Advances in the safety evaluation of mineral medicines - Cinnabar and Realgar

Mineral medicines have a long history in the treatment of diseases. Among these, cinnabar and realgar are the most commonly used. This review discusses the differences between cinnabar and realgar and other mercurials and arsenicals. In addition, it explores the toxicity studies carried out on cinnabar and realgar, which include acute and chronic toxicity, neurotoxicological effects, special toxicity, disposition and accumulation, and the relative mechanism of toxicity. Cinnabar and realgar are seldom used alone but rather in combination with herbs or animal medicines. Thus, in this article, we have also included a study of the effect of toxicity reduction and efficacy enhancement after cinnabar and realgar were combined with other Chinese medicinal materials. This review provides the theoretical evidence for their clinical application, suggesting that the dosage and treatment period using cinnabar and realgar should be rigidly controlled and emphasis should be placed on the drug safety of special populations.