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Rhubarb (Rheum officinale, Rheum palmatum)

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Also listed as: Rheum palmatum, Rheum officinale
Related terms
Background
Evidencetable
Tradition
Dosing
Safety
Interactions
Attribution
Bibliography

Related Terms
  • Aloe-emodin, Amaro Medicinale Giuliani, anthraglycosides, anthranoids, anthranols, anthraquinone, anthraquinone glucoside, arabinose, Baoshen pill, bastard rhubarb, calcium oxalate, Canton rhubarb, catechin, Chinese rhubarb, chinesischer Rhabarber (German), chrysophanol, chong-gi-huang, common rhubarb, da-huang, dahuang liujingao, daio, danning pian, DHP-1, DHP-2, emodin, English rhubarb, extractum rhei liquidum, fatty acids, flavonoids, galactose, galacturonic acid, gallotannin, garden rhubarb, glucoronic acid, glucose, heterodianthrones, heteroglycans, Himalayan rhubarb, hydroxyanthracene derivatives, Indian rhubarb, Japanese rhubarb, jiang-zhi, jinghuang tablet, liujingao (JZJFY), lyxose, medicinal rhubarb, monoanthrones, naphthalene glucoside, O-glucosides, oxalates, oxalic acid, palmidin A, palmidin B, palmidin C, pectin, phenolic carboxylic acids, physcion, physcion monoglucoside, piceatannol, pie plant, pie rhubarb, Polygonaceae (family), procyanidin, qing shen tiao zhi, QSTZ, racine de rhubarbee (French), resin, RET, Rhabarber (German), rhamnose, rhaponticin, rhapontigenin, rhapontin, rhei radix, rhei rhizoma, rheidin B, rheidin C, rhein, rhein-8-monoglucoside, rheinoside A, rheinoside B, rheinoside C, rheinoside D, rheirhubarbe de chine (French), rheum, Rheum australe, Rheum E, Rheum emodi, Rheum emodi Wall, Rheum officinale Baill, Rheum rhabarbarum, Rheum rhaponticum, Rheum tanguticum Maxim, Rheum tanguticum Maxim. ex. Balf., Rheum tanguticum Maxim L., Rheum undulatum, Rheum webbianum, rheum x cultorum, rhizoma, rhubarb extract tablet, resin, rubarbo, ruibarbo (Spanish), rutin, sennidin C, sennoside A, sennoside B, shengxue, shenlong oral liquid, shenshi rhubarb, starch, stilbenes, sugars, sweet round-leaved dock, tai huang, tannins, Turkey rhubarb, Turkish rhubarb, volatile oil, wine plant, xin qin ning, XQN, xylose.
  • Note: Garden (English) rhubarb (Rheum rhabarbarum or Rheum rhaponticum) is considered food rather than a medicinal herb and contains very small amount of anthraquinones.

Background
  • Chinese herbalists have relied on rhubarb rhizomes and roots for thousands of years. The rhizomes and roots contain powerful anthraquinones and tannins that act as stimulant laxatives and astringents, respectively. In traditional Chinese medicine, rhubarb is also used to treat gastric ulcers, chronic renal (kidney) failure, and pregnancy-induced hypertension (high blood pressure), pre-eclampsia and eclampsia. European herbalists have recommended rhubarb as a laxative, diuretic, and to treat kidney stones, gout (foot inflammation), and liver diseases. Externally, it is recommended to heal skin sores and scabs.
  • The current practice of using rhubarb to treat cancer (as an ingredient in the herbal Essiac® formula) lacks the support of controlled clinical trials. However, rhubarb is being tested for multiple other conditions, including hyperlipidemia (high cholesterol) and obesity.
  • Use for gingivitis, chronic renal failure and upper gastrointestinal bleeding seem to be the most promising, although more research should be done in these areas, specifically with rhubarb as a monotherapy.

Evidence Table

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *


Rhubarb has been used in traditional Chinese medicine for many gastrointestinal disorders, including upper gastrointestinal bleeding. Preliminary evidence suggests that rhubarb may be beneficial in reducing upper gastrointestinal bleeding. Higher quality studies are necessary to confirm this hypothesis.

B


Pyralvex® has been used for decades as a salve for gingivitis and the oral mucosa; Parodium® was introduced more recently as a similar treatment. Their active components both include rhubarb extract. The results from several clinical studies investigating Pyralvex® and Parodium® indicate that these combination treatments may be beneficial in treating gingivitis. However, additional study is needed in this area.

B


A traditional Chinese medicine, rhubarb has shown positive effects on renal (kidney) failure in the lab and seems promising in human studies. In some studies, rhubarb is more effective than captopril, and rhubarb combined with captopril is more effective than either substance alone. Higher quality studies are necessary to confirm this hypothesis.

B


Preliminary study has investigated rhubarb along with other herbs in the treatment of AAMI. Studies of rhubarb alone are needed to discern rhubarb's effect on aging and memory.

C


A combination mixture containing rhubarb seemed to alleviate aplastic anemia. However, the role of rhubarb in the treatment of this condition is still to be determined and additional study is needed in this area.

C


Rhubarb has been used in multiple cultures as a laxative. Although preliminary study is promising, more studies using rhubarb alone are needed to confirm these results.

C


A combination therapy, which included rhubarb, has been studied for non-alcoholic fatty liver disease. Because the therapy involved multiple herbs and other treatments, the effect of rhubarb on non-alcoholic fatty liver disease is difficult to discern. Additional study using rhubarb alone is needed in this area.

C


Rhubarb has been used in traditional Chinese medicine for many gastrointestinal disorders. Currently, there is insufficient available evidence to recommend for or against the use of rhubarb for gastrointestinal cancer surgery.

C


One double-blind controlled trial examined the effect of the herbal extract "Amaro Medicinale Giuliani" and its constituents, including rhubarb, on mild gastrointestinal disturbances. Although the herbal extract and a combination of rhubarb and gentian seem promising, higher quality studies with rhubarb as a monotherapy are need to discern rhubarb's effect on gastrointestinal disturbances.

C


One controlled trial indicates that a combination of rhubarb and sanchi powder seemed to reduce the hemorrhagic effects of nephritic syndrome more than dicynonum. However, higher-quality studies using rhubarb as a monotherapy are needed to discern rhubarb's effects on coagulation and bleeding time.

C


Two studies have been conducted on rhubarb and its effects on hepatitis. In the case series, high doses of rhubarb decreased the symptoms and serum levels associated with hepatitis. However, more higher quality studies are needed to establish rhubarb's effect.

C


One double-blind, controlled trial indicates that topically applied rhubarb-sage extract cream may reduce the symptoms of herpes. More high quality studies using rhubarb as a monotherapy are needed to discern rhubarb's effect on herpes symptoms.

C


Two very different uses of the rhubarb plant have been examined for their effects on hypercholesterolemia (high cholesterol). In one study, a combination product containing rhubarb (Rheum palmatum) seemed to lower cholesterol. In another study, rhubarb (Rheum rhabarbarum) stalk fiber also seemed to lower cholesterol. However, large, high quality studies using rhubarb as a monotherapy are needed to evaluate the impact of both uses of rhubarb.

C


One clinical trial has looked at the effect of a combination therapy that includes rhubarb on nasopharyngeal carcinoma (cancer of the nasopharynx). More higher quality studies with rhubarb as a monotherapy are needed to discern how rhubarb affects nasopharyngeal carcinoma.

C


A preliminary study using the combination therapy of decoction of qingre huoxue recipe (QHR), which contains less than 10% of rhubarb, may improve renal (kidney) function in patients with mid-advanced crescentic nephritis. Higher quality studies using rhubarb as a monotherapy are needed to evaluate rhubarb's effect on nephritis.

C


One three-stage study as looked at the effects of rhubarb on simple obesity. Although the study indicates a positive effect compared to two other obesity treatments and a control group, more high quality studies are needed to confirm rhubarb's role in weight gain and loss.

C


Two studies on rhubarb's effect on pre-eclampsia (a pregnancy disorder characterized by high blood pressure, swelling, and kidney malfunction) indicate that it may be a helpful treatment. More high quality trials are needed to confirm this hypothesis.

C


One study indicates that rhubarb may be helpful in treating systemic inflammation reaction syndrome. However, more high quality, large studies are needed to confirm this hypothesis.

C
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)


Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

  • Abortifacient (induces abortion), allergies, anal fissures, anthelmintic (expels worms), anticoagulation, antioxidant, antiparasitic, astringent, blood cleanser, blood disorders (disseminated intravascular coagulation), bruises, burns, cancer, conjunctivitis (pinkeye), constipation (acute), dental conditions (hypersensitive teeth), diarrhea, diuretic, dysentery (severe diarrhea), dyspepsia (upset stomach), fever, food uses, gastric ulcers, gastritis, gout (foot inflammation), headache, hemorrhoids, herpes simplex, hypertension (high blood pressure), immunomodulation, indigestion, jaundice, kidney stones, laxative, menstrual disorders, Oketsu syndrome, osteoarthritis, pregnancy-related complications (eclampsia), preparation for surgery (recto-anal), rheumatic pain, SARS, skin sores, tonic, toothache, trauma, ulcer, uterine stimulant, wound healing.

Dosing

Adults (18 years and older):

  • There is no proven safe or effective dose for rhubarb. Furthermore, there is no consensus about doses using rhubarb, and there is a wide range of doses and preparations that have been studied or used. Traditionally, rhubarb has been taken as a decoction, tincture, tea, or powdered root for conditions such as constipation, diarrhea, or upset stomach in doses ranging from 0.1-4.0 grams per day. Enemas using 10 grams of rhubarb powder have also been used twice a day for up to seven days in chronic renal (kidney) failure patients.
  • Rhubarb is possibly safe when used short-term (less than 8 days) in lower doses. For upper gastrointestinal bleeding, 3 grams alcoholic extract tablets or powder or 6 milliliters of rhubarb syrup two to four times daily for up to two weeks have been used. For gonorrhea, 7-8 tablets of rhubarb (dose not specified) three times daily for four days have been used.
  • Rhubarb is often taken in large doses when using the crude material (root or stalk), and up to 50 grams of Rheum officinale decocted in 200 milliliters of liquid ingested once a day for 16 days has been used for hepatitis. For hypercholesterolemia (high cholesterol), 27 grams of ground rhubarb fiber stalk taken daily for four weeks has been used. Lower doses (6-9 grams of rhubarb daily for 6-22 months with an initial dose of 1 gram daily has been used; 0.5 gram daily with maximum doses of 3 grams daily for four weeks has been used; 1-3 grams of rhubarb extract daily for 6-48 months, with an average of 18.9 months has been used) have been studied in chronic renal failure patients.
  • For pre-eclampsia, 0.75 gram of rhubarb taken by mouth daily for 9-10 weeks, from the 28th week of pregnancy until delivery, has been used.

Children (younger than 18 years):

  • There is no proven safe or effective dose for rhubarb in children. According to traditional use, when rhubarb is used in older children or elderly over age 65, lower strength preparations should be used. In case reports, rhubarb has caused neonatal jaundice.
  • For the treatment of hepatitis, 25-30 grams of Rheum officinale decocted in 200 milliliters of liquid once a day for 16 days, with a one-day break every six treatments, has been used. For simple obesity, 5 tablets of 2.5-3.75 grams of refined rhubarb extract every night for one week has been used.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

  • Avoid in individuals with a known allergy or hypersensitivity to rhubarb or its constituents. Anaphylaxis and rash have been reported.

Side Effects and Warnings

  • Rhubarb leaves contain poisonous oxalic acid. Oxalic acid may form insoluble calcium oxalate crystals in the blood that may be deposited in the kidneys, leading to kidney stones. Excessive consumption of rhubarb leaves may cause abdominal pain, electrolyte loss (especially potassium), hyperaldosteronism (overproduction of the hormone aldosterone), edema (swelling), burning of the mouth and throat, arrhythmias (irregular heartbeat), cardiac toxicity, diarrhea, seizures, bone deterioration, muscular weakness, nausea, vomiting, seizures and death.
  • Rhubarb may cause bright yellow or red urine. Chronic use of rhubarb stalk or root may cause dependence with possible need for increased doses. It may also lead to electrolyte depletion (especially potassium), hyperaldosteronism, accelerated bone deterioration, edema, inhibition of gastric motility, pseudomelanosis coli, intestinal griping, colic, melanosis coli, and atonic colon. Avoid using rhubarb for more than two weeks. Although not well studied in humans, rhubarb anthraquinones may cause nephrotoxicity (kidney damage).
  • Short-term use of rhubarb may cause elevations of serum ALT levels, spasmodic cramps, watery diarrhea, impaired hemostasis, hemorrhaging, and neonatal jaundice. High tannin levels of rhubarb root may increase the chance of hepatic necrosis (death of liver cells). Increased gurgling sounds, abdominal discomfort, increased stool passage, mild abdominal pain before defecation, nausea and vomiting has occurred with short-term use of rhubarb. The adverse effects of Pyralvex® (contain rhubarb) short-term use include abdominal pain, slight burning and dark discoloration of the gums. Use of rhubarb during menstruation may impair hemostasis.
  • Handling rhubarb leaves may cause rash.
  • Use cautiously in patients with bleeding disorders or using coagulation therapy, as rhubarb leaves may impair hemostasis and there was report of one patient having severe hemorrhaging because of respiratory tract infection and fever.
  • Use cautiously in patients with constipation because the astringent effects of rhubarb may exacerbate the condition.
  • Use cautiously in patients with hemorrhoids, due to the potential for inducing or aggravating hemorrhoidal thrombosis or prolapse.
  • Avoid using rhubarb if fever, inflammation and abdominal pain of unknown origin are present or in cases of appendicitis, due to possible rupture of inflamed viscus, such as the appendix.
  • Avoid using rhubarb with intestinal obstruction or ileus, due to cathartic effects of anthraquinone derivatives, rhein, and the sennosides.
  • Avoid using rhubarb with diarrhea, due to the chance of electrolyte disturbances.
  • Avoid using rhubarb in patients with Crohn's disease, ulcerative colitis, colitis, and irritable bowel syndrome (IBS), as rhubarb may have irritating effects.
  • Avoid in patients with insufficient liver function, as rhubarb may be hepatotoxic (liver damaging).

Pregnancy and Breastfeeding

  • Rhubarb is not recommended in pregnant or breastfeeding women due to a lack of available scientific research. In theory, rhubarb may have uterine stimulant effects. Due to anthraquinone alkaloids, which are potentially, mutagenic and genotoxic, rhubarb may be risky during breastfeeding. In case reports, rhubarb has also caused neonatal jaundice. Pregnant women considering taking rhubarb should consult with a qualified healthcare professional, including a pharmacist, to check for interactions.

Interactions

Interactions with Drugs

  • Rhubarb root contains tannins that may possess inhibitory activity against angiotensin converting enzyme (ACE). Caution is advised in patients with high blood pressure or those taking ACE inhibitors or other blood pressure lowering agents.
  • If taken within one hour, antacids may decrease the effectiveness of rhubarb.
  • Overuse of rhubarb may cause potassium depletion, increasing the risk of the toxicity of other anti-arrhythmic agents (treat irregular heartbeat), such as quinidine. It may also increase the risk of digoxin toxicity.
  • Rhubarb and low doses of anti-psychotic drugs reduced the need for higher doses of anti-psychotic drugs in schizophrenic patients.
  • In clinical trials, rhubarb has shown a synergistic effect with captopril to reduce serum creatinine levels.
  • Rhubarb may reduce gingivitis when used with chlorhexidine.
  • Although not well studied in humans, the combination of cisplatin and rhubarb may reduce the lethal toxicity and renal (kidney) toxicity of cisplatin, a common chemotherapeutic agent. The combination does not appear to interfere with the chemotherapeutic effect of cisplatin.
  • Rhubarb may increase potassium loss, thus aggravating electrolyte imbalance (e.g. with steroids). Concomitant use of rhubarb with other laxatives may increase electrolyte and fluid loss, potentiating their effect.
  • The high tannin level of rhubarb root may increase the chance of hepatic necrosis (liver death). Caution is advised when taking rhubarb with other potentially liver damaging agents due to the increased risk of liver damage.
  • Although not well studied in humans, the anthraquinones present in rhubarb may increase the risk of nephrotoxicity (kidney damage). Consult with a qualified healthcare professional, including a pharmacist, to check for interactions with other kidney damaging agents.
  • Rhubarb enhanced nifedipine's anti-pre-eclampsia effects.
  • Rhubarb's laxative effects with may reduce the absorption of other drugs taken by mouth due to a reduction in gastrointestinal transit time.

Interactions with Herbs and Dietary Supplements

  • Rhubarb is frequently used as a small component in multi-herb traditional Chinese medicine decoctions. Examples of herbs that have been combined with rhubarb include: Alismatics orientalis, sanchi powder, and sage.
  • Because of rhubarb's potential to deplete potassium, concomitant use of rhubarb may increase cardiac toxicity of cardiac glycoside-containing herbs. An increase in potassium depletion and severe cardiac toxicity may be caused by concomitant use of rhubarb with cardio-active herbs, such as calamus, ginger, and Panax ginseng.
  • Rhubarb may enhance the effects of some herbs or supplements, such as the laxative effects of Glauber's salt. Rhubarb used with leech therapy reduced the need for anti-psychotic drugs in schizophrenic patients.
  • The high tannin level of rhubarb root may increase the chance of hepatic necrosis (liver cell death).
  • The action of jimsonweed may be increased in chronic use or abuse of rhubarb.
  • Concomitant use of rhubarb and licorice or horsetail may cause potassium depletion. Although not well studied in humans, rhubarb may also have diuretic properties, which may compound diuretic-induced potassium loss. Rhubarb is also proposed to cause bowel movements and may cause potassium depeletion when used with other laxatives. Rhubarb may increase potassium loss when used with steroids as well.
  • Although not well studied in humans, the anthroquinones present in rhubarb taken with other potentially nephrotoxic (kidney damaging) herbs may increase the risk for kidney damage.
  • Concomitant use of rhubarb with other herbs taken by mouth may reduce their absorption, due to reduction in gastrointestinal transit time. Rhubarb may also decrease mineral absorption. Its oxalate content may bind multivalent metal ions in the gastrointestinal tract and decrease their absorption.

Attribution
  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
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  2. Cai J, Xuan ZR, Wei YP, et al. [Effects of perioperative administration of Rhubarb on acute inflammatory response in patients with gastric cancer]. Zhong.Xi.Yi.Jie.He.Xue.Bao. 2005;3(3):195-198.
  3. Deng YY, Chen YP, Wang L, et al. [Clinical study on treatment of mid-advanced crescentic nephritis by qingre huoxue recipe]. Zhongguo Zhong.Xi.Yi.Jie.He.Za Zhi. 2004;24(12):1084-1086.
  4. Fan JG. Evaluating the efficacy and safety of Danning Pian in the short-term treatment of patients with non-alcoholic fatty liver disease: a multicenter clinical trial. Hepatobiliary.Pancreat.Dis.Int 2004;3(3):375-380.
  5. Fu DC, Yu CY. [Observation on therapeutic effect of Rhubarb and sanchi powder in treating patients with hemorrhagic fever in nephrotic syndrome complicated with digestive tract bleeding]. Zhongguo Zhong.Xi.Yi.Jie.He.Za Zhi. 2005;25(8):744-747.
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  7. Ho TY, Wu SL, Chen JC, et al. Emodin blocks the SARS coronavirus spike protein and angiotensin-converting enzyme 2 interaction. Antiviral Res 5-15-2006.
  8. Li C, Zhou J, Gui P, He X. Protective effect of rhubarb on endotoxin-induced acute lung injury. J Tradit.Chin Med 2001;21(1):54-58.
  9. Pelletier JP, Yaron M, Haraoui B, et al. Efficacy and safety of diacerein in osteoarthritis of the knee: a double-blind, placebo-controlled trial. The Diacerein Study Group. Arthritis Rheum 2000;43(10):2339-2348.
  10. Peng SM, Wang SZ, Zhao JP. [Effect of rhubarb on inflammatory cytokines and complements in patients with systemic inflammation reaction syndrome and its significance]. Zhongguo
  11. Zhong.Xi.Yi.Jie.He.Za Zhi. 2002;22(4):264-266.
  12. Sauro S, Gandolfi MG, Prati C, et al. Oxalate-containing phytocomplexes as dentine desensitisers: An in vitro study. Arch Oral Biol 4-5-2006;
  13. Tseng SH, Lee HH, Chen LG, et al. Effects of three purgative decoctions on inflammatory mediators. J Ethnopharmacol. 4-21-2006;105(1-2):118-124.
  14. Yan M, Zhang LY, Sun LX, et al. Nephrotoxicity study of total rhubarb anthraquinones on Sprague Dawley rats using DNA microarrays. J Ethnopharmacol. 4-15-2006;
  15. Zhu W, Wang XM, Zhang L, et al. Pharmacokinetic of rhein in healthy male volunteers following oral and retention enema administration of rhubarb extract: a single dose study. Am J Chin Med 2005;33(6):839-850.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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