A comprehensive review of the traditional usages, phytochemistry, pharmacology, toxicology, quality control and other applications of Aconitum kusnezoffii Reichb.

ETHNOPHARMACOLOGICAL RELEVANCE: Aconitum kusnezoffii Reichb. is a well-known medicinal plant species in the Ranunculaceae family, commonly known as grass aconite, five-toxin root, or deadly herb. It has a long history of medicinal use in China, dating back over 2000 years to the Shennong 's Herbal Classic. The plant is widely distributed in northern China and parts of Northeast Asia, including Russia and Korea. Its tuberous roots have been used for their therapeutic properties, such as dispelling cold, alleviating rheumatism, and relieving pain. In recent years, A. kusnezoffii has garnered significant attention due to its rich pharmacological activities and potential medicinal applications.

AIM OF THE WORK: This review aims to provide a comprehensive analysis of the research progress on the geographical distribution, botany, traditional applications, phytochemistry, pharmacological activities, toxicology, processing and detoxification methods, quality control, pharmacokinetics, and clinical applications of A. kusnezoffii. Additionally, the current research status and future prospects of this plant are critically summarized.

MATERIALS AND METHODS: To comprehensively obtain ethnopharmacological research data on Aconitum kusnezoffii Reichb., this study systematically collected information from multiple channels, covering classical Chinese herbal medicine texts, Google Scholar, Web of Science, PubMed, China National Knowledge Infrastructure (CNKI), and ScienceDirect to gather traditional medicinal records and modern research. The Plant Catalog Database was utilized to gather botanical and geographical distribution information. Peer-reviewed clinical reports and the Chinese Pharmacopoeia (2025 edition) were consulted to obtain clinical evidence and quality standards. Searches employed core expanded keyword combinations of Aconitum kusnezoffii paired with terms such as ethnic medicine, traditional applications, and processing to reduce toxicity. The search scope covered database creation through August 2025, supplemented by reference list screening of included publications.

RESULTS: To date, approximately 199 compounds have been isolated and identified from various organs of A. kusnezoffii, including diterpenoid alkaloids, amino acids, volatile oils, organic acids, phenolic acids, nucleosides, sterols, coumarins, and polysaccharides. Modern pharmacological studies have demonstrated that A. kusnezoffii exhibits a wide range of biological activities both in vitro and in vivo, such as anti-inflammatory, analgesic, anti-tumor, anti-oxidant, immune regulation, and anti-microbial activities. Some of these activities have been applied in clinical practice. However, the plant is also known for its toxicity, primarily due to the presence of diterpenoid alkaloids. Various processing and detoxification methods have been developed to reduce its toxicity while retaining its medicinal efficacy.

CONCLUSION: A. kusnezoffii is a traditional medicinal plant with significant therapeutic potential. Despite its toxicity, its pharmacological activities make it a valuable resource for drug development. Current research on the active components and mechanisms of action of A. kusnezoffii is still limited. Further studies are needed to elucidate the pharmacokinetics and toxicology of this plant. Additionally, more in-depth research on the active components and their mechanisms of action is essential to fully understand its therapeutic potential. Future work should focus on optimizing processing methods to enhance safety and efficacy, as well as exploring new clinical applications for A. kusnezoffii.