Kampo (漢方), traces its origins to the 6th century when it was heavily influenced by Chinese medical practices introduced by Buddhist monks.
Early Japanese medical practices relied on a mixture of spiritual healing, herbal remedies, and rudimentary surgical techniques. The use of acupuncture and moxibustion (a form of heat therapy) was daily and influenced by Chinese medical readers such as the Huangdi Neijing (The Yellow Emperor’s Inner Canon).
Nara and Heian Periods (710-1185)
During the Nara (710-794) and Heian (794-1185) periods, Japan developed distinct medical practices while still drawing heavily from Chinese sources. The Taihō Code (701 AD) marked an early attempt at organizing medical care within the governmental structure, establishing positions for official court physicians and herbalists.
The creation of the “Ishinpō” (医心方), Japan’s oldest surviving medical text compiled by Tamba YasEmperor’s984, demonstrated the formalization of medical knowledge, incorporating a mix of Chinese and indigenous treatments.
Kamakura and Muromachi Periods (1185-1573):
The Kamakura (1185-1333) and Muromachi (1336-1573) periods saw the continued development of Kampo medicine. The Buddhist sects, notably Zen Buddhism, played a significant role in disseminating medical knowledge. Monasteries often served as centers for medical study and practice.
During this time, Japanese practitioners began integrating and modifying Chinese medical theories to suit local conditions, emphasizing practical, empirical approaches rather than strictly following Chinese doctrines.
Sengoku Period (1467-1603):
The Sengoku period, marked by constant military conflict and social upheaval, they have necessitated advancements in battlefield medicine. Surgeons known as “yasen” (野戦), specializing in treating wounds and injuries, became more prominent.
This period also saw the compilation of numerous medical texts, which began to reflect a uniquely Japanese approach to health and healing.
Edo Period: The Golden Age of Kampo
In the 18th century (late Edo period), practitioners who merged the perceived strengths of the Goseihoha and Kuhoha schools emerged, as did those who highlighted the medicinal use of kampo preparations and called them Secchuha (e “lectic school). Tokaku Wada and Sohaku Asada were representative figures of this school.
In 1804, Seishu Hanaoka succeeded in combining Dutch medicine (Rangaku) with Kampo and became the first surgeon to treat breast cancer with surgery and Tsusensan, a Kampo formulation.
One of his students, Soken Honma, wrote Naikahiroku and Yukahiroku to integrate kampo with Western medicine, and his school later became known as Rankin Secchuha. The Edo period was a time of relative peace and stability under the Tokugawa shogunate, allowing significant medical advancements in Japan.
- The Fall and Survival of Kampo
The wave of medical modernization that swept Japan during the late 19th century (Meiji period) led to the rapid decline of kampo. To facilitate modernization and a rise in wealth and military power, the Meiji government founded a new education and healthcare system in 1874 to prefer Western medicine and a license to practice medicine.
Furthermore, under the Dajokan (Grand Council of State) declaration in 1883, the medical licensing system granted licenses only to doctors who had passed a national examination to practice medicine.
By 1895, the Diet’s 8th National Assembly vetoed a request to continue the practice of compo, bringing it to the brink of extinction. Yet despite losing legitimacy, the tradition was kept alive mainly by dedicated grassroots doctors, pharmacists, and traditional medicine vendors.
Integration and Innovation of Japanese Medicine
The Tokugawa shogunate era witnessed a resurgence in Japanese medicine thanks to the efforts of influential figures like Manase Dōsan and Tashirō Sanki. Their empirical observation and diagnosis marked a significant departure from the theoretical foundations of Chinese medicine.
Dutch Influence:
The arrival of the Dutch in the 17th century introduced Japan to Western medical knowledge. Rangaku (蘭学), or “Dutch learning,” became a crucial conduit for European scientific and medical advancements.
Although the Tokugawa shogunate maintained strict isolationist policies, the Dutch trading post at Dejima in Nagasaki allowed limited but significant cultural and scientific exchange.
Physicians such as Sugita Genpaku (1733-1817) played pivotal roles in translating Dutch medical texts, leading to the publication of the “Kaitai Shinsho” (New Book of Anatomy) in 1774, which was Japan’s first modern anatomy book based on European knowledge.
Meiji Restoration and the Advent of Modern Medicine (1868-1912)
The Meiji Restoration of 1868 marked a monumental shift in Japan’s history, including in medicine. The new Meiji government prioritized adopting Western medical practices in its quest to build a modern nation-state.
This transformative period saw the establishment of medical schools and hospitals based on the German model and the sending of many Japanese doctors to Europe for further study, heralding a new era of scientific medicine in Japan.
Key Figures and Developments:
Several Japanese medical pioneers emerged during this period, leaving an indelible mark on the field. Kitasato Shibasaburō (1853-1931), a student of Robert Koch in Germany, made significant contributions to bacteriology, including discovering the bacterium causing tetanus. His work laid the foundation for modern infectious disease research in Japan.
Another notable figure, Takaki Kanehiro (1849-1920), implemented nutritional reforms in the Japanese navy, drastically reducing the incidence of beriberi among sailors. Their achievements are a testament to the spirit of innovation and dedication in Japanese medicine, evoking a sense of pride and admiration.
Taisho and Early Showa Periods (1912-1945): Consolidation and Expansion
The Taisho (1912-1926) and early Showa (1926-1945) periods saw further consolidation of Western medical practices and significant advancements in public health. Establishing the Ministry of Health and Welfare in 1938 marked a pivotal step in organizing public health efforts nationwide.
Vaccination programs, hygiene campaigns, and the development of medical infrastructure helped improve general health standards.
Medical Research and Education:
Universities such as Tokyo Imperial University (now the University of Tokyo) and Kyoto Imperial University (now Kyoto University) became leading medical research and education centers.
Japan’s healthcare system researchers significantly contributed to various fields, including surgery, pathology, and pharmacology. Umetaro Suzuki’s discovery of vitamin B1 (thiamine) in 1910 and the development of the chemotherapeutic agent Salvarsan for syphilis treatment were notable achievements.
Reconstruction and Reform
The aftermath of World War II necessitated a massive reconstruction of Japan’s healthcare system. Under the guidance of the Allied occupation, Japan reformed its medical education system, adopting the American medical training model.
The opening of universal health insurance in 1961 ensured that all citizens had access to medical care, significantly improving public health outcomes.
Technological and Medical Advances
The latter half of the 20th century saw Japan emerge as a global medical technology and pharmaceuticals leader. Japanese companies pioneered innovations such as developing the MRI scanner and advanced endoscopic techniques.
The country also made significant strides in regenerative medicine, with groundbreaking research in stem cell therapy led by scientists like Shinya Yamanaka, who won the Nobel Prize in 2012 for his employment on induced pluripotent stem cells (iPSCs).
Strengths of the Japanese Medical System
Japanese Medical System has evolved remarkably from its ancient roots in traditional Kampo medicine to becoming one of the most progressive healthcare methods globally.
This journey is marked by significant milestones such as incorporating Chinese medical practices in ancient times, introducing Western medical knowledge during the Meiji Restoration, and the post-World War II healthcare reforms that spread the foundation for modern medical practices.
Universal Health Coverage
Japan implemented a universal health insurance system in 1961, one of its most significant achievements. This system ensures every citizen can access medical care financed by public health insurance schemes and out-of-pocket payments.
The Japanese government regulates the cost of healthcare services and medications, maintaining affordability and accessibility.
High-Quality Care
The quality of care in Japan is generally very high, with a strong emphasis on preventative measures and early intervention. Routine health checks and screenings are standard, contributing to the country’s high life expectancy and low infant mortality rates. Japan’s focus on preventative care helps detect and manage health issues before they become severe.
Advanced Medical Technology:
Japan is at the vanguard of medical technology and innovation. The country has significantly contributed to various fields, including imaging technology (MRI and CT scans), minimally invasive surgical techniques, and regenerative medicine.
Integrating cutting-edge technology into everyday medical practice ensures patients acquire the most effective and efficient treatments.
Efficient Use of Healthcare Resources:
Japan’s healthcare system is known for its efficiency. The country has managed to provide high-quality care while keeping healthcare expenditure relatively low compared to other developed nations.
The government’s role in setting standardized fees for medical services helps control costs and prevents overcharging.
Research and Development:
Japan’s healthcare system is a leader in medical research and development. The country invests heavily in medical research, resulting in numerous innovations and breakthroughs.
Notable contributions include the discovery of iPSCs (induced pluripotent stem cells) by Shinya Yamanaka, which have vast potential in regenerative medicine and disease treatment.
Challenges Facing the Japanese Medical System
Japan has strict rules for importing medicine and what travelers can bring into the country for personal use. Drugs are categorized into five classes (general, narcotic, psychotropic, stimulant medicine, or medical device).
Depending on the drug’s classification, name, and quantity, you may need to apply for a permit/certification to bring the drug into the country.
Some drugs, including the stimulant drug dexamphetamine (used to treat ADHD) and pseudoephedrine (found in some cold and flu pills), are banned in Japan and can be found with them.
Others, such as narcotic drugs (codeine, morphine, and oxycodone), need you to apply for a narcotic certificate. The medicine may be confiscated if you do not have this certificate when entering Japan.
Some challenges that Japan faces in the Japanese Medical System are:
Aging Population in Japanese Medical System
One of the most pressing challenges Japan faces is its rapidly aging population. With one of the highest proportions of elderly citizens in the world, the demand for geriatric care and chronic disease management is increasing. This demographic shift significantly strains healthcare resources and necessitates healthcare policy and infrastructure adjustments.
Rising Healthcare Costs:
Despite efforts to control costs, healthcare costs are growing due to the geriatric population and the increasing number of chronic diseases. The financial sustainability of the healthcare system is a concern, and reforms to address funding and resource allotment without compromising the quality of care are required.
Workforce Shortages:
Japan is experiencing a lack of healthcare professionals, particularly in rural areas. The aging population raises the demand for healthcare services and affects the workforce supply, as many healthcare workers are approaching retirement age. Efforts to attract and maintain young professionals in the healthcare sector are critical to addressing this problem.
Regional Disparities
Significant disparities in healthcare access and quality exist between urban and rural areas in Japan. While urban centers tend to have well-equipped hospitals and a higher concentration of specialists, rural areas often struggle with limited medical facilities and shortages of healthcare professionals. Bridging this gap is vital for ensuring equitable healthcare access across the country.
Integration of Traditional and Modern Medicine
While Japan has a rich history of Kampo medicine, integrating traditional practices with modern medical approaches presents challenges. Ensuring that conventional treatments are scientifically validated and effectively integrated into the broader healthcare system is crucial for providing holistic care.
Addressing these challenges requires comprehensive reforms and a forward-thinking approach that leverages Japan’s strengths in technology and innovation.
By continuing to prioritize preventative care, embracing technological advancements, strengthening the healthcare workforce, and enhancing geriatric care, Japan can maintain and improve its healthcare system to meet the needs of its population now and in the future.
Current Reforms and Future Directions
Japanese Medical System is complex and dynamic, reflecting the country’s capability to adapt and innovate in reaction to changing needs. Its strengths lie in its universal health coverage, high-quality care, advanced medical technology, efficient use of resources, and robust research and development sector.
However, the system faces significant challenges, including an aging population, rising healthcare costs, workforce shortages, regional disparities, and the need to better integrate traditional and modern medicine.
Policy Reforms
The Japanese government is actively working on policy reforms to address the challenges of an aging population and rising healthcare costs. Measures include promoting preventative care, increasing efficiency in healthcare delivery, and exploring sustainable financing models.
The government is also encouraging the use of technology and telemedicine to enhance access to care, especially in rural areas.
Promoting Preventative Care
Preventative care is a cornerstone of Japan’s healthcare strategy. By focusing on early detection and management of diseases, Japan aims to reduce the long-term costs associated with chronic illnesses. Public health campaigns, routine screenings, and vaccinations are integral to this approach.
Embracing Technological Innovations
Japan continues to invest in medical technology and innovation. Integrating artificial intelligence (AI), robotics, and telemedicine into healthcare delivery will enhance efficiency and patient outcomes. For example, robotic-assisted surgery and AI-powered diagnostic tools are becoming increasingly prevalent.
Strengthening the Healthcare Workforce
Japan is implementing strategies to attract and retain healthcare professionals to address workforce shortages. Initiatives include:
- Offering incentives for working in rural areas.
- Expanding medical education and training program.
- Improving working conditions for healthcare workers.
Enhancing Geriatric Care
Given the aging population, Japan is focusing on improving geriatric care services. This includes developing specialized training programs for healthcare professionals in geriatrics, expanding long-term care facilities, and promoting community-based care models that allow elderly individuals to receive care in their homes.
Conclusion: History of Medicine in Japan
The history of medicine in Japan is a testament to the country’s ability to adapt and integrate diverse influences while forging a unique path in medical science.
From its early reliance on Chinese medicine to the adoption of Western medical practices during the Meiji Restoration and its current status as a leader in medical technology, Japanese Medical System reflects a dynamic interplay of tradition and modernity.
The evolution of Japanese medicine will likely involve addressing contemporary challenges while maintaining the high standards of care that have come to define its healthcare system. Japan’s healthcare system is characterized by its advanced medical technology, high-quality care, and comprehensive coverage.
However, the Japan’s healthcare system faces significant challenges, including an aging population, increasing healthcare costs, and the demand for bearable healthcare reform. Efforts continue to address these problems through policy reforms, technological innovation, and a focus on preventive care.
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