Rehmannia (Rehmannia glutinosa)

Category

Herbs & Supplements

Synonyms

Chinese foxglove, Digitalis glutinosa, di huang, dihuang, gan dihuang (dried rehmannia), Gesneriaceae (family), glutinous rehmannia, Go-shajinki-gan, Hachimijio-gan, huaiquing dihuang, juku-jio (Chinese or Japanese steamed or processed root), Kan-jio (Korean or Japanese dried root), Liu Wei rehmannia oral liquid, Rehmannia chinensis, Rehmannia glutinosa Liboschitz, Rehmannia glutinosa Libosch Forma hueichingenis Hsiao (Kaikei-jio in Japanese), Rehmannia glutinosa steamed root (RGAE), Rehmannia polysaccharide (PRP), Rehmanniae radix, Rhizoma rehmanniae, saengjihwang (Korean), Scrophulariaceae (family), sheng di huang (raw rehmannia), sho-jio (fresh root), shu di huang (cooked or cured rehmannia), sook-ji-whang, to-byun, Var. pupurea Makino (Akaya-jio in Japanese), xian dihuang (fresh rehmannia).

Background

Rehmannia has been used extensively in traditional Chinese medicine (TCM). Although thorough clinical trials are lacking, rehmannia has been used to treat rheumatoid arthritis, asthma, urticaria (hives), and chronic nephritis (kidney inflammation) in Chinese studies. Rehmannia may also be used to prevent the suppressive effects of corticosteroid (steroid) drugs.

Rehmannia looks promising in treating aplastic anemia, mitigating side-effects of chemotherapeutic agents and HIV medications, curing obdurate eczema (dry skin), relieving pain from lung or bone cancer or disc protrusion, and helping ameliorate lupus nephritis (kidney inflammation) and type 2 diabetes with hyperlipidemia (high cholesterol). However, presently, there are no high-quality, large randomized, controlled trials supporting the efficacy of rehmannia for any of these indications.

Rehmannia is in the Pharmacopoeia of the People's Republic of China. However, it is not on the United Kingdom's General Sale List, and is not covered by a Commission E monograph in Germany. The U.S. Food and Drug Administration (FDA) has not granted generalized recognized as safe (GRAS) status to rehmannia; it is available in the United States as a dietary supplement under the Dietary Supplement Health and Education Act of 1994.

Evidence

DISCLAIMER: 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.

Aplastic anemia (adjuvant): Rehmannia is frequently recommended to mitigate duration and severity of aplastic anemia. Although preliminary results appear promising, additional study is needed to draw a firm recommendation.
Grade: C

Hypopituitarism (Sheehan's syndrome): Rehmannia glutinosa has been used in the treatment of Sheehan's syndrome. However, the magnitude of therapeutic effects of rehmannia on Sheehan's syndrome remains unclear. More research is necessary in this area.
Grade: C

Tradition

WARNING: DISCLAIMER: The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.
Adrenal tonic, allergies, amenorrhea (absence of menstruation), anemia, antifungal, antipyretic (fever reducer), anti-inflammatory, asthma, autoimmune diseases, blood clotting disorders, cancer pain (bone cancer), cataracts, central nervous system disorders, chemotherapy adverse effects, cognitive processing, coronary heart disease (postmenopausal symptoms), dementia, diabetes mellitus type 2, diuretic, dizziness, dysmenorrhea (painful menstruation), eczema (dry skin), fatigue, fever, gastric adenoma (benign tumor), hair tonic (premature graying), hearing damage (gentamicin-induced), hematopoiesis (stimulation of blood cell production), hematuria (blood in the urine), HIV (medication side effects), hyperlipidemia (high cholesterol), hypertension (high blood pressure), hypotension (low blood pressure), hypoxia (very low oxygen levels, nocturnal), immunosuppression, laxative, liver protection, lumbar disc herniation (intervertebral disc protrusion), lung cancer, lupus nephritis measles, menorrhagia (heavy menstrual bleeding), metrorrhagia (irregular uterine bleeding), nephritis (inflamed kidney, chronic), nosebleeds, rheumatoid arthritis, sarcomas (cancer of the bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue), skin disorders, thirst, tinnitus (ringing in the ears), tonic, tranquilizer, urticaria (hives), vasoregulator, vasorelaxant, vertigo.

Dosing

Adults (18 years and older):

There is no proven safe or effective dose for rehmannia. Herbal decoctions used in clinical trials have contained 12-30 grams of rehmannia. For Sheehan's syndrome, 90 grams of cleaned and finely chopped Rehmannia glutinosa root added to 900 milliliters of water and boiled down to 200 milliliters has been used in three day courses with an intermission of three, six, and 14 days. After a one-month cessation, the second round of treatment commenced. Another dosing regimen used was 45-50 grams of Rehmannia glutinosa daily in five-day courses with an intermission of five days each time for 2-5 months.

Children (younger than 18 years):

There is no proven safe or effective dose for rehmannia in children.

Safety

DISCLAIMER: Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

Allergies

Avoid in individuals with a known allergy or hypersensitivity to rehmannia.

Side Effects and Warnings

Rehmannia has been generally well tolerated in available research studies. It has been well tolerated for 20 days to 1.2 years in human trials. Rehmannia may cause palpitations, edema (swelling), gastrointestinal upset, infertility, dizziness, and lack of energy. Use cautiously in patients with diabetes, as rehmannia may lower blood sugar or additively effect hypoglycemic (low blood sugar) agents. Avoid in patients with diarrhea and lack of appetite due to possible irritation of gastrointestinal tract by rehmannia.

Liu Wei Di Huang T'ang (decoction of rehmannia with six components) may lower blood pressure.

Use cautiously in children younger than two years of age and in women who may be pregnant or breastfeeding.

Pregnancy and Breastfeeding

Rehmannia is not recommended in pregnant or breastfeeding women due to a lack of available scientific evidence.

Interactions

Interactions with Drugs

The concomitant use of aminoglycosides and rehmannia may decrease toxicity associated with aminoglycoside therapy.

Man-Shen-Ling is a combination product that contains rehmannia, which may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin®) or heparin, anti-platelet drugs such as clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).

Rehmannia may interact with antihistamines.

Although not well studied in humans, Liu wei di huang t'ang (decoction of rehmannia with six components) may lower blood pressure. Caution is advised in patients with high blood pressure or taking any antihypertensive (blood pressure lowering) agents.

Rehmannia and corticosteroids (steroids) may result in a synergistic effect and possibility of reduced side effects.

Theoretically, rehmannia may decrease toxicity associated with chemotherapy. Shi-Quan-Da-Bu-Tang (SQT), which contains Rehmannia glutinosa, Paeonia lactiflora, Liqusticum wallichii, Angelica sinesis, Glycyrrhiza uralensis, Poria cocos, Atractlyodes macrocephala, Panax ginseng, Astragalus membranaceus and Cinnamomum cassia, was found to potentiate therapeutic activity of chemotherapy, radiotherapy, and prevent or minimize associated adverse events.

Rehmannia may have an additive effect with diuretics.

Rehmannia may interact additively with drugs that alter blood sugar because it can cause hypoglycemia (low blood sugar). Caution is advised in patients with diabetes or hypoglycemia and in those taking drugs that affect blood sugar. Serum glucose levels may need to be monitored by a healthcare provider, and medication adjustments may be necessary.

The concomitant use of cholesterol-lowering drugs with rehmannia may result in additive effects.

Rehmannia may have an additive effect with thyroid drugs. In a study on Sheehan's syndrome, Rehmannia glutinsoa may have improved clinical symptoms and stimulated the hypothalamic-pituitary system.

Interactions with Herbs and Dietary Supplements

Rehmannia may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.

Combination use of rehmannia with herbs/supplements that lower blood pressure may result in additive effects.

Rehmannia and corticosteroids (steroids) may result in a synergistic effect and there is a possibility of reduced side effects. Caution is advised in patients taking herbs with steroid-like effects.

Rehmannia may have an additive effect with diuretics, such as astragalus.

Rehmannia may interact additively with herbs that affect blood sugar because it may cause hypoglycemia (low blood sugar). Seishin-kanro-to, composed of rehmannia radix, may lower blood sugar levels. Caution is advised in patients with diabetes or hypoglycemia, and in those taking herbs or supplements that affect blood sugar. Serum glucose levels may need to be monitored by a qualified healthcare provider, and medication adjustments may be necessary.

The concomitant use of cholesterol-lowering herbs, such as red yeast rice, with rehmannia may result in additive effects.

Rehmannia may have an additive effect with thyroid herbs.

Attribution

This information is based on a systematic review of scientific literature, and was peer-reviewed and edited by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): Ethan Basch, MD (Harvard Medical School); Nicole Giese, MS (Natural Standard Research Collaboration); Sadaf Hashmi, MD, MPh (Johns Hopkins School of Hygiene and Public Health); Mary McGarry, RPh (University of Kansas); Gavin J. Putzer, MD, MPH (Harvard School of Public Health); Shaina Tanguay-Colucci, BS (Natural Standard Research Collaboration); Catherine Ulbricht, PharmD (Massachusetts General Hospital); Mamta Vora, PharmD (Northeastern University); Wendy Weissner, BA (Natural Standard Research Collaboration).

Bibliography

DISCLAIMER: 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.

Cui ZB, Yuan YD, Liu SH, et al. [Intervention effect of tongfei mixture on nocturnal hypoxia in patients with chronic obstructive pulmonary disease]. Zhongguo Zhong Xi Yi Jie He Za Zhi 2004;24(10):885-888.

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.

Kamei T, Kumano H, Iwata K, et al. The effect of a traditional Chinese prescription for a case of lung carcinoma. J Altern Complement Med 2000;6(6):557-559.

Kim H, Lee E, Lee S, et al. Effect of Rehmannia glutinosa on immediate type allergic reaction. Int J Immunopharmacol 1998;20(4-5):231-240.

Kim HM, An CS, Jung KY, et al. Rehmannia glutinosa inhibits tumour necrosis factor-alpha and interleukin-1 secretion from mouse astrocytes. Pharmacol Res 1999;40(2):171-176.

Liang R, Chen MR, Xu X. [Effect of dandi tablet on blood lipids and sex hormones in women of postmenopausal stage]. Zhongguo Zhong Xi Yi Jie He Za Zhi 2003;23(8):593-595.

Liang S. TCM treatment for 50 cases of acute protrusion of the lumbar intervertebral disc. JTCM 2001;21(4):265-266.

Park E, Kang M, Oh JW, et al. Yukmijihwang-tang derivatives enhance cognitive processing in normal young adults: a double-blinded, placebo-controlled trial. Am J Chin Med 2005;33(1):107-115.

Wang WK, Hsu TL, Wang YY. Liu-wei-dihuang: a study by pulse analysis. Am J Chin Med 1998;26(1):73-82.

Yap HK, Ang SG, Lai YH, et al. Improvement in lupus nephritis following treatment with a Chinese herbal preparation. Arch Pediatr Adolesc Med 1999;153(8):850-852.

Yin X, Zhang S, Kong Y, et al. Observation on efficiency of Jiangtang capsule in treating diabetes mellitus type 2 with hyperlipidemia. CJIM 2001;7(3):214-216.

Yu H, Oh-Hashi K, Tanaka T, et al. Rehmannia glutinosa induces glial cell line-derived neurotrophic factor gene expression in astroglial cells via cPKC and ERK1/2 pathways independently. Pharmacol Res 2006;

Yu Y, Sun W, Cao K, et al. Treatment of aplastic anemia by the kidney-tonifying and mediating method. JTCM 2001;21(4):252-255.

Yuan A, Liu C, Huang X. [Treatment of 34 cases of chronic aplastic anemia using prepared Rehmannia polysaccharide associated with stanozolol]. Zhongguo Zhong Xi Yi Jie He Za Zhi 1998;18(6):351-353.

Zhou Y, Huang Z, Huang T, et al. Clinical study of Shengxue Mixture in treating aplastic anemia. CJIM 2001;7(3):186-189.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.