Rhubarb
Rhubarb
Rhubarb
(http://www.mcp.edu/herbal/default.htm) and
The Center for Holistic Pediatric Education and Research
Overview
Chinese herbalists have relied on rhubarb rhizomes (roots) for thousands of years. The
rhizomes contain powerful anthraquinones that act as stimulant laxatives and tannins that act as
astringents1. The Chinese also use rhubarb to treat gastric ulcers, chronic renal failure, and
pregnancy-induced hypertension. The current practice of using rhubarb to treat cancer (as an
ingredient in the herbal Essiac formula) lacks the support of controlled clinical trials2. Rhubarb
root can cause severe diarrhea and abdominal cramps. Treatment periods as a laxative should not
exceed eight to ten days. Persons with a history of renal stones should avoid rhubarb due to its
high oxalate content. The high tannin content may cause upset stomach, renal damage, hepatic
necrosis and increased risk of esophageal and nasal cancer. Rhubarb root is not recommended
during pregnancy or lactation or by children less than 12 years old. There is marked variation in
the content of active compounds in commercially available rhubarb products. Consumers should
be aware that medicinal rhubarb root is not the same as the garden rhubarb used for food.
Botany
Medicinal species: Rheum officinale or R. palmatum L. Other rhubarbs from other parts of the
world include R. tanguticum Maxim. ex. Balf., R. emodi and R. webbianum, also known
as Indian or Himalayan rhubarb. Garden (English) rhubarb or R. rhaponticum is
considered food rather than medicine. Active ingredients vary by species; different
species are frequently substituted for one another in commercially available medicinal
rhubarb products, some of which may also be contaminated with heavy
metals9,10,11,12,13.
Common names: Canton rhubarb, Chinese rhubarb, chong-gi-huang, da-huang, daio, Japanese
rhubarb, medicinal rhubarb, racine de rhubarbee (French), rhabarber, rhei radix, rheum,
rhizoma rhei, shenshi rhubarb, tai huang, Turkish rhubarb, Turkey rhubarb.
Botanical family: Polygonaceae, which contains 51 genera and 1150 species, including
buckwheat14.
Plant description: Medicinal rhubarb (R. palmatum or R. officinale) is a large, leafy perennial
with hollow stalks that may reach ten feet in height. The root/rhizome is the part used
medicinally; it is thick and branching, with a brown exterior and a yellow interior. The
medicinal species are not garden herbs. Garden rhubarb typically grows to about three
feet and has reddish to purple stems. It contains similar active ingredients, but is much
less potent, so doses would need to be increased for medicinal use. Roots can be
harvested as early as the fourth year after planting; the plants are harvested in the
spring15.
Where its grown: Medicinal rhubarb is native to China and Tibet and is cultivated in Europe,
India and Pakistan; imports from developing countries may be contaminated8. The most
potent products are grown at high altitude such as in eastern Tibet.
The anthraquinones found in rhubarb are also found in other natural stimulant laxatives
such as senna, buckthorn, cascara sagrada and the lining of aloe leaves18. They enhance colonic
motility and stimulation of chloride and water secretion into the stool. Quantities of the active
ingredients vary during growth, by season and during processing19,20. Tests of the sennoside
content of different market rhubarb preparations in China and Japan reveal marked variations in
the content of active compounds, with some products containing no active ingredients9,21. The
British and European pharmacopeias specify that products must contain not less than 2.2% of the
hydroxyanthracene derivatives, calculated as rhein.
Oxalic acid combines with calcium in blood, forming insoluble calcium oxalate crystals
that may be deposited in the kidneys, leading to renal stones. Persons with a history of renal
stones should use great caution when consuming oxalate-containing herbs and consider avoiding
their use altogether22.
Rhubarb contains 5% - 10% tannins. Tannins are phenolic compounds found in many
herbs and common foods, such as sorrel and tea. Plants that contain more than 10% tannins have
potential adverse effects including upset stomach, renal damage, hepatic necrosis, and an
increased risk of esophageal and nasal cancer. Tannins are astringent and are traditionally used
topically for a variety of wet or oozing skin conditions such as poison ivy. Therapeutically,
tannins have been used to treat diarrhea and inflamed mucus membranes22. It is thought that at
low dosages, the tannin activity in rhubarb supersedes the anthraquinone activity, thus leading to
Experimental Studies
Rhubarb: Potential Clinical Benefits
1. Cardiovascular: Pregnancy-induced hypertension (PIH), myocardial contractility
2. Pulmonary: none
3. Renal and electrolyte balance: Diuretic, diabetic nephropathy and chronic renal failure, renal
protectant
4. Gastrointestinal/hepatic: Diarrhea, constipation, liver disease, ulcers, pancreatitis
5. Neuropsychiatric: none
6. Endocrine: none
7. Hematologic: none
8. Rheumatologic: none
9. Reproductive: Uterine tonic
10. Immune modulation: Immunostimulant, anti-inflammatory
11. Antimicrobial: Antiviral, antibacterial, molluscicidal, antitrichomonal
12. Antineoplastic: Ingredient in Essiac remedy
13. Antioxidant: none
14. Skin and mucus membranes: none
15. Other/miscellaneous: Toothache
Rhubarbs leaves are poisonous, impairing hemostasis and causing nausea and vomiting.
Potentially toxic compounds in rhubarb: Anthraquinones in roots, oxalic acid and tannins in
leaves. Products from China may be contaminated with other species or heavy metals.
Acute toxicity: Diarrhea, intestinal cramping. Patients may notice that urine becomes bright
yellow or red.
Chronic toxicity: Rhubarb should not be used as a laxative for more than 8 10 days; chronic use
may deplete potassium and potentiate the effects of cardiac glycosides. Chronic use may
also lead to pigmentation of the intestinal mucosa (melanosis coli). Rhubarb did not
display mutagenicity in the standard Ames test69.
Limitations during other illnesses or in patients with specific organ dysfunction: Rhubarb root is
traditionally not recommended for patients with chronic intestinal inflammation such as
gastric or duodenal ulcers, Crohns disease or ulcerative colitis. It is contraindicated for
patients with intestinal obstruction or ileus. It should be avoided or used with great
caution by patients with history of renal stones due to its oxalate content22.
Interactions with other herbs or pharmaceuticals: Rhubarb root may potentiate other laxatives. It
may increase potassium loss (e.g. with steroids). Because of its potential to deplete
potassium, it should be used cautiously by patients taking cardiac glycosides.
Safety during pregnancy and/or childhood: Because of its putative effect as a uterine stimulant,
rhubarb root is not recommended during pregnancy. Because it contains anthraquinone
alkaloids, it should not be used by nursing women. It is also not traditionally
recommended for children less than twelve years old4.
1. Huang KC. The pharmacology of Chinese herbs. Boca Raton: CRC Press, 1999.
2. Locock R. Herbal medicine: Essiac. Canadian Pharmaceutical Journal 1997; 130:p 18-19.
3. Peigen X, Liyi H, Liwei W. Ethnopharmacologic study of Chinese rhubarb. Journal of Ethnopharmacology
1984; 10:275-93.
4. Castleman M. The Healing Herbs: The Ultimate guide to the curative powers of nature's medicine.
Emmaus, PA: Rodale Press, 1991:305-307.
5. Peirce A. The American Pharmaceutical Association practical guide to natural medicines. New York:
William Morrow and Company, Inc., 1999.
6. Borgia M, Sepe N, Borgia R, Ori-Bellometti M. Pharmacological activity of an herbal extract: controlled
clinical study. Current Therapeutic Research 1981; 29:525-36.
7. Duke JA. Green Pharmacy. Emmaus, PA: Rodale Books, 1997:507.
8. Bissett NG. Herbal Drugs and Phytopharmaceuticals. Stuttgart: MedPharm CRC Press, 1994:566.
9. Seto T, Yasuda I, Hamano T, et al. Determination method of sennoside A, sennoside B, Rhein and Rhein 8-
glucoside in Kampo or crude drug preparations and the comparison of these components in processed
rhubarb. Natural Medicines 1996; 50:138-44.
10. Wang X, Lous Z, Mikage M, Namba T. Pharmacognostical studies on the Chinese crude drug da-huang
rhubarb II. Botanical origin of three unofficial da-huang. Shoyakugaku Zasshi 1988; 42:302-9.
11. Lou Z, Wang X, Mikage M, Namba T. Pharmacognostical studies on the Chinese crude drug da-huang
rhubarb I. Botanical origin of the official da-huang. Shoyokugaku Zasshi 1988; 42:291-301.
12. DePasquale A, Paino E, DePasquale R, Germano M. Contamination by heavy metals in drugs from
different commercial sources. Pharmacological Research 1993; 27:9-10.
13. Zwaving JH. The sennoside content of Rheum palmatum. Planta Medica 1972; 21:254-62.
14. Ghazanfar SA. Handbook of Arabian medicinal plants. Boca Rato: CRC Press, 1994.
15. Bradley PR. British herbal compendium : a handbook of scientific information on widely used plant drugs /
published by the British Herbal Medicine Association and produced by its Scientific Committee.
Bournemouth, Dorset: The Association, 1992.
16. Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A guide for Health-care Professionals.
London: The Pharmaceutical Press, 1996:296.
17. Chirikdjian JJ, Kopp B, Beran H. Laxative action of a new anthraquinone glycoside from rhubarb roots.
Planta Medica 1983; 48:34-7.
18. Fairbairn JW. The anthraquinone laxatives. Biological assay and its relation to chemical structure.
[Review] [35 refs]. Pharmacology 1976; 14:48-61.
19. Yoneda K, Mayehira Y, Matsumoto Y, Yoshida N. Studies on the resources of crude drugs (XI): The
effects of drying and freezing processing on the quality of rhubarb (Rheum palmatum). Natural Medicines
1995; 49:6-10.