Aconitum carmichaelii syn. A. fischeri, is a species of flowering plant of the genus Aconitum, family Ranunculaceae. It is native to East Asia and eastern Russia. It is commonly known as Chinese aconite, Carmichael's monkshood or Chinese wolfsbane (Chinese: 烏頭附子; pinyin: Wu-tou Fu-zi) (Japanese: 鳥兜 or トリカブト, Torikabuto). It is known in Mandarin as Fu Zi (meaning daughter root, or lateral root) and as Wu Tou (meaning tuberous mother root, or root tuber).
It is valued as a garden plant, and numerous cultivars have been developed, of which 'Arendsii' and 'Kelmscott' (Wilsonii Group) have gained the Royal Horticultural Society's Award of Garden Merit.
Marked symptoms may appear almost immediately, usually not later than one hour, and "with large doses death is almost instantaneous." Death usually occurs within two to six hours in fatal poisoning (20 to 40 mL of tincture may prove fatal). The initial signs are gastrointestinal including nausea, vomiting, and diarrhea. This is followed by a sensation of burning, tingling, and numbness in the mouth and face, and of burning in the abdomen. In severe poisonings pronounced motor weakness occurs and cutaneous sensations of tingling and numbness spread to the limbs. Cardiovascular features include hypotension, sinus bradycardia, and ventricular arrhythmias. Other features may include sweating, dizziness, difficulty in breathing, headache, and confusion. The main causes of death are ventricular arrhythmias and asystole, paralysis of the heart or of the respiratory center. The only post-mortem signs are those of asphyxia.
Treatment of poisoning is mainly supportive. All patients require close monitoring of blood pressure and cardiac rhythm. Gastrointestinal decontamination with activated charcoal can be used if given within one hour of ingestion. The major physiological antidote is atropine, which is used to treat bradycardia. Other drugs used for ventricular arrhythmia include lidocaine, amiodarone, bretylium, flecainide, procainamide, and mexiletine. Cardiopulmonary bypass is used if symptoms are refractory to treatment with these drugs. Successful use of charcoal hemoperfusion has been claimed in patients with severe aconite poisoning.
Poisoning may also occur following picking the leaves without wearing gloves; the aconitine toxin is absorbed easily through the skin. In this event, there will be no gastrointestinal effects. Tingling will start at the point of absorption and extend up the arm to the shoulder, after which the heart will start to be affected. The tingling will be followed by unpleasant numbness. Treatment is similar to poisoning caused by oral ingestion.
Aconitine is a potent neurotoxin that opens tetrodotoxin-sensitive sodium channels. It increases influx of sodium through these channels and delays repolarization, thus increasing excitability and promoting ventricular dysrhythmias.
- Aconitine: Raw Fu Zi, 0.004%; prepared Fu Zi, trace/none.
- Hypaconitine: Raw Fu Zi, 0.12%; prepared Fu Zi, 0.001%
- Mesaconitine: Raw Fu Zi, 0.033%; prepared Fu Zi, 0.001%
- Aconitum chinense Paxton [= Aconitum carmichaelii var. truppelianum]
- Aconitum japonicum var. truppelianum Ulbr. [≡ Aconitum carmichaelii var. truppelianum]
- RHS A-Z encyclopedia of garden plants. United Kingdom: Dorling Kindersley. 2008. p. 1136. ISBN 1405332964.
- "RHS Plant Selector - Aconitum carmichaelii 'Arendsii'". Retrieved 17 July 2013.
- "RHS Plant Selector - Aconitum carmichaelii 'Kelmscott'". Retrieved 17 July 2013.
- Aconitum carmichaelii
- Bisset, NG (1981). "Arrow poisons in China. Part II. Aconitum--botany, chemistry, and pharmacology". Journal of Ethnopharmacology. 4 (3): 247–336. doi:10.1016/0378-8741(81)90001-5. PMID 7029146.
- The Extra Pharmacopoeia Martindale. Vol. 1, 24th edition. London: The Pharmaceutical Press, 1958, page 38.
- One or more of the preceding sentences incorporates text from a publication now in the public domain: Chisholm, Hugh, ed. (1911). "Aconite". Encyclopædia Britannica. 1 (11th ed.). Cambridge University Press. pp. 151–152.
- Chan TY (April 2009). "Aconite poisoning". Clin Toxicol (Phila). 47 (4): 279–85. doi:10.1080/15563650902904407. PMID 19514874.
- Chyka PA, Seger D, Krenzelok EP, Vale JA (2005). "Position paper: Single-dose activated charcoal". Clin Toxicol (Phila). 43 (2): 61–87. PMID 15822758.
- Lin CC, Chan TY, Deng JF (May 2004). "Clinical features and management of herb-induced aconitine poisoning". Ann Emerg Med. 43 (5): 574–9. doi:10.1016/j.annemergmed.2003.10.046. PMID 15111916.
- The anthocyanin responsible for purplish blue flower colour of Aconitum chinense. Kosaku Takeda, Syuji Sato, Hiromitsu Kobayashi, Yoko Kanaitsuka, Mariko Ueno, Takeshi Kinoshita, Hiroyuki Tazaki and Takane Fujimori, Phytochemistry, June 1994, Volume 36, Issue 3, Pages 613–616, doi:10.1016/S0031-9422(00)89784-8
- Aconitum carmichaelii information from NPGS/GRIN
- Aconitum carmichaelii Debx. Medicinal Plant Images Database (School of Chinese Medicine, Hong Kong Baptist University) (traditional Chinese) (English)
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