This product is not intended to diagnose, treat, cure, or prevent any disease. These statements have not been evaluated by the Food and Drug Administration.
This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your healthcare provider before using herbs, especially if you are pregnant, nursing, taking medications, or have a medical condition.
Cao Wu contains aconitine derivatives that act on voltage-gated sodium channels in nerve cells, blocking pain signal transmission and producing powerful analgesic and anesthetic effects. The alkaloids inhibit nerve conduction, creating numbing and pain-relieving actions. These compounds also demonstrate anti-inflammatory properties. Proper processing and extended boiling are essential to hydrolyze toxic aconitine into less toxic compounds while preserving therapeutic effects. Evidence level: C.
What medications interact with Cao Wu?
Cao Wu has significant interactions with cardiac medications including antiarrhythmics, beta-blockers, and digoxin. The aconitine alkaloids can potentiate cardiotoxic effects, potentially causing dangerous arrhythmias when combined. It should not be taken with other herbs containing aconitine or cardiotoxic substances. Patients on heart medications should avoid Cao Wu entirely. Evidence level: C. Always consult a qualified practitioner before combining with any medications.
What is the correct dosage for Cao Wu?
The standard adult dosage for processed Cao Wu is 1.5-3 grams daily. Critical safety requirements include using only properly processed herb and boiling for at least 60 minutes to hydrolyze toxic aconitine compounds. Raw or underprocessed Cao Wu can be fatal. Dosage must be individualized by a qualified TCM practitioner based on constitution and condition severity. Evidence level: Traditional.
Is Cao Wu safe during pregnancy?
No, Cao Wu is strictly contraindicated during pregnancy and considered unsafe. The aconitine alkaloids can cross the placenta and may cause uterine contractions, fetal toxicity, or miscarriage. Breastfeeding women should also avoid this herb. Additionally, those with heart disease, weak constitution, or yin deficiency should not use Cao Wu. Evidence level: C. Consult a qualified practitioner for safer alternatives.
What are the dangerous side effects of Cao Wu?
Cao Wu can cause serious and potentially fatal side effects if improperly prepared or dosed. Toxic reactions include fatal cardiac arrhythmias, respiratory failure, severe numbness of the mouth and extremities, nausea, vomiting, and dizziness. Deaths have occurred from using raw or underprocessed herb. Even processed Cao Wu requires careful dosing. Seek immediate medical attention if toxicity symptoms appear. Evidence level: C.
PubMed-compiled information sheet
This sheet was compiled from PubMed (NIH) abstracts using AI assistance. Every factual claim is cited to a real PubMed article (see the source list). It has not yet been human-reviewed — confirm with a healthcare provider before use.
Compiled from 30 PubMed articles · model: gemma4:31b
Summary
Cao Wu (Aconitum kusnezoffii) is a traditional Chinese medicinal plant of the Ranunculaceae family known for its pharmacological activities and high toxicity [PMID:36646491, 41151648].
Background
Aconitum kusnezoffii Reichb., also known as grass aconite, five-toxin root, or deadly herb, is a perennial medicinal plant distributed in northern China and parts of Northeast Asia, including Russia and Korea [PMID:41151648, 35124993]. Its tuberous roots are the primary part used for therapeutic properties [PMID:41151648].
Traditional uses
It has a history of medicinal use in China for over 2000 years, traditionally used for dispelling cold, alleviating rheumatism, relieving pain, rheumatic fever, and some endocrinal disorders [PMID:35405250, 41151648].
Active compounds
The plant contains C19-diterpenoid alkaloids, most notably aconitine, mesaconitine, hypaconitine, and beiwudine [PMID:35405250, 21202557, 29600653, 9868164]. Other identified components include kusnezosines A-C and various aminoalcohol-diterpenoid alkaloids (ADAs) formed after processing [PMID:32387374, 36183950].
Mechanism of action
Aconitine is associated with anti-inflammatory, analgesic, and anti-tumor effects [PMID:35405250, 37180714]. Processing the herb via soaking, steaming, and boiling hydrolyzes highly toxic ester diterpenoid alkaloids into less toxic aminoalcohol-diterpenoid alkaloids (ADAs) [PMID:36183950].
Clinical evidence
Evidence DRheumatoid Arthritis
A Mongolian medicine formulation (Naru-3) containing A. kusnezoffii inhibited inflammation, synovial hyperplasia, and neovascularization in rat models of collagen-induced arthritis [PMID:37019159]
Evidence DBlood Stasis Syndrome
In rat models, Yunnan Baiyao (containing A. kusnezoffii alkaloids) reduced plasma and whole blood viscosity and improved pathological states such as inflammatory cell infiltration and edema [PMID:31602894]
Evidence CTumors
Aconitine from Aconitum species is noted for potential anti-tumor properties in preclinical studies [PMID:37180714]
Safety & adverse effects
A. kusnezoffii is highly toxic; excessive dosage or improper use can cause severe poisoning, including malignant arrhythmia (ventricular tachycardia, ventricular fibrillation), and death [PMID:36646491, 30967780]. In mice, doses of 5-10 mg/25 g body weight produced damaging effects on the liver and kidney [PMID:8519524].
Evidence summary
The evidence consists primarily of preclinical animal models, chemical analyses, and case reports of toxicity. There is a strong emphasis on the need for traditional processing (Paozhi) to reduce toxicity before clinical use.
PubMed sources
1.PMID: 35405250 (2022) — Aconitine: A review of its pharmacokinetics, pharmacology, toxicology and detoxification. · Journal of ethnopharmacology
3.PMID: 36646491 (2022) — [A case of aconitum kusnezoffii intoxication with severe arrhythmia]. · Zhonghua lao dong wei sheng zhi ye bing za zhi = Zhonghua laodong weisheng zhiyebing zazhi = Chinese journal of industrial hygiene and occupational diseases
4.PMID: 41151648 (2026) — A comprehensive review of the traditional usages, phytochemistry, pharmacology, toxicology, quality control and other applications of Aconitum kusnezoffii Reichb. · Journal of ethnopharmacology
5.PMID: 36183950 (2023) — A review: Pharmacokinetics and pharmacology of aminoalcohol-diterpenoid alkaloids from Aconitum species.
Government sources
No direct government monograph is available for this herb. The content below is AI-generated and has not been verified against an authoritative government source. Use the search links to check official sources before relying on this information.
6.PMID: 34865311 (2022) — Classification of diterpenoid alkaloids from Aconitum kusnezoffii Reichb. by liquid chromatography-tandem mass spectrometry-based on molecular networking. · Journal of separation science
7.PMID: 25780648 (2012) — Study of Single-dose Toxicity of Aconitum Kusnezoffii Reichb. Pharmacopuncture in Rats. · Journal of pharmacopuncture
8.PMID: 32387374 (2020) — Kusnezosines A-C, three C19-diterpenoid alkaloids with a new skeleton from Aconitum kusnezoffii Reichb. var. gibbiferum. · Fitoterapia
9.PMID: 31602894 (2019) — [Study on absorbed components of Aconitum kusnezoffii under Yunnan Baiyao compatibility in effect of activating blood circulation and removing blood stasis]. · Zhongguo Zhong yao za zhi = Zhongguo zhongyao zazhi = China journal of Chinese materia medica
10.PMID: 37180714 (2023) — Antitumor effects and potential mechanisms of aconitine based on preclinical studies: an updated systematic review and meta-analysis. · Frontiers in pharmacology
11.PMID: 27019554 (2016) — An Efficient High-performance Liquid Chromatography Combined with Electrospray Ionization Tandem Mass Spectrometry Method to Elaborate the Changes of Components Between the Raw and Processed Radix Aconitum kusnezoffii. · Pharmacognosy magazine
12.PMID: 30967780 (2019) — Metabolomics of Clinical Poisoning by Aconitum Alkaloids Using Derivatization LC-MS. · Frontiers in pharmacology
13.PMID: 29600653 (2018) — [Content determination of four diester diterpenoid alkaloids in leaves of Aconitum kusnezoffii by HPLC]. · Zhongguo Zhong yao za zhi = Zhongguo zhongyao zazhi = China journal of Chinese materia medica
14.PMID: 42111718 (2026) — Identification of key genes governing diester alkaloid biosynthesis in different tissues of Aconitum kusnezoffii. · Frontiers in plant science
15.PMID: 9868164 (1998) — Beiwudine, a norditerpenoid alkaloid from aconitum kusnezoffii. · Journal of natural products
16.PMID: 37019159 (2023) — Naru-3 inhibits inflammation, synovial hyperplasia, and neovascularization in collagen-induced arthritis in rats. · Journal of ethnopharmacology
17.PMID: 34899330 (2021) — Research Advances in Pharmacology, Safety, and Clinical Applications of Yunnan Baiyao, a Traditional Chinese Medicine Formula. · Frontiers in pharmacology
18.PMID: 24170571 (2014) — Ultra-fast LC-ESI-MS/MS method for the simultaneous determination of six highly toxic Aconitum alkaloids from Aconiti kusnezoffii radix in rat plasma and its application to a pharmacokinetic study. · Journal of separation science
19.PMID: 8519524 (1995) — Effects of decoctions prepared from Aconitum carmichaeli, Aconitum kusnezoffii and Tripterygium wilfordii on serum lactate dehydrogenase activity and histology of liver, kidney, heart and gonad in mice. · Human & experimental toxicology