Insights on neuropharmacological benefits and risks: Aconitum carmichaelii Debx.

Aconitum carmichaelii Debx., a traditional herb known for its potent bioactivities, has been widely used in Traditional Chinese Medicine, particularly in the forms of Chuanwu and Fuzi. Despite the therapeutic benefits of this plant, concerns have been raised regarding its neuropharmacological actions and potential neurotoxicity. This paper provides an in-depth analysis of the neuropharmacological effects, neurotoxicological mechanisms, and toxicity biomarkers of Aconitum roots. The neuropharmacological properties are linked to alterations in neurotransmitter synthesis and ion transport modulation, while the neurotoxic effects are primarily attributed to oxidative stress responses and the induction of mitochondrial apoptosis pathways. Through metabolomic profiling, we have identified several metabolic pathways affected by Aconitum roots, with a significant impact on tryptophan metabolism, which in turn influences cardiovascular and nervous system functions, liver detoxification, and energy metabolism. Furthermore, we discuss the modulation of ion channel protein activity, which is evidenced by recent studies, suggesting a critical role in the neurotoxic effects of Aconitum. An early detection strategy for toxicity biomarkers using metabonomics is proposed, emphasizing its crucial role in enhancing the diagnosis and treatment of Aconitum poisoning. It is recommended that regular monitoring of individuals at risk of Aconitum toxicity, including habitual consumers of TCM and accidental ingestion of the plant, be conducted in order to prevent toxic outcomes. This review emphasizes the importance of understanding the dual nature of Aconitum as both a therapeutic agent and a potential neurotoxin, aiming to optimize its clinical use and ensure patient safety.