Traditional Chinese medicine (TCM) is gaining popularity as a form of complementary and alternative medicine. Reports of the efficacy of TCM are increasing in numbers. TCM includes both crude Chinese medicinal materials (plants, animal parts, and minerals) and Chinese proprietary medicine (final dosage forms). Traditional mineral Chinese medicine is a characteristic part of Chinese medicine, in the development of traditional Chinese medicine has its unique role. Great pharmacological works of the Qin, Han and Ming Dynasties of China contain records of 1892 Chinese herb drugs. Of these 1892 drugs, over 160 types are of mineral origins (Minerals in Chinese Medicine, 1999). Mineral Chinese medicine is normally be divided into three types which included crude mineral drugs, mineral medicine, and preparation of mineral drugs. However, the use of mineral TCM has always been a controversial topic among the medical circle.
According to Ernst and Coon, epidemiologic and analytical investigations have shown that a considerable proportion of TCMs contains heavy metals. Severe clinical consequences and even fatalities are on record. Children are particularly vulnerable and have been involved relatively often. In many cases, TCM intake had been prolonged until a diagnosis of intoxication was made.
Numerous case reports and case series of heavy metal poisoning associated with the use of traditional Chinese medicines (TCMs) have been published ; lead has relatively often been implicated as the cause of such poisoning but mercury, cadmium, arsenic, copper, and thallium have also been found in TCMs . (Heavy metals in traditional Chinese medicines: A systematic review).
Moreover, the patient’s inappropriate or excessive use of mineral Chinese medicine causes adverse reactions. The mineral medicines of different origins, their coexisting elements, and associated minerals are not the same, and their physical properties will have a certain range of variation. Determination based on the quality and authenticity of mineral medicines by appearance traits will cause a lot of problems. For example, white vermiculite, arsenic, gypsum, anhydrite, soft talc, lead cream, and gouache are similar in shape and colour. They would become more difficult to identify especially after crushing which leads to misuse occurs.
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For the example of excessive use of mineral CMM, a five-year-old Chinese boy presented with recurrent oral ulceration followed by motor and vocal tics. The Chinese herbal mouth spray, named “Watermelon Frost” was prescribed by a local pharmacist. The spray was said to be useful in controlling pain and healing difficult mucosal wounds were found to have high mercury content. His blood mercury concentration was raised. Isolated tics as the sole presentation of mercury intoxication has not previously been reported. The patient admitted that he had been using the mouth spray up to 20 times a day for the preceding four weeks when the recommended dose was only one spray twice a day. His tics completely resolved once his blood mercury level was normalized and did not reappear despite new oral symptoms.
Other than mercury, lead is damaging to hematopoietic, nervous, reproductive, and renal systems and could result in anemia, neurological dysfunction, and renal failure at sufficient doses. Cadmium at high doses may be damaging to the immune system and kidney function. Recent studies have shown that arsenic may be considered an essential trace element. The nature and signs of arsenic deprivation involve factors related to methyl-group metabolism, as in arginine, choline, methionine, and taurine, and in processes involving zinc (19). Because arsenic is also a well-known human carcinogen, it should be used with extreme caution because, at sufficiently high doses, it causes damage to numerous organs (20). As mentioned earlier,
(Determination of trace elements in some natural drugs by atomic absorption spectrometry)
Koh and Woo reported the detection of toxic heavy metals that exceeded Singapore’s legal limits in 42 Chinese proprietary medicines. They collected 2080 samples of such medicines in Singapore and tested them for heavy metal content. Forty-two different medicines were found to contain metals in amounts exceeding the legal limits. Mercury was found in 28 products, lead in eight, arsenic in six and copper in one. One product contained both mercury and lead and another product contained both mercury and arsenic. Melchart et al.  analyzed all 317 batches of dried Chinese herbs delivered to a German hospital of Chinese medicine. Heavy metal content beyond the legal limits was detected in 3.5% of these samples. The same case happened in Hong Kong, the Consumer Council of Hong Kong warned the customer on excessive levels of toxic mercury in 2 brands of this widely-used folk Chinese proprietary medicine. (CHOICE # 274 | Consumer Council, 2019)( Chinese proprietary medicines in Singapore. Regulatory control of toxic heavy metals and undeclared drugs）
Modern medical doctors have once reduced the use of mineral medicines. This is due to the toxicity of inorganic compounds such as heavy metals such as arsenic, mercury, lead, and antimony, which have been gradually replaced by synthetic organic drugs. Existing proprietary Chinese medicines, such as Angong Niuhuang Pills and Niuhuang Jiedu Pills, have been eliminated to meet export requirements, and minerals such as realgar and cinnabar have been eliminated, and the application range of mineral medicines has been further narrowed.