Herbs & Botanicals · Traditional diuretic herb

Alisma

Q: What is alisma?

Alisma, or ze xie, is the dried rhizome of a water plant (Alisma orientale, now treated as a subspecies of Alisma plantago-aquatica). It is used in Chinese and Japanese medicine as a diuretic and fluid-clearing herb.

Q: Is it the same as European water plantain?

They overlap. The European plant Alisma plantago-aquatica is accepted as a separate species by GBIF, and reviews say it and the subspecies orientale are the two forms used as ze xie. Western herbal uses were not researched here, and 'plantain' alone is a different plant.

Q: Does alisma work as a water pill?

It is a traditional diuretic and acts that way in animals. No human trial of Alisma alone was found. Formulas containing it raised urine output in heart failure and diabetic kidney trials.

Q: Does it lower cholesterol or blood sugar?

Only in animals so far. A 29-study analysis of rodents found better cholesterol, triglycerides and glucose measures. No human trial of Alisma alone was found.

Q: Can it help fatty liver?

Mice and rats had less liver fat, but no human trial was found. Liver injury has also been reported with Chinese herbal products listing Zexie, so do not self-treat.

Q: Can it help kidney stones?

One 2004 rat study found fewer calcium oxalate deposits with isolated constituents. No human data. See a doctor for stones or flank pain.

Q: Is it safe for the kidneys?

Unclear. One review says no obvious adverse reactions are generally held within the prescribed range; another says high-dose or long-term use can cause kidney toxicity. Compounds damaged human kidney cells in the lab. People with kidney disease should ask a kidney doctor first.

Q: Is it safe for the liver?

Unknown. Zexie is listed in compilations of herbal liver injury, but case details were not read, and the hepatitis B study involved mixtures. People with liver disease should ask a liver doctor first.

Q: Can I take it with water pills, blood pressure, diabetes or cholesterol medicines?

Not without advice. A small trial combined an Alisma prescription with furosemide in hospital. Added effects with the other medicine types are theory only. CYP and P-glycoprotein effects were seen in rats and cells, and Goreisan's were judged minor.

Q: Is it safe in pregnancy or breastfeeding?

No human data. No LactMed or LiverTox entry was found. A computer-prediction paper raised possible liver and kidney toxicity targets, which is not proof. Avoid medicinal amounts unless a doctor who knows your case agrees.

Alisma orientale · also called Ze xie, zexie, Asian water plantain, Rhizoma Alismatis

Alisma, or ze xie, is the dried underground part of a water plant used in Chinese and Japanese medicine to help the body pass urine and clear extra fluid. Most human research tests multi-herb formulas that contain it, not the herb alone, and the cholesterol, blood sugar and fatty liver findings are from animals. Reviews disagree on safety: usual amounts are described as without obvious problems, but high or long-term use has been linked to kidney and liver injury in lab, animal and some case reports. Ask a doctor or pharmacist first if you have kidney or liver disease, take water pills or other medicines, or are pregnant.

General information, not medical advice. Last substantive update October 25, 2026 · Not medically reviewed. A named clinician has not signed off on this page. How this page is made

About Alisma

Alisma rhizome is a traditional water-clearing herb. Human research covers formulas of low certainty, and the animal findings on blood fats, blood sugar and fatty liver are not proven in people. Kidney, liver and fluid-balance safety matter more than any proven benefit.

Safety first

Kidneys: two reviews differ. A 2025 review says no obvious adverse reactions are generally held to occur within the prescribed range; a 2014 review says high-dose or long-term use can cause water-electrolyte imbalance, blood in urine, acidosis and even liver or kidney toxicity. Two Alisma compounds damaged human kidney cells in the lab, and very large amounts harmed rat kidneys (summary-only). No human case series was found. If you have kidney disease, ask your kidney doctor first.

Liver: Zexie appears in compilations of Chinese herbal liver injury, and Alisma orientale was named among suspected ingredients in hepatitis B patients taking mixtures. The case details were not read, so how common this is remains unknown. Absence of reports is not proof of safety.

Water pills and fluids: it is a diuretic herb. It can add to the effect of water pills and cause fluid and salt loss. Medicines such as digoxin and lithium depend on salt balance (theory only; no study found).

Pregnancy and breastfeeding: no human data, no LactMed or LiverTox entry found. Avoid medicinal amounts unless a doctor who knows your case agrees.

Drug interactions are by evidence type: a small trial of a formula with furosemide (human); CYP1A2/CYP3A4 effects in rats (animal); P-glycoprotein effects in cells (lab); blood pressure, diabetes and cholesterol medicines only in theory.

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What it is

Alisma is the dried rhizome of Alisma orientale, now treated by GBIF as the subspecies Alisma plantago-aquatica subsp. orientale. It is called ze xie in Chinese. The main chemicals are triterpenoids called alisols. Reviews say only two of 12 Alisma species are used as the Chinese drug.

It is not the same as a multi-herb formula such as Wu Ling San (Wuling powder), Oryeongsan, Goreisan or Liu Wei Di Huang Wan; those contain several herbs. The European water plantain, Alisma plantago-aquatica, shares the Latin name, so labels overlap.

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What the research shows

Formulas: low-certainty trials of formulas containing Alisma were done in heart failure, diabetic kidney disease and chronic subdural haematoma. They cannot show what Alisma itself does.

Animals: a 2025 analysis of 29 rodent studies found better blood fats and glucose measures, and preclinical work reports less liver fat. A 2004 rat study found fewer kidney stone deposits with isolated constituents.

For Alisma alone, no human trial was found for any use.

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Regulatory status

We found no EMA herbal monograph, no NCCIH page, and no LiverTox or LactMed entry for Alisma. Not found does not prove none exists; the EMA search could not be read. FDA, WHO and German Commission E records were not checked.

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At a glance

Traditional uses history, not proof

Promoting urination and clearing 'dampness' (fluid build-up)
Swelling (oedema) and difficult urination
High blood fats and diabetes (traditional Chinese uses)
Ingredient in formulas such as Wu Ling San and Goreisan

Studied for research

Heart failure fluid (formulas): low
Diabetic kidney disease (formula): low
Chronic subdural haematoma recurrence (Goreisan formula): low
Blood fats and blood sugar (animals): insufficient
Fatty liver (animals): insufficient
Kidney stones (rats): insufficient

Main compounds

Alisol A
Alisol A 24-acetate
Alisol B 23-acetate
Other triterpenoids and terpenoids

Common forms

Dried sliced rhizome (decoction)
Salt-processed rhizome
Granules or capsules
Multi-herb formulas and patent medicines

Research links: Zhu 2025: Alisma extracts, glucose and lipids, 29 rodent studies (PubMed) · Pan 2025: Rhizoma alismatis review incl. toxicology (PubMed) · Jung 2024: Oryeongsan for heart failure, 59 trials (PubMed) · Teschke 2015: herbal Chinese medicine liver injury cases (PubMed) · Research Library · Genes & Biomarkers Library

The plant and its history

Accepted scientific name: Alisma plantago-aquatica subsp. orientale (Sam.) Sam.
Naming authority: GBIF species match API, read 2026-10-25: 'Alisma orientale (Sam.) Juz.' (key 2865103) is a SYNONYM of the ACCEPTED subspecies Alisma plantago-aquatica subsp. orientale (Sam.) Sam. (key 2865101), family Alismataceae. NCBI Taxonomy lists the subspecies as taxid 262913 (esummary read 2026-10-25).
Synonyms: Alisma orientale (Sam.) Juz. (GBIF synonym); Alisma orientalis (spelling variant used in papers)
Common names: Alisma, Asian water plantain (English); Ze xie (Zexie), Rhizoma Alismatis, Alismatis rhizoma (Chinese / Latin); Takusha (Japanese (Kampo name; not verified in a source read))
Botanical family: Alismataceae (water-plantain family; family named in a rat P450 paper and GBIF)
Classification: Plantae > Alismataceae > Alisma > Alisma plantago-aquatica
Native range: Not verified in the sources read.
Habitat: Not covered; a water or wetland plant (a pollutant-uptake paper calls it a wetland plant - title only, not opened).
What the plant looks like: Roots: The dried underground part (rhizome/tuber) is the drug; shape details not verified.; Stems: Not verified.; Leaves: Not verified.; Flowers: Not verified.; Fruit: Not verified.
Cultivation: Not covered; reviews say there is no full traceability system from planting to sale (summary-only).
Harvest and processing: Used raw (dried, sliced) or salt-processed (stir-fried with salt); reviewers suggest salt processing may lower some alisols but data conflict (summary-only).
Look-alikes and adulterants: Name: European water plantain (Alisma plantago-aquatica L.); Note: GBIF accepts it as a separate species (key 2865100). The 2025 reviews say it and the subspecies orientale are the two forms used as the Chinese medicine, so labels overlap; Western herbal uses of the European plant were not researched here.; Name: Other Alisma species; Note: A 2025 review counts 12 species of which only two are used in Chinese medicine.; Name: Plantain (Plantago species); Note: A different plant, not related; our plantain page covers it.; Name: Formulas containing Alisma; Note: Wu Ling San (Wuling powder), Oryeongsan, Goreisan and Liu Wei Di Huang Wan are multi-herb products; their trial results are not results for Alisma alone.
Sustainability and conservation: Not covered.

Traditional use and history history, not clinical proof

Tradition or era	Documented use	Source
Traditional Chinese medicine	To promote water and dampness and vent heat; used for dysuria, oedema, kidney disease, high blood fats and diabetes	p25446590
Traditional Chinese medicine (2025 review)	Described as an important part of many prescriptions used for water-metabolism-related diseases	p41424795
Japanese Kampo	Ingredient of Goreisan, now used with surgery for chronic subdural haematoma	p37638721
Europe (EMA/HMPC)	No monograph found	s-ema-alisma-notfound

Traditional use shows how a plant was used. It does not show that a supplement works or is safe today.

What is inside, and how it may work

What the plant contains and how those compounds act in cells and animals. Laboratory and animal mechanisms are not proven effects in people.

Main compounds

Compound	Family	Where it is concentrated	Activity studied	Level of evidence
Alisol A PubChem 15558616	triterpenoid (alisols are described as tetracyclic triterpenoids)	Rhizome	Inhibited CYP3A in human liver microsomes without pre-incubation; reduced growth and caused cell death in kidney cells at tested concentrations. ^{14 15 6}	Laboratory research
Alisol A 24-acetate PubChem 76336194	triterpenoid	Rhizome	Raised kidney-injury markers and caused apoptosis in kidney cells. ^{14 20}	Laboratory research
Alisol B 23-acetate PubChem 14036811	triterpenoid	Rhizome	Raised kidney-injury markers and apoptosis in kidney cells; reversed P-glycoprotein drug resistance in cancer cells; reviews call its toxicity low. ^{14 20 19 22}	Laboratory research
Alisol B 23-monoacetate and alisol C (and other alisols)	triterpenoid	Rhizome	Alisol B 23-monoacetate caused cell death in kidney cells; alisol C and alisol B 23-acetate were the main therapeutic compounds in a computer model. ^{6 8}	In vitro / computer prediction
Sesquiterpenes and diterpenes	terpenoid	Rhizome	Named in a review as part of the main chemistry; roles not detailed. ¹⁸	Narrative review

Mechanisms, receptors and pathways

Target or pathway	Gene or receptor	What was found	Level
Glucose and lipid metabolism	Insulin signalling, lipid metabolism, gluconeogenesis, autophagy	Rodent meta-analysis lists antioxidant, anti-inflammatory, lipid-metabolism, anti-gluconeogenesis, insulin signalling, autophagy and anti-fibrotic effects of Alisma extracts. ²⁶	Animal research
Liver fat and bile acid receptor	Farnesoid X receptor (FXR), adiponectin	Preclinical review proposes that Alisma and alisols act as an FXR agonist and activate adiponectin. ²	Animal research
Kidney-cell injury	PI3K/Akt/mTOR, autophagy, Clusterin, Kim-1, TFF-3	Alisol A 24-acetate and alisol B 23-acetate switched off PI3K/Akt/mTOR, triggered autophagy and apoptosis, and raised injury markers in kidney cells. ²⁰	Lab
Kidney stones	Bikunin gene expression	Isolated constituents lowered bikunin mRNA and calcium oxalate deposits in rats with induced stones. ¹	Animal research
Drug metabolism and transport	CYP1A2, CYP3A4, P-glycoprotein	Rat: CYP1A2 induced, CYP3A4 inhibited; lab: Goreisan and alisol B 23-acetate act on P-glycoprotein; alisol A inhibits CYP3A in microsomes. ^{5 15 19}	Lab / animal
Water balance in people	Diuresis, sodium excretion	Alisma-containing prescriptions raised urine output and sodium excretion in people (formula trials); the herb's own mechanism in people is unknown. ^{21 7}	Human (formula)

Absorption, metabolism and elimination

Absorption: Not covered for people. Not researched in this build.
Distribution: Not covered.
Metabolism: Not covered in human data; lab papers on alisol metabolism were seen by title only.
Elimination: Not covered.
Bioavailability: Not covered.

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Isolated compounds versus whole extracts

Safety signals for the kidney come largely from isolated alisols tested on cells and from very high doses in rats, while the benefit data are from whole-extract rodent studies and multi-herb formulas. None of these can be transferred to a tea, capsule or powder of the rhizome taken by people. Salt-processed and raw rhizome may differ (summary-only).

Nutritional composition

Alisma is a medicinal herb, not a food or nutrient source. Our nutrient-graph summary classes it as a herb with no essential-nutrient role.

9benefits and uses looked at

26studies and sources checked

Low certaintybest evidence rating found

8lab markers tracked in trials

3 low certainty6 not enough evidence

What is Alisma good for?

The studied uses and how strong the evidence is. Nearly all human data are for formulas that contain Alisma, not the herb alone; the rest is animal research.

Passing urine and fluid build-up (traditional diuretic)Not enough evidenceUsed for centuries to promote urination. Diuretic effects are shown in lab and animal work; no human trial of Alisma alone was found. Heart failure fluid (Wu Ling San-type formulas)Low certaintyIn 59 trials a Wu Ling San-type formula added to usual care raised heart pumping and urine output; the gain was not significant against placebo. A small trial of an 8-herb prescription with Alisma allowed a lower furosemide dose. Not Alisma alone. Diabetic kidney disease (Wuling powder)Low certaintyIn 24 trials Wuling powder beat control on urine protein, creatinine and urine volume. HbA1c did not change significantly. A formula, with limited trial-quality information. Chronic subdural haematoma recurrence (Goreisan)Low certaintyFewer recurrences after surgery with the Kampo formula Goreisan in a meta-analysis (OR 0.72) and a 114-person randomized trial (5.4% vs 25.6%). A formula, small trials. Blood fats (cholesterol and triglycerides)Not enough evidenceRodent extracts lowered triglycerides, cholesterol and LDL in a 29-study analysis. No human trial of Alisma alone. Blood sugar and insulin resistanceNot enough evidenceImproved glucose and insulin measures in rodents. In formula trials fasting glucose was lower but HbA1c was not significantly different. Fatty liverNot enough evidenceLess liver fat and inflammation in mice and rats, possibly through the FXR receptor. No human trial found. Liver injury has also been reported with Chinese herbal products listing Zexie. Kidney stonesNot enough evidenceIsolated constituents reduced calcium oxalate deposits in rats in one 2004 study. No human data. Blood pressureNot enough evidenceReviews report blood-pressure-lowering activity in lab and animal work; a computer-prediction paper looked at pregnancy-related high blood pressure. No human trial of Alisma alone.

Benefits, one by one

Each card is a research question, not a promise. Tap a goal to filter. Open a card to see the studies, doses and limits.

Passing urine and fluid build-up (traditional diuretic)

Not enough evidence

Alisma is used in Chinese medicine to promote urination and clear fluid, and extracts act as a diuretic in animals. We found no human trial of Alisma on its own. Human data come from multi-herb formulas.

2 studiesDried rhizome decoctions, granules and capsules, mostly as part of fo…

Studies, doses and limits

What the trials found

No trial of the herb alone was found. Formula trials are covered in the next three entries.

Results

Reviews describe diuretic activity in lab and animal work only.

Effect sizes as reported

Not applicable

Why this rating

Insufficient: the only 'evidence' for the herb itself is traditional use and lab or animal work; formula trials cannot be credited to the herb alone.

Form and dose studied

Dried rhizome decoctions, granules and capsules, mostly as part of formulas. Amounts are for a practitioner or doctor to decide.

Who was studied

Adults.

Limits

No human trial of Alisma alone; reviews are narrative.

Why researchers looked

It is a classic ingredient in fluid-balance formulas and was studied as a water-promoting herb.

Traditional use

In Chinese medicine it is said to promote water and dampness and vent heat.

Proposed mechanism Preliminary mechanism

Diuretic effects are reported for extracts and compounds in lab and animal work.

A proposed mechanism does not show that the effect happens in people.

Possible fluid and salt loss; see the safety file.

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Heart failure fluid (Wu Ling San-type formulas)

Low certainty

In 59 trials, Oryeongsan, a Wu Ling San-type formula, added to usual care improved heart pumping and urine output in people with heart failure. The gain was not significant when the comparison group also got a placebo. This is a formula, not Alisma alone.

2 studiesDecoctions or granules of the formulas, taken with heart medicines in…

Studies, doses and limits

What the trials found

A 2024 meta-analysis of 59 randomized trials (5,069 people) found that Oryeongsan and variants added to conventional care raised LVEF by 6.36 points (95% CI 5.11 to 7.61) and improved total effective rate, walking test, quality of life, BNP, NT-proBNP and 24-hour urine volume. Against conventional care plus placebo, LVEF and total effective rate improved without significance. Adverse events did not differ. A 2025 trial of 68 people with heart failure and water-pill resistance found a slightly higher sodium excretion fraction (0.18% vs 0.16%, P=0.037) with an 8-herb prescription containing Alisma plus a lower furosemide drip; no difference in events or readmissions at 24 weeks.

Results

Higher LVEF and urine volume with formula plus usual care versus usual care alone; no significant gain versus placebo-controlled comparison; end-point events not different in the one trial that followed them.

Effect sizes as reported

LVEF mean difference 6.36 (95% CI 5.11 to 7.61) vs conventional care alone.

Why this rating

Low: formula not herb, comparison against usual care alone is open to expectation effects, the placebo-controlled gains were not significant, quality results are not in the abstract, and the 68-person trial is small and short.

Form and dose studied

Decoctions or granules of the formulas, taken with heart medicines in hospital studies. Do not combine with water pills or other heart medicines without a doctor.

Who was studied

Adults with heart failure in China, Japan, Korea.

Limits

Alisma is one of several herbs; the abstracts do not say how much Alisma contributed; no placebo in most trials; short follow-up.

Why researchers looked

Fluid congestion is the commonest reason people with heart failure go to hospital, and water pills cause salt problems, so doctors have looked at add-on formulas.

Traditional use

Formulas that contain Alisma are used in Asia to manage fluid imbalance, including heart failure.

Proposed mechanism Preliminary mechanism

Not established; Alisma compounds are diuretic in animals.

A proposed mechanism does not show that the effect happens in people.

Alisma may add to water-pill effects. Do not use instead of heart medicines; electrolyte tests matter.

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Diabetic kidney disease (Wuling powder)

Low certainty

In 24 Chinese trials, Wuling powder (Wu Ling San), a multi-herb formula that includes Alisma, was better than control treatment on urine protein, creatinine and urine volume. This is a formula, and the authors say better trials are needed.

1 studiesMulti-herb powder or decoction added to standard diabetes and kidney …

Studies, doses and limits

What the trials found

A 2022 meta-analysis of 24 randomized trials of Wuling powder in diabetic nephropathy found larger 24-hour urine volume, lower 24-hour urine protein, creatinine, urea nitrogen and urine albumin, lower fasting glucose and blood fats, and a higher total effective rate. HbA1c did not change significantly.

Results

Better kidney and urine measures than control; HbA1c unchanged.

Effect sizes as reported

24-hour urine protein WMD -1.30 (95% CI -1.82 to -0.78); serum creatinine WMD -10.17 (-11.13 to -9.21); total effective rate RR 1.40 (1.32 to 1.48).

Why this rating

Low: formula not herb; trial quality is not given in the abstract; the authors say higher-quality studies are needed; the printed HDL result is internally inconsistent.

Form and dose studied

Multi-herb powder or decoction added to standard diabetes and kidney care. Amounts are not covered here.

Who was studied

Adults with diabetic kidney disease in China.

Limits

Formula not Alisma alone; blood and urine tests rather than kidney failure or death; heterogeneous trials; nothing on long-term kidney harm.

Why researchers looked

Diabetic kidney disease causes protein in the urine and fluid retention; Chinese hospitals add formulas to standard care.

Traditional use

Wu Ling San is a classical fluid-draining formula.

Proposed mechanism Preliminary mechanism

Not established for the formula; Alisma compounds are diuretic and fat-lowering in animals.

A proposed mechanism does not show that the effect happens in people.

People with kidney disease should not add a diuretic herb without their kidney doctor.

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Chronic subdural haematoma recurrence (Goreisan, Japan)

Low certainty

Goreisan, a Kampo formula that includes Alisma, was linked to fewer recurrences of a chronic blood collection under the skull after surgery. This is a formula, not Alisma alone, and trials are small.

2 studiesKampo extract granules given for about 3 months after surgery in the …

Studies, doses and limits

What the trials found

A 2024 meta-analysis of 8 studies found fewer recurrences with Goreisan than with standard surgery care alone (OR 0.72; 95% CI 0.61 to 0.86), with no significant difference in complications (a very wide interval). A 2024 Japanese randomized trial (118 people, 114 analysed) found recurrence of 5.4% with Goreisan vs 25.6% with no medicine (P=.043) and no medicine-linked complications.

Results

Fewer recurrences after surgery with Goreisan.

Effect sizes as reported

OR 0.72 (95% CI 0.61 to 0.86) in the meta-analysis; 5.4% vs 25.6% in the trial.

Why this rating

Low: formula not herb; the meta-analysis mixes randomized trials with retrospective cohorts; the randomized trial is small and had no placebo; the version of Goreisan (which Atractylodes) mattered in the trial authors' view.

Form and dose studied

Kampo extract granules given for about 3 months after surgery in the trial. Prescription only in practice.

Who was studied

Adults after surgery for chronic subdural haematoma in Japan and China.

Limits

Alisma is one of several herbs; results may not carry over to other formulas or to the herb alone.

Why researchers looked

After surgery, chronic subdural haematoma comes back in a sizeable minority; Japanese neurosurgeons add Goreisan to cut recurrence.

Traditional use

Goreisan is a Kampo fluid-balance formula.

Proposed mechanism Preliminary mechanism

Not established; the authors of one trial suggest anti-inflammatory activity of its Atractylodes.

A proposed mechanism does not show that the effect happens in people.

Used only under a neurosurgeon; Alisma's own role is unknown.

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Blood fats (cholesterol and triglycerides)

Not enough evidence

In a 2025 analysis of 29 rodent studies, Alisma extracts lowered triglycerides, total cholesterol and LDL, and raised HDL. No good human trial of Alisma alone was found.

2 studiesExtracts in rodents; the amounts are not transferable to people.

Studies, doses and limits

What the trials found

No trial of Alisma alone in people was found. In the diabetic kidney disease formula trials (Wuling powder), total cholesterol, triglycerides and LDL were lower than control, but that is a multi-herb formula in a different population.

Results

A systematic review of 29 rodent studies found improved triglycerides, total cholesterol, LDL, HDL, body weight and liver fat with Alisma extracts.

Effect sizes as reported

Direction only in the abstract; sizes not given.

Why this rating

Insufficient for people: animal findings only; the formula result is not Alisma alone.

Form and dose studied

Extracts in rodents; the amounts are not transferable to people.

Who was studied

Rodents (animals); adults in formula trials.

Limits

Animal studies often do not carry over; extract preparations vary; no standardised amount.

Why researchers looked

The herb is used in Chinese medicine for high blood fats and 'phlegm and dampness'.

Traditional use

Chinese medicine uses it for hyperlipidaemia (high blood fats).

Proposed mechanism Animal research

Rodent studies point to antioxidant and anti-inflammatory effects, lipid-metabolism regulation and promotion of autophagy.

A proposed mechanism does not show that the effect happens in people.

Alisma may interact with cholesterol medicines in theory; see the safety file.

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Blood sugar and insulin resistance

Not enough evidence

In rodents, Alisma extracts improved fasting and after-meal glucose, glucose and insulin tolerance and insulin resistance. No human trial of Alisma alone was found.

2 studiesExtracts in animals; formula in people.

Studies, doses and limits

What the trials found

No trial of Alisma alone in people was found. In 24 Wuling powder trials in diabetic kidney disease, fasting glucose fell but HbA1c did not change significantly; it is a formula in a different question.

Results

Rodent meta-analysis: improved glucose and insulin measures. Formula meta-analysis: fasting glucose lower, HbA1c not significantly different.

Effect sizes as reported

Direction only for the rodent meta-analysis; Wuling powder: fasting glucose WMD -0.63 (95% CI -0.97 to -0.30), HbA1c WMD -0.11 (-0.30 to 0.08).

Why this rating

Insufficient for people: animal findings, plus an indirect formula result.

Form and dose studied

Extracts in animals; formula in people.

Who was studied

Rodents; adults with diabetic kidney disease in the formula trials.

Limits

No human trial of the herb alone; animal findings may not translate.

Why researchers looked

Chinese medicine lists diabetes among the uses of Alisma.

Traditional use

Used for diabetes in traditional Chinese medicine.

Proposed mechanism Animal research

Suggested mechanisms in rodents: less sugar made by the liver, better insulin signalling and anti-inflammatory effects.

A proposed mechanism does not show that the effect happens in people.

If you take diabetes medicines, ask a pharmacist; theoretical added blood-sugar lowering is not tested.

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Fatty liver (NAFLD/MASLD)

Not enough evidence

Alisma extracts and alisols reduced liver fat and inflammation in mice and rats, possibly by switching on the FXR receptor. No human trial of Alisma was found.

2 studiesExtracts and isolated alisols in animals.

Studies, doses and limits

What the trials found

No human trial of Alisma was found in our searches. A 2025 rodent meta-analysis found lower liver triglycerides and cholesterol; a 2019 review of preclinical studies found less fat build-up, injury and scarring signals.

Results

Lower liver TG and TC in rodent studies; improvements in liver injury panels in preclinical work.

Effect sizes as reported

Direction only; no numbers in the abstracts.

Why this rating

Insufficient for people: lab and animal data only. Also note that liver injury has been reported with some Chinese herbal products including Zexie (see the safety file), so animal benefit does not mean safety.

Form and dose studied

Extracts and isolated alisols in animals.

Who was studied

Mice and rats.

Limits

No human data; the isolated compounds in the lab work are not the whole herb.

Why researchers looked

Fatty liver is linked to high blood fats and insulin resistance, which Alisma affects in animals.

Traditional use

Used for 'dampness' and phlegm, a concept linked traditionally to excess fat.

Proposed mechanism Animal research

Lab and animal work: less liver fat build-up, antioxidant and anti-inflammatory effects, FXR (farnesoid X receptor) activation.

A proposed mechanism does not show that the effect happens in people.

Reports of liver injury in people taking Chinese herbal products that include Alisma make this a use to avoid self-treating.

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Kidney stones (calcium oxalate)

Not enough evidence

In rats, constituents isolated from Alisma reduced calcium oxalate deposits in the kidney. No human study was found.

1 studiesIsolated constituents given by stomach tube to rats.

Studies, doses and limits

What the trials found

No human study of Alisma for kidney stones was found.

Results

Rats given the active constituents had less calcium oxalate in the kidney, lower creatinine and urea nitrogen, and lower urine calcium than untreated stone-forming rats.

Effect sizes as reported

Kidney calcium 4.70 vs 9.49 mg/g (P<0.01); 24-hour urine calcium 37 vs 62 micromol (P<0.01) in rats.

Why this rating

Insufficient for people: a single old rat study (2004) with isolated constituents.

Form and dose studied

Isolated constituents given by stomach tube to rats.

Who was studied

Rats.

Limits

30 rats, isolated constituents, not the whole herb, one paper, no human data.

Why researchers looked

Chinese medicine uses Alisma for difficult urination.

Traditional use

Used to promote urination.

Proposed mechanism Animal research

In a rat model, isolated constituents lowered kidney calcium and urine calcium and changed bikunin gene expression.

A proposed mechanism does not show that the effect happens in people.

Do not self-treat kidney stones or flank pain; see a doctor.

Blood pressure

Not enough evidence

A review says Alisma extracts and compounds lowered blood pressure in lab and animal work. A computer model also predicted action on pregnancy-related high blood pressure. No human trial of Alisma alone was found.

2 studiesExtracts and compounds in lab models.

Studies, doses and limits

What the trials found

No human trial of Alisma alone was found.

Results

A 2025 review lists blood-pressure lowering among activities of extracts and compounds; a 2022 computer-prediction paper suggests targets for pregnancy-induced high blood pressure.

Effect sizes as reported

Not applicable

Why this rating

Insufficient: lab, animal and computer-model findings only.

Form and dose studied

Extracts and compounds in lab models.

Who was studied

Lab models and computer prediction.

Limits

Computer predictions are not evidence that Alisma treats or is safe in pregnancy.

Why researchers looked

It is used with other herbs for dizziness and high blood pressure in Asia.

Traditional use

Traditional Chinese formulas with Alisma are used for 'dizziness'.

Proposed mechanism Pharmacological theory

Lab and animal work reports blood-pressure-lowering activity; a computer prediction paper lists targets (not tested in people).

A proposed mechanism does not show that the effect happens in people.

Do not use Alisma for pregnancy-related high blood pressure; see a doctor.

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Connections to the rest of health

How Alisma connects to the rest of our health knowledge graph. Every link says what kind of connection it is. A safety link (for example to the liver) is a warning, not a benefit. A study that merely mentions a topic never creates a benefit link.

Explore every connection: goals, body systems, organs, symptoms, genes

Kind of connection Connected to Search

A. Wellness goals

Connected to	Kind of connection	Evidence status	Context	Studies
Fluid balance	Traditional use	Not enough evidence	Traditional diuretic; formula trials in heart failure show more urine output; risk of fluid and salt loss. Passing urine and fluid build-up (traditional diuretic): Alisma is used in Chinese medicine to promote urination and clear fluid, and extracts act as a diuretic in animals. We found no human trial of Alisma on its own. Human data come from multi-herb formulas. Preparation or compound: Rhizome; formulas such as Wu Ling San and Goreisan	^{7 21 18 13}
Heart Health	Potential benefit	Low certainty	Heart failure fluid (Wu Ling San-type formulas): In 59 trials, Oryeongsan, a Wu Ling San-type formula, added to usual care improved heart pumping and urine output in people with heart failure. The gain was not significant when the comparison group also got a placebo. This is a formula, not Alisma alone.	^{7 21}
Fluid Balance	Potential benefit	Low certainty	Heart failure fluid (Wu Ling San-type formulas): In 59 trials, Oryeongsan, a Wu Ling San-type formula, added to usual care improved heart pumping and urine output in people with heart failure. The gain was not significant when the comparison group also got a placebo. This is a formula, not Alisma alone.	^{7 21}
Kidney Health	Potential benefit	Low certainty	Diabetic kidney disease (Wuling powder): In 24 Chinese trials, Wuling powder (Wu Ling San), a multi-herb formula that includes Alisma, was better than control treatment on urine protein, creatinine and urine volume. This is a formula, and the authors say better trials are needed.	²³
Brain Health	Potential benefit	Low certainty	Chronic subdural haematoma recurrence (Goreisan, Japan): Goreisan, a Kampo formula that includes Alisma, was linked to fewer recurrences of a chronic blood collection under the skull after surgery. This is a formula, not Alisma alone, and trials are small.	^{24 9}
Cholesterol Balance		Not enough evidence	Blood fats (cholesterol and triglycerides): In a 2025 analysis of 29 rodent studies, Alisma extracts lowered triglycerides, total cholesterol and LDL, and raised HDL. No good human trial of Alisma alone was found.	^{26 23}
Blood Sugar Balance		Not enough evidence	Blood sugar and insulin resistance: In rodents, Alisma extracts improved fasting and after-meal glucose, glucose and insulin tolerance and insulin resistance. No human trial of Alisma alone was found.	^{26 23}
Liver Support		Not enough evidence	Fatty liver (NAFLD/MASLD): Alisma extracts and alisols reduced liver fat and inflammation in mice and rats, possibly by switching on the FXR receptor. No human trial of Alisma was found.	^{26 2}
Urinary Support		Not enough evidence	Kidney stones (calcium oxalate): In rats, constituents isolated from Alisma reduced calcium oxalate deposits in the kidney. No human study was found.	¹
Heart Health		Not enough evidence	Blood pressure: A review says Alisma extracts and compounds lowered blood pressure in lab and animal work. A computer model also predicted action on pregnancy-related high blood pressure. No human trial of Alisma alone was found.	^{13 8}

B. Body systems

Connected to	Kind of connection	Evidence status	Context	Studies
Kidney and urinary system	Adverse effect or risk	Mixed findings	Traditional diuretic; kidney injury in cells and rats at high exposure; reviews differ on risk at usual amounts. Preparation or compound: High or long-term rhizome; alisol A 24-acetate, alisol B 23-acetate	^{13 18 20}
Liver	Adverse effect or risk	Not enough evidence	Listed in compilations of herbal liver injury; details not read; hepatitis B patients. Preparation or compound: Zexie in Chinese herbal products	^{16 17 25}
Urinary System	Biological association	Not enough evidence	Studied for: Passing urine and fluid build-up (traditional diuretic) Studied for: Heart failure fluid (Wu Ling San-type formulas)	^{13 18 7 21 23 1}
Kidney Urinary	Biological association	Not enough evidence	Studied for: Passing urine and fluid build-up (traditional diuretic) Studied for: Diabetic kidney disease (Wuling powder)	^{13 18 23 1}
Cardiovascular System	Biological association	Low certainty	Studied for: Heart failure fluid (Wu Ling San-type formulas) Studied for: Blood fats (cholesterol and triglycerides)	^{7 21 26 23 13 8}
Nervous System	Biological association	Low certainty	Studied for: Chronic subdural haematoma recurrence (Goreisan, Japan)	^{24 9}
Metabolism Weight	Biological association	Not enough evidence	Studied for: Blood fats (cholesterol and triglycerides) Studied for: Blood sugar and insulin resistance	^{26 23}
Endocrine System	Biological association	Not enough evidence	Studied for: Blood sugar and insulin resistance	^{26 23}
Liver Detox	Biological association	Not enough evidence	Studied for: Fatty liver (NAFLD/MASLD)	^{26 2}
Digestive System	Biological association	Not enough evidence	Studied for: Fatty liver (NAFLD/MASLD)	^{26 2}

G. Root causes and contributing factors

Connected to	Kind of connection	Evidence status	Context	Studies
Herb-drug interaction		Not enough evidence	CYP and P-glycoprotein effects in rats and lab tests. Preparation or compound: Rhizome extract; alisol A	^{5 15}

I. Biomarkers

Connected to	Kind of connection	Evidence status	Context	Studies
24-hour urine volume	Biological association	Low certainty	Measured in trials: increased. A lab change is not the same as a health benefit.	^{23 7}
Serum creatinine	Biological association	Low certainty	Measured in trials: lowered. A lab change is not the same as a health benefit.	^{23 6}
Left ventricular ejection fraction (LVEF)	Biological association	Low certainty	Measured in trials: raised. A lab change is not the same as a health benefit.	⁷
Recurrence of chronic subdural haematoma	Biological association	Low certainty	Measured in trials: lowered. A lab change is not the same as a health benefit.	^{24 9}
Triglycerides	Biological association	Not enough evidence	Measured in trials: lowered. A lab change is not the same as a health benefit.	^{26 23}
LDL cholesterol	Biological association	Not enough evidence	Measured in trials: lowered. A lab change is not the same as a health benefit.	^{26 23}
Fasting blood glucose	Biological association	Not enough evidence	Measured in trials: lowered. A lab change is not the same as a health benefit.	^{26 23}
Liver triglycerides and cholesterol	Biological association	Not enough evidence	Measured in trials: lowered. A lab change is not the same as a health benefit.	^{26 2}

K. Biological pathways

Connected to	Kind of connection	Evidence status	Context	Studies
CYP3A4, CYP1A2	Preliminary mechanism	Animal / lab	Altered in rats by Alisma; CYP3A inhibited by alisol A in microsomes.	^{5 15}
P-glycoprotein	Preliminary mechanism	Lab	Inhibited by Goreisan extract (Caco-2) and affected by alisol B 23-acetate in cancer cells.	^{15 19}
PI3K/Akt/mTOR	Preliminary mechanism	Lab	Switched off by alisol A 24-acetate and alisol B 23-acetate in kidney cells.	²⁰
Farnesoid X receptor (FXR)	Preliminary mechanism	Animal	Proposed target in fatty-liver animal work.	²

L. Active compounds

Connected to	Kind of connection	Evidence status	Context	Studies
Alisol A	Biological association	In vitro	Inhibited CYP3A in human liver microsomes without pre-incubation; reduced growth and caused cell death in kidney cells at tested concentrations. Preparation or compound: Rhizome	^{14 15 6}
Alisol A 24-acetate	Biological association	In vitro	Raised kidney-injury markers and caused apoptosis in kidney cells. Preparation or compound: Rhizome	^{14 20}
Alisol B 23-acetate	Biological association	In vitro	Raised kidney-injury markers and apoptosis in kidney cells; reversed P-glycoprotein drug resistance in cancer cells; reviews call its toxicity low. Preparation or compound: Rhizome	^{14 20 19 22}
Alisol B 23-monoacetate and alisol C (and other alisols)	Biological association	In vitro / computer prediction	Alisol B 23-monoacetate caused cell death in kidney cells; alisol C and alisol B 23-acetate were the main therapeutic compounds in a computer model. Preparation or compound: Rhizome	^{6 8}
Sesquiterpenes and diterpenes	Biological association	Narrative review	Named in a review as part of the main chemistry; roles not detailed. Preparation or compound: Rhizome	¹⁸

Each connection is stored with the ingredient, the connected record, the kind of connection, the evidence status, the supporting studies, the preparation or compound involved, and a review date (last reviewed October 25, 2026).

Evidence at a glance: what changed in 7 lab markers

Tap a number to show only those markers. Counts are markers, not people.

Metabolic3 Organ function1 Other21

The evidence

The research centre for Alisma. Every record here was checked against PubMed or the publisher's page; we never list a study we have not verified.

Evidence by outcome

Passing urine and fluid build-up (traditional diuretic) 2 studies Not enough evidence Heart failure fluid (Wu Ling San-type formulas) 2 studies · 68 people in trials Low certainty Diabetic kidney disease (Wuling powder) 1 studies Low certainty Chronic subdural haematoma recurrence (Goreisan, Japan) 2 studies · 118 people in trials Low certainty Blood fats (cholesterol and triglycerides) 2 studies Not enough evidence Blood sugar and insulin resistance 2 studies Not enough evidence Fatty liver (NAFLD/MASLD) 2 studies Not enough evidence Kidney stones (calcium oxalate) 1 studies Not enough evidence Blood pressure 2 studies Not enough evidence

Bars show how many studies we found for each outcome, not how well it works. People are added up across trials only (reviews are not added, to avoid double counting).

How we rate evidence

High certainty

Several well-run trials or reviews agree; further research is unlikely to change the picture much.

Moderate certainty

Good trials point the same way, but some doubt remains.

Low certainty

Small, short or inconsistent trials. The finding could change with better research.

Very low certainty

Very little or very weak human data. Treat as a possibility only.

Mixed findings

Trials or reviews disagree with each other.

Not enough evidence

Not enough human research to say either way.

Evidence against

Good research found no benefit, or found harm.

We take the reviewers' own risk-of-bias and GRADE statements where they exist, and otherwise judge from study size, design, consistency, directness and whether a product matches what is sold. Many publications do not make evidence high. Method note: We read our existing herb summary, searched PubMed, read the abstract of each PubMed record cited, and checked names in GBIF and NCBI Taxonomy and compounds in PubChem. Regulator pages that could not be opened are marked not found or not verified.

Study library: every study we checked 26

Design Research type Plant part Year from Search

Study	Design	People	Product, dose, length	Result
Cao 2004 [The effects of the active constituents of Alisma orientalis on renal stone formation and bikunin expression in rat urolithiasis model]. Zhonghua Yi Xue Za Zhi · PMID 15387965	Animal study animal	30 Male Wistar rats with kidney stones induced by ethylene glycol and ammonium chloride (10 per group)	Active constituents isolated from Alisma orientalis rhizome (isolated constituents) not stated in abstract 4 weeks · vs Stone-forming group without treatment; healthy controls	Treated rats had less calcium oxalate in the kidney and lower creatinine, urea nitrogen, kidney calcium and 24-hour urine calcium than untreated stone-forming rats. For example, kidney calcium 4.70 vs 9.49 mg/g (P<0.01) and 24-hour urine calcium 37 vs 62 micromol (P<0.01). See results (None) Methods, limits and funding Outcomes: Calcium oxalate deposits in kidney, creatinine, urea nitrogen, bikunin mRNA, kidney calcium, urinary calcium and oxalate. Limitations: Rats; isolated constituents, not the whole herb; 2004 paper in Chinese with English abstract; no human data. Funding and conflicts: Not stated in abstract. Read: abstract
Choi 2019 Pharmacological Activities of Alisma orientale against Nonalcoholic Fatty Liver Disease and Metabolic Syndrome: Literature Review. Evid Based Complement Alternat Med · PMID 31275407 · DOI	Narrative review animal	Review of preclinical (lab and animal) studies	Alisma orientale extract and alisols (alisol A 24-acetate, alisol B 23-acetate, alisol F, alismol) rhizome not applicable not applicable · vs not applicable	In preclinical work the herb reduced liver triglyceride build-up, oxidative-stress and inflammation markers and scarring signals. Suggested mechanisms: adiponectin activation, or acting as a farnesoid X receptor (FXR) agonist. The authors say standardisation, safety testing and clinical trials are still required. Not applicable (None) Methods, limits and funding Outcomes: Fatty liver, blood fats, insulin resistance, obesity, blood sugar, appetite. Limitations: Preclinical only; no human trial reviewed in the abstract. Funding and conflicts: Not stated in abstract. Read: abstract
EMA 2026 EMA/HMPC herbal monograph for Alismatis rhizoma European Medicines Agency · Source	Not found		unspecified	No monograph found. A guessed monograph page returned page-not-found (HTTP 404) and the EMA site search returned HTTP 401 on 2026-10-25, so the EMA list was not searched. Methods, limits and funding Limitations: Not found is not proof that none exists. Not verified. Read: not-found
GBIF 2026 GBIF species records: Alisma orientale (synonym) and Alisma plantago-aquatica subsp. orientale (accepted) GBIF Backbone Taxonomy · Source	Authoritative guidance		unspecified	Read 2026-10-25. 'Alisma orientale (Sam.) Juz.' (key 2865103) is a SYNONYM of the ACCEPTED name Alisma plantago-aquatica subsp. orientale (Sam.) Sam. (key 2865101), family Alismataceae. 'Alisma plantago-aquatica L.' (key 2865100) is a separate ACCEPTED species, exact match, confidence 99. Methods, limits and funding Limitations: Taxonomy only. Read: full-text
Huang 2014 Effects of Alismatis rhizome on rat cytochrome P450 enzymes. Pharm Biol · PMID 24824320 · DOI	Animal study animal	Rats given a cocktail of probe drugs after 14 days of Alisma	Alismatis rhizome (Zexie) in three dose levels rhizome 10, 20 and 40 g/kg twice a day (rats) 14 days · vs Untreated rats	Alisma induced (sped up) CYP1A2 and inhibited CYP3A4 in rats; no effect on CYP2C9 or CYP2E1. The authors advise caution when it is taken with some CYP1A2 or CYP3A4 drugs. Not applicable (None) Methods, limits and funding Outcomes: Blood levels of drugs processed by CYP1A2, CYP2C9, CYP2E1 and CYP3A4. Limitations: Rats at high doses; not shown in people. Funding and conflicts: Not stated in abstract. Read: abstract
Huang 2024 The safety evaluation of Shenze Shugan capsule and mechanism of apoptosis induced by five potentially nephrotoxic components. J Ethnopharmacol · PMID 38219879 · DOI	Animal study animal	Rats given herbs for two months, and HK-2 kidney cells	Shenze Shugan capsule (rhubarb, cassia seed and Alismatis Rhizoma) and its single herbs; plus alisol A and alisol B 23-monoacetate on cells rhizome (with two other herbs) High doses, 60 times the adult clinical dose 2 months (rats) · vs Single herbs vs mixed herbs	At 60 times the clinical dose for two months, rhubarb, cassia seed or the mixed herbs raised creatinine and urea nitrogen and caused tubule changes in rats; the abstract does not list Alisma alone among them. The capsule itself showed no significant kidney difference. In cells, alisol A and alisol B 23-monoacetate (like the other three compounds) reduced growth and caused cell death. Not applicable (None) Methods, limits and funding Outcomes: Kidney function (creatinine, urea nitrogen), kidney tissue, cell death. Limitations: Rats and cells, a three-herb capsule, very high doses; the abstract does not give Alisma-alone kidney results. Not human evidence. Funding and conflicts: Not stated in abstract. Read: abstract
Jung 2024 Traditional herbal medicine Oryeongsan for heart failure: A systematic review and meta-analysis. Heliyon · PMID 39315159 · DOI	Meta-analysis	5069 People with heart failure; 59 randomized trials	Oryeongsan and variants (the Korean name of a Wu Ling San-type fluid-balance formula; the abstract does not list its herbs) added to conventional treatment rhizome (as one ingredient, per our herb summary; not stated in abstract) not stated in abstract not stated in abstract · vs Conventional treatment alone, or plus placebo	LVEF was higher with the formula (mean difference 6.36 points; 95% CI 5.11 to 7.61). Other measures improved too, including 24-hour urine volume. Against conventional treatment plus placebo, LVEF and total effective rate improved without statistical significance. Adverse events did not differ. MD 6.36 for LVEF (5.11 to 7.61) Methods, limits and funding Outcomes: Pumping function (LVEF), total effective rate, walking test, quality of life, BNP and NT-proBNP, 24-hour urine volume, adverse events. Limitations: Formula, not Alisma alone; the placebo-controlled comparison showed no significant gain; risk-of-bias results are not in the abstract; trials mostly in Asia. Funding and conflicts: Not stated in abstract. Read: abstract
Liao 2022 Exploring the mechanism of Alisma orientale for the treatment of pregnancy induced hypertension and potential hepato-nephrotoxicity by using network pharmacology, network toxicology, molecular docking and molecular dynamics simulation. Front Pharmacol · PMID 36457705 · DOI	Other other	Computer prediction from public databases (no animals or people)	Alisma orientale compounds (database entries) rhizome (computer model) not applicable not applicable · vs not applicable	The computer model predicted 29 compounds acting on 78 targets for high blood pressure in pregnancy, and 10 compounds linked to liver and kidney toxicity targets (PPARG and TNF named). It named alisol B 23-acetate and alisol C as main therapeutic compounds and emodin as the main toxic compound. The authors say experimental verification is needed before clinical use. Not applicable (None) Methods, limits and funding Outcomes: Predicted targets for pregnancy-induced high blood pressure and for liver and kidney toxicity. Limitations: Prediction only; not evidence that Alisma helps or harms pregnancy or the liver or kidney in people. Funding and conflicts: Not stated in abstract. Read: abstract
Matsumoto 2024 The Effect of Japanese Herbal Medicines (Kampo) Goreisan and Saireito on the Prevention of Recurrent Chronic Subdural Hematoma: A Prospective Randomized Study. Neurosurgery · PMID 37638721 · DOI	Controlled trial	118 Adults after burr-hole surgery for chronic subdural haematoma, Japan (114 analysed)	Goreisan (formula including Alisma rhizome, per our herb summary; a version with Atractylodes rhizome) or Saireito, versus no medicine rhizome (as one ingredient) not stated in abstract 3 months · vs No medication	Recurrence was 5.4% with Goreisan vs 25.6% with no medicine (P=.043) and 2.6% with Saireito. No complications linked to the Kampo medicines were seen. 5.4% vs 25.6% (None) Methods, limits and funding Outcomes: Symptomatic recurrence within 3 months; complications. Limitations: Small single-trial result (about 37 per group), not blinded as far as the abstract says (no placebo), formula not herb alone; funding not in abstract. Funding and conflicts: Not stated in abstract. Read: abstract
NCBI 2026 NCBI Taxonomy: Alisma plantago-aquatica subsp. orientale NCBI Taxonomy · Source	Authoritative guidance		unspecified	Read 2026-10-25: taxid 262913, rank subspecies, scientific name Alisma plantago-aquatica subsp. orientale, division monocots. Methods, limits and funding Limitations: Taxonomy only. Read: full-text
NCCIH 2026 NCCIH Herbs at a Glance: Alisma National Center for Complementary and Integrative Health · Source	Not found		unspecified	No Alisma page found. A guessed page returned HTTP 404 on 2026-10-25. The NCCIH search page returns content only through scripts and was not read. Methods, limits and funding Limitations: Not found is not proof none exists. Not verified. Read: not-found
NIH / 2026 LiverTox and LactMed (NCBI Bookshelf) entries for Alisma / Zexie LiverTox; LactMed · Source	Not found		unspecified	A Bookshelf search for 'alisma livertox', 'zexie livertox' and 'alisma lactmed' found no matching entry on 2026-10-25 (one query errored and was repeated, returning no entry). Methods, limits and funding Limitations: Search did not open any entry pages. Not found, not verified. Read: not-found
Pan 2025 Botany, traditional uses, phytochemistry, pharmacology, toxicology and processing of Rhizoma alismatis: a review. Front Pharmacol · PMID 41424795 · DOI	Narrative review	Narrative review of botany, traditional use, chemistry, pharmacology, toxicology and processing	Rhizoma alismatis (Alisma) extracts and isolated compounds rhizome not applicable not applicable · vs not applicable	Of 12 Alisma species, only Alisma plantago-aquatica L. and A. plantago-aquatica subsp. orientale are used as the Chinese medicine. Extracts and compounds show diuretic, liver-protective, blood-pressure-lowering, blood-sugar-lowering, anti-cancer, anti-inflammatory and antioxidant effects in lab and animal work. The authors say toxicity has long been debated and that it is generally held that no obvious adverse reactions occur within the prescribed dose range. Per our existing herb summary (full text; details below marked summary-only): rats given very large amounts for months had kidney tubule injury linked to alisol B 23-acetate and alisol A 24-acetate; the review advises people with impaired kidneys to be careful with long-term high amounts; older records mention electrolyte imbalance, blood in urine, acidosis and stomach symptoms; a DNA study cited found most market samples labelled subsp. orientale were A. plantago-aquatica; salt-stir-frying may lower some alisols but data conflict. Not applicable (None) Methods, limits and funding Outcomes: Botany, traditional uses, chemistry, pharmacology (diuretic, liver protection, blood pressure, blood sugar, anti-cancer, anti-inflammatory, antioxidant), toxicity and processing. Limitations: Narrative review, no systematic search or risk-of-bias rating. Toxicity details, the DNA market study and the salt-processing statement are from our own existing summary of the full text, not re-opened for this page (summary-only). Most evidence reviewed is lab and animal. Funding and conflicts: Not stated in abstract. Read: abstract + summary-only for details
PubChem 2026 PubChem compound records: alisol A, alisol A 24-acetate, alisol B 23-acetate PubChem · Source	Authoritative guidance		unspecified	Read 2026-10-25 via the PubChem name API: alisol A CID 15558616 (C30H50O5); alisol A 24-acetate CID 76336194 (C32H52O6); alisol B 23-acetate CID 14036811 (C32H50O5). Methods, limits and funding Limitations: Identity of compounds only. Read: full-text
Takiyama 2022 In vitro assessment of the inhibitory effect of goreisan extract and its ingredients on the P-glycoprotein drug transporter and cytochrome P-450 metabolic enzymes. Xenobiotica · PMID 35855663 · DOI	Laboratory research in-vitro	Cell and human liver microsome tests	Goreisan extract; alisol A, tumulosic acid and cinnamic acid rhizome (alisol A is an Alisma compound) not stated in abstract not stated in abstract · vs Controls in the assay	Goreisan extract inhibited P-glycoprotein in a concentration-dependent way. Alisol A inhibited only CYP3A, with no effect after pre-incubation. The authors judge these effects minor or negligible in vivo. Not applicable (None) Methods, limits and funding Outcomes: P-glycoprotein (drug transporter) and seven CYP enzymes. Limitations: Lab tests only; no human interaction study. Authors are from the Kampo manufacturer's research setting (funding not in abstract). Funding and conflicts: Not stated in abstract. Read: abstract
Teschke 2014 Traditional Chinese Medicine Induced Liver Injury. J Clin Transl Hepatol · PMID 26357619 · DOI	Narrative review	Literature review of reported liver-injury cases from herbal Chinese medicine	Many Chinese herbal products; Zexie (Alisma) is on the list rhizome (as named product) not applicable not applicable · vs not applicable	Zexie appears among the named products with reported liver injury. The author says causality was firmly established for some products by re-exposure or the CIOMS liver scale, but case quality was mixed because of adulteration with drugs, heavy-metal contamination and misidentified herbs. The abstract does not say which Zexie cases were firmly established, how many there were, or whether Zexie was the only ingredient. Not applicable (None) Methods, limits and funding Outcomes: Which Chinese herbal products have reported liver injury, and how well the cases were documented. Limitations: Abstract only; case details for Zexie not read. Funding and conflicts: Not stated in abstract. Read: abstract
Teschke 2015 Traditional Chinese Medicine and herbal hepatotoxicity: a tabular compilation of reported cases. Ann Hepatol · PMID 25536637	Narrative review	Review of 77 publications on 57 herbs or herbal mixtures	Chinese herbs and mixtures; Zexie is among those with causality established rhizome (as named product) not applicable not applicable · vs not applicable	Causality was established for 28 of 57 herbs or mixtures, and Zexie is on that list. The abstract does not give the number of Zexie cases, whether they involved Zexie alone, or the outcomes. 28 of 57 herbs or mixtures (None) Methods, limits and funding Outcomes: Causality by CIOMS scale or positive re-exposure. Limitations: Abstract only; the individual Zexie case reports were not read. Listing of a name does not tell us how common injury is. Funding and conflicts: Not stated in abstract. Read: abstract
Tian 2014 Traditional uses, phytochemistry, pharmacology, toxicology and quality control of Alisma orientale (Sam.) Juzep: a review. J Ethnopharmacol · PMID 25446590 · DOI	Narrative review	Narrative review	Rhizoma alismatis (Zexie) rhizome not applicable not applicable · vs not applicable	Traditionally used for dysuria (painful or difficult urination), oedema, kidney disease, high blood fats, diabetes, inflammation and tumours. Main chemistry is terpenoids (sesquiterpene, diterpene, triterpene). Extracts and compounds showed diuretic, kidney-protective, anti-hyperlipidaemic, anti-atherosclerotic, anti-cancer, anti-inflammatory and antioxidant activity. The authors state that high-dose or long-term use can lead to water-electrolyte imbalance, bloody urine, acidosis and even liver or kidney toxicity, which they say several studies have shown. They call for a standardised fingerprint and more precise toxicity work. Not applicable (None) Methods, limits and funding Outcomes: Traditional uses, chemistry, pharmacology, toxicology, quality control. Limitations: Narrative review; the abstract does not say how many of the toxicity reports are in humans, or give amounts. Funding and conflicts: Not stated in abstract. Read: abstract
Wang 2004 Reversal of P-glycoprotein-mediated multidrug resistance by Alisol B 23-acetate. Biochem Pharmacol · PMID 15294447 · DOI	Laboratory research in-vitro	Drug-resistant cancer cell lines	Alisol B 23-acetate isolated from Rhizoma Alismatis rhizome (compound) not stated in abstract not stated in abstract · vs Untreated cells	The compound restored cancer-cell sensitivity to several drugs that P-glycoprotein pumps out, raised doxorubicin accumulation and acted as a partial non-competitive inhibitor of P-glycoprotein. Not applicable (None) Methods, limits and funding Outcomes: Drug accumulation and efflux, P-glycoprotein activity. Limitations: Isolated compound on cell lines; not shown in people. Funding and conflicts: Not stated in abstract. Read: abstract
Wang 2017 Alisol A 24-Acetate and Alisol B 23-Acetate Induced Autophagy Mediates Apoptosis and Nephrotoxicity in Human Renal Proximal Tubular Cells. Front Pharmacol · PMID 28408883 · DOI	Laboratory research in-vitro	Human kidney proximal tubule (HK-2) cells, plus markers measured in vivo	Alisol A 24-acetate and alisol B 23-acetate (isolated compounds) rhizome (isolated compounds) not stated in abstract not stated in abstract · vs Untreated cells	Both compounds raised kidney-injury markers in vitro and in vivo, triggered cell death and autophagy in kidney cells, and switched off PI3K/Akt/mTOR signalling. The authors say this helps explain possible kidney toxicity and could aid safer clinical use of the herb. Not applicable (None) Methods, limits and funding Outcomes: Kidney-injury markers (Clusterin, Kim-1, TFF-3), cell death, autophagy, PI3K/Akt/mTOR signalling. Limitations: Isolated compounds on cells (and an animal readout not detailed in the abstract), not the whole herb at usual intake; concentrations not in abstract. Funding and conflicts: Not stated in abstract. Read: abstract
Wu 2025 [Effects and Efficacy of Wenyang Huayin Yangxin Prescription on the Traditional Chinese Medicine Syndromes of Patients With Chronic Heart Failure Combined With Diuretic Resistance]. Sichuan Da Xue Xue Bao Yi Xue Ban · PMID 40109465 · DOI	Controlled trial	68 People with chronic heart failure and resistance to water pills, China	An 8-herb prescription that includes Alisma rhizome, plus a lower furosemide drip rhizome (as one of 8 herbs) Per the abstract the prescription had a set weight for each herb; not reproduced here 2 weeks (24 weeks follow-up) · vs Higher-dose furosemide drip alone, with standard care	After 2 weeks the herb group had a slightly higher sodium excretion fraction (0.18% vs 0.16%; P=0.037), more urine and better symptom scores while using less furosemide. At 24 weeks there was no difference in end-point events or readmissions. FENa 0.18% vs 0.16% (None) Methods, limits and funding Outcomes: Sodium excretion (FENa), 24-hour urine volume, symptoms, heart output, NT-proBNP, events and readmissions. Limitations: Eight-herb prescription, not Alisma alone; small; no blinding or placebo is described in the abstract; short; Chinese-language report. Funding and conflicts: Not stated in abstract. Read: abstract
Wu 2026 Alisol B 23-acetate as a promising natural bioactive tetracyclic triterpenoid: A review of its extraction methods, pharmacokinetics, metabolism, pharmacology, and toxicity. Chem Biol Interact · PMID 41565045 · DOI	Narrative review in-vitro	Narrative review of one compound	Alisol B 23-acetate (isolated compound) rhizome (compound) not applicable not applicable · vs not applicable	Describes alisol B 23-acetate as a tetracyclic triterpenoid from Alisma orientale with anti-inflammatory, atherosclerosis, liver- and kidney-protective and anticancer activity in lab work, and calls its toxicity low. This conflicts in tone with the cell study of the same compound; both are lab data. Not applicable (None) Methods, limits and funding Outcomes: Extraction, pharmacokinetics, metabolism, pharmacology, toxicity of one compound. Limitations: Review of a single isolated compound; abstract has no numbers. Funding and conflicts: Not stated in abstract. Read: abstract
Yang 2022 Efficacy and Safety of Wuling Powder in the Treatment of Patients with Diabetic Nephropathy: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med · PMID 36212947 · DOI	Meta-analysis	People with diabetic kidney disease; 24 randomized trials (China)	Wuling powder (Wu Ling San), a multi-herb formula that contains Alisma; contents not listed in the abstract rhizome (as one ingredient) not stated in abstract not stated in abstract · vs Control treatment in each trial	Better than control on 24-hour urine volume (WMD 357.95; 95% CI 322.83 to 393.06; unit not stated), 24-hour urine protein (-1.30; -1.82 to -0.78), serum creatinine (-10.17; -11.13 to -9.21), urea nitrogen, urine albumin, fasting glucose, total cholesterol, triglycerides and LDL, and total effective rate (RR 1.40; 1.32 to 1.48). HbA1c did not change significantly (-0.11; -0.30 to 0.08). The HDL result is printed as WMD -0.32 with an interval of 0.03 to 0.62, which does not match in sign, so we do not interpret it. See results (See results) Methods, limits and funding Outcomes: 24-hour urine volume and protein, creatinine, urea nitrogen, urine albumin, blood sugar, HbA1c, blood fats, total effective rate. Limitations: Formula, not Alisma alone; trial quality is not given in the abstract; the authors say higher-quality studies are needed; very narrow intervals suggest results not fully reliable. Funding and conflicts: Not stated in abstract. Read: abstract
Yang 2024 Effectiveness of traditional herbal Kampo medicine Goreisan on chronic subdural hematoma recurrence: a meta-analysis. Front Pharmacol · PMID 39076594 · DOI	Meta-analysis	Adults with chronic subdural haematoma (blood collection under the skull covering) after standard neurosurgical treatment; 8 studies, randomized and non-randomized	Goreisan (Kampo formula that includes Alisma rhizome, per our herb summary; other ingredients not listed in the abstract) rhizome (as one ingredient) not stated in abstract not stated in abstract · vs Standard neurosurgical treatment alone	Fewer recurrences with Goreisan (OR 0.72; 95% CI 0.61 to 0.86; P=0.00003). No significant difference in complications such as tiredness, allergic reaction, liver dysfunction and interstitial pneumonia (OR 7.21; 95% CI 0.37 to 141.29) - a very wide interval, so rare harms are not ruled out. OR 0.72 for recurrence (0.61 to 0.86) Methods, limits and funding Outcomes: Recurrence of chronic subdural haematoma; complications. Limitations: Mix of randomized trials, prospective trials and retrospective cohorts; formula not herb alone; the authors say multicentre randomized trials are needed; funding not in abstract. Funding and conflicts: Not stated in abstract. Read: abstract
Yuen 2006 Traditional Chinese medicine causing hepatotoxicity in patients with chronic hepatitis B infection: a 1-year prospective study. Aliment Pharmacol Ther · PMID 17014576 · DOI	Case series	45 Hospitalised chronic hepatitis B patients with liver dysfunction, Hong Kong (7 of 45 attributed to Chinese medicine)	Various Chinese medicines; Alisma orientale was one of eight components named as hepatotoxic rhizome (as a component of mixtures) not stated in abstract not stated in abstract · vs None	In 7 of 45 patients (15.6%) the liver problem was attributed to Chinese medicine; 3 had bad outcomes (two deaths, one liver transplant). The named components included Alisma orientale (with Polygonum multiflorum, Cassia obtusifolia, Rheum palmatum, Glycyrrhiza uralensis and others). The authors determined each component's hepatotoxicity by searching the published literature, and one formula was adulterated with N-nitrosofenfluramine. 7 of 45 (15.6%) (None) Methods, limits and funding Outcomes: Cause of liver dysfunction, outcome. Limitations: People already had serious liver disease; patients took mixtures; Alisma's share of the harm cannot be separated; per-patient details are not in the abstract. Funding and conflicts: Not stated in abstract. Read: abstract
Zhu 2025 Effects and potential mechanisms of Alismatis Rhizoma extracts on glucose and lipid metabolism: A systematic review and meta-analysis of rodent studies. J Ethnopharmacol · PMID 40825387 · DOI	Meta-analysis animal	29 Rodent models of glucose and lipid disorders (29 preclinical studies)	Alismatis Rhizoma (Alisma) extracts rhizome (extracts) not stated in abstract not stated in abstract · vs Untreated or control animals	Extracts improved all of these measures in rodents. Suggested mechanisms: antioxidant, anti-inflammatory, lipid-metabolism, less sugar made by the liver, better insulin signalling, autophagy and anti-scarring effects. Direction only; numbers not in abstract (None) Methods, limits and funding Outcomes: Fasting and after-meal glucose, glucose and insulin tolerance, insulin resistance (HOMA-IR), triglycerides, total cholesterol, LDL, HDL, body weight, liver fat. Limitations: Animals only. The authors say current research is limited and well-designed studies are needed. Risk of bias was rated with the SYRCLE tool; the ratings are not in the abstract. Funding and conflicts: Not stated in abstract. Read: abstract

What we do not know yet

No human trial of Alisma alone for any use.
Formula trials have unknown trial quality and cannot isolate Alisma.
Kidney and liver harm: no human case details read; size of risk unknown.
No human data on pregnancy, breastfeeding, children or drug interactions.
No EMA, NCCIH, LiverTox or LactMed entry found.

How new research is added

New studies are found by a saved PubMed search and placed in a review queue. A person reads each one before it changes any rating or safety wording.

Lab markers

What changed in blood or saliva tests during trials. A changed number is not the same as feeling or being healthier, and we give no "normal ranges".

Metabolic 3

▼

Triglycerides

Lowered in trials

A type of blood fat linked to heart and liver risk.

Not enough evidence

Results and what it means

Why it was measured

Used to judge blood-fat treatments.

Statistical vs. clinical meaning

Statistically significant in formula pooled data, but the formula is not Alisma alone and the rodent data are not human.

Safety implication

Not a safety issue by itself.

Study	Result	People	Product
²⁶	Improved in rodents with Alisma extracts (size not in abstract)	Rodents, 29 studies	Alisma extracts
²³	Lower with Wuling powder; WMD -0.46 (95% CI -0.70 to -0.23), unit not stated	24 trials in diabetic kidney disease	Wuling powder (formula)

^{26 23}

▼

LDL cholesterol

Lowered in trials

The 'bad' cholesterol carried in the blood.

Not enough evidence

Results and what it means

Why it was measured

Used to judge heart risk.

Statistical vs. clinical meaning

As above.

Safety implication

Not a safety issue by itself.

Study	Result	People	Product
²⁶	Improved in rodents with Alisma extracts (size not in abstract)	Rodents, 29 studies	Alisma extracts
²³	Lower with Wuling powder; WMD -0.57 (95% CI -0.77 to -0.37), unit not stated	24 trials in diabetic kidney disease	Wuling powder (formula)

^{26 23}

▼

Fasting blood glucose

Lowered in trials

Blood sugar after not eating overnight.

Not enough evidence

Results and what it means

Why it was measured

Used to judge diabetes control.

Statistical vs. clinical meaning

As above; HbA1c was not significantly changed in the formula trials.

Safety implication

Possible added effect with diabetes medicines (theory).

Study	Result	People	Product
²⁶	Improved in rodents with Alisma extracts (size not in abstract)	Rodents, 29 studies	Alisma extracts
²³	Lower with Wuling powder; WMD -0.63 (95% CI -0.97 to -0.30), unit not stated	24 trials in diabetic kidney disease	Wuling powder (formula)

^{26 23}

Organ function 1

▼

Serum creatinine

Lowered in trials

A blood marker of kidney filtering; lower usually means better.

Low certainty

Results and what it means

Why it was measured

Used to follow kidney function in diabetic kidney disease.

Statistical vs. clinical meaning

Statistically significant in a pooled analysis; a blood marker, not kidney failure or survival; the formula is not Alisma alone.

Safety implication

Alisma compounds raised kidney-injury markers in cells and rats at very high amounts, so creatinine should be followed by a doctor if the herb is taken long-term.

Study	Result	People	Product
²³	Lower with Wuling powder; WMD -10.17 (95% CI -11.13 to -9.21), unit not stated	24 trials, diabetic kidney disease	Wuling powder plus standard care

^{23 6}

Other 4

●

24-hour urine volume

Increased in trials

How much urine a person passes in a day.

Low certainty

Results and what it means

Why it was measured

Used to judge how well a treatment clears fluid.

Statistical vs. clinical meaning

Statistically significant in formula meta-analyses; not shown for Alisma alone.

Safety implication

Too much urine loss can cause dehydration or salt imbalance.

Study	Result	People	Product
²³	Higher with Wuling powder; WMD 357.95 (95% CI 322.83 to 393.06), unit not stated in abstract	24 trials, people with diabetic kidney disease	Wuling powder (Alisma-containing formula) plus standard care
⁷	24-hour urine volume improved with Oryeongsan and variants (number not in abstract)	59 trials, 5,069 people with heart failure	Oryeongsan formula plus conventional care

^{23 7}

▲

Left ventricular ejection fraction (LVEF)

Raised in trials

The share of blood the heart pumps out with each beat.

Low certainty

Results and what it means

Why it was measured

Main measure of pumping strength in heart failure.

Statistical vs. clinical meaning

Statistically significant versus usual care alone; the placebo-controlled gain was not significant; formula not herb.

Safety implication

Not a safety issue by itself.

Study	Result	People	Product
⁷	Higher with Oryeongsan and variants; mean difference 6.36 (95% CI 5.11 to 7.61); not significant against a placebo-controlled comparison	59 trials, 5,069 people with heart failure	Oryeongsan formula plus conventional care

⁷

▼

Recurrence of chronic subdural haematoma

Lowered in trials

Whether the blood collection under the skull comes back after surgery.

Low certainty

Results and what it means

Why it was measured

The main outcome in the Goreisan studies.

Statistical vs. clinical meaning

Statistically significant; a real clinical event, but the studies are small and mixed and the formula is not Alisma alone.

Safety implication

No Goreisan-linked complications in the trial; the meta-analysis could not rule out rare harms.

Study	Result	People	Product
²⁴	Lower with Goreisan; OR 0.72 (95% CI 0.61 to 0.86)	8 studies of people after surgery	Goreisan (Alisma-containing Kampo formula) plus standard care
⁹	5.4% with Goreisan vs 25.6% with no medicine (P=.043)	118 randomized adults, Japan (114 analysed)	Goreisan for 3 months

^{24 9}

▼

Liver triglycerides and cholesterol

Lowered in trials

Fat stored in liver tissue (measured in animals).

Not enough evidence

Results and what it means

Why it was measured

Used to judge fatty liver in animal models.

Statistical vs. clinical meaning

Animal only.

Safety implication

Not applicable

Study	Result	People	Product
²⁶	Lower liver TG and TC in rodent studies (size not in abstract)	Rodents, 29 studies	Alisma extracts

^{26 2}

Safety

What studies and official sources say about side effects, medicines and who should check first. Each point shows what kind of evidence it comes from.

Main points to know 6

Kidney: lab and animal warnings, no clear human case series, and reviews that differ in tone. Two reviews disagree in emphasis. A 2025 review says it is generally held that no obvious adverse reactions occur within the prescribed range, and (per our summary of its full text) advises people with impaired kidneys to be careful with long-term high amounts. A 2014 review says high-dose or long-term use can lead to water-electrolyte imbalance, bloody urine, acidosis and even liver or kidney toxicity. Two alisol compounds raised kidney-injury markers and caused cell death in human kidney cells, and in rats very large amounts over months caused kidney tubule injury (summary-only). We found no human case series of kidney injury from Alisma. Absence of reports is not proof of safety, and the lab and animal findings are at amounts far above usual use. Animal research ^{13 18 20 6}
Liver: Zexie appears in compilations of reported herbal liver injury; details not read. Two literature compilations of Chinese herbal liver injury (2014 and 2015) list Zexie, and the 2015 paper says causality was established for 28 of 57 herbs or mixtures, including Zexie. The abstracts do not say how many Zexie cases there were, whether Zexie was the only ingredient, or the outcomes, and the author warns that case quality was mixed because of adulteration, heavy metals and misidentified herbs. A Hong Kong study of hepatitis B patients named Alisma orientale among eight components of Chinese medicines blamed for liver dysfunction in 7 of 45 admissions, but patients took mixtures. Cell studies suggest high concentrations can harm liver cells (summary-only). So a liver question is real but its size is unknown. Case series ^{16 17 25 13}
Water pill effect: fluid and salt loss, and added effect with diuretic medicines. Alisma is a traditional diuretic. Reviews link large or long-term use to water-electrolyte imbalance and acidosis. In a small trial an 8-herb prescription containing Alisma allowed a lower furosemide dose with more sodium excreted, which shows it can add to water-pill effect. Dehydration, dizziness and salt or potassium imbalance are the practical concerns, especially with water pills, vomiting, diarrhoea or heart or kidney disease. Controlled trial ^{18 21 13}
Pregnancy and breastfeeding: no human safety data. We found no human study, no regulator statement and no LactMed or LiverTox entry for Alisma in pregnancy or breastfeeding. A computer-prediction paper looked at Alisma for pregnancy-induced high blood pressure and also predicted liver and kidney toxicity targets; it is not evidence in people. Avoid medicinal amounts in pregnancy and while breastfeeding unless a doctor who knows your case agrees. Pharmacological theory ^{8 12}
Possible drug interactions: lab and rat data only. In rats Alisma sped up CYP1A2 and slowed CYP3A4. In human liver microsomes alisol A blocked CYP3A only without pre-incubation and Goreisan extract blocked the drug transporter P-glycoprotein; the authors call these effects minor or negligible in vivo. We found no human interaction study. Treat any interaction as possible, not proven. Animal research ^{5 15 19}
Quality: species mix-ups and unknown strength. Several Alisma species exist and only two are used in Chinese medicine; a DNA study cited by a 2025 review found most market samples labelled as the subspecies orientale were A. plantago-aquatica (summary-only). Alisol content varies by region and season. Chinese formulas have been found adulterated with unlisted drugs in at least one case. We found no independent test of Alisma supplements. Authoritative guidance ^{13 4 25}

Side effects 5

Effect	How often	Severity and recovery	Evidence
Water-electrolyte imbalance, blood in urine and acidosis with high-dose or long-term use Reported in reviews of historical records; patient detail, amounts and counts were not in the abstracts. The 2025 review calls adverse reactions unusual within the prescribed range.	Not established	not stated Not stated	Narrative review ^{18 13}
Stomach symptoms with large or long-term amounts From our existing summary of the 2025 review's full text (summary-only); not re-checked.	Not established	not stated Not stated	Narrative review ¹³
Kidney tubule injury and kidney-cell death at very high exposure Alisol A 24-acetate and alisol B 23-acetate raised kidney-injury markers and caused apoptosis in kidney cells; in a two-month rat study at 60 times the clinical dose of a three-herb capsule, the abstract names rhubarb, cassia seed or the mixed herbs, not Alisma alone, as raising creatinine.	Not established	not applicable (animals and cells) Not stated	Animal research ^{20 6}
Liver injury (reported cases listing Zexie) Case details not read; patients often took mixtures; one study was in hepatitis B patients, who are especially vulnerable.	Not established	not stated Not stated	Case series ^{16 17 25}
No medicine-linked complications in formula trials No complications linked to Goreisan in a 114-person randomized trial; no significant difference in adverse events in a 59-trial meta-analysis of Oryeongsan; wide interval in the Goreisan meta-analysis. Short trials of formulas, not Alisma alone, and not tracking long-term kidney or liver harm.	Not established	none reported not applicable	Controlled trial ^{9 7 24}

Liver

Liver injury has been reported with Chinese herbal products that include Zexie, but we could not see the case details. Teschke's 2014 and 2015 reviews list Zexie among products with reported liver injury and, in 2015, among 28 of 57 products where causality was established by the CIOMS scale or re-exposure; the abstracts give no case counts, and mixtures, contamination and misidentification are discussed as problems for such cases. A prospective Hong Kong study of people with chronic hepatitis B found Chinese medicine behind 7 of 45 liver admissions and named Alisma orientale among eight suspected components (identified from the literature, in mixtures). Rodent studies and a 2019 review describe liver-protective effects, which are not evidence for people. LiverTox: no Alisma entry found. ^{16 17 25 2 12}

How often. Unknown; cannot be estimated from the abstracts.

Monitoring. No agency monitoring advice found. People with liver disease, especially chronic hepatitis B, should not use Alisma-containing mixtures without a liver doctor. Stop and seek care for yellow skin or eyes, dark urine or severe tiredness.

This is a safety connection. It is not evidence that Alisma supports liver health.

Medicines and supplements 8

With	Why it matters	Importance	Evidence	What to do
Water pills (furosemide, thiazides, other diuretics) drug	Alisma is a traditional diuretic; an 8-herb prescription containing Alisma allowed a lower furosemide dose in one trial.	Possible extra fluid and salt loss, low blood pressure, dizziness or low potassium.	Controlled trial Low certainty ^{21 18}	Do not combine without your prescriber; salt and potassium blood tests may be needed.
Digoxin and lithium (levels and toxicity depend on salt and fluid) drug	Theory only: a diuretic herb can change salt and fluid balance.	If fluid or salt falls, these drugs can build up. No study of Alisma with either was found.	Pharmacological theory Very low certainty ¹⁸	Ask a pharmacist before any diuretic herb with these drugs.
Blood pressure medicines drug	A review reports blood-pressure-lowering activity of Alisma extracts and compounds in lab and animal work.	Possible added lowering and dizziness. Not tested in people.	Pharmacological theory Very low certainty ¹³	Check with your prescriber; monitor blood pressure.
Diabetes medicines (insulin, sulfonylureas, others) drug	Rodent studies show lower glucose and better insulin sensitivity; in formula trials fasting glucose was lower.	Possible added blood-sugar lowering. Not tested in people with the herb alone.	Animal research Very low certainty ^{26 23}	Check blood sugar more often and tell your clinician.
Cholesterol medicines (for example statins) drug	Rodent studies show lower blood fats; Alisma slowed CYP3A4 in rats, an enzyme that processes some statins.	Possible added effect or higher drug levels. Not tested in people.	Animal research Very low certainty ^{26 5}	Ask a pharmacist.
Drugs processed by CYP1A2 or CYP3A4, or moved by P-glycoprotein drug	Rats: Alisma induced CYP1A2 and inhibited CYP3A4. Lab: Goreisan extract inhibited P-glycoprotein and alisol A inhibited CYP3A without pre-incubation; alisol B 23-acetate interacted with P-glycoprotein in cancer cells.	Authors say effects are minor or negligible in vivo for Goreisan; rat results suggest caution. No human data.	Animal research Very low certainty ^{5 15 19}	Tell your pharmacist you use Alisma if you take drugs with narrow safety margins.
Other drugs or herbs that can harm the kidneys or liver other	Theory: additive stress on organs already questioned for high-dose Alisma.	Not studied.	Pharmacological theory Very low certainty ^{18 16}	Avoid stacking without advice; use caution with NSAID painkillers and other herbal products.
Other diuretic herbs (for example dandelion, corn silk, horsetail) herb	Theory: added water-loss effect.	Not studied.	Pharmacological theory Very low certainty ¹⁸	Do not combine several diuretic herbs without advice.

Who should check first 7

Situation	Advice	Evidence
Pregnancy and trying to conceive	Avoid medicinal amounts. No human safety data; a computer-prediction paper flagged possible liver and kidney toxicity targets, which is not proof.	Pharmacological theory ⁸
Breastfeeding	No LactMed entry or human data found; avoid medicinal amounts unless a doctor agrees.	Insufficient ¹²
Children	No child safety data found; do not give.	Insufficient ¹³
Kidney disease (including people on dialysis or with a transplant)	Ask a kidney specialist first; the 2025 review (per our summary of its full text) says people with impaired kidney function should be careful with long-term high amounts.	Narrative review ^{13 18}
Liver disease, especially chronic hepatitis B	Do not use mixtures that include Alisma without a liver doctor's advice.	Case series ^{25 16}
Dehydration, low blood pressure, vomiting or diarrhoea, or known salt or potassium problems	Avoid diuretic herbs until reviewed by a clinician.	Pharmacological theory ¹⁸
Painful urination, flank pain or kidney stones	Do not self-treat; see a doctor. The only stone data are from rats.	Insufficient ¹

Overdose, product quality and regulators

Summary. Toxicity of the rhizome has long been debated. The 2025 review says it is generally held that no obvious adverse reactions occur within the prescribed range; the 2014 review says high-dose or long-term use can cause water-electrolyte imbalance, blood in urine, acidosis and even liver or kidney toxicity.

Animal. Per our summary of the 2025 review's full text: rats given very large amounts for months had kidney tubule injury and inflammation, linked to alisol B 23-acetate and alisol A 24-acetate (summary-only). In a separate two-month rat study at 60 times the clinical dose, the three-herb capsule did not significantly change kidney structure or function, while rhubarb, cassia seed or the mixed herbs did, and the abstract does not list Alisma alone as doing so.

Human doses studied. Not reported here. Formula trials ran from 2 weeks to about 3 months with no medicine-linked complications reported; no safe long-term amount of the herb alone is established.

High dose or long term signals. Reviews list electrolyte imbalance, blood in urine, acidosis and stomach symptoms from historical records; kidney and liver injury signals in cells and animals.

Overdose response. Not found. For heavy urine loss, faintness, muscle weakness, an irregular heartbeat, little or no urine, or yellow skin, seek urgent care or call a poison centre.

Genotoxicity. Not found in the sources read.

Toxic plant parts. None identified in the sources read. The part used is the dried rhizome; other plant parts were not covered. Our summary notes the salt-fried rhizome may have lower alisols, but reviewers say data conflict (summary-only).

Species identity and strength are the main quality issues. Of 12 Alisma species only Alisma plantago-aquatica and its subspecies orientale are used in Chinese medicine, and market samples may be mislabelled. Formulas in general have been found adulterated in some reports.

Species mix-ups. A DNA study cited by the 2025 review found most market samples labelled as subsp. orientale were Alisma plantago-aquatica (summary-only). GBIF treats Alisma orientale as a synonym of A. plantago-aquatica subsp. orientale, and A. plantago-aquatica L. is a separate accepted species also named as a source of the Chinese drug, so labels overlap. ^{13 4}

Variable strength. Reviews say alisol content varies by region and season and that no full traceability from planting to sale exists (summary-only). ¹³

Adulterated Chinese formulas. In the Hong Kong study one Chinese formula was adulterated with N-nitrosofenfluramine, a highly hepatotoxic agent; this was not shown for an Alisma product. The 2014 Teschke review warns about adulteration with drugs, heavy metals and misidentified herbs in herbal case reports. ^{25 16}

Body	Action	Date

When to get medical help

Little or no urine, new swelling, blood in the urine or severe flank pain: get urgent care.
Yellow skin or eyes, dark urine, pale stools, severe tiredness or belly pain: stop it and get urgent care.
Faintness, muscle weakness or cramps, an irregular heartbeat or severe vomiting or diarrhoea while using it: get urgent care.
Rash, swelling of the lips or face, or trouble breathing: emergency care.

Stop the supplement and contact a clinician or emergency service. In the US, Poison Control is 1-800-222-1222.

General information only, not medical advice. Ask a clinician or pharmacist before use, especially with medicines, in pregnancy or with a health condition. See the Natural Remedy Safety guide.

Frequently asked questions

What is alisma?

Alisma, or ze xie, is the dried rhizome of a water plant (Alisma orientale, now treated as a subspecies of Alisma plantago-aquatica). It is used in Chinese and Japanese medicine as a diuretic and fluid-clearing herb.

^{4 13}

Is it the same as European water plantain?

They overlap. The European plant Alisma plantago-aquatica is accepted as a separate species by GBIF, and reviews say it and the subspecies orientale are the two forms used as ze xie. Western herbal uses were not researched here, and 'plantain' alone is a different plant.

^{4 13}

Does alisma work as a water pill?

It is a traditional diuretic and acts that way in animals. No human trial of Alisma alone was found. Formulas containing it raised urine output in heart failure and diabetic kidney trials.

^{18 7 23 21}

Does it lower cholesterol or blood sugar?

Only in animals so far. A 29-study analysis of rodents found better cholesterol, triglycerides and glucose measures. No human trial of Alisma alone was found.

^{26 23}

Can it help fatty liver?

Mice and rats had less liver fat, but no human trial was found. Liver injury has also been reported with Chinese herbal products listing Zexie, so do not self-treat.

^{2 26 17}

Can it help kidney stones?

One 2004 rat study found fewer calcium oxalate deposits with isolated constituents. No human data. See a doctor for stones or flank pain.

Is it safe for the kidneys?

Unclear. One review says no obvious adverse reactions are generally held within the prescribed range; another says high-dose or long-term use can cause kidney toxicity. Compounds damaged human kidney cells in the lab. People with kidney disease should ask a kidney doctor first.

^{13 18 20 6}

Is it safe for the liver?

Unknown. Zexie is listed in compilations of herbal liver injury, but case details were not read, and the hepatitis B study involved mixtures. People with liver disease should ask a liver doctor first.

^{16 17 25}

Can I take it with water pills, blood pressure, diabetes or cholesterol medicines?

Not without advice. A small trial combined an Alisma prescription with furosemide in hospital. Added effects with the other medicine types are theory only. CYP and P-glycoprotein effects were seen in rats and cells, and Goreisan's were judged minor.

^{21 5 15 26}

Is it safe in pregnancy or breastfeeding?

No human data. No LactMed or LiverTox entry was found. A computer-prediction paper raised possible liver and kidney toxicity targets, which is not proof. Avoid medicinal amounts unless a doctor who knows your case agrees.

^{8 12}

Do the Wu Ling San and Goreisan results apply to alisma?

No. They are multi-herb formulas, so results cannot be credited to Alisma alone. Ask a doctor or pharmacist about amounts and your medicines.

^{24 23 7}

Is alisma approved by EMA or listed by NCCIH?

We found no EMA herbal monograph and no NCCIH page. Not found is not proof none exists; the EMA search could not be read.

^{3 11}

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Editorial transparency

Written by: AlternativeMed editorial team. Research compiled with AI assistance, then checked against PubMed records.
Medical review: None. This page has not been reviewed by a physician or pharmacist.
First published: 2026-10-25
Last substantive update: 2026-10-25
How we research: We read our existing herb summary, searched PubMed, read the abstract of each PubMed record cited, and checked names in GBIF and NCBI Taxonomy and compounds in PubChem. Regulator pages that could not be opened are marked not found or not verified.
How we rate evidence: See "How we rate evidence" in the Evidence tab.
Independence: No product is promoted on this page. No affiliate links are shown.

Sources 26

Each source was opened and checked. Where we read only the abstract, it says so. The small numbers in the text point here.

Cao ZG, Liu JH, Zhou SW. [The effects of the active constituents of Alisma orientalis on renal stone formation and bikunin expression in rat urolithiasis model].. Zhonghua Yi Xue Za Zhi. 2004. PMID 15387965. (abstract)
Choi E, Jang E, Lee JH. Pharmacological Activities of Alisma orientale against Nonalcoholic Fatty Liver Disease and Metabolic Syndrome: Literature Review.. Evid Based Complement Alternat Med. 2019. PMID 31275407. DOI 10.1155/2019/2943162. (abstract)
EMA. EMA/HMPC herbal monograph for Alismatis rhizoma. European Medicines Agency. 2026. (not-found)
GBIF. GBIF species records: Alisma orientale (synonym) and Alisma plantago-aquatica subsp. orientale (accepted). GBIF Backbone Taxonomy. 2026. (full-text)
Huang Y, Zheng SL, Xu ZS. Effects of Alismatis rhizome on rat cytochrome P450 enzymes.. Pharm Biol. 2014. PMID 24824320. DOI 10.3109/13880209.2013.864685. (abstract)
Huang Q, Fan M, Ji F. The safety evaluation of Shenze Shugan capsule and mechanism of apoptosis induced by five potentially nephrotoxic components.. J Ethnopharmacol. 2024. PMID 38219879. DOI 10.1016/j.jep.2024.117777. (abstract)
Jung DH, Lee HG, Kwon S. Traditional herbal medicine Oryeongsan for heart failure: A systematic review and meta-analysis.. Heliyon. 2024. PMID 39315159. DOI 10.1016/j.heliyon.2024.e37830. (abstract)
Liao Y, Ding Y, Yu L. Exploring the mechanism of Alisma orientale for the treatment of pregnancy induced hypertension and potential hepato-nephrotoxicity by using network pharmacology, network toxicology, molecular docking and molecular dynamics simulation.. Front Pharmacol. 2022. PMID 36457705. DOI 10.3389/fphar.2022.1027112. (abstract)
Matsumoto H, Matsumoto A, Miyata S. The Effect of Japanese Herbal Medicines (Kampo) Goreisan and Saireito on the Prevention of Recurrent Chronic Subdural Hematoma: A Prospective Randomized Study.. Neurosurgery. 2024. PMID 37638721. DOI 10.1227/neu.0000000000002649. (abstract)
NCBI. NCBI Taxonomy: Alisma plantago-aquatica subsp. orientale. NCBI Taxonomy. 2026. (full-text)
NCCIH. NCCIH Herbs at a Glance: Alisma. National Center for Complementary and Integrative Health. 2026. (not-found)
NIH / NLM. LiverTox and LactMed (NCBI Bookshelf) entries for Alisma / Zexie. LiverTox; LactMed. 2026. (not-found)
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