草药“木通”在传统中药中长期存在严重的品种混淆问题，涉及无毒的木通Akebiae Caulis、川木通Clematidis Armandii Caulis及具有强肾毒性和致癌性的关木通Aristolochiae Manshuriensis Caulis。通过系统综述此类混淆的历史根源，包括名称变更、资源短缺和监管漏洞，并重点分析了马兜铃酸的毒性机制，涵盖代谢活化、DNA加合物形成及由此导致的A:T至T:A突变进而引发尿路上皮癌。尽管《中国药典》2005年版恢复了木通的使用并禁用关木通，但市场上掺假现象依然存在，凸显了传统鉴定方法的局限性。通过进一步全面评估从形态学、显微学到现代分子生物学和光谱学的多种鉴定技术，讨论了各自的优缺点。提出构建一个整合“现场-实验室-监管”的三位一体鉴定体系，融合便携式近红外光谱法联合聚合酶链式反应设备、人工智能辅助的液相色谱-质谱联合法数据库和基于区块链的药物追溯系统。最后，呼吁建立“功效-化学-毒性”三维评价模型，以科学重新诠释传统经验知识，从而提升中药的安全性和全球接受度。

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.

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澳门特别行政区科学技术发展基金资助项目（0075/2024/RIB2）；澳门特别行政区科学技术发展基金资助项目（0105/2022/A2）；澳门特别行政区科学技术发展基金资助项目（006/2023/SKL）