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Rhubarb (Da Huang) in Chinese Medicine

Rhubarb

Chinese: 大黄

Pinyin: Dà Huáng

Parts used: Dried root and rhizome

TCM category: Purgative herbs that drain downward

TCM nature: Cold

TCM taste(s): Bitter

Organ affinity: Spleen Stomach Large intestine Liver Pericardium

Scientific name: Rheum palmatum, Rheum tanguticum or Rheum officinale

Use of rhubarb (Da Huang) in TCM

Please note that you should never self-prescribe TCM ingredients. A TCM ingredient is almost never eaten on its own but as part of a formula containing several ingredients that act together. Please consult a professional TCM practitioner, they will be best able to guide you.

Preparation: Remove the stems and leaves from the rhizome and root, scrape off the rough skin and top buds, slice and dry.

Dosage: 3 - 12 grams

Main actions according to TCM*: Drains Excess Heat and eliminates Dampness, especially when in the Sunlight Yang stage. Cools the Blood and stops bleeding. Invigorates Blood, breaks up Stasis and relieves pain. Clears Heat and toxins from Excess. Applied topically for Hot sores and Blood Stasis.

Primary conditions or symptoms for which rhubarb may be prescribed by TCM doctors*: Constipation Fever Jaundice Dysentery Hematemesis Nosebleed Conjunctivitis Appendicitis Abdominal pain Sores Abcesses Amenorrhea traumatic bleeding Traumatic swelling Burns

Contraindications*: This herb should only be used where there is a definite condition of Heat and Dampness; Rhubarb should be used by nursing mothers with extreme caution.

Common TCM formulas in which rhubarb (Da Huang) are used*

Tao He Cheng Qi Tang

Source date: 220 AD

Number of ingredients: 5 herbs

Formula key actions: Dispels Heat and. Eliminates Blood Stagnation.

Conditions targeted*: LeiomyomaRetained placenta and others

Da Huang is a king ingredient in Tao He Cheng Qi Tang. Like the name indicates, it means it has more power than other ingredients in the formula.

In Tao He Cheng Qi Tang, Da Huang clears pathogenic Heat and purges accumulations. 

Read more about Tao He Cheng Qi Tang

Da Huang Mu Dan Pi Tang

Source date: 220 AD

Number of ingredients: 5 herbs

Formula key actions: Clears Stagnant Heat in the intestines. Reduces swelling and disperses lumps.

Conditions targeted*: AppendicitisPelvic inflammatory disease and others

Da Huang is a king ingredient in Da Huang Mu Dan Pi Tang. Like the name indicates, it means it has more power than other ingredients in the formula.

In Da Huang Mu Dan Pi Tang, Da Huang drains Heat and breaks up Blood Stagnation.

Read more about Da Huang Mu Dan Pi Tang

Da Cheng Qi Tang

Source date: 220 AD

Number of ingredients: 4 herbs

Formula key actions: Purges Heat from the Stomach and Intestines. Relieves constipation.

Conditions targeted*: PancreatisAppendicitis and others

Da Huang is a king ingredient in Da Cheng Qi Tang. Like the name indicates, it means it has more power than other ingredients in the formula.

In Da Cheng Qi Tang, Da Huang , as best described in the classic Divine Husbandman's Classic of the Materia Medica, "breaks up abdominal masses, accumulations, lingering Fluids, and harbored food by flushing them from the Stomach and Intestines, pushing out the old so that the new [can enter], unblocking [the passages for] food and drink, regulating the Middle [Burner so that it can again] transform food and the five Yin Organs are calmed."

Read more about Da Cheng Qi Tang

Xie Xin Tang

Source date: 220 AD

Number of ingredients: 3 herbs

Formula key actions: Drains Fire. Resolves Toxicity. Dries Dampness.

Da Huang is a king ingredient in Xie Xin Tang. Like the name indicates, it means it has more power than other ingredients in the formula.

In Xie Xin Tang, Da Huang drains excessive Fire. It also has the purging function that direct the Heat downwards and break up the clumping. Finally, it enters the Blood and stop bleeding, especially in the upper pat of the body. 

Read more about Xie Xin Tang

Zhi Shi Dao Zhi Wan

Source date: 1247 AD

Number of ingredients: 8 herbs

Formula key actions: Reduces and guides out stagnation and accumulation. Drains heat. Dispels dampness.

Da Huang is a king ingredient in Zhi Shi Dao Zhi Wan. Like the name indicates, it means it has more power than other ingredients in the formula.

In Zhi Shi Dao Zhi Wan, Da Huang strongly mobilizes the Stomach and Intestines to flush away accumulated obstruction due to Heat from Excess

Read more about Zhi Shi Dao Zhi Wan

Tiao Wei Cheng Qi Tang

Source date: 220 AD

Number of ingredients: 3 herbs

Formula key actions: Removes Heat and Dryness in the Lower Burner. Removes constipation.

Da Huang is a king ingredient in Tiao Wei Cheng Qi Tang. Like the name indicates, it means it has more power than other ingredients in the formula.

In Tiao Wei Cheng Qi Tang, Da Huang breaks up abdominal masses, accumulations, lingering fluids, and harbored food by flushing them from the Stomach and Intestines

Read more about Tiao Wei Cheng Qi Tang

Da Huang Fu Zi Tang

Source date: 220 AD

Number of ingredients: 3 herbs

Formula key actions: Warms the Interior. Disperses Cold. Unblocks the bowels. Alleviates pain.

Conditions targeted*: Trigeminal neuralgiaPeriarthritis of the shoulder and others

Da Huang is a deputy ingredient in Da Huang Fu Zi Tang. This means it helps the king ingredient(s) treat the main pattern or it serves to treat a coexisting pattern.

In Da Huang Fu Zi Tang, Da Huang is used here to flush the Intestines and purge Stagnant accumulation. It also enters the Liver Channel at the Blood level where it assists in the treatment of hypochondriac pain and directs the actions of the other herbs into the Intestines.

This is a more subtle and complex action than merely draining Fire through the stool. For this reason, the dosage of this herb is much lower than in formulas in which it serves as the key herb, such as Da Cheng Qi Tang.

Read more about Da Huang Fu Zi Tang

Ba Zheng San

Source date: 1107 AD

Number of ingredients: 9 herbs

Formula key actions: Clears Heat and Fire. Promotes urination. Unblocks painful urinary dribbling.

Conditions targeted*: GlomerulonephritisCystitis and others

Da Huang is an assistant ingredient in Ba Zheng San. This means that it either serves to reinforces the effect of other ingredients or it moderates their toxicity.

In Ba Zheng San, Da Huang drains Heat from the Triple Burner through the stool.

Read more about Ba Zheng San

Dang Gui Long Hui Wan

Source date: 1172 AD

Number of ingredients: 11 herbs

Formula key actions: Drains Liver and Gallbladder Fire Excess.

Conditions targeted*: VertigoTinnitus and others

Da Huang is an assistant ingredient in Dang Gui Long Hui Wan. This means that it either serves to reinforces the effect of other ingredients or it moderates their toxicity.

In Dang Gui Long Hui Wan, Da Huang drains Fire from the Yang Brightness and eliminates clumping.

Read more about Dang Gui Long Hui Wan

Yin Chen Hao Tang

Source date: 220 AD

Number of ingredients: 3 herbs

Formula key actions: Clears heat. Resolves dampness. Reduces jaundice.

Conditions targeted*: Viral hepatitisCirrhosis and others

Da Huang is an assistant ingredient in Yin Chen Hao Tang. This means that it either serves to reinforces the effect of other ingredients or it moderates their toxicity.

In Yin Chen Hao Tang, Da Huang purges Heat, eliminates stagnated Heat and directs downward

Read more about Yin Chen Hao Tang

Ma Zi Ren Wan

Source date: 220 AD

Number of ingredients: 7 herbs

Formula key actions: Moistens the Intestines. Invigorates Qi. Unblocks the bowels. Drains Heat.

Conditions targeted*: Incomplete intestinal obstructionPostoperative ileus and others

Da Huang is an assistant ingredient in Ma Zi Ren Wan. This means that it either serves to reinforces the effect of other ingredients or it moderates their toxicity.

In Ma Zi Ren Wan, Da Huang is a purgative. 

Read more about Ma Zi Ren Wan

Zhu Yu Zhi Xue Tang

Source date: 1826 AD

Number of ingredients: 8 herbs

Formula key actions: Invigorates Blood. Stops bleeding.

In Zhu Yu Zhi Xue Tang, Da Huang invigorates Blood and removes Stagnation.

Read more about Zhu Yu Zhi Xue Tang

Key TCM concepts behind rhubarb (Da Huang)'s properties

In Traditional Chinese Medicine (TCM), rhubarb are plants that belong to the 'Purgative herbs that drain downward' category. The herbs in this category are those whose main purpose is to treat constipation. The fact they're 'purgative' means that they do so by removing Excess Heat in the Intestines and/or Stomach. As such all herbs in this category are Cold in nature, in order to cool the Heat.

Furthermore rhubarb are plants that are Cold in nature. This means that rhubarb typically help people who have too much 'Heat' in their body. Balance between Yin and Yang is a key health concept in TCM. Those who have too much Heat in their body are said to either have a Yang Excess (because Yang is Hot in nature) or a Yin deficiency (Yin is Cold in Nature). Depending on your condition rhubarb can help restore a harmonious balance between Yin and Yang.

Rhubarb also taste Bitter. The so-called 'Five Phases' theory in Chinese Medicine states that the taste of TCM ingredients is a key determinant of their action in the body. Bitter ingredients like rhubarb tend to have a cleansing action on the body by clearing Heat, drying Dampness and promoting elimination via urination or bowel movements.

The tastes of ingredients in TCM also determine what Organs and Meridians they target. As such rhubarb are thought to target the Spleen, the Stomach, the Large intestine, the Liver and the Pericardium. In TCM the Spleen assists with digestion, Blood coagulation and Fluids metabolism in the body. The Stomach on the other hand is responsible for receiving and ripening ingested food and fluids. It is also tasked with descending the digested elements downwards to the Small Intestine. The Large Intestine receives the "impure" parts of the digested food from the Small Intestine, absorbs the remaining fluids and excrete the remainder as feces. The Liver is often referred as the body's "general" because it is in charge of regulating the movements of Qi and the Body Fluids. It also takes a leading role in balancing our emotions. The Pericardium is also called the "heart protector". It is the first line of defence for the Heart against external pathogenic influences

Research on rhubarb (Da Huang)

Combination of early enteral nutrition and rhubarb significantly improved the gastrointestinal function, inhibited systemic inflammation and disease severity and mitigated the disease-related damages of liver and kidney function in severe acute pancreatitis patients.1

Rhubarb is an effective herb in alleviating symptoms of primary dysmenorrhoea.2

The rhubarb stalk fiber is effective in lowering serum cholesterol concentrations, especially low-density lipoprotein cholesterol, in hypercholesterolemic men.3

Rhubarb can positively modulate the acute inflammatory response, promote the recovery of postoperative gastrointestinal motility, and benefit enteral nutrition support in patients who have undergone major operations for gastric cancer.4

Sources:

1. Wan B, Fu H, Yin J, Xu F. (2014). Efficacy of rhubarb combined with early enteral nutrition for the treatment of severe acute pancreatitis: a randomized controlled trial. Scand J Gastroenterol. , 49(11):1375-84. doi: 10.3109/00365521.2014.958523.

2. Rehman H, Begum W, Anjum F, Tabasum H, Zahid S. (2015). Effect of rhubarb (Rheum emodi) in primary dysmenorrhoea: a single-blind randomized controlled trial. J Complement Integr Med. , 12(1):61-9. doi: 10.1515/jcim-2014-0004.

3. Goel V, Ooraikul B, Basu TK. (1997). Cholesterol lowering effects of rhubarb stalk fiber in hypercholesterolemic men. J Am Coll Nutr. , 16(6):600-604.

4. Cai J, Xuan ZR, Wei YP, Yang HB, Wang H. (2005). Effects of perioperative administration of Rhubarb on acute inflammatory response in patients with gastric cancer. Zhong Xi Yi Jie He Xue Bao. , 3(3):195-8.

Use of rhubarb (Da Huang) as food

Rhubarb are also eaten as food. It is used as an ingredient in dishes such as Rhubarb pie.