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Overview

Rhubarb

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 (Click Here to view Natural Standard evidence-based validated grading rationale™.)

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
Bleeding (upper gastrointestinal) 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
Gingivitis 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
Renal failure (chronic) 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
Age-associated memory impairment (AAMI) 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
Aplastic anemia 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
Constipation (chronic) 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
Fatty liver (non alcoholic) 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
Gastrointestinal cancer surgery 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
Gastrointestinal tract disorders 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
Hemorrhagic fever (nephritic syndrome) 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
Hepatitis 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
Herpes 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
Hypercholesterolemia (high cholesterol) Two very different uses of the rhubarb plant have been examined for their effects on 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
Nasopharyngeal carcinoma 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
Nephritis (mid-advanced crescentic) 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
Obesity (simple) 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
Pre-eclampsia 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
Sepsis (systemic inflammation reaction syndrome - SIRS) 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

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.

Bibliography

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

Albrecht UW. [The efficacy and tolerability of Pyralvex solution and Pyralvex Gel in the treatment of gingivitis. Results of double-blind, randomised, controlled clinical trials]. Der Freie Zahnarzt 1997;9:76-80.

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. View Abstract

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. View Abstract

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. View Abstract

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. View Abstract

Greenway FL, Liu Z, Martin CK, et al. Safety and efficacy of NT, an herbal supplement, in treating human obesity. Int J Obes (Lond) 4-25-2006; View Abstract

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. View Abstract

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. View Abstract

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. View Abstract

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

Zhong.Xi.Yi.Jie.He.Za Zhi. 2002;22(4):264-266. View Abstract

Sauro S, Gandolfi MG, Prati C, et al. Oxalate-containing phytocomplexes as dentine desensitisers: An in vitro study. Arch Oral Biol 4-5-2006; View Abstract

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. View Abstract

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; View Abstract

Zhou Y, Huang Z, Huang T, et al. Clinical study of shengxue mixture in treating aplastic anemia. Chinese Journal of Integrated Traditional and Western Medicine 2001;7(3):186-189.

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. View Abstract

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.

Natural Standard Bottom Line Monograph, Copyright © 2009 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intendedfor informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.

Natural Standard's methodology , editorial board , and grading scales.

While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.

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Health Glossary

Rhubarb

Background

Evidence Table (Click Here to view Natural Standard evidence-based validated grading rationale™.)

Tradition

Tradition Theory

Dosing

Safety

Interactions

Attribution

Bibliography

Related Terms