Traditional Chinese Medicines Brought from China to Japan

Traditional Chinese Medicines Brought from China to Japan: History

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Subjects: Pharmacology & Pharmacy

Contributor:

Shihui Liu

Toshihiko Matsuo

Chie Matsuo

Takumi Abe

Japanese Kampo medicine has its origin in ancient Chinese medicine. In 742, a Tang Dynasty monk named Jianzhen (Ganjin) was invited by Japanese clerics to visit Japan and teach commandments in Buddhism. Because of the dangers of the voyage and also other obstacles, he took 11 years to reach Japan on the sixth voyage and he was blind when he arrived in Japan. He was the first person in China to go to Japan to establish the Buddhism commandments, and he was also the first person in Japan to directly teach traditional Chinese medicine. Until now, there have been few reports in English about the details of the Chinese herbal medicines he brought to Japan, including the types of herbal medicines, pharmacological activities, and formulations.

Jianzhen
Ganjin
traditional Chinese medicine
Kampo medicine
herbal medicine
medical history
Toshodaiji Temple
traditional Japanese medicine
Nara
Tang Dynasty

1. Introduction

Traditional Chinese medicine has a history of approximately 3000 years from the early Zhou Dynasty in China and even earlier, and the oldest medical writings on herbal medicine are found in the Book of Songs and the Book of Changes [1]. The sources of traditional Chinese medicine include plants, animals, and minerals. Herbal medicines make up the largest proportion and are most commonly used. As the accumulated knowledge was recorded in medical books, traditional Chinese medicine evolved into an independent discipline. Traditional Chinese medicine focuses on the balance of yin and yang to maintain health and prevent diseases. Once the balance is disrupted, it leads to different diseases or syndromes [2]. The purpose of traditional Chinese medicine is to correct the disrupted balance and restore the body’s ability to self-regulate but not to fight against specific pathogenic targets. According to the traditional Chinese medicine theory, disruption in diseases can be divided into several “patterns”. A disease may show several different “patterns” and be treated with several herbal medicines. Different diseases may be treated with the same herbal medicine due to their shared patterns. [3].

This article reviews how Jianzhen (Figure 1) acquired medical and pharmaceutical knowledge in his younger age from the viewpoint of traditional Chinese medicine brought to Japan, and summarizes the methods of identifying Chinese herbal medicines and part of prescriptions of herbal medicines. To this end, we introduced, for the first time to the best of our knowledge, a book that recorded the complete prescription of traditional Chinese medicine that Jianzhen brought to Japan named Jianshangren (Holy Priest Jianzhen)’s Secret Prescription.

Figure 1. Jianzhen’s image stamped on the certificate with the date (25 March, 4th year of Reiwa, 2022) for visit at Toshodaiji Temple, Nara, Japan. Authors’ original photograph taken in the background of Main Hall (Kondo).

2. Jianzhen’s Background in Medicine and Pharmacy

Jianzhen became a monk in Dayun Temple, Yangzhou, when he was 14 years old. At the age of 20, he followed his teacher Daoan (654–717) to study in two capitals (Luoyang and Chang’an) of the Tang Dynasty. Daoan’s teacher was Wengang (636–727), Wengang’s teacher was Hongjing (634–712), and Hongjing was a disciple of Daoxuan (596–667). Daoxuan was the founder of Nanshan Buddhism. Daoxuan made Tianwang Buxin Pills by himself as he suffered from heart disease. Daoxuan had a deep friendship with Sun Simiao (581–682), and Sun Simiao was a well-known doctor and pharmacy expert in China in the Tang Dynasty. Sun Simiao was known as the King of Medicine in China and is the author of A Thousand Gold Prescriptions and other books. Daoxuan learned a lot of medical knowledge from Sun Simiao and passed it on to Hongjing, who then passed it on to Jianzhen. They influenced and learned from each other in medicine and knowledge of Buddhism [4].

Jianzhen was born in Yangzhou, which was a traffic crossing point between the north-to-south canal and the Yangtze River. At that time, it was a city for international communication, a traffic tunnel for land, and water transportation. Jianzhen could see goods and medicines from all over the world in Yangzhou. Because of this unique geographical environment, Jianzhen mastered a lot of the knowledge for identifying the varieties, specifications, processing, and distinguishing the true from the false medicine [4].

Later, he went to Beijing and visited the imperial hospital and the pharmacy garden, where the imperial medicine garden and the medicine storehouse were located. The world’s first pharmacopoeia Newly Revised Materia Medica was promulgated here. Newly Revised Materia Medica is a book on clinical medicinal materials wrote by Su Jing (599–674) in the Tang Dynasty [5]. Jianzhen learned a lot of medical and pharmaceutical knowledge here.

In addition to being proficient in Buddhism and medicine, Jianzhen was also very proficient in other things, such as calligraphy, architecture, sculpture, art and crafts, and the Five Sciences. The Five Sciences in Buddhism refer to five academic fields: 1. Shengming/Shomyo (phonology and grammar); 2. Gongqiaoming/Kugyomyo (technics and technology); 3. Yifangming/Ihomyo (medical science); 4. Inming/Inmyo (ethics); 5. Neiming/Naimyo (study of a scholar’s religion, as in Buddhism for a Buddhist). He participated in the work of Longxing Temple and Daming Temple (Figure 2A,C), carried out voluntary medical treatment, and gained a great deal of clinical experience and medical knowledge in practice [6].

Figure 2. Photos of Daming Temple in Yangzhou, China, and Toshodaiji Temple in Nara, Japan. (A): Daming Temple, (B): Kondo (main hall) built in the late 8th century in Toshodaiji Temple, (C): Twin stone lanterns at Daming Temple given as a gift, (D): Original stone lantern of Toshodaiji Temple. (Authors’ original photographs).

3. Traditional Chinese Medicines Brought to Japan

Jianzhen took a large number of herbal medicines, spices, and medical books to Japan. He brought 36 kinds of herbal medicines from China to Japan, each herbal medicine with different pharmacological effects, and recipes for their different combinations to treat a variety of diseases (Figure 4, Table 2). The spices and the other things that he brought to Japan included musk, agarwood, snail, rosin, dipterocarp, fragrant gall, benzoin, incense, dutchman’s pipe root, pistacia lentiscus, piper longum, terminalia chebula/haritaki, asafoetida, sugar, sucrose, 10 bushels of honey, 80 bunches of sugar cane, and so on. In addition, Jianzhen also collected the medicines and objects that he encountered on the way to Japan and took them to Japan: for example, Stalactites and Zixue. During his stay in Guilin in the southern part of China, he saw many cauliflower stones (stalactites) that could be used as medicine, so he also brought them to Japan [8]. On their fifth trip to Japan, they drifted to Hainan, a southern island. During his stay in Hainan, due to the high temperature, beriberi was prevalent in this area. He found a new prescription and brought it to Japan [4]. After coming to Japan, Jianzhen built a medicinal garden in Toshodaiji Temple (Figure 2B,D) to grow medicinal herbs. Then, he distributed the herbal medicines to patients who helped themselves treat their illnesses [9].

Figure 4. Some representative herbal medicines in Table 2 exhibited currently at a drug shop in Japan. (A): Paeonia lactiflora Pall, (B): Glycyrrhiza glabra L., (C): Angelica sinensis (Oliv.) Diels, (D): Conioselinum anthriscoides ‘Chuanxiong’, (E): Inula japonica Thunb., (F): Atractylodes lancea (Thunb.) DC., (G): Pinellia ternata (Thunb.) Makino, (H): Gardenia jasminoides J.Ellis, (I): Phellodendron chinense C.K.Schneid., (J): Prunus amygdalus Batsch, (K): Cortex of Magnolia officinalis Rehder and E.H.Wilson, (L): Cinnamomum verum J.Presl, (M): Eucommia ulmoides Oliv., (N): Ziziphus jujuba Mill., (O): Rheum palmatum L. (Authors’ original photographs).

Table 2. 36 kinds of herbal medicines brought into Japan by Jianzhen.

NO.	Names of Herbs (Pinyin, Chinese and English Name)	Pharmacological Activities	References
1	Ma Huang (麻黄, Ephedra sinica Stapf)	treats asthma, bronchitis, and hay fever, etc.	[10]
2	Xi Xin (細辛, Asarum heterotropoides)	dispels cold, reduces phlegm, and relieves pain, etc.	[11]
3	Shao Yao (芍薬, Paeonia lactiflora Pall)	treats pain, immune disorders, and inflammation, etc.	[12]
4	Fu Zi (附子, Aconitum carmichaeli Debeaux)	treats rheumatic fever, some endocrine disorders, and painful joints, etc.	[13]
5	Yuan Zhi (遠志, Polygala senega L.)	anti-oxidative, anti-inflammatory, anti-aging, neuroprotective, hypnotic-sedative, anti-viral, anti-tumor, anti-arrhythmic, and anti-depressant effects, etc.	[14]
6	Huang Qi (黄芪, Astragalus mongholicus Bunge )	anti-viral, immunomodulatory, and anti-cancer effects, etc.	[15]
7	Gan Cao (甘草, Glycyrrhiza glabra L.)	treats cough, phlegm, dyspnea, spasms, and pain, etc.	[16]
8	Ku Shen (苦参, Sophora flavescens Aiton)	anti-inflammatory, anti-microbial, anti-pyretic, anti-nociceptive, and anti-tumor effects, etc.	[17]
9	Dang Gui (当帰, Angelica sinensis (Oliv.) Diels)	tonifies, invigorates blood, lubricates the intestines, relieves pain, treats female amenorrhea and irregular menstruation, etc.	[18]
10	Chai Hu (柴胡, Bupleurum falcatum L.)	treats cold fever, irregular menstruation, uterine prolapse, rectocele, chest and rib swelling pain, etc.	[19]
11	Chuan Xiong (川芎, Conioselinum anthriscoides ‘Chuanxiong’)	anti-inflammatory, anti-oxidative, anti-cerebral ischemia, anti-hypertensive, blood vessel protection, anti-myocardial ischemia, anti-thrombotic, anti-atherosclerosis, anti-spasmodic, anti-asthma, and anti-cancer effects, etc.	[20]
12	Xuan Shen (玄参, Scrophularia ningpoensis Hemsl.)	neuroprotective, anti-inflammatory, anti-ventricular remodeling and hepatoprotective effects, etc.	[21]
13	Di Huang (地黄, Rehmannia glutinosa (Gaertn.) DC.)	immune-enhancement, anti-hypertension, anti-diabetes, anti-tumor effects, homeostasis, treatment of urinary tract stones, and ulcerative stomatitis, etc.	[22]
14	Zi Su (紫蘇, Perilla frutescens (L.) Britton)	anti-inflammatory, anti-oxidant, anti-allergic, anticancer, anti-microbial, anti-cough, and anti-depressive effects, etc.	[23]
15	Dan Shen (丹参, Salvia miltiorrhiza Bunge)	anti-oxidative, anti-inflammatory, anti-tumor effects, treats cardiovascular and cerebrovascular diseases, etc.	[24]
16	Huang Qin (黄芩, Scutellaria baicalensis Georgi)	anti-oxidative, anti-inflammatory, anti-viral, anti-tumor, anti-bacterial, neuroprotective, and hepatoprotective effects, etc.	[25]
17	Jie Geng (桔梗, Platycodon grandiflorus (Jacq.) A.DC.)	anti-oxidative, anti-tumor, anti-diabetic, anti-obesity, cardiovascular protective, and hepatoprotective effects, etc.	[26]
18	Xuan Fu Hua (旋覆花, Inula japonica Thunb.)	anti-inflammatory, anti-oxidative, anti-tumor, anti-allergy, blood lipid reduction, anti-diabetic effects, anti-constipation, skin whitening, liver protection, etc.	[27]
19	Cang Zhu (蒼朮, Atractylodes lancea (Thunb.) DC.)	anti-inflammatory, anti-microbial, anti-cancer, anti-pyretic effects, activities on central nervous, gastrointestinal, and cardiovascular systems, etc.	[28]
20	Zhi Mu (知母, Anemarrhena asphodeloides Bunge)	anti-cancer, anti-inflammation, anti-coagulant, and anti-neuronal disorders, etc.	[29]
21	Ban Xia (半夏, Inellia ternata (Thunb.) Makino)	anti-tussive, expectorant, anti-bacterial, anti-emetic, anti-tumor, and sedative-hypnotic effects, etc.	[30]
22	Yuan Hua (芫花, Daphne genkwa Siebold & Zucc.)	treatment of sore throats, cough, edema, etc.	[31]
23	Zhi Zi (栀子, Gardenia jasminoides J.Ellis)	a positive effect on the digestive and cardiovascular systems, anti-inflammatory, neuroprotective, and antidepressant effects, etc.	[32]
24	Wu Wei Zi (五味子, Schisandra chinensis (Turcz.) Baill.)	hepatoprotective, anti-tumor, anti-myocardial dysfunction, anti-myocardial ischemia/reperfusion (I/R) injury, and anti-HIV effects, etc.	[33]
25	Huang Bo (黄柏, Phellodendron chinense C.K.Schneid.)	anti-inflammatory, anti-bacterial, anti-viral, anti-tumor, anti-ulcer, anti-gout, anti-atopic dermatitis, and neuroprotective effects, etc.	[34]
26	Xing Ren (杏仁, Prunus amygdalus Batsch)	anti-inflammatory, anti-tumor, anti-atherosclerosis, anti-fibrotic, analgesic, immunomodulatory, ameliorating reproductive system and digestive system, neuroprotective effects, improving myocardial hypertrophy, and reducing blood glucose.	[35]
27	Hou Po (厚朴, Cortex of Magnolia officinalis Rehder & E.H.Wilson)	pharmacological effects on the digestive system, cardiovascular, cerebrovascular, nervous systems, anti-inflammatory, anti-oxidative, anti-bacterial, anti-tumor, analgesic effects, etc.	[36]
28	He Hou Po (和厚朴, Magnolia obovata Thunb.),	anti-inflammatory, anti-allergic, anti-tumor, and anti-platelet effects, etc.	[37]
29	Rou Gui (肉桂, 桂皮, Cinnamomum verum J.Presl)	anti-inflammatory, anti-viral, anti-tumor, anti-diabetic, anti-obesity, anti-bacterial, analgesic, neuroprotective, cardiovascular protective, cytoprotective, immunoregulatory, anti-tyrosinase effects, etc.	[38]
30	Du Zhong (杜仲, Eucommia ulmoides Oliv.)	anti-oxidative, anti-hyperglycemic, anti-hyperlipidemia, anti-hypertensive, anti-tumor, anti-osteoporosis, immunomodulatory, and neuroprotective effects, etc.	[39]
31	Mu Gua (木瓜, Chaenomeles lagenaria (Loisel.) Koidz.)	anti-inflammatory, anti-hyperlipidemic, anti-hyperglycemic, anti-oxidative, anti-viral, anti-bacterial, anti-cancer, and anti-Parkinson effects, etc.	[40]
32	Da Zao (大棗, Ziziphus jujuba Mill.)	anti-oxidative, anti-inflammatory, anti-viral, anti-cancer, anti-hyperlipidemic, anti-hyperglycemic, immunoregulatory, neuroprotective, and sedative effects, etc.	[41]
33	Shan Jiao, Shu Jiao (山椒, 蜀椒, Zanthoxylum bungeanum Maxim.)	anti-oxidative, anti-inflammatory, anti-hyperlipidemia, anti-tumor effects, etc.	[42]
34	Hua Jiao (花椒, Zanthoxylum bungeanum Maxim.)	anti-inflammatory, anti-oxidative, anti-tumor, anti-bacterial, anti-fungal and analgesic effects, as well as regulatory effects on the nervous system and gastrointestinal system.	[43]
35	Pepper and Wu Zhu Yu (呉茱萸, Tetradium ruticarpum (A.Juss.) T.G.Hartley)	anti-inflammatory, anti-oxidative, anti-bacterial, anti-tumor, anti-obesity, regulating central nervous system homeostasis, cardiovascular protection effects, etc.	[44]
36	Da Huang (大黄, Rheum palmatum L.)	anti-inflammatory, anti-tumor, regulation of gastrointestinal flora, protection of the intestinal mucosal barrier, and inhibition of fibrosis effects, etc.	[45]

Before the arrival of Jianzhen, in the Asuka and Nara periods (6th to 8th centuries), traditional Chinese medicine was adopted in Japan, and the first medical law (Ishitsuryo in the Taiho Code, 701 AD) was enacted during the reform period in the early 8th century [46]. The Ishinho (Ishinpo) is the oldest medical book, consisting of 30 volumes, expounding the importance of foreign medical literature (such as traditional Chinese medicine) to the development of Japanese medicine. All these 36 kinds of herbal medicines are well developed in Japan and are called Kampo medicine now [47]. Japan formulated traditional Chinese medicine into Kampo medicine suitable for the constitution of the Japanese people’s bodies (Yoshiko Takahashi, 2019, https://www.premium-j.jp/en/japanesesenses/20190814_2783/#page-1, accessed on 1 June 2022). The representative prescriptions are in Table 3.

Table 3. Representative prescriptions sold currently in Japan that would have origins in Jianzhen’s herbal medicines.

NO.	Names of Herbs (Japanese, Kanji and English Name)	Prescriptions	Symptoms and Diseases	References
1	Mao (麻黄, Ephedra sinica Stapf)	Mao-To, etc.	fever, cold, etc.	[48]
2	Saishin (細辛, Asarum heterotropoides)	Sho Seiryu-To, etc.	bronchitis, rhinitis, cold, hay fever, etc.	[49]
3	Shakuyaku (芍薬, Paeonia lactiflora Pall)	Shakuyaku-Kanzo-To, etc.	pain relief (acute low back pain/abdominal pain), etc.	[50]
4	Bushi (附子, Aconitum carmichaeli Debeaux)	Mao-Bushi-Saishin-To, etc.	for colds with less heat from the elderly and frail people, etc.	[51]
5	Onji (遠志, Polygala senega L.)	Onji, etc.	expectorant, sedative, anti-dementia effect, etc.	[52]
6	Ogi (黄芪, Astragalus mongholicus Bunge)	Keishi-Ka-Ogi-To, etc.	frail constitution, poor circulation, etc.	[53]
7	Kanzo (甘草, Glycyrrhiza glabra L.)	Kanzo-To, etc.	severe cough, sore throat, mouth ulcer, hoarseness, etc.	[54]
8	Kujin (苦参, Sophora flavescens Aiton)	Shofu-San, etc.	beriberi, heat rash, eczema, hives, etc.	[55]
9	Toki (当帰, Angelica sinensis (Oliv.) Diels)	Toki-Shakuyaku-San, etc.	sensitivity to cold, irregular menstruation, dysmenorrhea, menstrual pain, etc.	[56]
10	Saiko (柴胡, Bupleurum falcatum L.)	Sho-Saiko-To, etc.	loss of appetite, tiredness, late symptoms of cold, etc.	[57]
11	Senkyu (川芎, Conioselinum anthriscoides ‘Chuanxiong’)	Shimotsu-To, etc.	postpartum or miscarriage recovery from fatigue, irregular menstruation, sensitivity to cold, etc.	[58]
12	Genjin (玄参, Scrophularia ningpoensis Hemsl.)	Kami-Untan-To, etc.	symptoms of gastrointestinal weakness: neurosis, insomnia, etc.	[59]
13	Jio (地黄, Rehmannia glutinosa (Gaertn.) DC.)	Hachimijio-Gan, etc.	difficulty urinating, mild urine leakage, low back pain, etc.	[60]
14	Shiso (紫蘇, Perilla frutescens (L.) Britton)	Koso-San, etc.	early stages of cold in a person with gastrointestinal weakness and nervousness, gastrointestinal cold, neurogenic gastritis, etc.	[61]
15	Tanjin (丹参, Salvia miltiorrhiza Bunge)	Kanshin Nigoho, etc.	angina, myocardial infarction, hypertension, etc.	[62]
16	Ogon (黄芩, Scutellaria baicalensis Georgi)	Kakkon-Oren-Ogon-To, etc.	diarrhea, acute gastroenteritis, mouth ulcer, glossitis, stiff shoulders, etc.	[63]
17	Kikyo (桔梗, Platycodon grandiflorus (Jacq.) A.DC.)	Kikyo-To, etc.	tonsillitis, etc.	[64]
18	Senpukuka (旋覆花, Inula japonica Thunb.)	Senpukuka, etc.	expectorant, antitussive, diuretic, etc.	[27]
19	Sojutsu (蒼朮, Atractylodes lancea (Thunb.) DC. )	Keishi-Ka-Jutsubu-To, etc.	joint pain, neuralgia, etc.	[65]
20	Chimo (知母, Anemarrhena asphodeloides Bunge)	Sansonin-To, etc.	insomnia, etc.	[66]
21	Hange (半夏, Pinellia ternata)	Hangeshashin-To, etc.	acute or chronic gastroenteritis, diarrhea, dyspepsia, gastroptosis, stomatitis, neurosis, etc.	[67]
22	Genka (芫花, Daphne genkwa Siebold & Zucc.)	Ju-So-To, etc.	tumor, inflammatory, and allergy, etc.	[68]
23	Shishi (栀子, Gardenia jasminoides J.Ellis)	Inchinko-To, etc.	jaundice, cirrhosis, urticaria, mouth ulcer, etc.	[69]
24	Gomishi (五味子, Schisandra chinensis (Turcz.) Baill.)	Seihai-To, etc.	cough with a lot of sputum, etc.	[70]
25	Obaku (黄柏, Phellodendron chinense C.K.Schneid.)	Unsei-In, etc.	menstrual irregularity, neurosis, eczema, dysmenorrhea, menopausal disorders, etc.	[71]
26	Kyonin (杏仁, Prunus amygdalus Batsch)	Makyokanseki-To, etc.	cough, common cold, childhood asthma, bronchial asthma, bronchitis, hemorrhoid pain, etc.	[72]
27	Koboku (厚朴, Cortex of Magnolia officinalis Rehder & E.H.Wilson)	Hangekoboku-To, etc.	cough, nervous gastritis, anxiety, etc.	[73]
28	Wakoboku (和厚朴, Magnolia obovata Thunb.)	none	none	-
29	Keihi (肉桂, 桂皮, Cinnamomum verum J.Presl)	Keishi-To, etc.	initial stage of the common cold, etc.	[74]
30	Tochu (杜仲, Eucommia ulmoides Oliv.)	Tochucha, etc.	constipation, hypertension, hyperlipidemia, etc.	[75]
31	Mokka (木瓜, Chaenomeles lagenaria (Loisel.) Koidz.)	Keimei-San-Ka-Bukuryo, etc.	fatigue of the lower limbs, difficulty walking, etc.	[76]
32	Taiso (大棗, Ziziphus jujuba Mill.)	Hochu-ekki-To, etc.	weak constitution, fatigue, weakness after illness, loss of appetite, common cold, night sweat, etc.	[77]
33	Sansho (山椒/蜀椒, Zanthoxylum bungeanum Maxim.)	Toki-To, etc.	feeling cold on the back, abdominal bloating and abdominal pain, etc.	[78]
34	Hoajao (花椒, Zanthoxylum bungeanum Maxim.)	Same as Sansho	Same as Sansho	[78]
35	Goshuyu (呉茱萸, Tetradium ruticarpum (A.Juss.) T.G.Hartley)	Goshuyu-To, etc.	headache, vomiting, etc.	[79]
36	Daio (大黄, Rheum palmatum L.)	Daio-Kanzo-To, etc.	constipation, etc.	[80]

This entry is adapted from the peer-reviewed paper 10.3390/compounds2040022

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