Rehmanniae Radix Preparata (Shu Di Huang)
Specifically for Attention-deficit Hyperactivity Disorder (ADHD)
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Why it works for Attention-deficit Hyperactivity Disorder (ADHD):
There is promising preclinical (animal + mechanistic) evidence that Rehmanniae Radix Preparata (Shu Di Huang, the prepared/cooked root of Rehmannia glutinosa) — largely via its principal active ingredient catalpol — can reduce hyperactive/impulsive behaviours in ADHD animal models and exerts neuroprotective, pro-neurogenesis and anti-apoptotic effects that plausibly address some ADHD-related brain changes. However — there are essentially no high-quality randomized controlled trials in humans proving Shu Di Huang by itself reliably treats ADHD. Use in practice is almost always as part of multi-herb TCM formulas under a qualified practitioner.
Animal behaviour models: RRP (Shu Di Huang) extracts reduced spontaneous/impulsive behaviour and improved learning/memory in spontaneously hypertensive rats (a standard ADHD animal model). The 2024 Frontiers neuroscience study tested RRP in SHR rats and reported improvements in hyperactivity/impulsivity and markers of hippocampal neurodevelopment. Frontiers+1
Active constituent (catalpol) — neuroprotection & neurodevelopment: Catalpol (an iridoid glycoside abundant in prepared Rehmannia) has been shown in multiple studies to: increase BDNF expression, promote hippocampal neurogenesis and synaptogenesis, improve mitochondrial function, reduce oxidative stress and neuroinflammation, and inhibit neuronal apoptosis — effects that can plausibly improve attention, impulse control and cortical/hippocampal development in models. These mechanisms are reported across animal and cellular studies and summarized in reviews. Frontiers
Structural/cortical effects (hypothesis): Reviews and the 2018 Evidence-Based Complementary & Alternative Medicine paper propose RRP and catalpol may reverse or attenuate structural abnormalities (cortex/hippocampus) linked to ADHD by neurodevelopmental support and anti-apoptotic action — giving a mechanistic rationale for why behaviour could improve. (This is largely preclinical and inferential.) Wiley Online Library
How to use for Attention-deficit Hyperactivity Disorder (ADHD):
Important framing: Shu Di Huang is almost always used inside multi-herb TCM formulas rather than alone. TCM prescribers tailor herbs and dosages to the patient’s TCM diagnosis (e.g., “kidney/liver yin deficiency,” “heart blood deficiency,” etc.). Below are typical practice patterns reported in the literature and herbal references — not a personalized medical prescription.
Common formulas containing Shu Di Huang for ADHD patterns:
- Yizhi Ningshen (or Yizhi Ningshen Granule) — example formula used in some clinical reports for pediatric ADHD; contains Rehmanniae Radix Preparata + other herbs (Polygala, Acorus, etc.). Wiley Online Library
- Other multi-herb formulas used in trials/reports include Duodongning granule and classical prescriptions modified for “nourish the kidney, calm the mind” syndromes. SpringerLink
Form & dose (reported in TCM literature / clinical reports):
- In classical decoctions or granules the usual single-herb equivalent of prepared Rehmannia (Shu Di Huang) used in formulas is commonly in the 6–15 g (dried herb) range per day as part of a combined decoction for adults; pediatric dosing is scaled down and/or provided as granules with practitioner guidance. (Exact dose depends on formula and practitioner.) Medscape and herbal monographs report a range of common dosing practices for preparations of Rehmannia; TCM trials typically report formula doses rather than isolated-herb dosing. Medscape
- Preparation: Shu Di Huang is the prepared (steamed/cooked) root — different from raw (Sheng Di Huang) — and is used according to its TCM function (tonify Blood/Kidney Yin). Most clinical uses in ADHD reports are as extracts or standardized granules or as part of an herbal decoction produced by a TCM clinic. tcmwiki.com
How practitioners administer it:
- Usually daily, in divided doses (morning and evening), as a decoction, concentrated granule, or patent herbal formula. It’s nearly always combined with other herbs chosen to address the patient’s full TCM pattern (e.g., sedating herbs for agitation, spleen-invigorating herbs for focus issues, etc.). childpsych.theclinics.com
Scientific Evidence for Attention-deficit Hyperactivity Disorder (ADHD):
Preclinical (animal + mechanistic) evidence (strongest body of evidence):
- Frontiers in Neuroscience (2024) — RRP extract improved hyperactivity/impulsivity and hippocampal neurodevelopment in SHR rats (ADHD model). Frontiers
- Studies of catalpol (the main active): multiple experimental papers show catalpol promotes neurogenesis, upregulates BDNF, reduces apoptosis and neuroinflammation, and improves cognition in animal models — these are mechanistic supports for the ADHD observations. Representative studies/reviews: Frontiers Pharmacology 2024, Evidence-based Complementary & Alternative Medicine 2013 (catalpol neuroprotection), MDPI and others. Frontiers
Human clinical trials:
- There are no robust, large, high-quality randomized controlled trials (RCTs) that prove Shu Di Huang alone is effective in ADHD. Most human evidence consists of small clinical reports, trials of multi-herb TCM formulas (that include Shu Di Huang among several herbs), or case series. Systematic reviews of herbal/TCM interventions for ADHD note that many included trials use combination formulas and that methodological quality is variable and often low. The 2018 eCAM review and other overviews summarize this gap. Wiley Online Library
Summary: promising preclinical work + TCM clinical experience exists, but we lack the high-quality RCT evidence needed to recommend Shu Di Huang as an evidence-based single treatment for ADHD in humans. Frontiers
Specific Warnings for Attention-deficit Hyperactivity Disorder (ADHD):
Pregnancy & breastfeeding: safety is not well established. Most resources recommend avoiding Rehmannia during pregnancy unless prescribed by a knowledgeable clinician. RxList
Blood sugar effects / diabetes: Rehmannia may affect blood glucose — people with diabetes or on hypoglycemic medications should use caution and monitor blood glucose. Also stop before surgery per some monographs because of effects on glucose control. RxList
Drug interactions: possible interactions include additive effects with antidiabetic drugs; theoretical interactions with immunosuppressants, and interactions affecting blood pressure or anticoagulant/antiplatelet medications are reported as possible in herb monographs — always check with a pharmacist/physician. WebMD
Common adverse effects: generally considered well tolerated in typical TCM doses, but reported side effects include gastrointestinal upset (diarrhea, abdominal pain), dizziness, palpitations, and fatigue in a minority of users. Monitor for new symptoms when starting any new herb. RxList
Quality & contamination risk: herbal products vary widely in concentration and purity. Use reputable suppliers, ideally products that provide batch testing for contaminants (heavy metals, pesticides) and standardized extracts if available. Drugs.com
General Information (All Ailments)
What It Is
Rehmanniae Radix Preparata, known in Chinese as Shu Di Huang (熟地黄), is the processed (prepared) root of Rehmannia glutinosa. The raw root (called Sheng Di Huang) is steamed or cooked, often with wine, to create the “prepared” form. This transformation alters its properties—making it warmer, sweeter, and more nourishing to the body according to traditional Chinese medicine.
In appearance, Shu Di Huang is dark brown to black, sticky, and soft, with a rich, sweet flavor. It is a classic yin- and blood-nourishing tonic, used in many formulas designed to strengthen vital essence and treat chronic conditions associated with deficiency syndromes.
How It Works
From a TCM perspective, Shu Di Huang primarily acts on the Liver, Kidney, and Heart meridians, working to:
- Nourish yin (body’s cooling and moistening energy)
- Replenish blood, particularly when depleted due to chronic illness or aging
- Tonify essence (jing), which is considered the foundation of vitality, fertility, and longevity
From a modern pharmacological standpoint, research suggests that Shu Di Huang contains iridoid glycosides (such as catalpol and rehmanniosides), polysaccharides, and amino acids that may:
- Support hematopoiesis (blood formation)
- Improve immune regulation
- Exhibit anti-inflammatory and antioxidant effects
- Support endocrine and reproductive system health
- Help with neuroprotection and anti-aging functions
These biochemical actions correspond to its traditional roles in nourishing blood, supporting the kidneys, and revitalizing overall body function.
Why It’s Important
Shu Di Huang holds a central place in TCM as a core herb for deficiency syndromes, particularly those involving:
- Blood deficiency: Symptoms such as dizziness, paleness, palpitations, and menstrual irregularities
- Kidney yin deficiency: Manifestations like tinnitus, night sweats, weakness of the lower back and knees, and infertility
- Essence depletion: Often seen in aging or chronic illness, leading to fatigue, hair loss, or reduced libido
It is a key ingredient in classic herbal formulas such as:
- Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) – to nourish kidney yin
- Ba Zhen Tang (Eight-Treasure Decoction) – to tonify qi and blood
- Zuo Gui Wan (Restore the Left Pill) – to enrich yin and essence
By strengthening yin and replenishing essence, Shu Di Huang plays a vital role in maintaining balance between yin and yang, ensuring overall health, vitality, and longevity.
Considerations
While Shu Di Huang is highly nourishing, certain considerations should be kept in mind:
Digestive Sensitivity: Its rich, cloying nature can sometimes impair digestion or cause bloating and loose stools, especially in individuals with weak spleen or digestive qi.
Appropriate Use: Best suited for true deficiency conditions (yin or blood deficiency). Using it in cases of excess conditions—such as dampness, phlegm accumulation, or stagnation—can worsen symptoms.
Quality and Preparation: The efficacy depends on proper preparation. Traditionally, it is steamed multiple times to develop its tonifying and moistening qualities. Poorly processed Shu Di Huang can be less effective or too heavy for digestion.
Dosage and Combination: Often used in combination with herbs that strengthen the spleen or move qi (such as Chen Pi or Sha Ren) to prevent stagnation. Dosage and formula composition should ideally be guided by a qualified practitioner.
Contraindications:
Should be avoided or used cautiously in cases of:
- Spleen deficiency with dampness
- Loose stools or poor appetite
- Phlegm or abdominal fullness
- Early stages of colds or infections (since it’s cloying and can “trap pathogens”)
Helps with these conditions
Rehmanniae Radix Preparata (Shu Di Huang) is most effective for general wellness support with emerging research . The effectiveness varies by condition based on clinical evidence and user experiences.
Detailed Information by Condition
Attention-deficit Hyperactivity Disorder (ADHD)
There is promising preclinical (animal + mechanistic) evidence that Rehmanniae Radix Preparata (Shu Di Huang, the prepared/cooked root of Rehmannia gl...
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