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[By Jurgen Christoph Aschoff in collaboration with Tashi Yangphel Tashigang]

Introduction Mercury as a metal (Tib. dnul chu) or as cinnabar (mercuric sulfide, HgS; Tib. rgya mchal or cog la ma) is an ancient medicine used in traditional Chinese, Ayurvedic and Tibetan systems of healing. Already in the rGyud bzi, the fundamental text of the Tibetan medical tradition and one of the oldest Tibetan books on medicine, in use from the twelfth century onwards, the therapeutic aspects of mercury are mentioned, in concurrence with earlier Chinese and Ayurvedic texts, as being valuable - when taken internally - in the treatment of illnesses of the nervous system. It is supposed to be generally stimulating and balancing as well as helpful for healing bone fractures. The art of using mercury as a medicine was always connected with a complex and time-consuming process as it had to be specially prepared for medical purposes. The Tibetan scholar and yogin Ogyen Rinchenpal (Tib. 'Orgyan-pa Rin-chen-dpal') brought to Tibet from his journeys to Northern India (Udyana/Swat) the art of preparing mercury for medicinal use. Under the Third Karmapa (1284-1339) this knowledge was utilised for the first time in Tibet to produce the 'black pills' (rin-chen ril-nag) which were subsequently called 'Karmapa black pills' in reference to the Karmapa's insignia, his black crown (or hat). An excellent and critical overview of Tibetan texts dealing with the preparation of mercury medications was published by Dr. Yonten Gyatso from the Research Department of the Tibetan Medical & AstroInstitute in Dharamsala.² 11229-1309; alternative life-data 1203-1309, or 1230-1303. 2 'The Secrets of the Black Pill Formulation', Tibetan Medicine 13, Dharamsala 1991, 38-55. The author states (p. 38) that 'the preparation of this precious pill, known as "Precious Black Pill" (Rin-chen ril-nag), is the highest form of pharmacological practice in Tibetan Medicine. It involves a wide range of techniques which require patience, precision and utmost care. In this formulation the most important and complicated part is the preparation of btsothal, a mixture of refined and detoxified powders of mercury, eight metals and eight rock minerals which are themselves processed individually with specific techniques. This powder is the basic compound to which various other ingredients are added. There are other kinds of precious pills, namely rat-na bsam-'phel, btso-bkru zla-shel and mang-sbyor chen-mo, to which btso-thal is added but these have fewer ingredients. There were other forms of mercury formulation prevalent in Tibet before the advent of the btso-thal practice. They are less com-

Along with the knowledge of the medical use of mercury, the medicinal use of 'jewels' (like gold, silver, gems, corals, as well as pearls and shells) was also brought to Tibet: these substances were combined in medicines generally known as 'precious medicines' or 'jewel pills'. Most of them also contain mercury in different forms. There are some 25 to 30 well-known formulations of jewel pills, but not all of them contain mercury. On the other hand mercury is used in certain 'non-precious' medicines as well. Precious pills consist of various mixtures of between twenty and over one hundred ingredients of medicinal plants, animal and mineral products and 'precious' substances as listed above. The 'jewel pill' Byu-dmar (pronounced dchou-mar) 25 (Tib.: Byu dmar 25) has been under special analysis with particular focus on its use as a prophylactic pill against migraine attacks. Mercury as one of its ingredients was investigated to some extent prior to the administration of the pill to our patients. Mercury-containing Byu-dmar 25: Diseases Cured and Side-effects If one buys Byu-dmar 25 in a Tibetan pharmacy in Delhi, Ladakh, Lhasa or Dharamsala, along with the medicine one often receives a bilingual brochure in English and Tibetan (or Chinese in Lhasa) published by the Tibetan Medical & Astro-Institute in Dharamsala, which states that the use of this particular medicine goes back to Tenzin Phuntsok (Dehu-dmar bsTan-hjin plicated. The simpler and less celebrated method of mercury formulation is taught in the Tibetan medical text (rGyud-bzhi), which devotes a detailed chapter to this. The time and origin of this text, despite being shrouded in mystery, undoubtedly predates the btso-thal practice. The btso-thal practice came to Tibet in 13 th century. It was brought by O-rgyan-pa rin-chen-dpal (1230-1303) who is said to have received its instructions from Vajra dakinis and he passed it on to Karma-pa rang-byung rdo-rje, the 3 rd Karma-pa (1284-1339), and transmission of the instruction from master to disciple carried on uninterruptedly, and it then came to Zur-mkhar mnyam-nyid rdo-rje (1439-1475) over one hundred years after the death of Karma-pa rang-byung rdo-rje. Zur-mkhar mnyam-nyid rdo-rje, the founder of Zur tradition (Zur-lugs) which was one of the two main medical traditions that evolved in 15 th century, is one of the greatest exponents in the history of Tibetan Medicine. Since he was one of the earliest in the lineage of instruction in Black Pill formulation, it is tempting to believe his claim, that his text, "Eternal Gem for the Clear Revelation of the Secrets of the Black Pill Formulation" (ril-nag gsang-ston gsal-byed 'chi-med nor-bu) is the first written instruction on the Precious Black Pill formulation. I regard myself fortunate to have been entrusted with the task of translating this text. The translation is from the text found in Rin-chen dngul-chu sbyor-sde phyogs-bsdebs (Collected Works on Mercury Formulation), published by the Library of Tibetan Works and Archives, Dharamsala, 1986, ff. 1-20. It can also be found in Zur-mkhar mnyam-nyid rdo-rje's Man-ngag bye-ba ring-bsrel (his Collected Works), published by three different publishers from different editions.'

J.C. Aschoff, T.Y. Tashigang, Mercury in Tibetan 'Precious Pills' 131 phun-chogs, born 1672), who tried it on himself and saved himself from a fatal illness. He himself was a famous Tibetan doctor practising in the early decades of the eighteenth century. His medical books, still well acknowledged even today, were originally printed in the monastery of Derge (Eastern Tibet). I will not go into detail about the other twenty-four substances in Byudmar 25, although these ingredients offer interesting and important information regarding its possible use in Western medicine. This part will be published separately,³ especially our research on the most important ingredient in this jewel pill: aconitum. For now I will comment only on the mercury. Amchi T. Y. Tashigang, collaborator on this article, reported in several sessions about his experiences with mercury-containing medicines made by him, particularly Byu-dmar 25: this jewel pill is commonly used by him to treat nervous illnesses of all kinds - even epilepsy - and also chronic recurring headaches caused by an imbalance of 'wind' (Tib. rlun) and 'phlegm' (Tib. bad-kan). He never has observed the typical side-effects of mercury intoxication reported in Western medicine, i.e. agitation, insomnia or tremors, in patients who had taken doses of one to two pills per day or two to three pills per week, over a period of several months or even years. However, Amchi Tashigang did point out that he, like other Tibetan doctors, until recently never made written records of his patients or systematic studies of treatments, and that the use of mercury as well as Tibetan medicine in general have remained rather static over the past centuries and mainly unaltered by any modern influence. The Indian Origin of Mercury Pills The use of cinnabar (i.e. mercuric sulphide, HgS) in Byu-dmar 25 is identical in both Ayurvedic and Tibetan medicine. In the Ayurvedic system of Indian medicine today, mercury is perhaps the most important substance for maintaining good health and for the treatment of many different nervous disorders. In an eight-stage preparatory process, mercury is purified by degrees by various different processes. The whole complex of physical/ chemical and philosophical concepts dealing with mercury (as well as with other metals and 3 Jurgen C. Aschoff, Thies Peters, T.Y. Tashigang, N. Batth, 'Tibetan Traditional Medicine for Migraine Prophylaxis', Tibetan Studies. Proceedings of the 7 th Seminar of the International Association for Tibetan Studies, Schloss Seggau, Graz, June 18 th-24 th 1995, Vienna 1996 (forthcoming). Originally from Ladakh, he studied Tibetan medicine and pharmacology in Menzekhang/Lhasa. He is one of the outstanding specialists in Tibetan pharmacology.

minerals) is entitled Rasasastra: Bhagwan Dash calls it 'iatrochemistry's and views it as closely linked to tantra and alchemy. The most important texts of this Rasasastra originate from the eighth century. According to these, the preparation and application of mercury in India for medicinal purposes was already well-known and valued even when Tibetan medicine was in the preparatory stages of being written down. An essential aspect of this Rasasastra in the field of medicine deals not so much with the treatment of illness but with prolonging human life beyond old age. This power was attributed to mercury along with the possibility of living a full cycle in excellent health and with the full mental and physical capacities until death, which is identical with views of early traditional Chinese medicine. Mercury today is still used and distributed in Ayurvedic and Tibetan medicines. One can buy these mercury pills in Asia in every Ayurvedic and Tibetan pharmacy. Mostly the inert mercuric sulphide (HgS = cinnabar; if produced synthetically called vermilion) is used, less commonly mercurous chloride Hg 2 Cl 2 (calomel) is found. Probably the best discussion about toxicity/non-toxicity, as well as the prescriptive ratios for the use of mercury in Ayurvedic (similar to Tibetan) medicine is given by A. K. Nadkarni." He describes all the different processes of preparation of mercury called 'detoxification' or 'purification', and these processes are still used in the same way by Tibetan doctors in preparing their medicines. How Much and What Kind of Mercury in a Jewel Pill? From my personal "scientific" perspective, these detoxifications do not have anything mystical or magical about them. A detailed description of these different ways of detoxification can also be found in the work of Bhagwan Dash.' All the described processes lead to the elimination of impurities of the mercury through its mechanical treatment, followed by a prolonged heat treatment. Sulphur is then added and through this process mostly the inert cinnabar is obtained. The daily dosage during an Ayurvedic treatment is about 30-40 mg of mercuric sulphide. This is usually given in combination with processed See his fundamental and in the given context very important work Alchemy and Metallic Medicines in Ayurveda, New Delhi 1986, 28 ff. 6 K. M. Nadkarni's Indian Materia Medica, revised and enlarged by A. K. Nadkarni, Bombay 1976, vol. 2, 67-83. Op. cit. in note 5, 40-103.

J.C. Aschoff, T.Y. Tashigang, Mercury in Tibetan 'Precious Pills' 133 aconite (together with the fruit of Terminalia chebula). One Tibetan Byu-dmar 25 'jewel pill' contains (depending on its origin) according to our analysis between 10-50 mg cinnabar which corresponds closely to the Ayurvedic prescriptions. With the use of atomic absorption spectrometry at the University of Ulm a project was undertaken to investigate Byu-dmar 25 pills from different origins: a wide variation in the concentration of mercury was thereby discovered (see fig. 1). It should be noted that nearly identical results were obtained independently in Ayurvedic drugs containing mercury.³ One result of our analysis seems to be of special importance: it was not only the inert, i. e. insoluble and therefore non-toxic HgS (cinnabar) which was discovered in Byu-dmar 25, but of the total mercury between 10 to 30% represent the equally insoluble metallic mercury (see fig. 1). According to the criteria of the WHO, the weekly dose of mercury that can be tolerated by the body is estimated at 0.3 mg (but this is stated exclusively for inhaled mercury vapour). With 5 to 10 mg of metallic mercury per Byu-dmar 25 pill, this 'jewel pill' thus contains some 15 to 30 times this amount, suggesting that the amount taken in with two to three pills is equivalent to the WHO tolerance boundary for the maximum annual dose. Even so there is still much confusion, especially in the modern mass media, about which kind of mercury is most dangerous for human health according to modern scientific knowledge. It should be stated clearly here that the really dangerous mercury, even in small amounts, is only the organically bound mercury (see below), and that could not be detected in our Tibetan pills. From a purely chemical standpoint, the amount of detected metallic and sulphur bound mercury passes through the human body practically without entering the blood and tissue and can therefore be considered as much less dangerous than organically bound mercury (like that accumulated in fish from polluted waters'). Mercury: Good for Health or Damaging the Brain? What conclusions can we draw from this information? We in the West are convinced - as are the Chinese, Tibetan and Indian Ayurvedic doctors who acknowledge and act in awareness of it - that organically bound mercury and higher doses of any kind of mercury are poisonous, 10 especially to the nervous 8 B. N. Misra and B. K. Mohanty, Hazards of Mercury in Ayurvedic Drugs, Delhi 1994. 9 The well known Minamata Bay disease is the result of a massive epidemic episode of human exposure to alkyl-mercury contaminated food sources (fish). 10 'Mercury as such is poisonous to the body cells' (Dash, op. cit. in note 5, p. 42).

DI system, and chronic poisoning is dangerous to our health." The most important difference is that in the light of the traditional concepts of Asian doctors small or very small amounts, as found in the Tibetan 'jewel pills', after special processing (and this process is the vital factor) are considered beneficial to health, while even these small amounts of mercury are considered to be harmful in the West (regardless of their chemical properties). Western scholarly medical opinion in addition distinguishes between the toxicity of inorganic mercury (as in the precious pills) and organically compounded mercury (as in the case of alkyl-mercuric compounds). Chronic poisoning through metallic mercury as well as organically bound mercury salts elicits, according to Western medical experience, symptoms such as headaches, vertigo and decreasing psychological function. With higher doses, the neurological symptoms of brain damage appear: a slight tremor, involuntary muscle spasms, deafness, spasms of arms and legs. At the early stages of poisoning there is frequently a pronounced restlessness called 'erethismus mercurialis', and chronic insomnia can dominate other symptoms of poisoning. Behavioural changes may appear as depression, increasing in severity with rising levels of poisoning. Ayurvedic and Tibetan doctors insist on never having seen this kind of side effect - but this has never been scientifically proven either way. 'Purification' and 'detoxification' - if they have any meaning - are irrelevant to German or European laws: today it is simply impossible and ethically unacceptable to administer any kind of mercury to patients. In order to overcome this problem and still to test Tibetan 'jewel pills' legally in Germany on people suffering e.g. from migraine, Amchi Tashigang from the Tibetan Medical Institute in Delhi has compounded a mercury-free new 'jewel pill' according to the Tibetan medical system, which contains between eight and thirteen 'jewels', minerals, and plants from the Himalayas, all of which ingredients have been extremely well investigated in Western medicine. This 11 Misra and Mohanty, op. cit. in note 8. These authors conclude (p. 56) that 'the results obtained in their scientific project show substantial bio-accumulation of mercury in the experimental animals administered with the master drug "Kajyolo", a mercurial indigenous drug. The effects are summarised in the schematic diagram (Appendix-I), which reveals a significant toxic effect on mammalian system. It is therefore suggested that such drugs should be avoided as far as practicable. The results further indicate that the mercury purified by the most complicated process in ayurvedic therapy still retains its toxicological properties as evident from the results presented here. The claim of ayurvedic therapists that the mercury loses its toxic properties after purification process is therefore not acceptable.' - It should be added that no alkyl-mercuric or other organic bound mercury could be detected but the same rather inert Hg and HgS as in the Tibetan pills.

J.C. Aschoff, T.Y. Tashigang, Mercury in Tibetan 'Precious Pills' 135 new 'jewel pill' (Byu-dmar 13) has already shown its positive action as a prophylactic medicine for severe migraine in a scientific research project currently being undertaken. 50 40. 40 mg per pill 30 20 20 30 10. 0 Lhasa Kathmandu Ladakh Delhi 3/93 Delhi 9/92 鈽� mercury-sulphide metallic mercury Figure 1 Mercury concentrations in 'jewel pills' from different localities