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This chapter examines the pharmaceutical aspects of the new knowledge available in the East Asian macroculture and how Kajiwara Shōzen benefited from access to and information about materia medica transported along the so-called Pharmaceutical Silk Road. The chapter first considers the increasing availability of overseas materia medica as well as the technical challenges faced by Shōzen in trying to understand formulas and materia medica. It then discusses some of the changes in Chinese medicine between the Tang and Song eras and the influence of Islamic medicine on Song medicine. It also explores the new illness category of disorders of qi and how it was understood by Shōzen. It concludes with some examples of Shōzen's use of formulas to illustrate how the preceding elements converged to influence Japanese medicine.

This chapter examines the impact of Song medical texts in medieval Japan and more specifically how they restructured the landscape of knowledge about Japanese medicine. Against a background of the scarcity of Japanese medical works and the plethora of information that became available in a new media as a result of the Song printing revolution, the chapter describes the contours of what is best understood as the appropriating context of Song-period Chinese medicine. It also looks at the variety of Song printed medical works as well as some of the works that Kajiwara Shōzen consulted. Some Chinese medical works are noted in the Ton'ishō and others in the Man'anpō. The chapter concludes by discussing the ways in which Shōzen benefited from Song medical knowledge and how print culture in China helped him become familiar with Song-period Chinese medicine.

This chapter focuses on the disease of rai or leprosy, as a medical issue. Leprosy was one of the most socially, religiously, and medically complex afflictions in medieval Japan. Prior scholarship has given much attention to leprosy as a social and religious matter—examining issues of discrimination and marginalization and aspects of Buddhist teachings, particularly the notion of karma, that may have justified some discrimination. The first medical description of rai—the symptoms, the nature of the affliction, and the treatments to be used—is provided by Kajiwara Shōzen in Ton'ishō and Man'anpō. This chapter considers Shōzen's initial understanding of the Buddhist etiology of leprosy as a karmic illness as seen in his two medical texts. It shows that the issue of rai is more complex than generally represented and that ideas of rai found in Song-era Chinese medicine led to a substantial reassessment of the disease that invalidated some previous assumptions about it.

This chapter considers how the Japanese city of Kamakura provided a conducive environment that made it possible for Kajiwara Shōzen to gain access to Song medical knowledge and to write his two landmark texts. It first compares attitudes to the outside world between Japan's aristocratic elite in the city of Kyoto and nonaristocrats near Hakata Bay on the southern island of Kyushu. It then looks the Buddhist networks that facilitated cultural and intellectual contacts, and especially how information about Chinese medicines circulated among monks over long distances and extended periods of time. It also examines the cult of the Mañjuśrī Bodhisattva and the Ritsu Precept sect, along with the medical facilities in Kamakura used by Shōzen for his activities. Finally, it discusses some aspects of the cosmopolitan milieu of Kamakura.

This epilogue offers a number of broader observations relating to the appropriation, testing, and refining of Song medical knowledge by focusing on Kajiwara Shōzen. It first considers some issues related to the transmission and appropriation of book knowledge and some of the things that Shōzen gained from Song-era Chinese medicine. It then explores issues relevant to the clinical engagement of that new knowledge and describes the process of inquiry. It also discusses the interaction of Buddhist and Chinese systems of explanation, citing an example where Song medicine was confirmed by reference to a Buddhist understanding and another example where Buddhist understanding was superseded by a Chinese understanding. For Shōzen, the major explanatory challenge involving karma related to rai; despite the notion of karma being so fundamental to Buddhism, he concluded that a Song medical explanation was a superior model for a disease that had been previously understood in terms of basic Buddhist textual teaching.