Download this page in PDF formatThe Classical Pearls Herbal Formula line by Heiner Fruehauf derives from the 1890′s “Sichuan Fire Spirit School” which decided that Aconite/Fu Zi was a super-herb. I’ve written about this in a couple other posts, As I contemplated the known analgesic and anaesthetic properties of Aconitine and other alkaloids in the Monkshood plant, I began to wonder more about its narcotic effects, since even Portland acupuncturist/herbalist Subhuti Dharmananda wrote:
Aconite poisoning occurs from time to time. In the West, processed aconite is always used. The analgesic action of 0.1 mg/kg of aconitine is stronger than 6 mg/kg of morphine; however, the quality of analgesia is different.
Is aconite addictive or habit-forming like morphine? Are the clinical, empirical results that inspired Heiner to build a formula line around it based on narcotic analgesia, not spiritual alchemy or proven curative abilities? This post serves to reference some of the known research in this area.
Pubmed.com has 26 hits for ‘aconite narcotic,’ such as this one:
High doses of processed Aconiti tuber inhibit the acute but potentiate the chronic antinociception of morphine.
The conclusion here was that there is overlap with action on the opiod receptors. Antinociception means ‘response to painful stimuli.’ Yes, this means they doped up rats and then poked them to see if they twitched or said “Ow!”
A few studies look at the use of small doses of Processed Aconite Tuber to help reduce tolerance to morphine. In other words, if someone is getting used to morphine and it’s not controlling their pain, they can take a tiny amount of aconite and their morphine will work better again.
The poor mice in this study helped researchers discover that “These results demonstrate that Fuzei processed by salt baking possesses analgesic effects within a large therapeutic range, probably via a mechanism involving central opioid receptors that mediate the antinociception.” They found that naloxone (which blocks a type of opiod receptor called ‘Mu’) reduces some of the effects of aconite, but not all. So it appears that aconite shares some central nervous system effects with opium/morphine, but has other receptors it works on as well.
Another mouse study found that lappaconitine, another analgesic alkaloid in aconite, is often weaker than morphine but more effective orally than morphine (morphine is much more effective when injected). ”The results show that lappaconitine has strong analgesic activity, and further suggest that the central nervous system may be involved in the action on the pain threshold.”
Google Books has an older account of Aconite toxicity which should serve to dissuade the experimentally minded narcotic fiend:
A 1905 pharmacopoeia (also available on Google Books) with a lengthy and impressive title has an interesting bit on aconite:
The national standard dispensatory : containing the natural history, chemistry, pharmacy, actions, and uses of medicines including those recognized in the pharmacopoeias of the United States, Great Britain, and Germany, with numerous references to other pharmacopoeias in accordance with the eighth decennial revision of the United States Pharmacopoeia
Hare, H. A. (Hobart Amory)
The Internal employment of this alkaloid ought rarely to be resorted to, on account of its dangerous activity as a poison. Aconitine has been administered in febrile diseases for the same reason that aconite and other sedatives of the heart have been employed, and the result has been that, although the medicine lessened the frequency of the pulse, it exerted no appreciable influence upon the course or issue of the disease.
Coming back to recent internet summaries, drugs.com reports:
Clinical data
Research reveals no clinical data regarding the use of aconite for medical purposes.
Guanfu base A, a new alkaloid isolated from the root of A. coreanum Rapaics, has been found to be an effective antiarrhythmic agent in preclinical and clinical studies and is now undergoing phase 3 clinical trials in China. 15
Shenfu injection, a traditional Chinese therapy that contains red ginseng and aconite root, has provided a protective effect against ischemia and reperfusion injury during mitral valve replacement with cardiopulmonary bypass, 24 and has also stimulated the immune system and reduce blood viscosity, improving postoperative recovery after abdominal surgery. 25 However, the effect of the aconite component has not been determined.
Dosage
Extreme caution is required. Fresh aconite is extremely toxic, and safe dosage is dependent on processing. Many species are used medicinally in China after processing. Traditional Western texts recommended 60 mg of the root per dose. Pure aconite 2 mg or aconite plant 1 g may cause death. 4
Pregnancy/Lactation
Documented adverse effects. Even external application is reported to cause toxic symptoms. Avoid use. 26
Here’s a toxicological report from the UK that recommends consideration of aconite as a causative agent in homicide, suicide, or accidental death:
A case of fatal poisoning with the aconite plant: quantitative analysis in biological fluid.
Elliott, S.P.
Science and Justice.42: 111-115.
In recent years recorded cases of plant poisoning have become rare, this may in part be due to the possibility of plant ingestion not being indicated at the beginning of an investigation. Aconitum napellus (aconite, Wolfsbane, Monkshood) is one of the most poisonous plants in the UK. It contains various potent alkaloids such as aconitine, isoaconitine, lycaconitine and napelline. Ingestion of Aconitum plant extracts can result in severe, potentially fatal toxic effects. This paper describes the analytical findings in a recent death in the UK, resulting from deliberate ingestion of Aconitum napellus extract. The concentrations of aconitine measured by HPLC-DAD in the post mortem femoral blood and urine were 10.8 ug/L and 264 ug/L, respectively. The aconitine concentration in the ante mortem urine was 334 ug/L and was estimated to be 6 ug/L in the ante mortem serum. Hence, accidental, suicidal or homicidal poisoning due to the ingestion of plant material remains a possibility and should be borne in mind when investigating sudden or unexplained death.
I’m almost finished with my references, thanks for bearing with me, dear reader!
Going back to the tradition of Chinese Medicine, here is what the rare and voluminous Orienta Materia Medica: A Concise Guide (931 concise pages!) by Hong-Yen Hsu says:
Aconiti Tuber (Aconite, Fu-Tzu, Wu-Tou)
Origins: Wu-tou and fu-tzu are recorded in Shen nung pen tsao ching [ed.: same as Shen Nung Ben Cao Jing] as low-grade drugs. There are more than 100 kinds of this herb, making identification difficult…
Processing: From ancient times both wu-tou and fu-tzu have been processed before being used because of their great toxicity…
In low doses, aconitine slightly stimulates the central nervous system and peripheral motor nerves as well as general awareness, and increases heart rate and amplitude of heart contractions. In large doses it has paralyzing action, decreasing the amplitude of heart contractions, then causing irregular heartbeats and finally cardiac arrest.
Yes, all of this leads up to encouraging the acupuncture student, herbalist-in-training, or patient of any proponents of the Sichuan Fire Spirit School, Heiner Fruehauf, or prescriber of the Classical Pearls Herbal Formula line to look at the claims and recommendations for the aconite-containing Classical Pearls formulas with great cautious skepticism.
After reading the above, please review this interview on classicalpearls.org called The Importance of Aconite (fuzi): Teachings of the Sichuan Fire Spirit School. I have met both Bob Quinn and Heiner Fruehauf in my student days at the Oregon College of Oriental Medicine–I respected them both then, but now am very suspicious of what I see as dangerous delusion and profit-motivation. Here are the most striking quotes from this interview, with my comments:
I found that fuzi features prominently in ancient texts. It was called baiyao zhi zhang, the “King of the 100 Herbs.”
I still have not seen any texts call Aconite the King of 100 Herbs–they refer to it as a lower-grade toxic medicine, from the earliest classics of Chinese herbal medicine.
…I realized that the main problem was not the fear of toxicity of the herb itself, but the non-traditional processing that this herb undergoes in the modern era.
Heiner repeats this type of claim several times, without once noting that an overdose can easily cause death. He is blaming the long-recognized toxity of aconite on the type of processing other companies use to make aconite safer. This is being used to promote his own products, seminars, classes, clinic, etc., all of which he profits from.
Because of the toxicity of the herb in the raw state, it is the processing that makes this herb usable and brings out its superlative healing properties. The experiences of modern doctors are, for the most part, patterned by the potential side effects that fuzi has in modern times.
Just so I don’t cherry-pick all of the times Heiner claims aconite isn’t toxic, here is the one time I see him admitting that the raw herb is toxic. However, it is followed by the claim of healing properties even though it appears through our research-based review that it has a morphine-like analgesic effect. It can, in rare cases of heart failure, be useful in increasing cardiac output and thus does have the potential to be a life-saving medication if used at the right dose at the right time.
The aconite plant then grows in the time of year when the yang is in its ascendancy and is harvested at the summer solstice before the yang starts its decline. This herb thus very literally absorbs only the energy of the yang part of the year. This attention to timing is important, but most growers now disregard this key feature. I believe very strongly that it is these types of detailed practical instructions that make Chinese medicine a science in its own right, and that it is important that they be heeded, whether modern laboratory verification has been able to perceive any benefits or not.
Here Heiner gets into the esoteric theories about the Yang energy aconite absorbs, and downplays laboratory science. The phrase “very literally absorbs only the energy of the yang part of the year” is curious, as he places that sort of symbolic thinking over laboratory science. Other reputable herb companies (such as Mayway who I prefer to do business with, who just published this fascinating article on Herb Identification and Authentication) do indeed pay attention to these things, despite Heiner’s self-serving claims of superiority.
With the modern fuzi most practitioners are forced to work with two things can happen: In the first scenario, the aconite is inert, as if sawdust had been added to the formula. In the second scenario, the patient may develop an allergic reaction to the aconite—- and remember, this toxicity stems from improper processing, not any sort of natural toxicity of the plant—-and gets some sort of uncomfortable feeling in their body. I can say with great confidence that this sort of reaction is not due to any sort of unwanted toxicity in the aconite itself.
Continuing to reject recognized laboratory science and decades of killing mice with aconitine and other aconite alkaloids, Heiner again clearly makes the unsubstantiated claim that any toxic effects patients experience are from processing, not “any sort” of aconite poisoning.
According to the Fire Spirit School and even Ye Tianshi, the pioneer of the fever school, heavy doses of an herb cause the qi to go to the lower burner, while light doses cause it to go to the upper burner. This is true not just for aconite, but for any herb. When asking similar questions to physicians in the Fire School lineage, they said that uprising symptoms like palpitations and dizziness—-which, again, is most often caused by improper herb processing—- can come from prescribing too small a dose of fuzi. Since fuzi is traditionally charged with drawing the fire of mingmen into the battery of the lower burner, higher doses are more appropriate for this purpose. In the case of the Fire Spirit School physicians, they start with 60 grams and go up to 120-200 grams of aconite per day.
Yes, Heiner clearly states that if someone takes aconite and gets heart palpitations and dizziness, it’s firstly most likely due to improper processing (i.e. other companies’ aconite), or secondarily from too low of a dose. The likelihood is that a small amount is an irritant but a larger amount completely numbs the nerves. His concept of what aconite does is to ‘draw the fire of mingmen into the battery of the lower burner.’ As a Qi Gong practitioner and acupuncturist, I know what he’s talking about, but when it comes to toxic alkaloids of aconite, I’ll stick to chemistry, thanks.
In my own clinical practice, I generally prescribe 18-30 grams of these fuzi granules in formulas designed to last a week.
His granules are in either a 5:1 or 8:1 concentration (that is, 5 pounds concentrated to 1 lb or 8 lbs to 1 lb). Taking the weaker granule, this equates to 90 gm to 150 gm of whole plant per week. Take the midpoint of 120 gm (just over 1/4 lb) and we have 17 gm of whole herb aconite equivalent per day. This is above any traditional recommended dose (it’s above the general dose for most herbs in most formulas, which are usually given as 3, 6, 9, or 12 grams, even for safe things like mint and ginger). Hopefully it is heavily processed to make it very weak. Still, this is likely to give an ongoing anaesthetic and analgesic effect which will certainly numb the perception of pain by its morphine-like action on the central nervous system. It is unlikely that it actually will assist to cure any disease, and it is unknown if it is habit-forming as no one in their right mind would recommend it as an ongoing therapy.
In medium amounts, fuzi drives out body pain. However, if you want to treat severe anxiety, severe insomnia, severe damage to the Heart- Kidney shaoyin layer, severe damage to the taiyin layer that aconite also enters, you need to use higher doses.
I guess an herb that can lead to slowed respiration, slowed heartbeat and coma could indeed have a calming effect on anxiety and insomnia. Ask your pharmacist about it.
Q: Correct me if I’m wrong, Heiner, but I don’t think the readers of this interview will find Qianyang Dan in Bensky or other formula manuals.
HF: Right, Qianyang Dan is an example of a clinical gem that, alongside other formulas with a strong local history, has not been included in standard textbooks. Keep in mind that the most voluminous handbook of Chinese formulas contains 96,000 traditional remedies, and Qianyang Dan is not even included in that.
Here we learn that even though Heiner is claiming to be at the ‘forefront of a global movement’ to restore Classical Chinese Medicine to it’s ancient roots based on the true Classics (which started with the Shen Nung Ben Cao Jing over 2000 years ago), he is basing this high-dose aconite therapy on a little known family tradition that started in the 1890′s and isn’t represented in any of the approved or standard texts of Chinese Medicine.
Q: Are there any other suppliers for genuine aconite out there that you know of?
HF: No. It was the complete lack of sources for medicinal grade aconite in the West that motivated me, a self-described scholar nerd, to jump into the herb industry. I could not find a true aconite anywhere to work with in my clinic. I found some sources to be better than others, but none rose to the level of the real thing, and many were outright useless or even dangerous.
Again, self-promotion and claiming that other established and reputable companies (disclosure: I like the herbs of Mayway and Spring Wind and am pleased to do business with them regularly) don’t have genuine aconite.
Maybe it would be instructive here to talk about how much aconite we use in one day in my own clinic, so people can see the potential dimensions of aconite use for chronic disorders—I probably go through ten bottles of aconite granules in a single day; in other words, an entire kilogram of the extracts I have just described.
Now we can get a picture of what Heiner’s clinical practice is like. If he’s giving 18 gm of the extract per patient per week, and using 1000 gm per day (remember that’s 5000 gm, which is 5 kg or 11 lbs of the whole herb!), that is preparing weekly aconite formulas for 55 patients per day. Heiner has a very busy practice, and he obviously promotes aconite heavily in it. In 8 hours, that would be 1 patient every 8 minutes that gets prescribed a weekly formula of strong aconite! If Heiner sees 110 patients a day, half of them qualify for high-dose aconite therapy (and he would spend just 4 minutes with each patient. At 5 days per week his clinic prescribes his own high dose aconite granules to 275 people every week. I suspect he doesn’t warn them of the toxicity, the side effects, or the fact that the best known explanation for why their pain subsides is that it has morphine-like analgesic action on the central nervous system. I couldn’t find any data about the addictive potential for aconite, but if he is prescribing this much to return patients who are in severe pain, it seems likely that they get quite habituated to it. I wonder how many of them end up having heart attacks…
Aconite is in several of his Classical Pearls formulas: Bamboo Pearls, Dragon Pearls, Heart Pearls, Moon Pearls, Ocean Pearls, Peace Pearls, Sugar Pearls, Tiger Pearls, and Vitality Pearls. For my complete cautionary analysis of his Classical Pearls Herb Formulas line, see this post.
The marketing material that put me over the edge and motivated me to blog about this in detail is the Ocean Pearls monograph, currently available here (and pictured below).
Heiner states:
To make the formula more suitable for long- term use, and to employ the dantian anchoring effect of aconite, the shaoyin remedy Sini Tang (Frigid Extremities Decoction) is also included.
Then he gives uses for it:
Typical Applications
• Ovarian cysts, kidney cysts
• Prostate cancer, ovarian cancer, cervical cancer, liver cancer, kidney cancer, bladder cancer
• Varicoceles; epididemitis
• Human Papilloma Virus (HPV),
gonorrhea, genital herpes
That would be enough of a final straw, but there is one more that certainly breaks any slightly rational camel’s back:
Dosage
Breast-feeding mothers:
2 capsules 1-2x/day
Here is a screen shot of the publicly available monograph as of 2/2/2012:
This screen shot does cut out their small print where they say: The FDA requires the following statement: These products have not been evaluated by the Food and Drug Administration. Please note that our products are formulated according to classical Chinese alchemical principles. References to modern disease names in this presentation are intended to convey a general idea of how these classical principles might be applied in a modern clinical context. This should not be understood as a claim on our part that the Classical Pearls products treat, cure, or prevent these conditions.
Cancer patients have been exploited by fanatical quacks for a long time. It is sad to take advantage of a desperate person with a serious cancer such as ovarian cancer and profit by giving them any sort of false hope. Giving them false hope in the form of a toxic herb that probably only serves to give a morphine-like analgesia while telling them that you are in possession of an ancient lineage that can cure serious diseases like cancer is even worse. Setting up a for-profit company to manufacture and promote that treatment is beyond worse. If Heiner really has a cure (or even life-extending treatment) for ovarian cancer and is motivated to help as many people as possible, he should use the well-established drug approval process to make sure that his theories and formulas are safe and have the effects he is claiming. The medical world would be thankful and he would win a positive place in modern medical history if he proved his claims.
Recommending that other acupuncturists prescribe Aconite Pearls for gonorrhea is only slightly less horrible than encouraging them to treat serious cancers. Then again, perhaps it’s worse, as it can easily be transmitted to others, including babies who can be born blind. Come to think of it, Silver Nitrate eyedrops were given to newborns to prevent blindness in case the mother had undiagnosed gonorrhea or chlamydia. Ironically, silver is a true alchemical medicine recognized by the real ancient Chinese Taoist doctors and verified as effective by modern medicine.
Gonorrhea can be cured by conventional antibiotic therapy, but requires thorough testing and monitoring to make sure it’s really gone. Acupuncturists do not have the access to the type of lab tests needed to diagnose STDs. The worst thing that one could do would be to give someone an unproven remedy for gonorrhea that made it seem like it was gone (which is exactly what ‘clinical experience’ or ‘empirical evidence’ mean in the absence of lab testing). This would likely lead to transmitting the STD to other people or having deeper complications from an uncured infection. If there is an antibiotic-resistant form of gonorrhea, it may be useful to combine colloidal silver with 2 antibiotics (I plan to write more about this soon).
From the Center for Disease Control:
In women, the symptoms of gonorrhea are often mild, but most women who are infected have no symptoms. Even when a woman has symptoms, they can be so non-specific as to be mistaken for a bladder or vaginal infection. The initial symptoms and signs in women include a painful or burning sensation when urinating, increased vaginal discharge, or vaginal bleeding between periods. Women with gonorrhea are at risk of developing serious complications from the infection, regardless of the presence or severity of symptoms.
…
What are the complications of gonorrhea?
Pelvic Inflammatory Disease (PID)
Untreated gonorrhea can cause serious and permanent health problems in both women and men.In women, gonorrhea is a common cause of pelvic inflammatory disease (PID). About 750,000 women each year in the United States develop PID. The symptoms may be quite mild or can be very severe and can include abdominal pain and fever. PID can lead to internal abscesses (pus-filled “pockets” that are hard to cure) and long-lasting, chronic pelvic pain. PID can damage the fallopian tubes enough to cause infertility or increase the risk of ectopic pregnancy. Ectopic pregnancy is a life-threatening condition in which a fertilized egg grows outside the uterus, usually in a fallopian tube.
In men, gonorrhea can cause epididymitis, a painful condition of the ducts attached to the testicles that may lead to infertility if left untreated.
Gonorrhea can spread to the blood or joints. This condition can be life threatening. In addition, people with gonorrhea can more easily contract HIV, the virus that causes AIDS. HIV-infected people with gonorrhea can transmit HIV more easily to someone else than if they did not have gonorrhea.
How does gonorrhea affect a pregnant woman and her baby?
If a pregnant woman has gonorrhea, she may give the infection to her baby as the baby passes through the birth canal during delivery. This can cause blindness, joint infection, or a life-threatening blood infection in the baby. Treatment of gonorrhea as soon as it is detected in pregnant women will reduce the risk of these complications. Pregnant women should consult a health care provider for appropriate examination, testing, and treatment, as necessary.
I cannot stress enough how inappropriate it is for an acupuncturist to attempt to treat any sexually transmitted disease with Aconite, Yin Care Effective Herbal Wash, or any other unproven remedy, no matter how ‘famous’ or ‘revered’ the teacher or formulation is claimed to be. In the case of Yin Care, the fact that the promoters import it as a ‘soap’ and then market it to acupuncturists as a cure for gonorrhea shows their level of ethics, respect for the law, and lack of concern for acupuncturists and their patients.
The implications of recommending a specific dosage of an aconite-containing formula for breast-feeding mothers who may be seeking a ‘natural’ treatment for gonorrhea or another STD (or type of cancer…) are truly horrendous. Claiming that the formula has been ‘balanced’ to make it ‘safe for long-term use’ shows that Heiner likes to recommend that his patients stay on aconite a long time (I can hear him repeating this recommendation every 8 minutes, 8 hours a day, 5 days a week…). Additionally, he claims it is balanced by Tortoise shell, which is noted for having a particularly high methylmercury content due to biomagnification, making it even worse for breast-feeding mothers.
If I may say so directly, many acupuncturists are willfully ignorant of medical science (some get into the profession because it’s ‘spiritual’ and the opposite of ‘evil’ Western Medicine), and most people who get gonorrhea aren’t known for their great medical training either. The combination of a patient and practitioner who want to avoid the world of MDs and pharmaceutical drugs may be fine when it is for non life-threatening diseases which aren’t transmissible to others, but clearly is a bad idea for aggressive cancers and STD’s.
There are 2 main issues to consider as you review Classical Pearls info, particularly evident with the Ocean Pearls uses discussed above.
1. Claiming something can effectively treat cancer and gonorrhea are serious drug claims that require approval in the form of proof of safety and efficacy. It doesn’t matter if the product is inert (like water) or toxic (like aconitine), it cannot be legally or ethically marketed without sufficient evidence. It also doesn’t matter if the product works 0% of the time, 50% of the time, or 100% of the time, it still needs research-based approval. If this product works 100% of the time for ovarian cancer, it is an amazing breakthrough in medicine, and should definitely be researched and approved to help as many people as possible–it would be a billion dollar seller and a major event in modern medical history.
2. The known probable actions of the ingredients are a different issue. Since there is a high liklihood that a significant portion of the ‘clinical effects’ observed are due to opiod actions of aconite alkaloids, and are still not totally understood, there is a certain level of informed consent and warnings of symptoms of overdose ethics demand, especially when recommending it for long term use or for breast-feeding women.
I’ve noticed that a few people have already found my blog via Google when searching for ‘natural cures for gonorrhea’ which just encourages me to keep writing about it. If you have gonorrhea (or cancer, or any other condition you were considering using Classical Pearls or aconite for), and read this, please drop me a line (in the comments or via e-mail: kevin at ancient way dot com to let me know if this helped you make a more informed decision about what treatment to use.
If you have been using Aconite, let me know your thoughts. Particularly, were you told it has morphine-like analgesic effects? Were you told it could be fatally toxic? Were you told it could cure cancer or STDs? Did you have symptoms of tingling, numbness, palpitations, etc.?
For more research on Aconite toxicity, browse the FDA’s Poisonous Plant Database: http://www.accessdata.fda.gov/scripts/plantox/index.cfm
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Update (2/9/12): Another acupuncturist pointed out that some of my toxicity figures appear updated, and directed me to the newer text _Chinese Medical Herbology and Pharmacology_ by John Chen, which I have but didn’t use in these posts. Following is what this newer text has to say about Aconite/Fu Zi toxicity (page 439):
The normal dosage is 3 to 15 grams. Fu Zi must be pre-decocted for 30 to 60 minutes.
There are two major schools of thought regarding appropriate dosages of Fu Zi. Some scholars have proposed dosages of up to 100 grams for severe cases. Others proposed small dosages _only_.
When prescribing this herb, the condition of the individual must be taken into consideration. An individual with a weak constitution will react to the toxicity of Fu Zi even when it is prescribed at a low dose… In some areas of China, Fu Zi is commonly used with other vegetables to make stew. Naturally, these people will have higher tolerance for the toxicity of Fu Zi…
Fu Zi is generally sold in the processed form only, as the unprocessed form is quite toxic…
Use of unprocessed Fu Zi, or overdose of the herb, are responsbile for the majority of possible adverse reactions. Proper processing reduces the toxicity of Fu Zi to between 1/2000 and 1/4000th of the toxicity of the unprocessed herb.
Cautions/Contraindications
Fu Zi is contraindicated during pregnancy…
Consumption of alcohol is contraindicated with Fu Zi, as absorption of the toxic elements will be greatly enhanced.
Side effects and adverse reactions are usually due to overdose, to improper processing, or to inappropriate combination with other herbs, and/or inaccurate diagnosis.
Overdosage
Signs and symptoms of Fu Zi overdose include involuntary salivation, nausea, vomiting, diarrhea, dizziness, blurred vision, dry mouth, vertigo, numbness of the body and extremities, alowed pulse, difficulty breathing, twitching limbs, convulsions, disorientation, urinary and fecal incontinence, decreased blood pressure and body temperature, arrythmia, tachyarrhythmia, bradycardia, and possible death.
One text divided Fu Zi overdose into acute and chronic cases. Symptoms in acute cases are described as numbness, tremor, irregularity, and deterioration. Numbness is characterized by numbness starting at the lips, tongue, and mouth, and gradually spreading to the body and extremities. Tremor is characterized by numbness starting at the lips, tongue, and mouth, and gradually spreading to the body and extremities. Tremor is characterized by involuntary movement and tremor of the tongue and extremities, which will impair normal speech and movement. Irregularity describes the heart rate and rhythm, which may be fast, slow, knotted, or unpredictable. Lastly, deterioration refers to compromise in all aspects of physical functioning, with altered consciousness, weak respiration, extremely weak pulse, hypotension, and extreme coldness of the extremities. Chronic cases of overdose are characterized by numbness of the legs, dysuria, painful urination, and blurred vision.
A hospital-based study in Hong Kong reported that up to 61% of all serious poisonings attributed to herbal medicines were associated with the use of various types of aconite root…
Note: Gross overdose of Fu Zi is potentially life-threatening. Therefore, treatment of overdose should be performed carefully, and only by qualified healthcare professionals.
Pharmacological Effects
Chen notes Cardiovascular effects that increase blood pressure and cardiac contraction, Anti-Inflammatory effects (reduction of joint swelling) which are not understood (may or may not involve the adrenal cortex), and Analgesic effects in rodent studies.
Herb-Drug Interaction
Antiarrhythmics: Patients who have a past history of cardiovascular disorders or are taking antiarrhythmic medications should take Fu Zi with extreme caution.
Toxicology
The LD50 for unprocessed Fu Zi in mice is 5.49 g/kg via oral administration and 0.49 g/kg via intravenous injection. The LD50 for processed Fu Zi is 161g/kg via oral administration and 3.516 g/kg via inravenous injection. The LD50 for water extract of Fu Zi in mice is 26.30 g/kg. [ed: Those references are from 1993 and 1983 texts.]
Authors’ Comments
Fu Zi is an extremely important herb to tonify yang, and there is no other herb in the entire pharmacopoeia with equivalent functions that can be used as a substitute. However, it should also be used with great caution, as it has a relatively narrow range of safety…
While Chen’s book notes a higher LD50 for Aconite than I found quoted elsewhere, he clearly states that extreme caution is needed, that it can cause significant and serious side effects in sensitive individuals, that it is contraindicated in pregnancy, and that adverse reactions or overdosage can be life-threatening. I see no info in Chen’s text that changes my basic premise about the dangers that prescribing high doses of Fu Zi without clear warnings presents.
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Update 2/10/12
I’ve been having private e-mail correspondence with a number of Chinese Medicine practitioners and professors around the world on this issue. I’ve even been invited to dinner in Taiwan! I’ve revised some of my statements based on this valuable feedback, such as calculations of Lethal Dose 50% (LD50). The LD50 is indeed a controversial area, and it is not accurate to extrapolate rodent or rabbit data to humans. This is one of the main arguments against animal testing, though it is useful in determining whether something has the potential to kill or not. So instead of giving estimated toxic doses for Aconite, I am editing to just note that it is clearly established that there are fatal doses of Aconite. Processed Aconite which is boiled for a long time has far less fatal potential, though it still seems to me that patients should be informed of what they are taking, why they are taking it, and possible complications/adverse reactions.
As I have clearly stated, I do want Aconite to continue to be available in the Chinese Herbal Pharmacy, and I do feel that it can be a powerful tool when carefully used for the right patient at the right time. One practitioner reported a story from a hospital where a man was about to die of heart failure and all conventional therapies failed to help him. His doctor gave him a high dose of prepared Aconite (100 gm), and the next day the patient was up and full of energy. This is due to the increased cardiac output Aconite can cause. While this is not extensive double-blind research, it seems reasonable to me that with appropriate medical supervision (such as in this story, in a hospital with an MD level heart doctor), Aconite can save lives. However, there is a low likelihood of a Licensed Acupuncturist having a practice where every 8 minutes, they see a patient who ‘needs’ a relatively high dose of Fu Zi granules, all day, every day.
More than one other acupuncturist has written me that they know Heiner Fruehauf personally and find him to be intelligent and talented in some areas (his language skills are very impressive), but are suspicious of his reliance on the Mora diagnostic device (a controversial electrodiagnostic machine from Germany similar to “Applied Kinesiology” or muscle testing which would be easy to show works with simple double-blind tests–something I plan to write about soon). I am no stranger to getting into a passionate rut where my beliefs become self-reinforcing until the whole world seems to confirm my odd theories, but I have tempered that tendency with age and healthy skepticism.
The various reports of people who have taken processed Fu Zi for a long time without noting serious side effects have me looking more at the conversion of aconitine to aconine through long boiling. I found this research from Japan which also suggests that there is a tolerance that builds to the Aconite alkaloids:
http://www.ncbi.nlm.nih.gov/pubmed/15607586
Forensic Sci Int. 2005 Feb 10;148(1):21-9.
Effects of long-term administrations of aconitine on electrocardiogram and tissue concentrations of aconitine and its metabolites in mice.
Wada K, Nihira M, Hayakawa H, Tomita Y, Hayashida M, Ohno Y.
Source
Department of Legal Medicine, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo 113-8602, Japan. kenwada@nms.ac.jp
Abstract
Aconitum alkaloids are well known for their acute and high toxicity, for example, in the causation of severe arrhythmias leading to death. Aconitine, one of the major Aconitum alkaloids, is a highly toxic compound from the Aconitum species. However, there has been no studies reported on the influence of the chronic administration of aconitine. Thus, this study was conducted to investigate the influence of chronic administration of aconitine in experimental animal models. A dose of 1mg/kg per day was administered to the experimental animal models. We determined the concentration of aconitine and its metabolites (benzoylaconine and aconine) in organs and blood with gas chromatography/selected ion monitoring (GC/SIM). In addition, we concurrently recorded the electrocardiogram (ECG). Fifteen minutes after administration on day 0, the early aconitine administered group (acute group) revealed peak organ and blood concentration levels of aconitine with a gradual decrease, thereafter. The concentration of aconitine in organs and blood (from days 0 to 22; 90 min after the last administration of aconitine) gradually decreased according to repeated administration, whereas benzoylaconine and aconine increased. ECG revealed various types of arrhythmias. However, the frequency of arrhythmias remarkably decreased with time and repeated administration of aconitine. These results indicate two possibilities. First, the increase in the activity of aconitine metabolism. Secondly, the decrease of effectiveness to the heart due to long-term (chronic) administration of aconitine.
PMID: 15607586 [PubMed - indexed for MEDLINE]
Here is an interesting article from the Hong Kong Medical Journal about ‘hidden’ aconite poisoning which brings to light the issue and the symptomatic picture: http://www.hkmj.org/article_pdfs/hkm0612p456.pdf. The takeaway point from this PDF is:
It is imperative that all medical staff managing these patients be able to recognise the clinical features of aconite poisoning. These patients usually present with paraesthesia, numbness in the mouth and limbs, weakness, and bradycardia. Ventricular dysrhythmias and refractory cardiovascular collapse occur in severe poisoning.
Most people laugh and shake their heads at pharmaceutical commercials that end with a rapidly recited list of potential side effects and adverse reactions. The requirement that prescription drugs carry these warnings in advertisements is an important feature of informed consent as well as a reinforced reminder for the practitioner to be alert for adverse reactions and serious side-effects. Since the natural medicine industry is devoid of an approval process and standards of care (which means that if you go to 10 different practitioners, you’ll probably get 10 different prescriptions, none of which is backed by carefully controlled modern studies), it is easy for patients and practitioners to hold to the naive belief that ‘natural’ items are safe. Clearly that is not the case with Aconite, and even if side-effects are rare when appropriately used and tolerance quickly develops, it is in everyone’s best interest (other than the delusionally profit-motivated marketer) that cautions and contraindications accompany each Aconite-containing formula, even if the dose is small and the Aconite is well-prepared. Additionally, warnings to avoid alcohol while taking Aconite-containing formulas and observance of the contraindication of Aconite for pregnant women seem highly prudent.
—Update 2/14/12
Dr. Duke’s Phytochemical database is more comprehensive than any book I’ve seen. I forgot to use it in my recent writings on Aconite, but am adding this section it now to this post: http://ancientway.com/blog/?p=710.
Wow, I was looking at your blog for a laugh but am really glad you opened my eyes to this serious issue. I didn’t know about any of that. Keep writing!
From a FB fan: Kevin, I read this a week ago, and have been transfixed in thought ever since. Fascinating. Before I go further into investigation, may I ask: have you received any rebuttal or concerned reply from Fruehauf – or any other classically trained FuZi enamorees? I am admittedly skeptical of your stance, on the argument of relative versus absolute safety, + the historical and current widespread medicinal and dietary use with relative safety and profound efficacy… And I wondered, before you changed your tune, had you had clinical experiences, either positive or negative, with prescribing FuZi? … All That Said, let me say I thoroughly enjoy your posts – I think you are a brilliant mind: XIe Xie Ni!
My reply: Thanks for joining the discussion. So far silence from Heiner (I e-mailed him directly a bit ago). I’m asking some other TCM pros to comment. I wouldn’t say Fu Zi has any widespread dietary use. I used it in my external Jow formula for years, had one report of heart palpitations. But that was very low dose and external. I didn’t really change my tune–I was just ignorant of the similarities of morphine and aconite. All of my teachers (many Chinese) taught it was toxic, but they didn’t say it was more analgesic/anaesthetic than morphine. As far as I can tell, that explains the ‘clinical efficacy’ of Aconite for painful conditions. Stay tuned (esp. to my blog) and I’ll keep you updated.
Thank you so much with regard to presenting everybody this valuable info. I’m not sure I agree that Aconite should be on the market for everyone, and I definitely draw the line at heroin or crack. You libertarians are sometimes too libertine. But it is nice to see you trying to self-regulate by exposing this sort of dangerous fraud. If we could trust everyone to self-educate, then I would agree with less consumer protection laws. But as you know, many people will take anything they are told may help them lose weight or grow hair.
This is very fascinating, You are an overly professional blogger. I have joined your rss feed and stay up for seeking extra of your wonderful posts on Chinese medicine. Also, I’ve shared your website in my social networks
I was prescribed Peace Pearls for anxiety/ADHD related issues. I took 3 pills yesterday morning and experienced tingling sensations in hands, feet, and face. I had cold sweaty palms and feet and hot flashes. Being underweight (due to high metabolism) at 117 lbs and 5’8″ my acupuncturist figured that the dose was too high and recommended to go down to 1 pill a day. But I feel a bit fearful of doing that after reading your blogs, the wiki article, and looked up the webMD website, I am a bit skeptical. A couple of more scientifically minded friends who heard I had alconite and heard about my symptoms were super worried and thought I should go to the hospital (but without medical insurance we just decided to wait for symptoms to get more severe). Anyway, I turned out all right and didn’t go to a hospital.
Anyway, I do know that there are plenty of medicines out there that do have positive effects at low doses and are poisons at high doses… but the studies just don’t seem to make alconite sound worth it… I do believe that there are benefits to herbals and applying alternative schema to understanding the relationship between body/mind/environment in medicine, but I am also a big fan of the scientific method in determining safety (all the times we used to prescribe mercury rings a bell). And I do know that pretty much that most medicines at normal doses are fine and at high doses are actually toxic. And I can also say that though it may work for one person it might not another. As someone who’s ODed on Adderall and was hospitalized many years ago can attest to that.
So given all of this, I am quite confused as to whether or not I should listen to my acupuncturist whom I for the most part trust as pretty good at her practice, to try out this out at one pill a day. Your fears seem to be around it being understudied and over prescribed, not at it being prescribed at all. Given this, it is hard to assess what cases you think it ought to be prescribed and when. As you said, you don’t support it being banned either. I guess you’d like to see more scientific studies before prescribing it more. You cite Subhuti Dharmananda and so I checked out her article and she does warn of poisoning but also mentions: “Blocking serotonin may be part of its action (the serotonin-inhibiting alkaloid drug methysergide is used as a migraine preventive agent). Several chemical derivatives of aconitine found in a large number of Aconite species have been analyzed; they all appear to function via alpha-adrenergic receptors. Many alpha-adrenergic blocking agents also block the effects of serotonin.” So clearly, it does seem to have some neurological basis for prescribing it. It just doesn’t look like that it works as a basis for prescribing it for anxiety/ADHD… though I don’t know enough to say either way.
That said, I think your caution warrants merit, and I may just ask my acupuncturist to back off of the fuzi for now. I just feel uncertain either way and don’t know who to trust. I’ve done A LOT of reading (including three of your posts) on the subject since yesterday and I am more confused not less in weighing through the material. And really, there are plenty of alternatives besides such a controversial plant. I would like to hear your thoughts…
Dear Reacted Badly,
Thanks for sharing your scary experience and thoughts. I agree with your last sentiment–there are plenty other alternatives out there. The fact that you reacted badly to a “normal” dose may indicate you have special sensitivity to Aconite’s alkaloids. I don’t think any responsible healthcare provider would want you to keep taking it, given that a bad reaction to Aconite can easily send someone to the hospital or worse.
If one has a Serious Adverse Event from a supplement which requires hospitalization, an FDA report is legally required. You fortunately didn’t have such a bad reaction, but it would be responsible to notify the manufacturer. Perhaps you (and your acupuncturist) can get a refund.
The typical adult dose recommended is 3-6 caps, 2x/day. Now you can see my concern about it having a specific recommendation for pregnant women and no cautions of any sort on the promotional literature. The manufacturer is living in a fantasy world where only other people’s Aconite causes problems. He’s encouraging trusting acupuncturists to prescribe these with no warnings about side effects. If a patient goes to the hospital or dies, the justified lawsuit will target everyone up the chain, regardless of their ignorance or good intentions.
Regards,
Kevin