page_title: Hanaoka Seishū
section_title: Hua Tuo and mafeisan
hierarchical_section_title: Hanaoka Seishū / Hua Tuo and mafeisan
caption_attribution_description: English: Portrait of the physician Hua Tuo from a Qing Dynasty edition of The Romance of the Three Kingdoms.
context_page_description: Hanaoka Seishū was a Japanese surgeon of the Edo period with a knowledge of Chinese herbal medicine, as well as Western surgical techniques he had learned through Rangaku. Hanaoka is said to have been the first to perform surgery using general anesthesia.
context_section_description: Hua Tuo (華佗, ca. AD 145-220) was a Chinese surgeon of the 2nd century AD. According to the Records of Three Kingdoms (ca. AD 270) and the Book of the Later Han (ca. 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 (麻沸散). Hua Tuo reportedly used mafeisan to perform even major operations such as resection of gangrenous intestines. Before the surgery, he administered an oral anesthetic potion, probably dissolved in wine, in order to induce a state of unconsciousness and partial neuromuscular blockade.
  The exact composition of mafeisan, similar to all of Hua Tuo's clinical knowledge, was lost when he burned his manuscripts, just before his death. The composition of the anesthetic powder was not mentioned in either the Records of Three Kingdoms or the Book of the Later Han. Because Confucian teachings regarded the body as sacred and surgery was considered a form of body mutilation, surgery was strongly discouraged in ancient China. Because of this, despite Hua Tuo's reported success with general anesthesia, the practice of surgery in ancient China ended with his death.
  The name mafeisan combines ma (麻, meaning "cannabis, hemp, 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 probably means something like "cannabis boil powder". Many sinologists and scholars of traditional Chinese medicine have guessed at the composition of Hua Tuo's mafeisan powder, but the exact components still remain unclear. His formula is believed to have contained some combination of:
  bai zhi (Angelica dahurica),
  cao wu (草烏, Aconitum kusnezoffii, Aconitum kusnezoffii, Kusnezoff's monkshood, or wolfsbane root),
  chuān xiōng (Ligusticum wallichii, or Szechuan lovage),
  dong quai (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 (Mandragora officinarum)
  rhododendron flower, and
  jasmine root.
  Others have suggested the 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"." Some 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 physicians have attempted to re-create the same formulation based on historical records but none have achieved the same clinical efficacy as Hua Tuo's. In any event, Hua Tuo's formula did not appear to be effective for major operations.
caption: Hua Tuo, Chinese surgeon, circa AD 200
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