Chuan Wu
StarAconitum carmichaelii Debeaux
Traditionally used for
- Cough & breathing
- Pain & joints
Cautions & contraindications
- Pregnancy
- Heart conditions
- Toxic — professional use only
☯ TCM Properties
Expels Wind-Dampness, d isperses Cold, w arms and activates the channels and s tops pain; Reduces swellings, induces ulceration and dispels putrefication; Treats unconsciousness caused by Phlegm Stagnation
Traditional Chinese Uses
Chuan Wu (川乌) is the raw, unprocessed mother (parent) root tuber of Aconitum carmichaelii — Aconiti Radix in the Chinese Pharmacopoeia 2020, which carries it as a monograph separate from the processed drug Zhi Chuan Wu (Aconiti Radix Cocta). Raw Chuan Wu is not administered internally in any amount. It carries diester diterpenoid alkaloids — aconitine, mesaconitine and hypaconitine — at levels where a few milligrams of alkaloid can be fatal; pao zhi processing hydrolyses these to monoester and aminoalcohol forms and drops acute toxicity by two to three orders of magnitude.
The clinical profile traditionally attached to the name “Chuan Wu” — dispelling Wind-Dampness, warming the channels, dispersing Cold and powerfully stopping pain in chronic cold bi (painful obstruction) syndrome, as in Wu Tou Tang — is the profile of the processed drug. See Zhi Chuan Wu for dosing and clinical use.
Contraindicated in pregnancy. Incompatible with Ban Xia, Gua Lou, Bei Mu, Bai Ji and Bai Lian (the eighteen incompatibilities, 十八反). Confirm the identity of any aconite article against its certificate of analysis before use.
Western Herbalism Properties
Relationships
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Botanical Description
Chuan Wu is the raw, unprocessed parent (mother) root tuber of Aconitum carmichaelii Debx. (Ranunculaceae), a perennial herb 60 to 150 cm tall of Sichuan and adjacent provinces with palmately divided dark green leaves and tall racemes of helmet-shaped deep blue-purple flowers. WARNING: The raw root is highly toxic owing to diester diterpenoid alkaloids, principally aconitine, mesaconitine, and hypaconitine, which can cause fatal cardiac arrhythmia and respiratory failure; only properly processed (Zhi Chuan Wu) material, prolonged-boiled to hydrolyze the alkaloids to far less toxic monoester forms, is used clinically. In traditional Chinese medicine Chuan Wu is acrid, bitter, hot, and toxic, entering the Heart, Liver, Kidney, and Spleen channels; it dispels wind-cold-damp, warms the channels, and relieves severe pain in bi-syndromes, cold abdominal pain, and traumatic injury, always under strict dose control.
Active Constituents
Aconitine
Diester diterpenoid alkaloid (C19)Concentration: Main toxic alkaloid; sharply reduced by processing
The principal toxic and analgesic diester alkaloid. It binds open voltage-gated sodium channels and prevents their inactivation, producing potent analgesia and anti-inflammatory effects but also severe cardiac and neurological toxicity in the raw root.
Mesaconitine
Diester diterpenoid alkaloid (C19)Concentration: Major toxic alkaloid
A highly toxic diester alkaloid with analgesic and anti-inflammatory activity and cardiotoxic potential comparable to aconitine.
Hypaconitine
Diester diterpenoid alkaloid (C19)Concentration: Major toxic alkaloid
One of the three principal diester diterpenoid alkaloids; analgesic and anti-inflammatory but cardiotoxic and neurotoxic.
Benzoylaconine
Monoester diterpenoid alkaloidConcentration: Increases with processing (hydrolysis of aconitine)
A monoester alkaloid formed when heat/processing hydrolyzes one ester bond of aconitine; far less toxic while retaining cardiotonic and anti-inflammatory activity, part of why 'pao zhi' processing detoxifies the herb.
Aconine
Aminoalcohol diterpenoid alkaloidConcentration: Increases with prolonged decoction/processing
The fully hydrolyzed aminoalcohol alkaloid, with much lower toxicity (roughly thousands-fold less than aconitine) and residual cardiotonic action.
Songorine
Diterpenoid alkaloidConcentration: Minor
A less-toxic diterpenoid alkaloid reported to have anti-inflammatory and cardiac activity.
⚠ Drug Interactions
Antiarrhythmic and cardiac drugs (including digoxin, class I/III antiarrhythmics)
Aconitine-type alkaloids persistently activate cardiac sodium channels and disturb intracellular calcium, promoting ventricular arrhythmias; combining with drugs that also affect cardiac conduction can be additive or unpredictable.
Clinical note: Avoid concurrent use; aconitine cardiotoxicity is managed with sodium-channel blockers such as lidocaine and supportive care.
CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin, ritonavir)
Aconitine alkaloids are metabolized largely by CYP3A; inhibiting this pathway raises plasma alkaloid concentrations and the risk of poisoning.
Clinical note: Avoid combining with strong CYP3A4 inhibitors; the narrow therapeutic margin makes even small increases dangerous.
Licorice / Glycyrrhiza (Gan Cao) co-medication
The classic Aconite-Licorice pairing reduces toxicity: licorice flavonoids can precipitate diester alkaloids and slow their intestinal absorption, and Glycyrrhiza can induce CYP3A to accelerate clearance of toxic alkaloids.
Clinical note: This is a traditional detoxifying combination, but doses and processing must still be controlled by a qualified practitioner.
Dosage
| Form | Amount | Frequency | Duration | Population | Notes |
|---|---|---|---|---|---|
| n/a | Not dispensed — raw drug | — | — | — | Raw Chuan Wu is not given internally. It is the starting material for Zhi Chuan Wu (Aconiti Radix Cocta), dosed 1.5–3 g/day and pre-decocted 30–60 min (ChP 2020). Any gram-scale internal dose attributed to RAW Chuan Wu is an error. |
Preparation Methods
Not for internal use (raw drug)
Parts: raw mother root
External application (restricted)
Parts: raw root
Dui Yao — Herb Pairs
The classical two-herb combinations this herb appears in, each with an action neither herb has alone.
Two related aconite roots that together strongly dispel wind-cold-damp, warm the channels and stop pain.
Chronic wind-cold-damp painful obstruction with numbness and pain. Both are highly toxic; processed forms only, long decoction, never with Ban Xia, Gua Lou, Bei Mu, Bai Lian or Bai Ji (eighteen incompatibilities); contraindicated in pregnancy.
Core pair of a classical formula — Xiao Huo Luo Dan, Tai Ping Hui Min He Ji Ju Fang
Together they strongly warm the channels, scatter cold and relieve pain, dispersing cold-damp lodged in the joints.
Painful cold obstruction with severe joint pain that prevents bending and stretching. Chuan Wu is highly toxic and must be processed and decocted appropriately.
Core pair of a classical formula — Wu Tou Tang, Jin Gui Yao Lue (Zhang Zhongjing)
Evidence Tier
Moderate evidence · 2 studiesRecorded studies by study design, strongest design at the top. This is a study-design tier only, not a GRADE rating: it does not weigh risk of bias, consistency or precision.
Systematic review / meta-analysis
0
Randomized controlled trial
1
0 verified · 1 unverified
Other clinical trial
0
Observational / case report
0
In vitro / animal
0
Other / unclassified
1
1 verified · 0 unverified
Verified: design read from PubMed for a DOI that resolves to the cited paper Unverified: taken from the study's recorded description
Clinical Studies
Randomized, Double-Blinded, Multicenter, Placebo-Controlled Trial of Shenfu Injection for Treatment of Patients with Chronic Heart Failure during the Acute Phase of Symptom Aggravation (Yang and Qi Deficiency Syndrome)
Shenfu injection (from Aconitum carmichaelii / Fuzi plus ginseng) added to standard therapy improved heart-failure outcomes and symptom scores in patients with yang and qi deficiency, illustrating the warming, yang-rescuing use of processed aconite root.
Efficacy and Safety of Fuzi Formulae on the Treatment of Heart Failure as Complementary Therapy: A Systematic Review and Meta-Analysis of High-Quality Randomized Controlled Trials
Pooling high-quality trials of Fuzi (processed root of Aconitum carmichaelii) formulae as add-on therapy for heart failure found improvements in cardiac function endpoints, while underscoring the need for strict processing and dosing for safety.
⚠ Safety & Contraindications
- Pregnancy
- Heart conditions
- Toxic — professional use only
Contraindications
Contraindicated in pregnancy and in cardiac disease. Aconite poisoning is a medical emergency; suspected cases need immediate cardiac monitoring.
Safety Warnings
- The Pharmacopoeia's severe grade applies to the raw mother root. Only the processed form is used clinically, and processing (prolonged boiling) hydrolyses the diester alkaloids to far less toxic monoester forms.
- Must be decocted first, for at least 30 to 60 minutes before the other herbs are added.
- Never taken with alcohol, which increases alkaloid absorption.
- Incompatible with Ban Xia, Gua Lou, Bei Mu, Bai Lian and Bai Ji under the classical eighteen incompatibilities.
⚠ Rule-Based Cautions
These entries come from the deterministic rule tables that gate Verscienta's formula tools — classical pair prohibitions, pregnancy and lactation contraindications, and dose ceilings.
Incompatibilities (十八反 / 十九畏)
- 十八反: Wu Tou × Ban Xia — avoid combining with Ban Xia / Pinellia (pair accepted when both members are processed)
- 十八反: Wu Tou × Gua Lou — avoid combining with Gua Lou / Trichosanthes / Tian Hua Fen
- 十八反: Wu Tou × Bei Mu — avoid combining with Bei Mu / Fritillaria / Chuan Bei / Zhe Bei
- 十八反: Wu Tou × Bai Lian — avoid combining with Bai Lian / Ampelopsis
- 十八反: Wu Tou × Bai Ji — avoid combining with Bai Ji / Bletilla
Pregnancy
Avoid toxic aconite
Breastfeeding
Avoid toxic to infant
Dose Ceiling
≤15g — prepared aconite 3–15g and must be pre-decocted; higher risks toxicity
≤6g — raw/less-processed aconite extremely toxic; keep low and pre-decoct
⚠ Toxicity Information
Perioral and limb numbness and tingling, nausea and vomiting, then cardiac arrhythmia — ventricular tachycardia and fibrillation — hypotension and respiratory paralysis. Onset can be within thirty minutes and death is well documented.
Historical Texts
Shen Nong Ben Cao Jing (Divine Husbandman's Classic of Materia Medica)
Han dynasty (c. 200 CE)Jin Gui Yao Lue (Essentials from the Golden Cabinet)
Eastern Han (c. 200-220 CE), Zhang ZhongjingBen Cao Gang Mu (Compendium of Materia Medica)
Ming dynasty, 1578, Li ShizhenReferences
- Chan TY. Aconite poisoning . Clinical Toxicology (2009) [DOI]
- Zhou G, Tang L, Zhou X, Wang T, Kou Z, Wang Z. A review on phytochemistry and pharmacological activities of the processed lateral root of Aconitum carmichaelii Debeaux . Journal of Ethnopharmacology (2015) [DOI]
- Chinese Pharmacopoeia Commission. Pharmacopoeia of the People's Republic of China (Radix Aconiti, Chuan Wu; processing and dosage) . China Medical Science Press (2020) [DOI]
This information is for educational purposes only and is not intended to replace professional medical advice. Always consult a qualified healthcare provider before using any herbal remedy, especially if you are pregnant, nursing, or taking medications.
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