Xue Shang Yi Zhi Hao
StarAconitum brachypodum Diels
Traditionally used for
- Teeth & mouth
- Digestion
- Nerves & recovery
- Pain & joints
- Heart & circulation
- Blood pressure
- Skin
Cautions & contraindications
- Pregnancy
- Young children
- Heart conditions
- Toxic — professional use only
☯ TCM Properties
Dispels Wind-Dampness; Invigorates Blood and Alleviates Pain; Reduces Swelling; Attacks Toxins and Kills Parasites
Traditional Chinese Uses
Xue Shang Yi Zhi Hao (雪上一枝蒿) is the dried tuberous root of Aconitum brachypodum Diels (Ranunculaceae), a short-stalk monkshood of the mountains of Yunnan and Sichuan. It is acrid and bitter in flavour and warm in nature, and it is violently toxic (有剧毒). It dispels Wind-Dampness, invigorates Blood and stops pain, and reduces swelling. It is used for rheumatic bone pain, traumatic injury with pain and swelling, limb pain, toothache, and sores and swellings, and in modern Chinese practice for cancer pain.
Toxicity governs every aspect of its use. The therapeutic dose and the toxic dose lie close enough together that the drug is placed under national special control in China (国家特殊管理药品). Where it is given internally at all, the recorded dose is 25 to 50 mg of the processed root once daily, with an absolute maximum of 70 mg — milligrams, not grams. The unprocessed root must never be taken internally. Overdose presents as intense vagal stimulation: salivation, vomiting, abdominal pain, cardiac arrhythmia, falling blood pressure, shock, laboured breathing, convulsions and coma, with death from circulatory and respiratory failure. It is contraindicated in pregnancy, in the elderly and debilitated, in infants and young children, and in patients with heart disease or peptic ulcer disease. Wine and spirit preparations are for external application only and must not be swallowed.
Most use is external: the root is steeped in wine and rubbed on, ground to powder and applied as a paste, or decocted as a hot wash.
The alias Yi Zhi Hao (一枝蒿) is shared with Artemisia rupestris, a benign hemostatic herb and an entirely different drug. The two must never be substituted for one another: confusing them means giving a violently toxic aconite in place of a mild Artemisia.
Relationships
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Botanical Description
Aconitum brachypodum, the short-stalk aconite, is a perennial herb of the Ranunculaceae family growing 30 to 100 cm tall from a cluster of carrot-shaped to fusiform tuberous roots 2 to 5 cm long. Stems are erect, slender, and sparsely covered with curved or appressed hairs in the upper part. Leaves are alternate, palmately divided nearly to the base into five primary segments, each further dissected into narrow linear ultimate lobes 1 to 2 mm wide, giving a finely divided lacy appearance. The terminal raceme bears few to many helmet-shaped flowers on very short pedicels (giving the species its name, brachypodum, short-footed), each with five deep blue-purple sepals, the upper one forming a tall narrowly conical galea. Fruits are clusters of three follicles. All parts contain highly toxic diterpenoid alkaloids of the aconitine series.
Active Constituents
Yunaconitine
C19-diterpenoid diester alkaloid (aconitine-type)Concentration: Detected together with crassicauline A in 6.00 percent of unprocessed Aconitum brachypodum root samples surveyed by UHPLC-QQQ-MS/MS; also identified directly in the medicinal wine implicated in a 2025 poisoning case
One of the four so-called hidden toxic Aconitum alkaloids, meaning alkaloids not covered by the pharmacopoeial assays that target aconitine, mesaconitine and hypaconitine. Its measured oral LD50 in female ICR mice is 2.37 mg/kg and its intravenous LD50 is 0.200 mg/kg, making it more acutely toxic than the alkaloids the standard assay looks for. Like all diester diterpenoid alkaloids it holds voltage-gated sodium channels open, producing paraesthesia, ventricular arrhythmia and cardiac arrest. It is not routinely quantified in quality control, so a batch can pass a conventional aconitine assay and still carry it.
Crassicauline A
C19-diterpenoid diester alkaloid (aconitine-type)Concentration: Co-detected with yunaconitine in 6.00 percent of unprocessed Aconitum brachypodum root samples (UHPLC-QQQ-MS/MS)
The second hidden toxic alkaloid found in this species. Oral LD50 5.60 mg/kg and intravenous LD50 0.980 mg/kg in mice. Same sodium-channel mechanism and same absence from routine assay panels.
Indaconitine
C19-diterpenoid diester alkaloid (aconitine-type)Concentration: Identified by UHPLC-QTOF-MS in the home-made medicinal wine prepared from this species that caused a documented 2025 poisoning
A diester alkaloid identified directly in a preparation of this species that poisoned a patient. Diester alkaloids of this class are the constituents responsible for the cardiotoxicity and neurotoxicity of Aconitum drugs; the narrow margin between an analgesic and a lethal dose is a property of these compounds.
Talatisamine
C19-diterpenoid amine alkaloid (non-ester, atisine-related series)Concentration: Identified in the medicinal wine prepared from this species in the 2025 poisoning case
A non-ester diterpenoid alkaloid, far less acutely toxic than the diesters. Its presence alongside indaconitine and yunaconitine in the same preparation illustrates that this drug delivers a mixed alkaloid load in which the toxic and the relatively benign travel together.
Chasmanine
C19-diterpenoid amine alkaloid (non-ester)Concentration: Identified in the medicinal wine prepared from this species in the 2025 poisoning case
Another non-ester alkaloid of the mixture. Recorded for completeness of the alkaloid profile actually measured in a preparation of this species rather than inferred from the genus.
Bullatine A
C20-diterpenoid alkaloid (atisine/denudatine series)Concentration: One of the major alkaloids of Aconiti brachypodi Radix; formulated as a total-alkaloid transdermal gel whose pharmacokinetics have been characterised by UPLC-MS/MS
The constituent most credited with the analgesic and anti-inflammatory action of this drug, and the one that is not a diester. In rat pain models it produced anti-hypersensitivity by stimulating spinal microglial dynorphin A expression, and in mice it reduced systemic inflammatory responses by inhibiting the ROS/JNK/NF-kappaB pathway. All of this is animal data. Its analgesic reputation does not make the whole drug safe, because the drug also contains the diester alkaloids above.
Songorine
C20-diterpenoid alkaloidConcentration: Isolated from Aconitum brachypodum Diels
Identified from this species and screened as an inhibitor of G protein-coupled receptors, with synthetic derivatives reaching IC50 values of 0.08 to 0.29 nM in a sandwich ELISA screen. Early-stage medicinal chemistry, not evidence about the herb.
Bullatine H
C20-diterpenoid alkaloid, 11,13-dioxygenated denudatine typeConcentration: Isolated from the roots of this species alongside ten known diterpenoid alkaloids
The first 11,13-dioxygenated denudatine-type diterpenoid alkaloid reported from Aconitum brachypodum. Included because it documents how chemically crowded the alkaloid fraction of this root is: eleven alkaloids from one isolation, sixteen from another.
11S-Aconicarnine D
C20-denudatine-type diterpenoid alkaloidConcentration: Isolated from the lateral roots together with fifteen known diterpenoid alkaloids
A newly described alkaloid of the lateral roots with antimicrobial activity against Alternaria panax (MIC 2.00 µg/mL). Recorded to note that the lateral root and the main root of this species have been studied separately and that the isolated alkaloid inventory continues to grow.
⚠ Drug Interactions
Ethanol and home-prepared medicinal wine or liquor
Both published poisoning cases involving this species followed ingestion of a home-made alcoholic maceration. In one, a 59-year-old man ingested a topical medicinal wine prepared from Aconitum brachypodum, arrested two hours after admission and required venoarterial extracorporeal membrane oxygenation for 46 hours with repeated defibrillation before his rhythm stabilised. In the other, a 54-year-old man presented after accidental ingestion of a home-made herbal wine in which indaconitine, yunaconitine, talatisamine and chasmanine were subsequently identified. Ethanol extracts diterpenoid alkaloids far more efficiently than water and, unlike a decoction, involves no heating step that would hydrolyse diesters to the much less toxic monoesters. A wine prepared for external use carries the same alkaloid load if it is drunk.
Clinical note: Never prepare or supply this drug as a home-made spirit maceration, and label any external preparation unambiguously. Ask directly about herbal liquors when a patient presents with perioral paraesthesia, vomiting and arrhythmia. Aconitine poisoning has no antidote; management is supportive with antiarrhythmics and, in refractory electrical storm, mechanical circulatory support.
Cistanche deserticola (Rou Cong Rong)
Cistanche deserticola, a drug-food homologue plant regarded as safe and used in tonic wines, resembles Aconitum brachypodum closely enough that accidental ingestion has been reported. The 2025 case report describing this confusion is explicit that the resemblance poses a risk of accidental ingestion, and the poisoning it describes arose from exactly that route. The consequence of the confusion is asymmetric: mistaking Cistanche for Aconitum is harmless, mistaking Aconitum for Cistanche can be fatal, and the direction of error that matters is the one where a patient takes what they believe is a safe tonic.
Clinical note: Verify the identity of any root supplied for a tonic wine. A patient who believes they took Rou Cong Rong and presents with paraesthesia and arrhythmia should be treated as aconitine poisoning until the material is identified.
Aconitum carmichaelii (Chuan Wu, Fu Zi) and Aconitum kusnezoffii (Cao Wu)
These drugs act on the same voltage-gated sodium channels through the same class of C19-diester diterpenoid alkaloids, so their toxicity is additive and the combined dose, not the individual dose, determines the risk. Species-specific acute toxicity data show that this is not a genus-uniform hazard: in a single mouse study using the up-and-down procedure, the oral LD50 was 0.380 g/kg for Aconitum brachypodum root, 0.950 g/kg for Aconitum vilmorinianum root and 1.89 g/kg for unprocessed Aconitum carmichaelii lateral root. Aconitum brachypodum was the most acutely toxic of the three by a factor of about five against the commonest of the Aconitum drugs. A dosing habit formed on Chuan Wu or Fu Zi does not transfer to this species.
Clinical note: Do not combine Aconitum drugs. If this species is used at all, dose it on its own species-specific data and not by analogy with Fu Zi, and remember that Chinese patent medicines may contain Chuan Wu, Cao Wu, Fu Zi or Aconitum brachypodum without that being obvious to the patient.
Antiarrhythmic drugs, digoxin, and drugs that prolong the QT interval
Diester diterpenoid alkaloids produce ventricular tachyarrhythmia and refractory ventricular fibrillation by persistent sodium channel activation. Any concurrent drug that alters cardiac conduction or repolarisation, including class I antiarrhythmics, digoxin, and QT-prolonging agents, sits on the same electrophysiological substrate. Aconitine poisoning in China carries a reported mortality of about 15 percent, and the arrhythmias are characteristically resistant to conventional treatment. No formal interaction study has been performed, which reflects the impossibility of studying this ethically rather than an absence of risk.
Clinical note: Regard this herb as contraindicated in any patient with cardiac disease or on cardiac drugs. Obtain an electrocardiogram in any suspected exposure.
Veratrilla baillonii Franch as a claimed antidote
Veratrilla baillonii is used by Naxi and Lisu communities in Yunnan as an antidote to Aconitum poisoning, and its water decoction has been shown to attenuate acute and subacute toxicity of Aconitum brachypodum in mice and rats and to reduce hepatic toxicity at transcriptome level. All of this is animal work by a small number of related groups. There is no human evidence, no established dose and no demonstrated effect on the arrhythmias that actually kill people in aconitine poisoning.
Clinical note: Do not treat this as an antidote or as a licence to increase the Aconitum dose. Aconitine poisoning has no proven antidote; management is supportive and urgent.
Unprocessed versus processed Aconitum brachypodum root
Processing is the traditional means of reducing the toxicity of this drug, and analysis of processed material by UPLC-QE-Orbitrap-MS shows the intensity of diester alkaloid signals greatly reduced and monoester alkaloid signals correspondingly increased, with acute toxicity reduced in mice while analgesic activity was retained. The alkaloid profiles and toxicity of the raw and processed drug are therefore different substances in practice, and safety statements about one do not apply to the other. The acute toxicity figures cited above, including the oral LD50 of 0.380 g/kg, were obtained on unprocessed root.
Clinical note: Establish and record whether the material dispensed is raw or processed. Raw Aconitum brachypodum root should not be given internally.
Dosage
| Form | Amount | Frequency | Duration | Population | Notes |
|---|---|---|---|---|---|
| powder | 25–50 mg (max 70 mg/day) | Once daily | — | — | MILLIGRAM scale. Yunnan Province Drug Standard (1974): 25–50 mg per dose once daily, absolute maximum 70 mg/day. Some sources are stricter still (≤0.02 g per dose, ≤0.04 g/day); an English-language review cites 0.06–0.12 g, which EXCEEDS the provincial maximum — prefer the lower figures. The therapeutic dose sits very close to the toxic dose. Mostly used externally. Aconitum brachypodum LD50 1.37 g/kg unprocessed; fatal cardiac poisoning, no antidote. Provincial standard, not a ChP national monograph. Practitioner-supervised only. Corrected from a generic 9–15 g decoction filler value. |
Evidence Tier
Moderate evidence · 10 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
0
Other clinical trial
0
Observational / case report
2
2 verified · 0 unverified
In vitro / animal
8
5 verified · 3 unverified
Show 8 studies
- Systematic investigation on the distribution of four hidden toxic Aconitum alkaloids in commonly used Aconitum herbs and their acute toxicity
- Bullatine A stimulates spinal microglial dynorphin A expression to produce anti-hypersensitivity in a variety of rat pain models
- Bullatine A exerts anti-inflammatory effects by inhibiting the ROS/JNK/NF-κB pathway and attenuating systemic inflammatory responses in mice
- Antitoxic effect of Veratrilla baillonii on the acute toxicity in mice induced by Aconitum brachypodum, one of the genus Aconitum
- The water extract of Veratrilla baillonii could attenuate the subacute toxicity induced by Aconitum brachypodum
- Effects of Veratrilla baillonii Extract on Hepatic Gene Expression Profiles in Response to Aconitum brachypodum-Induced Liver Toxicity in Mice
- Diterpenoid alkaloids from the roots of Aconitum brachypodum Diels
- A New Diterpenoid Alkaloid with Antimicrobial Activity from Aconitum brachypodum Diels
Other / unclassified
0
Verified: design read from PubMed for a DOI that resolves to the cited paper Unverified: taken from the study's recorded description
Clinical Studies
Systematic investigation on the distribution of four hidden toxic Aconitum alkaloids in commonly used Aconitum herbs and their acute toxicity
The key species-specific safety study for this drug. A UHPLC-QQQ-MS/MS method quantifying ten Aconitum alkaloids was applied across commonly used Aconitum herbs. Yunaconitine and crassicauline A were found in 6.00 percent of unprocessed Aconitum brachypodum root samples, against 7.04 percent of unprocessed Aconitum carmichaelii lateral root and 100 percent of Aconitum ouvrardianum root. Acute oral toxicity was measured in female ICR mice by the up-and-down procedure: the oral LD50 was 0.380 g/kg for Aconitum brachypodum root, 0.950 g/kg for Aconitum vilmorinianum root and 1.89 g/kg for unprocessed Aconitum carmichaelii lateral root, making Aconitum brachypodum the most acutely toxic of the three tested by roughly fivefold against the commonest Aconitum drug. Individual alkaloid LD50 values were 2.37, 5.60, 60.0 and 753 mg/kg orally and 0.200, 0.980, 7.60 and 34.0 mg/kg intravenously for yunaconitine, crassicauline A, 8-deacetylyunaconitine and 8-deacetylcrassicauline A respectively. Poisoning signs in mice were reduced activity, piloerection, palpebral oedema, vomiting, polypnoea and convulsions. The authors argue existing standards should be amended to supervise these four alkaloids, which conventional aconitine assays miss.
Microcirculatory Changes in a Venous-Arterial Extracorporeal Membrane Oxygenation-Supported Patient with Cardiac Arrest Due to Aconitine Poisoning: A Case Report
A 59-year-old man ingested a topical medicinal wine prepared from Aconitum brachypodum Diels. Despite conventional treatment he arrested two hours after admission. Venoarterial extracorporeal membrane oxygenation was started alongside repeated cardiopulmonary resuscitation and defibrillation; sinus rhythm was restored after six hours of support, which continued for 46 hours in total. He left intensive care after seven days and was discharged without sequelae. The authors note a reported mortality of about 15 percent for aconitine poisoning in China. Directly relevant because the exposure was this species, in the preparation form most commonly used for it, and because a topical preparation was taken orally.
When the cure turns toxic: a case report on toxic alkaloids identified by public mass spectral databases
A 54-year-old man presented with toxic symptoms after accidentally ingesting a home-made herbal wine. Analysis of the retained sample by UHPLC-QTOF-MS with GNPS spectral library matching identified indaconitine, yunaconitine, talatisamine and chasmanine. The authors set out the case in the context of Aconitum brachypodum, the source of the material, and note that Cistanche deserticola resembles it closely enough to cause accidental ingestion. This is the only published report giving a measured alkaloid inventory of an actual consumer preparation of this species.
Bullatine A stimulates spinal microglial dynorphin A expression to produce anti-hypersensitivity in a variety of rat pain models
Bullatine A, the major C20-diterpenoid alkaloid of Aconiti brachypodi Radix, produced anti-hypersensitivity across several rat pain models by stimulating dynorphin A expression in spinal microglia. Provides a defined mechanism for the analgesic reputation of this drug that does not run through the toxic diester alkaloids, but it is rodent evidence for an isolated compound, not for the herb.
Bullatine A exerts anti-inflammatory effects by inhibiting the ROS/JNK/NF-κB pathway and attenuating systemic inflammatory responses in mice
Bullatine A reduced lipopolysaccharide-driven activation of BV2 microglia in vitro and attenuated systemic inflammatory responses in mice, acting through the ROS/JNK/NF-kappaB pathway. In vitro and rodent evidence for the isolated alkaloid.
Antitoxic effect of Veratrilla baillonii on the acute toxicity in mice induced by Aconitum brachypodum, one of the genus Aconitum
The water decoction of Veratrilla baillonii, used as an antidote by Naxi and Lisu communities in Yunnan, reduced the acute toxicity of the chloroform fraction of Aconitum brachypodum in mice. Mouse data only. It should not be read as establishing an antidote for human aconitine poisoning, for which no proven antidote exists.
The water extract of Veratrilla baillonii could attenuate the subacute toxicity induced by Aconitum brachypodum
Companion subacute toxicity study in Sprague-Dawley rats, in which the same Veratrilla baillonii decoction attenuated the toxicity of Aconitum brachypodum. The authors state directly that no detoxication strategy is available for the complete elimination of the toxicity of Aconitum plants, which is the relevant clinical conclusion.
Effects of Veratrilla baillonii Extract on Hepatic Gene Expression Profiles in Response to Aconitum brachypodum-Induced Liver Toxicity in Mice
Transcriptome-level study of hepatic injury caused by an Aconitum brachypodum extract in mice, and of the protective effect of Veratrilla baillonii water extract on it. Notable here mainly for documenting that this species causes serious hepatic toxicity in mice, adding a liver signal to the better-known cardiac one.
Diterpenoid alkaloids from the roots of Aconitum brachypodum Diels
Isolation of bullatine H, the first 11,13-dioxygenated denudatine-type diterpenoid alkaloid from this species, together with ten known diterpenoid alkaloids from the roots. Chemistry only; establishes the breadth of the alkaloid fraction of the root.
A New Diterpenoid Alkaloid with Antimicrobial Activity from Aconitum brachypodum Diels
A new C20-denudatine-type diterpenoid alkaloid, 11S-aconicarnine D, and fifteen known diterpenoid alkaloids were isolated from the lateral roots. Two compounds inhibited Alternaria panax with minimum inhibitory concentrations of 2.00 and 8.00 µg/mL against nystatin at 1.00 µg/mL. Antifungal chemistry, with no bearing on human use.
⚠ 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
≤0.07g — dosed in milligrams — 25–50mg, max 70mg/day; grams are a lethal overdose
References
- Jiangming Wang, Changhao Bian, Yinan Wang, Quan Shen, Bin Bao, Junting Fan, Aixue Zuo, Wenhui Wu, Ruihua Guo. Syntheses and bioactivities of songorine derivatives as novel G protein-coupled receptor antagonists . Bioorganic and Medicinal Chemistry (2019) [DOI]
- R. Jin, Y. G. Wang, B. Zhang. [Establishment and verification of risk assessment scale for clinical safety medication of aconitine]. . Zhongguo Zhong Yao Za Zhi (China Journal of Chinese Materia Medica) (2018) [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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