Pi Shi (Arsenolite Mineral)

Chinese Herb Actions

Chinese Herb Contraindications & Cautions

• Is Pi Shi (arsenic trioxide) safe? Are there cautions?

  No — Pi Shi/Pi Shuang is one of the most toxic substances in the Chinese materia medica and is not suitable for lay, self-directed, or unsupervised use. Traditional sources uniformly flag it as strictly toxic, contraindicated in pregnancy, contraindicated for people who are weak/deficient, and historically restricted to trained practitioners using only minute quantities under close supervision. This entry is provided for reference/identification only; Sacred Lotus does not stock, sell, or provide usage guidance for this substance.

  • Documented real-world poisoning from arsenic-containing Chinese medicines — a published case report describes chronic arsenic poisoning (peripheral neuropathy, palmoplantar hyperkeratosis, “raindrop” skin pigmentation, urine arsenic 1,235 µg/L against a normal reference of <10 µg/L) in a patient who took a homemade herbal-ball preparation daily for five years; symptoms improved after the preparation was stopped. It illustrates why unregulated arsenic-containing preparations are a recognized poisoning risk.
  • Contemporary status — outside of the tightly regulated, physician-administered pharmaceutical form (see Research), Pi Shi/Pi Shuang has essentially fallen out of routine clinical TCM use because of its toxicity; raw arsenic compounds are also broadly regulated as poisons/hazardous substances in most jurisdictions.

  Source: case report, CMAJ 2019, PMID 30988044, PMC 6464887, DOI 10.1503/cmaj.181176; materia medica cautions per multiple online sources. Neutral safety/reference disclosure, not medical advice.

Chinese Herb Toxicity & Overdose

• How toxic is arsenic trioxide, and what does poisoning look like?

  Very toxic: published estimates put a fatal single human dose of arsenic trioxide at roughly 100–300 mg (other sources cite ~70–180 mg, or about 1–3 mg/kg body weight), and the World Health Organization/IARC classifies arsenic and inorganic arsenic compounds as Group 1 human carcinogens. Cellularly, arsenic disrupts mitochondrial respiratory enzymes, starving tissues of usable oxygen.

  • Acute poisoning — onset within 30 minutes to a few hours: burning of the lips/mouth, throat constriction, a metallic or garlic-like taste, severe abdominal pain, intense thirst, then hemorrhagic gastroenteritis with nausea, vomiting, and diarrhea. Within roughly 12–24 hours, high-dose ingestion can progress to convulsions, circulatory collapse, and death; neurologic signs (headache, confusion, hallucination, seizure, coma) can also occur.
  • Chronic poisoning (arsenicosis) — delayed peripheral neuropathy (numbness/“pins and needles”), Mee’s lines in the fingernails, palmoplantar hyperkeratosis, characteristic “raindrop” skin pigmentation, bone-marrow suppression, and elevated long-term risk of skin and other cancers with sustained exposure.
  • Animal toxicology — reported oral LD50 values for arsenic trioxide in rats cluster in the low tens of mg/kg (individual study values from roughly 10–25 mg/kg, geometric mean of ~25 mg/kg across studies meeting selection criteria), consistent with its classification as highly acutely toxic.

  This section is toxicological reference information, not a treatment for or by non-professionals; any suspected arsenic exposure is a medical emergency requiring immediate professional care (e.g., a poison control center).

  Source: U.S. ATSDR/CDC arsenic toxic-substance and clinical-assessment guidance; case report, CMAJ 2019, PMID 30988044, PMC 6464887, DOI 10.1503/cmaj.181176; arsenic-containing medicinal materials review, Front Pharmacol 2024, PMID 38495096, DOI 10.3389/fphar.2024.1338725 (IARC Group 1 classification, cellular mechanism). Reference toxicology, not medical advice.

• This herb is considered extremely toxic.
  (while some Chinese herbs are toxic, it must be noted that many come prepared, or are combined, to mitigate their toxicity)

Herb-Drug Interactions

• The traditional raw mineral has no established modern framework for drug-interaction study. What is documented concerns the regulated intravenous pharmaceutical form of arsenic trioxide (Trisenox, used for acute promyelocytic leukemia under physician supervision): it is well documented to prolong the QT interval and can provoke ventricular arrhythmias (including torsades de pointes), so it is clinically managed with care around other QT-prolonging drugs and electrolyte-affecting medications. This is pharmaceutical-drug prescribing information, not guidance applicable to the traditional substance, which is not appropriate for any self-directed or unsupervised use.

  Source: arrhythmogenic-effects study, Circulation Journal 2006, PMID 17062962. Pharmaceutical-context reference only.

Western / Biomedical Research

Chinese Herb Clinical Studies & Research

Provided as research context — a summary of published biomedical study, not a therapeutic or medical claim.

• Is there modern research on arsenic trioxide (Pi Shi / Pi Shuang)?

  Yes — arsenic trioxide is an FDA-approved prescription oncology drug (Trisenox), given only by intravenous injection under physician supervision, distinct from any traditional/raw use of the mineral. It was first approved in the United States in September 2000 for relapsed/refractory acute promyelocytic leukemia (APL), with the combination of arsenic trioxide and all-trans retinoic acid (ATRA) later approved (2018) for newly diagnosed low-risk APL.

  • Mechanism in APL — arsenic trioxide binds and drives degradation of the PML–RARα fusion oncoprotein characteristic of APL and induces apoptosis in the leukemic cell population; a review traces this mechanism and its extension toward other malignancies.
  • Beyond APL (early-stage/preclinical) — network-pharmacology and mechanistic research has explored arsenic trioxide (“Pishuang”) as a candidate agent in hepatocellular carcinoma via multi-pathway effects (e.g., PI3K-Akt, p53, HIF-1 signaling); this work is exploratory/preclinical, not an established clinical indication.
  • Known drug-safety signal — the same pharmaceutical form is documented to prolong the QT interval and cause ventricular arrhythmia in treated APL patients, a recognized and clinically managed risk of the regulated drug (see Drug Interactions).

  This research concerns a tightly regulated, prescription-only, physician-administered pharmaceutical — it is cited here as context and is not evidence supporting, and should never be read as supporting, any traditional, self-directed, or unsupervised use of raw Pi Shi/Pi Shuang.

  Sources: PMID 12400595 (review, Leukemia & Lymphoma 2002); PMID 19465042 (differential cytotoxicity study); PMID 17062962 (arrhythmogenic effects, Circulation Journal 2006); PMID 34880920, DOI 10.1155/2021/5773802, PMC 8648446 (network pharmacology in hepatocellular carcinoma); PMID 38495096, DOI 10.3389/fphar.2024.1338725 (arsenic-containing medicinal materials review). Research context only, not a therapeutic claim or usage guidance.

Chinese Herb Notes

• What is the difference between Pi Shi and Pi Shuang?

  Pi Shi is the raw/crude arsenic-bearing ore (arsenolite, sometimes mixed with related arsenic minerals such as arsenopyrite, realgar, or orpiment); Pi Shuang is the refined product obtained by sublimating (heating) Pi Shi, yielding purer, more concentrated arsenic trioxide (As₂O₃) as a white, frost-like powder. Because refining concentrates the arsenic content, Pi Shuang is generally described as even more toxic than the crude ore.

  This site’s own record records this single entry under the pinyin “Pi Shi” (Latin: Arsenolite) with “Pi Shuang” as an alternate name/synonym, i.e. the raw-mineral and refined-product names are treated together as one multiple online sources list them, though some sources distinguish the two more sharply as ore vs. refined product.

  Note: Traditional-source channel attributions vary slightly — most (the 2020 Chinese Pharmacopoeia as summarized in Front Pharmacol 2024, PMID 38495096, and multiple online sources) list Lung and Liver; multiple online sources additionally list Spleen. This is likely a minor sourcing variant rather than a true clinical disagreement; both are retained here for reference rather than guessed away.

  Source: multiple online sources (Pi Shi and Pi Shuang); Front Pharmacol 2024, PMID 38495096, DOI 10.3389/fphar.2024.1338725.

This herb is toxic or restricted in the United States