# Rheum officinale

**Canonical URL:** https://ingredients.hermeticasuperfoods.com/ingredients/rheum-officinale
**Data Source:** Hermetica Superfoods Ingredient Encyclopedia
**Updated:** 2026-04-02
**Evidence Score:** 2 / 10
**Category:** Other
**Also Known As:** Chinese rhubarb, Da Huang, Dahuang, Turkish rhubarb, Medicinal rhubarb, Rhubarb root, Rhei radix, Canton rhubarb, Shensi rhubarb, Chinese medicinal rhubarb

## Overview

Rheum officinale is a medicinal rhubarb species whose primary bioactive compounds — anthraquinones (emodin, rhein) and stilbenes — exert nephroprotective effects by suppressing TGF-β1-mediated renal fibrosis and reducing uremic toxin accumulation. Clinical evidence supports its use as an adjunct therapy in chronic kidney disease to meaningfully lower serum creatinine and blood urea nitrogen.

## Health Benefits

• Reduces serum creatinine in chronic kidney disease patients by 87.49 µmol/L based on a Cochrane review of 9 RCTs (n=682) - Moderate evidence quality
• Lowers blood urea nitrogen by 10.61 mmol/L in CKD patients according to systematic review data - Moderate evidence quality
• Inhibits renal fibrosis via miR-21/PTEN/Akt pathway regulation as shown in animal models - Preliminary evidence
• Improves renal function when combined with ACE inhibitors/ARBs, showing enhanced long-term effects (SCr reduction of 63.71 µmol/L) - Moderate evidence quality
• Reduces podocyte damage and ameliorates renal injury through anthraquinone compounds - Preliminary evidence from animal studies

## Mechanism of Action

The anthraquinone rhein inhibits TGF-β1/Smad3 signaling, suppressing extracellular matrix deposition and renal tubular fibrosis at the molecular level. Emodin downregulates NF-κB pathway activation, reducing [pro-inflammatory cytokine](/ingredients/condition/inflammation) output (IL-6, TNF-α) in glomerular mesangial cells. Additionally, stilbene glycosides in Rheum officinale inhibit renal tubular reabsorption of urea and creatinine, promoting their fecal and urinary excretion and thereby reducing circulating uremic solute concentrations.

## Clinical Summary

A Cochrane-reviewed meta-analysis of 9 randomized controlled trials (n=682) found that Rheum officinale supplementation reduced serum creatinine by a mean of 87.49 µmol/L and blood urea nitrogen by 10.61 mmol/L in chronic kidney disease patients compared to controls, with evidence rated as moderate quality. Additional systematic review data indicate significant attenuation of renal fibrosis biomarkers, including TGF-β1 and fibronectin, in both human and animal models. Most trials used standardized rhubarb root extract at doses of 0.75–1.5 g/day as an adjunct to conventional CKD therapy, with study durations ranging from 4 to 24 weeks. While results are consistently positive across endpoints, evidence limitations include heterogeneous patient populations, variable extract standardization, and predominantly Chinese trial settings, warranting cautious generalization.

## Nutritional Profile

Rheum officinale (medicinal rhubarb) root and rhizome contain the following key constituents: Anthraquinones (primary bioactives) at 3-5% total content, including emodin (0.5-1.2% dry weight), rhein (0.8-1.5% dry weight), aloe-emodin (0.3-0.8% dry weight), chrysophanol (0.2-0.6% dry weight), and physcion (0.1-0.4% dry weight). Stilbenes include resveratrol and rhapontigenin (0.05-0.2% dry weight). Tannins are present at 10-15% dry weight, predominantly gallotannins and condensed tannins including lindleyin and isolindleyin. Stilbene glycosides (rhaponticin, desoxyrhaponticin) contribute 0.1-0.3% dry weight. Total polyphenols range 15-25 mg gallic acid equivalents per gram dry weight. Dietary fiber content in the root is approximately 2-4 g per 100g fresh weight. Carbohydrates: starch and mucilages account for ~60-70% dry weight of root material. Protein content is modest at approximately 1-2% dry weight. Key minerals identified include calcium (approx. 145-350 mg/100g dry weight), potassium (approx. 400-600 mg/100g dry weight), magnesium (approx. 50-100 mg/100g dry weight), iron (approx. 5-10 mg/100g dry weight), and phosphorus (approx. 60-100 mg/100g dry weight). Oxalic acid is present at significant levels (200-1000 mg/100g depending on plant part), which substantially reduces bioavailability of calcium and iron through chelation. Vitamin C is present in small amounts (~10-15 mg/100g fresh root). Bioavailability notes: Anthraquinones undergo extensive first-pass hepatic [metabolism](/ingredients/condition/weight-management); emodin and rhein reach peak plasma concentrations within 1-2 hours post-ingestion with bioavailability of ~20-40% due to gut bacterial biotransformation. Stilbene glycosides are hydrolyzed by intestinal microbiota to active aglycone forms, enhancing absorption in the colon. Tannins bind proteins and reduce overall nutrient absorption when co-ingested with food. The high oxalate content warrants caution in individuals predisposed to calcium oxalate kidney stones, representing a pharmacological paradox given its use in CKD.

## Dosage & Preparation

Clinically studied doses include CPM-Rheum (patented extract) at 10-20 g/day orally, divided doses, taken alongside ACE inhibitors/ARBs for 3-24 months. Traditional powder/decoction forms range from 4-12 g/day raw herb equivalent. Consult a healthcare provider before starting any new supplement.

## Safety & Drug Interactions

Rheum officinale contains anthraquinone laxatives (emodin, rhein) that can cause dose-dependent diarrhea, abdominal cramping, and electrolyte imbalances — particularly hypokalemia — at doses exceeding 1.5 g/day or with prolonged use. Chronic high-dose use has been associated with anthraquinone nephropathy and hepatotoxicity in animal models, creating a paradox in CKD populations that warrants careful dosing and monitoring of liver enzymes and potassium levels. Clinically significant drug interactions include potentiation of antihypertensive and diuretic drugs (compounding electrolyte loss), and potential interference with immunosuppressants metabolized via CYP3A4, as emodin is a known CYP3A4 modulator. Rheum officinale is contraindicated in pregnancy due to anthraquinone-stimulated uterine contractions, in intestinal obstruction, and should be used cautiously in patients already receiving nephrotoxic medications.

## Scientific Research

A 2012 Cochrane systematic review (PMID: 22786510) analyzing 9 RCTs with 682 CKD patients found Rheum officinale significantly reduced serum creatinine and blood urea nitrogen compared to no treatment. A 2018 meta-analysis of 9 trials showed that combining CPM-Rheum with ACE inhibitors/ARBs provided greater renal protection than standard therapy alone, though studies lacked proper blinding and allocation concealment.

## Historical & Cultural Context

In Traditional Chinese Medicine, Rheum officinale (Da Huang) has been used for over 2,000 years as a purgative, [anti-inflammatory](/ingredients/condition/inflammation), and detoxifier for constipation, jaundice, and renal disorders. It is a key component in TCM formulas for chronic kidney disease, traditionally used to 'clear heat and promote diuresis,' often paired with Salvia miltiorrhiza for renal conditions.

## Synergistic Combinations

Salvia miltiorrhiza, ACE inhibitors, ARBs, kidney support herbs, traditional TCM kidney formulas

## Frequently Asked Questions

### How much does Rheum officinale lower creatinine levels?

Based on a Cochrane meta-analysis of 9 RCTs involving 682 chronic kidney disease patients, Rheum officinale supplementation reduced serum creatinine by a mean of 87.49 µmol/L compared to control groups. This reduction is considered clinically meaningful in CKD management, though the evidence is rated moderate quality due to heterogeneity across trials. Results were observed using standardized rhubarb extract at approximately 0.75–1.5 g/day as adjunct therapy.

### What are the active compounds in Rheum officinale?

The primary bioactive compounds in Rheum officinale are anthraquinones — specifically emodin, rhein, and aloe-emodin — along with stilbene glycosides such as rhaponticin and desoxyrhaponticin. Rhein is considered the principal nephroprotective agent, acting via TGF-β1/Smad3 pathway inhibition to reduce renal fibrosis. Emodin contributes anti-inflammatory activity by suppressing NF-κB signaling in kidney mesangial and tubular cells.

### Is Rheum officinale safe for people with kidney disease?

At doses of 0.75–1.5 g/day used in clinical trials, Rheum officinale appears relatively safe as adjunct CKD therapy, with the most common adverse effects being mild gastrointestinal symptoms including loose stools. However, prolonged use at higher doses raises concerns about anthraquinone-induced nephropathy — an important paradox — and hypokalemia risk, particularly in patients on diuretics or with low GFR. Close monitoring of serum potassium, liver enzymes, and kidney function is recommended, and use should always be under medical supervision in CKD patients.

### What is the recommended dosage of Rheum officinale for kidney disease?

Clinical trials supporting Rheum officinale's nephroprotective effects used standardized root extract at doses of 0.75 to 1.5 grams per day, typically divided into two or three administrations, over treatment periods of 4 to 24 weeks. Lower doses in this range (0.75 g/day) are preferred to minimize anthraquinone laxative effects while maintaining therapeutic benefit. No universally accepted standardized dosage protocol exists outside of Chinese clinical guidelines, and dosing should be individualized based on CKD stage and concurrent medications.

### Does Rheum officinale slow the progression of chronic kidney disease?

Evidence from systematic reviews suggests Rheum officinale significantly reduces key CKD progression biomarkers, including serum creatinine (−87.49 µmol/L), blood urea nitrogen (−10.61 mmol/L), and markers of renal fibrosis such as TGF-β1 and fibronectin. The anthraquinone rhein inhibits the TGF-β1/Smad3 fibrotic pathway, which is central to progressive nephron loss across CKD stages. While these surrogate endpoint improvements are promising, long-term randomized trials measuring hard outcomes like ESRD progression or GFR decline rates are still needed to confirm disease-modifying effects.

### Does Rheum officinale interact with blood pressure or heart medications?

Rheum officinale may potentiate the effects of antihypertensive medications due to its vasodilatory properties and should be used cautiously in patients taking blood pressure-lowering drugs. Additionally, its potassium-lowering effects in some cases require monitoring when combined with cardiac glycosides or ACE inhibitors. Consultation with a healthcare provider is essential before combining Rheum officinale with cardiovascular medications to avoid adverse interactions.

### Is Rheum officinale safe for long-term use in chronic kidney disease patients?

While moderate-quality evidence supports short- to medium-term use of Rheum officinale for CKD management, limited data exists on safety beyond 12 months of continuous supplementation. Its laxative properties and potential effects on electrolyte balance warrant periodic monitoring of kidney function and serum minerals during extended use. Long-term safety protocols should be established with a nephrologist before initiating prolonged treatment.

### What is the strength of clinical evidence for Rheum officinale's effects on kidney disease compared to standard treatments?

Rheum officinale demonstrates moderate-quality evidence from a Cochrane review of 9 RCTs (n=682) showing reductions in serum creatinine and blood urea nitrogen, though this evidence level is generally lower than for established pharmacological interventions. The preliminary evidence for its anti-fibrotic mechanisms via miR-21/PTEN/Akt pathway regulation is based primarily on animal models and requires confirmation in larger human trials. Current evidence suggests it may serve as an adjunctive rather than replacement therapy for conventional CKD management.

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*Source: Hermetica Superfoods Ingredient Encyclopedia — https://ingredients.hermeticasuperfoods.com*
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