A review of traditional and current methods used to potentially reduce toxicity of Aconitum roots in Traditional Chinese Medicine

Liu, Shuai; Li, Fēi; Li, Yan; Li, Weifei; Xu, Juan; Du, Hong

doi:10.1016/j.jep.2017.06.038

Cited by 103 publications

(65 citation statements)

References 31 publications

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“…CHM processing methods, known as paozhi, convert or transform the plant contents into secondary derivatives to lower the toxicity and increase the pharmacological efficacy. When Danfupian or Paofupian is prescribed in the formulation, at least 30 min of boiling in the decoction is needed for advanced detoxification prior to the addition of the other herbs; this hydrolyzes the remaining Aconitum alkaloids into derivatives that are almost non-toxic [13,14,16.] Higher doses of Fuzi can require as much as 2 h for decoction.…”

Section: Discussionmentioning

confidence: 99%

“…This requirement for pre-boiling should be emphasized on instruction sheets, and good compliance of patients can assure adequate decoction [23.] A territory-wide study based in Hong Kong reviewed 52 confirmed cases of aconite poisoning and concluded that the main contributing factors included exceeding the doses recommended by CP 2015 (3-15 g for processed ‘Fuzi'), unintentional contamination with aconite root, the use of misprocessed aconite root, and dispensary errors in which aconite root was dispensed by mistake [12,16,23.] The total amounts of Aconitum alkaloids can vary much as 10-fold between different species, origins, and times of harvest, as well as the later processing methods [12,24.]…”

Section: Discussionmentioning

confidence: 99%

“…In Taiwan, the Committee on Chinese Medicine and Pharmacy, Department of Health, set quality specification only on the highest detectable concentration of pesticide, heavy metal, aflatoxin, and sulfur dioxide. Given that Aconitum plants are natural preparations in which the concentrations of ingredients can fluctuate according to the weather, origin, and differences in cultivation, only officially standardized and modern phytochemical methods for processing, such as pressure-steaming and routine quantification by HPLC before merchandising and dispensing, can ensure product safety and retain the desired clinical effects [12,16]. …”

Section: Discussionmentioning

confidence: 99%

“…Various preparations of Fuzi are sold on the commercial markets, including Yanfuzi, Heishunpian, and Baifupian, which are made from Nifuzi that is salted and crystallized in brine as a preservative. In addition, roasting or boiling with liquorice roots produces Danfupian and Paofupian, respectively [16,17]. …”

Section: Introductionmentioning

confidence: 99%

“…However, it contains toxic diester diterpene alkaloids (DDAs), which are decomposed by the preparation methods to the less toxic monoester diterpene alkaloids (MDAs); this reduces the toxicity remarkably [14,15,16]. Unfortunately, there may be therapeutic and safety concerns when inadequate processing methods are employed [18].…”

Section: Introductionmentioning

confidence: 99%

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Bradycardia and Hypotension from Improper Use of Aconite Root: A Case Report and Brief Review

et al. 2018

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Background: Adverse reactions associated with Chinese herbal medicines (CHMs) are usually the result of unpredictable active/toxic ingredients, inaccurate or mistaken beliefs, or poor supervision. The herb that most commonly induces severe adverse effects in Hong Kong and China is aconite root. More than 200 species of Aconitum plants are used for medicinal purposes, with aconite roots producing analgesic, anti-inflammatory, cardiotonic, and anti-tumor effects. The active components are alkaloids; these can be toxic, but CHM processing methods lower their toxicity and increase the pharmacological efficacy. However, aconite poisoning can result from inadequate decoction time or exceeding the recommended dose. Case Report: Here we report the case of a 92-year-old woman who presented with life-threatening bradycardia and hypotension. This started 1 h after she inappropriately consumed a herbal decoction containing Fuzi for mood fluctuation and health maintenance; Fuzi, an aconite root, has known cardiotoxicity. Electrocardiography showed supraventricular abnormalities, including sinus bradycardia and low-amplitude P waves. After an infusion of normal saline and inotropic agents for 25 h, the clinical manifestations subsided, her sinus rhythm returned to normal, and she was discharged. At follow-up 2 weeks later, she was in good health and had ceased taking any CHM. Conclusions: Standardized processing methods, stringent regulations, and cooperation between health professions can ensure medication safety and establish a fully-fledged operating process for these valuable drugs. We hope this report will help establish correct attitudes toward CHM and will assist Traditional Chinese Medicine practitioners to become more familiar with Aconitum plants.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Bradycardia and Hypotension from Improper Use of Aconite Root: A Case Report and Brief Review

et al. 2018

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The effect of compatibility of Aconiti Radix and honey on the pharmacokinetics of five Aconitum alkaloids in rat plasma

Duan

Deng

et al. 2022

Biomedical Chromatography

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Aconiti Radix [Chuanwu (CW)] is widely used to treat chronic and intractable diseases due to its remarkable curative effect. CW has been combined with honey for thousands of years to reduce toxicity and enhance efficacy. This study first determined the compatibility mechanism of CW with honey using a comparative pharmacokinetic concept. We developed and validated a simple, sensitive, specific, and accurate UHPLC-MS/MS method to simultaneously determine five Aconitum alkaloids in rat plasma after the oral administration of CW decoction and CW-honey concentrated solution. Pharmacokinetic parameters were significantly different between the two groups (P < 0.01 and P < 0.05). Compared with the CW group, C max and AUC 0 ! t decreased in the CW-honey group for three diester-diterpenoid alkaloids (hypaconitine, mesaconitine, and aconitine); T max and T 1/2 were prolonged.However, C max and AUC 0 ! t increased in the CW-honey group for two monoesterditerpenoid alkaloids (benzoylaconine and benzoylmesaconine); T max was shortened, and T 1/2 was prolonged. These findings suggest that honey affected the pharmacokinetic behaviors of five Aconitum alkaloids. We speculate that the detoxification and synergism of honey might result from reducing the toxicity of diester-diterpenoid alkaloids and promoting the biological activity of monoester-diterpenoid alkaloids in vivo. This study provides a theoretical basis for the clinical use of CW combined with honey.

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Aconitine induces cardiotoxicity through regulation of calcium signaling pathway in zebrafish embryos and in H9c2 cells

Xie

Chen

et al. 2020

J of Applied Toxicology

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Fuzi, the processed lateral roots of Aconitum carmichaelii Debx., is a traditional herbal medicine that is well known for its excellent pharmacological effects and acute toxicity. Aconitine is one of the diester‐diterpene alkaloids and well‐known for its arrhythmogenic effects. However, the effects of aconitine in zebrafish have rarely been studied. Therefore, we investigated the effects of aconitine on zebrafish embryos and H9c2 cells. Zebrafish embryos at 48 hours postfertilization were exposed to aconitine, and then, cardiac function and apoptosis were measured. Through transcriptomic analysis, the cardiotoxicity of aconitine in zebrafish embryos was involved in regulating Ca2+ signal pathways. A reverse transcription‐polymerase chain reaction was performed to verify the expression of Ca2+ pathway‐related genes after 12, 24, 36 and 48 hours of treatment. Meanwhile, intracellular Ca2+ concentrations and cell apoptosis were observed in H9c2 cells treated with half‐maximal inhibitory concentration values of aconitine for 30 minutes. The protein levels of troponin T (TnT), caspase 3, Bcl‐2 and Bax were detected by western blot analysis. In vivo, 2.0 and 8.0 μm aconitine decreased the heart rate and inhibited the contraction of ventricles and atria in a dose‐ and time‐dependent manner. Furthermore, aconitine increased expression of cacna1c, RYR2, atp2a2b, Myh6, troponin C, p38, caspase 3, Bcl‐2 and Bax for 12 hours. In vitro, 1.5 and 4.5 mm aconitine caused intracellular Ca2+ ion oscillation, increased rates of apoptosis, inhibited TnT and Bcl‐2 protein expression, and promoted caspase 3 and Bax protein expression. These data confirmed that aconitine at various concentrations induced cardiac dysfunction and apoptosis were related to the Ca2+ signaling pathway.

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A review of traditional and current methods used to potentially reduce toxicity of Aconitum roots in Traditional Chinese Medicine

Cited by 103 publications

References 31 publications

Bradycardia and Hypotension from Improper Use of Aconite Root: A Case Report and Brief Review

Bradycardia and Hypotension from Improper Use of Aconite Root: A Case Report and Brief Review

The effect of compatibility of Aconiti Radix and honey on the pharmacokinetics of five Aconitum alkaloids in rat plasma

Aconitine induces cardiotoxicity through regulation of calcium signaling pathway in zebrafish embryos and in H9c2 cells

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