Family Name: Polygonaceae

Introduction

Rhubarb is a laxatiive. Period. It causes the bowels to evacuate their contents and has a tendency to leave people feeling a little sore after the fact.

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Notes from the Eclectic Physicians

Notes from the Eclectic Physicians

1874: Scudder
Prepare a tincture from the best Russian, Turkey , or India rhubarb, in the proportions of 35viij.to alchol 50%Oj. Dose,from the fraction of a dropto ten drops.

It is not worth while to speak of the common use of rhubarb, as there is no remedy better known and more used. But it will be noticed that we have recomended a wholly different preparation, and we propose to dispense it in small doses for its direct action.

In the proportion of tx tincture of rhubarb 3j,water 35ij., a teaspoonful every half hour or hour, it will be found one of oour best remedies to control irritation of the stomach, and arrest vomiting. In children, it is especially useful, where there is nervous irritability, manifested by restlessness, scrams, and convulsice contractio of muscles.

In the same doses, less frequently repeated, it will prove an exellant tonic, stengthening the functions of both the stomach and intetines, iving imporeved digesiton. In indigestion, with some diarhea, of a papaescent character, it will be found a good remedy.

In some cases it will prove our best remedy in the treatment of obstinate constipation. The cases are those in which there is an unnatural sensation of constriction in stomach and bowels, and contraction of the abdominal muscles. I prescribe it in thiese cases in doses of ten drops in a large glass of water, on rising in the morning. In the severer cases it is associated with thorough fatty innunction over the abdomen, and friction.

I employ it as a restorative, where there is special need of increased nutrition of nerve tissue. It is thus associated with the preparations of phosphorus and with cod liver oil.

1883: Scudder: Cathartic: Scudder: RHEUM
The root of rheum palmatum ‑ Asia . Preparations: The powdered root. A tincture. Compound powder and compound syrup. Dose: Of the powder, gr. j. to grs. xxx. Of the tincture, gtt.j. to 3ss. Of the compound powder (an infusion of 3ss. to 3iv.), one teaspoonful. Of the compound syrup, from gtt. x. to a tablespoonful.

Therapeutic action: Rhubarb is cathartic, astringent,tonic, and stomachic. In small doses it acts as an astringent tonic upon the digestive organs, promoting appetite, and aiding digestion. It checks diarrhea and improves the condition of the alvine evacuations. It acts slowly and mildly as a purge, seldom causing any dripping, and is often followed by constipation. It is said by some authors to aggravate febrile an inflammatory action in some cases. It renders the milk of the nurse purgative, and imparts to the secretions its yellow tinge. it may be said to occupy an intermediate position between tonics and drastic cathartic in its mode of action.

As a cathartic,it is peculiar and highly important. its peculiarity arises from its singular combination of properties;it is both cathartic and astringent,its cathartic action not seeming to be affected by its astringent influence. in addition to these properties, it is mildly tonic and stomachic.

As cathartic, the rhubarb is not an active or efficient one, and yet it is of great value, and one for which we may search the materia medica in vain for a substitute. It is of important, nor is it a proper cathartic to be prescribed in the early stages of fever, or during high grades of febrile an inflammatory excitement, neither is it suitable for the treatment of dropsy. It does not deplete, but simply evacuates the bowels, without reducing the volume of circulating fluids by stimulating the intestinal exhalants,neither does it arouse the glandular system, restore the secretions generally, or equalize the circulation, hence it is important in the early stages of diseases to which reference is made. It is however, of the first importance in another class of disease, and even in the advanced stages of these mentioned. Its peculiar efficacy is conspicuous dysentery, diarrhea, cholera infantum, and in atonic states of the bowels. where ever the intestinal canal is in a relaxed or atonic state.

In fevers of a typhoid type, in the advanced stages of all febrile and inflammatory diseases, after active purgation would no longer be admissible, this is an appropriate cathartic. It is also very useful in chronic disease, when there is debility of the system, and in those forms of dyspepsia attended with diarrhea. in shirt, in all cases of general debility where cathartics are indicated , and in feeble and relaxed states of the bowels, this is one f our most valuable medicinal agents. it does not exhaust the energies of the general system, but invigorates them. while at the same time it evacuates the bowels by its action on the muscular coat, upon which writers suppose it to exert its principal influence.

It is often combined with prepared chalk and cinnamon, and administered in diarrhea, especially in the treatment of children. in large doses it acts as a cathartic , and secondly as a tonic and astringent. In small doses it acts as a laxative or aperient, and as a tonic or stomachic, and astringent.

1898: Felter and Lloyd – RHEUM (U.S.P.) – RHUBARB
Action, Medical Uses, and Dosage – Rhubarb is cathartic, astringent and tonic; as a cathartic, it acts by increasing the muscular action of the intestines, rather than by augmenting their secretions, and effects the whole intestinal canal, especially the duodenum. Its cathartic effect is succeeded by a milk astringency, which has gained for rhubarb the reputation of being secondarily a calmative, as well as a stimulant of the digestive canal; with its astringent influence, it likewise exerts for the most part, a tonic action on the stomach, improving the appetite and digestive powers. It is absorbed in the course of its operation, making the serum of the blood yellow, the sweat tawny, and the urine red, which may be distinguished from bloody urine by heating it. If blood be present it will coagulate, and remove the red color, which will not happen if the tint be owing to rhubarb. Rhubarb applied moist to the skin, or when used to dress ulcers, as it sometimes is, has produced its peculiar purgative effects. Rhubarb is much used as a laxative for infants, in many infantile diseases; its mildness and tonic qualities rendering it peculiarly applicable, especially when enfeebled digestion an dirritation of the alimentary canal are present. In acute or chronic diarrhoea or dysentery, in convalescence from exhausting diseases, and in some irritable habits, where the mildest of all other laxatives are apt to excite hypercatharsis, rhubarb is an appropriate medicine. Its combination with soa or an alkali tends to counteract its astringent effects, and it thus becomes valuable in cases of constipation. It is useful in all cases of fecal accumulations, as it produces fecal, more than watery discharges. Sometimes it produces griping, which may be obviated by aromatics. The following pill I have found very beneficial in dyspepsia attended with constipation, chronic diarrhoea and dysentery, habitual constipation, hepatic derangements, piles, etc.: Take extract of rhubarb, extract of leptandra, hydrochlorate of berberine, and castile soap, of each, 1/2 drachm. Mix them well together, and divide into 30 pills. Of these, 1, 2, 3, or 4 may be taken daily, sufficient to keep the bowels regular, without causing catharsis. When more than 1 are required daily, they should be given in doses of 1 pill at a time at regular intervals through the day (J. King). Prof. Locke recommends it in the constipation of dyspeptics with hepatic torpor, combining the neutralizing cordial with specific podophyllum or aloes. He also recommends it in gout and rheumatism with constipation, and as a gentle laxative after parturition. The cordial is recommended in the nursing sore mouth of infants. Rhubarb is efficient in the bowel disorders following the excessive use of alcoholics. The following is efficient during convalescence from delirium tremens: R Leptandra, rhubarb, gentian aa, in powder, 3i; ginger, 3ii; diluted alcohol, Oj. Macerate. Sig. Dose, 1 teaspoonful (Lock). Rhubarb is generally contraindicated in severe febrile or inflammatory affections. Toasting dissipats its purgative property considerably, but without diminishing its astringency, and it is, thus prepared, recommended by some practitioners in diarrhoea, dysentery, cholera morbus, and other diseases where astringents are indicated. In the ordinary summer diarrhoea of both children and adults, and particularly when an acid condition presents, the neutralizing cordial (Locke’s formula preferred) is a most excellent corrective.

Specifically rhubarb is employed for a different action from that given above which represents the old but excellent uses of the drug. The specific object sought is the control of gastro-intestinal irritation, and this is nicely accomplished by the use of small doses of specific rheum. The red-pointed tongue, evidencing gastro-intestinal irritation, is the direct indication for its use. Add to this vomiting, nervous irritability as manifested by restlessness, screaming and convulsive muscular contractions, and the specific field of rhubarb is clarly set forth. The common method of administration is as follows: R Specific rheum, 3i; water, 3iv. Dose, a teaspoonful every 1/2 or 1 hour. The same doses given less often act as ane xcellent gastro-intestinal tonic, giving better digestion and controlling the papescent diarrhoea of indigestion when present. In chronic constipation with a sense of constriction in stomach and bowels and contraction of the abdominal muscles, 10 drops of specific rheum may be given in full glass of cold water in the morning. Fatty inunction of the abdomen adds to its efficacy. In conjunction with cod-liver oil and phosphorus preparations Prof. Scudder administered rhubarb where an “increased nutrition of nerve tissue” was demanded.

Dose of the powder as a purgative, from 10 to 30 grains; as a laxative, from 5 to 10 grains; as a tonic, from 1 to 5 grains; of the tincture or syrup, 1 or 2 fluid drachms; of neutralizing cordial, 1 to 4 fluid drachms. For specific effects, from 1/10 to 5 drops of specific rheum.

Specific Indications and Uses -Gastric irritation, nausea, vomiting, elongated tongue reddened at tip and edges; irritative diarrhoea with tenderness on pressure; sour smelling discharges imparting to the child a sour odor; gastro-intestinal irritation with nervous irritability, restlessness, screaming and convulsive muscular contractions; constipation, with a sense of intestinal constriction and abdominal contraction; light-colored fecal discharges.

1905: Petersen: RHEUM OFFICINALE:
Syn – Rhubarb

P. E. – Root

N. O. – Polygonaceae

N. H. Asia

Properties: Tonic, astringent. In large doses laxative.

Use: In snall doses it appears to have a mild tonic astringent effect on the gastro-intestinal tract. This action is most marked in the duodenum. In medium doses it is a laxative, while in very extremely large doses it acts as a cathartic. In small or medium doses it has a tendency to bring about normal conditions, correcting under or over-activity of the gastro-intestinal tract and especially so of the latter. As it is a tonic to the stomach and intestinal tract, we think of it in debilitated condition of these parts. For this reason it makes a good adjunct to other indicated remedies in constipation, diarrhoea and dysentery. It may be used in form of syrup as a menstrum for other remedies in above conditions.

1911: Fyfe
Indications: irritation of the stomach, with nausea and vomiting, tongue elongated and reddened at tip and edges;diarrhea, when the abdomen gives evidence of tenderness on pressure, sour smelling discharges from the bowels, ;weak digestion and dyspepsia, with tendency to diarrhea, especially in children, jaundice, especially when the digestive power is weak.

Rheum palmatum is tonic, astringent, cathartic, and carminative. in small doses it is constipating by reason of the tannic acid which it contains, and stomachic through a bitter principle. In large doses it is laxative in consequence of the cathartic acid which is one of its chief constituents.

1911: LLOYD
Rhubarb (Rheum officinale, etc.) is a gift of the Chinese, who have used it in domestic practice from all times, as noted in the herbal Pen-king, probably the production of the Emperor Shen-nung, the “father of Chinese agriculture and medicine,” about 2700 B.C. As exported from its home in China , it has been respectively known as Russian, Turkish and Chinese rhubarb, in accordance with the country through which it reaches the market from its native land. As a cathartic and a laxative this drug is sold in large amounts, having been accepted as a household remedy in syrups and tincture forms the world throughout. It is a gift of empiricism to the medical profession.

1921: Lloyd
Official in all editions of the U.S.P., from 1820 to 1910. The 1910 edition makes official the rhizome and roots of Rheum officinale, Rheum palmatum and variety tanguticum, and probably “other species of Rheum grown in China and Thibet.”

Rheum officinale, rhubarb, is a gift of the Chinese, who from all times have used it in domestic practice, as noted in the herbal Pen-king, (about 2700 B. C., Dymock), probably the production of the Emperor Shennung, the “father of Chinese agriculture and medicine.” (Fluckiger). As exported from its home in China , it has been known respectively as Russian, Turkish and Chinese rhubarb, in accordance with the countrythrough which it reached the market from its native land. As a drastic cathartic and a laxative this drug is used in large amounts, having been long accepted as a household remedy in syrup and tincture form the world throughout. Rhubarb is one of the great gifts of empiricism to the medical profession. Fluckiger naturally gives this drug detailed care, as is true also of Dymock, in his Pharmacographia Indica. From these two great publications we condense as follows:

History. – In the great Geography of China it is stated that rhubarb was a tribute of the province Sining-fu, from about the 7th to the 10th centuries of our era.

“As regards Western Asia and Europe , we find a root called pa or pnov, mentioned by Dioscorides as brought from beyond the Bosphorus. The same drug is alluded to in the fourth century by Ammianus Marcellinus, who states that it takes its name from the river Rha (the modern Volga), on whose banks it grows. Pliny describes a root termed Rhacoma, which when pounded yielded a colour like that of wine but inclining to saffron, and was brought from beyond Pontus .

“The drug thus described is usually regarded as rhubarb, or at least as the root of some species of Rheum, but whether produced in the regions of the Euxine ( Pontus ) or merely received from remoter countries, it a question that can not be solved.

“It is, however, certain that the name Radix pontica or Rha ponticum used by Scribonius Largus and Celsus was applied in allusion to the region whence the drug was received. Lassen has shown that trading caravans from Shensi in Northern China arrived at Bokhara as early as the year 114 B. C. Goods thus transported might reach Europe either by way of the Black Sea, or by conveyance down the Indus to the ancient port of Barbarike .

“The terms Rheum barbarum or Reu barbarum occur in the writings of Alexander Trallianus about the middle of the 6th century, and in those of Benedictus Crispus, archbishop of Milan, and Isidore of Seville, who both flourished in the 7th century. Among the Arabian writers on medicine, the younger Mesue, in the early part of the 11th century, mentions the rhubarb of China as superior to the Barbaric or Turkish. Constantinus Africanus about the same period speaks of Indian and Pontic Rheum, the former of which he declares to be preferable. In 1154, the celebrated Arabian geographer Edrisi mentions rhubarb as a product of China, growning in the mountains of Buthink – probably the environs of northeastern Tibet near Lake Tengri Nor.

“Rhubarb in the 12th century was probably imported from India, as we may infer from the tariff of duties levied at the port of Acon in Syria, in which document it is enumerated along with many Indian drugs. A similar list of A. D. 1271, relating to Barcelona, mentions Ruibardo. In a statute of the city of Pisa called the Breve Funda-cariorum, dating 1305, rhubarb (ribarbari) is classified with commodities of the Levant and India.

“The first and almost the only European who has visited the rhubarb yielding countries of China, is the famous Venetian traveller, Marco Polo, who speaking of the province of Tangut, says: ‘Among all the mountains of this province, rhubarb (reobarbe) is found in great abundance. And merchants buy it, and carry it all over the world.’

“The risk and expense of the enormous land-transport over almost the whole breadth of Asia, caused rhubarb in ancient times to be one of the very costly drugs. Thus at Alexandria in 1497, it was valued at twelve times the price of benzoin. In France, in 1542, it was worth ten times as much as cinnamon, or more than four times the price of saffron. At Ulm, in 1596, it was more costly than opium. A German price-list of the magistrate of Schweinfurt, of 1614, shows Radix Rha Barbari to be six times as dear as fine myrrh, and more than twice the price of opium. An official English list giving the price of drugs in 1657, quotes opium as 6s. per lb., scammony 12s., and rhubarb 16s.” (Fluckiger and Hanbury, Pharmacographia, pp. 493, 4 and 6.)

“Riwas (the plant Ri in the Zend language), was known to the ancient Persians, and the same name is still applied to a species of Rheum in the province of Gilan in Persia. Aitchison found R. Ribes, Gronov., on the Paropamisus range, to be known to the peasantry as Rewash, Rewand and Chukri; he states that the flowering branches are eaten, and the root used in coloring leather. In the Hari-rud Valley he found R. Tataricum, Linn., to be known as Rewash-i-dewana, ‘fool’s rhubarb,’ the fruit and root being used as a purgative. Ibn Sina notices both the plant Ribas (Riwas, Pers.) and the drug Rawand, the first an acid plant, and the second evidently Chinese rhubarb. Mesue, early in the 11th century, distinguishes between Chinese and Khorasan rhubarb, and Haji Zein-el-attar, writing in 1368, says: ‘I consider Rewand to be the same as Ribas. Ibn Jazla, author of the Minhaj, states that there are two kinds, China and Khorasan rhubarb, and that the latter is known as Rawand-el-dawabb, and is used in veterinary practice, whilst the Chinese is reserved for human beings. The latter is the best kind, and, when powdered, is of a saffron color; the fractured surface has the grain of a cow’s hump, and is friable; it is called “meaty rhubarb”, and should be in large pieces like a horse’s hoof, and not worm-eaten. In my experience there are three kinds of rhubarb, Chinese, Khorasan, and Indian. Mesue states that rhubarb is hot in the third degree and dry in the first.’

“Rhubarb is not an article of the Hindu Materia Medica, but the modern Hindus have become acquainted with its properties through Mahometan and European physicians.” (Dymock, Pharmacographia Indica, v. 3, pp. 153-4.)

The botanical history and description of the rhubarb is of great interest, but out of place in this publication. We venture to suggest that no greater service could be offered our members, or greater credit given our society, than a special volume devoted wholly to the botanical relatives of Pharmacopeial drugs, by the American botanical authorities, H. H. Rusby or Henry Kraemer.