Confluences of Medicine in Medieval Japan: Buddhist Healing, Chinese Knowledge, Islamic Formulas, and Wounds of War by Andrew Edmund Goble (review)

The history of Japanese medicine is a fascinating story of adoption, transformation, and ideol­ogy. Japanese medicine was originally an adaptation of traditional Chinese medicine, a system that views the healthy mind and body as an organic whole in harmony with its environment. Disease is perceived as disharmony, and the patterns of this disharmony are diagnosed mainly through palpation of the pulse. On the basis of these patterns, combinations of herbs and oth­er treatments like acupuncture are prescribed. As the centuries progressed, the classification of these patterns became increasingly theorized, and the formulas more and more complex.

The new theories were mainly transmitted to Japan through the medium of books. Not satisfied with just adopting those new theories, Japanese physicians constantly tried to sim­plify the elaborate theoretical foundations, integrating Japanese perceptions of health and disease and establishing a unique medicinal system. In the Edo period this simplifying pro­cess reached its zenith during a renaissance movement that ushered in a return to the oldest Chinese canons, especially clinical textbooks like the Shang han lun (Treatise on Exogenous Febrile Diseases), which were revised from an empirical perspective. This movement pro­vided fertile ground for the interaction with Western medicine that began to deepen at the end of the eighteenth century.

Rich as the history of Japanese medicine is in terms of natural philosophy and cultural in­teraction, few scholars inside or outside Japan have explored this subject to any great extent. Serious studies of the Japanese literature related to medicine concentrate on biographies of famous physicians, annotated bibliographies of medical books, or, at most, summaries of the most important innovations that have occurred in medical practice during a certain period. Few scholars have bothered to analyze the wealth of primary sources in order to try to trace the actual practice of medicine and its underlying philosophy, which accounts for the fact that these are still shrouded in mystery.

Confluences of Medicine in Medieval Japan, by Andrew Edmund Goble, is a welcome at­tempt to fill the vacuum. Goble's research focuses on the medical writings of the Buddhist priest and physician Kajiwara Shōzen (ca. 1265-ca. 1337). An excellent choice for exam­ining medieval medicine, Shōzen's works Ton'ishō (ca. 1304) and Man'anpō (1315-1327) are extensive compilations, providing us with a wealth of information on medical thought and practice unmatched in other contemporary works. By analyzing Shōzen's works along with several other sources, Goble seeks to describe the dissemination and appropriation of Song medicine in thirteenth- and fourteenth-century Japan. The book is divided into five main chapters. The first chapter sketches the historical context in which Shōzen wrote, emphasiz­ing the increased cultural interaction with China after the 1150s, the formation of Buddhist networks in East Asia, and Buddhist charitable activity as important factors in the develop­ment of his medical practice.

Chapters 2 to 5 each take up themes relating to Shōzen's medical practice. From their con­tents it is clear that Goble is less interested in the concrete medical or philosophical aspects of the subject than he is in the sociohistorical aspects. He focuses on the appropriation of knowledge by Shōzen, discussing the importation of Chinese medical books-examining in chapter 2 which works Shōzen used and describing in chapter 3 the trade in pharmaceuticals and the technical problems in adapting Chinese formulas to Japanese conditions. In chapter 4 Goble analyzes the classifications and related social conditions of rai (a term used for all sorts of diseases that affect the skin, especially leprosy), and in chapter 5 he searches for the sources of wound medicine. For each theme Goble highlights many examples from Shōzen's writings, but he does not offer in-depth analysis of Shōzen's medicine as such. An explana­tion of...