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Extraordinary Views of Abdominal Patterns: Fukosho-Kiran

Extraordinary Views of Abdominal Patterns: Fukosho-Kiran

Inaba Bunrei’s Fukushō-Kiran (Extraordinary Views of Abdominal Patterns) is considered to be the most authoritative work on abdominal diagnosis in Japan. This book distills the writings of Zhang Zhongjing into practical system of thought on abdominal diagnosis and the Shang Han Lun or Jin Gui Yao Lue formula which treats each abdominal pattern.

During the Edo period, Kampō, the native Japanese system of medicine began to evolve separately from traditional Chinese medicine, and abdominal diagnosis within Japan became more widely utilized among physicians compared to pulse diagnosis. One reason that abdominal palpation became popular was because it did not rely on the often complicated diagnostic techniques of Chinese medicine, as each abdominal pattern is thought to correspond to a single formula under a theory known as formula-pattern correspondence. These formula-pattern correspondences are captured in eighty-two illustrations, along with Inaba’s understandings on the pattern, formula, ingredients, and dosage. Inaba, like all good teachers, weaves stories and anecdotes from his lifetime experience of treating patients into the body of the work. The Fukushō-Kiran has been expertly translated by Jay Kageyama, and the Chinese Medicine Database is excited to add this Japanese text to our growing body of published translations.

SKU: B9780990602958

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JCM Review

This book is the recent addition to a line of illustrious classical Chinese medicine publications by the Chinese Medicine Database. As much a precious historical document as a clinical manual, it offers a wealth of insight and experience from its author Inaba Katsu Bunrei, thanks to the meticulous translation by Jay Kageyama. The book offers a profound insight into the context of Kampo medicine in the Edo period, whilst deepening one’s appreciation of what it takes to master the art of applying classical formulas. Inaba’s opening lines read, ‘One cannot draw (spring water) from a well using a short rope.’ Diligence in one’s studies is essential. Abdominal examination has existed since at least the end of the Eastern Han Dynasty, however owing to the emphasis placed upon pulse and tongue diagnosis in mainland China, the practice of abdominal diagnosis diminished and its methods failed to develop. However, the flourishing of Kampo medicine during the seventeenth century in Japan meant that abdominal examination became much more widely used. Generations of Kampo masters, most notably Todo Yoshimasu and Inaba Bunrei, refined with wisdom and diligence the methods of abdominal examination found in the Nan Jing (Classic of Difficulties) and Zhang Zhong Jing’s Shang Han Lun (On Cold Damage) and Jin Gui Yao Lue (Essential Prescriptions from the Golden Cabinet). Anyone interested in the patterns associated with classical formulas, particularly from the Eastern Han Dynasty, and who wishes to deepen their knowledge of the relationship between abdominal examination and formula patterns will greatly benefit from the instructions in this book. Jay Kageyama’s precision in translation, guided by the threefacet theory of translation, ‘faithful, expressive and elegant’, allows access to the richness of this text. Footnotes are impeccably researched and enlightening; a true repository of medical, historical and geopolitical information. Both Chinese and Japanese scripts precede the English translation to enable those who can read them to make their own interpretation of each pattern as well as of the insight and advice of Inaba Bunrei. The book is further enhanced through exquisite illustrations by the Edo artist Oka Yugaku of Naniwa (1762-1833 CE). Each illustration shows the exact anatomical location of an abdominal pattern together with its associated formula. These illustrations are beautiful works of art in their own right. The book comprises four volumes, the first two of which contain roughly equal numbers of abdominal patterns from Shang Han Lun and Jin Gui Yao Lue. The final two volumes have a higher proportion of Jin Gui Yao Lue formulas. Interspersed are fascinating Kampo formulas from Yoshimasu Todo, family lineage formulas and other formulas the origins of which are now lost to history. Each volume has its own index section detailing dosages formula by formula, which enables easy referencing. A short autobiography and introduction explains Inaba Bunrei’s humble origins, which were made particularly challenging by being orphaned as a small child. As an adult he fell into poor habits and in later years alcoholism plagued his life and led to him suffering several strokes. After a fruitless search for a teacher and being continually rejected by the medical establishment of Kyoto, he finally located a physician willing to take him on as a student at Naniwa. Despite him being ‘obstinate and foolish with vulgar and coarse behaviour’, Kaku Taiei agreed to take him on as his student of abdominal examination. As Inaba was illiterate his Sensei feared his advanced years precluded any hope of book learning. He instructed Inaba to ‘train day and night’ to understand the imparted teachings in order to perform medical treatment. Towards the end of his life, Inaba’s pupil Sosuke convinced him to commit to writing his experiences of abdominal patterns after years of successful administering of classical formulas. Volume One was written in 1799 and followed up in 1801 by Volume Two. Inaba died shortly after in 1805 and the volume was completed posthumously. Inaba’s first instruction concerns the correction of ‘Mind Qi’ in the patient and practitioner before starting abdominal examination, in which the physician focuses their mind on the goal of curing disease while examining the body of the patient. The specific method of using the palm, fingers and fingertips to diagnose is explained in detail. Once the abdomen has been thoroughly investigated, the external signs are inspected and lastly the patient is asked if they are suffering from any type of disease. This method of beginning from the innermost motivation of the physician, gradually reaching further outward to the physical core of the patient, until at last taking in the voice of the patient might seem in contrast to modern methods of diagnosis, which often start with questioning the patient. Congruent with this instruction, each pattern is first described in terms of the abdominal findings, followed by other observations of the condition. The book describes patterns for 59 formulas from Shang Han Lun and Jin Gui Yao Lue, several from other classical texts and 10 additional Japanese formulas, some of which are no longer understood, out of circulation or come from specific family lineages. Footnotes detail medical understanding of over the counter and prescription drugs currently available in Japan as well as fascinating details of ancient medical thought in Japan. In keeping with the order of the Shang Han Lun, the first pattern described is for Gui Zhi Tang. In the Shang Han Lun, it is not until Line 13 that there is mention of abdominal symptoms; previous lines concern the pulse as key to confirming symptoms. It is interesting to consider how Zhang Zhong Jing’s classical texts were appropriated by Kampo masters to make best use of abdominal examination. This is far from obvious. However the precision of Inaba’s methods and his indomitable confidence make clear that these methods were well established and understood, even to someone purportedly illiterate. His contribution is testament to his earnest and unrelenting pursuit of mastering abdominal examination. Many of the formula patterns presented are arguably focused on the treatment of chronic diseases. Inaba’s instructions are extremely precise; there are methods for attacking toxins through the use of single or multiple formulas, some applied simultaneously, others to follow one another. Each pattern is illustrated to show the precise location in the abdomen, with signs and symptoms to confirm in order to establish the correct formula. Inaba frequently cites cautions to bear in mind. For example, in the pattern for Chai Hu Jia Mang Xiao Tang he explains: ‘Hardness can be felt [upon palpation] it feels as if there are two large bamboo poles that have been placed [in the abdomen] … however those in the world ignorant about abdominal examination take this to be the pattern for Xiao Jian Zhong Tang or the pattern for hypertonicity that is treated with shao yao. These are grave errors.’ Inaba is brutally honest about his own errors and records these for the benefit of future students, for example the case of the following patient: ‘The abdomen is swollen, similar to [a case of] distention and fullness. [The patient presents with] squamous dry skin and tense abdominal skin. When palpated [the abdomen] is soft.’ Inaba recounts erroneously prescribing this patient Da Cheng Qi Tang, followed by Da Chai Hu Tang, both with no improvement. Inaba then consulted Kaku-Sensei who severely admonished him: ‘It is because of people with poor skills such as you that have greatly caused this ancient way of medicine to become corrupted … the pattern in which the patient presents with squamous dry skin, tense abdominal skin and a soft [abdomen] upon palpation is the pattern for Yi Fu Zi Bai Jiang San. Where are the patterns for the formulae of Da Cheng Qi Tang and Da Chai Hu Tang that you used?’ Indeed, the abdominal findings are quite distinct. The Da Cheng Qi Tang pattern: ‘The abdomen is completely full and feels hard upon palpation’ or ‘ there is a long hard region in the centre of the abdomen … pain may not necessarily be present.’ Whereas in the case of Da Chai Hu Tang: ‘The patient presents with bitter fullness in the chest and ribsides and slight hypertonicity is present … manifested as a lump … the abdomen will spring back when pressed with the fingertips … the abdomen has slight replete fullness and the region below the heart has not hardness but only glomus.’ The value and richness of this book cannot be overstated. For clinicians already versed in abdominal examination, it promises a wealth of fascinating detail to enhance practice. For those setting out to acquire the necessary skills of abdominal examination, Inaba’s experiences and advice will encourage and inform a student’s learning this important art. I recommend this book, with gratitude to Inaba Katsu Bunrei for overcoming the profound obstacles and adversity in his life, for his dedication to the practice of abdominal examination, and for so generously giving modern practitioners insight into his clinical practice and allowing them to benefit from it; gratitude also goes to Jay Kageyama for his meticulous attention to detail and to the Chinese Medicine Database for preserving and bringing forward such an important and precious historical document.

Victoria Conran.


AuthorInaba Bunrei
Publication Date18/08/2018
PublisherChinese Medicine Database
Number Of Pages326
Book FormatSoftback

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