The toxicity and safety of Chinese medicine from the bench to the bedside.

• Common chemical material, toxicity mechanisms and detoxification strategies of Chinese medicines were all summarized. • Universal problems and feasible solutions existed in modern Chinese medicine researches were Pointed out. • A systematic evaluation strategy for toxic herbal medicines was proposed. According to the Chinese Pharmacopoeia (2015 edition), human physiology and drug administration are the major factors related to adverse reactions to traditional Chinese medicine (TCM). To promote the research and supervision of TCM, particularly the toxic medicines, the risk factors of the two aspects were first summarized. Risk factors from a drug and its administration include misidentification of herbs, improper processing, overdose, long duration of administration, inappropriate diagnosis, inappropriate combining of herbs, and contamination from microorganisms/heavy metals. Risk factors from the human body involve physiology, pathology, and genetics. The authors analyzed the positive and negative effects from classic applications of toxic Chinese herbs (e.g., Aconite spp., Aristolochia spp., Polygonum multiflorum , Realgar spp., and Tripterygium wilfordii). Furthermore, for the rational use of these toxic Chinese medicines, some common chemical substances were discussed as well as the associated toxic mechanisms of them, and then summarized the traditional and modern methods of effective detoxification. It was reported that alkaloids, glycosides, toxic proteins, polypeptides, amino acids, tannins, anthraquinones, phenols, organic acids, terpenes, lactones, and heavy metal contamination were related to TCM toxicity. Meanwhile, some methodological studies (represented by network pharmacology and network toxicology) on the toxicity of TCM were discussed. Finally, a systematic evaluation strategy for toxic Chinese medicines was proposed. Overall, once the clinical side effects of herbal medicine are discovered and validated, a systematic study from the chemical substances to the toxicological mechanism should be conducted to solve the toxicity problems. [ABSTRACT FROM AUTHOR]