There is no knowledge of the germ theory of disease in the EN. [...] The imbalance of humors [...]
I think that this is a little weird, though. I can understand medicine not being advanced enough to know about germs yet --medical jutsu as an effective cure-all would do little to spur innovation and research, much in the way that bacta/kolto is used for everything under the sun in Star Wars --but Tsunade knows that humors are bullshit. The Third Hokage knew that humors are bullshit. So why is it still one of the prevailing medical theories in the EN?
I can get why Tsunade wouldn't spend her life researching --as it is, she's reshaped the medical side of ninjutsu on her own --since that was always Orochimaru's passion, whereas her is more humanitarian in scope. But she wrote books, right? I seem to remember that she (or was it her students) wrote books and did all that they could to fling them across the world. So, knowing that, why are they ignoring her easily verifiable research? Is it simply that the information still isn't readily accessible to civilians --and, thereby, the majority of the EN's population?
Tsunade isn't actually pro-civilian though, it'd be more accurate to say that she's anti-disease
I'd say that she is pro-civilian, though. We don't know much about Tsunade personally, but we know that she wanders and heals, right? Teaching medical techniques (that might not even be jutsu) and whatnot to small villages and then being notably upset that they were wiped off the map next time she tried to visit. We must also remember that she's the granddaughter of the Shodaime. The guy who wanted peace and then made it. The guy who created, enforced, and maintained a village of different clans during what would later be called
"The Warring Clans Era."
I would be willing to bet my hat that Tsunade's far more progressive than 90% of ninja. I'm of the opinion that she's simply disinterested or disillusioned with the village system as a whole. She was actively dismissive of her political weight until the Hyuuga Hokage (can't remember his name, finals are killing me right now) promised to lend his aid in furthering her cause.
I mean, it just feels a little weird to go "release the gates of hell, make them wish for death, slaughter our enemies" but then feel icky about getting them sick or poisoning them.
I believe that characters in fiction can be contradictory because people in real life are contradictory. She might not give two shits about slapping an enemy down a peg
(she how she tested Mari? And that was her playing nice, since she knew that the old pervert liked Mari in some capacity... also, we really don't know much about her, do we?) but then draw the line at biological warfare. A good example of this in real life is the American President Thomas Jefferson. He wrote against political tyranny, he wrote against the divine right and sacral nature of kingship, he wrote "give me liberty or give me death." But Thomas Jefferson was also someone who literally
owned other people and had rape babies with many of his slaves.
Characters can be contradictory and flawed because
people are contradictory and flawed.
Edit for clarity of thought. Finals are a thing and, because of that, my head is pounding while coffee floods my veins and usurps the place of my blood.