During the course of history, we can find efforts at creating one form or another of general anesthesia. These attempts can be tracked in the writings of the ancient Sumerians, Babylonians, Assyrians, Egyptians, Greeks, Romans, Indians, and Chinese. The first attempts at general anesthesia were probably herbal remedies administered in prehistory. Alcohol is the oldest known sedative; it was used in ancient Mesopotamia thousands of years ago.
One man who made notable strides in this field was Hua Tuo. Hua Tuo (c. 140–208) was a Chinese surgeon of the 2nd century AD who lived in the late Eastern Han Dynasty. According to the Records of Three Kingdoms (c. AD 270) and the Book of the Later Han (c. AD 430), Hua Tuo performed surgery under general anesthesia using a formula he had developed by mixing wine with a mixture of herbal extracts he called mafeisan. Hua Tuo reportedly used mafeisan in order to induce a state of unconsciousness and partial neuromuscular blockade to perform even major operations such as resection of gangrenous intestines.
Hua Tuo’s Sanguozhi biography describes him as resembling a Daoist xian (Wade–Giles: hsien; 仙, “immortal”) and details his medical techniques:
“If a sickness were concentrated internally where the effect of acupuncture needles and medicines could not reach it, Hua-t’o would recognize that it was necessary to operate. In such cases, he would have his patients drink a solution of morphean powder whereupon they would immediately become intoxicated as though dead and completely insensate. Then he could make an incision and remove the diseased tissues. If the disease were in the intestines, he would sever them and wash them out, after which he would stitch the abdomen together and rub on an ointment. After a period of about four or five days, there would be no more pain. The patient would gradually regain full consciousness and within a month he would return to normal.” (tr. Mair 1994:688-689).
The name mafeisan combines ma (麻, meaning “cannabis, numbed or tingling”), fei (沸, meaning “boiling or bubbling”), and san (散, meaning “to break up or scatter”, or “medicine in powder form”). Therefore, the word mafeisan may mean something like “cannabis boiling powder”. Hua Tuo’s corresponding Houhanshu biography explains that this mafeisan “cannabis boiling powder” concoction was dissolved in jiu (“alcoholic beverage; wine”).
Unfortunately Hua’s prescription for mafeisan anesthetic liquor was lost or destroyed, along with all of his writings, leaving sinologists and scholars of traditional Chinese medicine to guess at the composition of Hua Tuo’s mafeisan powder. Although the exact components still remain unclear, his formula is believed to have contained some combination of:
bai zhi (Chinese:白芷，Angelica dahurica),
cao wu (Chinese:草烏, Aconitum kusnezoffii, Aconitum kusnezoffii, Kusnezoff’s monkshood, or wolfsbane root),
chuān xiōng (Chinese:川芎，Ligusticum wallichii, or Szechuan lovage),
dong quai (Chinese:当归,Angelica sinensis, or “female ginseng”),
wu tou (烏頭, Aconitum carmichaelii, rhizome of Aconitum, or Chinese monkshood”),
yang jin hua (洋金花, Flos Daturae metelis, or Datura stramonium, jimson weed, devil’s trumpet, thorn apple, locoweed, moonflower),
ya pu lu (押不芦,Mandragora officinarum)
Some researchers suggest that Hua Tuo’s potion may have also contained hashish, bhang, shang-luh, or opium. Victor H. Mair wrote that mafei “appears to be a transcription of some Indo-European word related to ‘morphine.’” While other authors believe that Hua Tuo may have discovered surgical analgesia by acupuncture, and that mafeisan either had nothing to do with or was simply an adjunct to his strategy for anesthesia. Many attempts have been made by physicians over time to re-create the same formulation based on historical records but none have achieved the same purported clinical efficacy as Hua Tuo’s. This has led some to conclude that Hua Tuo’s formula did not appear to be effective for major operations.
When Hua Tuo burned his manuscripts just before his death, the exact composition of mafeisan along with all of Hua Tuo’s clinical knowledge was lost. The composition of the anesthetic powder was not mentioned in either the Records of Three Kingdoms or the Book of the Later Han. After Hua Tuo’s death and despite his reported success with general anesthesia, the practice of surgery in ancient China ended and Hua Tuo’s practices were completely abandoned.