Ideas about disease and healing methods in Heian-era Japan

In his monumental work Ishinhō (984), translated here as “The True Method of Treatment,” court physician Tamba Yasuyori (912 995) reorganized the received corpus of Chinese medical knowledge and proposed a new classification of illnesses and therapies, thereby laying key foundations for Japanese medicine. This article examines the distinctive features of Heian-period (794 1185) medical practice, with particular attention to the diversity of diagnosed diseases, their etiology, and the principal actors involved in treatment. Methodologically, the study draws primarily on 11^th 12^th-century court diaries Midōkanpakuki (Fujiwara no Michinaga), Shōyūki (Fujiwara no Sanesuke), and Gyokuyō (Kujō no Kanezane). Unlike the Ishinhō, these sources document the day-to-day application of therapies in considerable detail and illuminate the inseparable integration of medicine and ritual: pharmacological prescriptions, incantations, and exorcistic rites routinely complemented one another in the management of illness. The diaries attest to an extensive nosology, but the most prevalent and feared condition was “wind disease,” a disorder marked by heterogeneous etiologies and a wide range of symptoms. Treatment typically involved three categories of specialists court physicians, onmyōji (yin-yang diviners), and genja (Buddhist ritual adepts) each performing distinct functions within a shared therapeutic enterprise. Although their domains at times overlapped and produced competition, and even open rivalry, such tensions generally did not undermine therapeutic efficacy; rather, their combined interventions made treatment notably adaptable. Explanations of causation ranged from pathogenic qi, intensified by noxious winds in accordance with Chinese medical theory, to the agency of kami and other supernatural beings capable of inflicting serious harm. Chief among the presumed culprits were vengeful spirits (mononoke). No universal cure existed: different categories of malevolent entities called for distinct therapeutic modalities herbal decoctions, liturgical recitations, or elaborate exorcisms deployed in combination as circumstances required.

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