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Abstract

In the past, renowned physicians who practiced Yang-nourishing techniques and took large doses of Aconite Lateral Root for health maintenance often enjoyed long lives. However, in modern times, cases of aconitum poisoning have become frequent, with reports of cumulative toxicity.

The author, while researching the bidirectional regulatory properties of Jiangyou Aconite Lateral Root and methods to improve the loss of active ingredients during its processing, returned to Jiangyou, Sichuan. After multiple visits to local Aconite Lateral Root farmers and personally processing the materia medica, the author discovered the reasons behind the low efficacy and high toxicity of processed Aconite Lateral Root.

It turns out that during the processing of Aconite Lateral Root, apart from some products losing active ingredients due to excessive washing, producers often use highly toxic and carcinogenic chemical materials for peeling, whitening, and dyeing. They also excessively inject bile to increase weight, aiming to produce visually appealing and heavy toxic products at low cost. Additionally, it is common to pass off Aconite Lateral Root from other regions as authentic Jiangyou Aconite Lateral Root.

Clinically, many cases of aconitum poisoning that do not resemble Aconite Mother Root alkaloid reactions, or specific discomforts after patients take Aconite Lateral Root, are mostly caused by artificial additives in the Aconite Lateral Root. Once switching to Aconite Lateral Root produced under standardized processing, the discomforts often disappear, and the treatment efficacy significantly improves.

Aconite Lateral Root is just the tip of the iceberg regarding issues with Yang-nourishing medicines. The key to effective classical formulas and Yang-nourishing treatments lies in the quality control of the medicines, involving only a few main types of herbs. The author urges peers to strengthen the exchange of information on authentic medicinal sources, ensure the quality of medicines, and reject inferior materials.

Main Text

Since Master Zheng Qin-an, renowned Yang-nourishing physicians across China have often enjoyed long lives, some even surpassing a hundred years. These physicians commonly took large doses of Aconite Lateral Root for health maintenance and disease prevention. Calculating based on consuming two taels of Aconite Lateral Root weekly, the lifetime consumption should be at least five hundred catties, with some exceeding a thousand catties. Thus, the safety of long-term Aconite Lateral Root consumption should not be doubted.

The ancient sage Zhang Zhongjing did not require Aconite Lateral Root to be decocted first, believing that without the medicinal dizziness, the disease would not be cured. In contrast, modern practitioners generally agree that heating Aconite Lateral Root converts Aconite Mother Root alkaloids into benzoylaconine and aconine, reducing toxicity by nearly two thousand times. Therefore, physicians usually advise patients to decoct Aconite Lateral Root first. Hence, the hydrolysis degree of Aconite Mother Root alkaloids in modern Aconite Lateral Root preparations is much higher than in Zhang Zhongjing's era, and the toxicity should be extremely low.

However, in reality, cases of aconitum poisoning are frequently reported, including so-called cumulative toxicity. Renowned Yang-nourishing physicians are often troubled by patients showing no effect or atypical Aconite Mother Root alkaloid reactions after taking Aconite Lateral Root, sometimes leading them to consider abandoning its clinical use. The recent attention to over-processing of Aconite Lateral Root materia medica may explain the low efficacy but not why patients still experience frequent abnormal reactions after taking long-decocted Aconite Lateral Root.

The author, originally from Sichuan, previously worked as a clinical neurosurgeon and later focused on Chinese medicine research, particularly on Yang-nourishing formulas for tumor treatment.

Literature suggests that Jiangyou Aconite Lateral Root contains unique pharmacological components, exhibiting specific bidirectional regulatory properties in clinical use. The author considers this as one of the pharmacological backgrounds for the advanced development of special medication techniques by Sichuan's renowned Yang-nourishing physicians (e.g., nourishing Yang to benefit Yin for Yin diseases, using Yang to transform Yin for Yang diseases). Additionally, the author aimed to address the loss of active ingredients during Aconite Lateral Root processing. Thus, during the summer and autumn of this year, the author returned to Jiangyou, Sichuan, visited local Aconite Lateral Root farmers multiple times, and personally processed the materia medica to test its efficacy over several months.

When the author first came into contact with Aconite Lateral Root farmers, their wariness was generally extremely high, and they were unwilling to say even a single extra word. It was only after the author repeatedly expressed that the sole purpose was to produce high-quality Aconite Lateral Root independently, in order to improve clinical efficacy, and after working together in the fields, making purchases together, and even living and eating together in their homes for an extended period, that the author was able to immerse themselves in the community of Aconite Lateral Root farmers and processors. Only after being recognized as one of their own did the author finally hear the truth. This led to the shocking realization of how the current low efficacy and high toxicity of Aconite Lateral Root are formed. The firsthand experiences and observations during this period were truly eye-opening!

Recently, online reports have indicated that some Aconite Lateral Root manufacturers claim the reason for abandoning the traditional processing of materia medica is "simple": the outdated facilities cannot meet the "modern" GMP standards. But is this really the case?

First, let me introduce the processing of Aconite Lateral Root.

According to traditional production standards, Aconite Lateral Root is made from fresh Aconite Lateral Root harvested locally in Jiangyou. After washing, it must be soaked in brine the same afternoon or evening. For every thousand catties of fresh Aconite Lateral Root, five hundred catties of brine are used. Typically, it is soaked in brine for 6-7 days, followed by rinsing with river water five times, once a day. Then, it undergoes peeling, slicing, and heat treatment. This method generally requires about five catties of fresh Aconite Lateral Root to produce one catty of processed Aconite Lateral Root slices. The final product is light and crisp, yellow in color with a dull cut surface, and slightly buoyant in water.

First, let's discuss why brine is used.

Jiangyou's geography belongs to the Kun (Earth) element, and its Aconite Lateral Root best embodies the principle of fire hidden within the earth, making its yang-supporting medicinal effects unparalleled. However, because it is related to this principle, Jiangyou Aconite Lateral Root must grow from the first yang (Yiyangsheng) to the Summer Solstice (the 10th solar term) for its medicinal properties to fully develop. Once summer passes, it cannot be preserved. It should only be dug up between July 1st and 3rd or 5th each year. If not dug up within a few days of this period, it will rot underground. Aconite Lateral Root grown elsewhere often lacks this characteristic, can be planted in other months, and is easier to preserve. However, its form and medicinal properties will also vary.

If Jiangyou Aconite Lateral Root is not dug up on time, it will rot underground. After being dug up, if it is not dried under continuous hot sun within two or three days, it will quickly rot and cannot be air-dried. It is famously known as the "overnight rot"! Because Jiangyou Aconite Lateral Root is so prone to rotting, the original purpose of soaking it in brine in ancient times was to efficiently preserve and transport it within the short harvest period, rather than to adjust its medicinal properties.

Now, let's talk about the properties of brine: The chemical formula of brine is CaCl₂ (not the same as table salt, NaCl). It is yin-supporting and toxic, and has been used by rural people for suicide, such as the suicide drug used by Yang Balao in the play "The White-Haired Girl." The real reason for the recent trend of soaking Aconite Lateral Root in large amounts of brine is that brine is much cheaper than Aconite Lateral Root. After soaking, the Aconite Lateral Root can nearly double in weight, and it looks shiny, attractive, and heavier, naturally increasing profits. Hence, there is a saying among Jiangyou Aconite Lateral Root producers: "No brine, no weight; no brine, no shine!"

As for peeling, besides the fact that the toxicity of Aconite Lateral Root is concentrated in the cutaneous region, it is also done to improve the product's appearance. However, the traditional method of peeling with bamboo knives requires a large number of additional workers due to the short harvest and processing period of only about ten days each year. In the past, the wage for peeling one catty of Aconite Lateral Root was three jiao, but this year it has risen to eight jiao per catty, and it is still difficult to find workers.

The production methods of unscrupulous merchants are shocking: First, they boil Aconite Lateral Root with sodium metabisulfite (bleaching agent), industrial hydrogen peroxide, industrial caustic soda, and foaming agents for over ten minutes to completely remove the skin. These chemicals are highly carcinogenic but allow for low-cost, high-speed peeling and make the Aconite Lateral Root white, transparent, shiny, and attractive. Then, they excessively soak the Aconite Lateral Root in brine, extending the soaking process to over 15 days and only rinsing it with river water once or twice. During the heat treatment process, they even directly inject brine into the Aconite Lateral Root. They place a large amount of brine on top of wooden steamers, and when heated, the liquefied brine directly pours into the Aconite Lateral Root slices, which is alarming. During smoking, they may also add industrial sulfur to whiten the product (without sulfur, it won't be white). This method uses only 2.5 catties of fresh Aconite Lateral Root to produce one catty of slices. The final product sinks quickly in water, has a heavy body, a shiny surface, and white flesh, but is very hard. Authentic processed Aconite Lateral Root is very brittle, but the fact that we often see pharmacies using large copper hammers to crush the slices is a result of this processing method.

As for the preparation of Aconite Lateral Root, the ancient method involves digging out the fresh Aconite Lateral Root and immediately stir-frying it with sand for 1 to 2 days. It is said that this is the method closest to the preparation of Aconite in the era of Zhongjing. The resulting product is larger in size, with slightly charred and dry skin, and a loose, porous texture in the shallow layer. Although this method is simple, it is labor-intensive and yields are too low, making it rarely used today. If this product appears on the market, it is often mixed and referred to as Big Aconite Root.

The current market process for real processed Aconite Lateral Root is mostly based on the aforementioned soaking and sulfur fumigation processes for weight gain, plus an additional step of direct heating, giving it a slightly charred appearance, which is then passed off as processed Aconite Lateral Root.

What is yellow Aconite Lateral Root? The ancient method of making yellow Aconite Lateral Root involved boiling Aconite Lateral Root with Turmeric and Carthamus for two to three hours. Due to high costs, this method is no longer used, and even renowned stores like Beijing XX Hall do not sell authentic products!

The first alternative production method involves using chemical dye lemon yellow to dye the Aconite Lateral Root slices, boiling them for just ten minutes. The downside is the unnatural color, which fades after six months. Hence, a more extreme production method uses tender meat yellow (a highly carcinogenic substance) for dyeing, resulting in low-cost, beautiful, natural, and non-fading products.

What is black Aconite Lateral Root? The proper method involves boiling with black soybean, Liquorice Root, or brown sugar. The alternative method uses industrial black dye, resulting in a product that is black on the surface and transparent black in the center, also known as glass Aconite Lateral Root.

What about raw Aconite Lateral Root? The proper method is to dry it under intense sunlight or in a low-temperature drying oven. As long as it is thoroughly boiled or steamed before medicinal use, it should be the most effective and least likely to cause cumulative poisoning, making it an excellent supplement for warming yang.

However, as mentioned earlier, raw Aconite Lateral Root must be dried within a few days after being dug up. A low-temperature drying oven cannot dry much Aconite Lateral Root in a few days. If the first few days of July are cloudy, it can only be dried using microwave or direct charcoal fire combined with sulfur fumigation. This method produces relatively good Aconite Lateral Root, but the higher heating temperature reduces its effective components, requiring a larger dosage and longer cooking time compared to sun-dried Aconite Lateral Root. Currently, most raw Aconite Lateral Root in Jiangyou is roasted with sulfur-containing coke. Sulfur-free and smoke-free coke costs more than double, and no one is willing to incur losses for processing.

Among Chinese medicinals, the most irreplaceable and life-saving (warming yang five tiger generals) have been wronged in modern times. The most wronged is Aconite Lateral Root! Why? Because its toxicity is man-made! Modern literature indicates that properly heated and hydrolyzed raw Aconite Lateral Root can have effective components more than ten times higher than commercially processed Aconite Lateral Root. In LD50 tests, mice given doses equivalent to dozens of kilograms of Aconite Lateral Root per day for humans showed no deaths and no long-term damage to zang-fu organs. In other words, natural Aconite Lateral Root can be non-toxic. However, processed Aconite Lateral Root is almost always toxic and even carcinogenic! zang-fu organ damage was observed. In other words, natural Aconite Lateral Root can be non-toxic. However, processed Aconite Lateral Root is almost always toxic and even carcinogenic!

Are we reporting isolated incidents of a few illegal processors? No! According to internal information obtained after getting familiar with several Jiangyou processors and samples purchased from major wholesale and retail pharmacies at home and abroad, about 80-90% of the currently circulating Jiangyou Aconite Lateral Root is processed this way!

When processors need to produce Aconite Lateral Root, they only need to call a chemical raw material store, specify the quantity and type of Aconite Lateral Root to be produced, without explicitly stating the chemical agents to be purchased. The store will weigh and deliver the required chemicals, and the invoice will not record the actual types of chemicals purchased. Local processors jokingly call this "one-stop service."

True Aconite Lateral Root experts can tell at a glance. Otherwise, ordinary people can also find significant issues with Aconite Lateral Root by carefully analyzing publicly available data!

This year's production of Aconite Lateral Root in Jiangyou has dropped to a historic low of only 500 tons, and the local purchase price of raw Aconite Lateral Root has risen to around 12 yuan per kilogram. As we have introduced, to produce one jin of processed Aconite Lateral Root according to standard production requirements, it generally takes five jin of fresh Aconite Lateral Root, while counterfeit methods can produce one jin of processed Aconite Lateral Root with only 2.5 jin of fresh Aconite Lateral Root. In other words, if produced according to standards, one jin of processed Aconite Lateral Root requires five jin of raw Aconite Lateral Root, with a purchase cost of 30 yuan, plus the costs of processing materials, site, labor, utilities, taxes, packaging, storage, transportation, and profit... If the wholesale price is below 70 yuan, there is no profit at all, and if it is below 60 yuan, it doesn't even cover the production costs! So, if the Jiangyou Chuanfu you ordered is priced at 30 to 40 yuan per jin, can it be produced according to standards?

At the very least, it is unlikely to be Jiangyou Aconite Lateral Root, because Aconite Lateral Root from other regions would be much cheaper in terms of raw material cost. Some shareholders of Jiangyou manufacturers have underground cellars or private warehouses at home, which are used to store miscellaneous Aconite Lateral Root purchased from other regions... Therefore, don't assume that what you buy in Jiangyou is necessarily authentic Aconite Lateral Root; it might just be dry Aconite Lateral Root from Hanzhong, Shaanxi!

The production of Jiangyou Aconite Lateral Root has drastically declined, while the national demand has suddenly increased. Some manufacturers did not purchase Aconite Lateral Root from local farmers during the harvest period in July, nor did they hire additional workers for the peeling process. So, how was the supply-demand issue resolved? Some production bases sometimes don't operate substantially for two or three years. Where does the processed Aconite Lateral Root circulating in the market come from? It's quite thought-provoking!

In fact, many major manufacturers' shareholders are also local individual processors. As for other production areas outside Jiangyou, their output is smaller. Even if the products are branded under big manufacturers, they are often supplied by (counterfeit) households behind the scenes! The real processing flow of Aconite Lateral Root is self-evident. The current processing situation of Jiangyou Aconite Lateral Root is representative nationwide. Processes like filling with bile, peeling, dyeing, adding toxins, and whitening are the same across the country, as the processing experience of Jiangyou masters has already spread widely nationwide.

In summary, the processed Aconite Lateral Root circulating in the market is inseparable from four issues:

1. Aconite Lateral Root heavily filled with bile but not fully removed (Bile Aconite Lateral Root). The bile content in this type of Aconite Lateral Root can exceed the standard product by more than ten times. It tastes numb and bitter, with a salty and astringent flavor, heavy and hard in texture, and has a semi-transparent luster on the surface. Beginners in the industry are most likely to mistake it for good Aconite Lateral Root.
2. Aconite Lateral Root containing a large amount of highly toxic, even carcinogenic chemical materials (Toxic Aconite Lateral Root). The toxicity of this type of Aconite Lateral Root comes from chemicals rather than Aconite Mother Root alkaloids, so prolonged boiling does not help in detoxification.
3. Aconite Lateral Root residue that needs to be repeatedly processed with river water to remove bile for certain reasons. This type of Aconite Lateral Root will definitely pass the Aconite Mother Root alkaloid content test during quality inspection; however, the Aconite Mother Root alkaloids are not hydrolyzed into effective Aconite Mother Root amines but are washed away by water. Sometimes, using half a pound of this Aconite Lateral Root has less medicinal effect than one or two taels of properly processed Aconite Lateral Root, or even three qian of raw Aconite Lateral Root!
4. Aconite Lateral Root from other regions, mixed and sold as authentic Jiangyou Aconite Lateral Root.

Most of the processed Aconite Lateral Root sold in the market is a combination of these four factors. Therefore, the patient's reaction after taking Aconite Lateral Root is largely not related to the physician's prescription level but depends on which type of Aconite Lateral Root they happened to encounter! Imagine, even if you are a master physician, if some troublemaker triples your sovereign medicinal at one time, reduces it five times at another, and adds a large amount of carcinogenic substances at yet another... How could you not be in big trouble?

This situation is something I have seen a lot in Sichuan, Hong Kong, and Shenzhen. Patients, after taking Aconite Lateral Root, have not yet experienced the dizziness reaction typical of Aconite Mother Root alkaloids but have already shown abnormal discomfort in the head or gastrointestinal tract. This abnormal manifestation is often mistaken by some colleagues as a healing crisis; in fact, it is mostly caused by artificial additives in Aconite Lateral Root.

Around the Summer Solstice this year, I asked several Jiangyou Aconite Lateral Root households to produce one to two thousand jin of processed and raw Aconite Lateral Root slices according to the standardized production steps I required. During this process, every Aconite Lateral Root household shook their heads and sighed, considering it (against tradition), and claimed that even if they followed my instructions, I was destined to suffer a huge loss (I privately agreed that their advice might be very correct)!

After the production was completed, I specifically paid attention to using the standardized Aconite Lateral Root on (1) cases that had previously shown abnormal discomfort after taking commercially available Aconite Lateral Root; and (2) cases that had long-term use of Fuyang formula with correct pattern identification but unclear efficacy. The result was a very encouraging breakthrough in both cases!

For example, in a family, all members experience severe headaches upon consuming commercially available Aconite Lateral Root. However, when using genuine Aconite Lateral Root, no matter how much is consumed, there is no occurrence of headaches.

Another patient, suffering from severe arrhythmia, coronary heart disease combined with heart failure, had long sought treatment from renowned experts in Fuyang medicine but saw no improvement. Recently, the condition worsened to the point where the patient could no longer sit up in bed unaided. I prescribed a formula largely similar to previous ones, but replaced the key ingredient with genuine Aconite Lateral Root. Remarkably, the patient's condition improved overnight, allowing them to stand and get out of bed, and within a week, they could climb stairs! My medical skills are undoubtedly far inferior to those of the renowned experts the patient had previously consulted. The stark difference in efficacy highlights the detrimental impact of inferior medicinal materials!

Reflecting on the reasons for the decline in the quality of Aconite Lateral Root production, it began with an irrational fear of its toxicity, leading to excessive processing methods for materia medica. Additionally, classical formula medicine and Fuyang principles were historically neglected, causing many clinicians to view Aconite Lateral Root merely as a "cardiac stimulant" in Chinese medicinals, without understanding the prevalence of Three Yin diseases in modern populations. This oversight led to a diminished appreciation of Aconite Lateral Root's importance and a consequent decline in demand.

Due to the overall contraction of the supply and demand market, Aconite Lateral Root producers, under the pressures of insufficient market support, disregard for regional authenticity, and heavy tax burdens, resorted to cost-cutting measures through substandard production methods. This further exacerbated the loss of efficacy caused by excessive processing and introduced genuinely harmful toxicity. In such a vicious cycle, how could the prized Jiangyou Aconite Lateral Root not face decline?

In fact, the issue with Aconite Lateral Root is just the tip of the iceberg in the broader problem of Fuyang medicinal materials. During my time in Hong Kong and Guangzhou, I witnessed some Fuyang practitioners specially ordering Cinnamon Twig and Epimedium Herb from overseas, or dedicating dry fields to prepare aged ginger. The quality and potency of these herbs far surpassed those commonly available domestically. It is disheartening to think that China, the homeland of Chinese medicine, lacks the circulation of high-quality medicinal materials for its own market.

For effective Fuyang formulas, the quality of medicinal materials is paramount. Many contemporary Fuyang experts use Aconite Lateral Root in large quantities, not out of preference but based on their experience that modern processed Aconite Lateral Root requires several taels to match the efficacy of a few qian of ancient-processed or raw Aconite Lateral Root, equivalent to a small dose of Zhang Zhongjing's Cold-Extremities Decoction.

Raw Aconite Lateral Root, after prolonged decoction and concentrated processing into granules, allows practitioners to prescribe it confidently while sparing patients the inconvenience of lengthy decoction. This represents an important direction for the modernization of Aconite Lateral Root. To preserve the characteristics of classical formula medicine, processed Aconite Lateral Root should not be abandoned. Improvements in production standards and clinical efficacy observations should continue for raw, water-steamed, and sand-fried processed Aconite Lateral Root.

The authorities only regulate the alkaloid content of Aconite Mother Root, neglecting the preservation of active components and ignoring the infiltration of toxic chemicals. This is a significant flaw that must be addressed! We urge the national drug quality management departments to rigorously rectify the toxic substances infiltrating the processing and production of Aconite Lateral Root to ensure its medicinal properties and protect public health.

To date, the so-called large-scale production or certification labeling systems have not provided substantial support to the Aconite Lateral Root industry. We still need a multitude of dedicated individuals to challenge this lamentable status quo.

Classical formula medicine and Fuyang medication involve a relatively limited number of key medicinal species. I hereby call upon my peers to unite, strengthen the exchange of information on authentic medicinal sources within the industry, rigorously ensure the quality of medicinal materials, and reject inferior products. I believe that within a few years, the Chinese medicine community in our country will witness a new and vibrant transformation.