Chapter 5 Prevention of poisoning from Chinese medicine (1) Strengthen the management of pharmacy, clarify the phenomenon of confusion and shoddy varieties of Chinese medicinal materials, and prohibit the production of unreasonable concoctions and preparations. All Chinese herbal medicines that should be concocted should be concocted according to the law, and raw horn products should be forbidden to be taken internally. (2) Strictly control the dosage used according to the patient’s condition, age and physique, especially for toxic Chinese medicines. Generally, the dosage is gradually increased from small doses. Do not overdose indiscriminately. Use toxic Chinese medicines with caution for those with cardiac, hepatic and renal insufficiency, pregnant women, the elderly and infirm, children and those with allergies. (3) Strengthen the publicity of the knowledge of toxicity of Chinese medicine and do not take the medicine by yourself. Pay attention to the drug indications, strictly control the dosage, and reasonably decoct Chinese medicines. (4) Strictly abide by the relevant national regulations on the management of toxic and restricted Chinese medicines, especially the regulations on the management of 28 kinds of Chinese medicines with strong toxicity and 4 kinds of proprietary Chinese medicines. References 1. Huang, P., et al. New Chinese medicines and clinical pharmacology 1993,4(3):43 2. Tang, Cheng-An, Progress in the occurrence and treatment of pharmacogenic diseases in Chinese medicines in the past 10 years, Progress in Chinese medicine science and technology at home and abroad, 1993,132 3. Peng, Quan, et al. Analysis of adverse reactions, Journal of Traditional Chinese Medicine, 1986,(6):45 5. Zhou Furong, Prevention of poisoning by Chinese herbal medicines, Bulletin of Traditional Chinese Medicine, 1983, 8(4):36 6. Tang Wen’an, Three cases of harm caused by misuse of Atractylodes macrocephala, Journal of Guiyang College of Traditional Chinese Medicine, 1987,(4):45 7. 8. Wu Rubiao, A review of 635 cases of aconite poisoning in China in the past 29 years, Chinese Medicine Information, 1988 (2):40 9. 11. Yang Yufu, Report of 21 cases of dependence caused by long-term use of senna, Chinese Journal of Traditional Chinese Medicine, 1992, 17(3):184. 12. Chen Chengbo, Report of 3 cases of dermatological diagnosis caused by Stachybotrys sinensis, Zhejiang Journal of Traditional Chinese Medicine, 1989,(12):550. 13. Yao Shanye, Report of 1 case of severe allergic reaction caused by oral administration of turtle nail, Chinese Journal of Traditional Chinese Medicine, 1990, 15( 4):52. 14, Qiao Xiangde, Tonic drugs should not be abused, Chinese Medicine Bulletin, 1986, 11(7):6 15, Zhu Yafeng, Chinese medicine manual of proprietary medicines, Beijing: People’s Military Medical Publishing House, 1981. 1, Qiyeyizhihua Rhizoma Paridis [synonym] Flea Hu, Chonglou, Iron Lantern. [Source] The genus Paris polyphylla simnth var, yunnanensis(Franch) Hand, Mazz, or Qiyeyizhihua polyphylla Simth, var, Chinensis(Franch,) Hara. The rhizome of Hara. [It mainly contains steroidal saponins. It is flecainide and flecainoside. In addition, it also contains alkaloids, amino acids, sugars (for glucose, rhamnose and arabinose). [Pharmacology] ①Anti-snake venom: Flea Huo is strong in clearing heat and detoxifying snake venom. It has obvious protective effect on mouse pit viper venom and cobra venom poisoning. ②Antibacterial effect:It has a broad-spectrum antibacterial effect. It has strong antibacterial effect on Asian influenza A virus and septicococcus. In addition, it has antibacterial effects on S. dysenteriae, S. paratyphi, Salmonella and E. paratyphi, etc. ③Anti-inflammatory effects: The decoction has antibacterial effects on “sterile inflammation” caused by dextran. ④Pro-adrenocortical function: It has the effect of promoting the function of adrenal cortex. ⑤ Sedative and analgesic effect. (6) Anti-cough and asthma. ⑦Anti-tumor. ⑧ on smooth muscle action: this product saponin on the isolated rabbit ear vascular smooth muscle has a direct contraction effect, this product decoction and saponin on the guinea pig isolated ileum have excitatory effects. [Efficacy and measurement]:Clearing heat and detoxifying. Treating sores and toxins, carbuncles and malignant sores, moths, swelling, high fever and spasms in children. Dosage:3-15g. [Adverse effects] The rhizome of Heptaceae contains steroidal saponin (pariphyllin) and diosgenin, the dosage for adults is 3-15g, too large a dose has toxic effects on the gastrointestinal tract and nervous system. Toxic manifestations: irritability, pale face, vomiting, cardiac arrhythmia, etc. [Example] A 20-day-old child took 20g of decoction of Hepatica spp. and cried after 2h, followed by irritability, pallor, vomiting twice, both with gastric contents, depression, mild cyanosis of lips, normal respiratory sounds in both lungs, heart rate about 128 beats per minute, arrhythmia, slightly obtuse heart sounds, no pathological murmur heard in each valve area. Electrocardiogram: ① sinus rhythm + ectopic. ②frequent’ atrial precontractions (premature beats), partially differential conduction, partially not downward transmitted, short burst atrial tachycardia. (iii) Junctional escape beats. References Lan Yuanming, et al. Report of a case of neonatal poisoning caused by Bajiaofeng Radix A1angii, Guangxi Medicine, 1990,12(4):128 2. [Source] The roots or leaves, flowers, fibrous roots and root bark of Anacardium alangium chinese (Lour, Harms) in the family Anacardium. [Composition] The bearded root and root bark contain alkaloids, phenols, amino acids, organic acids, resins, and the bearded root mainly contains anise maple alkaloids, i.e. poison quinoa alkaloids, and also contains cardiac alkaloids. [Pharmacology] ①Muscle relaxation and analgesic effect: It has obvious transverse muscle relaxation effect and certain analgesic effect. (2) Contraceptive effect: It has obvious anti-pregnancy and anti-implantation effects. Cardiotonic effect:It can slow down the heart rate, make the atrial precontraction (premature beat) disappear in rheumatic patients, and turn the degree I atrioventricular block to normal. [Efficacy and Dosage] Expelling wind and promoting circulation, dispersing blood stasis and relieving pain. It also has anesthetic and muscle relaxation effects. For the treatment of rheumatic pain, numbness and paralysis, heart failure, strain and back pain, bruises and injuries. Internal use: 1,5-3g for bearded roots, 3-6g for roots. [Adverse effects] Toxicity test: Injected intravenously into anesthetized rabbits or dogs, the total alkaloids of Anacardium can cause transient respiratory excitation. Respiration was stopped by increasing the dose. During respiratory excitation, the blood pressure of rabbits decreases and that of dogs increases. If artificial respiration is performed, the dose that causes respiratory arrest has little effect on blood pressure and heart rate. In cats, blood pressure decreased significantly when acidic alcohol extract was administered intravenously at 0.1g per kg. The lethal dose is 4g per kg. medium dose can cause hematuria, adrenal hemorrhage and muscle tremors. Example] The patient, a 27-year-old male, felt dizzy, blurred vision and irritability after drinking anise decoction (about 100g of fresh medicine), and suddenly fainted when he got up to urinate. [Prevention and control] This product is toxic, the dose must be strictly controlled, should start from a small dose, until the patient appears to varying degrees of weakness, fatigue feeling. References: Pan Yousheng, et al., death by poisoning with Bajiaohuixiang, Jiangxi Traditional Chinese Medicine, 1984, (5): 58 3. Bajiaohuixiang Fructus Anisi Stellati [synonym] Da Yinxiang (“Health Miscellaneous Xing”), Hublot Yinxiang, Yinxiang Bajiaohuixiang (“Compendium”) (Figure 1-2). [Source] The fruit of Illicium verum Hook, f, Magnoliaceae. [Composition] The fruit contains volatile oil (aniseed oil) 8%-12%, fatty oil about 22%, content 80%-90%. [Pharmacology] The inhibition of Gram-positive bacteria by alcoholic extract in vitro is similar to 20u per ml of penicillin potassium salt; the inhibition of Gram-negative bacteria is similar to 50u per ml of streptomycin sulfate; the inhibition of fungi is greater than 1% of benzoic acid and salicylic acid. [Efficacy and Dosage] Warming Yang, dispersing cold, regulating Qi. Treating mid-cold vomiting, cold hernia and abdominal pain, ‘kidney deficiency and lumbago, dry and damp feet. Internal use:3-6g. [Adverse effects] Wen Shangkai et al. determined the volatile oil content of a total of 14 species of star anise and its pseudo-products from different origins, specifications and grades in Guangxi and compared their toxicity. The results showed that:Anise showed no toxic reactions. The pseudo-aniseeds showed significant toxic reactions. (Toxicity size in order: Anise > red fennel > maple skin fruit) [Example] Mangiferous seeds misused as anise for cooking caused 55 cases of poisoning, of which 1 person died. The clinical manifestations were nausea, vomiting, burning pain in the epigastrium, salivation, and excessive sweating. Pupil narrowing, heart rate slowing down, headache and dizziness, chest tightness and shortness of breath, numbness of limbs, movement disorders, eye swelling, urinary retention, irritability, convulsions, elevated blood pressure, dyspnea, cyanosis coma, urinary incontinence, dilated pupils, and fever. [Prevention and control] Unify drug varieties and prevent counterfeit human drugs. Reference 1.Wen Shangkai, Determination of volatile oil content and comparison of toxicity test of Anise and its counterfeit products, Chinese Journal of Traditional Chinese Medicine, 1990,(9):8 2.Zeng Qingpei, Clinical analysis of 55 cases of poisoning by Chinese mangiferous seeds and discussion of prevention and treatment methods, Chinese Journal of Traditional Chinese Medicine, 1981,6(3):33 4.Ginseng Renshen Radix Ginseng [synonym] 鬼蓋 ( Ben Jing), earth essence, sacred herb, yellow ginseng, blood ginseng (Wu Pu Ben Cao), hundred feet of disobedience (Ben Cao Tu), stickleaf (Liaoning Main Herbs) (Figure 3-8). [Source] Ginseng Panax ginseng C, A, Mey, dried roots, family Wujia. [The roots contain ginsenosides, volatile components (ginsenol, panaxynd), volatile oil, ginseng polysaccharides (panaxans), etc. [Pharmacological] ①Effects on the nervous system: It mainly strengthens the excitatory process of the cerebral cortex, but also strengthens the inhibitory process and improves the flexibility of the neural activity process. It also improves the general cerebral and physical functions of human. It has a significant anti-fatigue effect on animals and a significant anti-fatigue effect on humans. ②Effects on the reactivity of the organism: It has “adaptogen”-like effects. That is, it can enhance the body’s defense ability against various harmful stimuli. ③Effects on the endocrine system: () Significant anti-stress effects. () on gonads: Ginseng has no gonadal-like effects, but can excite the pituitary gland to secrete gonadotropins. (④Effects on substance metabolism:In diabetic dogs, on the basis of insulin application, ginseng can improve general symptoms and lower blood sugar. However, it cannot completely correct its metabolic disorder. Ginseng extract can enhance the synthesis of ribonucleic acid in the liver of rats. It can increase body weight and increase plasma albumin to globulin ratio in rabbits at appropriate doses. It has some enhancing effects on isolated heart. Long-term administration of small doses can cause hyperfunction of the reticuloendothelial system. Excessive doses have the opposite effect. [Efficacy and Dosage] It is a great tonic for the vital energy, consolidates the body, and calms the mind. Internal use: 3-9 g. It can also be boiled as a paste or used in pills or powder. [Adverse Effects] Causing headache and dizziness, redness and swelling of the mouth and tongue, gum swelling and pain, restlessness, excitement and insomnia. It may cause stomach fullness, loss of appetite, nausea, vomiting; epistaxis, hemoptysis, blood in stool, cerebral hemorrhage; or shortness of breath and convulsions. The injection causes generalized convulsions, foaming and unconsciousness. [Example] ① Foreign reported 133 cases of continuous use of ginseng from 1 month to 2 years, the average dose of which was 3g per day, up to 15g, and most patients showed euphoric effects. Such as easy awakening and insomnia, neurasthenia, tremor, hypertension, euphoria and other central nervous system excitement and agitation symptoms. A small number of patients exhibit loss of appetite, hypotension, rash, throat irritation, morning diarrhea, edema, depression, and menstrual disorders. Depersonalization and psychosis may occur in some patients. These symptoms resulting from long-term ginseng use are called “ginseng abuse syndrome.” In one case, he took 40g of red ginseng decoction and finished 200ml of the decoction before noon, and then took the same amount of ginseng decoction in the afternoon, and at 10:00 p.m. that night, he suddenly vomited about 300ml of stomach contents, followed by convulsions and fainting, incontinence of stool and urine, fever, bilateral pupils of unequal size, and was diagnosed with cerebral hemorrhage. The diagnosis was cerebral hemorrhage, followed by acute left heart failure, pulmonary edema, and vomiting coffee-like substance before death. ③One case was treated with 20ml of intravenous ginseng and wheat liquid, and died after 1h of panic and shortness of breath, blue lips, inability to lie down, and vomiting white foamy sputum. ④3 cases of neonates who received large amount of ginseng orally within 20h of birth showed high excitement of nervous system, restlessness, crying and unable to sleep, even convulsions or jumping. The heart rate was significantly slowed down and the heart sounds were changed like adult-like. Two cases were cured and one case died after resuscitation. ⑤ One case took 20g of ginseng juice decoction of about 150ml in the morning and finished it in one dose. 6. One case took 10g of red ginseng in tea stew and after the medicine, red papules appeared all over the body, especially on the face with slight itching, accompanied by swelling and headache. (7) One case took about 15g of red ginseng and felt dizziness, blurred vision, restlessness and heat, with trembling hands and general lethargy a few minutes after taking the medicine. (8) One case of cough with occasional blood in summer, took chicken soup with stewed ginseng, and coughing blood in the next morning. ⑨. 2 cases of dizziness, weakness of lower limbs, irritable heartbeat, internal heat, dry and bitter mouth, blurred vision, confused speech, and talkative, etc. after taking red ginseng. In one case, the decoction of ginseng 9g was about 500ml, and it was prepared to be finished in 3 times, but less than 1h after the first dose, he felt pain in the stomach and epigastric region, dry mouth and lips, panic and distress, followed by red skin, swollen eyelids and no vision, soon the whole body was swollen, the face and lips were blue, cough and asthma were especially bad, and finally he became confused and his condition was critical, which was saved by rescue. Two cases of arrhythmia induced by oral ginseng. In one case, ginseng was injected intramuscularly and fainted after 5 min, with pale face, cyanosis of lips, deep and fast breathing, wet and cold extremities, no pulse and zero blood pressure, which was rescued. The patient took 10g of Korean red ginseng and felt more dizziness and headache, irritability, dry mouth and bitterness, pain in stomach and epigastrium, and twitching of limbs after about 4h. The patient was given potassium chloride diluted intravenously and the symptoms were relieved after 2h. Misuse of ginseng resulted in four cases of diseases of the five senses: one case of blurred vision with astringent eyes, one case of epistaxis, one case of gingival swelling and pain, and one case of tinnitus in both ears. References 1. Li Weimin, et al. Adverse reactions of Chinese ginseng, Chinese Journal of Traditional Chinese Medicine, 1992,17(5):312 2. Mao Jiong, et al. Hypokalemic reaction caused by taking ginseng, Chinese Journal of Traditional Chinese Medicine, 1992,17(5):314 3. Kim Myung-soo, 4 cases of five senses disease caused by misuse of ginseng, Sichuan Traditional Chinese Medicine, 1994,(9):49 5. Jiulixiang Jiulixiang Folium et Cacumen Murrayae [synonym] Qianlixiang, Manshanxiang (“Raw Herbs and Medicinal Properties Preparation”), Yuexiang (“Zhongshan Transmissions Record”), Shuiwanqing (“Nanning City Drug Records”), Over-Shanxiang (“Fujian Chinese Herbal Medicine”), Qianzhiye (“Wenshan Chinese Herbal Medicine”) (Figure 9). [Source] The branches and leaves of Murraya paniculata ( L.) Jack and Murrava exotica L., family Rutaceae. [The leaves contain 0.25% volatile oil, the stem bark contains mexoticin, the petals contain scopoletin, the fruits contain semi-a-carotenone, and the anti-fertility active ingredient is glycoprotein or proteoglycan. [Pharmacology] Petroleum ether extract of ninhydrin: ① has a relaxing effect on both small and large intestine of isolated white rats; it cannot block the spasm induced by acetylcholine, and has an antagonistic effect on the spasm induced by histamine and barium chloride. ②It has obvious inhibitory effect on isolated frog heart. ③Bacterial inhibition test: The ethanolic infusion of this product has inhibitory effect on Staphylococcus aureus and Streptococcus haemolyticus. [Efficacy and dosage] Jiu Li Xiang has anaesthetic, sedative, detoxification, swelling, wind dispelling and activating effects. It is mainly used for treating bruises and swelling pain, rheumatism and bone pain, stomachache, toothache, tetanus, epidemic B encephalitis, insect and snake bites, etc. It can also be used for local anesthesia. Jiu Li Xiang Root Decoction has been used in hundreds of cases of mid-term pregnancy induction in Fujian, with a success rate of 91%-100%. Dosage:6-12g (15-30g fresh). For external use: Pound the fresh leaves in appropriate amount and apply to the affected area. [Adverse reactions] Experimental evidence: Polysaccharide, glycoprotein or proteoglycan class of abortifacient drugs may have similar chemical structure with pyrogenic substances and present pyrogenic-like febrile adverse reactions. Clinical applications include fever (38,5-40,50C) and chills. Fever occurs at the peak of contractions and subsides spontaneously to normal after delivery of the fetus. References 1. Wang Shuru, et al. Isolated potency and toxicity of anti-fertility substances of Jiuxiangchong bark, Journal of China Pharmaceutical University, 1987,18(3):184 6. Jiuxiangchong Aspongopus [synonym] black hoodworm (Phylum), melon black bug (Insects and Drugs), fartboard bug (Compilation of Medicinal Materials), dung beetle bug, fart beating bug ( Chinese Medicine Journal) (Fig. 10). [Source] Dried whole insects of Aspongopus chinesis Dallas, a stink bug family. [Composition] The insects contain fat, protein and chitin. The fat contains stearic acid and brown shelf acid oleic acid. [Pharmacology] Antibacterial test: The worm has strong antibacterial effect on Staphylococcus aureus, S. typhi, A. paratyphi and S. fowleri. [Efficacy and Dosage] Relieving Qi and pain, warming the middle and strengthening Yang. It is used for treating Qi stagnation in the chest and diaphragm, pain and stuffiness in the epigastrium, spleen and kidney deficiency, soreness and weakness in the waist and knees, and impotence. Internal use: 3-9g in decoction, or in pills or powder. [Example of Adverse Reaction] One case of burning in the throat, mute voice, red face and body heat after taking Jiu Xiang Worm, followed by flaky erythema around the face and itchy rash. References 1. Shen Guizi, Report of a case of allergic reaction caused by Jiu Xiang Worm decoction. Jiangsu TCM, 1988,(6):13 7. Sanqi Radix Notoinseng [synonym] 山漆, 金不换(《纲目》), 血参(《医林篡要》), 参三七(本草便读》), 田三七, 田漆(《伪藥条辨》) (Figure 11). [Source] The roots of Panax notoginseng (Burk,) F, H, Chen, family Wujia. [It contains about 12% total saponin, mainly ginsenoside Rb1, Rg1, Rg2, and a small amount of Ra, Rb2, Rd, Re, Rc, without ginsenoside Ro. It also contains Panax notoginseng saponin R1, R2, Panax notoginseng flavonoid B, quercetin, β-sitosterol and volatile oil, etc. [Pharmacological] ①Hemostatic effect: presumably related to the liver, also can shorten the prothrombin time. ②Action on circulatory system:There is a significant increase in coronary blood flow and it can counteract the effect of posterior pituitary hormone. ③Other effects:It has an inhibitory effect on Newcastle virus. [Efficacy and dosage] Stopping bleeding and dispersing blood stasis, relieving swelling and fixing pain. Treating hematemesis; hemoptysis, epistaxis, hematemesis, dysentery, collapse, Y obstruction, postpartum hematemesis, malignant dew, stasis of blood after falling, traumatic bleeding, canker soreness. Internal use: decoction 3-9g, powder 1-3g; for external use: grind the appropriate amount of juice to apply, grind the powder to sprinkle or mix. [Examples of adverse reactions] 1. 3 cases took 2-3g of this product, and rash and itchy rash appeared 1-3 days after taking the drug. The symptoms disappeared after stopping the drug. 1 case of anaphylactic shock caused by Panax notoginseng: After mixing Angelica and Panax notoginseng injection for acupuncture point injection, itchy skin cancer and wind mass occurred in the first 4 times, and shock reaction occurred after the 5th injection. The intradermal test with 10% Panax notoginseng injection 1:1 dilution showed positive reaction. ③One case suddenly developed numbness and hardness of the mouth and tongue, sweating all over the body, slowed heart rate (about 50 times per minute), cold extremities and double vision in front of the eyes 30 min after taking Panax ginseng tablets. ④, 2 cases of acute nephritis in children with internal allergy caused by Panax notoginseng, resulting in hematuria throughout. ⑤. 1 case developed abdominal pain and diarrhea 1,5h after taking 1,0g of Panax ginseng powder due to skin purpura, with unformed stools without pus and blood. The routine laboratory tests were normal and the occult blood was negative. (6) One case of allergic drug rash caused by internal administration: a small amount of scattered bright red macules with itching on the abdomen and chest and back. (vii) 1 case of scattered purpura and purpura blisters appeared on the trunk and extremities after internal administration, and the color did not subside under pressure. (⑧) 1 case of zoonotic rash and shortness of breath in the limbs and whole body after internal administration. References 1. Lu Liping, et al. 3 cases of drug rash caused by oral administration of Panax ginseng powder reported in New Chinese Medicine, 1984,(6):35 2. Wang Lixian, 1 case of anaphylactic shock caused by Panax ginseng, Journal of Clinical Dermatology, 1981,10(3):162 3. Kou Huirong, Allergic reaction caused by Panax ginseng tablets, Chinese Journal of Traditional Chinese Medicine, 1995,20(8):507 4. Xie Zongchang, Hematuria in pediatric acute nephritis 5. Liu Qingchi, et al. Panax pseudoginseng powder causing abdominal pain and diarrhea, Chinese Journal of Traditional Chinese Medicine, 1995,(6):374. 6. Shu Yi, Report of a case of drug rash caused by oral administration of Panax pseudoginseng powder, Jiangsu Traditional Chinese Medicine, 1991,(11):16. 7. Zhang Daocheng, Report of a case of allergy caused by Panax pseudoginseng, Journal of Guiyang College of Traditional Chinese Medicine, 1991,(1): 8. Liu Yuanming, et al. Report of three cases of allergy to traditional Chinese medicine, Hebei Chinese Medicine, 1993, 15(2):39 8. Tubeimu Rhizoma Bolbostemmae [synonym] 土贝母 (Hundred Herbs Mirror), 大贝母 (Compendium Gleaner), 地苦胆, 草贝 (Shaanxi Chinese Herbal Medicine) (Fig. i2) o [source] 土贝母 (Cucurbitaceae) The tuber of Bolbostemma paniculatum ( Maxim ,) Franquet. [Constituents] The tuber contains maltose, and after drying, sucrose; the petiole mainly contains reducing sugar, and the leaf mainly contains sucrose. [Efficacy and Dosage] Dispersing nodules and toxins, relieving carbuncles and swellings. For treating canker sores, scrofula and phlegm nuclei, sores, swelling and poisoning of snakes and insects, and hypertrophic rhinitis. Internal use: 4,5-9g in decoction, or in pills or scatter. For external use: Powdered and mixed or boiled in paste. [Examples of adverse reactions] ①, 3 cases of vomiting, diarrhea, abdominal pain, dysuria, dizziness and panic, shortness of breath, convulsions, decreased white blood cells and platelets, and infantile cells in peripheral blood. ②Two cases of poisoning by accidental ingestion of Euphorbia globosa, one case was cured by decoction of Huang Jing and Da Qing Ye, and the other case died of poisoning. References 1. Luo Zhenya, 3 cases of poisoning with Eupolyphaga seu Steleogphaga, Journal of Physician Training, 1982, (10):13 2. An Yuxiang, et al. The name of this species is also used as a synonym for the turtle, Tubiechong Eupolyphaga seu Steleogphaga. [Source] It is the dried female body of the insect Euplyyphaga sinensis Walker (Boleny), a turtle insect of the family Blattidae. [Ingredient] Contains volatile oil, amino acids and B-sitosterol. [Pharmacology] In test tubes, ground turtle infusion (water decoction followed by alcohol precipitation) has been measured to inhibit leukocytes in leukemia patients by the Melan method. However, negative results were obtained with the Waber respirator method. The mixture of the earthworm, scorpion, and clam made into “tuberculosis powder” had no inhibition effect on human tuberculosis bacilli in the test tube. Its aqueous extract has anticoagulant and lipid regulating effects, and has a certain delaying effect on the formation of atherosclerosis. [Efficacy and Dosage] Expelling blood stasis and breaking up accumulation, promoting blood circulation and treating injuries. It is used for treating accumulation of obstruction in Y, blood stagnation and menstrual closure, postpartum stasis and abdominal pain, bruises and injuries, and heavy tongue. Internal use: 3-9g in decoction, or in pills or powder. For external use: Decoction with water for gargling or pounding. [Examples] ①, 1 case of allergy: itching all over the body, with bright red lesions on the skin like the size of beans. In another case, dense, small papules with bright red color and itching appeared on the skin of the whole body. In two cases, after adding turtle worms to the decoction, the whole abdomen showed vague pain to unbearable pain, and the pain was even in both sides of the abdomen, with no food and drink, and normal urination and defecation, which was relieved after stopping the medicine. ③In one case, the local skin rash appeared with numerous red rashes and itching, followed by itching and erosion of the glans scrotum. ④In one case, the skin of the limbs and trunk successively developed congestive papules and itching when turtle worms were added to the internal formula. The rash fused into patches after continuous administration, and a rash also appeared on the face, which was itchy and receded under pressure. References 1. Zhu Bogang, et al. 2 cases of allergic reactions caused by the turtle worm, Chinese Journal of Traditional Chinese Medicine, 1989, 14(2): 52 2. Chang Qingxiong, 2 cases of abdominal pain after taking turtle worm decoction, Chinese Journal of Traditional Chinese Medicine, 1995, 20(10): 634 3. Tan Anbang, 1 case of allergic reaction caused by the external use of turtle, Sichuan Traditional Chinese Medicine, 1990,(7): Feng San 4. Zhang Huichuan, 1 case of allergic reaction caused by the decoction of turtle worm, Chinese Journal of Traditional Chinese Medicine, 1990,(7): Feng San 4. 10. Daqingye Folium Isatidis [synonym] Daqingye (Ben Cao Jing Ji Bu) (Fig. I4) o [source] The leaves of Isatis indigotica Fort, a plant of the Cruciferae family. [The fresh leaves contain about 1% of isatem B, indinibin, tryptanthxin, and β-sitosterol. Isatem B is easily hydrolyzed by co-existing enzymes (isatase) or weak bases to produce indole alcohol, which is then oxidized to indigo (indigo ). [Pharmacology] Antibacterial effect: Its decoction has bactericidal effect on all kinds of dysentery bacilli in test tube; it also has killing effect on meningococcus. It is also effective against leptospira Pomona group, jaundice bleeding group Walden type and seven-day fever type. [Efficacy and Dosage] Clearing heat and detoxifying, cooling the blood and stopping bleeding. It is used for treating warm fever and thirst, influenza, acute infectious hepatitis, bacillary dysentery, acute gastroenteritis, acute pneumonia, dengue, hematemesis, epistaxis, jaundice, laryngeal paralysis, mouth sores, carbuncle and swelling. Internal use: Decoction of 9-15g (30-60g for fresh) or pounded juice. For external use: Pounding or decoction. [Adverse Reactions] Da Qing Ye is safe and effective when administered orally. However, its toxicity needs to be explored when it is made into injection. One case of hematuria caused by the application of Daphyllum leaf injection has been reported. Experimental evidence:The acute toxicity test of double green injection (equivalent to 1g of the original drug) in animals resulted in the death of 4 mice due to respiratory depression. All 5 mice died due to respiratory depression in the acute toxicity test of the aqueous extract of Dazhong leaf. [Example] 1 case caused heart distress, profuse sweating, thirst, foaming at the mouth and pinpoint or mung bean size rash all over the body after 2 min of intramuscular injection using compound dacryophyllum leaf. References 1.Wang Jarey, et al. Exploration of the toxicity of Da Qing Ye, Chinese Medicine Information, 1995,(2):13-14 2.Wang Kunshan, A review of the reports of adverse reactions to traditional Chinese medicine in the past 3 years, Zhejiang Journal of Traditional Chinese Medicine, 1988 (11):521 11.Dahuang Dahuang Radix et Rhizoma Rhei [synonym] General (Medicine Record), Jinling Dahuang (The Qianjin Fang), Chuanjun (Handbook of Traditional Chinese Medicines), Jun (Tibetan Name) (Fig. 15). [Source] The rhizome of Rheum palmatum L, Tangut Rhubarb, Rheum tanguticum Maxim, ex Balf, Rheum officinale Baill, Polygonaceae. [Ingredients] Contains onion glycosides and free anthraquinone derivatives 2%-5, 2%. The free anthraquinone derivatives include rhubarb acid (rhein ), rhubarbin (emodin ), rhubarb phenol ( chrysophanol ), aloe rhubarbin (aloe-emodin ), and rhubarbin methyl ether (physcion). The anthranilic glycosides include rhubarb acid-8-monoglucoside and monoglucoside of rhubarb, aloe-emodin, rhubarb phenol, rhubarb methyl ether, etc.; double glycosides of rhubarb acid, aloe-emodin, rhubarb phenol, etc., and sennoside A, B, C, D, E, F and other double anthranilic glycosides. It also contains about 5% tannin, including gallic acid glucose, d-catechin and rhubarb tetramer (trann), etc. [Pharmacology] ①Laxative effect: It has a slow down effect, and only acts on the large intestine, but has no obvious effect on the small intestine. Antibacterial effect: It has antibacterial effect on most gram-positive bacteria and some gram-negative bacteria in the test tube. ③Anti-tumor effect: It can directly destroy tumor cells and inhibit the growth of animal tumors. [Efficacy and Dosage] Clearing away heat and toxins, breaking up stagnation and removing blood stasis. For constipation with real heat, delirium and frenzy, food stagnation and fullness, dysentery at the beginning, dysentery with urgency and heaviness, menstrual arrest, obstruction of menstruation, accumulation of Y obstruction, red pain in violent eyes, vomiting of blood, epistaxis, edema of Yang Huang, gonorrhea and urination, carbuncle and swelling, furuncle, scalding and fire injury. Internal use: 3-12g in decoction, or in pills or powder. For external use: Powdered and mixed with water or vinegar. [Example] ①l case of allergic purpura (abdominal type) with oral administration of rhubarb tablets. Sudden paroxysmal abdominal cramps 2h after taking the medicine, vomiting about 10ml of bright red liquid, with pressure pain around the umbilicus and right lower abdomen, without rebound pain and muscle tension. Several scattered purpura of different sizes were seen above and below the knee joints of both lower extremities, basically symmetrical, and the color did not fade when pressed. The platelet count, bleeding and clotting times were within normal limits. The patient had bleeding spots on both lower limbs 3 months ago after taking rhubarb soda for poor nasal function. In one case, the use of raw rhubarb gum resulted in a deep-rooted star opacity; the original ocular ulcer deepened, and the star opacity was deep-rooted and seemed to have the potential to penetrate the cornea. [Experiments on mice showed that the lethal dose was more than 40 times larger than the diarrhea-causing dose. It reveals that the amount commonly used in clinical practice is very safe. And rhubarb can reduce the toxicity after several times of steaming and drying, while still maintaining the slow diarrhea effect of rhubarb. The results of animal experiments confirm that: ① Long-term use of large amounts of rhubarb can cause serious gastrointestinal reactions and immunosuppressive effects. There are also clinical reports of jaundice and liver cirrhosis caused by the use of rhubarb. Therefore, its hepatotoxicity needs to be further studied. ②Animal experiments found that long-term administration of rhubarb can cause degeneration and atrophy of the gonads, so its effect on reproductive function should be taken seriously. The Chinese Pharmacopoeia states: “Take with caution in pregnancy.” Available data suggest that rhubarb may contain some mutagenic or carcinogenic components. However, these data are mainly based on the results of animal experiments and may not be extrapolated to humans. Rhubarb has been used in China for more than a thousand years and has not been found to be significantly related to tumors. References 1. Tian Zizhi Zeng, 1 case of allergic purpura caused by rhubarb, Chinese Journal of Traditional Chinese Medicine, 1994,19(7):439 2. Cheng Xiaoshang, et al.
3. Yang Shouye, et al. Comparison of the laxative action and acute toxicity of different concoctions of Rhubarb, Chinese Materia Medica, 1991, 14(7):29 4. Zhao Junning, Advances in the toxicology of Rhubarb, Journal of Traditional Chinese Medicine, 1990,(5):48 12. 16). [Source] The roots and rhizomes of Sophora tonkinensis Gapnep, Leguminosae. [It contains a variety of alkaloids, mainly matrine and oxymatrine. It also contains sophoradin, sophoranone, etc. [Pharmacology] ①Anti-tumor effect:It has obvious inhibitory effect on inoculated cervical cancer, and the deoxygenase of leukocytes in acute lymphocytic leukemia and acute granulocytic leukemia patients are inhibited by sophoradin. ②Red psyllium root glycoside inhibited the fungus that infected the plant, and Zojiruso sophorol chromene prevented murine ulcers. ③Euchresta japonica Benth. has significant effect on malignant tumors. The adverse effects are small and safe. And it does not reduce white blood cells. The test animals were generally in good condition. It is considered suitable for clinical trial. [Efficacy and dosage] Clearing heat and detoxifying, relieving swelling and pain. For the treatment of laryngeal carbuncle, laryngeal wind, laryngeal paralysis, gum swelling and pain, panting and hot cough, jaundice and dysentery, hemorrhoids, heat swelling, baldness, scabies, snake, insect and dog bites. Internal use: Decoction 3-6g, or grinded juice. For external use: Gargling or pounding. [Examples] ①More than 200 cases of poisoning with samphire root were reported: the main symptoms were nausea and vomiting, headache and abdominal pain. In severe cases, the whole body is chilled, the limbs tremble, the limbs convulse and contracture, the heart rate is accelerated, and in more serious cases, death can be caused by respiratory failure. The roots of the legume Sophora genus contain neurotoxic components, which mainly affect the central nervous system. It manifests as headache and vomiting, ataxia, slurred speech, or symptoms of autonomic dysfunction such as nystagmus, blurred vision, and even profuse sweating. In severe cases, there were chills in the limbs, decreased blood pressure and irregular respiratory rhythm, and the product had accumulative effects in the body. ③Mistakenly used as northern bean root to prevent cold soup, and the dosage was too large, more than 200 people had headache and abdominal pain, nausea and vomiting, cold body, trembling limbs, rapid heartbeat and increased blood pressure. ④1 case of taking 130g of sasanqua root decoction, about 1h felt dizzy, nausea and vomiting, numbness of the limbs, and getting heavier, headache, shortness of breath, abdominal distension, fullness, muscle tremors, limb convulsions. ⑤ 1 case of dizziness, nausea and vomiting, trembling of the limbs, accelerated heart rate, increased blood pressure, and dullness of sensation. ⑥ 1 case of internal poisoning, dizziness and chest tightness, frequent vomiting. (7) 1 case of decoction of 60g of dried santou root, with confusion and coma after 2h, and death due to ineffective resuscitation. [Prevention] ① unified drug species, to prevent counterfeit products into the drug: all with broad bean root, mountain bean root, southern bean root can pay the root of the legume Sophora subprostrata Chun et T, Chen; open the northern bean root, pay the root of the family of antibiotics Menispermurn dauricum DC,. ②Do not exceed the dosage of 3-9g prescribed by pharmacopoeia. ③Resuscitation:gastric lavage, infusion, decoction of 30g of licorice. References 1. Yang Guang, Clinical medicinal use of bean root should be distinguished between north and south, Beijing Traditional Chinese Medicine, 1983,(4):56 2. Li Xin, Analysis of the causes of poisoning by bean root, Chinese Journal of Traditional Chinese Medicine, 1993,18(11):700 3. Qiu Longzhang, et al. 5. Gao Juntai, One case of poisoning by santou root, Journal of Shaanxi College of Traditional Chinese Medicine, 1984,7(2):13 6. Wen Yumei, One case of poisoning by oral consumption of santou root, Chinese Journal of Hospital Pharmacy, 1991,(6):271 7. Pan Zhining, Dizziness and vomiting caused by santou root, Sichuan Traditional Chinese Medicine, 1991,(7): 8. Jia G. Liao, A case of pulmonary edema caused by taking yam bean root, Henan TCM, 1987,(5):32. 13. Yam Shanyao Rhizoma Dioscoreae [synonym] Dioscorea, yam (Benjing), snake taro (Zhejiang Traditional Chinese Medicine Manual), wild yam bean (Jiangsu Phytopharmacology), white moss (Sichuan TCM), white yam seed (Hangzhou (Figs. 17-18). [Source] The rhizome of Dioscorea opposita Thunb, family Dioscoreaceae. [The rhizome contains mannan, choline, phytic acid, glycoprotein, more than 10 kinds of amino acids, polyphenol oxidase, vitamin C,3,4, dihydroxyphenethylamine, allantion, dopamine, and batatasine. [Efficacy and Dosage] Nourishing the spleen and stomach, promoting the production of body fluid and benefiting the lung, tonifying the kidney and astringent essence. It is used for treating spleen deficiency diarrhea, prolonged dysentery, deficiency cough, thirst, spermatorrhea and dysmenorrhea, and frequent urination. Internal use: 15-30g, or in pills or powder. For external use: Pounded and applied. [Example] ①External application of raw product caused itching of the neck and chest and back in one case, with restlessness and restlessness in sitting and sleeping. ②A case of a 3-month-old child with fever of 38, 50C, red face and gas, crying and restlessness after taking yam porridge. ③1 case of allergic reaction after internal administration. References 1. Guo Tingzan, Allergic reaction to raw yam applied externally, Sichuan Traditional Chinese Medicine, 1991,(4):41 2. Yuan Dyming, Report of a case of fever caused by yam, Journal of Guiyang College of Traditional Chinese Medicine, 1992, 14(1):44 3. Huang Linchu, Allergic reaction to Huaiyam, Chinese Journal of Traditional Chinese Medicine, 1993,(4):246 14. Chuanbeimu Bulbus Fritillariae Cirrhosae [synonym] 尖贝, 平贝, 川贝 (Fig. 19-20). [Source] This product is a member of the lily family Chuanbeimu Fritillaria cirrhosa D, Don dark purple shellfish Fritillaria unibracteata Hsiao et K, C, Hsia Gansu shellfish Fritillaria przewalskii Maxim, or pokeweed shellfish Fritillaria delavayi Franch. The dried bulbs of Fritillaria delavayi Franch. The first three are customarily called “Songbei” and “Qingbei” respectively according to their different herbal properties, and the latter is called “Ovenbei”. [It mainly contains many alkaloids such as fritimine, sipemine, chinpeimine and sonpeimine, etc. It also contains saponin. [Pharmacology] ① Cough expectorant effect. The cough latency period of mice can be prolonged significantly by the infusion of Bayberry saponin. It is suggested that the effective part of cough suppressing effect of Chuanbei mum is saponin. Chuanbei mum fluid extract, Chuanbei mum alkaloids and Chuanbei mum saponin all have different degrees of expectorant effects, with the alkaloids and saponin having more obvious expectorant effects. ② Relaxing the intestinal muscles and exciting the uterus. ③Intravenous injection of Chuanbei alkaloids in cats produces a persistent decrease in blood pressure accompanied by transient respiratory depression. ④Raise blood sugar. [Efficacy and Dosage] Clearing heat and moistening the lung, resolving phlegm and relieving cough. Used for dry cough with lung heat, dry cough with little phlegm, cough with Yin deficiency, cough with blood in phlegm. Dosage:3-9g, powdered, 1-2g at a time. [Adverse Reaction] A case was reported that less than 2h after taking 6g of Chuan Bai Mu, the whole body skin was itchy and scarlet fever-like drug rash appeared. After treatment with anti-allergic drugs and topical application of Furfuranate lotion, all symptoms disappeared after 5 days. References 1, Zhu Bowl, Report of a case of scarlet fever-like rash caused by Chinese herbal medicine, Chinese Journal of Dermatology, 1960,8 (1):51 15, Chuanwu Radix Aconiti [Source] The mother root of Aconitum carmichaeli Debx, family Trichosanthesae (Figure 21). [The main alkaloids are hypaconitine, aconitine, mesaconitine, talatisamine, chuanwu-base A, and chuanwu-base B. [Pharmacology] ① Action on heart: aconitine on the isolated or in situ frog heart, initially slowing down the heart rate, followed by a sudden acceleration of heart rate and strengthening of heart contraction due to high stimulation of the myocardium, soon appearing heart rhythm disturbance and weakening of heart contraction. The heart contracted like a mulberry, and eventually the heart stopped. In therapeutic amounts, in humans, the heart rate is slowed, the pulse is soft and weak, and the blood pressure is slightly reduced. Toxic amounts can cause tachycardia, ventricular fibrillation, and flutter in dogs. Its effect on the heart is partly due to the effect of the vagus nerve, but more importantly its direct effect on the myocardium: fibrillogenic effect as well as cardiotonic effect. ②Effects on blood pressure vascularity:Aconitine decreases blood pressure, and the decoction of cooked sophora causes significant vasodilation of the lower extremities. ③Anti-inflammatory effect and its relationship with adrenal cortex: It has obvious anti-inflammatory effect on formaldehyde and egg white stomping joints, and can significantly reduce the content of ascorbic acid in the adrenal glands of rats. Effects of ④ on the central nervous system: It can destroy the electric defensive-motor climbing pole conditioned reflex of rats, and the unconditioned reflex was also mildly destroyed. The ammonia content of all parts of the brain decreased sharply, and aconitine had some analgesic effect. ⑤Other effects:Aconitine can inhibit the respiratory center to slow down the breathing. The sensory nerve endings of local skin and mucous membrane are first excited, itching and burning sensation, followed by paralysis and loss of perception, and can reflexly cause salivary hypersecretion and lower the body temperature of fever and normal animals. It has a choline-like effect on the isolated intestine. It can inhibit bacteria in the test tube. [Efficacy and Dosage] Dispelling cold and dampness, dispersing wind, warming menstruation and relieving pain. It is used for treating wind-cold and damp paralysis, wind pain at all joints, constricted limbs, hemiplegia, headache, cold pain in the heart and abdomen, and poisoning by Yin gangrene. Internal use: 1,5-3g of Chuan Wu, preferably decocted for a long time, or in pills or powder. For external use: Powdered and mixed. [Adverse effects] Salivation and nausea, vomiting and diarrhea, dizziness and dizziness, numbness of the mouth, tongue, limbs and whole body, decreased pulse, dyspnea, hand and foot convulsions, confusion, urinary and fecal incontinence, decreased blood pressure and body temperature, cardiac rhythm disturbance, ventricular prophase contraction, duplex rhythm or sinus rhythm with frequent ventricular prophase contraction and atrial arrest from multiple sources. [Example] ①5 cases of arrhythmia caused by aconitine poisoning were cured by resuscitation with atropine, lidocaine, and electric shock resuscitation. ②2 cases of bidirectional tachycardia caused by poisoning with aconite and iron rod hammer. ③1 case of s2-year-old male with rheumatoid arthritis who took 120g of aconite boiled in 1h, developed lip and tongue numbness and frequent vomiting. 3h later, he suddenly fainted and developed cardio-cerebral hypoxic syndrome. Electrocardiogram showed ventricular fibrillation. The patient was cured by boxing, chest compressions and other comprehensive resuscitation measures. ④89 cases of acute poisoning caused multiple symptoms. Such as numbness of the lips and tongue, distress and vomiting, numbness of the hands and feet, pale face, emotional tension, panic and cold limbs, aggravated numbness upward, chest tightness, dyspnea, irritability, vomiting and diarrhea, headache and dizziness. Some have severe arrhythmias or sinus bradycardia, sinus arrest, and shock. Some had difficulty swallowing, poor speech, impaired tongue movement, blue face, cold extremities, decreased body temperature and blood pressure, increased muscle tone, and blunted reflex to light. Two cases died. ⑤ 6 cases of aconite poisoning showed blurred eyes, visual impairment, numbness of the mouth and lips, nausea and vomiting, numbness of the limbs, convulsions, and even cardiac rhythm disturbance, drop in blood pressure, and even shock. Sixteen cases of Chuanwu poisoning caused cardio-cerebral syndrome: the symptoms were similar to the above, accompanied by unclear language. [Prevention and control] Master the dose of medicine. Poisoning dose: 3-9g of Chuanwu; 15-60g of sophora; 0,2mg of aconite orally. First aid is often used 1:5000 potassium permanganate, 2% saline or strong tea repeated gastric lavage, and later instill 20-30ml of magnesium sulfate to induce diarrhea. Application of high-dose atropine rescue, can reduce symptoms, so that the electrocardiogram back to normal. Lidocaine can significantly reduce the mortality of animals. Dried ginger and licorice cooked with cooked slices of sap can make its toxicity greatly reduced, and reduce the mortality of animals, or prolong the time of death. In addition, honeysuckle, mung bean and rhinoceros horn can also detoxify. It has been reported that chewing fresh mint for about 15 min relieved the symptoms, and the poisoning symptoms disappeared for about 15 h. The fibrillation caused by aconitine in the isolated atria, procaine, antihistamines, quinidine, and prochlorperazine hydrochloride (insulin) can inhibit it. In the rescue of aconitine poisoning and serious arrhythmia, whether early, adequate and bold application of anticholinergic drugs is the key to the success or failure of rescue. Early application of adequate amounts of atropine, scopolamine and scopolamine was experienced in 12 resuscitation cases to control arrhythmias as soon as possible. Scopolamine has the ability to inhibit the excitability of ectopic agonists, prevent folding excitation and inhibit ischemic myocardium from producing premature ventricular beats, and protect the myocardium from ventricular fibrillation. The combination of atropine and scopolamine has an additive effect and is more conducive to the control of arrhythmias. REFERENCES 1. Jiangsu New Medical College, edited by the Dictionary of Traditional Chinese Medicine, Beijing: People’s Health Publishing House, 1977, 228 2. Zhang Yongfu, Arrhythmia due to aconitine, Chinese Journal of Internal Medicine, 1981,20(6):330 3. Jia Lizhong, et al, Report of 2 cases of bidirectional tachycardia caused by poisoning with Cao Wu and iron rod hammer, Shaanxi New Medicine, 1982,11(1):37-38 4. Wang Jingxue, et al. A case of cardiac arrest due to aconite poisoning with 35 min of drug defibrillation was successfully resuscitated. 7. Zhang Jun, Report of 6 cases of aconite poisoning, Shandong Journal of Traditional Chinese Medicine, 1994, 13(3):116 8. Qiu Weiwen, et al, Analysis of 16 cases of cardio-cerebral syndrome caused by Chuanwu, Fujian Traditional Chinese Medicine, 1993, 24(4):21 9. 10. Yang C., et al., Easing the poisoning of Aconite and Sempervivum, Chinese Medicine, 1994,(8):56