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Table of Contents
RESEARCH ARTICLE
Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 83-86

Taking mafei powder (麻沸散) as an example to explore the evidence of the existence of ancient anesthesia


1 Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
2 Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine; Laboratory of Molecular Biology, Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China

Date of Submission22-Jan-2020
Date of Acceptance26-Mar-2020
Date of Web Publication29-Jun-2020

Correspondence Address:
Prof. Leimiao Yin
Shanghai Research Institute of Acupuncture and Meridian, Shanghai
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CMAC.CMAC_11_20

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  Abstract 


Anesthesia has a long history in China. Ancient doctors have already created a variety of anesthetic formulae for surgery and the most famous one is Mafei powder (麻沸散). However, there are a few literatures about Mafei powder and Mafei powder was not recorded at that time. This article tries to discuss the existence of Mafei powder by summarizing relevant records in ancient books such as San Guo Zhi (《三国志》 Records of The Three Kingdoms) and Hou Han Shu (《后汉书》 History of the Latter-Han Dynasty) and analyzing the anatomical, surgical, and pharmaceutical conditions at Hua Tuo's (华佗) time.

Keywords: Historical evidence, Hua Tuo, literary evidence, Mafei powder (麻沸散)


How to cite this article:
Yuan H, Zhou D, Yin L. Taking mafei powder (麻沸散) as an example to explore the evidence of the existence of ancient anesthesia. Chin Med Cult 2020;3:83-6

How to cite this URL:
Yuan H, Zhou D, Yin L. Taking mafei powder (麻沸散) as an example to explore the evidence of the existence of ancient anesthesia. Chin Med Cult [serial online] 2020 [cited 2020 Jul 11];3:83-6. Available from: http://www.cmaconweb.org/text.asp?2020/3/2/83/288530



Anesthesiology has a long history in China. As early as in the Warring States period, Lie Zi Tang Wen (《列子·汤问》) records that Bian Que (扁鹊) used anesthesia for surgery: “Bian Que asked two patients to drink poison wine and the patients fainted for three days. After that, Bian Que dissected the patient's chest and exchanged their hearts.”[1] (扁鹊遂饮二人毒酒, 迷死三日, 剖胸探心, 易而置之0) In the above record, Bian Que used “poison wine” as anesthetic to the patient for surgery.

Our ancestors have already discovered that some traditional Chinese medicines had the effects of anesthesia and analgesia. They used these medicines into anesthetic prescriptions and the most famous is Mafei powder. It is said that Hua Tuo's son, Fei Er (沸儿), died of eating Man Tuo Luo Hua (曼陀罗花Mandala flower) by mistake. In order to commemorate his son, Hua Tuo named the anesthetic formula “Mafei Powder.”

Although the name of Mafei powder is well known, the literature about Mafei powder is fragmentary and has not been systematically summarized. This article tries to discuss the existence of Mafei powder by summarizing relevant records in ancient books such as San Guo Zhi (《三国志》 Records of The Three Kingdoms) and Hou Han Shu (《后汉书》 History of the Latter-Han Dynasty) and analyzing the anatomical, surgical, and pharmaceutical conditions at Hua Tuo's time.


  Documentary Records Top


Researching relevant ancient books, the records of Mafei powder are mainly found in San Guo Zhi and Hou Han Shu. Mafei powder is first recorded in San Guo Zhi Hua Tuo Zhuan (《三国志·华佗传》 Records of The Three Kingdoms [Figure 1]. The biography of Hua Tuo), by Chen Shou (陈寿), a historian of Western Jin dynasty (西晋). This book records: “If lesions wereinside the bodyand could not be treated with acupuncture and medicine, Hua Tuo would let patients take Mafei Powder. A moment later, the patients looked like drunk and unconscious. Then Hua Tuo performed an operation and removed lesions”[2] (若病结积在内, 针药所不能及, 当须刳割者, 便饮其麻沸散, 须臾便如醉死无所知, 因破取0). In this record, Hua Tuo treated diseases by surgery in which acupuncture and medicine could not work.
Figure 1: Hua Tuo (华佗)

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Hou Han Shu Fang Shu Lie Zhuan (《后汉书·方术列传》 History of the Latter-Han Dynasty· technology), written by Fan Ye (范晔), a historian of Liu Song period in the Nan dynasty (南朝刘宋时期), also contains relevant records of Mafei powder. This book records: “If lesions wereinside the bodyand could not be treated with acupuncture and medicine, Hua Tuo would let patient take Mafei Powder and alcohol. A moment later, the patient looked like drunk and unconscious. Then Hua Tuo performed an operation and removed lesions”[3] (若疾发结于内, 针药所不能及者, 乃令先以酒服麻沸散, 既醉无所觉, 因刳破腹背, 抽割积聚0). Compared with the records in San Guo Zhi, this description of Hua Tuo's surgical treatment used alcohol as an auxiliary anesthetic. In Lie Zi Tang Wen, there has been a record of using alcohol to relieve pain and perform operations with alcohol anesthesia. Modern pharmacological studies have also shown that ethanol can directly activate the inward-rectifying potassium channel controlled by G protein gate, thus inhibiting nerve excitability and producing analgesic effect.[4],[5]


  Historical Background Top


During the period of Hua Tuo's time (the late Eastern Han dynasty, between AD 141 and 208),[6] anatomy, surgery, and traditional Chinese medicine have developed to a certain extent. Hua Tuo's time had the conditions for the production of anesthetic prescription basically.[7],[8],[9]

Anatomical conditions

Before the Eastern Han dynasty (东汉), Chinese anatomy had developed to a very high level. The shape of the character “xin” (心 heart) in Jia Gu Wen (甲骨文 the inscriptions on bones or tortoise shells) of the Shang dynasty (商朝) found in Yin Ruins (殷墟) is very similar to the shape of a physical heart.[10] In the Western Han dynasty (西汉), the book Ling Shu Wei Chang (《灵枢 ·肠胃》 Miraculous Pivot·Intestines and Stomach) details the size and shape of each organ of the digestive tract: “The length from lip to teeth is about nine centimeters (九分) and the width is about eight centimeters (两寸半); The depth from teeth to epiglottis is about eleven centimeters (三寸半) and the cubage is half a liter (五合)……”[11] (唇至齿, 长九分, 广二寸半; 齿以后至会厌, 深三寸半, 大容五合 ……). The ratio of esophagus to intestine in this record (1:36) is almost identical to that in Spalteholz's Anatomy of the Human Body (1:37).[12]

Later, Huangdi Neijing (《黄帝内经》 The Inner Canon of Huang Di) and Nan Jing (《难经》 Canon On 81 Difficult Issues) supplemented the shape and weight of the five zang organs (五脏). Nan Jing Si Shi Er Nan(《难经·四十二难》 Canon On 81 Difficult Issues·40-s Difficulty) recorded: “The liver weights two jin and four liang (两斤四两). There are three liver lobes on the left, four on the right and seven in all…… The lung weights three catty and two tael (三斤三两). There are eight lung lobes in all; There are two kidneys and they weight one catty and one tael (一斤一两)”[13] (肝重二斤四两, 左三叶, 右四叶, 凡七叶0 ……肺重三斤三两,凡八叶0 肾有两枚, 重一斤一两0) . The weight and shape of the five zang organs described here are roughly in accordance with the modern anatomy. In the following section, we take the heart as an example to compare the anatomical description of the heart in the ancient documents before the Eastern Han dynasty (东汉) with the anatomical description of the heart in modern medicine [Table 1].[14],[15]
Table 1: Anatomical description of the heart in modern medicine and before the Eastern Han dynasty

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It can be seen that the ancient medical experts in the era of Hua Tuo had a profound understanding of human anatomy and established a relatively complete system of ancient anatomy in China, which created an essential condition for the development of surgery and anesthetic prescription.

Surgical conditions

Surgery has a long history in China. The “Shang doctor” (疡医 surgeon) recorded in Zhou Yi (《周易》 The Rites of Zhou) in the Western Zhou dynasty (西周) is equivalent to a modern surgeon. These doctors are specialized in treating sore, swelling, trauma, fracture, and other surgical diseases.[16] Wu Shi Er Bing Fang (《五十二病方》 Prescriptions for 52 Diseases), a book in Warring States period (春秋战国时期), records the surgical removal method about “Pin Zhi” (牝痔 internal hemorrhoids): “Kill the dog and take out its bladder. Cover a bamboo tube with bladder and insert the bamboo tube into the rectum. Then Blow into the bladder to squeeze out Pin Zhi and cut off Pin Zhi”[17] (杀狗, 取其脬, 以穿龠, 入直中, 吹之, 引出, 徐以刀割去其巢0). This surgical treatment for Pin Zhi is similar to the modern Western medicine's cork-assisted hemorrhoidectomy.[18]

Huang Di Nei Jing, a book in the Western Han dynasty, records 17 surgical diseases. This book gives a detailed description of the treatment and prognosis of Tuo Ju (脱疽 gangrene): “The site of Tuo Ju is toe. If the color is swarthy, the patient will die. If the color is not swarthy, the patient can be cured”[11] (发于足趾, 名脱痈, 其状赤黑, 死不治; 不赤黑. 不死。不衰,急斩之,不则死矣。). This is the earliest record of the use of surgical amputation to treat gangrene.

Shi Ji Bian Que Cang Gong Lie Zhuan (《史记·扁鹊仓公列传》 Records of History· Biography of Bian Que and Cang Gong) documented: “I heard that in ancient times, there was a doctor called Yu Fu (俞跗) who could treat disease with operation instead of decoction and wine (汤液醴酒), stone needle and stretching (镵石挢引), massage and moxibustion (案扤毒熨)” (臣闻上古之时, 医有俞跗, 治病不以汤液醴酒, 镵石挢引, 案扤毒熨0). In this record, the surgery performed by Yu Fu is also very standard in the eyes of modern medicine, including Ge Pi Jie Ji (割皮解肌 opening the skin and muscle), Jue Mai Jie Jin (诀脉结筋 Vascular Ligation), and Die Huang Zhua Mu (揲荒爪幕 Peritoneum Separation).[19] Such a surgery cannot be performed without experience. In addition, Hua Tuo lived in the late years of the Eastern Han dynasty, with frequent wars and vwounds, which provided necessary conditions for the development of surgery.

Through the analysis of the related records of surgical operations in ancient books and the social conditions at the end of the Eastern Han dynasty, it can be inferred that surgery had developed before the Eastern Han dynasty. The development of surgery inevitably led to the emergence of anesthetic prescription.

Pharmaceutical conditions

Ancient doctors have found some traditional Chinese medicine, such as Wang Bu Liu Xing (王不留行 the Seed of Cowherb), Lang Dang Zi (莨菪子 Hyoscyamus niger L.), and Yang Zhi Zhu (羊踯躅 Rhododendron molle [Blume] G. Don), which have obvious analgesic effect of anesthesia. Sheng Nong Ben Cao Jing (《神农本草经》 Sheng Nong's herbal classic) records various traditional Chinese medicines with anesthetic and analgesic effects. For example, Wang Bu Liu Xing can limit bleeding and relieve pain[20] (主金疮止血, 逐痛出刺); Lang Dang Zi can relieve toothache and muscle pain[20] (主齿痛出虫, 肉痹拘急); and Yang Zhi Zhu can relieve skin pain[20] (主贼风在皮肤中淫淫痛). Jin Gui Yao Lue (《金匮要略》 Synopsis of Golden Chamber), written by Zhang Zhongjing (张仲景) at Hua Tuo's time, records five prescriptions with Wu Tou (乌头 Aconite) as the main ingredient for pain relief.[21]

Modern pharmacological studies have also proved that the ingredients in these traditional Chinese medicines have anesthetic effects. For example, scopolamine and atropine contained in Lang Dang Zi are choline receptor blockers, which can inhibit the central nervous system and have good anesthetic effect.[22],[23] Aconitine contained in Wu Tou has good analgesic effect. It can be used externally to paralyze peripheral nerve endings.[24],[25] The discovery and use of these Chinese medicine laid a solid foundation for the production of anesthetic formulations.


  Conclusion Top


By systematically combining the literature and analyzing the historical background of Hua Tuo's period, it can be found that Mafei powder had certain conditions for its emergence in the late Eastern Han dynasty (东汉末年). The anesthetic prescription represented by Mafei powder played an important role in ancient China. For example, Lin Daoren (蔺道人) in the Tang dynasty (唐代) used Zheng Gu Yao (整骨药) to anesthetize bone injuries in his book Xian Shou Li Shang Xu Duan Mi Fang (《仙授理伤续断秘方》); Bian Que Xin Shu (《扁鹊心书》 Bian Que Heart Book), a book written by Dou Cai (窦材) in the Song dynasty (宋代), records the general anesthesia prescription Shui Sheng San (睡圣散);[26] In Yuan dynasty (元代), Wei Yilin (危亦林) created Cao Wu powder (草乌散), an anesthetic formulation for fracture, recorded in Shi Yi De Xiao Fang (《世医得效方》 Effective Formulae Handed Down for Generations).[27] In the continuous exploration of anesthetic formulations, ancient doctors gradually establish some standards for the use of anesthetics. For example, Dou Cai emphasized that the dose of taking Shui Sheng San should be distinguished between adult and child: “The adult takes three Qian (三钱 15 grams) at a time and the child takes one Qian (一钱 5 grams) at a time” (每服三钱, 小儿只一钱); Wei Yilin also emphasized that patients should take different doses of anesthetics according to specific conditions such as different ages and constitutions.

Anesthesia plays an important role in the field of traditional Chinese medicine, but it also has shortcomings such as incomplete anesthesia, incomplete mechanism of action, and cannot meet the surgical requirements at present. Therefore, modern anesthesia technology and ancient anesthesia technology should be integrated in order to reduce the amount of anesthetics and side effects.[28] Mafeisan and a large number of ancient anesthetic prescriptions are the medical treasures of China. We must make textual research on these prescriptions and understand their historical backgrounds so as to have a correct understanding and research on these ancient prescriptions.

Financial support and sponsorship

This work is supported by the National Key R and D Program of China (No. 2019YFC1709704) and National Science Foundation of China (No. 81922076; No. 81973951; No. 81973952; and No. 81873373).

Conflicts of interest

There are no conflicts of interest.



 
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