Traditional practices such as the application of black stone (BS) following snakebite are common in rural settings of Asia, Africa and Latin America. However, the use of black stone remains controversial. While proponents of BS claim that it absorbs venom to mitigate systemic envenoming, critics raise concerns regarding its safety and efficacy. The World Health Organisation guidelines advise against its use, yet reliance on this practice persists. This narrative review aims to synthesise and provide comprehensive evidence on BS, emphasising its identity, proposed mechanism, efficacy, associated risks, and the potential drivers of its continued use. The review involved peer-reviewed biomedical literature retrieved from PubMed and Google Scholar using appropriate search terms. It focused on experimental studies, reviews, and observational studies. The precise composition of BS remains unclear. However, studies suggest that it is derived from burned animal horn, bone, or stone. Its purported mechanism involves venom absorption at the bite site, although this remains unproven. Animal studies and WHO guidelines do not support its clinical use in the management of snakebite. Its persistent use is potentially driven by socioeconomic, cultural, and health system factors. In conclusion, BS currently lacks validated therapeutic benefits and may contribute to delays in seeking appropriate hospital treatment, as well as cause infections and tissue injuries. Snakebite-affected areas should improve community and school education to nullify dependence on traditional post-snakebite practices, including the use of black stone, and engage with traditional healers in a culturally sensitive manner to ensure timely access to antivenom.
BT - Toxicon: official journal of the International Society on Toxinology C1 - https://www.ncbi.nlm.nih.gov/pubmed/41905668 DA - 06/2026 DO - 10.1016/j.toxicon.2026.109088 J2 - Toxicon LA - ENG M3 - Article N2 -Traditional practices such as the application of black stone (BS) following snakebite are common in rural settings of Asia, Africa and Latin America. However, the use of black stone remains controversial. While proponents of BS claim that it absorbs venom to mitigate systemic envenoming, critics raise concerns regarding its safety and efficacy. The World Health Organisation guidelines advise against its use, yet reliance on this practice persists. This narrative review aims to synthesise and provide comprehensive evidence on BS, emphasising its identity, proposed mechanism, efficacy, associated risks, and the potential drivers of its continued use. The review involved peer-reviewed biomedical literature retrieved from PubMed and Google Scholar using appropriate search terms. It focused on experimental studies, reviews, and observational studies. The precise composition of BS remains unclear. However, studies suggest that it is derived from burned animal horn, bone, or stone. Its purported mechanism involves venom absorption at the bite site, although this remains unproven. Animal studies and WHO guidelines do not support its clinical use in the management of snakebite. Its persistent use is potentially driven by socioeconomic, cultural, and health system factors. In conclusion, BS currently lacks validated therapeutic benefits and may contribute to delays in seeking appropriate hospital treatment, as well as cause infections and tissue injuries. Snakebite-affected areas should improve community and school education to nullify dependence on traditional post-snakebite practices, including the use of black stone, and engage with traditional healers in a culturally sensitive manner to ensure timely access to antivenom.
PY - 2026 T2 - Toxicon: official journal of the International Society on Toxinology TI - Persistent use of black stone for snakebite envenoming in tropical and subtropical Asia and Africa: a literature review. VL - 276 SN - 1879-3150 ER -