Cannabis in Traditional Chinese Medicine: A 2,000-Year History

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In the second century AD, a physician in what is now northern China was reportedly mixing cannabis resin with wine to knock patients out cold before cutting into their abdomens. Western surgeons wouldn't manage anything comparable until ether entered operating rooms in the 1840s, more than 1,600 years later. This isn't a footnote in cannabis history -- it's one of the plant's earliest and best-documented medical applications anywhere on earth, and it happened in China.

That history sits awkwardly against the present. Cannabis for drug use is illegal across all of China, full stop, with penalties that can be severe. Yet drive through parts of Yunnan province and you'll pass open fields of industrial hemp stretching toward the horizon, grown legally, processed into CBD, and shipped into international supply chains. Two provinces -- Yunnan and Heilongjiang -- carve out this exception under otherwise uncompromising national drug law.

None of this makes sense without the older story. China didn't back into a hemp industry by accident, and Beijing's current wariness toward cannabinoids isn't reflexive prohibitionism either -- it's the latest chapter in a relationship with the plant that split into separate tracks, fiber, food, medicine, and drug, long before anyone was writing modern statutes. Understanding how those tracks formed explains both why the hemp economy exists at all and why regulators keep tightening the screws on it.

Fiber First, Medicine Later

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Long before anyone in China was writing about cannabis as medicine, they were wearing it. Archaeological finds in Taiwan point to hemp fiber processing dating back roughly 10,000 years, placing it among the oldest textile-related uses of the plant documented anywhere in the world. Cordage, coarse cloth, and paper predecessors all trace back to hemp stalks split and retted using techniques that, in broad strokes, persisted for millennia. This was a utilitarian crop first -- rope, fabric, fishing nets -- centuries before anyone associated it with healing.

The medicinal turn gets credited, by tradition rather than documented history, to Emperor Shennong, the 'Divine Farmer' said to have ruled around 2800 BCE. Legend holds that Shennong personally tasted hundreds of plants to catalog their effects on the human body, sometimes poisoning himself in the process, and that he identified cannabis among the useful ones. It's worth being direct about what Shennong actually is: a foundational figure in Chinese agricultural and medical mythology, not a monarch anyone can verify through archaeological or textual record in the way we can verify, say, Han Dynasty emperors. He functions closer to how figures like Aesculapius function in Greek medical tradition -- a name that anchors a body of accumulated knowledge rather than a single historical author.

What matters is that this mythology stuck, and it shaped how cannabis got classified for the next two thousand years of Chinese pharmacology. The plant entered the record simultaneously as a fiber crop and a medicinal substance, two separate identities that never fully merged. That split is still visible today in the most literal way possible: China's legal code treats industrial hemp and drug-type cannabis as fundamentally different things, grown under different rules, regulated by different agencies. The template was set before anyone had a word for pharmacology.

The Shennong Bencao Jing and Cannabis as a 'Noble' Drug

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The text that formalized cannabis as medicine in China is the Shennong Bencao Jing, the Divine Farmer's Materia Medica, and its origins are murkier than its influence. Most scholars believe it was compiled from oral pharmacological traditions and set down in writing sometime between the 1st and 2nd centuries AD, then attributed retroactively to the mythical emperor for authority and prestige. That's a common move in classical Chinese texts -- attach a revered name to consolidate scattered knowledge into something authoritative.

The Bencao Jing organized 365 medicaments across three volumes, graded by potency and safety, and cannabis seed -- huo ma ren -- landed among the 120 entries in the top tier, the 'noble' or superior-grade drugs. That's genuinely significant company: ginseng, cinnamon bark, and licorice root sat in the same category. Noble-grade status wasn't a minor technical distinction. It meant the substance was considered non-toxic and suitable for sustained, regular consumption, the pharmacological equivalent of a staple rather than a last-resort intervention. This wasn't a plant reserved for desperate cases -- it was something you could take routinely without fear of harm.

The prescribed use reflects that classification. Cannabis seed was recommended to moisten the intestines, relieve constipation, and nourish qi -- the vital energy at the center of Chinese medical theory. This is food-as-medicine thinking, not intoxicant-seeking behavior. Nobody was smoking flower for effect in this framework; they were incorporating seed preparations into a broader regimen aimed at maintaining bodily balance. The Bencao Jing went further still, naming cannabis among the 'Supreme Elixirs of Immortality,' credited with conferring longevity and sustained vitality when taken over time. That's an extraordinary designation for a plant now classified globally as a controlled substance, and it says something about how differently ancient Chinese pharmacology approached the question of what makes a drug dangerous versus beneficial.

A Remedy for a Hundred Ailments

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Once cannabis entered the classical pharmacopeia, physicians kept finding uses for it. Later texts expanded well beyond the Bencao Jing's original entries, recommending cannabis preparations for more than a hundred distinct conditions over the following centuries -- gout, rheumatism, malaria, beri-beri, and a cluster of symptoms translated roughly as absent-mindedness or mental fog. That's a striking range for a single botanical, and it reflects how TCM practitioners were thinking about the plant's mechanism rather than treating it as a specialty item for one narrow complaint.

The staying power of this reputation is worth noting on its own: cannabis is still counted among the 50 'fundamental' herbs used in Traditional Chinese Medicine practice today, a list that represents the core toolkit taught to practitioners and stocked in TCM pharmacies. It didn't get phased out as newer botanicals came into fashion. It remained part of the working repertoire straight through to the present, even as the plant's legal status for drug purposes hardened into total prohibition.

What's easy to miss, especially looking at this through a Western lens, is which parts of the plant were actually in use. Classical and contemporary TCM applications center overwhelmingly on seeds and stalks -- material processed for digestive, circulatory, and metabolic complaints -- not on smoking flower for psychoactive effect. The intoxicating cannabinoid content that defines cannabis in Western drug policy debates was essentially beside the point in this medical tradition. That's the crucial distinction: TCM treated cannabis as a balancing agent meant to correct disruptions across the qi system and the body's networks, a broad-spectrum tool in a holistic model, rather than a drug targeted at a single symptom or receptor. The framework simply asked a different question of the plant than modern pharmacology does.

Hua Tuo and the Birth of Surgical Anesthesia

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The single most consequential figure in this history is Hua Tuo, a physician active during the late Han Dynasty, roughly 140 to 208 AD. Hua Tuo is credited as the first person on record anywhere to use cannabis as a surgical anesthetic, and the claim isn't a marginal one in Chinese medical history -- it's a centerpiece.

His method combined a preparation known as ma fei san, a powder built around cannabis and administered with wine, alongside acupuncture, to render patients insensate enough to undergo surgery. Historical accounts describe him performing abdominal procedures under this regimen, which, if accurate, would represent genuine surgical sophistication at a time when most of the ancient world had no reliable way to manage surgical pain beyond restraint and speed. Whatever the precise clinical details, one point deserves emphasis without inflating the claim: this predates comparable Western anesthetic techniques, developed with ether and chloroform in the 19th century, by well over a thousand years.

The linguistic residue of this history is still sitting in plain sight in modern Mandarin. The word for anesthesia today is mazui (麻醉), and the first character, ma, is the same character used for cannabis and hemp. It's not a coincidence or a loose etymological rhyme -- it's a direct trace of Hua Tuo's work embedded in the language itself, the kind of linguistic fossil that survives long after the practices that produced it have changed beyond recognition.

Hua Tuo himself remains a celebrated figure in Chinese medical history, invoked regularly as evidence of how advanced early Chinese surgical practice was relative to contemporaneous traditions elsewhere. He's a folk hero in medical circles the way certain early Greek or Persian physicians are treated in their own traditions -- part documented history, part legend, but genuinely foundational to how the culture understands its own medical lineage.

From Sacred Herb to Controlled Substance

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Everything shifts in the 20th century, and it shifts hard. Under China's current Drugs Prohibition Law, marijuana is classified as a narcotic drug, and its use is prohibited in any form nationwide. Cultivation of drug-type cannabis -- plants bred or grown for THC content -- is generally illegal across the entire country, with no broad medical or recreational carve-out anywhere near what exists in North America or Western Europe. This is enforced seriously, and anyone assuming TCM's historical embrace of the plant translates into lenient modern policy is working from outdated assumptions.

The exception is narrow and specific: industrial hemp. Only two provinces, Yunnan and Heilongjiang, have written provisions in their local Anti-Drug Regulations permitting regulated hemp cultivation. Yunnan moved first, issuing its Provisional Regulation on Industrial Hemp in 2003 and updating the framework in 2010 as the industry matured. The scale that followed is substantial -- by 2020, Yunnan had more than 13,000 hectares of open-field hemp under cultivation aimed largely at CBD extraction, with close to 160 companies registered in CBD-related business activity in the province. That's a real industry, built on decades of provincial regulatory groundwork, not a loophole.

But the ground is shifting again. On August 5, 2024, six government departments -- including the Ministry of Public Security and the National Medical Products Administration -- jointly announced tightened controls covering seven substances, cannabidiol among them. The details of implementation are still working through provincial systems as of this writing, and they will keep evolving. What the move signals, though, is unmistakable: Beijing is increasingly treating CBD less like an agricultural commodity and more like a controlled compound requiring active monitoring, even while it keeps two provincial hemp economies alive rather than shutting them down outright. It's a hedge, not a reversal -- but it's a meaningfully harder line than existed even five years ago.

There's a tendency to narrate cannabis history as a straight arc -- ancient acceptance sliding gradually into modern prohibition. China's story refuses that shape. Somewhere around two thousand years ago the plant split into distinct lanes: fiber crop, food-grade medicinal seed, surgical and pharmacological remedy, and, much later, a controlled narcotic subject to strict national law. Those lanes never fully recombined, and the fork is still the organizing logic of Chinese cannabis policy today -- which is exactly why a country with a total ban on marijuana can simultaneously host a legitimate, exportable hemp and CBD industry across thousands of hectares in Yunnan.

The August 2024 tightening on cannabidiol is worth sitting with, because it complicates the easy assumption that non-intoxicating hemp derivatives are simply outside Beijing's concern. A plant with a documented medical pedigree stretching back to Hua Tuo's surgical anesthetic and the Bencao Jing's noble-grade classification is now getting folded into the same regulatory apparatus that governs narcotics -- even on its non-psychoactive side. That's not contradiction so much as continuity: China has always drawn sharp administrative lines around this plant, it's just drawing them in a different place now.

For anyone sourcing hemp fiber, CBD isolate, or related products out of Chinese supply chains, the practical takeaway is straightforward -- treat this as a live regulatory environment, not a settled one. Provincial rules in Yunnan and Heilongjiang, national narcotics classifications, and the newer cannabinoid-specific controls are all capable of moving independently of each other, and the only responsible move is checking current standing rules directly before any cross-border deal is built on assumptions from a year or two ago.