In the past, Japan has confronted the issues of high infant mortality rate, and a high prevalence

of infectious disease such as tuberculosis. In a relatively short period, however, Japan has succeeded in

reducing the infant mortality rate to the lowest in the world, as well as all but eliminating tuberculosis,

that was once called a “national scourge,” and Japan is now the nation with the greatest longevity in the

world. The history of Japan’s experiences in the field of public health and medical services has a rich

history throughout centuries past. Factors in this remarkable development have included national

supervision of the network of public health and medical systems, with a national approach to the main

diseases prevalent in each historical era; formulation and enactment of policy based on a firm grasp of

the actual situation, achieved through surveys of public health and medical services and rigorous

statistical collation with the assistance of scientific academia; collaboration between government,

doctors and midwives in private practice, non-government organizations, community organizations, and

the media in overcoming various challenges; outreach services provided by public health nurses finely

attuned to the needs of their local community; and the achievement of universal health insurance

coverage during a period of financial restraint.

Beginning with the most ancient and fundamental aspects of Japan’s health is their timeless

practice of Kampo medicine. It was originally based on Chinese medicine but had been adapted to the

Japanese culture and resources. Kampo literally translates to “the Han Method”, referring to the herbal

system of China that developed during the Han Dynasty. Although Kampo encompasses acupuncture,

moxibustion, and other components of the traditional Chinese medical system, it relies primarily on

prescription of herb formulas. Korean physician, Te Lai, and Chinese Buddhist, Zhi Cong, imported

medical texts with them in 459 and 562 A.D. respectively according to historical records. 1 This was

during a period of early contact with mainland Asia where Japan was learning and incorporating Chinese

written language so that the people could learn from China about Buddhism, Confucianism, government

structure, and the divination arts, opening the way for study of Chinese medicine. Prior to that time,
Japan mainly relied upon shamanism, exorcism, and purifications, with only basic use of symbolic herbs.

By order of the Empress Suiko (reign: 592-628 A.D.) the Japanese court started sending envoys to China.

Some of the Japanese diplomats on their missions brought back medical classics of China. The Empress

Komyo (reign: 701-760 A.D.) established the Taiho Ritsuryo Code (a series of edicts structuring political

and academic structure in 701 A.D.) that provided for, among many other things, founding of a ministry

of health. 1 However, the services of the health ministry were restricted to the royal court and

aristocracy, while Buddhist temples took care of the poor.

Widespread interest in Chinese medicine apparently arose as the result of a visit from the blind

yet generous Chinese Buddhist priest Jian Zhen who arrived in Japan in 753 A.D. and had developed a

great knowledge of medicine and herbs with a zeal to teach it. It took five attempts over a period of 12

years before he was able to cross the rough seas to reach Japan and was said that he had refined his

sense of smell so that he could distinguish between true herbs and any false substitutes despite his lack

of eyesight. Most importantly, he provided free medical services, which boosted the respect for both

Buddhism and Chinese medicine and, along with the charitable act of Empress Komyo a few years

earlier, introducing the concept of social medicine by building no-cost medicinal dispensaries for the

poor in 730 A.D. 1 Being introduced to Chinese medicine by Jian Zhen, numerous Japanese people

became inspired to learn and spread the tradition in Japan, and accumulate more medical works from

China. The basic texts of Chinese medicine, such as the Neijing Suwen Lingshu, and the Materia Medica

came to Japan during the 7th through 9th centuries and were compiled to make the publication of a

compendium of Chinese medical theory and practice in Japan called the Ishimpo. 1 The original Materia

Medica of China classified the herbs into three groups: upper, middle, and lower herbs. The upper-class

herbs were said to be suited for long-term administration to preserve health and attain long life. While

there were numerous plant medicines in this category, the dominant ingredient at the time, the one

used most often by Taoist seekers of immortality, was cinnabar (mercuric sulfide). Only the wealthy
could afford to be taking medicine on a regular basis and thus suffered and died from the poison they

were ingesting. The middle- and lower-class herbs were to be used for treating specific diseases, used

for a relatively short time and thus avoided toxic dosing ironically thanks to the disparity of healthcare

distribution amongst the caste of Japanese citizens. Shanghan Lun and Jingui Yaolue developed formulas

that were mostly comprised of plant materials and safer minerals, the majority which had low toxicity. 1

To this day, many Kampo practitioners study and praise them for steering Eastern medicine onto a safer

path. Japan entered a period of isolation soon after the Ishimpo was published; the last envoys from

China returned in 894 A.D. whose medical theories and practices of their time, dominated Kampo until

the end of the 15th Century. 1

The Portuguese a introduced Western medicine to Japan by 1590 and additional entry of Western

medicine came via Spain during the early 1600s, but this influence of Portugal and Spain was limited to

the coastal regions. Japanese leadership adopted a policy of national isolation soon after the Portuguese

and Spanish incursions, allowing trade and interchanges only with the Dutch (among Western powers)

starting in 1639, which brought entry of Dutch physicians and medical works. 1 Foreign medicine took on

importance only after Japanese scholars analysed and wrote their perspective of the findings. For

example, in 1774, Genpaku Sugita published Kaitai-shinsho (The New Book of Anatomy), which greatly

enhanced the reputation of Western medicine.

In 1852 President Millard Fillmore ordered Matthew Calbraith Perry, who commanded the U.S. East

India Squadron, to travel to Japan, meet with its leader, and open diplomatic and trading relations. Perry

sought to present a letter to the Emperor, but he was forced to leave. He returned in February 1854

with eight ships—one-third of the U.S. Navy—and on 31 March 1854, he signed the Treaty of Kanagawa,

which opened Japan to trade and provided for care of shipwrecked Americans. Japanese leaders saw
China being battered by the British and French and the spread of the so-called unequal treaty system

granting the Western power extensive rights and privileges in China; there also were powers in Japan,

rich daimyo, or feudal lords, in the southwest, who wanted to reform Japan to resist foreign

encroachments.

1. Dharmananda S. Kampo Medicine: The Practice of Chinese Herbal Medicine in Japan.

Itmonline.org. http://www.itmonline.org/arts/kampo.htm . Published 2010. Accessed October,
30. 2018.
2. 2. Japan's Experiences In Public Health And Medical Systems. Tokyo: Japan Internal Cooperation
Agency; 2005. https://www.jica.go.jp/jica-ri/IFIC_and_JBICI-
Studies/english/publications/reports/study/topical/health/