Aconitine accidental poisoning: two case reports and literature review

Introduction

Chinese Herbal Medicine (CHM) is widely integrated into clinical practice across Asia and other regions for disease treatment and health maintenance. Aconitine, a potent diterpenoid alkaloid derived from plants of the Aconitum genus (e.g., Aconitum carmichaelii and Aconitum kusnezoffii), exhibits significant pharmacological activity but also considerable toxicity. While properly processed Aconitum herbs are prescribed for their analgesic and anti-rheumatic properties, inadequate detoxification during processing or improper clinical use can lead to accidental aconitine poisoning. This condition characterized by severe cardiotoxicity and neurotoxicity, which may progress to fatal outcomes. Recently, with the expanding clinical application of traditional medicines globally, the incidence of aconitine poisoning has risen, particularly in Asian populations.