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Rhubarb is traditionally used for constipation and other digestive disorders

Rhubarb

Rheum officinale / R. palmatum Polygonaceae

Many Rhubarb species are effective stimulant laxatives, especially those native to China and Tibet. It is widely used in herbal medicine for the treatment of acute constipation and has a long standing reputation as a purgative.

Sustainability Status

Sustainability status

Not currently on risk lists but complete data may be missing on the status of the species. Commonly cultivated though may be sourced from the wild. Only source cultivated supplies or from certified sustainable wild collection. Read more about our sustainability guide.

Key benefits
  • Stimulant laxative
  • Hepatic
  • Bitter
  • Alterative
  • How does it feel?

    Rhubarbs taste is predominately bitter and astringent. A slightly acidic or sour taste may follow along with rich earthy and mildly smoky pungent qualities.

  • What can I use it for?

    rhubarbRhubarb is used predominantly in the treatment of occasional constipation taken short term as a stimulant laxative. It does however have a limitation for this use as it is only symptomatic treatment, and it must be used as part of an approach to treat the underlying cause where the problem is chronic or reoccurring.

    A herbalist will always give a holistic assessment of their patients with ongoing or recurring constipation, as there may be a number of different reasons why this symptom has occurred and that treatment needs to address that unique set of circumstances to deliver an effective, long term treatment.

    For example; there may be dietary or lifestyle considerations or other more organic causes to do with the physiological function of the intestines. This may include poor gut health or enzymatic activity. Each cause would have to be addressed individually.

    Rhubarb is however an extremely effective stimulant laxative for the symptomatic treatment of constipation. It also has multiple other benefits. Whilst it removes debris from the digestive tract it also exerts a detoxifying action on the tissues via an astringent action on the mucosa of the digestive system.

    It is worth noting that there are a number of safety considerations including herb/ drug interactions and contraindications for this plant. It is best to consult a herbalist before using rhubarb species if in doubt.

    Rhubarb may be used at the recommended dose for a maximum of 2 weeks as it can cause habituation of the bowel. If symptoms do not start to improve within 5 days- seek medical attention.

  • Into the heart of rhubarb

    rhubarb plantIn old Western medicine, rhubarb was used as a purgative of all humours  blood, yellow bile, black bile, and phlegm. Its actions detoxify the blood systems through its bitter action on the liver. Bitter herbs like rhubarb directly support liver function. This improved eliminatory action can have widespread effects throughout the body to reduce systemic inflammation which is why rhubarb is sometimes indicated for rheumatic conditions (5).

    In Ayurvedic medicine, there is a different model and understanding of what each organ does and how they connect. Ayurveda has its own unique philosophy and understanding of bodily systems and herbal qualities that has been built up over thousands of years of empirical observation. In Ayurveda, there are three doshas: vata, pitta and kapha. Their energies are believed to circulate in the body and govern physical, mental and emotional characteristics. They are described as follows; vatacontrols basic bodily functions as well as the mind, pitta governs metabolism, digestion and hormones linked to appetite and finally kapha is responsible for strength and stability, muscle growth, weight and the immune system.

    In Ayurveda, rhubarb is understood to have light, dry and cooling qualities. Its dosa effect is PK- V+ meaning that it reduces pita (heat) and kapha (congestion). It is said to be an invaluable medicine for intestinal congestion, bleeding and blood toxicity. It directs the flow of vata via its downward effect on the lower intestine as a laxative (3).

    The common indications for high kapha and pita may be seen as manifestations of damp-heat symptoms in the gut. There may be dysentery or blood and mucus in the stool. It is important to note that blood in the stool requires immediate medical investigation. If this symptom occurs refer to a general practitioner to identify the cause (3).

  • Traditional uses

    Rhubarb was originally imported from China and Tibet as R. palmatum and R. officinale. Therefore, the ancient uses of this medicine will have been carried forwards in traditional Chinese medicine.

    It has a long-standing use as an antibacterial, anti-inflammatory and anticancer medicine in China. It is thought to have been a valuable adjunct in the clearing of tumors and toxins from the bowel. This tradition of use still stands today in TCM as well as in the Ayurvedic use of rhubarb.

    Traditionally rhubarb was ground in vinegar. This would be used externally as a poultice for the treatment of freckles, eczema, and inflammations. Internally, it is used to relieve flatulence, and to treat stomach and intestinal weakness, jaundice, ascites, inflammation of liver and spleen, cough, asthma and bleeding. It is also referenced to have been traditionally used to relieve renal and urinary bladder pain.

  • Traditional actions

  • Traditional energetic actions

    Herbal energetics are the descriptions Herbalists have given to plants, mushrooms, lichens, foods, and some minerals based on the direct experience of how they taste, feel, and work in the body. All traditional health systems use these principles to explain how the environment we live in and absorb, impacts our health. Find out more about traditional energetic actions in our article “An introduction to herbal energetics“.

  • What practitioners say

    rhubarb close upDigestive system

    Rhubarb is a stimulating laxative which also works as a purgative and astringent to the digestive system. This enhancing action on the excretory function of the gastrointestinal tract combined with rhubarbs astringency and antiseptic properties also exerts a deeply cleansing action on the mucous membranes. This takes strain off of the liver and gall bladder by supporting elimination in the localised digestive tissues, removing viscid mucus and debris. Lower doses of rhubarb may be used as a tonic hepatic, whereas larger doses are more generally cathartic or purging (2).

    There is also a dose dependent use of rhubarb for diarrhoea. The anthraquinones purge the bowel, exerting a laxative effect in higher doses. Whereas lower doses provide the correct level of tannins to astringe and tone in the treatment of mild diarrhoea (3).

    The use of rhubarb for diarrhoea is less common. It is primarily used as a stimulant laxative. Rhubarb has a number of unique compounds which are responsible for these effects. The primary compound hydroxyanthracene and its derivatives possess a laxative effect. Its β linked glucosides are converted in the large intestine by the gut bacteria into anthrones.

    At the higher dosage, these compounds enhance motility by stimulation of peristaltic contractions in the large intestine. They are also thought to stimulate the intestinal fluids (i.e. mucus) which helps to improve the movement of stool through the bowel (1).
    There is a delay of around 8 hours after taking rhubarb before the laxative effects occur. This is due to the transit time between ingestion and metabolic conversion of active compounds in the colon.

    The liver stimulating bitter action of rhubarb makes it also useful for conditions of the liver and gallbladder. This is sometimes used by herbalists as part of an approach to treat cirrhosis or acute hepatitis where there is liver congestion and heat. It is also an effective cholagogue and may be used as part of an integrated approach for the elimination of small gall stones (<0.5mm) (3).

    Cellular health

    Rhubarb has cellular protective action due to its antioxidant content. It also has strong potential to be used as part of an integrated approach with other herbs and interventions in certain forms of cancer. There has been some promising research that demonstrates that extracts of rhubarb have an inhibiting effect on lung adenocarcinoma, breast and cervical cancer cells. Rhubarb and its extracts have been shown to be anti-proliferative, anti-metastatic and apoptotic (1).

  • Research

    rhubarb leavesDigestive system

    In vitro studies have identified a strong inhibition of Helicobacter pylori bacteria using a water based extract of rhubarb. Rhein is a constituent in rhubarb that in combination with antibiotics ampicillin and oxacillin have synergistic effects against methicillin-resistant Staphylococcus aureus strains (MRSA). Ethanol extracts also demonstrated antiviral activity against Herpes simplex virus, preventing cellular attachment and penetration. Rhein isolated from rhubarb has also been exhibited antimicrobial and anti fungal activity against Candida albicans and Bacteroides fragilis (1,6,7).

    A randomised controlled study was carried out to investigate the efficacy of R. Officinale for the treatment of incomplete intestinal obstruction. The subjects were randomised into a treatment group and a control group with 29 cases in each group. The control group was given an enema laxative, while the treatment group received R. officinale in powdered form internally in addition to an enema. The time of flatulence, bowel movements, and abdominal bloating intensity was observed. The treatment group was observed to have significantly improved scores from that in the control group. The study concludes that R. officinale is an effective medicine in treating incomplete intestinal obstruction (4).

    Cellular health

    Rhubarb and its extracts have been shown to have anti proliferative, anti-metastatic and apoptotic properties. These actions have been demonstrated using in-vitro studies on human chronic cyelocytic leukaemia K562 cells, pancreatic cancer cells, cervical cancel help cells, hepatoma cells neuroblastoma cells and tongue squamous cancel cells (1).

    Several phenolic compounds in rhubarb were found to have cytotoxic effects via induction of apoptotic cell death in both human oral and lung squamous cell carcinomas.

    Urinary system

    A Cochrane database systemic review of clinical trials found R. officinale had a concurrently positive effect on serum creatinine and BUN on of patients with chronic kidney disease compared to those with no treatment (5).

Additional information

  • Botanical description

    Rheum are robust rhizomatous herbaceous perennials with large, simple or palmately lobed leaves and tall leafy stems bearing large panicles of tiny flowers. Its leaves are large and scalloped with a stout hollow stem and fine white hairs at the nodes. It has tall panicles of white flowers which grow from 2m long stems in spring. These are followed by large winged seeds in late summer/ autumn.

  • Common names

    Rhubarb spp R. palmatum and R. officinale are used interchangeably in herbal medicine. Note that garden rhubarb is not the same plant as discussed in this monograph, so do not confuse them.

    Other names: Rheum palmatum is also known as Turkey rhubarb, East Indian rhubarb, or palmate rhubarb. Rheum officinale is also known as Indian rhubarb, Tibetan rhubarb, or medicinal rhubarb.

  • Safety

    Rhubarb is not recommended for use during pregnancy and lactation. It is also not recommended for use in children under 10 years of age.

  • Interactions

    Hypokalaemia (resulting from long term laxative abuse) potentiates the action of cardiac glycosides and interacts with anti-arrhythmic drugs or with drugs which induce reversion to sinus rhythm (e.g. quinidine).

    Concomitant use with other drugs inducing hypokalaemia (e.g. thiazide diuretics, adreno-corticosteroids and liquorice root) may aggravate electrolyte imbalance (1). It is not advised to use liquorice root or the former mentioned medications alongside rhubarb.

  • Contraindications

    Rhubarb should not be used in medical preparations in cases of intestinal obstruction and stenosis, atony, inflammatory bowel disease (i.e. Chron’s disease, ulcerative colitis), appendicitis, abdominal pain of unknown origin, severe dehydration states with electrolyte depletion (1).

  • Preparation

    • Dried or powdered
    • Decoction
    • Tincture
  • Dosage

    For use as a stimulant laxative the dosage may vary. The advice is to use the smallest amount required to produce a comfortable soft-formed motion. Build up from the lowest recommended dose for the desired effect.

    Dried/ powdered: 0.5g is astringent for treatment of diarrhoea. Whereas 3g+ is used for laxative and purgative effects. This may be taken daily.

    Decoction: A similar scale of dosage using dried or powdered root may be used as a decoction. Simply add the root to hot water, simmer for 10 minutes strain and drink.

    Tincture (1:3 at 25%): Take between 1- 6ml a day.

    Please note: Stimulant laxatives should not be used for periods of more than 2 weeks (unless advised by a healthcare practitioner).

  • Plant parts used

    Root

  • Constituents

    • Hydroxyanthracene derivatives (3- 12%) – consisting mainly of 60= 80% of mono and diglucosides of Rhein, chrysophanol, aloe-emodin, physcion, and emotion. Smaller amounts of dianthrone glycosides (sennosides)
    • Gallotannins (5%)
    • Chromones
    • Phenylbutanones
    • Volatile oil (traces) (1)
rhubarb illustration
  • Habitat

    Rhubarb spp are native to China and Tibet. They are found in fresh water habitats and may be found growing by streams in scrub and rocky places.

  • Sustainability

    According to the IUCN Red List of Threatened Plants Status:

    Habitat loss and over harvesting from the wild are two of the biggest threats faced by medicinal plant species. There are an increasing number of well known herbal medicines at risk of extinction. We must therefore ensure that we source our medicines with sustainability in mind.

    The herb supplement industry is growing at a rapid rate and until recent years a vast majority of medicinal plant produce in global trade was of unknown origin. There are some very real and urgent issues surrounding sustainability in the herb industry. These include environmental factors that affect the medicinal viability of herbs, the safety of the habitats that they are taken from, as well as the welfare of workers in the trade.

    The botanical supply chain efforts for improved visibility (transparency and traceability) into verifiably sustainable production sites around the world is now certificated through the emergence of credible international voluntary sustainability standards (VSS). Read our article on Herbal quality and safety: What to know before you buy to learn more about what to look for and questions to ask suppliers about sustainability.

  • Quality control

    Herbal Medicines are often extremely safe to take, however it is important to buy herbal medicines from a reputed supplier. Sometimes herbs bought from unreputable sources are contaminated, adulterated or substituted with incorrect plant matter.

    Some important markers for quality to look for would be to look for certified organic labelling, ensuring that the correct scientific/botanical name is used and that suppliers can provide information about the source of ingredients used in the product.
    A supplier should be able to tell you where the herbs have come from. There is more space for contamination and adulteration when the supply chain is unknown.

  • How to grow

    Rhubarb spp grow best in humus-rich, acidic to neutral, moist soil. They should be positioned in full sun to partial shade.

    • Propagate from seed or division in spring. Sow seeds in seed compost or plant root clumps or plantlet into small pots.
    • Splitting or planting a root division is a way to refresh older plants that have fulfilled their optimum growing potential. You may take pieces of mature root systems, and then transplant, water and fertilise these for more young plants. However do not divide plants that have been in the ground for less than three years.
    • This ornamental rhubarb is an architectural plant that demands space. Plant it out in a sunny location with adequate space for a wide spread of its palmate leaves. Cut down flowering stems after blooming and mulch annually to conserve moisture.
  • References

    1. Bernat (2019). Rhei radix (Rhubarb) – Online consultation. [online] ESCOP. Available at: https://escop.com/rhei-radix-rhubarb-online-consultation/ [Accessed 26 Apr. 2023].
    2. Hoffman, D. (2003). Medical Herbalism: The Science Principles and Practices Of Herbal Medicine. Hardback (1st Edition). Independently published
    3. Pole, S. (2013). Ayurvedic medicine : the principles of traditional practice. London ; Philadelphia: Singing Dragon, Cop.
    4. Yu, M. (2016). Clinical Study onDa Huang (Rheum Officinale) Powder Application at Shenque (CV 8) for Incomplete Intestinal Obstruction. Shanghai Journal of Acupuncture and Moxibustion, [online] pp.541–542. Available at: https://pesquisa.bvsalud.org/portal/resource/pt/wpr-487382 [Accessed 3 May 2023].
    5. Akbar, S. (2020). Rheum officinale Baill.; R. palmatum L. (Polygonaceae). doi:https://doi.org/10.1007/978-3-030-16807-0_158.
    6. Gou K, Sun L, Lou W, Ling C, Wang Y.Fourcompoundsofanthraquinone in Rheum officinale on Helicobacter pylori inhibition. ZhongguoYaoxue Zazhi (Beijing) 1997;32:278-80.
    7. Bae EA, Han MJ, Kim NJ, Kim DH. Anti-Helicobacter pylori activity of herbal medicines. Biol Pharm Bull 1998;21:990-2. https://doi.org/10.1248/bpb.21.990
Aromatic
An ‘aromatic’ remedy, high in volatile essential oils, was most often associated with calming and sometimes ‘warming’ the digestion. Most kitchen spices and herbs have this quality: they were used both as flavouring and to ease the digestion of sometimes challenging pre-industrial foods. Many aromatics are classed as ‘carminatives’ and are used to reduce colic, bloating and agitated digestion. They also often feature in respiratory remedies for colds, chest and other airway infections. They are also classic calming inhalants and massage oils, and are the basis of aromatherapy for their mental benefits.
Astringent taste
The puckering taste you get with many plants (the most familiar is black tea after being stewed too long, or some red wines) is produced by complex polyphenols such as tannins. Tannins are used in concentrated form (eg from oak bark) to make leather from animal skins. The process of ‘tanning’ involves the coagulation of relatively fluid proteins in living tissues into tight clotted fibres (similar to the process of boiling an egg). Tannins in effect turn exposed surfaces on the body into leather. In the case of the lining of mouth and upper digestive tract this is only temporary as new mucosa are replenished, but in the meantime can calm inflamed or irritated surfaces. In the case of open wounds tannins can be a life-saver – when strong (as in the bark of broadleaved trees) they can seal a damaged surface. One group of tannins, the reddish-brown ‘condensed tannins’ are procyanidins, which can reduce inflammation and oxidative damage.
Bitter
Bitters are a very complex group of phytochemicals that stimulate the bitter receptors in the mouth. They were some of the most valuable remedies in ancient medicine. They were experienced as stimulating appetite and switching on a wide range of key digestive functions, including increasing bile clearance from the liver (as bile is a key factor in bowel health this can be translated into improving bowel functions and the microbiome). Many of these reputations are being supported by new research on the role of bitter receptors in the mouth and elsewhere round the body. Bitters were also seen as ‘cooling’ reducing the intensity of some fevers and inflammatory diseases.
Blue-purple colouring
Any fruits with a blue-purple colouring contain high levels of the polyphenols known as anthocyanins. These work 1) on the walls of small blood vessels, helping to maintain capillary structure to reduce a key stage in inflammation, and improving the microcirculation to the tissues; 2) to improve retinal function and vision; 3) to support connective tissue repair around the body.
Cooling
Traditional ‘cold’ or cooling’ remedies often contain bitter phytonutrients such a iridoids (gentian), sesiquterpenes (chamomile), anthraquinones (rhubarb root), mucilages (marshmallow), some alkaloids and flavonoids. They tend to influence the digestive system, liver and kidneys. Cooling herbs do just that; they diffuse, drain and clear heat from areas of inflammation, redness and irritation. Sweet, bitter and astringent herbs tend to be cooling.
Hot
Traditional ‘hot’ or ‘heating’ remedies, often containing spice ingredients like capsaicin, the gingerols (ginger), piperine (black or long pepper), curcumin (turmeric) or the sulfurous isothiocyanates from mustard, horseradich or wasabi, generate warmth when taken. In modern times this might translate as thermogenic and circulatory stimulant effects. There is evidence of improved tissue blood flow with such remedies: this would lead to a reduction in build-up of metabolites and tissue damage. Heating remedies were used to counter the impact of cold, reducing any symptoms made worse in the cold. .
Mucilaginous
Mucilages are complex carbohydrate based plant constituents with a slimy or ‘unctuous’ feel especially when chewed or macerated in water. Their effect is due simply to their physical coating exposed surfaces. From prehistory they were most often used as wound remedies for their soothing and healing effects on damaged tissues. Nowadays they are used more for these effects on the digestive lining, from the throat to the stomach, where they can relieve irritation and inflammation such as pharyngitis and gastritis. Some of the prominent mucilaginous remedies like slippery elm, aloe vera and the seaweeds can be used as physical buffers to reduce the harm and pain caused by reflux of excess stomach acid. Mucilages are also widely used to reduce dry coughing. Here the effect seems to be by reflex through embryonic nerve connections: reduced signals from the upper digestive wall appear to translate as reduced activity of airway muscles and increased activity of airway mucus cells. Some seed mucilages, such as in psyllium seed, flaxseed (linseed) or guar bean survive digestion to provide bulking laxative effects in the bowel. These can also reduce rate of absorption of sugar and cholesterol. .
New-mown hay aroma
The familiar country odour of haymaking, of drying grass and other plants, is largely produced by coumarins (originally isolated from tonka beans – in French coumarou) and widely used in perfumery. They are chemically categorised as benzopyrone lactones and are important phytochemicals, with strong antioxidant activity in the laboratory and likely effects in modulating inflammation. They were most often associated with the calming effect linked to their use in stuffing mattresses and pillows and plants, high In coumarins were commonly used for these properties.
Resinous
Resins are most familiar as tacky discharges from pine trees (and as the substance in amber, and rosin for violin bows). They were most valued however as the basis of ancient commodities like frankincense and myrrh (two of the three gifts of the Three Wise Men to the baby Jesus) and getting access to their source was one benefit to Solomon for marrying the Queen of Sheba (now Ethiopia). Resins were the original antiseptic remedies, ground and applied as powders or pastes to wounds or inflamed tissues, and were also used for mummification. With alcohol distillation it was found that they could be dissolved in 90% alcohol and in this form they remain a most powerful mouthwash and gargle, for infected sore throats and gum disease. They never attracted much early research interest because they permanently coat expensive glassware! For use in the mouth, gums and throat hey are best combined with concentrated licorice extracts to keep the resins in suspension and add extra soothing properties. It appears that they work both as local antiseptics and by stimulating white blood cell activity under the mucosal surface. They feel extremely effective!
Salty
The salty flavour is immediately distinctive. A grain dropped onto the tongue is instantly moistening and a sprinkle on food enkindles digestion. This easily recognisable flavour has its receptors right at the front of the tongue. The salty flavor creates moisture and heat, a sinking and heavy effect which is very grounding for the nervous system and encourages stability. People who are solid and reliable become known as ‘the salt of the earth'.
Sharpness
The sharp taste of some fruits, and almost all unripe fruits, as well as vinegar and fermented foods, is produced by weak acids (the taste is generated by H+ ions from acids stimulating the sour taste buds). Sour taste buds are hard-wired to generate immediate reflex responses elsewhere in the body. Anyone who likes the refreshing taste of lemon or other citrus in the morning will know that one reflex effect is increased saliva production. Other effects are subjective rather than confirmed by research but there is a consistent view that they include increased digestive activity and contraction of the gallbladder.
Sweet
In the days when most people never tasted sugar, ‘sweetness’ was associated with the taste of basic foods: that of cooked vegetables, cereals and meat. In other words sweet was the quality of nourishment, and ‘tonic’ remedies. Describing a remedy as sweet generally led to that remedy being used in convalescence or recovery from illness. Interestingly, the plant constituents most often found in classic tonics like licorice, ginseng are plant steroids including saponins, which also have a sweet taste.

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