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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>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.

Aside from serving as a physician for Deshima, Siebold was sent to Japan by the Dutch to help convince the Japanese that they deserved special consideration, when and if Japan was opened up to foreign trade. The Dutch hoped to preserve the fiction in the eyes of the Japanese that the Netherlands was repository of Western learning.<ref>Bowers, <i>Western Medical Pioneers in Feudal Japan</i>, 108.</ref> Therefore, Siebold was chosen because he was considered to be an outstanding emissary. Initially, Siebold was an outstanding emissary. He was popular with the city officials from Nagasaki and he attracted students from throughout Japan. He began to build a reputation as an outstanding physician. Japanese physicians even began to take their problem cases to Nagasaki in order to have a consultation with Siebold. These physicians would often stay and join Siebold’s students in the lecture room.<ref>Bowers, <i>Western Medical Pioneers in Feudal Japan</i>, 112.</ref>

Siebold ultimately attracted so many students that he established a free medical school in Nagasaki, the Narutakijuki. A student even provided Siebold with a building in Nagasaki to conduct lectures and surgeries. Siebold’s school taught exclusively Western medical practice and surgery. Not only did Siebold lecture to his students, but there is evidence which suggests that he “taught by demonstration” which was unheard of Japanese medical schools. Siebold may have conducted as many as six operations in front of his students to demonstrate Western surgical techniques.<ref> Nakamura, <i>Practical Pursuits</i>, 32-33.</ref> Siebold diagnostic techniques also differed dramatically from the pulse diagnosis, tongue examination and patient observation common in Japanese medicine.<ref>Bowers, <i>Western Medical Pioneers in Feudal Japan</i>, 112.</ref>