It is well known that aconitine-alkaloids is effective for treatment of rheumatoid arthritis (RA). However, the clinical use is limited in part because of its side effects. In this study we examined the therapeutic effects of newly processed “bushi” (Shujibushi) in which the contents of original forms of aconitines were reduced to aboid their undesirable effects. The effectiveness of the “Shujibushi” was recognized in 65.8% (45/67) for clinical and definite RA and in 80.7% (21/26) for probable RA. There were not any adverse side effects.
In order to obtain possible explanations for the high effectiveness of the “Shujibushi”, we analized ingredients of the “Shujibushi” in comparison with “Uzu” another type of aconitine-alkaloids medicine. The “Shujibushi” contained the significantly larger amounts of total alkaloids compared with “Uzu”. The satisfactory effectiveness of the “Shujibushi” might be brought on by the high content of total alkaloids which seem to be composed of aconitine-metabolites and its original forms.

In order to reduce the side effects of aconitine alkaloids, various types of processed Aconitine Tuber have been developed. We have been using 2 types of processed materials: the “Shujibushi” and the “Uzu” for the treatment of rheumatoid arthritis.
Original forms of aconitines (aconitine, hypaconitine and mesaconitine) and total alkaloids of these processed materials were analyzed. Hypaconitine content was 4.9 times larger in the “Uzu” than in the “Shujibushi”. In contrast, the content of total alkaloids was significantly larger in the “Shujibushi” than in the “Uzu”. Accordingly, the amount of total alkaloids eluted to the decoction was 1.3-1.8 times larger in the “Shujibushi” than in the “Uzu”.
Our data indicate that 1) The effectiveness of the processed Aconiti Tuber may depend on the contents of the total alkaloids as well as the original forms of aconitines; 2) Elution rates of total alkaloids to the decoction vary among the types of herb complex resulting in the difference of their clinical effectiveness and reduction of side effects.