医療から見る江戸時代の深みThe Depth of the Edo Period Seen Through Medicine

The history of medicine in Japan is profoundly deep yet still shrouded in many mysteries, and although the countless techniques for compounding and using medicines invented by the Jomon and Yayoi peoples certainly continue to trickle faintly into the headwaters of Japan’s pharmaceutical culture today, they needed no writing at all, so everything was passed down orally from generation to generation; yet as time went on under the influence of China’s advanced civilizations, Japan, too, could not avoid a trend toward the systematization and monopolization of medical techniques, and eventually a great turning point arrived—that was the Edo period, and when we consider this intriguing era in the history of medicine, a place we should focus on in particular is Doshomachi (道修町) in Osaka.

The history of Doshomachi, located in one quarter of Osaka City, is old, and it goes back to the time before the Edo period, when Toyotomi Hideyoshi (1537–1598) seized national hegemony and, in building Osaka Castle as his base, launched a large-scale castle-town construction project; at that time there was “a certain quarter,” the source of what would become the development of Doshomachi, and that was Semba (船場); in today’s map Semba lies to the west of Osaka Castle and corresponds to the core of modern Osaka’s business district, but because the scenery is already completely transformed from Semba as it once was, we can only imagine its former appearance; today Semba’s surroundings have been reclaimed into land, and buildings crowd the area so the traces remain faint, but formerly Semba was an enclave surrounded on four sides by rivers—Tosabori (north), Nagahori (south), Higashi-Yokobori (east), and Nishi-Yokobori (west); positioned as a strategic stronghold of the Toyotomi clan that had seized power, Semba was a principal base that supported Toyotomi finances, and the roles and responsibilities placed upon it were exceedingly heavy; however, the character of Semba would later undergo a great transformation as hegemony shifted from the Toyotomi to the Tokugawa; because the Tokugawa established Edo Castle and the shogunate far away in Edo rather than in the vicinity of Osaka Castle under Toyotomi influence, the loosening of surveillance opened room for great development; among these changes, with the transfer of hegemony from Toyotomi to Tokugawa, Semba was in a sense released from Toyotomi pressure, and room opened for the merchants who had gathered there to begin building a town on their own terms, which was also possible because there already existed a merchant culture that had developed in autonomous cities like Sakai and Hirano in south-central Osaka.

In the oldest records, the name “Doshomachi” already appears in 1588 during the Toyotomi regime, and the north side of Semba was already undergoing major development in that era, but then movements began that would determine the character of Semba as it continues to the present; linked to this was the sakoku (鎖国) of the early seventeenth century, initiated to sweep away the malign influence of Portugal, which was plotting to bring Japan under its sway; incidentally, there remains a major error in the prevailing understanding of “sakoku,” for strictly speaking there are no examples of the Edo shogunate itself using the term at the time—it first appears only in 1853, when the shogunate was already crumbling; in other words, the reality of sakoku is far from the image commonly circulated, and personally I think it was influenced rather by Anglo-American strategies in the mid-nineteenth century aimed at opening Japan’s markets; the reason is that, without needing the West’s help, highly organized systems had already been realized throughout Edo-period Japan; Britain and America arbitrarily judged these as “inferior” and “barbaric,” and by instilling that feeling in the Japanese, they succeeded in opening Japan’s markets while simultaneously spurring the purchase of British and American goods; in short, general interpretations of the Edo period are not those of the Japanese themselves up to that time but are based on modern Anglo-American value systems, and to be frank I constantly feel that understanding has deteriorated to a level that requires an overall reassessment; both domestically and abroad, I find interpreters’ readings of the Edo period to be excessively poor.

After this, in the era commonly called sakoku, the routes by which foreign goods entered were concentrated in Nagasaki, and so merchants specializing in imported goods via Nagasaki gathered in one quarter of Semba and began business one after another; in response to this flow, merchants starting with those of Sakai and Hirano who discerned the arrival of new business opportunities, as well as powerful merchants from nearby Omi and Fushimi, began to assemble, and the ethos of Semba naturally took shape; this is why Osaka is called a city of merchants, and why it differs greatly in character from Edo, which was called a city of townspeople; as Semba’s blocks were gradually developed, the streets took on distinct characters, and amid these currents a development occurred that would determine Doshomachi’s character; the trigger was that, between 1624 and 1644, the Sakai merchant Konishi Kichiemon opened a medicinal-ingredient wholesaler in Doshomachi; this was the root of Doshomachi’s development as a “medicine town.”

When Konishi moved there, there had not yet been major development, but people running medicinal-ingredient wholesalers gathered in tandem with him; the momentum for a big change arrived with the Kyoho Reforms, shogunal administrative reforms led by Tokugawa Yoshimune; first, from 1722 onward, during the midst of these reforms, the drug-ingredient dealers who had gathered in Doshomachi were organized as kabunakama (株仲間), and a major shift occurred; kabunakama were a new system born during the Kyoho Reforms, in which, as a measure to stabilize prices and fiscal revenue, the shogunate organized and unionized previously dispersed and self-governing people in the same trade to bring them under control; under the Kyoho Reforms, voluntary guilds were officially recognized as kabunakama, and it is noteworthy that the formation of kabunakama was permitted for all merchants and artisans; in exchange for realizing this kabunakama system, the shogunate levied taxes from merchants and artisans belonging to the kabunakama and aimed to stabilize shogunal finances; needless to say, this generated collusion between merchants and officials and inevitably gave rise to vested interests; in fact, if the shogunate applied pressure on the kabunakama, it could manipulate commodity prices, and for merchants, while they outwardly placated officials, this became a source for constantly devising gray methods that slipped through the meshes of the system; I personally think that operating business while moving swiftly across this duality was the biggest reason merchants, especially in Osaka, achieved great development; the roots of this character likely lie in the polish and hard-earned judgment of the Sengoku period, when merchants in places like Sakai and Hirano navigated difficult times dealing with samurai, and as those battle-hardened traders clustered in one quarter of Osaka City, the merchant spirit that had survived the rough seas of the age was pooled, achieving significant development that continues to this day; Semba was the nerve center of that development.

Thus, Doshomachi, which had been only a fraction of Semba where medicinal-ingredient dealers gathered, also organized a kabunakama; thereby it transformed into a place that monopolized the work of inspecting, grading, and pricing all medicinal ingredients; why did this occur in Osaka rather than Edo, the capital at the time? Geographically, the distance from Nagasaki—the port of import—to Edo was simply too great, and in terms of sea routes, Nagasaki–Osaka was a sea lane cultivated since antiquity; moreover, situated at a point upriver from Osaka Bay, Semba’s location allowed goods to be sent to Kyoto via the Yodo River and to Nara via the Yamato River; combining river routes with Osaka Bay’s sea lanes and with overland routes, Osaka was literally Japan’s commercial hub where goods could be traded to every region nationwide; furthermore, if such organization were attempted in Edo, one would always have to consider interference from the shogunate, whereas Osaka, distant from Edo and bearing the legacy of Toyotomi rather than Tokugawa influence, could, in my view, conduct business without worrying as much about Tokugawa moves.

In this way, Doshomachi, which had been only a part of Semba, became a locus where monopoly rights to supply medicinal ingredients nationwide were consolidated and entered a golden age; this is the origin of Doshomachi’s reputation as a “medicine town,” and interestingly its traces remain even now; if you walk the Doshomachi area today, you still find pharmaceutical companies with roots in the Edo period standing shoulder to shoulder, and many people involved in the pharmaceutical industry, and led by the flow of pharmaceutical firms in Doshomachi, Osaka itself hosts a proliferation of company headquarters, many of which have roots in particular shops that ran medicinal-ingredient wholesaling at the time and later became corporations in and after the Meiji era; yet if we look closely, another side reveals a fascinating history, namely that no matter how much Doshomachi consolidated medicinal-ingredient prerogatives, it was impossible to manage Japan nationwide in that era; that is, in the Edo period, when centralized national population management like today’s was impossible, how did the kabunakama engaged in the medicinal-ingredient trade in Doshomachi greatly expand their vested interests? Naturally, there must have been, in modern terms, legal and illegal, as well as a wide gray zone in between.

As a fundamental historical fact for viewing this, from around the 1720s the Doshomachi area was an aggregation point where all manner of medicinal ingredients concentrated; seen from another angle, Doshomachi in the Edo period was a sacred ground of medicine where one could obtain all kinds of ingredients, whether legal or illegal, whether recorded or unrecorded; this is the crux; I personally consider it possible that, taking advantage of this unique environment, experiments to meet all sorts of demands were carried out, and of course, as an unspoken gray zone beyond officials’ detection, such activities would have been dispersed and dotted around the Semba vicinity; many officials themselves, after all, were likely bought by Semba merchants and colluded with them, so while outwardly following rules set by officials, merchants working their full measure of ingenuity to slip past regulations may never even have caught the shogunate’s eye; in practice, things like this do not remain in documents.

In fact, during the Kyoho era (1716–1736), when reforms were underway, there were as many as 124 shogunate-licensed businesses in Doshomachi related to medicinal ingredients alone, and besides these, numerous independent traders dotted Osaka City and its environs, selling to physicians and pharmacies; wholesalers at the time also conducted business both “front” and “back,” using their own distinctions such as omote-dana (表店, front-of-street shops) and ura-dana (裏店, back-alley shops), and we can see that merchants left no stone unturned in diversifying risk to survive a tumultuous age; after all, in the maelstrom of shifting hegemony from Oda Nobunaga to Toyotomi Hideyoshi to Tokugawa Ieyasu, vested interests once obtained could be swept away if the hegemon changed, and at that time it was entirely unforeseeable how long Tokugawa rule would last; we must take account of such temporal conditions.

Furthermore, going back before the kabunakama were organized, in 1658, thirty-three medicinal-ingredient dealers in Doshomachi, who had gathered through the migration of the Sakai merchant Konishi, submitted a jointly signed petition (連印状) to the shogunate requesting stricter crackdowns on “fake medicines”; this is important in that it hints that products regarded as “fake medicines” were already quite rampant within Osaka City at the time—in short, it was a backlash against the initial vested interests of the medicinal-ingredient wholesalers being threatened; the point to note is that already in those days there existed drugs that, in modern nuance, were designated “illegal,” and those fakes were so widespread that they dealt serious blows to the business profits of medicinal-ingredient wholesalers; because conversely, it suggests that by the 1650s the wholesalers’ vested interests already existed; Semba did not only deal in medicinal ingredients—it hosted countless trades such as inns for boatmen, restaurants, money changing, drapery, and hardware—so it is highly likely that complex vested interests were already intertwined within the relatively small Semba district; why, then, did fake medicines circulate, and why did merchants in the Doshomachi area, who were coming to grasp the vested interests, petition the shogunate for countermeasures? By reading the circumstances of the age behind this, one glimpse of the Edo period comes into view.

Behind the circulation of fake medicines lay the fact that To-yakushu (唐薬種, Chinese medicinal ingredients), imported via Nagasaki under the permitted trade at the time, were prized, while domestically produced Wa-yakushu (和薬種, Japanese medicinal ingredients) were looked down upon; that is, rather than the quality of the drugs as such, what mattered more was that the crude drugs, their raw ingredients, originated in China, a civilization with a history that, for Japan, represented an exemplary high culture; this is also evident from the shogunate’s special esteem for the Neo-Confucianism of Zhu Xi; in the early Edo period there were indeed many scholars around the shogunate who lauded China—a fact paralleled exactly by the early Meiji period, when scholars who lauded the West clustered around government; yet even if one understands its importance, in practical terms the To-yakushu, as limited imports under sakoku, were extremely expensive and not accessible to all; thus, people who applied their wits in various regions manufactured medicines that “resembled” the To-yakushu using inexpensive domestic materials, or, to keep prices down, produced mixtures of Chinese and Wa-yakushu and sold them repeatedly—those medicines became wildly popular; since the kabunakama had not yet been formed at that time, there must have been an enormous number of such people; unlike today, most of Japan had not undergone modern development and nature remained abundant, so even with the medicinal ingredients obtainable within their own living spheres, village communities across the country likely managed; in other words, this was fundamentally a phenomenon limited to urban dwellers—essentially a story about Osaka and Edo.

What is important here is that in this era most Wa-yakushu were treated as adulterants (i.e., “fake medicines”) for To-yakushu and, in principle, their sale on their own was prohibited; but prohibition notwithstanding, actually enforcing this was almost impossible; hence, after such unstable circumstances, a major turning point came in 1722; that year, representatives of the Doshomachi kabunakama attended in Edo a course titled “Examination of the Authenticity of Japanese Materia Medica” (和薬真偽吟味), which, as far as Doshomachi’s merchants were concerned, should be seen as a measure to suppress rampant illegal drugs and to bring not only To-yakushu but also Wa-yakushu under their centralized control—in a sense, an interest-expansion plan; this course amounted to creating a new prerogative to scrutinize, evaluate, and price Wa-yakushu under the unitary management of the Doshomachi medicinal-ingredient guild; why did they go to the trouble of taking it in Edo instead of Osaka? It was to claim, via shogunate-affiliated scholars, that they had obtained this right directly from the shogunate—speaking volumes, in a way, about how thoroughly Semba merchants were already colluding with Osaka officials.

As a result of this shogunal protection, in that same year 1722, 124 member shops of Doshomachi’s medicinal-ingredient fraternity established, with official sanction, an authority to manage Wa-yakushu; seen from the perspective of medicinal ingredients, this institutionalized the elimination of “suspicious medicines” to the greatest extent possible and cannot be overlooked; however, I personally think that, beyond the effect of a shift from imported Chinese to domestic Wa-yakushu, the spirit of the times was strongly involved and stirring behind the scenes—the struggle of the kokugaku scholars.

This can be seen symbolically in the provenance of the Sukunahikona Shrine (少彦名神社), erected in a gap among the towers that still crowd Doshomachi and revered by those in the pharmaceutical trade; originally the shrine enshrined Shennong (神農), one of ancient China’s Three Sovereigns and Five Emperors, who is said to have taught people medicine and agriculture, but in 1780 they took the step of inviting, from Kyoto, not only Shennong but also Sukunahikona, a deity who appears in Japanese myth, to be jointly enshrined; behind this, we may surmise, lay a robust critique from kokugaku of foreign (Chinese) influence, and the period sits around the handover from the eminent kokugaku scholar Kamo no Mabuchi to Motoori Norinaga, when a counter-movement of ideas against imported Confucianism and Buddhism was swiftly intensifying; Osaka, unlike Edo, possessed a unique environment: Nara and Kyoto were nearby, and scholars from autonomous domains on the west side of the archipelago, where ties with the Tokugawa house were weaker, also gathered, so I think these cutting-edge currents of thought percolated more quickly than in Edo; above all, merchants drove Osaka’s cultural efflorescence; merchants constantly read the age ahead and excelled at survival by dispersing risk; from this vantage, it is interesting to see a different lineage from Edo’s mainstream schools intervening and influencing the structure of Doshomachi.

Kokugaku scholars held that, rather than Buddhist and Confucian scriptures that ostentatiously bore foreign influence or the Nihon Shoki, modeled on Chinese histories, the deep insights of the Man’yoshu and the Kojiki, where such influence was lighter, were essential to restoring Japan’s native thought; whether this movement also influenced the public mood or not, the 1780 decision to enshrine not only Shennong (China) but also Sukunahikona (Japan) is significant; that said, Sukunahikona, though appearing in Japanese myth, is himself an immigrant deity; at the same time, because Sukunahikona is also a god of medicine, like Shennong, he was cherished within the Doshomachi ethos; what I find most interesting is that Doshomachi merchants did not exclude Shennong (China), whom they had originally enshrined, but welcomed Sukunahikona (Japan) and enshrined them doubly—this is quintessentially merchant-like; the commercial temperament of pioneering risk dispersion by anticipating the times while leaving an escape route well prepared—a spirit that may still remain in Doshomachi today—is visible in the faith surrounding Sukunahikona Shrine.

Moreover, across long history there existed throughout the country unique compounding techniques for “combined medicines,” aigusuri (合薬), that differed by locale and household; under diverse forms such as secret transmissions and hereditary teachings, these always existed as hidden remedies that history does not narrate; this is not a simple matter of “front” and “back,” but rather it is on this side that we find an abundance of true history, yet because it leaves no records, it is impossible to know its inner reality.

Here the character of Semba becomes important; surrounded on four sides by rivers and, as a merchants’ district, less burdened by the strict codes that constrained warriors, the wealthy merchants of Semba never lacked for amusements; that is, the more Semba burgeoned as a merchants’ quarter, the more, inevitably, pleasure quarters and theaters and other entertainments blossomed gorgeously around Semba and captivated people; in fact, even now one can sense that Osaka’s entertainment districts orbit around old Semba, and needless to say, a culture of entertaining clients must have flourished, and many shady figures must have infiltrated; if anything went wrong, the character of Semba—surrounded by rivers on all sides—bought time to flee until officials arrived en masse.

Particularly, Doshomachi was a one-of-a-kind place in Japan where professionals of medicine gathered both openly and covertly; there were many legitimate traders who handled medicinal ingredients and engaged in compounding, but at the same time there must also have been a considerable number of people working on the underside; for example, as underground trades, there would have been numerous instances of procuring and selling medicinal ingredients—including smuggled items unobtainable legally—as well as making prohibited compounds, yet history does not tell us who these people were; what must not be forgotten at this time is that those who held permits to move in and out of Nagasaki’s Dejima, the only open port, and who gathered information from the Dutch—licensed to trade—and concluded smuggling arrangements with them were not officials, scholars, or merchants, but prostitutes designated specifically for the Dutch to prevent crimes against other Japanese citizens (Dutch Wife); in other words, these Dutch-designated prostitutes, who were allowed to enter Dejima, procured information and goods from the Dutch and, together with people engaged in underground trades, diverted them westward, and I believe this shadow flow of information and goods was consolidated in Osaka—an underside that must have been an important aspect of Osaka in the Edo period; precisely because of this, Osaka may have been able to carry out, one after another, experimental undertakings that could not be done in Edo at the time—this is the facet of Osaka’s history that I find most fascinating.

Nor is this something to judge by the good and evil of the modern era; in fact, when cholera spread in Osaka in 1822, an unnamed town doctor in Osaka created a new remedy as a plague preventative, which spread starting in Semba—the drug was called “Koto-sakki Yuo-en” (虎頭殺鬼雄黄圓); intriguingly, its ingredients were a proprietary blend of ten Chinese and Japanese medicinal substances, including tiger skull, a medicine one could not even conceive without deep familiarity with domestic and foreign medical arts and compounding; this was an era when an otherwise-unknown physician could calmly create such a medicine—a thing unimaginable today; and beyond the record, there also existed the roving drifters of sea and mountain who moved history itself by moving through it.

Lately, the Edo-period character that personally fascinates me most is this temporal quality mediated by the trade in medicinal ingredients—front and back—aggregated in Osaka, and when I, born and raised in Osaka, look back anew, I sense that its traces remained among the elders.