The toxicity of traditional Chinese medicines (TCMs), along with the four natures and five flavors, ascending, descending, floating, and sinking, and channel tropism, belongs to the category of pharmacological theory and together constitutes the fundamental principles guiding clinical TCM practices. However, the complex composition of highly toxic medicinal materials makes it difficult to fully elucidate their toxic components and mechanisms of action. Additionally, the diversity of clinical medication regimens and significant individual differences pose considerable challenges to related research. Based on the characteristics of highly toxic medicinal materials, this study systematically reviews the highly toxic medicinal materials included in the 2025 edition of the Chinese Pharmacopoeia. By integrating herbal textual research with modern pharmacological studies, this paper provides an in-depth analysis from multiple perspectives, including common toxic components and pathways, the bidirectional relationship between toxicity and efficacy, and strategies for reducing toxicity while preserving efficacy.Furthermore, it reviews the current application of modern analytical detection techniques in the quality control of these medicinal materials and discusses other potentially toxic substances in TCMs along with risk management strategies. This review aims to serve as a reference for promoting safe and rational clinical use of highly toxic medicinal materials and strengthening the prevention and control of toxicity risks.

highly toxic traditional Chinese medicinal materials  /  common toxic components and pathways  /  bidirectional relationship between toxicity and efficacy  /  reducing toxicity while preserving efficacy  /  quality control