HEALING AND MEDICINE: HEALING AND MEDICINE IN JAPAN

This article is confined to healing and medicine among the Japanese. For lack of space, no specific discussion on minorities in Japan, such as the Ainu, Koreans, Chinese, and Okinawans, is included. Neither is the vast variation in practices among the Japanese specifically addressed. Excluded are the medical dimensions of the so-called new religions (shinkō), shamanism, and ancestor worship. Numerous new religions mushroomed in Japan after World War II. Although they have many adherents and health-related matters often occupy a central place in their beliefs and practices, their role in health care is limited to their memberships. Once a powerful nonformalized religion in Japan, shamanism used to play a significant role in the health care of the people, but much of it has now been transformed and absorbed into new religions. Consequently, its importance for the general public has been significantly reduced. So-called ancestor worship remains perhaps the most important aspect of the religiosity of contemporary Japanese, including urbanites, regardless of class. However, the role of ancestors is to look after the living in very general and diffused ways and thus it is not covered here.

Major Characteristics of Japanese Notion of Health/Illness/Healing

Several major concepts that characterize the notions of health, illness, and healing are: health as an ephemeral state; the importance of the notion of balance, with imbalance leading to illness; the principle of purity (health/balance) and impurity (illness/imbalance); and the importance of the intactness of the body.

Upon birth, one receives a body with all its weaknesses, including one's taishitsu, "inborn constitution," and jibyō, a chronic illness one is born with. The most commonly recognized taishitsu are "strong" (jōbu ); "ordinary" (futsu'u ); "weak" (kyojaku ); "nonenergetic and constitutionally susceptible to illness" (senbyōshitsu ); "very weak" (horyūshitsu ); and "extra-sensitive" (shinkeishitsu ). Others referring only to somatic characteristics of a particular body part include "chilling disposition" (feeling of chill in the stomach and the legs), "tendency to get tired easily," and others.

Jibyō means an illness or illnesses that a person carries throughout life and suffers at some times more acutely than at others. The word is written in two characters, the first one meaning "carrying" and the second one "illness." Common jibyō are rheumatism (ryūmachi ), "weak stomach" (ijaku ), "descended stomach" (ikasui ), gastralia (ikeiren ), excess stomach acid (isankata ), and high/low blood pressure.

Many Japanese are quite aware of their own taishitsu and jibyō. Parents are especially keen on being watchful over their offspring's departures from health by, for example, not allowing a child with weak taishitsu to exert him- or herself. One nurtures the body given at birth rather than trying to conquer and alter it, while constantly monitoring minute fluctuations of the body. Even with the diffusion of jogging and other health care practices from the United States, perfect health is seen as ephemeral and ordinary health is a condition that fluctuates.

This fluctuation is caused by an ever fluid system of bodily balance and imbalance, the latter inviting an illness to take over the body, as further detailed in the section on kampō. Bodily imbalance is a state of impurity, whereas its balance/health is assigned the value of purity. The purity/impurity opposition is an important principle that governs daily hygiene and notions of health and illness, as well as contemporary practices of shrines and temples.

Some of the most important early socialization training for Japanese children is to take their shoes off, wash their hands, and, in some families, gargle when they come into the house from outside. The Japanese explain this custom by stating that one gets dirty from germs outside. Although the concept is expressed as "germs" in biomedical terms, it is the symbolic association of the spatial "outside" with culturally defined "dirt." To keep oneself clean and healthy "inside" one's living quarters, one must get rid of this dirt through cleaning/purification of impurity. Thus, even after Western-style housing, including apartments, were introduced, all homes have a genkan, a square or rectangular space at the entrance where people take their shoes off. Many overseas Japanese continue to adhere to this practice wherever they go. The "inside" includes seats on taxis, trains, and buses, where children must take their shoes off if they wish to sit to look out the window. The strikingly white starched covers on the seat of taxis and bullet trains are a symbolic expression of "inside," and people are expected to treat them as such.

That the welfare of the body is essential to the welfare of the soul is clearly expressed in the two most important and interrelated characteristics of the Japanese concept of the body: the intactness of the body (gotai ) and nonviolence to the body. Together these notions lead to the Japanese emphasis on the "natural" state of the body or the "natural" course of life.

Pluralistic System of Medicine and Healing in Contemporary Japan

The perspective taken in this article is the folk perspective of everyday health care rather than the institutional or doctrinal perspective of Shintoism and Buddhism—two major institutional religions of Japan. The major characteristic of the Japanese system of medicine and healing is that it is pluralistic. The system includes: kampō (the Japanese system of healing with Chinese origin), healing at the religious institutions of shrines (Shintoism) and temples (Buddhism), and biomedicine, of which only the first two are introduced here because they are embedded in religions and the worldview of the Japanese. Their peaceful coexistence, as it were, is striking, since in terms of their basic premise they are contradictory to each other. In addition, despite their basic differences, each absorbed others so that biomedical health care makes room for kampō and religious elements. It is the people who adopted these different systems and somehow made them into their own and use all of them simultaneously.

Chinese-derived Japanese Healing: KampŌ

As with other humoral medicines, traditional Chinese medicine is based on "a system of correspondence," rather than "a system of causation," which characterizes biomedicine. For the Japanese traditional medicine of kampō, derived from Chinese medicine, the basic premise of medical treatment is restoration of the balance of the body, which then would remove etiological conditions and therefore pathogens as well. Its basic premise, therefore, is very similar to the Japanese folk's understanding of health, illness, and healing.

Given the premise, then, treatment is not aimed directly at removing the pathogen, and thus surgery is the polar opposite of the notion of treatment and is actually seen to further aggravate the body's imbalance. Therefore, despite the prestige and glory accorded biomedicine in Japan, the Japanese have been quite cautious and selective about adopting surgery. For the Japanese, who avoid going outside after taking a bath so as not to shock the body by the cold air and who have not practiced body mutilations for aesthetic purposes (until recently, under American influence), surgery is an extreme form of violence to the body, although its popularity has rapidly increased in the last couple of decades. The enormous hesitancy of the Japanese to adopt organ transplantation relates to this aversion to violence to the body, as well as to the importance they place upon the intactness of the body, both for the living and for the dead; peaceful afterlife is predicated upon the intactness of the body of the deceased.

In contemporary Japan kampō comes in all shades, from orthodox practice to mass-produced and prepackaged extracts of herbs to street-corner computer diagnoses. The orthodox kampō practice today is a medicinal system developed in Japan after its introduction from China. In a radical departure from biomedicine, kampō does not recognize categories of illness. Diagnosis does not consist of labeling the illness. Each departure from health is diagnosed on the basis of the combined total of symptoms the patient experiences and those the kampō doctor detects. The sum total, called shōkōgun, is carefully evaluated against the sex, age, and constitution of the patient and the climate in which the patient resides in order to reach a proper prescription for treatment. A kampō doctor, using auditory, tactile, olfactory, and visual faculties in reading the patient's condition, prescribes a specific treatment. Its treatment consists of moxibustion (burning of the cones of dried young mugwort leaves), acupuncture, and herbal and animal medicine. In the case of herbs, it is a mixture consisting of a dozen or so, which the patient brews in an earthen kettle for a long time and drinks. Every patient therefore has a unique illness and requires a unique set of treatments.

Even though the American Occupational Forces prohibited moxibustion and acupuncture at the end of the World War II and they went underground, in contemporary Japan not only has kampō become enormously popular among laypeople but also the government has supported this system of medicine by financially supporting research in kampō and gradually adding kampō treatments under health insurance coverage. It exists in a symbiotic mode with biomedicine in that it specializes in chronic illnesses, especially those accompanied by chronic pain; new types of illnesses, including gerontological illnesses; and illnesses resulting from environmental pollution and traffic and industrial accidents, none of which biomedicine has been successful in treating. Its popularity is also in part the result of reaction to the negative side effects of biomedicine.

Religious Healing: The Role of Temples and Shrines in Health Care

Except for native Shintoism, other religions were introduced from abroad: Buddhism from India via Central Asia, China, and Korea; Confucianism, Daoism, and several other religions from China; and Korean shamanism. These religions have permeated the daily lives of the Japanese; they have become part of their customs without requiring any psychological commitment on the part of the individual to any one of them. Most Japanese subscribe to more than one religion, often without consciously realizing it. They go through Shintō rituals related to life, such as births and marriages, but most funerals and the rituals related to the deceased are Buddhistic. The annual statistics on Japanese religious affiliation consistently list the total membership in various religious organizations as one and a half times the total population of Japan. In other words, over half of the people in Japan belong to more than one religious organization.

The current popularity of temples and shrines in Japan is phenomenal and in fact has been increasing for some time. Many temples and shrines throughout Japan attract literally millions of people a year for a number of reasons, including pure tourism. They go to these religious institutions by tour buses, with friends and families, or alone. Temples and shrines provide healing of illness, promotion of the general welfare of the people, or promise of the fulfillment of wishes.

Healing of illnesses

Some temples and shrines are known for their efficacious administration of moxibution or acupuncture so that it is hard to draw a line between kampō and healing at these religious institutions. On the other hand, people go to most of these institutions to purchase amulets and talismans that are thought to have healing power, and they write their prayers/wishes on votive plaques.

Some of these institutions are so popular that bus companies operate regular tour buses that take people to them. The tours for older people target temples and shrines that specialize in illnesses of older people, such as strokes and hemorrhoids. On the other hand, medical and other uses of temples and shrines are by no means confined to the aged. With an increase in the cancer rate, those that specialize in the cure of cancer are visited by people of all walks of life and of all ages. For example, the deity enshrined at Ishikiri Shrine to the northeast of Osaka used to be good for various kinds of boils and growths, but its major appeal at present is its efficacy in treating cancer. Visitors here are not confined to the aged, although young people are fewer because cancer afflicts mostly older people.

A number of temples and shrines are known for their power to guarantee safe and easy childbirth and illnesses related to childbirth, which is not considered illness in itself. A brief description of Nakayama-dera near Osaka shows the role of religion among people in their day-to-day lives. The major hall (hondō) of the temple is situated on top of a hill and flanked by numerous jizō, the guardian buddha of children, on the hillside. On both sides of this central pathway are separate temples enshrining various buddhas, each specializing in a certain function. One is a temple that specializes in success in the university entrance examination. Another temple enshrines a buddha who specializes in taking care of infants who have temper tantrums, do not sleep, cry at night, or are constitutionally very weak. Another temple, which bears a sign in front for traffic safety and the naming of newborn infants, also houses Mizuko Jizō (the jizō buddha for aborted fetuses). Inside this temple are many jizō for aborted fetuses, and numerous votive plaques are hung on two wooden structures. Often apologies, such as "Please forgive me/us," are written and signed by the mother or by the couple. "Please sleep peacefully" is another common prayer on these plaques.

At the top of the hill, in front of the main hall, is a large metal incense burner. People buy bundles of incense, light them, and place them in the burner; many then "scoop" up the smoke with a hand and bring it onto an ailing part, such as the hip, to apply its "healing power." Visitors, especially women with infants, also purchase white bibs, write prayers and their names and addresses on them, and hang them on a stake around the buddha in front of the main hall. The main hall itself houses two offices. On the right side is a small office where the temple employees sell sashes. Many pregnant women in Japan continue to wear the traditional long white sash (iwata obi ) over the stomach during pregnancy. After purchasing a sash, a woman would ask the priest of the temple to write a sūtra on it. They then take it to their biomedical obstetrician, who writes a character for happiness in red on the sash. On the left is another small office where used sashes must be returned.

The composition of visitors to Nakayama Temple also reflects the complex human network involved in childbirth. Although pregnant women and mothers with young children comprise the core of the visitors, many are accompanied by older women and sometimes by older men. A number of women are accompanied by their husbands, reflecting the recently increased emphasis on the conjugal bond and the nuclear family.

The central focus of the temple is childbirth and matters related to infancy, including easy and safe delivery, the healthy growth of children, and memorial services for aborted fetuses. The temple has long served also as a place for the shichigo-san celebration—a celebration marked by a visit to a shrine, usually on November 15, when a child is three, five, and seven years old (shichigo-san means seven, five, and three).

General welfare and prayers for wishes

Young people may go to temples and shrines less for illnesses than for other reasons; most common are success in entrance examinations and luck in finding a boy- or girlfriend. These wishes are written on votive plaques and hung on a wooden structure provided for them. Similarly, with a strong emphasis on school trips in Japanese schools, one often sees school tours at temples and shrines, with elementary, middle, and high school students flocking to buy amulets, charms, and other souvenirs for themselves and for their families. The youngsters today hang the amulets and charms for protection from traffic accidents on their knapsacks or pocketbooks, just as every taxi and private car, even those driven by young people, has an amulet for traffic safety hanging from the rearview mirror.

One of the most popular uses of shrines and temples in contemporary Japan is for the purification of automobiles on New Year's Day. With the rapid increase in private car ownership, "my car"—a term borrowed from English and pronounced in Japanese as "mai ka"—is both a popular word and a symbol of a new way of life, symbolizing the new emphasis on nuclear families and the image of young parents with strong conjugal bonds, contrary to the image of the traditional extended family. Despite the modern image of these "my car" owners, who are usually young or middle-aged, all flock to shrines and temples on New Year's Day to have their cars purified. This is the time when the Japanese engage in all sorts of activities to get rid of impurity accumulated during the past year, but the purification of "my car" is a new addition. The purification service includes a purification rite, a prayer, amulets, and bumper stickers. The service has become so profitable for temples and shrines that some of them have constructed extra parking space and other facilities to accommodate "mass" purification rites.

Goriyaku: "Occupational specializations" of deities and buddhas

To the Japanese, perhaps the most meaningful feature of the multitude of deities, buddhas, and other supernaturals is their goriyaku— the benevolent functions they perform. The lives and fates of these deities do indeed reflect the major concerns of people of the time. Outmoded specializations are often discarded or transformed into new, more meaningful roles. The roles related to childbirth, child welfare, and general matters of illness and health comprise over half of the specializations of temples and shrines in general, indicating that these are perennial concerns of the people. In contrast, functions related to calamities, including traffic accidents, are much fewer in number, and their nature changes over time. For example, natural disasters and fire were major concerns in the past and were reflected in the specializations of deities and buddhas at the time. Contemporary Japanese seem to place more emphasis on luck and success in life. Of paramount importance in the past, the deity of smallpox is no longer meaningful in contemporary Japan, and its function had been expanded to incorporate contagious diseases in general. Likewise, the Deity of Coughing was originally a very popular deity when influenza was a major threat. Since influenza is better controlled in contemporary Japan, the deity is now also consulted for chronic respiratory illnesses, including asthma.

Summary

The roles played by religions in contemporary Japan offer an example of how religions remain important in people's lives, including the young, in contrast to a view of unilinear "progression" in which religion is replaced by science. Japan's case is by no means unique, as Americans remain profoundly religious, though not in the same way the Japanese are, and in many postindustrial European countries, such as France and Italy, folk religions—religions as practiced by the folk—remain important in their medicine and healing.

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Emiko Ohnuki-Tierney (2005)