Exchange of information in rheumatology between east and west: FromMan'yo-shu to the future

Abstract

The most ancient record of rheumatoid arthritis (RA) in Japan is found in the Man’yo-shu, the oldest of the imperial anthologies of Japanese poetry published in the 8th century (AD 759), the Nara era of Japan’s history. Man’yo-shu is composed of 20 volumes, including 4,500 poems. One of the authors, Yamonoueno Okura (Figure 1), who died in AD 733, had progressive destructive polyarthropathy. He wrote many elegant and beautiful poems in the Man’yo-shu and also one article, entitled “Lament for my life with the disease” in the fifth volume. In the article, he expressed the thought that none of the treatments could release his pain and he would not mind turning into a mouse from a human being if somebody could remove the symptoms from his body. Those descriptions lead us to think that he was suffering from rheumatoid arthritis. If only at that time he had the possibility to receive some of the current treatments for RA, now, 1,300 years later, we could enjoy much more his beautiful poems. Several years ago, one of the authors of this article traveled to Tours in France and found in a tiny bookshop an ancient edition of a medical book titled Traite des principaux objets de Medecine, printed in 1762 (Figure 2A). Only one chapter of this book is dedicated to arthritis, chapter V, in the second volume entitled “De la Goutte” (Figure 2B). There is no description of RA, as all arthritis was classified as gout. The first paragraph in chapter V reads, “Is Moxa effective for arthritis?” The author writes “Moxa is used in Japan.” Moxa is a Japanese dried leaf of mugwort used for cautery. Therefore, ancient oriental treatment was performed in France before the French Revolution, showing that there was exchange of rheumatology knowledge between the East and the West before the 18th century. How the exchange of clinical information occurred at that time is not known, but it is likely that knowledge circulated using the ancient trade route called The Silk Road that linked East with West and carried active trade of goods and ideas between two great civilizations. Nowadays, communication and exchange of information between East and West is much easier. In the field of rheumatology, the American College of Rheumatology (ACR) and international journals, in particular Arthritis & Rheumatism (AR Tsuneyo Mimori MD, PhD: Graduate School of Medicine, Kyoto University, Kyoto, Japan. Address correspondence to Tatsuya Atsumi, MD, PhD, Department of Medicine II, Hokkaido University Graduate School of Medicine, N15 W7, Kita-ku, Sapporo 060-8638, Japan. E-mail: at3tat@med.hokudai.ac.jp. Submitted for publication September 12, 2007; accepted September 12, 2007.