Aconitum gymnandrum in the Snowy Mountains, is a rhizome of the Ranunculaceae plant family. It is widely distributed in the Qinghai-Tibet Plateau and is one of the most toxic medicinal herbs used in Tibetan medicine. This article analyzes and discusses the causes, mechanisms, and clinical rescue measures of poisoning caused by Aconitum gymnandrum, in order to increase people's understanding of Aconitum gymnandrum and improve the success rate of clinical rescue and reduce the mortality rate.
I. Pharmacological Characteristics
Aconitum gymnandrum is mainly distributed in deep mountain valleys and river meadows in Tibet, Qinghai, Gansu and other regions, with some distribution in Yunnan as well. It has a pungent and bitter taste, and is hot in nature with strong toxicity. It can clear "saliva", dispel wind, kill parasites, and alleviate pain. It is mainly used for the prevention and treatment of various types of epidemics, such as toothache, arthritis, gout pain, and inflammation and pain of fractures and sprains.
Aconitum gymnandrum is widely used in Tibetan medicine. The commonly used oral formulas include Wu Wei Qu Wen Qiong A Pill, Da Si Hong Pill, and Shi Wu Wei Qu Feng Bai Qiong San, while external formulas include Jia Qiong Wen Bu Tu Fu San and anti-inflammatory and analgesic Aconitum gymnandrum paste.
According to the pharmacological and toxicological experiments on the related plant Aconitum kusnezoffii, the therapeutic dose and toxic dose are similar. The oral dose is 25-50mg per day, with a maximum dose of 75mg.
Acute poisoning by Aconitum gymnandrum mainly occurs through oral ingestion, often caused by intentional or unintentional increase in drug dosage, mistaken ingestion of external use medicine or raw herbs.
The severity of Aconitum gymnandrum poisoning is also determined by factors such as the dosage, duration of intake, and the patient's physical condition. The toxicity is greater when raw herbs or single herbs are ingested.
IV. First Aid
1. Common first aid treatments
Common first aid treatments for Aconitum gymnandrum poisoning include:
(1) Inducing vomiting.
(2) Gastric lavage with a 1:5000 potassium permanganate solution.
(3) Oral administration of 50ml of 50% sodium sulfate for laxative effect.
(4) For severe vomiting and diarrhea, after gastric lavage, there is no need to use laxatives. Magnesium oxide 10g, tannic acid 10g, and medicinal charcoal 20g can be mixed with warm water to form a paste for oral administration. If there is still constipation, a 2% saline enema can be used for laxative effect.
(5) Large doses of atropine can be used to counteract the excitation of the vagus nerve. The specific dosage can be adjusted according to the severity of poisoning. For mild cases, it can be administered subcutaneously or intramuscularly, and for severe cases, it can be administered intravenously.
The dosage is generally 0.5-1mg every 2-4 hours, and for severe poisoning, the dosage can be increased and the time between administrations can be shortened.
(6) Administration of 5% or 10% glucose solution to promote excretion of toxins.
(7) Symptomatic treatment can be given for shock, arrhythmia, seizures, and metabolic acidosis.
(8) Blood purification therapy can be performed for severely ill patients to thoroughly remove toxins from the body.
(9) Hyperbaric oxygen therapy can be performed for patients in the recovery period.
2. Tibetan medical treatment
In accordance with the basic medical conditions in Tibet and the special requirements of some patients, Tibetan medicine can be used to treat acute drug poisoning. The main methods include:
(1) Inducing vomiting
For patients with short poisoning time, clear consciousness, and cooperation, forcing them to drink a large amount of warm water (about 500ml) and stimulating the pharynx with fingers to induce vomiting. If the effect is not good, Banbo Soup or Daji Jiajian Soup can be used for gastric lavage and emetic treatment. This method can be repeated, but it should not be used for patients with long poisoning time and severe condition.
(2) Laxative
Generally used as a supplementary detoxification method after inducing vomiting. Taking 3-5 pills of Liu Wei Neng Xiao Wan or adding 1-5g of high mountain rhubarb root powder for laxative effect. This method should be used with caution in patients with weak constitution or a history of gastrointestinal ulcers.
(3) Adjusting medication therapy
Tibetan medicine generally uses a comprehensive treatment approach of clearing, reducing, and eliminating toxins to thoroughly treat poisoning. However, for acute poisoning, detoxifying drugs such as Jinhe Qingdu San, Wangri Jiedu Wan, Shier Wei Shanglu Ka Cai San, and Shisan Wei Honghua Ka Cai San can be directly taken for neutralization and elimination.
(4) Symptomatic treatment
For symptoms such as restlessness, palpitations, shortness of breath, arrhythmia, coma, and weakness during the later stage of treatment, symptomatic treatment can be applied according to the condition.
