This product is the mineral Realgar, a sulfide mineral. The ripened Realgar, with its vivid color, is of the highest quality and is known as Xiongjing or Yaohuang. It is primarily produced in Guizhou, Sichuan, and other regions. It can be mined at any time, with impurities removed, and ground into fine powder or used by grinding with water. It must not be calcined by fire.

bubble_chart Properties and Meridians

Acrid warm, toxic. Act on heart, liver and stomach meridians.

bubble_chart Efficacy

Removing toxin, killing worms.

bubble_chart Indications

1. Used for boils and sores, eczema, scabies, and snake or insect bites. Realgar has a good effect of removing toxins. For treating boils and sores, it is often used with frankincense, myrrh, and other medicines that invigorate blood to resolve carbuncles, such as Waike Quansheng Ji Wake-Up Subsiding Pill; for treating eczema and scabies, it is mixed with an equal amount of Alum to form a powder, which is then applied to the affected area with clear tea to enhance the effect of drying dampness and relieving itching, such as Yizong Jinjian Two-Ingredient Toxin-Removing Powder; for treating snake or insect bites, Realgar powder can be used alone, mixed with sesame oil and applied to the affected area, or taken infused with yellow wine.
2. Used for abdominal pain caused by parasitic infections. This product has a killing worms effect. It can be used for abdominal pain caused by intestinal parasitic diseases such as roundworms, often used with Areca Seed, Pharbitis Seed, and other vermifugal medicines. In addition, it can also treat perianal pruritus caused by pinworm disease. This product can be mixed with copper green to form a powder and sprinkled on the anus, or a gauze strip made of Realgar powder and Vaseline can be inserted into the anus.
3. In addition, this product also has the effects of drying dampness, dispelling phlegm, and preventing malaria attacks. It can also be used for asthma, malaria, and fright epilepsy.

bubble_chart Documentation

1. Benjing: "It governs cold and heat, scrofula, malignant sores, gangrene, hemorrhoids, and dead flesh, and kills the toxins of various worms."
2. Rihuazi Bencao: "It governs scabies, tinea, wind evil, epilepsy, and all injuries caused by insects and beasts."

bubble_chart Usage and Dosage

0.3 to 0.9 grams. For external use, apply an appropriate amount by grinding into powder and sprinkling, or mix with sesame oil for application. For internal use, take in pill or powder form.

bubble_chart Cautions and Contraindications

This product is highly toxic and should be taken orally with caution, avoiding excessive or prolonged use. It is contraindicated for pregnant women. This product can also be absorbed through the skin; therefore, it should not be applied over large areas or used continuously for extended periods when applied externally. It must not be calcined, as calcination decomposes it into arsenic trioxide, which is highly toxic.

bubble_chart Modern Pharmacology

This product mainly contains arsenic disulfide (As₂S₂), and also contains small amounts of other heavy metal salts. The water extract of Realgar (1:2) has varying degrees of inhibitory effects on multiple skin fungi in vitro. Fumigation with Acorus, Mugwort, and Huang mixture for more than 2 to 4 hours has bactericidal effects on Staphylococcus aureus, Proteus, and Pseudomonas aeruginosa, and also has anti-schistosome and anti-malarial effects.

Acute arsenic poisoning: Generally occurs half an hour after ingestion, with symptoms including dry throat, abdominal discomfort, pain, nausea, general weakness, etc.; in severe cases, intense vomiting, diarrhea, rice-water-like stools, decreased blood pressure, oliguria or anuria, unconsciousness, convulsions, difficulty breathing, and finally respiratory paralysis leading to death.

AD

1. Central nervous system: delirium, spasms, confusion, unconsciousness.
2. Peripheral nervous system: 1 to 2 weeks later, loss and weakening of sensation in half of the body, motor weakness, ascending paralysis, sensitive limb pain.
3. Cardiovascular system: palpitations, hypotension, myocarditis, atrioventricular block, T wave changes, QT prolongation leading to Torsade de Pointes, a specific type of ventricular arrhythmia.
4. Gastrointestinal system: nausea, vomiting, diarrhea, abdominal colicky pain, which can be fatal due to dehydration in severe cases.
5. Hematological system: most arsenic in the blood (>95%) binds to red blood cells; hemolytic anemia, thrombocytopenia, pancytopenia, agranulocytosis, aplastic anemia.
6. Kidneys: acute tubular necrosis, hematuria, renal cortical necrosis.
7. Liver: elevated liver enzymes, jaundice.
8. Skin: erythematous pruritus, pigmentation, keratosis, Mee's lines on nails, ulceration, chronic exposure can lead to skin cancer.
9. Other symptoms: fever, rhabdomyolysis, acute myositis, blackfoot disease.

Pathogenic and toxic mechanisms

The pathogenic mechanism of arsenic in the human body is generally believed to be due to arsenic inhibiting the activity of sulfhydryl (SH-) enzymes and affecting the activity of enzymes in the respiratory chain, leading to cellular and tissue damage. Arsenic generally exists in compounds in trivalent and pentavalent forms, with trivalent arsenic being more toxic than pentavalent arsenic. Generally, ingestion of about 100mg of arsenic can cause clinical poisoning symptoms, and more than 200mg can be fatal.

Rescue methods (the following are general literature-recommended methods for removing toxins):

1. Acute arsenic poisoning is a potentially fatal emergency, with hypotension and arrhythmias being the main causes of death, thus requiring aggressive management. Hypotension is usually caused by dehydration and requires large amounts of fluid replacement. In the acute phase, an ECG monitor should be used to monitor arrhythmias, and attention should also be paid to electrolyte balance, especially the concentrations of potassium, calcium, and magnesium ions.
2. If acute oral ingestion occurs, immediate medical attention is required. Gastric lavage (using 0.05% potassium permanganate solution or 1% sodium thiosulfate solution) can be considered; activated charcoal does not significantly reduce arsenic absorption. If abdominal X-rays show metallic density in the intestines, more aggressive whole bowel irrigation can be used to accelerate emptying, but when using laxatives (using ferric hydroxide (12% ferrous sulfate solution mixed with 20% magnesium oxide suspension, mixed in equal parts before use, shaken well), one spoonful every 5~10 minutes until vomiting stops, then using 50% magnesium sulfate solution 30ml for catharsis), attention should be paid to fluid and electrolyte balance.
3. Chelating Agent Use: For symptomatic patients or when urine arsenic concentration exceeds 200 mg/l, it is generally recommended to start using chelating agents for metal poisoning. The following three medications can be considered:
   1. Dimercaprol (BAL): Administer intramuscularly at a dose of 3-5 mg/kg every 4 to 12 hours until symptoms alleviate, or switch to another chelating agent, or until urinary arsenic levels drop to 50 mg/24 hours.
   2. DMSA (succimer), a soluble analog of BAL, is clinically more effective and less toxic. The initial dose is 10 mg/kg every 8 hours for 5 days, then switch to every 12 hours for an additional 14 days, completing a full treatment course. (This drug is currently unavailable in Taiwan.)
   3. D-Penicillamine can be used in both acute and chronic arsenic poisoning. The oral dose is 100 mg/kg/day, divided and administered over 5-7 days.
4. Accelerated excretion: For patients with clinical signs of renal failure, hemodialysis may be considered to improve renal failure and may also aid in the excretion of arsenic and dimercaprol complexes.