Rehmannia (Rehmannia glutinosa)
Natural Standard Bottom Line Monograph, Copyright © 2013 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.
While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.
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).
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.
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.
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.
*Key to grades:A: Strong scientific evidence for this use; B: Good scientific evidence for this use; C: Unclear scientific evidence for this use; D: Fair scientific evidence against this use (it may not work); F: Strong scientific evidence against this use (it likely does not work).
The below uses are based on tradition or scientific theories. 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 health care professional.
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.
The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.
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.
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.
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.
Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.
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.
This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
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. View Abstract
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. View Abstract
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. View Abstract
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. View Abstract
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. View Abstract
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. View Abstract
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. View Abstract
Wang WK, Hsu TL, Wang YY. Liu-wei-dihuang: a study by pulse analysis. Am J Chin Med 1998;26(1):73-82. View Abstract
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. View Abstract
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; View Abstract
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. View Abstract
Zhou Y, Huang Z, Huang T, et al. Clinical study of Shengxue Mixture in treating aplastic anemia. CJIM 2001;7(3):186-189.
Copyright © 2013 Natural Standard (www.naturalstandard.com)
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.
March 22, 2017