Confluences of Medicine in Medieval Japan: Buddhist Healing, Chinese Knowledge, Islamic Formulas, and Wounds of War

Chapter 4 Leprosy, Buddhist Karmic Illness, and Song Medicine

Chapter 4 LEPROSY, BUDDHIST KARMIC ILLNESS, AND SONG MEDICINE We do not know how prevalent the disease of rai 癩 (in modern times, the term for Hansen’s disease or leprosy) was prior to the Kamakura era, and we do not know how common it was even during that era. However, rai leprosy and the condition of those who contracted it were significant medical, social, and religious issues during Kajiwara Shōzen’s lifetime. The religious and social status of those suffering from it was sufficiently problematic that historians regularly identify rai and the response to it as central to understanding issues of discrimination in the medieval era. In medieval Japan, rai was an affliction that contained multiple cultural meanings.1 The term rai was applied to a number of conditions that affected face, torso, and limbs. Symptoms included a variety of sores, hair loss, scaly skin, and loss of fingers and toes. Skeletons from the era reveal that the bones of the arms and legs might also be damaged, but this was not known contemporaneously.2 While the symptoms of rai were unsightly, medical texts, dictionaries, written descriptions, and visual depictions from the era suggest that other skin conditions were just as striking, or repellent, as those of rai.3 For example, a fourteenth-century pharmacist’s handbook notes a treatment for horrible sores that have not healed in ten years and that resemble rai. Another work refers to untreatable pustulant sores that get worse between the twelfth and twenty-third years, and the person dies.4 The label of rai evoked strong responses that body condition alone did not. Efforts to control rai sufferers ranged from official regulation of 68 leProsy, BUddHIst KarMIC Illness, and song MedICIne communities of rai sufferers to active persecution and harassment. They were generally physically marginalized. Contemporary visual sources paint a bleak picture of their lives under shacks and flimsy shelters, begging for food, and ailing. Those who contracted or thought they had contracted rai knew that it would permanently affect their social existence.5 Rai was also a powerful metaphor for deserved punishment, and rivals and enemies were excoriated for having it.6 However, others sought to alleviate the condition of rai sufferers. The priest Nichiren (1221–1281) saw rai as a positive sign that karmic sins were about to be expiated and preached that sufferers were to be embraced rather than shunned.7 Medical specialists, even if they felt that rai was untreatable, tried to alleviate the suffering by giving at least palliative care.8 More positively, and, perhaps motivated by their understanding of the stigma attached to rai as much as by the medical challenge it posed, physicians also tried to determine whether symptoms were in fact those of rai.9 The most significant medical efforts to treat rai took place at Gokurakuji in Kamakura, and the first medical description of it—the symptoms, the nature of the affliction, and the treatments to be used—is provided by Shōzen. He has one discussion in chapter 34 of the Ton’ishō and another in chapter 5 of the Man’anpō. However, while these groundbreaking descriptions are obviously important, scholars have tended not to explore Shōzen’s writing with much nuance.10 Nor have they been particularly sensitive to the notion that rai contained multiple meanings, that perceptions of it were not monolithic, or that the notion of karmic illness might also be nuanced. By exploring rai as a medical issue, I will show not only that the issue of rai is more complex than generally represented, but also how ideas of rai found in Song medicine led to a substantial reassessment of the disease that invalidated some previous assumptions about it. sHōzen’s desCrIPtIon oF leProsy In tHe ton’IsHō Shōzen’s description of rai in chapter 34 of the Ton’ishō is the most extensive colloquial description of it that we have for the entire premodern era. Following are two selections from that description. Here is the first selection: As to the origins of rai ailment, [various theories have been put forward. Namely the notion of] the five rai and the eight winds; the conditions that come in one hundred and thirty varieties; that as a result of sinful leProsy, BUddHIst KarMIC Illness, and song MedICIne 69 karma in previous lives there is just punishment from the gods and the Buddhas; that it is from...