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Tokugawa Yoshimune and his healthcare projects
Published online by Cambridge University Press: 28 September 2023
Abstract
In Japanese scholarship, the notion of public health is closely associated with modernisation and the adoption of Western medicine in the nineteenth century, which influenced the centralisation of medical affairs and the establishment of hospitals. This article aims to challenge this assumption. A closer look at Japan's medical history shows that government institutions caring for the sick and destitute existed before the introduction of Western concepts of medicine. Furthermore, Japan had other ways of providing welfare, in addition to establishing hospitals. These included government-sponsored medical manuals designed to deliver healthcare via published texts, an aspect of welfare that has been neglected in the history of public health in Japan. This article fills this gap by illuminating and grasping lesser-known strands of healthcare delivery to enhance our understanding of the relationship between the state and medicine in early modern Japan. In particular, it examines welfare initiatives implemented by the tenth shogun, Tokugawa Yoshimune (r. 1716–1745), a prominent and well-researched figure in the history of Tokugawa Japan and a key player who laid the foundations of welfare in this era.
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References
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3 Ibid.
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11 Also known as Seyakuin Sōhaku 施薬院宗伯 (1576–1663), a physician of the early Tokugawa period: Nihon jinmei daijiten 日本人名大辞典 (Unabridged Dictionary of Japanese Names) (Kodansha 2001), p. 1046.
12 Also called shisetsutan 紫雪丹, a medicine that contains vermillion and serves as antipyretic to treat beriberi, abdominal pain, malign abscesses, and other ailments. Nihon daijiten kankōkai 日本大辞典刊行会 (ed.), Nihon kokugo daijiten (shukusatsuban) 日本国語大辞典[縮刷版] (Tokyo, 1982), vol. 5, p. 549d. It is still sold in China.
13 ‘Tōshōgū gojikki 東照宮御実紀 22’, Kokushi taikei, vol. 38, p. 346.
14 Kosoto Hiroshi, Nihon kanpō tenseki jiten 日本漢方典籍辞典 (Encyclopaedia of Japanese Works on Kanpō Medicine) (Tokyo, 1999), p. 352.
15 Kokushi daijiten 国史大辞典 (Encyclopaedia of Japanese History) (Tokyo 1993), vol. 14, p. 410. Yoshida House was also a famous money broker; see also Sugitatsu Yoshikatsu 杉立義一, Kyō no ishiseki tanpō 京の医史跡探訪 (Inquiry into the Medical History of Kyoto) (Kyoto, 1991), pp. 57–58.
16 The number of formulas differ depending on the literature. According to Goldschmidt, the original text contained 297 formulas, whereas Kosoto specified 301; Goldschmidt, Asaf, The Evolution of Chinese Medicine: Song Dynasty, 960–1200 (London, 2009), p. 118Google Scholar; Kosoto, Hiroshi, ‘Volumes of knowledge: observations on Song-period printed medical texts’, in Tools of Culture. Japan's Cultural, Intellectual, Medical, and Technological Contacts in East Asia, 1000s–1500s, (eds) Goble, Andrew E., Robinson, Kenneth R. and Wakabayashi, Haruko (Ann Arbor, 2009), p. 219Google Scholar.
17 On the enormous influence of Bencao gangmu on the study of materia medica in Japan, see also Sugimoto Tsutomu 杉本つとむ, Nihon honzōgaku no sekai. Shizen, iyaku, minzoku goi no tankyū 日本本草学の世界, 自然 医薬 民族語彙の探究 (World of Japanese Materia Medica: In Search of Nature, Medicines, and People's Vocabulary) (Tokyo, 2011), pp. 22–61. In his work on Chinese materia medica, George Métailié briefly outlines Chinese materia medica texts that became influential in Japan; see George Métailié, Traditional Botany: An Ethnobotanical Approach. Part IV of Science and Civilisation in China, Vol. 6: Biology and Biological Technology, (ed.) Joseph Needham (Cambridge, 2015), pp. 545–567.
18 Ueda Sanpei 上田三平, Nihon yakuenshi no kenkyū 日本薬園史の研究 (Research on the History of Japanese Medicinal Gardens) (Japan, 1972), pp. 12–13; for a list of medicinal gardens, see ibid., p. 27.
19 Ibid., pp. 12 and 15.
20 ‘Yūtokuin dono gojikki furoku 15’, Kokushi taikei, vol. 46, p. 291.
21 Yasuda Ken 安田健, ‘Kaidai 解題 (Explanatory Notes)’, in Saiyakushi 採薬志 (Record on Collections of Medicinal Drugs) 1, vol. 6 of Kinsei rekishi shiryō shūsei 近世歴史資料集成, second series (Tokyo, 1994), p. 1251.
22 Fukui Tamotsu 福井保, Edo bakufu hensanmono 江戸幕府編纂物 (Compilated Works of the Edo Bakufu) (Tokyo, 1983), p. 191. See also Figure 1.
23 ‘Yūtokuin dono gojikki furoku 10’, Kokushi taikei, vol. 46, p. 244.
24 Fukui, Hensanmono. Many handwritten copies of Shoshū saiyakuki, especially of the abbreviated version, have survived and have been digitised by the National Diet Library; see http://dl.ndl.go.jp/search/searchResult?featureCode=all&searchWord=%E8%AB%B8%E5%B7%9E%E6%8E%A1%E8%96%AC%E8%A8%98&viewRestricted=0 (accessed 18 August 2023).
25 Yasuda Ken, ‘Kaidai’, p. 1251. These botany surveys appear to have served a second purpose, in addition to collecting plants and minerals. They offered an ideal opportunity for spying; see Marcon, Federico, The Knowledge of Nature and the Nature of Knowledge in Early Modern Japan (Chicago; London, 2015), pp. 125–126CrossRefGoogle Scholar.
26 Sōda Hajime 宗田一, ‘Kinsei honzōgaku to kokusan yakushu 近世本草学と国産薬種 (Materia medica in the early modern period and the domestic production of crude drugs)’, Jitsugakushi kenkyū 実学史研究 (Study of the History of Practical Learning) 1, 1984, p. 89.
27 Kasaya, Kazuhiko, ‘The Tokugawa Bakufu's politics for the national production of medicines and Dodonaeus’ “Cruijdeboeck”’, in Dodonaeus in Japan. Translation and the Scientific Mind in the Tokugawa Period, (eds) Walle, W. E. Vande and Kasaya, K. (Leuven; Kyoto, 2001), pp. 174–175Google Scholar.
28 Yoshioka Shin 吉岡信, Edo no kigusuriya 江戸の生薬屋 (Pharmacies in Edo) (Tokyo, 1994), p. 54.
29 Suzuki Hiroshi 鈴木洋, Kanpō no kusuri no jiten 漢方のくすりの事典 (Dictionary of Kanpō Medicines) (Tokyo, 1995), pp. 319–320. For its other names, see also Imamura Tomo 今村鞆, Ninjinshi 人参史 (History of Ginseng) (Kyoto, 1971), vol. 7, especially pp. 40–42.
30 Yoshioka, Edo no kigusuriya, p. 56.
31 For a detailed account of the cultivation of ginseng, see Imamura, Ninjinshi, vol. 5; see also Kasaya, ‘The Tokugawa Bakufu's politics’, pp. 175–180.
32 Imamura, Ninjinshi, p. 173. See also Ōba Hideaki 大場秀章 (ed.), Nihon shokubutsu kenkyū no rekishi. Koishikawa shokubutsuen sanbyakunen no ayumi 日本博物研究の歴史.小石川植物園三百年の歩み (History of Japanese Botanical Studies. The Development of Three Hundred Years of Koishikawa Botanical Garden) (Tokyo, 1996); Ueno Masuzō 上野益三, Nihon hakubutsugakushi 日本博物学史 (History of Japan's Natural History) (Tokyo, 1973).
33 ‘Byōin’, Kokushi daijiten.
34 Shinmura Taku 新村拓, Nihon iryō shakaishi no kenkyū. Kodai chūsei no minshū seikatsu to iryō 日本医療社会史の研究.古代中世の民衆生活と医療 (Study of Japan's Social History of Medical Care: People's Lives and Medical Care in Ancient Times and the Middle Ages) (Tokyo, 1985), p. 40.
35 Ibid. The Wake and Tanba families were famous physicians, who also played an important role in the following centuries.
36 Andrew E. Goble, ‘Kajiwara Shōzen (1265–1337) and the medical Silk Road: Chinese and Arabic influences on medieval Japanese medicine’, in Tools of Culture, Goble et al. (eds), p. 232.
37 Literally ‘field of merit’; for the Sanskrit explanation, see https://www.oxfordreference.com/display/10.1093/oi/authority20110803100354938 (accessed 31 August 2023).
38 Shinmura, Nihon iryō no shakaishi no kenkyū, p. 37; Kokushi daijiten.
39 ‘Koishikawa yōjōsho no koto 小石川養生所之事 (About the Koishikawa Sanatorium)’, Sen'yō ruishū 撰要類集 7–2, in Minami Kazuo 南和男, Edo no shakai kōzō 江戸の社会構造 (Edo's Social Structure) (Tokyo, 1969), p. 299.
40 ‘Yūtokuin dono gojikki furoku 15’, Kokushi taikei, vol. 46, p. 289.
41 For the figures, see Kyōhō sen'yō ruishū, in Nihon iryōshi 日本医療史 (History of Medical Care in Japan), (ed.) Shinmura Taku (Tokyo, 2006), p. 114. Kyōhō sen'yō ruishū is a collection of laws and ordinances from 1716–1753, digitised by the National Diet Library.
42 Ibid.
43 It was also the setting of Shimizu Satomu's popular novel, The Tales Of Dr Redbeard (Akahige shinryōtan 赤ひげ診療譚, 1958), which was made into the film Redbeard, directed by Kurosawa Akira.
44 Shinmura (ed.), Nihon iryōshi; it is unclear whether the Taki whom Yōan Shinmura mentions was a descendant of the influential Taki family of physicians, whose ancestry can be traced back to Tanba Yasuyori, a representative of an unknown branch of this family, or just a confused reference to Taki Antaku 多紀安琢 (1824–1876). No person of this name is mentioned in Mori Junsaburō 森潤三郎, ‘Takishi no jiseki 多紀氏の事績 (Achievements of the Taki House)’, in Kōshōgaku ronkō: Edo no kosho to zōshoka no chōsa 考証学論攷: 江戸の古書と蔵書家の調査 (About the Study of Evidence: Investigations into Edo's Old Documents and Book Collectors) (Nihon shoshigaku taikei 日本書誌学体系) (Kyoto, 1985), or the Kansei chōshū shokafu 寛政重修諸家譜 (Genealogies of Various Houses Compiled in the Kansei Period), 9 vols (Tokyo, 1922–1923).
45 For more about the changing fortunes of the hospital, see Andō Yūichirō 安藤優一郎, Edo no yōjōsho 江戸の養生所 (Edo's Sanatorium) (Tokyo, 2005). Little research has been carried out in Western scholarship into the role of dispensaries and hospitals in Japan's medical history. In Japanese scholarship, the first steps in this field have been made by Shinmura Taku, who examined healthcare institutions of ancient times and the Middle Ages (see footnote 34).
46 ‘Yūtokuin dono gojikki furoku 15’, Kokushi taikei, vol. 46, p. 290.
47 Kosoto, ‘Observations on Song-period printed medical texts’, p. 213. See also Goldschmidt, The Evolution of Chinese Medicine, chapter 4.
48 Also known as Waitai biyao.
49 Chinese-English Chinese Traditional Medical Word-Ocean Dictionary 漢英中医辞海 (Taiyuan, 1995), p. 570; Waitai miyao, vol. 1 with a Foreword by Wang Tao, Mingban fanke Songban jiaokan Waitai miyao fang 明版翻刻宋版校勘外臺秘要方 (Ming Period published and Song Period revised edition of Waitai miyao), Ju pingan yangshouyuan ban yingyin 據平安養壽園版影印 (Pingan and Yangshouyuan edition) (Taibei, 752 [1980]), p. 55a.
50 Fukui Tamotsu 福井保, Edo bakufu kankōbutsu 江戸幕府刊行物 (Publications of the Edo Bakufu) (Tokyo, 1985), p. 80.
51 Ibid.
52 Miki Sakae 三木栄, Chōsen ishoshi 朝鮮医書誌 (Bibliography of Korean Medical Books), 2nd edn (Ōsaka, 1973), pp. 98–99; see also the preface by Yi Chŏngkyun 李廷亀 (dates unknown) to Tong‘ŭi pogam, available at http://archive.wul.waseda.ac.jp/kosho/ya09/ya09_00773/ya09_00773_0003/ya09_00773_0003.pdf (accessed 18 August 2023).
53 Kornicki assumes that the invasions increased the supply and variety of printed copies of Chinese (medical) texts; see Kornicki, Peter, ‘Korean books in Japan: from the 1590s to the end of the Edo period’, Journal of the American Oriental Society 133.1 (January–March 2013), p. 79Google Scholar.
54 Fukui, Edo bakufu kankōbutsu, p. 80; the Kyōhō edition is included in the series Yasuda Ken and Asami Megumi (eds), Kinsei rekishi shiryō shūsei 近世歴史資料集成 5, vol. 5 (Tokyo, 2009). See also Figure 2.
55 Tong‘ŭi pogam, Afterword, p. 3a. Unless otherwise noted, all dates have been converted using the Gregorian calendar.
56 Probably Manase Seikei 正珪 (1686–1748) who is also known as Manase Yōan'in.
57 Shōsan nenpu 商山年譜, in Kosoto Hiroshi 小曽戸洋 and Seki Nobuyuki 関信之, ‘Bakufu ikan Hosokawa Tōan no jiseki 幕府医官細川桃庵の事績 (Achievements of the Bakufu physician Hosokawa Tōan)’, Nihon ishigaku zasshi 日本医史学雑誌 (Journal of Japanese History of Medicine) 39 (1993.3), p. 35.
58 Fukui, Edo bakufu kankōbutsu, pp. 80 and 83; see also Miki, Chōsen ishoshi, p. 101.
59 A list of the main sources used is given in Miki, Chōsen ishoshi, p. 97.
60 Asami, ‘kaisetsuhen sakuinhen 解説編索引篇 (Explanation volume, Index bolume)’, in Igakuhen 医学編, vol. 6 of Kinsei rekishi shiryō shūsei, fifth series, 近世歴史資料集成, (eds) Asami Megumi 浅見恵 and Yasuda Ken 安田健 (Tokyo, 2014), p. 3
61 Chinese-English Chinese Traditional Medical Word-Ocean Dictionary, p. 489.
62 Leung, Angela, ‘Medical instruction and popularization in Ming-Qing China’, Late Imperial China 24.1 (2003), p. 135CrossRefGoogle Scholar.
63 Ibid., p. 136.
64 Kosoto Hiroshi, Nihon kanpō tenseki jiten, p. 364. For more information on Okamoto Ippō and the controversies about his easy-to-read treatises and commentaries written in kana for his students, see Trambaiolo, Daniel, ‘The languages of medical knowledge in Tokugawa Japan’, in Rethinking East Asian Languages, Vernaculars, and Literacies, 1000–1919, (ed.) Elman, Benjamin A. (Leiden; Boston, 2014), pp. 155–156Google Scholar.
65 Mayanagi claims that the Jinling edition of Bencao gangmu came to Japan in 1604, while Watanabe et al. give the year as 1607. Mayanagi Makoto 真柳誠 and Tomobe Kazuhiro 友部和弘, ‘Chūgoku iseki torai nendai sōmokuroku (Edo ki) 中国医籍渡来年代総目録 (江戸期) (Chronological list of Chinese medical books brought to Japan in the Edo period)’, Nihon Kenkyū 日本研究 (Japan Studies) 7 (1992), p. 177; Watanabe Kōzō 渡辺幸三, Honzōsho no kenkyū 本草書の研究 (Study of Materia Medica Books) (Ōsaka, 1987), p. 136. See also Endō Shōji 遠藤正治, Honzōgaku to yōgaku: Ono Ranzan gakutō no kenkyū 本草学と洋学:小野蘭山学統の研究 (Studies of Materia Medica and Western Studies: An Investigation into Ono Ranzan ) (Kyoto, 2003), pp. 157–158.
66 Endō, Honzōgaku to yōgaku, p. 158.
67 Kokushi daijiten 1, p. 762.
68 Ahn Sang Woo and Kwon Ohmin (eds), Dongui bogam: Treasured Mirror of Eastern Medicine, (trans) Kim Namil and Cha Woong Seok et al. (Seoul, 2013).
69 ‘Yūdono gojikki furoku’, Kokushi taikei, vol. 46, p. 291.
70 ‘Yūdono gojikki’, Kokushi taikei, vol. 45, pp. 497 and 513, Imaōji was also known by the name Manase Genki 曲直瀬玄耆; according to Kosoto, he also chose the title: Kosoto, Nihon kanpō tenseki jiten, p. 329.
71 Takayanagi Shinzō 高柳真三 and Ishii Ryōsuke 石井良助 (eds), Ofuregaki Kanpō shūsei 御触書寛保集成 (Tokyo, [1934]), p. 994; Fukui, Edo bakufu kankōbutsu, p. 84.
72 Kosoto, Nihon kanpō tenseki jiten, p. 329.
73 Li Shizhen 李時珍, Bencao gangmu 本草綱, two vols (Beijing, 1596 [1982]), 17, part II, p. 35a. The references in the original are provided in a small font in the translation.
74 Also kabuna; there are basically two different varieties: European and Asian. For more on Kabuna and its historical significance, see Arioka Toshiyuki 有岡利幸, Haru no nanakusa 春の七草 (The Seven Spring Herbs) (Mono to ningen no bunkashi 物と人間の文化史 146) (Tokyo, 2008), pp. 169–187.
75 Bencao gangmu 26, p. 43b.
76 Ch. yin chen, botanical name: artemisia capillaris Thunb. Suzuki, Kanpō no kusuri no jiten, pp. 15–16; Bensky, Dan and Gamble, Andrew, Chinese Herbal Medicine: Materia Medica (Seattle, 1993), pp. 146–147Google Scholar.
77 Chinese-English Chinese Traditional Medical Word-Ocean Dictionary, p. 199.
78 Hayashi Ryōteki and Niwa Shōhaku, ‘Fukyū ruihō 普救類方 IV part 1’, in Minkan chiryō 民間治療 (Vernacular Therapies), vol. 1 of Kinsei rekishi shiryō shūsei 近世歴史資料集成, second series, (eds) Asami Megumi 浅見恵 and Yasuda Ken 安田健 (Tokyo, 1730 [1991]), pp. 13a–b. See also Figure 3.
79 Tsukamoto Manabu 塚元学, Tokai to inaka: Nihon bunka gaishi 都会と田舎:日本文化外史 (City and Village: The Unofficial History of Japanese Culture) (Tokyo, 1991), p. 220.
80 Bencao gangmu 1, pp. 1205–1206.
81 For a discussion of literacy, see Peter Kornicki, The Book in Japan: A Cultural History from the Beginnings to the Nineteenth Century (Honolulu, 2001), pp. 273–274. May pursued questions of availability and literacy in the context of the commercialisation of literature: May, Ekkehard, Die Kommerzialisierung der Japanischen Literatur in der Späten Edo-Zeit (Wiesbaden, 1983), pp. 108Google Scholar and 112.
82 Kornicki, The Book in Japan, pp. 395–397; Shibata Mitsuhiko 柴田光彦, Daisō zōshomokuroku to kenkyū 大惣蔵書目録と研究 (A Study on the Daisō Library Catalogue) (Nihon shoshigaku taikei 日本書誌学体系 27), 2 vols (Musashimurayama, 1983), p. 432.
83 Yabuuchi Kiyoshi 藪内清 (ed.), Sō Gen jidai no kagaku gijutsushi 宋元時代の科学技術史 (History of Science in Song and Yuan Dynasties) (Kyōto, 1967), pp. 141–142; see also Sugimoto, Masayoshi and Swain, David L., Science and Culture in Traditional Japan (Rutland, 1989), p. 138Google Scholar.
84 Zōkō taihei keimin wazai kyokuhō 増広太平恵民和剤局方 (Enlarged Edition of Prescriptions of the Imperial Pharmacy of the Taiping era) (1732, Maekawa Kenheiee edition). (Digitised by the National Diet Library.) Here, Fukui seems to have confused the generations of the Hosokawa family. It was not Hosokawa Tōan Motomichi who was involved in the revision, but his adopted son Hosokawa Tōan Motonobu. See Fukui, Edo bakufu kankōbutsu, p. 89. For more on the Hosokawa clan and its activities, see Kosoto Hiroshi 小曽戸洋 and Seki Nobuyuki 関信之, ‘Bakufu ikan Hosokawa Tōan no jiseki 幕府医官細川桃庵 (The achievements of the Bakufu physician Hosokawa Tōan)’, Nihon ishigaku zasshi 39 (1993.3), pp. 27–42. See also Figure 4.
85 Kosoto, Nihon kanpō tenseki jiten, p. 349; Goble et al. (eds), Tools of Culture, p. 235.
86 Goble et al. (eds), Tools of Culture.
87 Nakamura Teruko 中村輝子, Matsuzaki Aiko 松崎亜衣子 and Endō Jirō 遠藤次郎, ‘Wazaikyokuhō ni okeru hōkōsei ken'iyaku no kentō: seiiki no igaku no eikyō nit suite 和剤局方における芳香性健胃薬の検討―西域の医学の影響について’ (Investigations into Aromatic stomachics in the Hejiju fang—On Western regions and their medical influences), Yakushigaku zasshi 薬史学雑誌 (Journal of the History of Drugs) 35.2 (2000), pp. 153–158; Nakamura Teruko, Matsuzaki Aiko and Endō Jirō, ‘Wazaikyokuhō issai kihen no kentō 和剤局方一切気篇の検討 (Hejiju fang—investigations into the chapter, “All disorders of vital energy”)’, Kanpō no rinshō 漢方の臨床 (Clinical Practice of Kanpō Medicine) 47.11 (2000), pp. 119–126; Nakamura Teruko, Miyamoto Hirokazu and Endō Jirō, ‘Wazaikyokuhō ni mirareru seizai no tokuchō 和剤局方にみられる製剤の特徴 (Characteristics of the formulae in Hejiju fang)’, Yakushigaku zasshi 薬史学雑誌38.2 (2003), pp. 185–192; Goble et al. (eds), Tools of Culture, p. 244. See also Figure 5.
88 Goble et al. (eds), Tools of Culture, pp. 245–249.
89 Felix Gutzwiller and Fred Paccaud (eds), Sozial- und Präventivmedizin—Public Health, 4th edn (Bern, 2011), p. 13.
90 Ueda, Nihon yakuenshi no kenkyū, p. 14.
91 Kasaya, ‘The Tokugawa Bakufu's politics’, p. 176; see also Kasaya, ‘Arai Hakuseki to Tokugawa Yoshimune. Tokugawa jidai no seiji to honzō 新井白石と徳川吉宗―徳川時代の政治と本草 (Arai Hakuseki and Tokugawa Yoshimune. Politics and materia medica in the Tokugawa Period)’, in Mono no imēji: honzō to hakubutsugaku e no shōtai 物のイメージ: 本草と植物学への招待 (The Image of Things: An Invitation into Materia Medica and Botanical Studies), (ed.) Yamada Keiji (Osaka, 1994).
92 Kasaya, ‘The Tokugawa Bakufu's politics’, p. 179.
93 For more information on medical texts in connection with learning in early modern Japan, see Machi, Senjurō, ‘The evolution of “learning” in early modern Japanese medicine’, in Listen, Copy, Read. Popular Learning in Early Modern Japan, (eds) Horiuchi, Annick and Hayek, Matthias (Leiden; Boston, 2014), pp. 163–204Google Scholar.
94 Gutzwiller and Paccaud, Sozial- und Präventivmedizin, p. 13.