How Did Edo-Period Doctors Practice Medicine? The Intersection of Kampo, Western Learning, and Commoner Healthcare
In Japan during the Edo period (1603–1868), there were no modern hospitals, medical licensing systems, or pharmacies. So, what did commoners do when they fell ill? We will explore the medical landscape of Edo, where Kampo practitioners, Western-style doctors, pharmacists, masseurs, and shamans coexisted, and unravel the connections to modern medicine and the wisdom that protected the health of the common people.
The Edo Medical System: A World of Unlicensed Medicine
An Era When Anyone Could Become a "Doctor"
In the Edo period, there was no medical licensing system as a national qualification like there is today. It was common to become a doctor through an apprenticeship system, where one would train and study under a master before setting up an independent practice. Formally, being appointed as a "medical official" (ishiyaku) by the shogunate or a domain served as proof of "official recognition," but most town doctors (machi-isha) opened their practices without any qualification screening.
The quality of medical care varied greatly; while there were excellent doctors, there were also "quacks" (yabu-isha) who lacked qualifications and knowledge. The term "yabu-isha" originated in the Edo period and became established as a critical label for doctors who performed ineffective treatments.
Types of Doctors in Edo
Medical practitioners in Edo were more diverse than those today.
Kampo practitioners (Kampo-i): The mainstream group of doctors who diagnosed patients based on Chinese medicine (the four diagnostic methods: inspection, listening/smelling, inquiry, and palpation) and prescribed Kampo medicines (decoctions and pills).
Ranpo practitioners (Ranpo-i): Doctors who studied Dutch medicine (Western medicine). They possessed techniques not found in Kampo, such as anatomy, surgical procedures, and smallpox vaccination. Their primary path of learning was from doctors stationed at the Dutch trading post in Nagasaki (such as von Siebold).
Kinso-i (Surgeons): Surgeons specializing in sword wounds and external injuries. They often served samurai families.
Acupuncturists and Masseurs: Specialists who performed treatments using acupuncture, moxibustion, and massage. Many blind people made a living as masseurs, and the shogunate recognized the massage profession for the blind as a specific privilege.
Medicine Peddlers and Pharmacists: Merchants who sold medicine. At the time, self-diagnosis and self-medication were common, and purchasing over-the-counter drugs from pharmacies was a standard option.
Edo Medical Philosophy: Yin-Yang Five Elements and "Qi, Blood, and Water"
Basic Concepts of Kampo
The mainstream medicine of the Edo period was Kampo (Kampo medicine) derived from China. Kampo is based on the medical philosophy that health is the balance of the flow of three elements: "Qi" (energy), "Blood," and "Water," and that disturbances in these are the cause of illness.
Qi: The flow of life energy and vitality. When "Qi stagnates," various ailments occur.
Blood: Blood and its flow. The idea that "stagnant blood" (oketsu) is the root of all diseases.
Water (Body Fluids): Moisture and body fluids within the body. Excess, deficiency, or imbalance of moisture causes edema, dryness, phlegm, etc.
To restore the balance of these three, Kampo medicines (crude drugs derived from plants, animals, and minerals) are prescribed.
The Dispute Between the Gosei-ha and Kohō-ha Schools
There was a major school rivalry in Edo-period Kampo. The conflict persisted between the "Gosei-ha" (Later School), which theoretically emphasized Chinese Jin-Yuan medicine (such as Li Dongyuan and Zhu Danxi), and the "Kohō-ha" (Classical School), which advocated returning to the classics of the Han dynasty (the Shanghan Lun and Jin Gui Yao Lue).
Yoshimasu Tōdō (1702–1773) is cited as a representative of the Kohō-ha. Tōdō emphasized "abdominal palpation" (fukushin) and maintained an empirical stance that prioritized actual patient observation over conceptual theory. This attitude can be said to be a precursor to modern Evidence-Based Medicine (EBM).
The challenge of Rangaku physicians: Anatomy and surgery
The Kaitai Shinsho and Sugita Genpaku
In 1774 (the 3rd year of the An'ei era), Sugita Genpaku, Maeno Ryotaku, and others published the Kaitai Shinsho, a translation of the Dutch anatomical text Ontleedkundige Tafelen. This was Japan's first translation of a Western medical book and a groundbreaking work that scientifically demonstrated the anatomical structure of the human body.
The publication of the Kaitai Shinsho introduced to Japan the concept of an 'anatomical body,' which was completely different from the conceptual view of the body based on 'Qi, Blood, and Water' in Kampo medicine. Rangaku physicians began to understand the brain, heart, lungs, and intestines as concrete organs, and developed practical skills in areas such as surgery, wound treatment, and smallpox vaccination.
In the National Diet Library's collection, the first edition of the Kaitai Shinsho (published in 1774) is available in their digital collection, allowing us to confirm the precision of the anatomical illustrations from that time even today.
Healthcare for commoners: Hot springs, folk remedies, and faith
Pilgrimages to Yakushi Nyorai and Ise, and prayers for health
For commoners in the Edo period, seeing a doctor was not easy due to costs and accessibility. When they fell ill, the common order of action was to first visit a Yakushi Nyorai (the Buddha of healing), then try self-medication (patent medicines or family remedies), and only consult a doctor if the condition did not improve.
Hot springs (toji-ba) across the country were actively used as places for recuperation and convalescence. Trips from Edo to hot springs like Kusatsu, Ikaho, and Hakone were a major pleasure for commoners and functioned as heat therapy for chronic conditions such as skin diseases, neuralgia, and rheumatism.
The culture of household medicines
A unique form of medicine distribution called 'oki-gusuri' (placed medicine) developed during the Edo period. The distribution system from the Toyama Domain (Etchu Toyama)—based on the principle of 'use first, pay later'—continues to this day and is one of the prototypes of Japanese home healthcare culture.
Summary
Healthcare in the Edo period was a pluralistic system where unlicensed doctors, the theoretical framework of Kampo, the anatomy of Rangaku, folk remedies, and faith-based healing coexisted. However, much of the wisdom from that time, such as 'abdominal diagnosis for empirical evidence,' 'plant-based herbal medicine,' 'heat therapy,' and the 'oki-gusuri culture,' has been passed down to the present day.
The encounter between Kampo and Western medicine began in the late Edo to Meiji periods, but that intellectual tension became the soil that produced the unique development of modern Japanese medicine. The medical landscape of Edo, where 'quacks' and 'master physicians' coexisted, is a candid reflection of an era when pre-modern medicine was supported by individual empirical knowledge and trial and error.
References and Sources
National Diet Library Digital Collections — Reference materials: Sugita Genpaku's 'Kaitai Shinsho' (1774 first edition), medical books from the Kosei-ha and Koho-ha schools, and historical materials on Edo-period patent medicine culture (such as 'Morisada Manko')
Agency for Cultural Affairs: 'Historical cultural properties of Rangaku and Western studies'
CiNii Research (National Institute of Informatics) — Reference materials: Domestic historical research papers on the Edo-period physician system, the Kampo Koho-ha school, and Rangaku physicians (Journal of the Japan Society of Medical History, etc.)
This article is based on publicly available historical information and highly credible web sources.
Please note that it may contain stylistic choices for readability or original interpretations, and therefore does not guarantee complete academic accuracy. We hope you enjoy it as a piece of informative reading.
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