A class of complex Tibetan pills commonly called precious pills, or Rinchen rilbu in Tibetan, is a compounded Tibetan formula combining dozens of minerals and herbs. Tsotel (btso thal), the key medicinal compound in precious pills, synergizes with the other herbs and minerals in each formula and is used to treat strokes, inflammation, chemical poisoning, such as anthrax, neural disorders and diseases arising from various toxicities. Tibetans have used these medicines for at least 2000 years. However, since the medicinal compound of tsotel includes minerals such as gold, iron, and especially mercury, some scholars and physicians have toxicity concerns surrounding tsotel administration. Thus, elucidating the traditional process of compounding this medicinal substance will improve our understanding of tsotel’s safety and efficacy.