Skip to Content

Chinese Foxglove

Scientific Name(s): Rehmannia glutinosa (Gaertn.) Libosch. ex Fisch & C.A. Mey
Common Name(s): Chinese foxglove, Di-Huang, Gun-Ji-Whang, Juku-Jio, Jyuku-Jio, Kan-Jiou, Saeng-Ji-Whang, Sheng Di Huang, Sho-Jio, Shou-Jiou, Shoudihuang, Shu Di Huang, Sook-Ji-Whang, To-Byun, Xiandihuang

Clinical Overview

Use

Rehmannia rhizome extracts have been used extensively in traditional Chinese medicine. Because the preparation is often used in combination with other agents, it is difficult to attribute any benefits to R. glutinosa. Efficacy of R. glutinosa acteoside in the management of primary chronic glomerulonephritis has been suggested; however, clinical trials are lacking to support any use.

Dosing

Clinical studies are lacking to inform dosage. Common nonprescription polyherbal products contain varying amounts of Rehmannia root extract.

Contraindications

Chronic liver disease and GI disorders, including diarrhea.

Pregnancy/Lactation

Avoid use. Rehmannia has traditionally been used as an emmenagogue.

Interactions

None well documented.

Adverse Reactions

Minor and transient adverse reactions have been reported and include GI reactions (eg, diarrhea, abdominal pain), edema, heart palpitations, fatigue, and vertigo.

Toxicology

No data.

Botany

R. glutinosa is a perennial herb that grows wild in northern and northeastern China, particularly in Hunan province. It grows to a height of 0.3 to 0.6 m and has large, sticky leaves and purple flowers. The seed is sown in the autumn and spring; the yellow-brown to blackish-brown root is harvested after the plant has flowered in autumn. The fresh and dried roots and rhizomes have a soft texture, with deep longitudinal wrinkles on the external surface and a darker central cortex.Chevalier 1996, WHO 2007

History

R. glutinosa has been considered a panacea in traditional Chinese medicine, primarily in combination with other herbs. Dried Rehmannia rhizome is reputed to "nourish the yin" and remove heat from the blood, and is used as a tonic for the liver.

Documented historical uses include treatment of anemia, cancer, constipation, diabetes, fatigue, bacterial and fungal infections, hypertension, insomnia, tinnitus, inflammatory conditions, burns, impotence, and osteoporosis.WHO 2007, Zhang 2008

Chemistry

The major chemical constituents of the herb are polysaccharides and iridoid monoterpenes (eg, catalpol, ajugol, aucubin, rehmanniosides, monomelittoside, melittoside, verbascoside, jionosides). Two acidic polysaccharides, rehmannans SA and SB, were isolated from the dried root of R. glutinosa of Chinese origin. These polysaccharides were composed of differing molar ratios of L-arabinose, D-galactose, L-rhamnose, and D-galacturonic acid. Additional polysaccharides have been isolated. Pharmacological activity of the plant species varies depending on processing (dried or steamed) and location of cultivation (eg, Japan vs China). Other sesquiterpenoids and furans have been isolated.Kitagawa 1991, Li 2005, Oshima 1993, Oshio 1982, Tomoda 1994, WHO 2007 The most recently identified constituents include 3 alkaloids, rehmanalkaloids A, B, and C.Li 2017

Uses and Pharmacology

Rehmannia is most commonly used in combination with other herbs. Existing clinical trials do not provide evidence for a definitive place in therapy.

Antiobesity effects

Clinical data

In a small clinical study (N=12), steamed roots of R. glutinosa consumed over 8 weeks decreased waist circumference. The researchers suggested a prebiotic action, based on observed changes in fecal microbiota.Han 2015

Antioxidant effects

In vitro data

Antioxidant effects have been described in several experiments, including in auditory cells.Yu 2006, Yu 2006

Cancer

Animal and in vitro data

One study suggests R. glutinosa steamed root may play a role in regulating apoptosis induced by ultraviolet radiation, presumably through scavenging of reactive oxygen species.Shin 2008 In another study, hot water–extracted R. glutinosa inhibited proliferation and stimulated p53-mediated apoptosis in human hepatocellular carcinoma cells.Chao 2006 Antitumor effects and increases in T-lymphocyte production in mice bearing S180 have also been described for R. glutinosa polysaccharides.Chen 1995, Zhang 2008

Cardiovascular effects

Animal and in vitro data

A 50% ethanolic extract of R. glutinosa inhibited decreases in fibrinolytic activity and erythrocyte deformability, decreases in erythrocyte counts, and increases in connective tissue in rodents. The extract was ineffective in reducing edema and acute or chronic inflammation. R. glutinosa prevented decreases in erythrocyte deformability in rats with endotoxin-induced disseminated intravascular coagulation. In normal rats, R. glutinosa enhanced or increased erythrocyte deformability and fibrinolytic activity. Effects on the hemopoietic system have also been described based on in vitro studies.Kubo 1994, Kubo 1996, Zhang 2008

Clinical data

A small clinical study (N=40) reported on the effect of R. glutinosa pharmacopuncture on heart rate variability, with suggested activation of both the sympathetic and parasympathetic nervous systems.Kim 2016

CNS effects

Animal and in vitro data

In vitro studies and animal models to evaluate the effects of the monoterpene catalpol on aging have been conducted by a limited pool of researchers.WHO 2007, Zhang 2008 Catalpol exerted antioxidant effects on glial cell cultures, protected against beta-amyloid–induced apoptosis, increased hippocampal neuroplasticity, and upregulated gene expression of glial cell line–derived neurotrophic factor, among other suggested mechanisms.Liang 2009, Wang 2009, Xu 2010

An aqueous extract of the roots prolonged phenobarbital-induced sleeping time in mice with stress- or yohimbine-induced sleep deprivation, and had an antagonistic effect on caffeine-induced excitability and an antidepressant effect on induced chronic stress in mice.WHO 2007, Zhang 2008, Zhang 2009

Diabetes

Animal data

Decreased hyperglycemia was demonstrated in several studies in which diabetes had been induced in animals. Suggested mechanisms of action for aqueous or methanol R. glutinosa extracts, oligosaccharide, catalpol, rehmannioside D, or other polysaccharide extracts include decreasing glucose-6-phosphatase and fructokinase activity, decreasing plasma C-reactive protein, increasing hepatic glycogen content and pancreatic insulin release, and decreasing insulin resistance, as well as effects on nrf-2 activity and regulation.Miura 1997, Ren 2017, Waisundara 2008, WHO 2007, Zhang 2004, Zhang 2008 Additionally, protective effects were documented for diabetic nephropathy and obesity in animal models,Jiang 2008, Liu 2008, Zhang 2008 while other studies reported no effect on plasma cholesterol or triglycerides.Waisundara 2008

A hot water extract of Radix rehmanniae, an herbal medicine consisting of the dried roots and rhizomes of R. glutinosa Libosch. or R. glutinosa Libosch. Var. purpurea Makino (Scrophulariaceae),WHO 2007 showed hypoglycemic effects in a hyperglycemic silkworm model.Matsumoto 2016

Gastric ulcer

Animal and in vitro data

A reduction in ethanol-induced gastric mucosal damage was demonstrated with an aqueous extract of the root. Inhibition of gastric acid secretion was observed in animal studies.WHO 2007, Zhang 2008

Inflammatory/Immunomodulatory effects

Animal data

In animal studies, R. glutinosa has exerted effects on the immune system, including enhanced T-lymphocyte activity, reduction of histamine release and tumor necrosis factor production, and inhibition of hemolytic plaque-forming cells. The polysaccharide extracts jionoside and acteoside have been evaluated.Kim 1998, Sasaki 1989, WHO 2007, Zhang 2008 R. glutinosa root has shown anti-inflammatory and antiproliferative effects in experimental studies of psoriasis vulgaris.Zhang 2014

Clinical data

Research reveals no quality clinical data regarding the effects of Chinese foxglove on the immune system. In a poorly described clinical study, arthritis symptoms including reduced joint pain and swelling improved, and joint mobility increased.WHO 2007

Osteoporosis

Animal data

An in vivo study evaluating the effects of R. glutinosa extracts on ovariectomy-induced osteoporosis in rats showed an alleviation of decreased trabecular bone mineral density and increased cortical bone thickness and trabeculation of bone marrow spaces. R. glutinosa extracts may enhance bone metabolism in osteoporosis by stimulating the proliferation and activity of bone-forming osteoblasts and inhibiting generation and activity of bone-resorbing osteoclasts. The extract may also increase the expression of bone-related genes.Oh 2003

Clinical data

No clinical trials of R. glutinosa used alone for osteoporosis have been conducted. More than 100 clinical trials have used Radix rehmanniae in combination with other herbs to treat postmenopausal, senile, and secondary osteoporosis. However, trial methodologies are generally of poor quality, with limitations such as small patient sample size, short treatment duration, and poor clinical design. In addition, attribution of outcomes to a single ingredient is not possible.Liu 2017

Renal effects

Animal data

A protective effect of R. glutinosa plant ethanol extracts was demonstrated in animal models of renal failure and diabetic nephropathy.Lee 2009, Zhang 2004, Zhang 2008

Clinical data

In limited clinical studies by 1 group of researchers, R. glutinosa has been evaluated in the management of primary chronic glomerulonephritis, alone and in combination with the angiotensin receptor blocker irbesartan. Reductions in proteinuria and erythrocyturia were reported.Qiu 2013, Qiu 2014

Wound healing

Animal data

In animal models of diabetic foot ulcer, enhanced fibroblast cell viability occurred, as well as a trend toward decreased wound area and greater epithelialization.Lau 2009, Lau 2009

Clinical data

In combination with Radix astragali, Radix rehmanniae has been studied in the healing of diabetic foot ulcers (N=16). Improved wound healing and sensation at 6 months was reported in the study.Ko 2014

Dosing

Clinical studies are lacking to inform dosage. Common nonprescription polyherbal products contain varying amounts of Rehmannia root extract (range, 55 to 350 mg).

R. glutinosa acteosides given as two 200 mg capsules twice daily, both alone and in combination with irbesartan, for 8 weeks has been studied in primary chronic glomerulonephritis.Qiu 2013, Qiu 2014

Pregnancy / Lactation

Avoid use. Rehmannia has been used traditionally as an emmenagogue; however, no teratogenic or abortifacient effects were observed in rats following administration of a 70% methanol extract. An anti-implantation effect in female mice has been recorded.WHO 2007

Interactions

None well documented. Antiplatelet action has been described, based on in vitro studiesWHO 2007; however, antagonism of the effects of aspirin on coagulation time has also been reported.Zhang 2008 In mice, an aqueous extract prolonged sleeping time in phenobarbital-induced sleep, and also had an antagonistic effect on caffeine-induced excitability.Zhang 2008

Adverse Reactions

Some ingredients in a combination preparation have been suspected to cause liver toxicity, and the Pharmacopoeia of the Republic of Korea lists liver disease as a contraindication to Rehmannia use. Minor and transient adverse reactions have been reported and include GI reactions (eg, diarrhea, abdominal pain), edema, heart palpitations, fatigue, and vertigo.WHO 2007 In a study of more than 400 patients with primary chronic glomerulonephritis, adverse drug reactions reportedly occurred at a similarly low rate in the treatment group (0.4%) and control group (1.2%, P=0.3724).Qiu 2014

Toxicology

Information regarding toxicity is limited. Aqueous extracts of Radix rehmanniae were not mutagenic in Salmonella assay tests; however, intraperitoneal administration of the extract at doses 10 to 40 times human doses was mutagenic in mice.WHO 2007 An anti-implantation effect in female mice has been recorded; no teratogenic or abortifacient effects were observed in rats following administration of a 70% methanol extract.WHO 2007

References

Chao JC, Chiang SW, Wang CC, Tsai YH, Wu MS. Hot water-extracted Lycium barbarum and Rehmannia glutinosa inhibit proliferation and induce apoptosis of hepatocellular carcinoma cells. World J Gastroenterol. 2006;12(28):4478-4484.16874858
Chen LZ, Feng XW, Zhou JH. Effects of Rehmannia glutinosa polysaccharide b on T-lymphocytes in mice bearing sarcoma 180. Zhongguo Yao Li Xue Bao. 1995;16(4):337-340.7668105
Chevalier A. The Encyclopedia of Medicinal Plants. New York, NY: DK Publishing; 1996.
Han K, Bose S, Kim YM, et al. Rehmannia glutinosa reduced waist circumferences of Korean obese women possibly through modulation of gut microbiota. Food Funct. 2015;6(8):2684-2692.26139477
Hu L, Sun Y, Hu J. Catalpol inhibits apoptosis in hydrogen peroxide-induced endothelium by activating the PI3K/Akt signaling pathway and modulating expression of Bcl-2 and Bax. Eur J Pharmacol. 2010;628(1-3):155-163.19962976
Jiang L, Zhang NX, Mo W, et al. Rehmannia inhibits adipocyte differentiation and adipogenesis. Biochem Biophys Res Commun. 2008;371(2):185-190.18395006
Kim H, Lee E, Lee S, Shin T, Kim Y, Kim J. Effect of Rehmannia glutinosa on immediate type allergic reaction. Int J Immunopharmacol. 1998;20(4-5):231-240.9730258
Kim YJ, Lee CH, Kim JU, Yook TH. Effects of distilled Cervi Pantotrichum Cornu and Rehmannia glutinosa pharmacopuncture at GB21 (Jianjing) on heart rate variability: A randomized and double-blind clinical trial. J Acupunct Meridian Stud. 2016;9(6):311-318.28010833
Kitagawa I, Fukuda Y, Taniyama T, Yoshikawa M. Chemical studies on crude drug processing. VII. On the constituents of Rehmanniae radix. (1): Absolute stereostructures of Rehmaglutins A, B, and D isolated from Chinese Rehmanniae radix, the dried root of Rehmannia glutinosa Libosch. Chem Pharm Bull. 1991;39:1171-1176.
Ko CH, Yi S, Ozaki R, et al. Healing effect of a two-herb recipe (NF3) on foot ulcers in Chinese patients with diabetes: a randomized double-blind placebo-controlled study. J Diabetes. 2014;6(4):323-334.24330156
Kubo M, Asano T, Shiomoto H, Matsuda H. Studies on Rehmanniae radix. I. Effect of 50% ethanolic extract from steamed and dried Rehmanniae radix on hemorheology in arthritic and thrombosic rats. Biol Pharm Bull. 1994;17(9):1282-1286.7841954
Kubo M, Asano T, Matsuda H, Yutani S, Honda S. Studies on Rehmanniae radix. III. The relation between changes of constituents and improvable effects on hemorheology with the processing of roots of Rehmannia glutinosa [in Japanese]. Yakugaku Zasshi. 1996;116(2):158-168.8717282
Lau TW, Chan YW, Lau CP, et al. Radix astragali and Radix rehmanniae, the principal components of two antidiabetic foot ulcer herbal formulae, elicit viability-promoting effects on primary fibroblasts cultured from diabetic foot ulcer tissues. Phytother Res. 2009;23(6):809-815.19148881
Lau TW, Lam FF, Lau KM, et al. Pharmacological investigation on the wound healing effects of Radix rehmanniae in an animal model of diabetic foot ulcer. J Ethnopharmacol. 2009;123(1):155-162.19429355
Lee BC, Choi JB, Cho HJ, Kim YS. Rehmannia glutinosa ameliorates the progressive renal failure induced by 5/6 nephrectomy. J Ethnopharmacol. 2009;122(1):131-135.19146934
Li YS, Chen ZJ, Zhu DY. A novel bis-furan derivative, two new natural furan derivatives from Rehmannia glutinosa and their bioactivity. Nat Prod Res. 2005;19(2):165-170.15715261
Li M, Wang X, Zhang Z, Zhang J, Zhao S, Zheng S, Feng W. Three new alkaloids and a new iridoid glycoside from the roots of Rehmannia glutinosa. Phytochem Let. 2017;21:157-162.
Liang JH, Du J, Xu LD, et al. Catalpol protects primary cultured cortical neurons induced by Abeta(1-42) through a mitochondrial-dependent caspase pathway. Neurochem Int. 2009;55(8):741-746.19631247
Liu HR, Tang XY, Dai DZ, Dai Y. Ethanol extracts of Rehmannia complex (Di Huang) containing no Corni fructus improve early diabetic nephropathy by combining suppression on the ET-ROS axis with modulate hypoglycemic effect in rats. J Ethnopharmacol. 2008;118(3):466-472.18585879
Liu C, Ma R, Wang L, et al. Rehmanniae radix in osteoporosis: A review of traditional Chinese medicinal uses, phytochemistry, pharmacokinetics and pharmacology. J Ethnopharmacol. 2017;198:351-362.28111216
Matsumoto Y, Sekimizu K. A hyperglycemic silkworm model for evaluating hypoglycemic activity of Rehmanniae radix, an herbal medicine. Drug Discov Ther. 2016;10(1):14-18.26902904
Miura T, Kako M, Ishihara E, et al. Antidiabetic effect of seishin-kanro-to in KK-Ay mice. Planta Med. 1997;63(4):320-322.9270376
Oh KO, Kim SW, Kim JY, et al. Effect of Rehmannia glutinosa Libosch extracts on bone metabolism. Clin Chim Acta. 2003;334(1-2):185-195.12867291
Oshima Y, Tanaka K, Hikino H. Sesquiterpenoid from Rehmannia glutinosa roots. Phytochemistry. 1993;33:233-234.
Oshio H, Inouye H. Iridoid glycosides of Rehmannia glutinosa. Phytochemistry. 1982;21:133-138.
Qiu H, Fan W, Fu P, et al. General acteoside of Rehmanniae leaves in the treatment of primary chronic glomerulonephritis: a randomized controlled trial. Afr J Tradit Complement Altern Med. 2013;10(4):109-115.24146510
Qiu H, Fu P, Fan W, et al. Treatment of primary chronic glomerulonephritis with Rehmannia glutinosa acteosides in combination with the angiotensin receptor blocker irbesartan: a randomized controlled trial. Phytother Res. 2014;28(1):132-136.23519822
Radix rehmanniae. In: WHO Monographs on Selected Medicinal Plants. Vol. 3. Geneva, Switzerland: World Health Organization; 2007:283-295.
Ren L, Xu Y, Qin G, Liu C, Wang S. Effects of water extracts of Rehmannia glutinosa on antioxidant system of Nrf2 in paraquat-induced insulin resistance diabetic rat model. Exp Ther Med. 2017;14(6):5847-5850.29285131
Sasaki H, Nishimura H, Morota T, et al. Immunosuppressive principles of Rehmannia glutinosa var. hueichingensis1. Planta Med. 1989;55(5):458-462.17262458
Shin SW, Park CI, Yang CH, Park JW. Protective effect of Rehmannia glutinosa on the UV-induced apoptosis in U937 cells. Am J Chin Med. 2008;36(6):1159-1170.19051343
Tomoda M, Miyamoto H, Shimizu N, Gonda R, Ohara N. Two acidic polysaccharides having reticuloendothelial system-potentiating activity from the raw root of Rehmannia glutinosa. Biol Pharm Bull. 1994;17(11):1456-1459.7703962
Waisundara VY, Huang M, Hsu A, Huang D, Tan BK. Characterization of the anti-diabetic and antioxidant effects of Rehmannia glutinosa in streptozotocin-induced diabetic Wistar rats. Am J Chin Med. 2008;36(6):1083-1104.19051338
Wang Z, Liu Q, Zhang R, Liu S, Xia Z, Hu Y. Catalpol ameliorates beta amyloid-induced degeneration of cholinergic neurons by elevating brain-derived neurotrophic factors. Neuroscience. 2009;163(4):1363-1372.19635525
Xu G, Xiong Z, Yong Y, et al. Catalpol attenuates MPTP induced neuronal degeneration of nigral-striatal dopaminergic pathway in mice through elevating glial cell derived neurotrophic factor in striatum. Neuroscience. 2010;167(1):174-184.20123001
Yu HH, Kim YH, Jung SY, et al. Rehmannia glutinosa activates intracellular antioxidant enzyme systems in mouse auditory cells. Am J Chin Med. 2006;34(6):1083-1093.17163596
Yu HH, Seo SJ, Kim YH, et al. Protective effect of Rehmannia glutinosa on the cisplatin-induced damage of HEI-OC1 auditory cells through scavenging free radicals. J Ethnopharmacol. 2006;107(3):383-388.16698207
Zhang R, Zhou J, Jia Z, Zhang Y, Gu G. Hypoglycemic effect of Rehmannia glutinosa oligosaccharide in hyperglycemic and alloxan-induced diabetic rats and its mechanism. J Ethnopharmacol. 2004;90(1):39-43.14698506
Zhang RX, Li MX, Jia ZP. Rehmannia glutinosa: review of botany, chemistry and pharmacology. J Ethnopharmacol. 2008;117(2):199-214.18407446
Zhang D, Wen XS, Wang XY, Shi M, Zhao Y. Antidepressant effect of Shudihuang on mice exposed to unpredictable chronic mild stress. J Ethnopharmacol. 2009;123(1):55-60.19429340
Zhang CS, Yu JJ, Parker S, et al. Oral Chinese herbal medicine combined with pharmacotherapy for psoriasis vulgaris: a systematic review. Int J Dermatol. 2014;53(11):1305-1318.25208594

Disclaimer

This information relates to an herbal, vitamin, mineral or other dietary supplement. This product has not been reviewed by the FDA to determine whether it is safe or effective and is not subject to the quality standards and safety information collection standards that are applicable to most prescription drugs. This information should not be used to decide whether or not to take this product. This information does not endorse this product as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this product. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this product. This information is not specific medical advice and does not replace information you receive from your health care provider. You should talk with your health care provider for complete information about the risks and benefits of using this product.

This product may adversely interact with certain health and medical conditions, other prescription and over-the-counter drugs, foods, or other dietary supplements. This product may be unsafe when used before surgery or other medical procedures. It is important to fully inform your doctor about the herbal, vitamins, mineral or any other supplements you are taking before any kind of surgery or medical procedure. With the exception of certain products that are generally recognized as safe in normal quantities, including use of folic acid and prenatal vitamins during pregnancy, this product has not been sufficiently studied to determine whether it is safe to use during pregnancy or nursing or by persons younger than 2 years of age.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Hide