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Arsenic Trioxide (Pishuang)

Taste: Bitter, sour. Toxicity: Toxic. Indications: Mainly treats various types of malaria and wind-phlegm in the chest and diaphragm. It can be used as an emetic but should not be taken for a long time as it damages the human body. It is produced by sublimating yellow arsenic (Pihuang), and its preparation involves special methods. (This section is a later addition.)

Minister Yuxi et al. respectfully note: Rihuazi states that Arsenic Trioxide is warm in nature. It treats pain caused by blood and qi rushing to the heart in women and has the effect of aborting fetuses. Additionally, Yellow Arsenic (Pihuang) is warm and also toxic. It is inhibited by mung beans, cold water, and vinegar. It is used to treat malaria, "Shenqi Dai" (a condition related to kidney qi), and repels fleas and lice. When used in medicine, it must first be boiled in vinegar to neutralize its toxicity before use.

"Tujing" (Illustrated Classic) states: Arsenic Trioxide was not recorded in older texts regarding its place of origin. Currently, it is found near copper mountains, but the best quality comes from Xinzhou. The lumps can be quite large, with a color like goose yellow, bright and clear without impurities. This substance is rare in its local area; one tael of a genuine large lump is highly prized by people, with market prices exceeding that of gold. It is occasionally used in ancient elixir formulas, but only this specific high-quality type is suitable for medicinal use. What is stored in markets consists of fragments like fine dust, often mixed with soil and stones. Using these for medicine causes significant harm. If accidentally poisoned, the antidote is to drink mung bean juice ground with cold water, which resolves the toxicity.

Lei Gong states: For processing, place it in a small porcelain bottle, then add two herbs: Zi Bei Tian Kui (Ocimum basilicum var. purpurascens) and Shi Long Rui (Ranunculus japonicus). Heat these three items together from Si hour (09:00-11:00) to Shen hour (15:00-17:00). Then soak in licorice water from Shen hour to Zi hour (23:00-01:00). Remove, dry, put back into the bottle, and calcine over fire. Grind thirty thousand times before use.

"Shenghui Fang": Treats stroke with coma resembling drunkenness, copious phlegm-saliva, and flaccidity of the four limbs. Formula: Use Arsenic Trioxide pieces the size of mung beans, grind finely, mix with fresh well water, and take a small amount. Follow with warm water. Profuse vomiting indicates recovery. If no vomiting occurs, administer again. Another formula for treating malignant thorns (toxic sores): Grind Arsenic Trioxide finely, mix with glue solution, and apply topically.

"Boji Fang": Treats pediatric gingival bleeding (Yaxuan) with continuous fresh blood and foul-smelling, rotting gums. Take 1 qian of Yellow Arsenic (Pihuang) and 0.5 qian of Musk. Grind together finely. First, coat a paper strip with raw oil, then sprinkle the powder on it. Cut the medicated paper into small square pieces matching the lesion size, and insert it into the affected area.

Sun Shangyao: Treats dysentery. Take 2 liang of Xinzhou Arsenic, grind into powder separately. Take 3 liang of Cold Water Stone (Hanshuishi), grind into powder separately. Use a raw iron crucible. Spread half of the stone powder at the bottom, pile the arsenic powder on top, and cover with the remaining stone powder. Cover with a thick ceramic lid. Seal the edges tightly with ten layers of paper strips pasted with vinegar paste. Heat with one jin of charcoal. When the paper turns black, remove it, place on cold ground to cool, open the lid, and scrape off the purified arsenic powder. Mix with soft millet rice paste to form pills the size of sophora seeds. Make smaller pills for children. Coat with processed Cinnabar (Chensha). Store in porcelain jars when dry. Dosage: On the day of onset, take one pill early in the morning with aged tea infusion. Do not consume hot food within 24 hours. Preparation environment must be clean and isolated from women, cats, dogs, chickens, and rats. Storage conditions are similar. If a woman suffers from the disease, a man holds the pill in his mouth; if a man suffers, a woman does so.

"Lingyuan Fang": Treats scrofula (Luoli). Use Xinzhou Yellow Arsenic, grind finely, add concentrated ink juice, and form pills the size of sophora seeds. Stir-fry in a crucible until dry, then store in a bamboo tube. Application: Moxibustion or acupuncture to break the skin at the lesion site. Crush half a pill and apply topically. Continue until the tissue naturally necroses and falls off. Apply a small amount more when the effect diminishes.

Qingxiazi's "Baozang Lun" states: If Arsenic Trioxide is covered by grass during heating and its color does not change, melting into liquid, it can turn copper into silver. If the material is dry and brittle, it is unusable. "Danfang Jingyuan" states: Arsenic Trioxide can volatilize mercury from copper. "Bieshuo" notes: In Xinzhou Yushan, there are arsenic wells strictly sealed by the government. Raw arsenic free of stone impurities is deep red, resembling realgar. Ground with cold water, it effectively clears heat-toxins and treats phlegm obstruction. Proximity to fire is lethal. This refers to the substance described in "Tujing" as worth more than gold. Commercially available arsenic is often derived from mountain rocks containing sand and stone, smoked into white frost, resulting in sharp, fragmented shards. Those heavily fired appear as large, slightly yellow blocks, corresponding to the "goose-yellow, bright and clear" description in "Tujing". Ancient formulas rarely included it in medicine; it was mainly used by alchemists. Recently, many use it for malaria, originally based on the idea that raw arsenic clears heat-toxin, addressing the summer-heat pathogen in malaria. However, contemporary physicians fail to understand this principle and directly use the calcined frost, causing inevitable vomiting and diarrhea. Accidental recoveries led to its standardization, but it has caused immense harm since then. Caution is essential. During the initial sublimation process, standing upwind more than ten zhang away is necessary; vegetation downwind dies. It is also commonly used to poison rats with rice bait; cats and dogs eating poisoned rats also die. Its toxicity far exceeds that of Aconitum alkaloids (She Wang). One should investigate this carefully. Additionally, arsenic from Hengshan is considered inferior to that from Xinzhou.

"Yanyi" states: Arsenic Trioxide is sometimes used by malaria patients. Exceeding the dosage causes simultaneous vomiting and diarrhea. Drinking concentrated mung bean juice mixed with cold water, along with petroleum ether (Shinao You), can suppress the toxicity. Currently, Xinzhou mines arsenic via shafts. These shafts are usually sealed and contain turbid green water. The water is pumped out before mining. Raw arsenic is called Pihuang, with a color resembling beef flesh, sometimes with pale white veins. It is neither stone nor soil. Taken with wine, it treats accumulations and qi stagnation. Upon exposure to fire, its toxicity increases significantly; it must not be taken rashly. Method of extraction: Place raw arsenic on fire, cover with a vessel to collect the rising arsenic fumes. They condense and hang down like milk droplets. Pointed and long crystals are superior; flat and short ones are inferior. "Tujing" mentions large blocks, but these are of lower grade; fragments like dust are the lowest grade. For medicinal use, select the pointed, long crystals resembling milk droplets. Extreme care and precision are required.