Medical Marijuana and TCM

One of the more frequently asked questions asked in my clinic is “what is Chinese medicine’s take on the use of medical cannabis or marijuana?” Over the course of the next few blogs I will share my thoughts on the subject and will begin with the Chinese medical understanding of the drugs.

Cannabis sativa or Hou ma jen was one of three hundred and sixty five herbs, animal parts and mineralsoriginally listed in theDivine Farmer’s Materia Medica” (Shen Nong Ben Cao). The Ben Cao is one of Chinese medicines oldest books and was cited by authors and scholars as early as the Qin Dynasty period around 221 BCE. Even by then however, the original manuscripts had been lost to history. In the Materia Medica the plant part of particular interest of cannabis sativa was the seed and it was listed as a “superior class cereal”.

The cannabis seed or Huo ma ren has a sweet and balanced nature, enters the spleen, stomach and large intestine, supplements the “center” and boosts the qi. Prolonged consumption of the seed may “make one fat (a good thing in ancient China), strong and never senile”. Contraindications are that overconsumption causes dizziness and vertigo. With women there was also a contraindication during pregnancy.

Hemp seeds are still widely used as medicine in both China and the west, they function to dredge wind, relax the spleen, moisten dryness, promote lactation and hasten delivery, disinhibit urination and defecation. We use them mostly for their effect of moistening the intestines to unblock the bowels and are the go to herb for any kind of constipation.

Cannabis seeds, like other herbs in the Moist Laxative category are various seeds and nuts. The major known ingredients in the seeds are unsaturated fats in the form of lipids and, what little cannabinol is in the seeds is inconsequential, and the seeds are processed so that they cannot germinate and are thus not a controlled substance. Having said that, the sesame seed Hu ma ren is as effective as cannabis seed in this capacity and has none of the stigma of being related to a schedule I drug.

The leafy and flowering or folium and flos parts of Hou Ma Jen are acrid, windy and balanced in nature and mainly treated the “seven damages” which are injuries to the spleen, liver, kidneys, lungs, heart, ‘storms and extreme climate’ injuries of the body, and ‘fear and indulgence’ injury to the will. Hou Ma Jen also disinhibited the five viscera, i.e. heart, spleen, lung, kidney and liver.  

Hou Ma Jen precipitated blood and cold qi but are cautioned that consuming too much of the folium causes one to ‘behold ghosts and frenetically run about’. Protracted consumption of the folium may also encourage one to ‘communicate with spirits’.

Due to the mind altering properties of Cannabis, the leaves, buds and flowers were not used much at all mostly because there were many other plant medicines to choose from with the same positive effects but none of the negative side effects. It is interesting to note that in ancient China, cannabis, when used at all, was taken as a liquid decoction or tea and never smoked.

From the point of view of Chinese Medical Psychiatry, the use of cannabis generally elicits one of two responses. In the first case many people experience a pleasant euphoria and sense of relaxation. Other common effects in this first scenario, which may vary dramatically among different people, include heightened sensory perception (e.g., brighter colors), laughter, altered perception of time, and increased appetite.

The euphoria and relaxation are due to the movement of qi via coursing the liver, changes in the intensity of light and color are the eyes responding to the relaxing quality of the drug on the liver. Laughter and giddiness are the typical response to the free flow of qi of the heart and the increased appetite is due to the unrestrained liver harmonizing and rectifying the spleen and stomach.

All of the above responses indicate an underlying mild condition of liver qi stagnation and some degree of spleen qi vacuity. Cannabis clearly helps alleviate these two conditions but only for a short period of time, 1-3 hours. Because the effects are short lived we can conclude two things, one is that cannabis is not an appropriate drug for liver qi stagnation because it does nothing to fortify the qi while releasing constrain. And that over consumption will eventually result in qi vacuity which will cause greater qi constraint and the drug will have to be taken more frequently and or at greater strength to achieve the same euphoric effect.

The above is one of the definitions of addiction, and with this understanding there is no relevant argument for cannabis being non-addictive.

Pleasant experiences with marijuana are by no means universal. Instead of relaxation and euphoria, many people experience anxiety, fear, distrust, or panic. People who have taken large doses of marijuana may experience an acute psychosis, which includes hallucinations, delusions, and a loss of the sense of personal identity. These unpleasant but temporary reactions are distinct from longer-lasting psychotic disorders, such as schizophrenia, that may be associated with the use of marijuana in vulnerable individuals.

This second scenario occurs in people who are already suffering from, for instance, heart timidity and gall bladder qi vacuity. The consumption of qi through the action of the acrid natured cannabis quickly lowers the resources of the already depleted heart qi and gall bladder meridians and organ systems which are very susceptible to acrid herbs. The consumption of qi and blood through cannabis use can affect other organ system conditions as well such as; spleen qi vacuity, spleen qi and heart blood vacuity, liver qi stagnation with blood vacuity and about twenty other commonly seen conditions.

Persons with any of those conditions are considered vulnerable and are at risk, over time and prolonged use, to longer lasting psychotic disorders.

As with the primary scenario, the substance is addictive by nature so the probability and risk factor is increased.

So, from a traditional Chinese medical and psychiatric perspective, the use of medical cannabis or marijuana for indications of pain management, addiction withdrawal, constipation and lack of appetite is not advised given the historical understanding and the negative side effects involved.

Next time I will explore conventional medical science regarding medicinal marijuana and cannabis.

Yours in good health,

Robert Kienitz, DTCM