Key Lab for Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, Guizhou 563006, China.
Key Lab of Pharmacology and Safety Evaluation of Tibetan Medicine, Northwest Institute of Plateau Biology, Chinese Academy of Sciences, Xining 810008, China.
J Ethnopharmacol. 2018 Jan 10;210:340-350. doi: 10.1016/j.jep.2017.08.037. Epub 2017 Aug 31.
Herbo-metallic preparations have a long history in the treatment of diseases, and are still used today for refractory diseases, as adjuncts to standard therapy, or for economic reasons in developing countries.
This review uses cinnabar (HgS) and realgar (AsS) as mineral examples to discuss their occurrence, therapeutic use, pharmacology, toxicity in traditional medicine mixtures, and research perspectives.
A literature search on cinnabar and realgar from PubMed, Chinese pharmacopeia, Google and other sources was carried out. Traditional medicines containing both cinnabar and realgar (An-Gong-Niu-Huang Wan, Hua-Feng-Dan); mainly cinnabar (Zhu-Sha-An-Shen Wan; Zuotai and Dangzuo), and mainly realgar (Huang-Dai Pian; Liu-Shen Wan; Niu-Huang-Jie-Du) are discussed.
Both cinnabar and realgar used in traditional medicines are subjected to special preparation procedures to remove impurities. Metals in these traditional medicines are in the sulfide forms which are different from environmental mercurials (HgCl, MeHg) or arsenicals (NaAsO, NaHAsO). Cinnabar and/or realgar are seldom used alone, but rather as mixtures with herbs and/or animal products in traditional medicines. Advanced technologies are now used to characterize these preparations. The bioaccessibility, absorption, distribution, metabolism and elimination of these herbo-metallic preparations are different from environmental metals. The rationale of including metals in traditional remedies and their interactions with drugs need to be justified. At higher therapeutic doses, balance of the benefits and risks is critical. Surveillance of patients using these herbo-metallic preparations is desired.
Chemical forms of mercury and arsenic are a major determinant of their disposition, efficacy and toxicity, and the use of total Hg and As alone for risk assessment of metals in traditional medicines is insufficient.
草药与金属制剂在治疗疾病方面有着悠久的历史，如今仍被用于治疗难治性疾病，作为标准治疗的辅助手段，或在发展中国家出于经济原因而使用。
本综述以朱砂（HgS）和雄黄（AsS）为例，讨论其在传统医学混合物中的存在、治疗用途、药理学、毒性以及研究前景。
对 PubMed、中国药典、Google 等来源的朱砂和雄黄文献进行了检索。讨论了含有朱砂和雄黄的传统药物（安宫牛黄丸、华佗丹）；主要含朱砂的药物（朱砂安神丸；左归丸和右归丸），以及主要含雄黄的药物（黄黛片；六神丸；牛黄解毒丸）。
传统药物中使用的朱砂和雄黄都经过特殊的制备程序以去除杂质。这些传统药物中的金属处于硫化物形式，与环境中的汞剂（HgCl、MeHg）或砷剂（NaAsO、NaHAsO）不同。朱砂和/或雄黄很少单独使用，而是作为与草药和/或动物产品的混合物存在于传统药物中。目前采用先进技术对这些制剂进行了表征。这些草药与金属制剂的生物利用度、吸收、分布、代谢和消除与环境金属不同。需要证明将金属纳入传统疗法的基本原理及其与药物的相互作用。在更高的治疗剂量下，权衡利弊至关重要。希望对使用这些草药与金属制剂的患者进行监测。
汞和砷的化学形式是决定其处置、疗效和毒性的主要因素，仅使用总汞和总砷来评估传统药物中金属的风险是不够的。
