While many associate rhubarb only with the sour celery-like stalks commonly used in pies, traditional Chinese medicine has known about this group of plants for thousands of years. Rhubarb has been used as a remedy for a wide variety of diseases, ranging from gut issues to inflammation. Read on to learn more about this versatile herb.
What is Rhubarb?
Rhubarb is the name used to describe several plant species in the genus Rheum, native to China, Iran, Turkey, and India. Its underground storage organs – roots and rhizomes – have been used in traditional Chinese medicine since the third millennium BC. Rhubarb has been historically used to heal a wide variety of issues such as constipation, fever, inflammation, and kidney failure [1, 2, 3+, 4, 5, 6, 7+].
Rhubarb is known for its very sour, celery-like stalks, which vary in color, from pale pink to pale green. While the stalks can be used for cooking, the leaves are very poisonous. Some common varieties of rhubarb include [1, 7+]:
- Chinese rhubarb (Rheum officinale or Rheum palmatum)
- Garden or culinary rhubarb (Rheum rhabarbarum)
- Rhapontic rhubarb or false rhubarb (Rheum rhaponticum L.)
- Syrian rhubarb (Rheum ribes L.)
- Chinese rhubarb may help with liver and kidney issues
- Rhapontic rhubarb helps with symptoms of menopause and menstrual pain
- Fights bacteria
- May boost gut health
- The leaves are very toxic
- Probably not effective for weight loss
- Can cause diarrhea due to its laxative effect
- Various plant pigments (anthraquinone compounds such as aloe-emodin, chrysophanol, emodin, and rhein)
- Laxative phenolic compounds (anthraquinone glycosides such as sennosides)
- Antioxidant phenolic compounds (catechins)
- Other phenolics (naphthalenes, glucose gallates)
- Polysaccharides (complex sugars)
Rhubarb contains toxic compounds known as salts of oxalic acid/oxalates, which are not broken down during cooking. These compounds are highly concentrated in the leaves, which should not be consumed [7+].
Mechanisms of Action
Anthraquinone compounds such as sennosides are well-known laxatives that stimulate bowel movements. These compounds are not absorbed in the intestine and reach the colon unchanged. Gut bacteria then break them down into active metabolites, which reduce the amount of water the colon reabsorbs. This increases the fluid content and volume in the stool, easing constipation [3+].
Other anthraquinone compounds such as aloe-emodin, emodin, and rhein have antibacterial properties. They may work by disrupting cell membranes of bacteria and their protein and energy production. Aloe-emodin can also act as a laxative .
Health Benefits of Rhubarb
1) Liver Diseases
Non-Alcoholic Fatty Liver Disease
A Chinese herbal medicine containing rhubarb called Danning Pian improved non-alcoholic fatty liver disease symptoms and reduced ALT levels, a marker of liver damage (clinical trial of 232 people) .
A very common and serious complication of liver cirrhosis is a buildup of fluid in the abdominal area (cirrhotic ascites). In a clinical trial of 92 people, Xiaozhang Tie, a Chinese herbal medication with rhubarb, moderately reduced abdominal swelling and overall symptoms. It was given alongside conventional treatment .
Genetic Disorders of the Liver
Infantile cholestatic hepatitis syndrome is a rare genetic disorder that causes bile build-up in the liver of newborns. Rhubarb was 89% effective at reducing jaundice, yellowish pigmentation of the skin that indicates bile buildup. This points to the potential of rhubarb to greatly enhance liver function (clinical trial of 64 people) .
In summary, rhubarb has the potential to be safely used as a supplement for boosting liver function, alongside conventional treatments.
2) Kidney Failure
In people with chronic kidney failure, levels of blood urea nitrogen (BUN) and creatinine are often high, as the kidneys struggle to eliminate waste products from the blood. Supplementation with 1 g/day of rhubarb normalized levels of BUN, creatinine, and other waste products (clinical trial of 48 people) .
Similarly, a Chinese herbal supplement containing rhubarb (Niaodujing) increased the removal of creatinine from the blood in a clinical trial of 105 people with chronic kidney failure .
Taking a Chinese herbal combination with rhubarb, Rheum E, helped slow the progression of chronic kidney failure in a clinical trial of 30 people. It was effective both alone and in combination with a drug for high blood pressure called Captopril .
Combined with dialysis, a Chinese medication with rhubarb (Xinqingning) reduced uremia, a buildup of toxins in the blood. It helped slow the progression of chronic kidney failure (clinical trial of 57 people). Baoyuan Dahuang Decoction, a different rhubarb-containing Chinese mixture improved the quality of life in people with chronic kidney failure (clinical trial of 56 people) [17, 18].
To sum it up, various Chinese herbal remedies containing rhubarb show benefits for people with kidney failure by reducing overall symptoms and the buildup of waste products.
3) Diabetic Kidney Disease
Kidney disease is a common complication of diabetes. When people with this condition took a Rhubarb-containing Chinese herbal mixture (Tangshen Recipe) with their insulin, they experienced a similar improvement in biomarkers to those taking conventional anti-diabetes drugs with insulin (clinical trial of 112 people) .
4) Kidney Inflammation
In a clinical trial of 32 people with kidney inflammation, a rhubarb-containing Chinese herbal remedy (Decoction of Qingre Huoxue) added to steroidal anti-inflammatory drugs improved kidney function better than the drugs alone. This remedy may allow for the dosage of steroids to be lowered while achieving equal anti-inflammatory benefits .
5) Lowers Cholesterol
Consuming 27 g/day of ground rhubarb stalks reduced total and LDL cholesterol by 8 – 9% in a clinical trial of 10 men. Levels started to rise again one month after stopping rhubarb. The benefits were most likely due to the high fiber content of the powder .
Similarly, in a clinical trial of 83 people with clogged arteries, a Chinese rhubarb preparation (50 mg/kg) lowered total and LDL cholesterol and also improved artery health .
6) High Blood Pressure
A Chinese herbal with rhubarb (Jiangzhuoqinggan) was as effective as the standard drug, irbesartan, at reducing both systolic and diastolic blood pressure .
Pregnancy can temporarily cause high blood pressure. A low dose of Chinese rhubarb (0.75 g/day) was able to reduce the rates of this condition in pregnant women at high risk (clinical trial of 333 women) .
7) Menopause Symptoms
In a clinical trial of 109 women approaching menopause, a rhapontic rhubarb supplement (ERr 731) reduced improved the quality of life and reduced symptoms such as the frequency and severity of hot flashes. Importantly, this supplement didn’t alter important gynecological factors (such as uterus health or bleeding) .
8) Soothes Menstrual Pain
In a clinical trial of 45 women, Himalayan rhubarb (1,260 mg, 2x/day) was equally effective at reducing menstrual pain as the painkiller mefenamic acid .
9) Reduces Pancreas Inflammation
According to a meta-analysis of 16 clinical trials with over 900 people, rhubarb used with a specific class of drugs (trypsin inhibitors) is effective and safe for reducing pancreatic inflammation .
In a clinical trial of 126 people with severe inflammation of the pancreas, the use of Chinese rhubarb powder (15 g, 1 – 2x/day) with a specific nutrition plan (early enteral nutrition) lowered inflammation in the whole body, disease severity, and liver and kidney damage .
A raw Chinese rhubarb solution (50 g/100 mL) helped reduce pancreas inflammation and abnormally high pancreatic enzyme levels in the blood after endoscopy (clinical trial of 500 people) .
10) Herbicide/Pesticide Poisoning
A meta-analysis of 12 studies concluded that Chinese rhubarb has a beneficial effect on people with pesticide poisoning (despite the low quality of some studies) .
10 g/day of Chinese rhubarb in combination with other herbs, stomach washing, and clay, was effective for herbicide poisoning. This protocol helped eliminate toxins, reduced their absorption, sped up recovery time, and prevented damage to multiple organs .
Chinese rhubarb combined with mineral powder and blood purification was more effective at treating severe herbicide poisoning than the standard procedure. Rhubarb reduced the duration of the hospital stay and the use of artificial breathing machines, helping the patients recover consciousness more quickly .
11) Reduces Complications from Blood Poisoning (Sepsis)
After 6 days of crude Chinese rhubarb (3 g/3x a day), people with blood poisoning stemming from a severe infection (sepsis) had improved intestinal permeability (clinical trial of 40 people). Another clinical trial of 40 people using 9 g/day of raw Chinese rhubarb found the same benefits [37, 38].
Additionally, a meta-analysis of 27 animal studies determined Chinese rhubarb may help reduce organ damage from blood poisoning. The benefits possibly derive from its antioxidant and anti-inflammatory properties .
12) Gut Issues
In a clinical trial of 30 people, Chinese rhubarb (10 g/day, fed nasally 3x/day) added to the normal treatment improved gut function .
In another trial of 89 critically-ill children, a Chinese herbal remedy (Fu’an Liquid) added to conventional drugs successfully reduced gut dysfunction. However, even though a greater number of treated children survived, death rates were still high (30%) .
13) Heals Gut Infections
Syrian rhubarb syrup (2.5 – 5 mL) along with an antibiotic (ceftriaxone) reduced fever, diarrhea, and the duration of stomach pain in a clinical trial of 150 children with an intestinal infection. It also reduced the need for anti-fever medication .
14) Digestive Tract Bleeding
Chinese rhubarb helped stop digestive tract bleeding in a study of 312 hospitalized people .
In a clinical trial of 60 people with digestive tract bleeding and fever, taking ground Chinese rhubarb (3 g, 3-4x/day) with ground Chinese ginseng (sanchi powder) boosted recovery. The combination worked by constricting the blood vessels, increasing platelets, improving platelet clumping, and reducing bleeding time .
15) Heals Ulcers
Chinese rhubarb extract (5%) was moderately effective at speeding the healing from recurring mouth ulcers in a clinical trial of 125 people .
16) Systemic Inflammatory Response Syndrome
Systemic inflammatory response syndrome (SIRS) causes widespread inflammation. In people with SIRS, Chinese rhubarb powder added to the conventional treatment helped cure the disease, reduced organ damage and deaths. It probably acted by lowering inflammatory substances (TNF-alpha, C-reactive protein, complement 3, and complement 4) in the blood (clinical trial of 78 people) .
17) Improves Recovery after Surgery
In a clinical trial of 360 people, a Chinese herbal concoction (Dannang Recipe No. 2) helped people undergoing gallbladder removal surgery recover gut functionality more quickly. It also reduced the length of the hospital stay and the need for IV fluids better than just antibiotics (Ceftizoxime sodium or Levofloxacin) .
18) Aids Stroke Recovery
A meta-analysis of studies with close to 1k participants determined that Chinese herbal mixtures that contain rhubarb, in addition to conventional medication, helped patients recover from strokes by reducing the severity of their post-stroke symptoms .
Rhubarb (5 – 10 g, 2 – 3x/day) given after surgery to stroke patients decreased markers of inflammation (complement 3, complement 4, and hypersensitive C-reactive protein), indicating improved healing .
19) Protects Against Radiotherapy
Radiotherapy for lung cancer can cause severe damage. In a clinical trial of 80 people, not only did 20 mg/kg rhubarb reduce the incidence of lung toxicity, but it also improved lung function and reduced levels of inflammatory substances (TGF-beta1 and IL-6) .
20) Reduces Fungal Infections
In a study with over 1k people, Chinese rhubarb preventatively given to patients with life-threatening bacterial blood poisoning (sepsis) lowered fungal infections, especially when combined with adequate nutrition (via stomach tubes or IV nutrition) .
Rhubarb may be a good natural anti-fungal for common and less dangerous yeast infections as well, but this has not been scientifically examined.
21) Reduces Inflammation
In a clinical trial of 56 people, 10% Chinese liquid rhubarb along with conventional treatment lowered key inflammatory markers (c-reactive protein and IL-6) in stomach cancer patients .
Similarly, 50 mL, 3x/day of a Chinese herbal (Hengyan medicine) used with conventional medication decreased levels of the inflammatory agents IL-6, IL-10, and TNF-α (clinical trial of 45 people with a life-threatening infection) .
22) Boosts Mental Function
Chinese rhubarb added to a Chinese remedy (Compound Tong Jiang Oral Liquid), improved memory and had antioxidant effects in senile people .
23) Topical Herpes Treatment
Unfortunately, many current topical treatments for herpes sores are not very effective. A sage and Chinese rhubarb (23 mg/g) topical cream was almost as effective as a common herpes medication (Zovirax) at healing herpes sores (clinical trial of 145 people) .
24) Improves Acute Respiratory Distress Syndrome
Acute Respiratory Distress Syndrome causes serious lung inflammation. In a clinical trial of people with this disease, 30 g/day of Chinese rhubarb was able to reduce fluid buildup in the lungs .
25) Weight Loss
A traditional Chinese herbal remedy that contains rhubarb (Xin-Ju-Xiao-Gao-Fang) at typical to low doses (10%) decreased the body weight and insulin resistance in a clinical trial of 140 obese people .
A similar Chinese herbal remedy (Jiangzhuoqinggan) reduced waist circumference in a clinical trial of 240 people with high blood pressure .
Animal and Cell Studies
The following studies were performed only on animals or cells.
The anthraquinones in rhubarb have antibacterial properties. One such compound, emodin, is effective against Staphylococcus aureus (even antibiotic-resistant strains), the bacteria that causes staph infections .
Limitations and Caveats
Chinese rhubarb, which the majority of the studies used, is usually combined with other Chinese herbs and medicinal plants. The effects of rhubarb alone remain very obscure.
Many of the Chinese rhubarb articles were conducted in China with Chinese people, which limits the conclusions that can be drawn.
The health effects of the other forms of rhubarb have not been studied extensively.
4 meta-analyses examined rhubarb’s effects on herbicide poisoning, stroke recovery, pancreatic inflammation, and blood poisoning (sepsis). All four analyses considered the examined studies had poor methodologies [34, 6, 47, 31].
The stroke meta-analysis determined a lack of blinding (which confers a high risk of bias), inadequate reporting of adverse events, and no follow-up .
The blood poisoning meta-analysis only examined animal studies with very small sample sizes .
Side Effects & Precautions
- High ALT levels
- Skin rash
- Changes in urine color
Because rhubarb has a laxative effect, please discuss with your doctor before taking it with any medication. Combining it with digoxin (Lanoxin, Digox), used for treating heart failure, can be especially dangerous .
Is Rhubarb Poisonous?
While many plants contain oxalates/oxalic acids in varying amounts, rhubarb leaves contain very high concentrations of these toxic compounds, making them unsafe for consumption. However, the stalks are low in oxalates and safe to eat. Both Chinese and common rhubarb, the most common types, are generally considered safe for consumption [7, 61].
- Dried root pieces
- Traditional Chinese Medicine combination remedies (most common)
The dosages for rhubarb widely vary. Clinical trials used doses ranging from 50 mg to 50 g/day.
For Chinese rhubarb in a crude powder form, a common dosage is approximately 10 – 30 g/day.
The dosage of ERr 731 (rhapontic rhubarb) is 1 tablet/day.
One reviewer said rhubarb extract alleviated their kidney stone symptoms completely. Another mentioned that taking rhubarb extract helped boost their mood and curb their cravings. One person said rhubarb supplements improved their energy levels.
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The roots and rhizomes of Rhubarb have been used in various cultures around the world, from Iran and India to Russia and China.
This herb is especially important in Traditional Chinese Medicine (TCM), which considers it a vital remedy for various diseases. Scientific studies have confirmed numerous benefits that range from gut, liver and kidney protection to reducing inflammation and fighting infections. Rhubarb is often combined with other herbs and dietary changes to achieve synergistic effects in TCM.
Common rhubarb, on the other hand, is an effective and gentle remedy for women. It can soothe menstrual pain and may help women experience fewer symptoms transitioning to menopause. Some studies suggest it may also help reduce anxiety and boost mood in women around menopause.
The parts of rhubarb medicinally used are generally very safe and cause few side effects. It’s also important to keep in mind that Rhubarb has laxative action, which is desired in some cases but may cause discomfort in others. The leaves of Rhubarb are toxic and should not be consumed.
If you’re considering supplementing with this herb, make sure to get a formulation suited to your needs. Many products exist, often in combination with other herbs.