I-do (The Medical Service Under The Japanese Ritsuryo System) (医道)

"I-do" refers to the medical service under the Japanese "Ritsuryo system" (system of centralized regime based on the ritsuryo code), or the education of the youth to make them offer services. Even today, some people, such as those in the Medical Ethics Council, call medical science I-do after this. Under the Yamato Court, the general youth education was implemented at "Daigakuryo" (Bureau of Education under the Ritsuryo system) under the direct control of "Shikibusho" (the Ministry of Ceremonial), while the I-do education was distinctively implemented at "Tenyakuryo" (the Bureau of Medicine) under the direct control of Imperial Household Ministry.

According to "Yoro ritsuryo code" (code promulgated in the Yoro era), "shitokan" (four classifications of bureaucrats' ranks), including "Tenyaku no kami" (the head of Tenyakuryo), were established within Tenyakuryo, and there existed four kinds of technocrats, that is, doctor, acupuncturist, masseur, and necromancer. Moreover, Tenyakuryo had an educational organization that was headed by an "I-hakase" (Master of Medicine), a "Hari-hakase" (Master of Acupuncture), an "Anma-hakase" (Master of Massage), and a "Jugon-hakase" (Master of Necromancy), who were selected as excellent in their knowledge and medical techniques from all technocrats. In the organization, there were 40 students of medicine, 20 students of acupuncture, 10 students of massage, and 6 students of necromancy. The whole system of Tenyakuryo was modeled after the system of "Taiisho" in the Tang dynasty of China. Under the Tang dynasty, I-hakase was at Senior Eighth Rank, Upper Grade, Hari-hakase was at Junior Eighth Rank, Lower Grade, Anma-hakase was at Junior Ninth Rank, Lower Grade, and Jugon-hakase was at Junior Ninth Rank, Lower Grade, while in Japan, they were placed at Senior Seventh Rank, Upper Grade, Junior Seventh Rank, Lower Grade, Senior Eighth Rank, Upper Grade, and Junior Seventh Rank, Upper Grade, respectively. This reflects the situation that doctors were highly valued in Japan at that time. And in the field of pharmacy, there was no "Yaku-hakase" (Master of Pharmacy), and instead, "Yakuenshi" (an official in charge of managing medicinal herb gardens) directly taught students about medicinal herb gardens under the control of Tenyakuryo, and also taught the students of pharmacy under control of "Naiyakushi" (the office in charge of providing medical examination and prescription drugs to the Imperial Family).

Students of medicine and other fields were restricted in their age (from 13 to 16). And in their adoption, the court prioritized those from "kusuri-be" (the hereditary occupational group on pharmacology), such as "Hachida no Kusushi" and "Nara no Kusushi," and those from "seshu" (the lineage engaged in medicine for three consecutive generations). If there was vacancy, the court adopted students from the ordinary people. In the basic course, students had to study "Kotei Ko-otsukyo" (the Chinese classic on clinical acupuncture, written by Huangfu Mi), "Myakukyo" (the oldest Chinese book on sphygmoscopy), and "Shinno Honzogyo" (Divine Husbandman's Classic on pharmacology, which is a Chinese classic), and in 787, the last textbook was replaced with "Shinshu Honzo" (Chinese pharmacology, completed in A.D. 659). And they also had to learn "Shobonho" (the Chinese classic on pharmacopoeia, written by Chen Yan Zhi) and "Shugenho" (a Chinese classic on pharmacopoeia highly valued along with Shobonho). In addition, students of acupuncture had to study "Kotei Somonkyo" (Basic Questions in Yellow Emperor's Inner Canon, covering the theoretical foundation of Chinese medicine and its diagnostic methods), "Kotei Shinkyo" (Needling Canon in Yellow Emperor's Inner Canon, discussing the acupuncture therapy in detail), "Myakuketsu" (a Chinese classic on sphygmoscopy), and "Kotei Myodokyo" (a Chinese classic on acupuncture, highly valued along with Kotei Shinkyo). And they also had to learn "Ruchugyo" (a Chinese classic on acupuncture), "Osokuzu" (a Chinese classic illustrating acupuncture), and "Shaku Jinshinkyo" (a Chinese classic illustrating acupuncture). When "Engishiki" (the codes and procedures on national rites and prayers established in the middle of the Heian period) were in effect, students also had to learn "Hachijuichi Nankyo" (a Chinese classic on acupuncture) and "Taiso" (the commentary of Yellow Emperor's Inner Canon, written by Yang Shang Shau). After studying these textbooks, students advanced to the professional course, and for example, in the case of 40 students of medicine, 24 students advanced to the course of "tairyo" (internal medicine), 6 to the course of "soshu" (surgery), 6 to the course of "shosho" (pediatrics), and 4 to the course of ear, eye, mouth, and tooth. The court required the students of tairyo and acupuncture to study seven years, those of soshu and shosho to study five years, and those of ear, eye, mouth, and tooth to study four years. They had to take examinations every month, every season, and every year. When they passed the final examination at the Imperial Household Agency, they were sent to "Dajokan" (Grand Council of State), and after the examination at Shikibusho for appointment, they were conferred with ranks. Successful examinees were adopted as doctors at various offices, such as the Tenyakuryo, Naiyakushi, "Efu" (the office of Palace guard), "Meryo" (the section taking care of imperial horses), and local provinces under the Ritsuryo system. Each local province had one doctor, and the doctor was, just the same as Tenyakuryo, responsible for training students of medicine, whose number differed according to the size of the province (10 students for an ultra-large province/8 for a large province/6 for a middle-sized province/4 for a small province).

However, talented doctors were greatly lacking. In principle, the doctor at a local province should have been the person who came from the very province, but in reality, some provinces had no doctors and some doctors served two or more provinces at the same time. In an extreme case, a student who was still studying was appointed to the doctor. Against this tendency, the court took countermeasures, such as rewarding KICHITA no Yoroshi (called Kichiyoroshi for short) in 721 for his contribution to I-do, and newly establishing the post of "Nyoi Hakase" (Female Master of Medicine) in Naiyakushi. In 730, the court selected the three "itokugosho" (best students of medicine) from among excellent students, and gave them almost the same treatment as the students of Daigakuryo. In 814, the court added four more itokugosho, who were treated as members of the Naiyakushi, and in 820, the court similarly selected the five best students of acupuncture. The court gave other preferential treatment as well, such as enlarging "kangakuden" (fields provided in order to cover the students' expenses) and "hakase-sikiden" (fields provided in order to cover the masters' expenses). The name "I-do" was modeled after "Myogyo-do" (the study of Confucian classics) and others, and the name took root among the public around the Jogan era (A.D. 859 - A.D. 877). In the 10th century, I-do became almost the hereditary learning of the Tanba clan and the Wake clan, and the Naiyakushi was integrated into the Tenyakuryo. In 894, TANBA no Yasuyori wrote "Ishinbo" (the oldest book on medicine of all remaining ones written by Japanese) and dedicated it to the emperor. This gave the decisive advantage to the Tanba clan, and the clan thereafter occupied Tenyaku no kami, which was depicted as the supreme leader within the I-do community in "Shokugensho" (book on the history of Japanese governmental posts written by Chikafusa KITABATAKE).

[Original Japanese]