presentation
on "The Present State of Oriental Medicine Outpatient Clinics of University
Hospitals" at the 8th Symposium on Japanese Kampo Therapy, held earlier
this year in Tokyo, provides a useful overview of Kampo therapeutics in
Japan today. The report focuses on five of the 25 Kampo clinics now established
at nationally-recognized universities in Japan, representing some of the
most prestigious institutions as well as leaders in Kampo therapy and education:
the University of Tokyo, Toyama Medical and Pharmaceutical University, Keio
University, Osaka Medical College and the Research Institute of Oriental
Medicine at Tokyo Women's Medical College. Highlights of the presentation
follow. The oldest of the five clinics and the first Kampo treatment facility to be located at a state university, the Department of Japanese Oriental (Kampo) Medicine Clinic at Toyama Medical and Pharmaceutical University was set up in 1979. In 1993, the department was upgraded to a full-fledged academic department. According to Prof. Katsutoshi Terasawa, who holds the Kampo chair at the university, this victory was hard-won. The central government was at first unwilling to grant him the necessary staff, space or other facilities to set up the clinic. In order to win government support, says Prof. Terasawa, "you have to show them results."
All the other facilities were established in the last few years: Osaka Medical College established its Kampo treatment clinic in 1991, the Tokyo Women's Medical College in 1992, and Keio University in 1993. The University of Tokyo clinic, established only in November 1994, is the newest.
There is considerable variety among the five institutions in regard to the organization of treatment services. For example, the University of Tokyo outpatient clinic does not accept patients directly, only when they are referred by attending physicians in other departments of the Faculty of Medicine. On the other hand, the Kampo treatment unit at Toyama Medical and Pharmaceutical University offers 15 beds for inpatient treatment in addition to regular outpatient facilities. The other three clinics are primarily outpatient facilities.
With a staff of six full-time physicians and three acupuncturists, The Research Institute of Oriental Medicine at Tokyo Women's Medical College treats the largest number of patients, a total of 5,000 per month. The University of Tokyo clinic, on the other hand, is the most well-staffed of the five institutes, with 13 in-house physicians as well as five outside physicians. Because the clinic was still relatively new, only about 15 patients were reported to be treated per day.
Patient traffic at the other, better-established Kampo clinics is quite heavy. For instance, Toyama Medical and Pharmaceutical University's Kampo unit treats about 100 patients daily, while the Keio University clinic, which has seven physicians on staff, handles a total of about 1,300 patients per month. Osaka Medical College's relatively small clinic, with three staff physicians on rotation, treated over 100 patients in 1994.
While their relations with their respective parent institutions vary, the clinics generally operate within the overall jurisdiction of a pre-existing Western medical infrastructure. The University of Tokyo clinic, as noted earlier, only accepts patients diagnosed by physicians at other departments of the medical school and, thus, functions as a kind of consultation clinic. Similarly, the Keio University clinic does not accept first-visit patients, requiring beforehand a definitive diagnosis by either the Department of Internal Medicine (for patients over 16 years of age) or the Department of Pediatrics (if they are under 16). Intra-institutional referrals also make up the bulk of cases at Osaka Medical College, where the First Department of Internal Medicine has administrative jurisdiction over the Kampo clinic. According to university officials, this dual approach of integrating Western medicine-based diagnoses and traditional Kampo treatments works better than a stand-alone Kampo clinic.
On the other hand, internal referrals constitute a relatively small part of the total patient load at the Research Institute of Oriental Medicine at Tokyo Women's Medical College and the Toyama Medical and Pharmaceutical University. In both cases, word-of-mouth recommendation and media publicity account for most patient visits.
Equivocal symptoms, atopic disease, neurosis, depression, gynecological problems, gastrointestinal disorders, motor organ dysfunctions and post-surgical care are the most common conditions for which Kampo treatment is sought at the five clinics. These tend to be ailments that cannot be understood from the viewpoint of Western medicine and diseases for which no appropriate therapies are available. Women far outnumbered men among the patient population.
Kampo medical education plays an important role for many of these outpatient clinics, all of which are attached to teaching hospitals or academic departments. For students enrolled in mainstream, Western-style medical degree programs at the University of Tokyo, Keio University and Osaka Medical College, training in Kampo techniques is offered either as part of the clinical medicine curriculum or as optional lecture courses of varying lengths. Formal courses are supplemented by case study meetings, readings and seminars.
In programs more specifically focused on Oriental medicine, such as those at Tokyo Women's Medical College and the Department of Japanese Oriental Medicine at the Toyama Medical and Pharmaceutical University, instruction is more detailed and involves lectures, bedside teaching and outpatient clinic tours. Up to now, the Kampo faculty at Toyama has graduated 21 physicians who have taken the normal medical curriculum together with a doctoral degree in Kampo medicine.