The herb “Mutong” has long been plagued by significant species confusion in traditional Chinese medicine, involving non-toxic Mutong (Akebiae Caulis), Chuanmutong (Clematidis Armandii Caulis), and the highly nephrotoxic and carcinogenic Guuanmutong (Aristolochiae Manshuriensis Caulis). This paper provides a systematic review of the historical origins of such confusion, including changes in nomenclature, resource shortages, and regulatory gaps, with a focused analysis of the toxicity mechanisms of aristolochic acids (AAs), encompassing metabolic activation, DNA adduct formation, and the resultant A:T to T:A mutations leading to urothelial carcinoma. Although the Chinese Pharmacopoeia reinstated the use of genuine Akebiae Caulis and prohibited Aristolochiae Manshuriensis Caulis in 2005, widespread adulteration persists in the market, highlighting the limitations of conventional identification methods. This study further comprehensively evaluates various identification techniques ranging from morphology and microscopy to modern molecular biology and spectroscopy, discussing their respective strengths and weaknesses. It proposes the development of an integrated “field-laboratory-regulatory” tripartite identification system, incorporating portable NIR-PCR devices, AI-assisted LC-MS databases, and blockchain-based drug traceability systems. Finally, the paper calls for establishing a three-dimensional “efficacy-chemistry-toxicity” evaluation model to scientifically reinterpret traditional empirical knowledge, thereby enhancing the safety and global acceptance of traditional Chinese medicine.

Akebiae Caulis  /  Clematidis Armandii Cauli  /  Aristolochiae Manshuriensis Caulis  /  aristolochic acids  /  species adulteration  /  DNA barcoding  /  identification of traditional Chinese medicine