IntroductionAconitine, the main toxic and active compound in Aconitum species, is a key component of Traditional Chinese Medicine (TCM), valued for its anti-inflammatory, cardiotonic, and analgesic properties. However, its potent neurotoxicity and cardiotoxicity, potentially leading to fatal outcomes, necessitate careful evaluation and management.ObjectivesAccurately identifying aconitine in natural products is one of the hot issues of international concern regarding the safety of TCM. This review systematically evaluates the current scientific literature to assess advancements in analytical methodologies for identifying and quantifying aconitine.MethodsThis review systematically evaluates literature from 2000 to 2025 regarding analytical methods for aconitine determination, utilizing databases such as PubMed, ScienceDirect, and Google Scholar.ResultsFrom 2237 identified articles, 90 were evaluated. This review highlights the advantages of LC-MS, DESI-MSI, and ambient MS techniques for identifying and quantifying aconitine, emphasizing their rapid analysis, minimal sample preparation, and cost-effectiveness. These advanced methods offer significant potential for reliable applications in various fields. DESI-MSI and DART-MS enable solvent-free, rapid analysis in native conditions, whereas oEESI-MS offers high throughput, precise quantification, and reduced solvent/sample use. The modified methods, H-oEESI-MS, allow direct analysis of Aconitum herbal materials without pretreatment, demonstrating high efficiency.ConclusionsThis review identifies research gaps and future directions using advanced analytical methods for aconitine determination, aiming to enhance quality control, regulatory compliance, and product safety. The integration of artificial intelligence into aconitine detection and analysis in TCM presents transformative potential, promising enhanced accuracy, efficiency, and safety while stimulating innovation and guiding future research directions in analytical science.