Abstract: Aristolochia manshuriensis has been widely used in clinical applications because of its effects on analgesia, diuresis and anti-inflammatory. However, with the wide application of traditional Chinese medicine, its safety has become more and more concerned. The traditional Chinese medicines with toxicity and efficacy coexist such as Aristolochiae manshuriensis, the clinical irrational application can lead to a higher incidence of adverse events. This paper combines the literature reports of adverse reactions related to Aristolochiae manshuriensis in the past 26 years to analyze the root causes of adverse reactions in Aristolochiae manshuriensis, and to explore the essence of toxicity from the perspective of toxic components, so as to propose rationalization suggestions on how to promote the rational use of drugs in aristolochic traditional Chinese medicine such as Aristolochiae manshuriensis.