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

Chapter 5 Warfare, Wound Medicine, and Song Medical Knowledge

Chapter 5 WARFARE, WOUND MEDICINE, AND SONG MEDICAL KNOWLEDGE The preceding chapters have looked at the engagement of Song medical knowledge in a time of peace. The environment was conducive to acquiring books, to gauging the efficacy of medicines, and to spending extended periods of time reflecting upon medicine, and it facilitated ready access to a wide range of materia medica. In 1333, however, four years before Kajiwara Shōzen’s death, that environment changed radically. While the details need not detain us here, an unprecedented explosion of violence resulted, for the first time in Japanese history, in the obliteration of an entire institution of government. The Kamakura bakufu was destroyed, the governing Hōjō warrior dynasty was virtually eliminated as over a thousand males were killed in battle or in spectacular scenes of selfimmolation , and much of the city of Kamakura was reduced to ashes. A society that had relied upon the force of authority became one that relied upon the authority of force, and warfare became one of the distinguishing characteristics of Japanese society for nearly three centuries thereafter.1 For our purposes, the most important by-product of the fighting in the fourteenth century was that, even though Japan’s warrior class had been in existence for some centuries, battle wounds were for the first time incurred with sufficient frequency and in sufficiently large numbers to prompt the emergence of wound medicine as a specialty. The first works on wound medicine, the anonymous Kinsō ryōjishō 金瘡療治抄 (On Healing Incised Wounds) of 1356 or 1357,2 and Tominikōji Norizane’s 90 WarFare, WoUnd MedICIne, and song MedICal KnoWledge 富小路範實 Kihō 鬼法 (Demon Formulas) of 1391,3 were thus written in specific historical circumstances, and changes in the nature of warfare were directly linked to developments in Japanese medicine. These circumstances also provide us with an opportunity to see another range of factors that shaped the appropriation of Song medicine in the medieval era. As will be seen, while knowledge about the treatment of wounds gained from printed books was minimal, the conceptual understanding of wound medicine was provided by a Song author, and materia medica associated with Song medicine was an integral part of wound treatment. tHe neW WarFare enVIronMent FroM tHe 1330s From 790 there was no standing Japanese army, but there were also no domestic or foreign threats to guard against. There was thus no formal infrastructure for training, instruction in strategy, military engineering, or combat medical services. Weapons and armor were produced by a limited number of craft specialists. Internal security was provided by a self-equipped provincial warrior elite that served mainly as local officials within a framework of civil administration.4 The rare armed conflict that occurred was limited geographically and primarily took the form of skirmishes and ad hoc campaigns.5 While fighting was prosecuted with verve and was unconstrained by notions of chivalry, it was rarely pursued to bloody conclusion.6 Even the nationwide fighting of the 1180s that ushered in the Kamakura bakufu was less a concerted mobilization than a series of campaigns punctuated by local score-settling, though it did end with a destructive pacification expedition against a regional power center in 1189 (after which the army was disbanded).7 The fighting against the Mongols in 1274 and 1281, while intense, was of limited duration.8 Finally, participation in conflict was essentially limited to members of the warrior class. The fighting in 1332 and 1333 that led to the destruction of the Kamakura bakufu in mid-1333 ushered in an epochal change in the nature of military conflict in Japan: Battles and campaigns were replaced by the larger phenomenon of warfare.9 Four elements in particular illustrate the way in which the nature of fighting changed. First, conflict was pursued with a greater intensity than previously. We note periods of fighting when a larger proportion of wounds were inflicted by close-in weapons such as swords, in contrast to the standoff weapon of the bow and arrow that WarFare, WoUnd MedICIne, and song MedICal KnoWledge 91 had previously dominated the battlefield. The practice of suicide in the face of defeat became common. Extended sieges of fixed fortifications, a new development, usually resulted not in surrender or the abandoning of the siege but in starvation, cannibalism, fighting to the last, and execution of survivors.10 Second, campaigning occurred in all seasons and in all weather conditions. Cold-weather fighting...