Alisma
AlismataceaeAlisma plantago-aquatica
Also known as: Ze Xie, Water Plantain, Asian Water Plantain
clinical_notes Clinical Summary
Alisma (Alisma plantago-aquatica, Ze Xie) is a key diuretic herb in TCM, used for over two millennia to drain Dampness and promote urination in edema, dysuria, and hyperlipidemia.
Its protostane triterpenoids (alisol A/B and their acetates) confer diuretic, hypolipidemic, and hypoglycemic activity.
Human clinical trials support its use in cholesterol reduction and vertigo; concurrent use with diuretics or long-term high-dose use may risk electrolyte imbalance and nephrotoxicity.
Pregnancy Safety
Traditional TCM restricts use in pregnancy due to draining nature; modern safety data are limited.
Lactation Safety
Insufficient safety data during lactation; avoid.
warning Contraindications
- Kidney Yin or Essence Deficiency with spermatorrhea (TCM) (caution)Theoretical
- Long-term high-dose use (hepatotoxicity/nephrotoxicity risk) (caution)Theoretical
- Fresh/raw root use (oral) (avoid)Theoretical
- Concurrent diuretic or potassium-depleting medication (caution)Theoretical
vital_signs Clinical Profile
Primary Indications
- check_circle edema
- check_circle dysuria
- check_circle urinary tract infection
- check_circle hyperlipidemia
- check_circle fatty liver
- check_circle diarrhea
- check_circle dizziness
- check_circle vertigo
- check_circle hypertension
- check_circle kidney stones
Therapeutic Actions
System Affinities
- check_circle kidney
- check_circle bladder
- check_circle urinary
labs Active Constituents
alisol A
alisol B
alisol B 23-acetate
alisol A 24-acetate
alisol C 23-acetate
alismol
protostane triterpenoids
guaiane sesquiterpenes
polysaccharides
history_edu Traditional Use
Traditional Chinese Medicine (TCM)
泽泻 (Zé Xiè)
Nature: cool
- Damp-Heat
- edema
- dysuria
- vertigo from phlegm-damp
- hypertension
- hyperlipidemia
Chief diuretic herb in TCM. Dose-dependent actions: raw form is more draining, bran-fried form (fu chao) is gentler and used for Spleen support. Translates as 'Marsh Drain'.
Traditional Uses Across Healing Systems
While many herbs lack controlled clinical trials, centuries of traditional practice across cultures provide valuable insight into their therapeutic applications.
Promotes urination and drains Dampness; clears Heat from the Kidneys and Bladder; resolves phlegm causing dizziness; regulates blood lipids. Core diuretic in the classic Liu Wei Di Huang Wan formula.
One of the most important damp-draining herbs in TCM. Classical texts note it can 'remove impure water' from the body.
Known as Takusha; used in Hachimi-jio-gan, Rokumi-gan, and Gorei-san for edema, dysuria, and kidney-related vertigo.
Key component of multiple Kampo formulas.
Cherokee used Alisma subcordatum topically for wounds, bruises, and ulcers. Cree used the stem base for stomach and bowel conditions.
Different species but same genus with similar uses.
spa Parts Used
rhizome
- edema
- dysuria
- hyperlipidemia
- vertigo
- dizziness
Rhizome harvested in winter; cleaned, sliced, and dried. Bran-fried (Fu Chao Ze Xie) form is gentler and used for Spleen deficiency diarrhea.
shield Safety
Contraindications — Evidence Basis
Kidney Yin or Essence Deficiency with spermatorrhea (TCM)
Traditional TCM contraindication; its draining, diuretic nature may deplete Yin/Jing.
Long-term high-dose use (hepatotoxicity/nephrotoxicity risk)
Long-term high-dose use or aqueous extracts at ≥50 g/kg in rats may cause tubular injury and hepatotoxicity via alisol A/B 23-acetate.
Fresh/raw root use (oral)
Fresh roots and leaves contain toxic compounds that are deactivated by cooking/drying; use only dried or cooked preparations.
Concurrent diuretic or potassium-depleting medication
Additive diuretic effect may cause electrolyte imbalance, dehydration.
Monitoring Parameters
Monitor during use, especially with prolonged or high-dose therapy.
Serum creatinine, BUN, and liver enzymes (ALT/AST)
Baseline and every 3 months with long-term use (>3 months)Animal studies show potential renal tubular injury and hepatotoxicity with prolonged high-dose use.
flagThreshold: ALT/AST >2x ULN or creatinine increase >30% baseline: discontinue and reassess
Serum potassium and electrolytes
Baseline and at 4 weeks with concurrent diuretic useAdditive diuretic effect may cause hypokalemia or dehydration.
flagThreshold: Potassium <3.5 mEq/L: discontinue or adjust
Toxicity
No acute toxicity at typical therapeutic doses (6–10 g dried rhizome). At 50 g/kg/day in rats, tubular toxicity observed.
Renal tubular injury, elevated liver enzymes with prolonged high-dose use.
Discontinue; supportive care and monitoring of renal and hepatic function.
Adverse Effects
CYP Metabolism
Alisol compounds show potential induction of autophagy in renal cells; limited clinical interaction data.
swap_horiz Interactions
Spironolactone
Class: Potassium-sparing diuretic
Alisma's triterpenoids increase urinary K+ excretion, but when combined with potassium-sparing diuretics the net effect on K+ is unpredictable. Additive diuresis raises the risk of dehydration and hyponatremia.
Monitor electrolytes (especially K+) and volume status. Avoid combination in patients with advanced kidney or cardiac disease.
Furosemide
Class: Loop diuretic
Alisma triterpenes (alisol A, alisol B, alisol B 23-acetate) produce a dose-dependent diuretic effect by increasing urinary Na+, K+, and Cl- excretion and reducing aquaporin-2 mRNA in renal medullary cells. Additive diuresis with loop diuretics may lead to electrolyte depletion and dehydration.
Monitor serum electrolytes (K+, Na+, Mg2+) and renal function. Adjust diuretic dose if volume depletion develops.
Lithium
Class: Mood stabilizer
Alisma's marked diuretic effect may alter renal lithium clearance and sodium balance, potentially raising serum lithium levels to toxic ranges, consistent with other strongly diuretic herbs.
Avoid combination unless lithium levels and renal function are monitored closely. Watch for toxicity (tremor, confusion, ataxia).
Atorvastatin
Class: HMG-CoA reductase inhibitor (statin)
Alisma and its triterpenoids (especially alisol B 23-acetate) have well-documented hypolipidemic activity via modulation of lipid metabolism; combination with statins produces additive LDL lowering.
Combination is generally beneficial. Monitor lipid panel routinely.
Metformin
Class: Biguanide antidiabetic
Alisma has demonstrated hypoglycemic activity via AMPK activation and improved insulin sensitivity in preclinical models; effects are complementary to metformin's mechanism.
Monitor blood glucose. Dose adjustment rarely required; watch for hypoglycemia in tightly controlled patients.
Ibuprofen
Class: NSAID
Both alisma and NSAIDs can affect renal hemodynamics; NSAIDs decrease renal prostaglandins while alisma's diuretic activity may exacerbate volume depletion, increasing risk of prerenal acute kidney injury when used together, especially in older adults.
Avoid long-term concomitant use in patients with CKD or dehydration. Ensure adequate hydration and monitor renal function.
Digoxin
Class: Cardiac glycoside
Alisma-induced diuresis and potassium loss can precipitate digoxin toxicity; hypokalemia sensitizes myocardium to digoxin effects, increasing arrhythmia risk.
Monitor serum potassium and digoxin levels. Replace potassium if depleted. Avoid combination in elderly patients with heart failure unless tightly monitored.
hub Combinations
Synergistic pairings can enhance therapeutic outcomes, while knowing suitable substitutes helps when specific herbs are unavailable or contraindicated.
Classical Formulas
2Atractylodes
Traditional UseUsed together in Ze Xie Tang for phlegm-damp vertigo and dizziness.
Classical formula from Jin Gui Yao Lue.
Rehmannia
Strong EvidenceCore pairing in Liu Wei Di Huang Wan — Ze Xie drains turbid water while Rehmannia nourishes Kidney Yin.
Classic formula in wide use; extensively studied in hypertension, diabetes, and menopause.
Synergistic Combinations
2Poria
Traditional UseBoth drain dampness via urination; core pairing in Wu Ling San for water metabolism disorders.
Classical Shang Han Lun formula.
Zhu Ling
Traditional UseCombined in Wu Ling San and Zhu Ling Tang to drain dampness and resolve heat without injuring Yin.
Classic TCM pairing for urinary damp-heat.
science Studies
Effects and potential mechanisms of Alismatis Rhizoma extracts on glucose and lipid metabolism: A systematic review and meta-analysis of rodent studies
Meta-AnalysisThis systematic review and meta-analysis of 29 preclinical rodent studies evaluated the efficacy and mechanisms of Alisma plantago-aquatica rhizome (AR) extracts on glucose and lipid metabolism disorders. AR extracts significantly improved fasting plasma glucose, postprandial glucose, insulin resistance (HOMA-IR), total cholesterol, triglycerides, LDL-C, and body weight in rodent models. Proposed mechanisms include antioxidant effects, anti-inflammatory activity, inhibition of gluconeogenesis, enhancement of insulin signaling, promotion of autophagy, and anti-fibrotic effects. Study quality was assessed by SYRCLE risk-of-bias tool, and statistical analysis followed CHSRI standards. The authors noted that while preclinical evidence is robust and consistent, well-designed human trials are still needed to translate these findings into clinical recommendations.
Alisma plantago-aquatica polysaccharides ameliorate acetaminophen-induced acute liver injury by regulating hepatic metabolic profiles and modulating gut microbiota
In VivoThis in vivo study investigated the hepatoprotective effects of Alisma plantago-aquatica polysaccharides (ARP50 and ARP70) in an acetaminophen (APAP)-induced acute liver failure mouse model. In vitro free radical scavenging assays confirmed notable antioxidant activity of both ARP fractions. In vivo, both polysaccharide fractions exerted dose-dependent protective effects against APAP-induced liver injury, with hepatic metabolite profiling revealing restoration of the liver antioxidant system through modulation of metabolism pathways. Gut microbiota analysis showed significant alterations associated with liver protection, suggesting a gut-liver axis mechanism. These findings provide first-in-kind evidence that Alisma polysaccharides protect against drug-induced acute liver injury through antioxidant and microbiota-modulating mechanisms.
medication Dosing
decoction
6–10 g dried rhizome
1–2x/day
Classical TCM dose; decoct 20–30 minutes.
powder
1.5–3 g powdered rhizome
2–3x/day
May be stirred into warm water or decoction.
tincture
2–4 mL (1:5, 45% ethanol)
2–3x/day
Modern Western herbal application; use only dried root to ensure safety.
Disclaimer: This information is largely AI-generated and reviewed by human experts at Evara Health. It is intended for educational and clinical reference purposes only and should not replace professional medical advice.
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