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Medicine during the <i>Edo</i> period became increasingly Balkanized as five separate schools of medicine were practiced in Japan. Each of these schools was based on the Chinese medical tradition. In the sixth century, Chinese medicine, <i>kanpō</i>, was brought to Japan by Buddhist priests.<ref>Lock, <i>East Asian Medicine in Urban Japan</i>, 27.</ref> <i>Kanpō</i> utilized Chinese herbs, acupuncture, moxibistion and massage. Chinese medicine was based on the principle that the body, like the universe, can potentially achieve “a state of dynamic equilibrium if no strain is imposed on the system.”<ref>Lock, <i>East Asian Medicine in Urban Japan</i>, 32.</ref> Unfortunately, the body was constantly disturbed by internal and external influences which manifest themselves as either deficiencies (ying) or excesses (yang) of energy. Because patients were seen as part of nature, illness was caused by these continual environmental forces acting on their bodies.<ref>Lock, <i>East Asian Medicine in Urban Japan</i>, 32-33.</ref> Physicians working in the Chinese system focused on categorizing illness under a complex set of groupings that demonstrated the relationships between man and the universe. The Chinese medical system did not bother portraying the body in an anatomically accurate way because it was far more concerned with the “functional interrelationships between the parts of the body.”<ref>Lock, <i>East Asian Medicine in Urban Japan</i>, 34.</ref> While Japanese physicians in the five separate sects adopted and modified the Chinese medicine, the theoretical foundations for kanpō remained tied to Chinese medicine.
The <i>goseiha</i> or <i>rich</i> school (founded in during the late 1500s) was highly theoretical, but doctors from this school were not necessarily tied blindly to theory and trusted their own experience.<ref>Lock, <i>East Asian Medicine in Urban Japan</i>, 54.</ref> The <i>goseiha</i> sect was eventually overshadowed by the koihō sect. The <i>koihō</i> school sought to return to Confucian scholarship and was essentially as a reactionary movement against the goseiha school. But this sect would later emphasize clinical experimentation and an understanding of anatomy.<ref> Nakumura, Practical Pursuits, 12.</ref> By the mid-seventeen hundreds, a reform school called the kōshōgaku led by the powerful Taki family altered Japanese medicine’s course and relied on the Shōkanron, a Chinese medical text from 200 A.D.<ref>Lock, <i>East Asian Medicine in Urban Japan</i>, 54.</ref> By 1791, the kōshōgaku sect’s medical school became the official school of the <i>Bakufu</i>(the Shogunate).<ref> Nakumura, Practical Pursuits, 12.</ref>
The <i>wahō</i> sect differed from its competitors because it sought to emphasize its Japanese roots. Instead of relying on Chinese texts, <i>wahō</i> physicians “emphasized observation based on the five senses and experience.”<ref>Nakumura, <i>Practical Pursuits</i>, 12</ref> Physicians of the <i>wahō</i> sect studied classic Japanese texts. On the other hand, the <i>kanransetchu</i> or Chinese-Dutch eclectic school focused on outside influences and combined some elements of Western and Chinese medicine. Physicians from the </i>karansetchu</i> school incorporated some Westerner surgical, bloodletting and obstetrics techniques. A karansetchu physician, Hanoako Seishu (1760-1835), developed anesthesia forty years before Europeans.<ref>Nakumura, <i>Practical Pursuits</i>, 13</ref> While <i>karansetchu</i> physicians incorporated Western elements into their practices, they were not true <i>ranpō</i> or Western doctors. These systems of medicine dominated throughout the Edo period, but Western medicine began to slowly filter into Japan and challenge their dominance.