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Routledge Handbook of Chinese Medicine

Vivienne Lo, Michael Stanley-Baker, Dolly Yang

Chinese-style medicine in Japan

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Katja Triplett
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35
CHINESE-STYLE MEDICINE
IN JAPAN
Katja Triplett

Chinese-style medicine became the dominant style of medicine in Japan from the period of
early state-building in the fifth century CE onwards. It is only since the middle of the nine-
teenth century that it has been called Kanpō 漢方, literally the ‘Han method, or formulæ’ of
medicine. The history of Chinese-style medicine in Japan can be roughly divided into three
periods. These periods are: early encounters with Chinese-style medicine and initial adap-
tations; the development of autonomous medical traditions; and the decline and revival of
Chinese-style medicine in modern Japan (Michel-Zaitsu 2017). Medical ideas and practices
reflect those in China but as they reached Japan in an irregular if not erratic fashion, Japan
developed independent and unique approaches (Rosner 1989). Periods of intense exchange
between Japan and her neighbours alternated with phases of near complete termination of
these exchanges following the breakdown of diplomatic and trade relations in times of war
and strife. Adaptation of ideas from European doctors and scientists in the early modern
era, primarily from the seventeenth century onwards (Otori 1964; Bowers 1970), resulted
in an even more hybrid system of medicine in Japan. These developments can, in part, be
explained by the location and geography of the Japanese island empire.
The global trade conducted in Nagasaki, Ōsaka, Kōbe, Edo (today’s Tōkyō) and other
places has always included the import of raw materials for Chinese-style medicine as prac-
tised in Japan. Many of the plants, animal products and minerals necessary for practising this
form of medicine had to be imported because they could not be found widely or at all on
the Japanese archipelago. While attempts to cultivate the requisite plants in the seventeenth
century were somewhat successful, Japan continued to depend on imported raw materials
for medicines.
From the fifth century, immigrants, including doctors, monks and nuns, smiths and other
craftsmen, settled in Yamato. The first doctors came from the Korean kingdoms of Silla,
Baekje and Goguryeo. As part of early state-building, the Yamato monarchs, who called
themselves ‘heavenly rulers’ (tenn ō 天皇), introduced Chinese-style forms of bureaucracy.
New institutions were established including a Bureau of Medicine (Ten’yakuryō 典薬寮,
renamed Yakuin 薬院 in the sixteenth century), a medical school and medicinal gardens
(Chapters 6 and 7 in this volume). The eighth-century legal codes and their commentaries
mention doctors who were to practise Chinese-style acupuncture, moxibustion, herbology,
exorcism and massage (Hattori 1945).

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Another important development in the history of medicine in Japan was the introduction
of Buddhism from Baekje (Chapter 28 in this volume). Following a period of conflict with
practitioners of Shintō 神道, the established religion devoted to the worship of local deities,
Mahāyāna Buddhism became the dominant religion in Japan (Bowring 2005: 15–35). The
Japanese started to practise Buddhism in its East Asian version in combination with Shintō.
Indian medical ideas arrived in Japan with Buddhist writings that were often direct trans-
lations from Sanskrit into Chinese. There is no convincing record of direct encounters be-
tween Indian and local doctors in Japan, as there is for medieval China (Unschuld 1998: 64).
Indian medical ideas were studied but were generally not put into practice. An exception here
is that Indian-style eye surgery (cataract couching) was practised, and indeed became widely
popular in medieval and early modern Japan (Mishima 2004: 65; Triplett 2017, Triplett
2019: 80–91). Buddhism remained a prevailing cultural force until the end of the sixteenth
century and has continued to be influential in Japanese culture and society. As centres of
learning and erudition, Buddhist temples in Japan offered training in Chinese-style medi-
cine while state institutions also educated doctors. Secular court doctors were organised in
family lineages. Both groups of medical practitioners, Buddhist monastics and court doctors,
engaged in healing members of the ruling elite while Buddhist monastics also treated other
members of medieval and early modern society (Hattori 1982; Shinmura 2013; Andreeva
2017; Triplett forthcoming).
Professionalisation through private and state academies in the Neo-Confucian style as
well as an increasing differentiation between the religious and the secular sphere in Japanese
society resulted in the emancipation of qualified doctors from the seventeenth century on-
wards. The new government that came to power in 1868 decreed an official separation of
Buddhist and medical practice in 1874 in order to separate these two spheres more strictly.
The introduction of Western medical systems and state licensing in this period of ‘moderni-
sation’ led to the decline of traditional medicine in Japan. Kanp ō medicine has enjoyed a
revival since the 1950s after various efforts to obtain official recognition.

Early encounters with Chinese-style medicine in Japan and

first adaptations
When the central state of Yamato became fully established in the eighth century CE, the
tenn ō ordered the composition of official chronicles following the Chinese model. The Re-
cord of Japan (Nihon shoki 日本書紀, 720) mentions the activities of doctors from the Korean
Peninsula. During the reign of Kinmei tennō 欽明天皇 (509–571, r. 539–571), contact with
the Asian continent intensified. The tenn ō invited a doctor, herbalists and others specialising
in various sciences from Baekje to Japan to exercise their skill and train local students. The
Chinese-style medical arts practised in the Korean kingdoms were greatly admired but med-
ical texts and medicines also reached Japan directly from China. Treatises such as the Sui-­
dynasty Treatise on the Origins and Symptoms of All Disorders (Zhubing yuanhou lun 諸病源候論,
compl. 610), the Arcane Essentials from the Imperial Library (Waitai miyao, or Waitai biyao 外臺
秘要, 752) by Wang Tao 王燾 as well as Sun Simiao’s 孫思邈 (581–682) Important Formulas
Worth a Thousand (Qianjin yaofang 千金要方, 650–659) had an important impact on Japanese
medical culture (Chapter 8 in this volume). The early eighth-century legal codes – the no
longer extant Taihō Code 大寶律令 and the later Yōrō Code 養老律令 that is preserved in
the commentary Ryō no gige 令義解 of 833 (transl. Dettmer 2010) – regarding the medical
training of official medical personnel closely followed the Penal Code of the Tang (Tanglü shuyi
唐律疏義). The Japanese codes prescribed several standard medical textbooks (Ryō no gige

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book 8, part 24, sections 3, 4, 11 and 13; Dettmer 2010: 438–42): the third-century Numbered
Classic of the [Yellow Emperor] ([Huangdi] jiayijing 黄帝甲乙經), the as yet unidentified Pulse
Classic (Maijing 脈經) from the same period and Materia Medica (Bencao 本草), the latter prob-
ably being the Tang-dynasty Revised Materia Medica (Xinxiu bencao 新修本草). Works that
students had to study in Japan included many books that are now lost or unknown. Others
are still standard works for medical students today. The legal code lists the following books:
the Lesser Grade Remedies (Xiaopinfang 小品方), Collection of Experiential Formulas ( Jiyanfang
集驗方) and Luminous Hall (Mingtang 明堂) – all now lost – the Needling Classic of the Yellow
Emperor (Huangdi zhenjing 黄帝針經), which may refer to the Lingshu, as well as the extant
Basic Questions (Suwen 素問) and Pulse Diagnostics (Maijue 脉訣). The latter was most prob-
ably an alternate title for Stratagems for Taking the Pulse (Maijingjue 脈經訣) (Dettmer 2010:
441n26). Students were also to memorise the images used in the Flowing Commentary (Liuzhu
流注), a work that cannot be identified today, and in the equally unknown Images from the
Side while Lying Down (Yancetu 偃側圖). The list is concluded by the now lost Divine Needling
Classic in Red and Black [Ink] (Chiwu shenzhenjing 赤烏神針經). Later Japanese sources indicate
that the educational material varied in some respects but that, overall, the training closely
resembled Tang-dynasty education in this early period. Bureaucratic organisation devel-
oped in a different way from that intended by the tenn ō. In Japan, the practice of medicine
remained for the most part hereditary and tied to family clans not to offices obtained by
intellectual or moral achievement.
The Bureau of Medicine was also in charge of training exorcists who applied their D ­ aoistic
incantations within the field of medicine. However, Daoist institutions did not take hold in
Japan and Daoist-style rituals were largely absorbed into Buddhist rituals (Lomi 2014). Inter-
estingly, the medical regulations of the early legal codes prohibited Buddhist monks and nuns
from using Daoist incantations but allowed Buddhist healing spells. Monastics strove to study
medicine as one of the traditional ‘five sciences’ according to the Indian tradition. Charismatic
monks frequently appear as healers in Japanese sources (Kleine 2012). In the Buddhist world,
the training in the ‘five sciences’ was thought to be necessary for compassionate acts in society.
In Japan, monks and nuns particularly conducted healing rituals for the ruling elite. The fierce
competition between monastic healers and the court doctors in regard to caring for the elite is
attested to in diaries of courtiers in the twelfth and thirteenth centuries (Drott 2010).
Empress Kōmyō 光明皇后 (701–760), who is known to have emulated the Chinese
(female) ruler Wu Zetian 武則天 (625–705), piously supported Buddhist institutions and
founded a dispensary for medical drugs. The dispensary offered free medicines for all. She
also donated a number of precious raw materials to the magnificent temple Tōdaji 東大寺
her husband Shōmu tennō 聖武天皇 (701–756, r. 724–749) had established. Nearly forty of
the sixty materials that were originally donated survived over 1200 years in the Shōsōin 正
倉院, the treasure house of the temple. Modern surveys have established that some of these
drugs came from Persia, India, China, Thailand, Korea and other places in Asia (Kunaichō
and Shibata 2000, Torigoe 2005). In times when epidemics ravaged the land, demand for
free medicines increased to such an extent that a sufficient amount could not be sourced
from the medicinal garden in Nara and imports from abroad. The government purchased
plants gathered in the wild and those grown in the provinces in order to meet demand (Ueda
1930: 7–8). Textual records such as the collection of rules and procedures for governmental
agencies, the Procedures of the Engi Era (Engishiki 延喜式, 927), list over fifty different medic-
inal herbs to be gathered from the wild or cultivated in the provinces and sent to the capital
(which was Kyōto since 794). This list of over 200 drugs makes this work an important
source on early medieval pharmaceutical knowledge in Japan (Hattori 1955).

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The tenth century also saw the compilation of a materia medica compendium Japanese
Names for the Materia Medica (Honzō wamyō 本草和名, 901–923) by the court physician
­Fukane Sukehito 深根輔仁 (dates unknown) (Karow [1948] 1978) and an early medical
compilation in Japan, Essentials of Medical Treatment (Ishinpō 医心方) by the court physician
Tanba Yasuyori 丹波康頼 (912–995) which he presented to the tenn ō in 984. Tanba Yasuyori
belonged to one of the two most important family clans of doctors, the second one being the
Wake 和気. Both the Tanba and the Wake attempted to keep the coveted knowledge gleaned
from Chinese sources and their own clinical notes secret for centuries. Essentials of Medical
Treatment is a compendium of a wide range of Chinese medical sources – many of them now
lost – with comments for the local readership in Japan, making it an important source for
the reconstruction of early Chinese medicine. Tanba Yasuyori also included Japanese names
for plants to enable doctors and herbalists to identify medicinal plants in nature. The Shin-
gon 真言 monk Fujiwara Ken’i (or Kenni, 藤原兼意, 1072–ca. 1169) compiled important
compendia of precious substances, incense, drugs and cereals (Triplett 2012). These, often
exotic, substances were used in Buddhist rituals and exact knowledge of their identity was
indispensable for the proper execution of the rituals.
Song-dynasty works reached Japan in the twelfth century but these did not immediately
exert much influence there. One notable exception was the monastic physician Kajiwara
Shōzen 梶原性全 (or Jōkan 浄観, 1265–1337) (Goble 2009, 2011) who belonged to a re-
forming Buddhist movement founded by the charismatic monk Eison 叡尊 (1201–1290) and
known for its humanitarian engagement. This movement, the Shingon Ritsu school (Shingon
Risshū 真言律宗), established a large temple hospital and other care facilities for both humans
and animals in Kamakura, at the seat of the military ruler at the time (Hattori 1964). Contact
with China flourished and new influences reached Japan via trade, personal visits and study
stays. Myōan Eisai 明菴栄西 (or Yōsai, 1141–1215), one of the Japanese who spent an extended
period in China gained the support of Hōjō Masako 北条政子 (1156–1225), a powerful female
leader of the military regime in Kamakura. With her support, he built the first temple prop-
agating Meditation, or Zen (Ch. Chan 禪) Buddhism in Kamakura, the seat of the de facto
government at the time, was established. Eisai not only propagated Zen Buddhism but also
recommended the consumption of green tea. Among his writings is the Record on Drinking Tea
for Nourishing Life (Kissayōjōki 喫茶養生記, 1211) (trans. Benn 2015: 157–71).
Takeda Shōkei 竹田昌慶 (1338–1380), who spent nearly ten years in China, studied under
a Daoist named Jin Weng 金翁 and returned not only with his teacher’s daughter as his wife
but also with an ingenious Chinese invention: a doll for the practice of needling, usually
called ‘bronze doll’ (dōningyō 銅人形) or ‘channels doll’ (keiraku ningyō 經絡人形) (Chapter
12 in this volume). He founded an influential school of physicians and rose to become the
personal doctor of a member of yet another clan of military rulers: the Ashikaga. During
the Ashikaga period, the seat of the de facto government returned to Kyōto and there was
constant civil strife between local rulers in the provinces. Still, in this period, Japan devel-
oped several unique medical traditions that increasingly departed from the Chinese model
although the basic outlook and the taxonomies remained intact during the late medieval and
the early modern eras (sixteenth to nineteenth centuries) (Hattori 1971).
Tashiro Sanki 田代三喜 (1465–1537), who spent twelve years in China, was responsible
for making Jin-Yuan dynasty medicine popular in Japan, particularly the theories of the
scholar Li Dongyuan 李東垣 (or Li Gao 李杲, 1180–1251) and the works of the physician
Zhu Danxi 朱丹溪 (1281–1358) (Chapter 9 in this volume). Both emphasised therapies of
balancing and calming the qi. These therapies were adapted and established in Japan, espe-
cially by Tashiro Sanki’s student Manase Dōsan 曲直瀬道三 (1507–1594) and his successors

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(Machi 2014). This school of medicine is today called the ‘School of the medical meth-
ods of the later epoch’ (Goseihōha 後世方派) because its proponents departed from earlier
Song-dynasty medical theory and concentrated on the later epoch of the Jin-Yuan dynasties.

Development of autonomous medical traditions

After many decades of war between local factions in Japan and failed attempts to conquer
Korea, a period of political stability began in 1600 with a new military ruling clan, which
had its seat in Edo. The shōgun (military ruler) and his military court attracted advisors
and scholars in the Neo-Confucian tradition of Zhu Xi 朱熹 (1130–1200). Stagnation of
qi became a major concern in this phase in Japanese medicine as state control began to
dominate all areas of life and stagnation and blockages were part of one’s daily experience
(Michel-Zaitsu 2017: 185). Most doctors and thinkers advocated staying within the tightly
controlled social spaces and recommended that people did their utmost to preserve or in-
crease their vitality in order to fulfil their social role in an increasingly Confucian society
(Ahn 2012).
One of the shōgun’s most influential advisors was Hayashi Razan 林羅山 (or Dōshun 道春,
1583–1657) (Marcon 2015). He purchased Li Shizhen’s 李時珍 (1518–1593) monumental
Compendium of Materia Medica (Bencao gangmu 本草綱目) in Nagasaki and wrote a glossary for
Japanese readers. The Bencao gangmu by Li Shizhen and the Cure of Myriad Diseases (Wanbing
huichun 萬病回春, 1587) by Gong Tingxian 龔廷賢 (or Yunlin 雲林, active 1577–1593)
were other more comprehensive medical works from China that were printed and adapted
in Japan.
The shōgunate ordered plant explorations in Japan to gather or complement knowledge
on the natural resources of the country. There was also an effort to cultivate valuable ginseng
and other useful plants. Japan’s official policy to become independent from imports resulted
in the revival and the establishment of medicinal gardens in many parts of the country. The
government also ordered herbals and other books from Europe. While Rembert Dodoens’
(1517–1585) herbal Cruijdeboeck (1554) was not held in very high regard in Europe itself, a
copy of this book incited much interest in Japan (Vande Walle and Kasaya 2001). ‘Dutch
studies’ (rangaku 蘭學), as the study of European medicine and sciences was called, became
firmly established in this period.
The influx of new ideas in the field of medicine was not limited to those developed in
Europe. The eighth shōgun Yoshimune 吉宗 (1684–1751) who was a particularly active
supporter of the advancement of medicine and the natural sciences, ordered that the Korean
compendium Treasured Mirror of Eastern Medicine (Dongui bogam 東醫寶鑑, 1613) be adapted
for a Japanese readership and printed in Japan (Chapter 34 in this volume). The resulting
work was printed in 1724 and 1730, with a second edition printed in 1799 (Mayanagi 2004).
Scholars in Japan also published new materia medica compendia and other medical works
(Hübner 2014). One of the pioneers in this field, the Neo-Confucian Kaibara ­Ekiken 貝
原益軒 (or Ekken, 1630–1714), published the herbal Japanese Materia Medica (Yamato honzō
大和本草, 1708–1709). Kaibara Ekiken also wrote on ‘nourishing life’ (yōjō 養生), or self-­
cultivation, which was an exceptionally popular topic in the early modern period. His
­Japanese herbal was based on Li Shizhen’s work but introduced a different classification
system. The most comprehensive Japanese herbal, Illumination of the Principles and Varieties of
Materia Medica (Honzōk ōmoku keim ō 本草綱目啓蒙, 1803), was compiled by the doctor and
scholar Ono Ranzan 小野蘭山 (1729–1810) who was knowledgeable in both East Asian and
European medicine.

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Another famous doctor of this dynamic period, Nagata Tokuhon 永田徳本 (1513–1630),
emphasised the importance of the Han-dynasty classic Treatise on Cold Damage (Shanghan
lun 傷寒論) by the doctor Zhang Zhongjing 張仲景 (150–219) (Chapter 8 in this volume).
Japanese physicians such as Nagoya Gen’i 名古屋玄医 (1628–1696), Gotō Konzan 後藤艮山
(or Gonzan, 1659–1733) and several others even saw the approaches in the Treatise on Cold
Damage as the only authoritative medicine. Interestingly, proponents of this school of med-
icine in Japan, later to be called the ‘School of the old medical methods’ (Kohōha 古方派),
criticised Zhang Zhongjing, the author of this important Chinese medical work. This school
distanced itself from some fundamental principles such as concepts of yin and yang and the
channels. Gotō Konzan and others can be said to have ‘Japanised’ Chinese medicine (Otsuka
1976: 328).
Misono Isai’s 御園意斎 (1557–1616) unique acupuncture style of applying the needle to
the abdomen with a small hammer, the ‘tapping acupuncture insertion technique’ (dashin-
hô 打鍼法), originally invented by the sixteenth-century Zen monk Mubun 無分 (dates
­unknown), is practised to this day (Michel-Zaitsu 2017: 79–80). Mubun envisioned the ab-
dominal region as a map of the internal organs. Misono Isai developed a specific diagnostic
technique of palpating the abdominal region, based on Mubun’s ideas. In general, abdom-
inal palpation ( fukushin 腹診) departs from Chinese models and is thus a Japanese-specific
technique.
Sugiyama Wa’ichi 杉山和一 (1610–1694) relied heavily on palpation, touching and feel-
ing when examining his patients because he was blind. The masseur and acupuncturist is the
inventor of a technique that involves using a small tube to direct and stabilise the acupunc-
ture needle. Sugiyama’s ‘guide tube acupuncture insertion method’ (kanshinh ō 管鍼法) and
other needling techniques such as using very fine needles are widely employed to this day.
He founded a school to train the visually impaired in acupuncture and became a doctor of
high renown. Before Sugiyama, most visually impaired individuals who wanted to work in
the medical field could only train in Chinese-style massage (anma 按摩).
Understanding of the body was also altered by anatomical knowledge imported from
Europe and local observations via autopsy and dissection. This knowledge especially served
surgeons such as Takashi Hōyoku 高志鳳翼 (fl. eighteenth century) whose illustrated trea-
tise Precious Notes on the Medical Therapy of Bone-setting (Honetsugi ryōji ch ōh ōki 骨継療治
重宝記, 1746) can be said to be the foundation of osteopathy in Japan. It combines tradi-
tional Chinese and European knowledge but also includes Takashi’s personal observations
­(Michel-Zaitsu 2017: 170–1).
The above-mentioned Gotō Konzan who explored new avenues in the medical field
suggested that one of his students, Yamawaki Tōyō 山脇東洋 (1706–1762) dissect an otter to
clarify the ambiguities about the inner organs encountered in the various Chinese sources.
Yamawaki, however, was not satisfied by the results and obtained permission to organise the
dissection of the body of an executed man. His exploration of the organs of the man opened
the way for other autopsies in Japan.
Yoshimasu Tōdō 吉益東洞 (1702–1773) who developed innovative diagnostics and medi-
cal therapies is another remarkable doctor of this epoch, and is even regarded as the ‘father’ of
modern Kanp ō medicine (Trambaiolo 2015). He followed a radical path that initially alien-
ated him from other doctors until Yamawaki Tōyō started to support him. Yoshimasu Tōdō
claimed that ‘all diseases have one poison as their single cause’ (manbyō ichidoku 萬病一毒).
According to him, this ‘poison’ triggered the various diseases by attacking different parts of
the body. A doctor must localise the ‘poison’ in the individual body of the patient and treat
it with ‘poison’. He therefore started classifying the traditional Chinese-style materia medica

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according to their degree of ‘toxicity’, clearly departing from Zhang Zhongjing who consid-
ered the effect of the entire formula and not of its individual ingredients.
The surgeon Hanaoka Seishū 華岡青洲 (1760–1835) used careful observation to look
for useful narcotic substances. Hanaoka is known to have engaged in experiments on both
animals and humans. He sought the Han-dynasty Chinese doctor Hua Tuo’s 華佗 (d. 220)
legendary formula for inducing general anaesthesia, the enigmatic ‘hemp boiled powder’
(Ch. mafeisan 麻沸散). The decoction Hanaoka eventually used, the ‘Powder for Communi-
cating with Transcendents’ (tsūsensan 通仙散), consisted of a mixture of extracts from parts
of highly toxic plants. He used it in hundreds of operations, mainly related to breast cancer.
The formula remained within the closed circle of his students.
Other eighteenth-century developments include an increased interest in bloodletting
and bathing therapies, in the production of simplified and easily accessible medical drugs
and in the printing of material on medical therapies and self-cultivation (‘nourishing life’)
directed at a more general audience. The flourishing book market saw new editions, some-
times pioneering print editions of authoritative medical texts from the medieval period.
Most personal medical manuscript notes, however, remained within the schools or lineages
of transmission, although some students did publish their notes on their master’s teachings.
The students’ master was often their father.
Medical practice was not a purely male pursuit. As women of the elite normally pos-
sessed a higher education in the Chinese and Japanese classics, calligraphy, poetry and other
subjects, they contributed to intellectual life although they were dissuaded from taking a
public role. Sources on female medical activities are scarce but some women’s lives are bet-
ter documented than others. We know that the haikai 俳諧 (short poem, haiku) poet Shiba
Sonome 斯波園女 (1664–1726), a student of the famous poet Matsuo Bashō 松尾芭蕉 (1644–
1694), for instance, practised ophthalmology alongside her husband. The learned Nonaka En
野中婉 (1660–1725) worked as a doctor after she was released in 1703 following four decades
under house arrest due to kin punishment (Sanpei and Nihon joishi hensai iinkai 2008).
While many doctors continued to practise within a Buddhist framework, the numbers
of those who were tonsured but not ordained and those without any clerical rank increased
throughout the Edo period (1600–1868) (Hattori 1978). Tensions between these groups rose
and controversies intensified over the extent to which scholars, including medical doctors,
were to follow or depart from China as the perennial model. Interestingly, critical philolog-
ical research blossoming in eighteenth-century China also took root in Japan. The govern-
ment Institute of Medicine (Igakkan 医学館) in Edo followed it and started systematically to
collect and also edit medical texts. This philological trend also inspired nativist movements.

Decline and revival of Chinese-style medicine in modern Japan

The new state under the ‘reinstated’ Meiji tennō 明治天皇 (1852–1912) saw the introduc-
tion of an official qualification system for medical doctors trained at institutions modelled
after German clinics and universities. Doctors who were influenced by the ‘Dutch stud-
ies’ medicine or the empiricist Kohōha promulgated and easily adapted to the new system.
However, the new developments led to the marginalisation of traditional Japanese medicine
that was based on Chinese-style medicine but, as we saw above, was of a highly pluralistic
and heterogeneous nature. Nativist trends after the pervasive Meiji-period reforms resulted
in nationalistic, xenophobic, even racist forms of medicine. These had roots in an earlier
movement called the ‘way of the ancient [ Japanese] medicine’ (ko’idō 古医道) (Karow and
Weller 1954). As the Meiji state established a form of state ritual for the tenn ō, the Emperor

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and his divine ancestors, the Society for the Preservation of Knowledge (Onchisha 溫知社),
founded in 1879, received nationwide attention and support despite the fact that European
biomedicine was already firmly established in Japan. A more politically active association,
founded in 1891, fought for the full acceptance of traditional Japanese Chinese-style medi-
cine, which tended to be called ‘imperial Chinese [-style] medicine’ (k ōkan igaku 皇漢医學),
and a revision of the qualification law. However, the Sino-Japanese War of 1894–1895 that
ended in China’s defeat – allegedly caused by the backwardness of the once greatly admired
neighbour – ended these activities.
Some doctors who were in favour of the Western-style approbation law also engaged in
the preservation of tradition by, for instance, trying to develop a curriculum for the study of
Japanese Chinese[-style] medicine (wakan igaku 和漢医學) adapted to the Western-style pro-
gramme. This attempt failed because of the inherent differences between the European and
Chinese medical systems and their foundational paradigms (Oberländer 1995: 71–2). There
were also attempts to harmonise ‘traditional’ and ‘modern’ knowledge in order to improve
the health of the people in Japan, and even reach an international audience. Traditional
concepts of self-cultivation (‘nourishing life’) and nutrition as expounded by Kaibara Ekiken
played an outstanding role in these novel formulations. Sakurazawa Yukikazu 桜沢如一 (or
Nyoichi, 1893–1966) alias George Ohsawa who developed the ‘macrobiotic diet’ must be
mentioned in this context. Sakurazawa translated into French carefully selected parts of an
influential 1927 work by the ultra-nationalist Nakayama Tadanao 中山忠直 (1895–1957) for
the Sinologist and writer George Soulié de Morant (1878–1955). The resulting book, Acu-
puncture et médecine chinoise vérifiées au Japon (Acupuncture and Chinese medicine as verified
in Japan, 1934), and de Morant’s own writings made acupuncture more widely known in
France and the West.
Meanwhile, in the Japanese Empire and her colonies, Nakayama Tadanao and others
fruitfully propagated a nationalistic form of Kanp ō medicine and successfully sold ‘tradi-
tional’ medicinal drugs (Michel-Zaitsu 2017: 292–8, Oberländer 1995: 202–3). After the
First World War, mass-produced Chinese medicines also paved the way for the revival of
Kanp ō medicine. Commercial success and an increase in credibility due to evidence-based
analysis were not the only factors in the revival (Shin 2016). The idea that Kanpō is a ho-
listic and gentle medicine and has a beneficial role in the treatment of chronic diseases
eventually led to its official recognition. This idea goes back to the generation of early
­t wentieth-century doctors who had not been trained in Chinese-style medicine but admired
and appreciated the tradition. The post-Second World War association The Japan Society
for Oriental Medicine (Nihon Tōyō Igakkai 日本東洋医学会), founded in 1950, remains a
leading body in the promotion and advancement of Kanpō medicine as well as in the study
of Chinese-style medicine in Japanese history, although there are numerous similar associa-
tions. Kanp ō (or Kampō) is now largely considered to be pharmacotherapeutics. Moxibustion
and acupuncture, bone setting, massage and related arts developed autonomously and, as
extra-medical activities, were less impeded by legal pressures (Otsuka 1976: 337–8). Today,
Kanp ō medicine is generally accepted as complementary medicine and practised alongside
modern biomedicine in Japan.
Japan inherited and developed Chinese medicine, not in isolation from other regions
in Asia but in occasionally frequent and fruitful exchange among medical practitioners,
bureaucrats as well as traders in medical books or pharmaceuticals. The Japanese history of
Chinese-style medicine unfolded in the various political and social contexts, and while de-
parting from Chinese models the new or divergent medical institutions, theories, therapies

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and formulæ that evolved in Japan never completely lost their connection to styles current on
the Asian continent. The developments at the turn of the nineteenth to the twentieth cen-
tury were the most dramatic and at the same time threatening to the Japanese medical tradi-
tions that were based on Chinese medicine. Eventually new forms of what is now referred to
as Kanpō emerged that, along with treatments such as acupuncture, moxibustion and various
styles of massage, contribute to a vibrant hybrid medical culture in Japan and beyond.

Bibliography
Pre-modern sources
Cruijdeboeck, 1554, Rembert Dodoens, Antwerp: J. van der Loe.
Dongui bogam 東醫寶鑑 (Treasured Mirror of Eastern Medicine) 1613, Heo Jun 許浚, Heo Jun 許浚
(compiler) and Minamoto Gensō 源元通 (1724) Teisei t ōi h ōkan 25 kan 訂正東醫寶鑑 25 巻 (Re-
vised Treasured Mirror of Eastern Medicine in 25 Fascicles), n/a: Hayashi Tsugai Tōbei.
Engishiki 延喜式 (Procedures of the Engi Era) 927, Torao Toshiya 虎尾俊哉 and Shint ō taikei hen-
sankai 神道大系編纂会 (1991), in Shint ō taikei hensan 神道大系編纂 (ed.) Shint ō taikei 神道大系
(Important Shintō Sources) vol. 11–12, Tōkyō: Shintō taikei hensankai.
Honetsugi ryōji ch ōh ōki 骨継療治重宝記 (Precious Notes on the Medical Therapy of Bone-setting)
1746, Takashi Hōyoku 高志鳳翼 (2006–2007), in Nagatomo Chiyoji 長友千代治 (ed.) Ih ō –
yakuh ō 医方・薬方 (Medical and Medicinal Treatments) vol. 3, (Chōhōki shiryō shū sei 重宝記資料
集成 vol. 25). Tōkyō: Rinsen shoten.
Honzō wamyō 本草和名 ( Japanese Names for the Materia Medica) 901–923, Fukane Sukehito 深根輔
仁 (1926) (Nihon koten zenshū 日本古典全集, vol. 1) Tōkyō: Nihon koten zenshū kankōkai.
Honzōk ōmoku keim ō 本草綱目啓蒙 (Illumination of the Principles and Varieties of Materia Medica)
1803, Ono Ranzan 小野蘭山 (1991–1992) (Tōyō bunko 東洋文庫 vols. 531, 536, 540, 552) Tōkyō:
Heibonsha.
Ishinp ō 医心方 (Essentials of Medical Treatment) 984, Tanba Yasuyori 丹波康頼 (1935), Nihon koten
zensh ū 日本古典全集, vol. 7, Tōkyō: Nihon koten zenshū kankōkai; (1993), in Maki Sachiko 槇佐
知子 (ed.) Ishinp ō: Maki Sachiko zenshaku seikai 医心方: 槇佐知子全訳精解 (Essentials of Medicine:
complete translation with explanations by Maki Sachiko), Tōkyō: Chikuma shobō.
Kissayōjōki 喫茶養生記 (Record on Drinking Tea for Nourishing Life) 1211, Myōan Eisai 明菴栄西
(2000), in Furuta Shōkin 古田紹欽 (ed.) (Kōdansha gakujitsu bunko 講談社学術文庫, vol. 1445).
Tōkyō: Kōdansha.
Nihon shoki 日本書紀 (Record of Japan) 720, Toneri shinnō 舎人親王, in Sakamoto Tarō 坂本太郎,
Ienaga Saburō 家永三郎, Inoue Mitsusada 井上光貞 and Ōno Susume 大野晋 (eds) (1965–1967),
Nihon koten bungaku taikei 日本古典文學大系 (Complete Works of Japanese Classical Literature) vols.
67–8, Tōkyō: Iwanami shoten.
Wanbing huichun 萬病回春 (Cure of Myriad Diseases) 1587, Gong Tingxian 龔廷賢.
Xinxiu bencao 新修本草 (Revised Materia Medica) Tang-dynasty, Su Jing 蘇敬 (1983) Tosho ryō sōkan,
Kunaichō shoryōbu 圖書寮叢刊 / 宮内庁書陵部 (eds), Tōkyō: Kunaichō shoryōbu.
Yamato honzō 大和本草 ( Japanese Materia Medica) 1708–1709, Kaibara Ekiken 貝原益軒 (1911)
­Ekiken-kai 益軒会 (ed.) Ekiken zensh ū 益軒全集, vol. 6, Tōkyō: Ekiken zenshū kankōbu.

Modern sources
Ahn, J.Y. (2012) ‘Worms, germs, and technologies of the self – religion, sword fighting, and medicine
in early modern Japan’, Japanese Religions (Special Issue: Religion and Healing in Japan, ed. by
Christoph Kleine and Katja Triplett), 37.1 and 2, 93–114.
Andreeva, A. (2017) ‘Explaining conception to women? Buddhist embryological knowledge in
the Sansh ō ruij ū sh ō 産生類聚抄 (Encyclopedia of Childbirth, ca. 1318), ‘Asian Medicine, 12,
pp. 170–202.
Benn, J.A. (2015) Tea in China: a religious and cultural history, Honolulu: University of Hawaiʻi Press.
Bowers, J.Z. (1970) Western Medical Pioneers in Feudal Japan, Baltimore, MD: John Hopkins Press.
Bowring, R.J. (2005) The Religious Traditions of Japan, 500–1600, Cambridge: Cambridge University
Press.

521
 Katja Triplett
Downloaded By: 10.3.97.143 At: 14:24 10 Jan 2024; For: 9780203740262, chapter35, 10.4324/9780203740262-41

Dettmer, H.A. (2010) Der Yōrō -Kodex: Die Gebote; Übersetzung des Ryō no gige, Teil 2 Bücher 2–10
(Veröffentlichungen des Ostasien-Instituts der Ruhr-Universität Bochum 55, 1–4), Wiesbaden:
Harrassowitz.
Drott, E.R. (2010) ‘Gods, Buddhas, and organs: Buddhist physicians and theories of longevity in early
medieval Japan’, Japanese Journal of Religious Studies, 37.2: 247–73.
Goble, A.E. (2009) ‘Kajiwara Shōzen (1265–1337) and the medical silk road: Chinese and Arabic
influences on medieval Japanese medicine,’ in Goble, Andrew Edmund, Robinson, Kenneth R.
and Wakabayashi, Haruko (eds) Tools of Culture: Japan’s cultural, intellectual, medical and technological
contacts in East Asia, 1000–1500s, Ann Arbor, MI: Association for Asian Studies, pp. 231–57.
——— (2011) Confluences of Medicine in Medieval Japan: Buddhist healing, Chinese knowledge, Islamic for-
mulas, and wounds of war, Honolulu: University of Hawai’i Press.
Hattori Toshiyoshi (Toshirō) 服部敏良 (1945) Nara jidai igaku no kenky ū 奈良時代医学史の研究 (Stud-
ies in the Medical History of the Nara Period), Tōkyō: Tōkyō -dō (reprint Yoshikawa kobunkan
1988).
——— (1955) Heian jidai igaku no kenky ū 平安時代医学の研究 (Studies in the Medical History of the
Heian Period), Tōkyō: Kuwana bunseidō.
——— (1964) Kamakura jidai igakushi no kenky ū 鎌倉時代医学史の研究 (Studies in the Medical His-
tory of the Kamakura Period), Tōkyō: Yoshikawa kōbunkan.
——— (1971) Muromachi Azuchi Momoyama jidai igaku-shi no kenky ū 室町安土桃山時代医学史の研
究 (Studies in the History of Medicine in the Muromachi, Azuchi, Momoyama Periods), Tōkyō:
Yoshikawa kōbunkan.
——— (1978) Edo jidai igakushi no kenky ū 江戸時代医学史の研究 (Studies in the Medical History of
the Edo Period), Tōkyō: Yoshikawa kōbunkan.
——— ([1968] 1982) Bukkyō kyōten o ch ūshin toshita Shaka no igaku 仏教経典を中心とした釈迦の医学
(Shakyamuni’s Medicine According to Buddhist Classical Texts), Nagoya: Reimei shobō.
Hübner, R.B. (2014) State Medicine and the State of Medicine in Tokugawa Japan: K ōkei saiky ūh ō (1791), an
emergency handbook initiated by the Bakufu, PhD thesis, University of Cambridge.
Karow, O. ([1948] 1978) ‘Das Honz ō -Wamyō. Eine japanische Pharmakopoe der Heian-Zeit, und
seine Bedeutung für die Geschichte der altjapanischen Medizin’, Archiv für Ostasien, 1.1: 72–4 (repr.
in Dettmer, Hans Adalbert and Endreß, Gerhild (eds) Opera Minora, 1978, pp. 195–201).
Karow, O. and Weller, F. (1954) ‘Das Daidōruijuhō und die Kokugaku’, Monumenta Nipponica, 10:
45–64.
Kleine, C. (2012) ‘Buddhist monks as healers in early and medieval Japan’, Japanese Religions (Special Is-
sue: Religion and Healing in Japan, ed. by Christoph Kleine and Katja Triplett) 37.1 and 2: 13–38.
Kunaichō Shō sōin jimusho 宮内庁正倉院事務所 and Shibata Shōji 柴田承二 (2000) Zusetsu Sh ōsōin
yakubutsu 図説正倉院薬物 (The Medicinals of the Shō sōin, Illustrated), Tōkyō: Chūōkōron.
Lomi, B. (2014) ‘Dharanis, talismans, and straw-dolls ritual choreographies and healing: strategies of
the Rokujikyōhō in medieval Japan’, Japanese Journal of Religious Studies, 41.2: 255–304.
Machi, S. (2014) ‘The evolution of “learning” in early modern Japanese medicine’, in M. Hayek and
A. Horiuchi (eds) Listen, Copy, Read: popular learning in early modern Japan, Leiden; Boston: Brill,
pp. 164–204.
Marcon, F. (2015) The Knowledge of Nature and the Nature of Knowledge in Early Modern Japan, Chicago,
IL; London: University of Chicago Press.
Mayanagi Makoto 真柳誠 (2004) ‘Kankoku dentō igaku bunken to Nichi-Chū -Kan no sōgo denpa
韓国伝統医学文献と日中韓の相互伝播, (Books on Medicine in the Korean Tradition and Their
Distribution between Japan, China and Korea)’ Kankoku gengo bunka kenky ū 韓国言語文化研究 (九
州大学韓国言語文化研究会) 6: 41–8.
Michel-Zaitsu, W. (2017) Traditionelle Medizin in Japan von der Frühzeit bis zur Gegenwart, München:
Kiener Verlag.
Mishima, S. (2004) The History of Ophthalmology in Japan, Oostende: Jean-Paul Wayenborgh.
Nakayama, T. (1934) Acupuncture et médecine chinoise vérifiées au Japon, traduites du japonais par T. Saku-
razawa et G. Soulie de Morant et precedees d’une preface de G. Soulie de Morant, Paris: Editions Hippocrate.
Oberländer, C. (1995) Zwischen Tradition und Moderne: Die Bewegung für den Fortbestand der Kan-
p ō -Medizin in Japan, Stuttgart: Steiner.
Otori, R. (1964) ‘The acceptance of western medicine in Japan’, Monumenta Nipponica, 19.3 and 4:
254–74.

522
 Chinese-style medicine in Japan
Downloaded By: 10.3.97.143 At: 14:24 10 Jan 2024; For: 9780203740262, chapter35, 10.4324/9780203740262-41

Otsuka, Y. (1976) ‘Chinese traditional medicine in Japan’, in C. Leslie (ed.) Asian Medical Systems,
Berkeley: University of California Press, pp. 322–40.
Rosner, E. (1989) Medizingeschichte Japans (Handbuch der Orientalistik Abt. 5: Japan Bd 3 Abschnitt
5), Leiden: E.J. Brill.
Sanpei Kōko 三瓶孝子, and Nihon joishi hensai iinkai 日本女医史編纂委員会, eds (2008) Hataraku
josei no reikishi: Nihon joishi 働く女性の歴史. 日本女医史 (History of the Working Woman: history
of the Japanese women doctors), Tōkyō: Kuresu shuppan.
Shin, Chang-Geon (2016) ‘The formation and development of the self-image of Kampō medicine in
Japan: the relationship between Showa-period Kampō and science’, in O. Kanamori (ed.) Essays on
the History of Scientific Thought in Modern Japan, Christopher Carr and M.G. Sheftall (trans), Tokyo:
Japan Publishing Industry Foundation for Culture, pp. 235–67.
Shinmura Taku 新村拓 (2013) Nihon bukkyō no iryōshi 日本仏教の医療史 (History of Japanese Bud-
dhist Medical Therapeutics), Tōkyō: Hō sei daigaku shuppankyoku.
Torigoe Yasuyoshi 鳥越泰義 (2005) Sh ōsōin yakubutsu no sekai: Nihon no kusuri no genry ū wo saguru 正倉
院薬物の世界: 日本の薬の源流を探る (The World of Medicinals of the Shō sōin: searching for the
origins of Japanese medicines) (Heibonsha shinsho 平凡社新書 296), Tōkyō: Heibonsha.
Trambaiolo, D. (2015) ‘Ancient texts and new medical ideas in eighteenth century Japan’, in B. Elman
(ed.) Antiquarianism, Language, and Medical Philology: from early modern to modern Sino-Japanese medical
discourses, Leiden: Brill, pp. 81–104.
Triplett, K. (2012) ‘Magical medicine? Japanese Buddhist medical knowledge and ritual instruction for
healing the physical body’, Japanese Religions (Special Issue: Religion and Healing in Japan, ed. by
Christoph Kleine and Katja Triplett), 37.1 and 2: 63–92.
——— (2017) ‘Using the golden needle: Nā g ā rjuna bodhisattva’s ophthalmological treatise and other
sources in the essentials of medical treatment’, in P. Salguero (ed.) Buddhism and Medicine: an anthology
of premodern Sources, New York: Columbia University Press, pp. 543–8.
Triplett, K. (2019) Buddhism and Medicine in Japan: a topical survey (500–1600 CE) of a complex relationship,
Berlin: De Gruyter.
Ueda Sanpei 上田三平 ([1930] 1972) Nihon yakuen-shi no kenky ū 日本薬園史の研究 (Study of the His-
tory of Medicinal Gardens in Japan), Takada-machi: n/a. (repr. Tōky`: Watanabe shoten).
Unschuld, P.U. (1998) Chinese Medicine, Brookline, MA: Paradigm.
Vande Walle, W. and Kasaya, K. (2001) Dodonaeus in Japan: translation and the scientific mind in the
Tokugawa period, Leuven; Kyoto: Leuven University Press; International Research Center for Jap-
anese Studies.

523