Aconite Poisoning over 5 Years

Abstract

In the majority of cases in this series, the causes of poisoning can be traced to poor-quality herbs, poor quality of prescription practice, or dispensary errors. The quality issues of TCM practice should be critically addressed to minimize this poisoning threat.

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

“…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.]…”

“…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.] The amount of Fuzi ingested by the patient reached almost 2-fold of the upper limit of the recommended dose and the time for decoction was less than 1 h, which mean the patient had ingested too much DDA and MDA whether the Fuzi was processed correctly before delivery or not.…”

“…The amount of Fuzi ingested by the patient reached almost 2-fold of the upper limit of the recommended dose and the time for decoction was less than 1 h, which mean the patient had ingested too much DDA and MDA whether the Fuzi was processed correctly before delivery or not. A further factor is that the prescribing and dispensing unit for herbs is the gross weight rather than the content of the active ingredients, which means that toxicity resulting from too great an amount of active ingredient can occur even when the dry weight of Aconitum plant is within the recommended dose [12]. Furthermore, to achieve the desired therapeutic effects or compensate for suboptimal effects, prescriptions by TCM physicians or self-medication can result in doses that exceed the safety level [12,19.]…”

“…In Hong Kong, around 0.2% of acute admissions to general medical wards were because of herbal poisoning [11]. The 3 herbs that most commonly induce severe adverse effects are aconite roots ( Aconitum carmichaeli and A. Kusnezoffii ) in Hong Kong and China, followed by Tripterygium wilfordii Hook f. and Isatis tinctoria L. [10,12,13]. …”

“…Unfortunately, there may be therapeutic and safety concerns when inadequate processing methods are employed [18]. Furthermore, self-medication without the supervision of professionals, and misconceptions regarding these herbs, may increase the risk of fatal poisoning [12,19]. Thus, a comprehensive view of Aconitum requires consideration of the therapeutic effects, its toxicity, and relevant administrative measures.…”