The oldest known record of marijuana use dates back to 2727 BCE in ancient China, where the Chinese emperor Shen Nung recommended the use of marijuana for a variety of medical purposes, such as treating gout, rheumatism, and malaria, as well as a sedative and anesthetic. The plant was also used for spiritual and religious ceremonies in ancient cultures, including in India and Africa. The use of marijuana spread throughout Asia, Europe, and Africa over time, and was even used as a medicine in the United States during the 19th century.