Although members of the Aconitum genus like Aconitum carmichaelii have been used for hundreds of years in Tibetan, Ayurvedic, Unani, Siddha, and Chinese medical traditions, their use in the hands of an untrained practitioner can easily prove fatal. Rich in a number of highly toxic alkaloids, Aconitum carmichaelii must be meticulously treated before use to remove these compounds without destroying its utility as a medicinal herb. No longer used in North American or European schools of naturopathic medicine, Aconitum carmichaelii has retained its place as one of the most powerful members of Asian herbal pharmacopoeias. In these traditions, it is used singly and in formulations as a treatment for a wide variety of conditions, including general debility, yang deficiency, appendicitis, severe pain, water retention, high blood pressure, inflammation, rheumatism, cardiac weakness, gastric pain, weak circulation, and decreased kidney function.
Wolfsbane or monkshood, as Aconitum carmichaelii is sometimes called, requires extreme caution not only during administration, but also when it is being collected and processed for use. Toxins within the plant are readily absorbed through the skin, particularly through the fingertips, eyes, nose, lips and other mucous membranes. It is possible to absorb a toxic dose by simply handling the leaves or roots of the herb without proper skin protection. When handling large amounts of the dried herb, a mask or respirator must be worn to prevent absorbing the toxins through the inhaled dust. The symptoms of exposure to Aconitum carmichaelii are numbness of the lips, tongue, and throat, followed by intense salivation, nausea, vomiting, weakness, loss of coordination, blurred vision, color distortion, diarrhea, the sensation of pins and needles spreading across the whole body, severe dehydration, and death due to cardiac arrhythmia.
The chemical generally held responsible for the plant's toxicity is aconitine, although the less potent hypaconitine and mesaconitine are also poisonous. Properly processed aconite contains less than 0.001% of the latter chemicals and negligible amounts of aconitine, while retaining biologically active levels of the stimulant and cardiotonic alkaloid higenamine. Higenamine has a similar pharmacological profile as the b-adrenergic agonist drug isoproterenol, and it is likely the active ingredient in processed Aconitum carmichaelii formulations. Due to the intensity of the plant's activity, it is almost always used in combination with other herbs when administered internally. The use of milder herbs like licorice and ginger alongside aconite is thought to help offset the incidence of side effects.