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REVIEW
published: 10 March 2017
doi: 10.3389/fphar.2017.00108
Frontiers in Pharmacology | www.frontiersin.org 1March 2017 | Volume 8 | Article 108
Edited by:
Giuseppe Esposito,
Sapienza University of Rome, Italy
Reviewed by:
Anastasia Karioti,
Aristotle University of Thessaloniki,
Greece
Rajendra Karki,
St. Jude Children’s Research Hospital,
USA
*Correspondence:
Zhongzhen Zhao
zzzhao@hkbu.edu.hk
Specialty section:
This article was submitted to
Ethnopharmacology,
a section of the journal
Frontiers in Pharmacology
Received: 24 October 2016
Accepted: 21 February 2017
Published: 10 March 2017
Citation:
Brand EJ and Zhao Z (2017) Cannabis
in Chinese Medicine: Are Some
Traditional Indications Referenced in
Ancient Literature Related to
Cannabinoids?
Front. Pharmacol. 8:108.
doi: 10.3389/fphar.2017.00108
Cannabis in Chinese Medicine: Are
Some Traditional Indications
Referenced in Ancient Literature
Related to Cannabinoids?
E. Joseph Brand and Zhongzhen Zhao *
School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, Hong Kong
Cannabis sativa L. (Cannabaceae) has a long history of utilization as a fiber and seed
crop in China, and its achenes (“seeds”) as well as other plant parts have been recorded
in Chinese medical texts for nearly 2000 years. While the primary applications of
cannabis in Chinese medicine center around the use of the achenes, ancient indications
for the female inflorescence, and other plant parts include conditions such as pain
and mental illness that are the subject of current research into cannabinoids such as
cannabidiol (CBD) and 19-tetrahydrocannabinol (THC). However, little previous research
has been conducted to analyze the Chinese medical literature in light of recent advances
in the pharmacology and taxonomy of cannabis, and most of the relevant Chinese
historical records have not yet been translated into Western languages to facilitate
textual research. Furthermore, many key questions remain unresolved in the Chinese
literature, including how various traditional drug names precisely correspond to different
plant parts, as well as the implications of long-term selection for fiber-rich cultivars on
the medical applications of cannabis in Chinese medicine. In this article, prominent
historical applications of cannabis in Chinese medicine are chronologically reviewed, and
indications found in ancient Chinese literature that may relate to cannabinoids such as
CBD and 19-THC are investigated.
Keywords: Cannabis, Chinese medicine, historical changes, bencao, cannabidiol
INTRODUCTION
Cannabis sativa L. has been cultivated in China for millennia for use as a fiber, food, and medicine.
References to cannabis are found throughout classical Chinese literature, including in many famous
works of philosophy, poetry, agriculture, and medicine. Fiber-rich biotypes of cannabis (hemp)
were extensively used in ancient China for clothing and the production of paper, rope, and fishing
nets (Dai, 1989), and the achenes (“seeds”) of cannabis have been continuously used in Chinese
medicine for at least 1800 years. Today, China is regarded as one of the world’s ancient epicenters
of hemp cultivation, resulting in a diverse germplasm with genetically distinct regional varieties of
Brand and Zhao Cannabis in Ancient Chinese Medical Literature
FIGURE 1 | The chemical structures of cannabidiol (CBD, left) and
19-tetrahydrocannabinol (19-THC, right).
fiber-rich hemp that are adapted to local environmental
conditions throughout the country (Gao et al., 2014; Zhang et al.,
2014).
The prominence of hemp in ancient Chinese culture can
be seen by its occurrence in classical literature from the
Warring States Period (475–221 BC), including philosophical
works by Confucius, Mencius, Xunzi, Zhuangzi, and Mozi,
as well as the Classic of Poetry (Shi Jing;Sun, 2016). By
the first to second century AD, the ancient Shuowen
dictionary (Shuo Wen Jie Zi) featured multiple Chinese
characters that illustrate knowledge of the dioecious
nature of cannabis and discriminate based on gender
(Liu, 1999).
In the sixth century AD, the agricultural text Essential
Techniques for the Welfare of the People (Qi Min Yao Shu)
described techniques for the cultivation of hemp in great detail,
and its monograph on cannabis cultivation features one of the
first textually documented applications of fertilizer in the history
of Chinese agriculture (Shi, 1957). This text also demonstrates
the knowledge that removal of male plants at the initiation of
flowering will result in a lack of seeds; however, the text focuses
exclusively on cultivation and harvesting practices to maximize
the production of seeds and the quality of fiber and does not
reference the deliberate production of seedless cannabis (Shi,
1957).
It is notable that most classical Chinese references focus on
the use of cannabis for its seeds and fiber, with few, if any, explicit
references to drug effects seen outside of the medical literature.
Although early Chinese medical literature suggests that both drug
and fiber biotypes of cannabis were known in ancient times, more
research is needed to clarify the implications of these different
biotypes in medical applications. Additionally, further research
is needed to probe whether the medical applications of cannabis
in ancient Chinese literature may relate to non-psychoactive
cannabinoids such as cannabidiol (CBD), which may have been
present in ancient fiber biotypes as well as drug biotypes (see
Figure 1).
CANNABIS IN CHINESE MEDICINE
Cannabis has been continually documented in Chinese medicine
for ∼1800 years. In the modern era, its achenes (commonly
referred to as “seeds” and known in TCM as huomaren
火麻仁) are frequently used as a moistening laxative and are
official in the Chinese Pharmacopeia (CP, 2015). All parts of the
cannabis plant have been recorded in historical Chinese medical
texts, including the achene (seed), female inflorescence, leaf, and
root, as well as the cortex of the stalk and the water used to
process the stalk into fiber. However, only the achenes (seeds) are
currently used in clinical practice (Brand and Wiseman, 2008).
In contrast to the prominent use of the achenes in
Chinese medicine, many applications of cannabis in early
Western medicine focused on preparations made from the
female flowering tops of drug varieties of cannabis, which
were featured in early Western pharmacopeia texts from the
nineteenth to twentieth century (Wood, 1918). In the modern
era, the investigation of cannabis for medical purposes in
the West has continued to primarily focus on cannabinoids,
resulting in prescription medicines such as the botanically
derived drug “Sativex” by GW Pharmaceuticals (a mixture
of 19-THC and cannabidiol in an oromucosal spray that
is sold by prescription in 15 countries, including the UK,
Germany, Italy, Canada, Australia, and Spain; Russo et al.,
2007).
The notable contrast between the medical applications of
cannabis in traditional Chinese medicine and Western medicine
has been poorly explored in current ethnopharmacological
literature. Despite the fact that cannabis preparations have
been extensively and consistently documented in Chinese
bencao (materia medica) texts for ∼1800 years, no English-
language publications have systematically assessed the medicinal
indications of cannabis in the Chinese bencao literature
and historical changes in the plant parts used. Few reliable
translations of Chinese monographs on cannabis from traditional
bencao texts exist, which has led to significant gaps in the
Western understanding about how cannabis was used in Chinese
medicine.
Additionally, many problems related to cannabis in TCM
remain unresolved in the contemporary Chinese literature.
Modern Chinese journal articles as well as historical authors
have attempted to clarify the complicated nomenclature of
the female inflorescence in bencao literature (Liu and Shang,
1992; Liu, 1999; Liu et al., 2009; Wei et al., 2010), and
monographs in modern TCM texts detail different plant parts
and their use across a range of historical texts (Editorial
Committee, 1977; Cui and Ran, 1993). However, a number
of modern and historical Chinese sources contradict each
other in terms of which plant parts correspond to certain
traditional drug names such as mafen (麻蕡), mahua (麻花), and
mabo (麻勃), complicating the interpretation of their medical
actions.
As the difference between drug and fiber varieties of cannabis
is largely determined by genetics, the historical and geographic
prevalence of different biotypes of cannabis in China likely
influenced its applications in Chinese medicine. However, this
crucial question has received only limited attention in the
Chinese literature. Furthermore, most Chinese publications that
have attempted to address the topic of speciation as it relates to
the historical application of cannabis in Chinese medicine utilize
a relatively simplistic taxonomic model that does not take recent
scientific advances into account (Liu and Shang, 1992; Wei et al.,
2010).
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Brand and Zhao Cannabis in Ancient Chinese Medical Literature
BIOTYPES OF CANNABIS IN CHINA
The complicated taxonomic history of cannabis has been
previously summarized in numerous publications (Schultes et al.,
1974; Small and Cronquist, 1976; Hillig and Mahlberg, 2004).
Cannabis is often described as a monotypic genus with wide
morphological and chemical variation, and the Flora of China and
the Chinese Pharmacopeia adopt the monotypic classification of
Chinese cannabis as Cannabis sativa L. (Chen and Gilbert, 2006;
CP, 2015). By contrast, many of the Chinese publications that
have investigated historical questions related to the speciation
of cannabis in Chinese medicine across different dynastic
periods have adopted a polytypic approach to nomenclature
that primarily differentiates the genus into two species based on
chemotype, with varieties focused on fiber and seed production
described as C. sativa L. and drug varieties described as C. indica
Lamarck (Liu and Shang, 1992; Liu, 1999).
Cannabis is a classic example of taxonomic debates related
to “lumping vs. splitting” (i.e., whether the genus should be
considered as monotypic or polytypic) as well as morphological
vs. chemotype distinctions. Advances in DNA research have
added further complexity to the picture, and terms such as
“broad leaflet hemp” (BLH) vs. “broad leaflet drug” (BLD) and
“narrow leaflet hemp” (NLH) vs. “narrow leaflet drug” (NLD)
have recently been used to describe cannabis varieties based on a
combination of morphology and chemotype (Piluzza et al., 2013).
The complex debate about cannabis taxonomy initially
developed after Lamarck proposed the name C. indica in 1785
to describe psychoactive Indian cannabis in contradistinction
to Linnaeus’ description of non-psychoactive European hemp
(Hillig and Mahlberg, 2004), which was regarded as C. sativa L.
While Lamarck’s original type specimen of C. indica reflected
a narrow leaflet drug (NLD) variety, Schultes later applied the
name C. indica to refer to broad leaflet drug (BLD) varieties from
Afghanistan that shared the characteristic of psychoactivity but
differed in morphology (Clarke and Merlin, 2013). In contrast
to European hemp, which is considered as representative of a
narrow leaflet hemp biotype (NLH), most landraces of Chinese
cannabis are characterized as a broad leaflet hemp (BLH) biotype
(Russo et al., 2008) (see Figure 2). Chinese hemp has strong
fiber and is generally not psychoactive, but DNA and chemotype
distinctions suggest that Chinese hemp is more closely linked
genetically to C. sativa subsp. indica [=C. indica Lamarck] than
to European hemp (C. sativa subs. sativa [=C. sativa L.]) (Hillig
and Mahlberg, 2004; Hillig, 2005). Accordingly, Chinese hemp
expresses the BTalleles necessary for the biosynthesis of THC
more prominently than European hemp, even though long-term
selection for fiber has led Chinese hemp to produce only low
levels of THC (Clarke and Merlin, 2013). This suggests that
drug and fiber biotypes of cannabis in China may have shared
a common ancestor and diverged through human selection, but
the precise timeline of fiber hemp’s increasing dominance in the
Chinese gene pool remains unclear.
Recent archeological evidence from a 2700 year old tomb
discovered in the Yanghai region of China’s Xinjiang province
suggests that drug biotypes of cannabis were known to the
ancient inhabitants of the region (Jiang et al., 2006), and genetic
FIGURE 2 | Broad-leaflet hemp in Guangxi province, China.
testing has shown that the 2700 year old cannabis specimens
from the tomb maintain some similarities to feral cannabis that
remains in the surrounding region today (Mukherjee et al.,
2008). However, the Yanghai tomb housed a body of Caucasian
ancestry (Russo et al., 2008), and the region was located well
outside of the boundary of early Chinese cultural influence.
In more central Chinese regions, archeological artifacts provide
abundant evidence of hemp fiber but little evidence of drug
cannabis, suggesting that the historical divergence of fiber and
drug biotypes occurred early in Chinese history (Clarke and
Merlin, 2013).
Today, cannabis landraces throughout most regions of China
reflect fiber biotypes, and some provincial standards have
followed international trends by defining fiber biotypes for
cultivation as varieties containing <0.3% 19-THC by weight (Lu
et al., 2007). In modern China, intermediate and drug biotypes
have primarily been reported in isolated regions in the northwest
province of Xinjiang and the southwest province of Yunnan
(Zhan et al., 1994; Hu et al., 2015) (see Figure 3). Drug use of
cannabis in Xinjiang province was recorded along the Silk Road
from the Qing Dynasty (1644–1911 AD) to the twentieth century,
and was described in a report by the Russian explorer Shoqan
Walikhanov in 1858 (Ali et al., 2004; Zhou, 2015); however,
there is little evidence outside of bencao literature that suggests
that drug cannabis was known or used in other parts of ancient
China. Furthermore, according to texts that focus on the history
of drug prohibition in China, there is little evidence that cannabis
was either abused or prohibited in China prior to the first
documented seizures of imported cannabis products in Xinjiang
in 1936 (Ali et al., 2004; Qi and Hu, 2004). This stands in notable
contrast to other drugs that have a well-documented history of
regulation, medical use, abuse, and prohibition in China, such
as opium and deliriant drugs derived from tropane alkaloid-
containing plants such as henbane (Hyoscyamus niger L.) and
datura (Datura spp.; Li, 1999; Qi and Hu, 2004).
On the whole, the abundance of references to hemp and
the paucity of references to drug cannabis in early Chinese
history suggest that fiber and drug varieties had diverged by
ancient times. As cannabis is wind-pollinated and its biotype
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Brand and Zhao Cannabis in Ancient Chinese Medical Literature
FIGURE 3 | Feral cannabis in Yunnan province, China.
distinctions are genetically determined, the long-term and
abundant cultivation of fiber-rich biotypes in China likely
supplanted or diluted any drug biotypes that were once present.
However, the timeline of this process has been poorly elucidated,
and bencao literature suggests that drug effects of cannabis were
recognized in Chinese medicine from ancient times up through
Ming dynasty texts written in the sixteenth century AD. This
curious anomaly suggests that the evolution of Chinese cannabis
biotypes may have taken place gradually, and merits further
investigation to determine if bencao literature can help to clarify
when fiber and drug biotypes diverged in ancient China, and the
implications of such a divergence on its medical applications.
MATERIALS AND METHODS
Pre-modern Chinese materia medica texts, known as bencao,
were systematically reviewed to investigate the historical
applications of different parts of the cannabis plant. In particular,
records related to plant parts such as the flowers and leaves were
comprehensively investigated for applications that may relate to
cannabinoids such as CBD and 19-THC; such records may also
help to clarify the evolution of fiber vs. drug biotypes of cannabis
in ancient China.
Representative bencao texts were selected for analysis,
including influential bencao texts from different dynastic periods,
thematic bencao texts dedicated to specialized topics, and
regional bencao texts dedicated to specific geographic regions
(Zhao and Chen, 2014). Additionally, modern Chinese materia
medica compilations as well as texts focused on ethnic minority
traditions in China were reviewed. The selected texts were
organized chronologically by dynasty, and monographs on
cannabis from bencao texts representing different historical
periods were reviewed. The sources were analyzed based on the
plant parts that were described, as well as the nature, flavor,
actions and indications of the various cannabis materials within.
A diverse range of properties and indications have been
ascribed to various parts of the cannabis plant over the centuries,
and space limitations preclude a comprehensive translation of all
the bencao records related to cannabis. Thus, special attention
was given to tracing the historical development of applications
related to seizures, pain, and mental effects or mental illness, as
TABLE 1 | Influential bencao from different dynastic periods.
The Divine Farmer’s Classic of Materia Medica (神農本草經Shen Nong Ben
Cao Jing) (Anonymous, Eastern Han Dynasty, 25–220 AD)
Collection of Commentaries on the Classic of the Materia Medica (本草經集
注Ben Cao Jing Ji Zhu) (Tao Hongjing, early sixth century AD)
Newly Revised Materia Medica (新修本草Xin Xiu Ben Cao) (commissioned
by the Tang Dynasty government, 659 AD)
Materia Medica Arranged According to Pattern (證類本草Zheng Lei Ben
Cao) (Tang Shenwei, 1108 AD)
Compendium of Materia Medica (本草綱目Ben Cao Gang Mu) (Li Shizhen,
1593 AD)
these conditions have been the subject of extensive research in the
context of cannabinoids such as CBD and 19-THC (Mechoulam
et al., 2002; Devinsky et al., 2014). As cannabinoids are primarily
concentrated in the female flowering tops and leaves rather than
the achenes, cortex, and roots, these plant parts were emphasized
in this review.
SELECTION OF TEXTS AND TEXTUAL
EDITIONS
Authentic editions of over 800 historical bencao texts are
collected together in a set known as the Complete Ben Cao (本草
全書Ben Cao Quan Shu); a set of this compilation stored at Hong
Kong Baptist University was used as a primary reference in this
study. In particular, five influential texts from different dynasties
are recognized as milestones in bencao literature (Zhao and Chen,
2014); these texts were extensively reviewed and are detailed in
Table 1. Multiple textual editions were reviewed for each of these
bencao texts to ensure accuracy and textual integrity.
For example, the longest and most detailed monograph on
cannabis in the bencao literature is found in the sixteenth century
Compendium of Materia Medica (Ben Cao Gang Mu) by Li
Shizhen, which is widely regarded as the pinnacle achievement of
bencao literature. For the review of this text, three authoritative
editions were selected to ensure textual accuracy. The editions
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Brand and Zhao Cannabis in Ancient Chinese Medical Literature
reviewed included an original copy of the 1603 AD “Shiquge (石
渠閣)” print run of the Compendium of Materia Medica from the
collection of Sir Hans Sloane at the British Library (see Figure 4),
as well as a modern reproduction of the original “Jinling (金陵)”
edition of the Compendium of Materia Medica (Li, 1999), and an
authoritative modern annotated edition known as Compendium
of Materia Medica Research (Liu et al., 2009).
In addition to these five representative bencao texts of different
dynasties, records related to cannabis were reviewed from 84
additional pre-modern bencao texts dating from the twelfth
century to the late nineteenth century. The sources included
6bencao texts from the Song Dynasty (960–1279 AD), 4 texts
from the Yuan Dynasty (1271–1368 AD), 32 texts from the Ming
Dynasty (1368–1644 AD), and 47 texts from the Qing Dynasty
(1644–1911 AD).
Most historical bencao texts that were written prior to the
invention of printing in the Song Dynasty are no longer intact,
but their content has been preserved in printed texts such as
the Materia Medica Arranged According to Pattern (證類本草
Zheng Lei Ben Cao) from 1108 AD. Accordingly, the Materia
Medica Arranged According to Pattern, which cited 25 previous
historical sources in its discussion on cannabis, was selected as a
FIGURE 4 | Entry on cannabis in the Compendium of Materia Medica.
representative source for pre-Song Dynasty content (Tang, 1999).
An additional early source of records related to cannabis from the
Treatise of the Five Viscera (五臟倫Wu Zang Lun), a manuscript
discovered in an archeological excavation at Dunhuang that is
thought to date from the Tang Dynasty (618–907 AD), was also
reviewed.
Additionally, four thematic bencao were reviewed to
investigate records related to specific geographic regions and
imported medicinals. These texts include the tenth century
Materia Medica from Overseas (海藥本草Hai Yao Ben Cao),
the thirteenth century Materia Medica from Steep Mountainsides
(履巉 巖 本草Lu Chan Yan Ben Cao), the fifteenth century
Yunnan Materia Medica (滇南本草Dian Nan Ben Cao),
and the nineteenth century Illustrated Reference of Botanical
Nomenclature (植物名實圖考Zhi Wu Ming Shi Tu Kao).
Finally, monographs on cannabis from a variety of modern
materia medica compendiums were reviewed. In addition to
each edition of the Chinese Pharmacopeia from 1977 to 2015,
several twentieth century compendiums of materia medica
were reviewed, including the Great Encyclopedia of Chinese
Medicinals (中藥大辭典Zhong Yao Da Ci Dian), the Sea
of Chinese Medicinals (中華藥海Zhong Hua Yao Hai), the
National Collection of Chinese Herbal Medicines (全國中草
藥彙編Quan Guo Zhong Cao Yao Hui Bian), the Chinese
Materia Medica (中華本草Zhong Hua Ben Cao), and the
Chinese Great Encyclopedia (中華大典Zhong Hua Da Dian).
Modern compilations focused on Chinese herbal formulas and
ethnic minority medical traditions in Western China were also
reviewed, including texts on Uighur, Yao, Miao, and Tibetan
medicine. Additionally, publications from English and Chinese
scientific journal databases such as CNKI, Wanfang, Google
Scholar, and Scopus were analyzed based on a wide range of
search terms related to Chinese medicine and cannabis in both
English and Chinese.
APPROACH TO TRANSLATION OF
TECHNICAL TERMS
Preserving the traditional terminology of Chinese medicine is
essential in order for translations to capture the original meaning
of historical sources. In this work, a source-oriented approach to
translation is utilized; in most cases, the technical terms used in
translation can be cross referenced to the original Chinese using
the terminology established in A Practical Dictionary of Chinese
Medicine (Wiseman and Feng, 1998). Additional bilingual
term lists referenced in the process of translation include: the
Dictionary of the Ben cao gang mu, Volume 1: Chinese Historical
Illness Terminology (Zhang and Unschuld, 2014), the WHO
International Standard Terminologies on Traditional Medicine in
the Western Pacific Region, and International Standard Chinese-
English: Basic Nomenclature of Chinese Medicine.
In the context of cannabis, several unique challenges relate to
the translation of the plant parts used, as historical sources offer
conflicting descriptions of different plant parts. In particular,
historical and contemporary sources are divided regarding the
botanical structures that correspond to the terms mafen (麻
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Brand and Zhao Cannabis in Ancient Chinese Medical Literature
蕡), mahua (麻花), and mabo (麻勃), as well as terms related
to the fruit or seed such as mazi (麻子), maziren (麻子仁),
and mashi (麻實). In this review, these terms are preserved
via a combination of English, Pinyin, and Chinese, and the
implications of their historical and contemporary confusion are
discussed.
IDENTIFICATION OF TRADITIONAL
ACTIONS AND INDICATIONS THAT MAY
REFLECT CANNABINOIDS
In contemporary Chinese medicine, fiber-rich biotypes of
cannabis provide the achenes used as huomaren (Cannabis
Fructus). However, as the achenes of cannabis contain at
most only trace amounts of cannabinoids such as CBD and
19-THC (Mölleken and Husmann, 1997), the indications of
the achenes are unlikely to relate to cannabinoids and their
observed effects are unreliable for differentiating the historical
prevalence of different biotypes of cannabis in Chinese medical
applications. Similarly, Chinese medical records related to
other plant parts with minimal cannabinoid content, such as
the stalks and roots of cannabis, are of limited value for
differentiating historical biotypes or evaluating applications that
may relate to cannabinoids. Thus, the primary plant parts that
can be reasonably expected to illustrate effects that relate to
cannabinoids are the leaf and female inflorescence. Accordingly,
while the actions, indications, and properties of all parts of the
cannabis plant were reviewed in the historical texts described
above, the female inflorescence and leaf formed the focus of the
investigation.
A review of the nature, flavor, actions, and indications of
various cannabis plant parts in Chinese bencao reveals a number
of terms that may indicate the presence of intermediate or
drug biotypes of cannabis. For example, applications related
to severe pain, perceived toxicity, or actions such as inducing
anesthesia or hallucinations may reflect the historical presence of
drug biotypes. Accordingly, the terminology associated with such
effects was compared with descriptions of other drugs found in
the Chinese materia medica that have known hallucinogenic or
narcotic effects, such as Datura spp., Hyoscyamus niger L., and
Papaver somniferum L. Additionally, the bencao literature was
reviewed for other medical applications that have been associated
with cannabinoid-rich preparations, including applications for
conditions such as epilepsy and mental illness that may be
related to the pharmacology of cannabidiol CBD rather than
psychoactive cannabinoids such as 19-THC (Mechoulam et al.,
2002; Devinsky et al., 2014).
RESULTS AND DISCUSSION
Cannabis has been documented in bencao texts from the Eastern
Han Dynasty (c. 200 AD) up through the twentieth century
materia medica literature. All parts of the plant were recorded
in bencao texts by 659 AD, but the inflorescence (mafen) and
the “seed” (achene fruit) tend to appear more frequently as
monograph headings than the leaf, root, and cortex (Zheng,
2008); the achenes are the only plant part that remains used
in modern clinical practice. As described below, the bencao
literature suggests that both drug and fiber biotypes were known
in ancient China, but bencao texts never differentiated the plant
into drug vs. fiber or oil varieties. Consequently, determining the
implications of different biotypes on the historical applications of
cannabis requires an in-depth analysis of the actions, indications,
and plant parts used in ancient medical texts.
Furthermore, although records in the historical literature
that suggest intoxication or altered consciousness may help to
indicate preparations with significant levels of cannabinoids,
such references may overlook effects that relate to non-
psychoactive cannabinoids such as CBD, which are the
predominant cannabinoids in the cannabis (hemp) varieties
widely grown in China today. Consequently, indications cited in
ancient texts for conditions such as epilepsy, seizures, and pain
may in some cases relate to cannabinoids such as CBD rather than
19-THC (Mechoulam et al., 2002), making it difficult to reliably
use overt drug effects as a proxy for identifying cannabinoid-
related medical applications.
Our textual analysis suggests that drug biotypes of cannabis
were known in ancient Chinese medicine, but it is possible that
long-term selection of fiber-rich cultivars caused drug biotypes
to fade in terms of their medical importance over time. Several
trends in the literature suggest that drug biotypes of cannabis
were rarely applied in Chinese medicine or gradually became
less prominent, including: (1) the increased prominence of the
achenes and reduced prominence of other plant parts such as
the female inflorescence in the bencao literature over time; (2)
enduring nomenclature confusion regarding plant parts, which
suggests limited practical application and experience by later
authors; and (3) actions and indications in many early texts
that were repeated over the centuries but had relatively little
elaboration and practical application in later bencao sources.
Prominence of the Achenes in Clinical
Application
Many early bencao texts from the second century through
the twelfth century AD feature the inflorescence (mafen) as a
main monograph heading with the achenes (known as mazi or
maziren) presented as an addendum, but over time the emphasis
gradually tended to favor the achenes. For example, in the
Compendium of Materia Medica (Ben Cao Gang Mu) from the
late sixteenth century, ∼3 times as many words are dedicated to
the discussion of the properties and indications of the achenes in
comparison with the inflorescence (Liu et al., 2009). By the time
of the Qing Dynasty (1644–1911 AD), many bencao texts only
contained monographs on the achenes, and the inflorescence
(mafen) was often omitted entirely, a practice that has carried
over into modern clinical textbooks of TCM.
Beyond the context of bencao texts, an emphasis on the use
of the achenes in clinical practice can also be seen from TCM
formula literature. For example, the achenes are featured as a
key ingredient in the classical formula Cannabis Seed Pill (Ma Zi
Ren Wan 麻子仁丸), which was first recorded by the physician
Zhang Zhongjing around the second century AD and remains
prominent in both clinical use and TCM textbooks in the modern
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Brand and Zhao Cannabis in Ancient Chinese Medical Literature
era (Brand and Wiseman, 2008). According to data from the
National Health Insurance system in Taiwan collected in 2003,
this formula ranked #40 out of the 301 most frequently prescribed
TCM formulas for insurance reimbursement, with over 10,705 kg
of concentrated dry extract prescribed in Taiwan in 2003. In
the same year in Taiwan, 967 kg of concentrated dry extract
from the achenes (huomaren) was also prescribed for insurance
reimbursement as a single-herb addition to formulas, ranking it
as #140 of 353 single herb extracts by weight (Jian, 2006).
By contrast, the inflorescence of cannabis rarely appeared in
historical formulas, with the exception of a relatively modest
range of small formulas that are found in bencao texts. No named
formulas that feature the inflorescence of cannabis are found
in the Great Encyclopedia of Chinese Medicinal Formulas (中醫
方劑大辭典Zhong Yi Fang Ji Da Ci Dian), which contains
96,592 historical formulas and features 69 formulas that utilize
the achenes of cannabis as a primary ingredient (Peng, 2005).
While a small number of combinations with other herbs are
listed in bencao texts, the relatively small number of compound
formulas that feature the inflorescence of cannabis thus suggests
that the inflorescence was rarely used in clinical applications
when compared with the achenes.
Abundant bencao references to cannabis as a food and
fiber crop suggest that fiber and seed production were
emphasized from an early time. For example, in the Collection
of Commentaries on the Classic of the Materia Medica (Shen Nong
Ben Cao Jing Ji Zhu) from the sixth century AD, the author Tao
Hongjing notes that cannabis was used to make cloth and shoes
(Tao, 1999). Additional references to pressing the seeds for oil
and using the fiber for cloth and candlewicks are also found
in later texts such as the Compendium of Materia Medica (Ben
Cao Gang Mu) by Li Shizhen in the sixteenth century (Liu et al.,
2009). Furthermore, cannabis was frequently classified in bencao
texts with other food crops under the heading of “grains,” which
suggests that it had a prominent role as a food (Li, 2005). Hemp
seed continues to be consumed as a food in modern China; it has
a reputation as a “longevity” food in the Bama region of Guangxi
province (Wang et al., 2010), and in Hong Kong beverages made
of hemp seed are commonly sold in street stalls as well as in
bottled products made by large companies including Coca-Cola.
However, despite the prominence of the achenes in ancient
and modern applications, contemporary and historical texts
contain contradictions related to nomenclature that remain
poorly resolved. Although colloquially referred to as “seeds” in
both English and Chinese, in botanical terms the brown, lustrous
achenes with intact shells seen in TCM pharmacies today are
fruits that contain seeds under the brown pericarp.
Confusion between the “fruit” vs. “seed” of cannabis is found
in both ancient and modern sources. In the 2015 and 2005
editions of the Chinese Pharmacopeia (CP), huomaren (火麻
仁) is defined as the dried mature fruit, resulting in the Latin
drug name of “Cannabis Fructus” (CP, 2015). However, the
name “Cannabis Semen” was featured in the 2010 edition of
the Chinese Pharmacopeia, which stated its identity as the
mature seed but featured a description of the fruit. In other
contemporary texts such as the National Collection of Chinese
Herbal Medicines (全國中草藥彙編Quan Guo Zhong Cao
Yao Hui Bian), the identity of huomaren is listed as either the
fruit or the seed with the pericarp removed. By contrast, the
Chinese Materia Medica (中華本草Zhong Hua Ben Cao) and
the Great Encyclopedia of Chinese Medicinals (中藥大辭典Zhong
Yao Da Ci Dian) list only the seed but feature macroscopic
and microscopic descriptions that match the fruit (Editorial
Committee, 1977; Zheng, 2008). Furthermore, in some historical
texts it is difficult to definitively identity the botanical structures
of cannabis that are referenced by traditional terms such as “fruit”
(實shi), “seed” (子zi), “kernel/seed” (仁ren), and “shell” (殼
qiao). This mirrors the challenges inherent in interpreting the
complex terminology surrounding the terms used to refer to the
female inflorescence (and infructescence) in bencao texts.
Enduring Confusion Regarding Plant Parts:
Resolving Traditional Nomenclature
One of the most significant challenges for the interpretation
of bencao records related to cannabis lies in the traditional
terminology used to describe the flowering tops of the plant.
Three terms are prominently used in bencao texts, and
different authors from different historical eras describe them in
contradictory ways. These terms, mafen (麻蕡), mahua (麻花),
and mabo (麻勃), all refer to the spike-shaped inflorescence of the
plant, but various contemporary and historical sources interpret
them differently.
Mafen (麻蕡), which is the term most frequently encountered
as a heading for cannabis in ancient bencao texts, is often defined
as the immature inflorescence of the female flower or the mature
infructescence of the seeded female flower (Liu and Shang, 1992;
Liu, 1999). It was first listed in the Divine Farmer’s Classic of
Materia Medica (神農本草經Shen Nong Ben Cao Jing, c. second
century), wherein the term mabo (麻勃, literally “cannabis
spike”) was listed as a synonym but no physical descriptions
were provided. As the text was transmitted, commentary known
as Additional Records of Famous Physicians (Ming Yi Bie Lu)
was added to clarify that mafen was the “rising spike on the
cannabis flower,” and should be harvested on the 7th day of
the 7th month (based on the lunar calendar). This harvest time
stands in contrast to the achenes, which were harvested in the
9th month according to the same source (which also noted
that mafen is “toxic” while the achenes are non-toxic; Tang,
1999).
In the sixth century, the Divine Farmer’s Classic of Materia
Medica and the Additional Records of Famous Physicians
were transmitted along with additional commentary from Tao
Hongjing, a physician and Taoist alchemist who utilized different
colors of ink to differentiate his annotations from the original
transmitted text. Tao’s comments initiated centuries of debate
because he described mafen as cannabis without fruit, which
clashed with previous definitions from the Er Ya dictionary that
described mafen as the fruit of cannabis. Later authors disagreed
about the identity of mafen (麻蕡), mahua (麻花“cannabis
flower”), and mabo (麻勃“cannabis spike”), with some sources
regarding the terms as synonymous while others regarded them
as separate entities using poorly defined concepts of fruit vs.
flower, leading later sources to divide them into multiple entries.
Notably, Li Shizhen attempted to rectify these nomenclature
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Brand and Zhao Cannabis in Ancient Chinese Medical Literature
issues in the sixteenth century while dividing mabo and mafen
into separate monographs in the Compendium of Materia Medica,
but his analysis introduced additional confusion that carried
over into modern materia medica compilations and remains
unresolved to this day.
The complex debate surrounding the nomenclature of mafen
has been summarized in several contemporary Chinese journal
publications (Liu and Shang, 1992; Liu, 1999). In addition to
the immature female inflorescence and the mature seeded female
infructescence, modern bencao scholars have also proposed
that the identity of mafen includes the bracts surrounding the
achenes but not the achenes themselves (Chen and Huang,
2005). Prominent historical bencao authors also discussed the
meaning of mafen, including Su Jing (659 AD), Su Song
(1062 AD), and Tang Shenwei (1108 AD; Zheng, 2008). The
author Li Shizhen summarized the disparate views advanced by
earlier historical authors in the Compendium of Materia Medica
(Ben Cao Gang Mu) in 1593 AD, and Li’s descriptions and
corrections were influential in shaping the definitions established
by contemporary texts such as the Great Encyclopedia of Chinese
Medicinals (Zhong Yao Da Ci Dian).
In the Compendium of Materia Medica, Li summarized the
discrepancies between the Divine Farmer’s Classic of Materia
Medica, Su Jing and Su Song’s descriptions. Li chose to follow
descriptions from Wu Pu’s Materia Medica (Wu Pu Ben Cao) that
established synonymy between the terms mabo (cannabis spike)
and mahua (cannabis flower), which were classified as acrid and
non-toxic, and separated these terms from mafen, which was
classified as acrid, sweet, and toxic. Thus, despite the fact that
the Divine Farmer’s Classic of Materia Medica listed mabo as a
synonym of mafen, Li Shizhen split the two into separate entries.
For the entry on mabo, Li listed mahua (cannabis flower)
as a synonym, and cited a statement from the sixth century
agricultural text Essential Techniques for the Welfare of the People
(Qi Min Yao Shu) that referenced removing the males at the time
that the plant produces “bo” (the budding spike-shaped flower)
as evidence that “bo clearly refers to the flower” (Liu et al., 2009).
Although it is unclear whether the term “bo” refers to the male or
female flower in the text cited, Li’s classification was later adopted
by the Great Encyclopedia of Chinese Medicinals, which lists the
male flower under the heading of mahua (Editorial Committee,
1977).
In the entry on mafen, Li stated that mafen refers to mazi
(the achenes or possibly the mature infructescence) with the
“shell” (qiao) intact (Liu et al., 2009). Li noted that mafen was
different from edible cannabis because the shell is toxic and the
inner kernel is non-toxic, but his description failed to adequately
clarify whether the shell was a reference to the pericarp or the
bract surrounding the achene fruit. In the contemporary Great
Encyclopedia of Chinese Medicinals, the term mafen is defined as
the immature racemes (Editorial Committee, 1977).
The question of which plant tissues correspond to mabo,
mahua, and mafen is thus poorly resolved, as early bencao texts
regarded them as synonyms but some later texts divide them by
gender. For example, mahua is regarded as a synonym of mabo
in the Chinese Materia Medica (Zhong Hua Ben Cao); this text
describes it as the male flower but its pharmacology section refers
only to 19-THC, which is not found in significant quantities in
the male flower. In the Sea of Chinese Medicinals (Zhong Hua
Yao Hai), the term mabo is listed as a synonym for mafen, which
is described as the immature racemes (Cui and Ran, 1993). The
sixth century author Tao Hongjing listed mabo as a synonym of
mafen and stated that mafen lacked fruit (Tao, 1999), which along
with the non-toxic properties ascribed to mabo in later texts may
have influenced its classification as the male flower; however, no
major Chinese texts have proposed that mafen lacking fruit could
refer to the seedless female inflorescence.
The wide range of different interpretations for the identity
of mafen presented over the centuries suggests that many
later authors were preserving previous quotations yet had little
practical experience with materials such as mafen,mabo, and
mahua. Indeed, the author Tao Hongjing noted as early as the
sixth century AD that “mafen was rarely used in formulas” (Tao,
1999).
Applications of Cannabis in the Chinese
Medical Literature That May Relate to
Cannabinoids
The earliest historical references to cannabis in Chinese medicine
are found in the Divine Farmer’s Classic of Materia Medica (Shen
Nong Ben Cao Jing) from the first to second century AD. This
text, along with the added notes known as the Additional Records
of Famous Physicians (Ming Yi Bie Lu), contains many of the
fundamental statements that were repeated about cannabis in
later centuries.
The original text of the Divine Farmer’s Classic of Materia
Medica ascribes the following properties to mafen: “Flavor:
acrid; balanced. Governs the five taxations and seven damages,
benefits the five viscera, and descends blood and cold qi;
excessive consumption causes one to see ghosts and run about
frenetically. Prolonged consumption frees the spirit light and
lightens the body. Another name is mabo” (Tao, 1999). To this
base description, the Additional Records of Famous Physicians
adds that it is “toxic,” and is used to “break accumulations, relieve
impediment, and disperse pus” (Liu et al., 2009).
Many authors have interpreted the statement “excessive
consumption [of mafen] causes one to see ghosts and run about
frenetically” as evidence that mafen had drug effects due to the
presence of cannabinoids such as 19-THC (Chen and Huang,
2005). Additionally, the reference to “relieving impediment”
from the Additional Records of Famous Physicians refers to a
traditional category of conditions that typically result in pain and
restricted movement, which may also relate to cannabinoids such
as CBD or 19-THC.
These original statements were repeated in many later bencao
texts, and have likely influenced the properties listed for mafen in
contemporary Chinese texts. For example, the Great Encyclopedia
of Chinese Medicinals states that mafen “dispels wind, relieves
pain, and settles tetany” (a traditional disease category associated
with severe spasm). According to this text, it is indicated
for conditions traditionally known as “impediment patterns”
(typically manifesting in pain and restricted movement), gout,
withdrawal and mania, insomnia, and panting and cough
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Brand and Zhao Cannabis in Ancient Chinese Medical Literature
(Editorial Committee, 1977). Additionally, in the 1935 text
Illustrated Analysis of Medicinal Substances (Yao Wu Tu Kao),
the ancient statement that cannabis descends blood and cold qi
was interpreted by the author Yang Huating as an indication
that mafen quickens the blood. Yang recommended mafen
(which he regarded as the female inflorescence) for a variety of
conditions including headache, menstrual irregularities, itching,
convulsions, anemia, and dry cough (Editorial Committee,
1977). However, despite these twentieth century publications
that summarize traditional indications using contemporary
descriptions, only a few texts offered new information or
applications for mafen between the sixteenth century and Yang’s
1935 text (Zheng, 2008).
Applications for Pain
Several applications of cannabis for pain in Chinese medicine
may relate to cannabinoids. As noted above, the first reference
to mafen for pain is found in the Additional Records of Famous
Physicians from the sixth century AD, which notes its use for
“relieving impediment” (impediment is a traditional disease
category that is also known as “bi” or “painful obstruction”;
Wiseman and Feng, 1998). Some authors also speculate that
an early anesthetic formula known as “mafei powder” (ma fei
san) developed by the famous physician Hua Tuo around the
turn of the third century AD contained mafen (at the time, the
name mafen is believed to have shared the same pronunciation
as the characters in the formula name; Chen and Huang, 2005).
However, any link between cannabis and Hua Tuo’s formula
is purely speculative, as the original ingredients of the ancient
formula ma fei san are lost.
In another application related to pain, the Tang Dynasty
physician Sun Simiao (581–683 AD) recorded that the leaves
of cannabis could be crushed to extract their juice, which was
used to treat unbearable pain due to fractured bones (Chen and
Huang, 2005).
By 1070 AD, the Song Dynasty text Illustrated Classic of
Materia Medica (Tu Jing Ben Cao) included a quotation from a
previous source titled Formulas Within a Small Box (Qie Zhong
Fang) that referenced a preparation of cannabis for severe pain
that inhibited movement (Su, 1994). In the original recipe, the
preparation method specifies that the seeds of cannabis are
soaked in water, then the sediment is collected from the bottom
of the water, stir-fried until aromatic in a silver vessel, and
ground into a fine white powder; this is then boiled with alcohol
and taken internally on an empty stomach (Su, 1994). It is
indicated for “bone marrow wind toxin” with pain that prevents
movement; the text says that even in severe cases, “by 10 servings
the suffering must be alleviated; its effect cannot be surpassed”
(Zheng, 2008). This prescription was repeated in many later texts
under the name “cannabis seed wine” (da ma ren jiu) under
entries for the achenes (Editorial Committee, 1977); however it
differs strikingly from other preparations of the achenes because
it is used for severe pain. If the achenes were soaked in water
with the bracts intact, it is possible that the preparation method
described would yield cannabinoids, as broken resin glands
from the bracts would sink in water; when this sediment was
stir-fried, THC acids would be decarboxylated into bioavailable
THC, which would then be efficiently extracted when boiled
with alcohol, as in the original preparation. Nonetheless, while
cannabinoids offer a plausible explanation for the unusual
effects and preparation methods used for this formula, such
an interpretation remains purely speculative in the absence of
confirming evidence.
The first well-documented application of cannabis in an
anesthetic formula in China appeared in the text Heart Text
of Bian Que (Bian Que Xin Shu, 1127–1270 AD). The flower
of cannabis (under the name mahua) was used internally in
combination with datura flower (Datura spp.) as an anesthetic
to decrease the sensation of pain when moxa cones were
applied (Dou, 1992). This remedy was known as “sagacious
sleep powder” (shui sheng san). The source text notes that it
induces a stupor-slumber in which the person experiences no
pain and is not harmed. The same combination is repeated in the
Compendium of Materia Medica in the sixteenth century, which
contains an additional recipe for wind disease with numbness
that combines cannabis flower (mahua) with wild aconite root
(caowu;Liu et al., 2009). By the seventeenth century, the text
Reaching the Source of Materia Medica (Ben Jing Feng Yuan)
reported that cannabis flower (mahua) can treat hidden wind
within the body, and records further that it is used as an
anesthetic, noting that it can be used to painlessly apply a stone
needle to swollen welling-abscesses (Zhang, 2011).
Applications That Relate to Mental Effects or Mental
Illness
A variety of historical sources describe mental effects from
cannabis or applications to treat mental illness. In some cases,
these applications may reflect cannabinoids, as CBD has been
researched for anti-psychotic effects (Mechoulam et al., 2002)
and some of the mental effects described may be related to
the effects of cannabinoids such as 19-THC. As noted above,
the early statement that “excessive consumption causes one to
see ghosts and run about frenetically” is often regarded as a
sign of mental effects (Liu and Shang, 1992). In the sixteenth
century Compendium of Materia Medica, Li Shizhen repeated
this statement and added a previous recipe that states: “for those
seeking to see ghosts, take unprocessed cannabis [the text says
“cannabis seeds” (sheng ma zi) but lists the recipe under the
entry for mafen], acorus rhizome (shi chang pu,Acorus spp.) and
dysosma (gui jiu, Dysosma spp.) in equal parts and form into
pellet pills. Take one pill every morning facing the sun and after
100 days one will see ghosts” (Liu et al., 2009). Additionally, in
973 AD, the Materia Medica of the Kaibao Era (Kai Bao Ben
Cao) quoted an earlier author from the eighth century with the
statement that “cannabis causes happiness in the heart” (Zheng,
2008).
Other early quotations suggest that mental effects were
observed from the use of cannabis. For example, in the sixth
century Collection of Commentaries on the Classic of the Materia
Medica (Ben Cao Jing Ji Zhu), the author Tao Hongjing noted:
“adepts (likely referring to Taoist alchemists) take cannabis flower
(mabo) with ginseng and know of things that have not yet
come” (Tang, 1999). In the Compendium of Materia Medica
in the sixteenth century, the author Li Shizhen regarded this
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Brand and Zhao Cannabis in Ancient Chinese Medical Literature
as “an overstatement,” instead stating that the combination of
ginseng and cannabis allows one to “know the affairs of the four
directions” and treats forgetfulness. The Compendium of Materia
Medica also noted that the leaf of cannabis was indicated to treat
malaria and was said to induce a state of drunkenness (Liu et al.,
2009).
In addition to mental effects observed from the use of
cannabis, historical bencao texts featured applications for
cannabis in the context of mental illness. The first appearance
of these applications dates to the seventh century text Formulas
Worth a Thousand Gold (Qian Jin Fang) by Sun Simiao (Tang,
1999), which stated that cannabis treated wind-withdrawal, a
traditional category of disease that relates to mental illness
(Wiseman and Feng, 1998). Similar indications are ascribed
to the same quote from Sun Simiao by Li Shizhen in the
Compendium of Materia Medica, which lists wind-withdrawal
and “the 100 diseases” as indications for mafen. By the Qing
Dynasty, the seventeenth century text Reaching the Source of
Materia Medica (Ben Jing Feng Yuan) stated that cannabis flower
(mahua) treats “120 types of malign wind” as well as itching, and
expels all malign wind and blood; it was also indicated to treat
lack of free flow following menstruation. These quotations may
have inspired the actions listed for mafen in twentieth century
texts such as “dispelling wind” and treating mania-withdrawal (a
traditional category of mental illness in Chinese medicine).
In some cases, it is possible that actions that were ascribed
to mafen in twentieth century Chinese texts were acquired from
Western applications of cannabis. For example, the 1905 text
Pharmacognosy (Sheng Yao Xue) by Li Chenghu stated that
cannabis treated agitation, hysteria, spasmodic cough, and nerve
pain, while the 1935 text Illustrated Analysis of Medicines (Yao
Wu Tu Kao) by Yang Huating added many new indications
such as mania-withdrawal, convulsions, and insomnia that were
not previously discussed in historical texts (Editorial Committee,
1977).
In the case of traditional actions seen in contemporary
Chinese medical texts for mafen such as settling tetany (a
traditional disease term associated with severe spasm and
convulsions; Editorial Committee, 1977), it remains unclear
whether this action is related to assimilation of Western medical
theories in the early twentieth century or whether it is derived
from traditional indications for wind and wind-withdrawal. In
ancient times, the line between “withdrawal” (dian) as a mental
disease sometimes overlapped with the concept of epilepsy (dian
xian), which is characterized by seizures and is associated with
“wind” in traditional Chinese medical theory (Wiseman and
Feng, 1998). However, the historical record provides insufficient
detail to ascertain whether the seventh century indications for
cannabis in the context of wind-withdrawal overlapped with
epilepsy or seizures, or whether the meaning was primarily
limited to mental illness and/or erratic behavior.
CONCLUSION
In recent years, cannabinoids such as CBD and 19-THC
have attracted increased attention in the context of modern
pharmacology and popular Western culture, yet little research
has been done to explore the historical applications of cannabis in
Chinese medicine. Given China’s long history of hemp cultivation
and its rich body of un-translated medical literature, it is
surprising that little academic attention has focused on exploring
the ways in which cannabis was used in Chinese medicine. The
importance of cannabis as a fiber and food crop in ancient China,
combined with the extensive use of the achenes in medicine,
makes the Chinese historical record particularly valuable.
Bencao literature opens a window into the history and culture
of ancient Chinese medicine. As all parts of the cannabis plant
were recorded in bencao texts, the Chinese medical literature
can help to clarify many details about the historical applications
of cannabis in Chinese medicine, as well as providing clues
into the historical prevalence of different biotypes as ancient
Chinese farmers gradually selected superior varieties for fiber
and seed crops. The significant differences in how cannabis
has been employed in Chinese vs. Western medicine likely
relate to differences between drug and fiber biotypes as well
as cultural factors, but thus far minimal research has focused
on exploring this issue. Similarly, minimal attention has been
given to the topic of CBD in Chinese medical history, as
even fiber-rich biotypes of cannabis that were not associated
with drug use may have had potential therapeutic applications
related to CBD. While this modest review can only scratch the
surface of the Chinese medical literature of cannabis and the
questions it raises, it is hoped that further research will help
to further elucidate these questions using a multidisciplinary
approach.
AUTHOR CONTRIBUTIONS
EB: Primary research and manuscript creation. ZZ: Expert
review, source suggestions, revisions, and feedback.
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Conflict of Interest Statement: The authors declare that the research was
conducted in the absence of any commercial or financial relationships that could
be construed as a potential conflict of interest.
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