Ze Xie
StarAlisma orientale (Sam.) Juzep.
Traditionally used for
- Urinary & fluids
Cautions & contraindications
- Kidney conditions
☯ TCM Properties
Promotes Urination and Drains Dampness; Clears Heat; Transforms Turbidity and Lowers Lipids; Drains Kidney Fire
Traditional Chinese Uses
Ze Xie (water plantain rhizome) is a cold, sweet herb with a focused and reliable diuretic action. It promotes urination and drains Damp-Heat from the Bladder and Kidneys, addressing urinary difficulty, urinary tract infections, and edema from fluid accumulation. It also has an important secondary action of clearing Kidney Fire to relieve the hot, steaming sensations of Kidney deficiency with Fire. In modern Chinese medicine, it is commonly used to support healthy cholesterol and blood lipid levels.
Western Herbalism Properties
Used In Formulas (8)
Relationships
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Botanical Description
Alisma orientale is an emergent aquatic herbaceous perennial in the Alismataceae, native to eastern Asia including China, Korea, Japan and the Russian Far East, where it grows in shallow water at the margins of ponds, ditches, marshes and slow-flowing streams. Plants arise from a short, fleshy, globose to ovoid corm-like rhizome and reach 50-100 cm tall in flower. The long-petiolate basal leaves are ovate to lanceolate with rounded or shallowly cordate bases, parallel-curving venation and bright green, glossy blades held above the water surface. In summer the species produces a tall, much-branched, whorled pyramidal panicle of small white to pale pinkish flowers, each with three rounded petals and six stamens. The flowers are followed by flattened, ridged achenes arranged in a ring. The species is cultivated for medicine in Fujian and Sichuan, the rhizomes being lifted in winter, peeled and dried.
Active Constituents
Alisol B 23-acetate
Protostane-type triterpenoidConcentration: One of the three principal triterpenoids of the salt-processed drug; in salt-processed material the measured ratio of alisol A 24-acetate to alisol B to 23-acetylalisol B was about 5.4 to 14.3 to 11.3, and provenance shifted the ratio substantially
The single most consequential constituent for drug safety. It is a potent and specific agonist of the human pregnane X receptor, and it induced endogenous CYP3A4 messenger RNA both in pregnane-X-receptor-overexpressing hepatoma cells and in human primary hepatocytes. It does not act on CAR, LXR, FXR or the PPARs, so the effect is a targeted transcriptional induction rather than general nuclear-receptor promiscuity.
Alisol A 24-acetate
Protostane-type triterpenoidConcentration: One of three components used to define the quality of salt-processed rhizome; the lowest of the three in the optimal ratio determined for the Fujian geoherb
Part of the triterpenoid fraction that carries the diuretic and lipid-lowering activity. Work on the salt-processed geoherb concluded that the ratio between alisol A 24-acetate, alisol B and 23-acetylalisol B, rather than the absolute content of any one, determines the strength of the diuretic effect.
Alisol B
Protostane-type triterpenoidConcentration: The most abundant of the three marker triterpenoids in salt-processed material from the Fujian geoherb region
Contributes to the diuretic effect measured in rats as increased urine volume with increased urinary sodium, potassium and chloride, alongside reduced aquaporin-2 in the renal medulla and in HK-2 cells.
Alismol
Guaiane-type sesquiterpene alcoholConcentration: A minor sesquiterpene of the tuber, purified for pharmacological study rather than routinely assayed
Purified alismol relieved acute lung injury in mice through Nrf2 activation. It is one of the non-triterpenoid constituents that make the crude drug pharmacologically broader than its alisol markers suggest.
Orientalols L to P
Guaiane-type sesquiterpenesConcentration: Minor novel sesquiterpenes isolated from the rhizome; not quantified in routine quality control
These are the constituents that carry the recorded nephrotoxicity signal. They were tested directly on HK2 human renal proximal tubular cells and were nephrotoxic in that assay. The kidney is both the target organ of the drug's intended action and the organ of concern, which is why species identity, dose and duration matter more here than for most damp-draining herbs.
Alismanin A
Triterpenoid with a C34 skeletonConcentration: A structurally unprecedented minor triterpenoid isolated from the rhizome
A second, independent pregnane X receptor agonist from the same drug. Its existence means the pregnane-X-receptor signal is not attributable to a single compound and is unlikely to be eliminated by changing supplier or chemotype.
⚠ Drug Interactions
CYP3A4 substrates (ciclosporin, tacrolimus, midazolam, simvastatin, many oral contraceptives, several antiretrovirals)
Alisol B 23-acetate, isolated from this rhizome by bioassay-guided fractionation, is a potent and specific agonist of the human pregnane X receptor and induced endogenous CYP3A4 messenger RNA in human primary hepatocytes as well as in engineered cells. Alismanin A from the same drug is a second pregnane X receptor agonist. Pregnane X receptor activation is the canonical mechanism of enzyme induction and hence of reduced exposure to CYP3A4 substrates. The evidence is in vitro, including in human primary hepatocytes, but no clinical pharmacokinetic study of Ze Xie has been published, so the size of the effect at dispensary doses is unknown.
Clinical note: Ze Xie appears in very common formulas including Wu Ling San and Liu Wei Di Huang Wan, so this is not an exotic exposure. In transplant recipients or patients on a critical CYP3A4 substrate, either avoid it or arrange trough-level monitoring at the start and on stopping. Warn patients relying on hormonal contraception.
Nephrotoxic drugs (aminoglycosides, cisplatin, chronic NSAIDs, tenofovir, calcineurin inhibitors)
Novel sesquiterpenes isolated from this rhizome (orientalols L to P) were shown to be nephrotoxic in HK2 human renal proximal tubular cells, the cell type these drugs also injure. A 2014 review of the drug records that high-dose or long-term use has produced water and electrolyte imbalance, blood in the urine, acidosis and even hepatotoxicity or nephrotoxicity in reported studies. A 2025 review takes a more conservative position, calling the toxicity of the drug a long-standing controversy and holding that no obvious adverse reactions occur within the prescribed dose range. Both positions belong in the record: the signal is real and it is dose-dependent.
Clinical note: Do not use Ze Xie as a long-term daily herb in a patient with reduced renal function or on a nephrotoxic drug. Keep courses short and within the standard dose range, and check renal function if it is being used for months rather than weeks. Haematuria on Ze Xie is a reason to stop and investigate, not to attribute to the underlying condition.
Loop and thiazide diuretics
Salt-processed Alisma orientale produced a significant increase in rat urine volume together with increased urinary sodium, potassium and chloride concentrations, and lowered aquaporin-2 in the renal medulla and in HK-2 cells. That is a genuine natriuretic and kaliuretic effect, not merely increased water turnover, so it stacks with pharmaceutical diuretics on the electrolytes as well as on the volume.
Clinical note: Check potassium and sodium if Ze Xie is added to a loop or thiazide diuretic, particularly in older patients. The classical caution that prolonged use of Ze Xie is harmful maps onto exactly this risk.
Lithium
Sodium and volume depletion increases proximal tubular reabsorption of lithium and raises serum lithium levels. Ze Xie has demonstrated natriuretic activity in rats. No study has measured lithium levels alongside Ze Xie, so this is inference from an established class effect of diuretics rather than a documented herb-drug event.
Clinical note: If a patient on lithium wants to take a Ze Xie-containing formula, check a lithium level before and about a week after starting, and again on stopping.
Dosage
| Form | Amount | Frequency | Duration | Population | Notes |
|---|---|---|---|---|---|
| decoction | 6–10 g | Daily | — | — | 中国药典 2020 【用法与用量】6～10g。 【性味与归经】甘、淡，寒。归肾、膀胱经。 — Chinese Pharmacopoeia 2020, quoted verbatim; route and cautions preserved. Replaces a cleared category-filler value. |
Dui Yao — Herb Pairs
The classical two-herb combinations this herb appears in, each with an action neither herb has alone.
Drains water downward while strengthening the spleen to transform dampness, resolving thin mucus that clouds the head.
Thin mucus below the heart with severe dizziness.
Core pair of a classical formula — Ze Xie Tang, Jin Gui Yao Lue (Zhang Zhongjing)
Evidence Tier
Moderate evidence · 5 studiesRecorded studies by study design, strongest design at the top. This is a study-design tier only, not a GRADE rating: it does not weigh risk of bias, consistency or precision.
Systematic review / meta-analysis
0
Randomized controlled trial
0
Other clinical trial
0
Observational / case report
0
In vitro / animal
4
0 verified · 4 unverified
Show 4 studies
- Orientalol L–P, novel sesquiterpenes from the rhizome of Alisma orientale (Sam.) Juzep and their nephrotoxicity on HK2 cells
- Alisol B 23-acetate from the rhizomes of Alisma orientale is a natural agonist of the human pregnane X receptor
- The structural composition of components contributes to the superiority of the geoherb Alisma orientale for “diuresis and diffusing dampness”
- Hypolipidemic effect of Alisma orientale (Sam.) Juzep on gut microecology and liver transcriptome in diabetic rats
Other / unclassified
1
0 verified · 1 unverified
Verified: design read from PubMed for a DOI that resolves to the cited paper Unverified: taken from the study's recorded description
Clinical Studies
Orientalol L–P, novel sesquiterpenes from the rhizome of Alisma orientale (Sam.) Juzep and their nephrotoxicity on HK2 cells
Isolation of five novel guaiane sesquiterpenes from the rhizome of the species named in this monograph, with direct nephrotoxicity testing on HK2 human renal proximal tubular cells. This is the primary chemical evidence behind the nephrotoxicity signal for Ze Xie, and it is cell-based rather than clinical.
Alisol B 23-acetate from the rhizomes of Alisma orientale is a natural agonist of the human pregnane X receptor
Bioassay-guided fractionation identified alisol B 23-acetate as the pregnane X receptor-activating compound of Alisma rhizome, which had shown the strongest activity in a screen of medicinal plant extracts. The compound raised pregnane X receptor transactivation concentration-dependently, drove the pregnane X receptor to SRC-1 interaction, left CAR, LXR, FXR and the PPARs untouched, and induced endogenous CYP3A4 messenger RNA in human primary hepatocytes. The authors themselves flag the implication for clinical use of Alisma-containing Chinese and Kampo medicines.
The structural composition of components contributes to the superiority of the geoherb Alisma orientale for “diuresis and diffusing dampness”
Salt-processed Alisma orientale from seven provenances was tested in rats and in HK-2 cells. All samples were diuretic, raising urine volume and urinary sodium, potassium and chloride and lowering renal medullary aquaporin-2; Fujian material was strongest. Principal component analysis identified alisol A 24-acetate, alisol B and 23-acetylalisol B as the main components, and an optimised ratio of about 5.4 to 14.3 to 11.3 matched the Fujian geoherb most closely. Directly relevant to processing: the drug studied here is the salt-fried form, not the raw rhizome.
Hypolipidemic effect of Alisma orientale (Sam.) Juzep on gut microecology and liver transcriptome in diabetic rats
Rat study in a diabetic model examining the lipid-lowering effect of the species named in this monograph through changes in gut microbial ecology and hepatic gene expression. Supports the classical description of Ze Xie transforming turbidity and lowering lipids, at the level of an animal model only.
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
Computational network pharmacology and network toxicology study proposing targets for both the antihypertensive action and the hepatic and renal toxicity of this species. It is modelling, with no wet-laboratory or clinical validation, and is included only because it documents that the hepato-nephrotoxicity question is being asked of this herb rather than as evidence that the toxicity occurs.
Historical Texts
Shen Nong Ben Cao Jing (Divine Farmer's Classic of the Materia Medica)
Han dynasty, compiled c. 200 CEShang Han Lun (Treatise on Cold Damage), Zhang Zhongjing
Han dynasty, c. 200 to 220 CEJin Gui Yao Lue (Essential Prescriptions of the Golden Cabinet), Zhang Zhongjing
Han dynasty, c. 200 to 220 CEBen Cao Gang Mu (Compendium of Materia Medica), Li Shizhen
Ming dynasty, 1596References
- Tian T, Chen H, Zhao YY. Traditional uses, phytochemistry, pharmacology, toxicology and quality control of Alisma orientale (Sam.) Juzep: A review . Journal of Ethnopharmacology (2014) [DOI]
- Pan T, Tang R, Wang J, Gao J, Jiang F, Chen B. Botany, traditional uses, phytochemistry, pharmacology, toxicology and processing of Rhizoma alismatis: a review . Frontiers in Pharmacology (2025) [DOI]
- Shu Z, Pu J, Chen L, Zhang Y, Rahman K, Qin L, Zheng C. Alisma orientale: Ethnopharmacology, Phytochemistry and Pharmacology of an Important Traditional Chinese Medicine . The American Journal of Chinese Medicine (2016) [DOI]
- Wang C, Huo XK, Luan ZL, Cao F, Tian XG, Zhao XY, Sun CP, Feng L, Ning J, Zhang BJ, Ma XC. Alismanin A, a Triterpenoid with a C34 Skeleton from Alisma orientale as a Natural Agonist of Human Pregnane X Receptor . Organic Letters (2017) [DOI]
- Kim KH, Kim S, Kwun MJ, Lee JY, Oh SR, Choi JY, Joo M. Alismol Purified from the Tuber of Alisma orientale Relieves Acute Lung Injury in Mice via Nrf2 Activation . International Journal of Molecular Sciences (2023) [DOI]
This information is for educational purposes only and is not intended to replace professional medical advice. Always consult a qualified healthcare provider before using any herbal remedy, especially if you are pregnant, nursing, or taking medications.
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