Mafeisan — The World's Earliest Anesthetic

Those who have read the novel Romance of the Three Kingdoms may still recall the episode in which Guan Yu, the great general of the Kingdom of Shu, while battling the forces of Cao Ren of the Kingdom of Wei, was struck in the right arm by a poisoned arrow. His entire arm became red, swollen, and critically endangered. The Shu army dispatched the renowned physician of the time, Hua Tuo, to Xiangyang to treat Guan Yu. After examining the wound, Hua Tuo decided to perform surgery and recommended that Guan Yu take Mafeisan for anesthesia. Guan Yu refused, so Hua Tuo bound his injured arm to an iron ring on a wooden frame and applied a potent topical anesthetic to the area. Taking out a sharp knife, he scraped away all the decayed flesh and damaged periosteum, applied medicine, and then stitched the wound closed with silk thread — thus saving Guan Yu's life and his arm.

The “Mafeisan” described in the novel is, in fact, the first anesthetic ever invented and used in the world. It was created by Hua Tuo, the outstanding physician of the late Eastern Han dynasty and the Three Kingdoms period. As early as the 2nd century CE, China was already using Mafeisan for general anesthesia to perform laparotomies. It was not until the mid-19th century that European and American physicians began to administer anesthetics — a full 1,600 years later than China. This incomparable pioneering achievement placed Chinese medicine at the forefront of the world for centuries.

According to legend, Hua Tuo also intended to use Mafeisan to treat Cao Cao's chronic head-wind disease. He proposed that Cao Cao ingest Mafeisan, after which Hua Tuo would open his scalp and excise the root of the disease. Regrettably, Cao Cao did not trust Hua Tuo's skill and instead had him executed.

There are many legends regarding the fate of the formula for Mafeisan. Some say Hua Tuo burned it; others say that while in prison, Hua Tuo gave it to a guard, but the guard's wife burned it, and the guard only managed to save a portion; still others say that what Hua Tuo burned was merely a copy, and the original text remained at his home.

In 1979, a Chinese and foreign publishing house released a book titled Hua Tuo Shen Fang (Hua Tuo's Divine Formulas), compiled by the Tang dynasty physician Sun Simiao. Within it was the long-desired formula for Mafeisan that so many had yearned to see. Its composition is as follows: Chinese azalea (Rhododendron molle) 9 grams, jasmine root 3 grams, Chinese angelica (dang gui) 30 grams, and sweet flag (chang pu) 0.9 grams, decocted in water and taken as one bowl.

The book also records that this formula was specifically used to treat abdominal masses — whether round or oblong — that had failed to respond to other medicines and required surgical incision of the lower abdomen for removal; or for diseases within the brain that necessitated opening the skull to extract the pathogenic matter, after which the head-wind would resolve on its own. Taking this formula renders a person unconscious, unaware of all external events, so that one may be cut open without feeling pain or itch — demonstrating that its anesthetic effect was extremely potent. From this, it can be seen that Hua Tuo's level of achievement in the fields of brain surgery, general surgery, and anesthesiology was extraordinarily advanced for his time. Tracing even further back, a certain story records that during the Warring States period, the divine physician Bian Que used a “poisonous wine” as an anesthetic to perform a heart-exchange operation on two patients suffering from cardiac disease. Regrettably, there is no written record of the ingredients of this “poisonous wine”; otherwise, the discovery of anesthetics in China would date back even further!