Rhubarb has a long history of use in Traditional Chinese Medicine (TCM) as a therapeutic agent for chronic kidney disease (CKD), primarily for its detoxifying properties and ability to remove blood stasis. This review examines the efficacy and safety of rhubarb-containing TCM formulations in the treatment of CKD, specifically in randomized controlled trials (RCTs), and compares the outcomes to standard Western medicine (WM) treatment alone, while evaluating potential risks.
RCTs on chronic renal failure and diabetic nephropathy have demonstrated that a combination of rhubarb and WM treatment can significantly reduce proteinuria and improve key renal function markers, such as serum creatinine and blood urea nitrogen levels, compared to either rhubarb or WM treatment alone. Notably, the incidence of progression to end-stage renal disease (ESRD) was lowest in the combination therapy group (13.5%), followed by the rhubarb-only group (25.9%), and the WM treatment group (54.3%). These findings suggest that rhubarb can play a significant role in enhancing the efficacy of standard treatments for CKD. Furthermore, increased albumin levels following rhubarb treatment indicate potential improvements in patient health and overall renal function.
While rhubarb has demonstrated beneficial effects, potential adverse reactions must be carefully monitored. Follow-up studies have noted that some patients experienced transient diarrhea when rhubarb was used at doses exceeding 6 grams. However, a gradual increase in dosage has been shown to reduce this side effect. The optimal dose that maximizes therapeutic benefits while minimizing side effects is considered to be around 5 grams per day, with the expected outcome being regular defecation (2-3 times daily).
Hyperkalemia (elevated potassium levels) was reported in 12% of patients in both the combination therapy and WM treatment groups. However, hyperkalemia appears more commonly associated with WM treatments compared to rhubarb use alone. Although rhubarb is known to contain high levels of potassium, evaluating the risk based solely on potassium concentration is not recommended, as TCM herbs contain complex compounds that may interact differently within the body. Importantly, no significant changes in potassium levels were found before and after treatment with rhubarb-based TCM formulations. In contrast, some WM medications used for hypertension are known to increase potassium levels, which may pose additional risks to CKD patients.
One potential concern with long-term rhubarb use is the development of melanosis coli, a condition characterized by dark pigmentation of the colon. While this is not commonly reported, it is a possible risk with chronic rhubarb use and should be considered in long-term treatment plans.
The combination of rhubarb and Western medicine appears to offer substantial benefits for CKD patients, enhancing treatment efficacy and potentially reducing the toxicity of standard therapies. However, the incorporation of rhubarb into treatment plans requires careful attention to preparation methods, dosage, and monitoring for potential adverse effects. Individualized treatment plans and regular patient assessments are vital to optimize therapeutic outcomes and ensure patient safety. While rhubarb can be a valuable addition to CKD treatment regimens, its use must be guided by professional oversight to prevent complications and achieve the best possible results.
References
1. 戚莉,易韬,王晓柠,等.基于文献的中药复方治疗肾纤维化用药规律研究. 中国中医药信息杂志. 2014,21(12):34-37.
2. 俞雨生,黎磊石,章旭.中药大黄治疗慢性肾衰的远期疗效观察. 肾脏病与透析肾移植杂志.1995(01):32-35+101.
3. 陈茂盛, 黄晓敏, 刘琳, 任燕, 林波, 张维, 刘岳明, 邹文利, 何强. 黄芪当归大黄方治疗早中期糖尿病肾病疗效及安全性研究[J]. 中国中西医结合肾病杂志.2017,18(07): 586-589.
4. 周冬梅.大黄不同剂量中药复方治疗慢性肾功能衰竭的临床观察.成都中医药大学. 2014.
5. 杨丽虹. 中药对慢性肾脏病3-5期（非透析）患者血钾影响的临床研究.广州中医药大学. 2012.
6. 刘涛,梁莹,余仁欢. 口服中药汤剂对慢性肾脏病3期-5期患者血钾影响的临床调查. 中国中西医结合学会肾脏疾病专业委员会.中国中西医结合学会肾脏疾病专业委员会2011年学术年会暨2011
年国际中西医结合肾脏病学术会议论文汇编.中国中西医结合学会肾脏疾病专业委员会:中国中西医结合学会. 2011:1.
7.7. 郁强. 结肠黑变病的发病特点及与结肠癌相关性的临床和实验研究. 北京中医药大学. 2018
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