This article first reviews the political, economic, and cultural context within which Japanese during the Tokugawa era (1600–1866) mastered Kanbun 漢文 as their elite lingua franca. Sino-Japanese cultural exchanges were based on prestigious classical Chinese texts imported from Ming (1368–1644) and Qing (1644–1911) China via the controlled Ningbo-Nagasaki trade and Kanbun texts sent in the other direction, from Japan back to China. The role of Japanese Kanbun teachers in presenting language textbooks for instruction and the larger Japanese adaptation of Chinese studies in the eighteenth century is then contextualized within a new, socio-cultural framework to understand the local, regional, and urban role of the Confucian teacher–scholar in a rapidly changing Tokugawa society. The concluding part of the article is based on new research using rare Kanbun medical materials in the Fujikawa Bunko 富士川文庫 at Kyoto University, which show how some increasingly iconoclastic Japanese scholar–physicians (known as the Goiha 古醫派) appropriated the late Ming and early Qing revival of interest in ancient Chinese medicine rather than continue to follow more recent Song-Jin-Yuan 宋金元 medical practices (Goseiha 後世派) based on Song interpretations of the Huangdi neijing 黃帝內經 (Yellow Emperor's inner classic). This group favored ancient treatment formulae and empirically based diagnoses, which drew on the Shanghan lun 傷寒論 (Treatise of Cold Damage Disorders) as a medical text and Zhang Zhongjing 張仲景 as a pioneering physician. Although many Japanese physicians favored Western medicine (transmitted via Dutch Learning 蘭學) over Chinese medicine in the mid-nineteenth century, most in the mid- and late-eighteenth century focused on mastering classical Chinese, and then Ming and Qing medical books entering Nagasaki from China. These new, critical currents of Chinese medicine in Japan provided the impetus later for growing Japanese interest in Dutch Learning and modern Western medicine.

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