Herbal Monograph
Fo-ti
Reynoutria multiflora (Thunb.) Moldenke
Polygonaceae (Buckwheat family)
Classical Chinese tonic for premature aging and Liver/Kidney nourishment — hepatotoxicity risk requires caution
Overview
Plant Description
Twining, woody herbaceous perennial vine, growing 2–4 m or more in length. Stems slender, reddish-brown, climbing or scrambling over supports. Leaves alternate, ovate to broadly ovate, 4–8 cm long, 2.5–5 cm wide, with a cordate (heart-shaped) base, acute apex, entire margins, and long petioles. Flowers small, white or greenish-white, borne in axillary and terminal panicles, blooming August–October. Fruit a small, shiny, dark brown to black, 3-angled achene enclosed by persistent perianth wings. The medicinal part is the tuberous root (actually a large, swollen rhizome/root), which is irregularly shaped, 5–15 cm long, 4–12 cm diameter, with a dark reddish-brown to black cortex and pinkish-white to reddish internal flesh. The fresh tuber is starchy with a slightly bitter taste; processed tuber is darker and sweeter.
Habitat
Forest margins, thickets, valley shrublands, stream banks, and hillside slopes at elevations of 200–3,000 m. Prefers warm, moist, partly shaded conditions in well-drained, humus-rich soil. In its native range, commonly found along the edges of deciduous and mixed forests.
Distribution
Native to central and southern China, Taiwan, Japan, and Vietnam. Cultivated extensively in China, particularly in Guizhou, Sichuan, Hubei, Guangxi, Zhejiang, and Anhui provinces. Guizhou province (especially Dejiang County) is traditionally considered the source of the highest quality He Shou Wu. Also cultivated in Japan and Southeast Asia for medicinal use. Has naturalized in parts of North America and Europe as an invasive species.
Parts Used
Root tuber — PROCESSED (Zhi He Shou Wu / 制何首烏)
Preferred: Processed (Zhi) dried slices for decoction; processed root powder in capsules or pills
The processed (prepared) root is the primary medicinal form used as a tonic in TCM. Processing with black soybean juice through repeated steaming and drying cycles transforms the chemical profile: free anthraquinones (laxative, potentially hepatotoxic) are reduced while bound glycoside forms increase. Processed He Shou Wu is the form used for the classical tonic indications — nourishing blood, blackening hair, strengthening liver and kidney. The processing is NOT optional for tonic use. Unprocessed/processed distinction is one of the most clinically important distinctions in Chinese herbal medicine.
Root tuber — RAW (Sheng He Shou Wu / 生何首烏)
Preferred: Raw dried slices for short-term decoction use; NOT for tonic applications
Raw (unprocessed) root has dramatically different properties from processed root. Raw He Shou Wu is a LAXATIVE and detoxifying agent — the high free anthraquinone content (especially emodin) stimulates bowel movements. Raw form is used for constipation, abscesses, scrofula, and skin conditions in TCM. It is NOT used as a tonic. Raw form carries HIGHER hepatotoxicity risk than processed. Many adverse hepatotoxicity reports appear to involve raw or inadequately processed material.
Vine/stem (Ye Jiao Teng / 夜交藤)
Preferred: Dried vine for decoction
The vine (caulis) is used as a separate TCM medicine called Ye Jiao Teng ('vine that crosses at night'). It is considered a sedative and used for insomnia, dream-disturbed sleep, and skin itching. Has a different action profile from the root and is generally considered safer. Less commonly available in Western herbal practice.
Key Constituents
Anthraquinones and their glycosides
The anthraquinone profile is the key to understanding the raw vs. processed distinction. RAW root: high free anthraquinones → laxative action + higher hepatotoxicity risk. PROCESSED root: reduced free anthraquinones, increased bound glycosides, preserved THSG → tonic action + lower (but not eliminated) hepatotoxicity risk. The Chinese Pharmacopoeia establishes separate quality standards for Sheng (raw) and Zhi (processed) He Shou Wu, reflecting their fundamentally different clinical applications.
Stilbene glycosides
The stilbene fraction, dominated by THSG, is considered the primary basis for the tonic, anti-aging, and protective properties attributed to processed He Shou Wu. THSG content is the quality control marker in the Chinese Pharmacopoeia. The neuroprotective and cardioprotective effects of THSG provide a modern pharmacological rationale for the traditional claim that He Shou Wu 'nourishes the liver and kidney, benefits essence and blood, and prevents premature aging.'
Phospholipids and lipids
The lecithin content contributes to cholesterol-lowering effects observed in some clinical studies. It also provides structural support for cell membranes and may confer some hepatoprotective effect, potentially contributing to the superior safety profile of whole-root preparations compared to isolated anthraquinone fractions.
Tannins and phenolic acids
The polyphenolic fraction contributes to the overall antioxidant capacity of He Shou Wu extracts. Gallic acid and catechins provide complementary antioxidant mechanisms to THSG. Tannins contribute the astringent taste and mild astringent action on the GI tract.
Herbal Actions
Protects the liver from damage
PROCESSED root only. Paradoxically, while raw He Shou Wu can cause hepatotoxicity, properly processed He Shou Wu has demonstrated hepatoprotective effects in preclinical models — THSG protects hepatocytes against oxidative injury, reduces lipid peroxidation in liver tissue, and supports hepatic antioxidant enzyme activity (SOD, GSH-Px, catalase). This paradox reflects the critical importance of processing: raw and processed roots have essentially opposite effects on the liver.
[2, 4]Prevents or slows oxidative damage to cells
Strong antioxidant activity attributed primarily to THSG and the polyphenolic fraction. THSG is a potent scavenger of superoxide anion, hydroxyl radical, and DPPH radicals. In animal models, processed He Shou Wu extracts increase tissue levels of SOD, catalase, and glutathione peroxidase while reducing malondialdehyde (a lipid peroxidation marker). The anti-aging tradition is largely supported by this antioxidant activity.
[4]Helps the body adapt to stress and restore homeostasis
Processed He Shou Wu is classified as a tonic (bu yao) in TCM, with properties consistent with the adaptogenic category in Western herbalism. Animal studies show improved stress resistance, enhanced endurance, and modulation of HPA axis markers. However, the evidence for adaptogenic effects is less robust than for established adaptogens like ashwagandha or rhodiola.
[4]Promotes bowel movement
RAW root only. The high free anthraquinone content (emodin, chrysophanol, physcion) provides stimulant laxative activity via increased intestinal secretion and peristalsis. This is the primary action of raw (Sheng) He Shou Wu and the indication for its use in constipation. Processed root has greatly reduced laxative effect.
[2]Modulates and balances immune function
Processed He Shou Wu extracts have demonstrated immunomodulating activity in animal models, including enhancement of macrophage phagocytosis, modulation of T-cell subsets, and support of hematopoietic function. The polysaccharide fraction and THSG both contribute. Consistent with the TCM classification of He Shou Wu as nourishing to blood and essence.
[4]Reduces inflammation
THSG, emodin, and chrysophanol all demonstrate anti-inflammatory activity through inhibition of NF-kB signaling, COX-2, and pro-inflammatory cytokines (TNF-α, IL-6, IL-1β). Both raw and processed forms have anti-inflammatory properties, though through different constituent profiles.
[4]Supports and calms the nervous system
THSG demonstrates neuroprotective effects in multiple preclinical models: protects against Aβ-induced neurotoxicity (relevant to Alzheimer's disease), reduces neuroinflammation, supports neurite outgrowth, and improves learning and memory in aged animal models. The vine (Ye Jiao Teng) has more pronounced sedative/nervine effects than the root.
[4]Strengthens and tones the heart muscle
THSG and lecithin contribute to cardiovascular protective effects including reduction of total cholesterol and LDL, inhibition of atherosclerotic plaque formation, improvement of endothelial function, and antioxidant protection of cardiac tissue. Some clinical studies in China have reported lipid-lowering effects of processed He Shou Wu preparations.
[4]Therapeutic Indications
Hepatobiliary System
Liver and Kidney Yin deficiency (TCM pattern)
The defining traditional indication for processed He Shou Wu. In TCM, Liver/Kidney Yin and Blood deficiency manifests as premature graying of hair, hair loss, dizziness, tinnitus, blurred vision, soreness of the lower back and knees, nocturnal emissions, and general signs of premature aging. He Shou Wu is one of the premier herbs for this pattern, often combined with Shu Di Huang (Rehmannia glutinosa), Gou Qi Zi (Lycium barbarum), and Niu Xi (Achyranthes bidentata).
[2, 5]Hyperlipidemia
Several Chinese clinical studies have reported cholesterol-lowering effects of processed He Shou Wu preparations, including reductions in total cholesterol, LDL, and triglycerides. The lecithin and THSG content are the proposed active constituents. However, most studies are small, open-label, and published only in Chinese journals, limiting the quality of evidence by Western standards.
[4]Skin / Integumentary
Premature graying of hair
The most famous traditional indication — the Chinese name 'He Shou Wu' literally means 'Mr. He's black hair,' referring to a legend about a man whose gray hair turned black after taking the herb. THSG has demonstrated melanogenesis-promoting activity in vitro by upregulating tyrosinase and MITF expression in melanocyte cell lines. While the dramatic hair-restoration effects of legend are not supported by clinical trials, there is pharmacological plausibility for some melanin-supporting activity. Processed root is used for this indication.
[4, 5]Hair loss (alopecia)
Traditionally used for hair loss associated with Liver/Kidney deficiency patterns. The proposed mechanism involves improving blood circulation to the scalp, providing antioxidant protection to hair follicles, and supporting melanocyte function. Limited clinical evidence.
[5]Nervous System
Age-related cognitive decline and neurodegenerative diseases
THSG has shown neuroprotective effects in animal models of Alzheimer's disease (reduces Aβ-induced neurotoxicity), Parkinson's disease (protects dopaminergic neurons), and age-related cognitive decline (improves learning and memory in aged rats). These preclinical findings support the traditional anti-aging claims but have not been validated in human clinical trials.
[4]Insomnia and dream-disturbed sleep
The vine (Ye Jiao Teng) is the preferred part for insomnia in TCM. The root is sometimes included in formulas for sleep disturbance associated with Blood and Yin deficiency (night sweats, vivid dreams, restlessness).
[5]Cardiovascular System
Atherosclerosis and cardiovascular disease prevention
THSG has demonstrated anti-atherosclerotic effects in animal models: reduces vascular inflammation, inhibits smooth muscle cell proliferation, improves endothelial function, and reduces oxidized LDL. The lecithin content supports cholesterol metabolism. These findings provide a pharmacological rationale for traditional anti-aging cardiovascular claims.
[4]Immune System
Immune deficiency and weakened resistance
Processed He Shou Wu is traditionally used to strengthen constitution and resistance to disease in patterns of deficiency. Animal studies show enhanced white blood cell production and improved immune cell function. Consistent with the TCM concept of nourishing essence (jing) and blood (xue).
[5]Reproductive System
Nocturnal emissions and spermatorrhea
Traditional TCM use for excessive seminal emission and weakness of Kidney Essence. The astringent quality of He Shou Wu is said to 'secure' Kidney Essence. Used in formulas with other Kidney-securing herbs.
[5]Male and female infertility (associated with Liver/Kidney deficiency)
Used in TCM fertility formulas as a blood and essence tonic. Believed to support reproductive capacity through Liver/Kidney nourishment rather than direct hormonal action.
[5]Digestive System
Constipation (Blood deficiency type)
RAW He Shou Wu only. The stimulant laxative effect of free anthraquinones (emodin, chrysophanol) is used for constipation in elderly or blood-deficient patients. Similar mechanism to other anthraquinone laxatives (senna, cascara, aloe). Raw He Shou Wu is specifically indicated for dry, hard stools from Blood deficiency or Yin deficiency. NOT for chronic, long-term laxative use due to hepatotoxicity concerns.
[2, 5]Energetics
Temperature
warm
Moisture
slightly moist
Taste
Tissue States
cold/depression, atrophy/deficiency
In TCM energetics: Processed He Shou Wu — Flavor: bitter, sweet, astringent. Nature: slightly warm. Channel tropism: Liver, Kidney. Actions: Tonifies Liver and Kidney, nourishes Blood and Essence, blackens the hair, secures Kidney Essence. Used for patterns of Liver/Kidney Yin and Blood deficiency with premature aging signs. RAW He Shou Wu — Flavor: bitter, sweet. Nature: neutral to slightly warm. Channel tropism: Heart, Liver, Large Intestine. Actions: Resolves toxins, moistens the intestines, unblocks the bowels. Used for constipation from Blood deficiency dryness, and for external toxic conditions. In Western energetic terms, the processed root is a warming, nourishing, blood-building tonic suited for depleted, cold constitutions showing signs of premature aging.
Traditional Uses
Traditional Chinese Medicine (TCM)
- PROCESSED (Zhi He Shou Wu): Premier Liver/Kidney tonic — nourishes Liver Blood, supplements Kidney Essence, blackens the hair, strengthens sinews and bones
- Classical formula: Qi Bao Mei Ran Dan ('Seven Treasures Pill for Beautiful Hair') — the most famous He Shou Wu formula, combining processed root with Dang Gui, Gou Qi Zi, Tu Si Zi, Bu Gu Zhi, Niu Xi, and Psoralea for premature aging and gray hair
- Used for Liver/Kidney Yin deficiency manifesting as dizziness, tinnitus, blurred vision, premature graying, hair loss, weak lower back and knees
- RAW (Sheng He Shou Wu): Resolves toxic swelling, moistens intestines — used for constipation, abscesses, scrofula, malaria, skin eruptions
- VINE (Ye Jiao Teng): Nourishes the Heart, calms the spirit — used for insomnia, dream-disturbed sleep, external itching and skin rashes
- Considered a 'longevity tonic' and included in many anti-aging formulas
- Combined with Dang Gui (Angelica sinensis) as the classic Blood-nourishing pair
"He Shou Wu first appeared in the Tang Dynasty text 'He Shou Wu Lu' (Record of He Shou Wu) by Li Ao (c. 813 CE), which recounts the legend of He Tianer (later called He Shou Wu — 'Mr. He with black hair') who reportedly rejuvenated and lived to 160 years. The herb was subsequently included in all major Chinese materia medica texts including the Ben Cao Gang Mu (Li Shizhen, 1596). The Chinese Pharmacopoeia (2020) lists both raw and processed forms with distinct indications."
Ayurvedic and South Asian medicine
- Not a classical Ayurvedic herb but has been adopted into modern Indo-Chinese herbal practice
- Used similarly to Chinese indications: anti-aging tonic, hair health, blood building
- Sometimes marketed as an Ayurvedic supplement in South Asian markets, though this is a modern adoption rather than classical use
"He Shou Wu is primarily a Chinese herb that has been adopted into broader Asian and global herbal practice through cultural exchange. Its use in the Indian subcontinent is modern rather than classical Ayurvedic."
[4]
Western herbal medicine (modern adoption)
- Adopted into Western herbal practice primarily through the influence of TCM integration in the late 20th century
- Used as an adaptogenic tonic for premature aging, gray hair, and general vitality
- Included in 'anti-aging' and 'longevity' supplement formulas
- Marketed heavily in the supplement industry as a hair and longevity tonic
- Western practitioners are increasingly cautious about hepatotoxicity risk — the distinction between raw and processed forms is critical and not always respected in commercial products
"Fo-ti entered Western herbal awareness primarily through the work of herbalists and acupuncturists trained in TCM. Its popularity in the supplement industry has sometimes outpaced clinical caution, leading to products of variable quality and processing standards."
Modern Research
Hepatotoxicity — systematic review of adverse event reports
Multiple case reports and case series have documented liver injury associated with He Shou Wu products. A systematic analysis of published hepatotoxicity cases worldwide provides the most comprehensive overview of this safety concern.
Findings: Dozens of cases of drug-induced liver injury (DILI) associated with He Shou Wu / Polygonum multiflorum have been documented in the literature, primarily in China, Korea, Japan, and Western countries. Liver injury patterns include hepatocellular (most common), cholestatic, and mixed. Most cases involved idiosyncratic reactions occurring weeks to months after initiating use. Both raw and processed forms have been implicated, though raw or poorly processed products appear overrepresented. Most cases resolved after discontinuation, but severe cases including acute liver failure requiring transplantation have been reported. Risk factors may include female sex, pre-existing liver conditions, and concurrent hepatotoxic drugs or alcohol. The Chinese CFDA issued warnings about He Shou Wu hepatotoxicity in 2014.
Limitations: Case reports and series — cannot establish incidence rates. Product quality, processing adequacy, and adulterant testing are inconsistently documented. Causal attribution using RUCAM and other DILI causality scales is variable. Many cases involve multi-ingredient products where He Shou Wu is one of several components.
[4]
THSG — neuroprotective effects in Alzheimer's models
2,3,5,4'-Tetrahydroxystilbene-2-O-β-D-glucoside (THSG), the principal stilbene glycoside of processed He Shou Wu, has been studied extensively in animal models of neurodegenerative disease.
Findings: THSG protects against β-amyloid-induced neurotoxicity in hippocampal neurons, reduces neuroinflammation (decreases TNF-α, IL-1β, iNOS in brain tissue), inhibits acetylcholinesterase activity, improves learning and memory performance in aged mice and AD model mice (Morris water maze), and promotes neurite outgrowth. Mechanisms include antioxidant protection of neural tissue, suppression of NF-kB signaling, and upregulation of BDNF expression.
Limitations: All preclinical animal studies. Doses used in animal models may not translate directly to achievable human tissue concentrations. No human clinical trials for cognitive outcomes. Bioavailability of orally administered THSG in humans is not fully characterized.
[4]
THSG — cardioprotective and anti-atherosclerotic effects
THSG has demonstrated cardiovascular protective effects in multiple animal models, supporting the traditional anti-aging cardiovascular indications.
Findings: In high-fat diet-fed animal models, THSG reduces atherosclerotic plaque formation, lowers total cholesterol and LDL-C, reduces vascular inflammation (suppresses MCP-1, VCAM-1, ICAM-1 expression), improves endothelial function (enhances eNOS/NO pathway), inhibits vascular smooth muscle cell proliferation, and reduces oxidized LDL formation. The lecithin fraction of He Shou Wu also contributes to cholesterol-lowering effects through enhanced bile acid secretion.
Limitations: Animal data only. No large-scale human RCTs for cardiovascular endpoints. Cholesterol-lowering effects reported in some Chinese clinical studies but with limitations in study design and reporting.
[4]
Processing effects on chemical profile and toxicity
Studies comparing the chemical profiles and biological effects of raw versus processed He Shou Wu confirm that traditional processing fundamentally transforms the herb.
Findings: Traditional processing with black soybean juice (nine steam-dry cycles): reduces free emodin content by 50–80%, reduces total free anthraquinone content significantly, preserves or slightly increases THSG content, increases combined/bound anthraquinone glycoside ratio, and reduces hepatotoxicity markers in cell-based assays. Processed roots show significantly less cytotoxicity to HepG2 and L-02 liver cell lines compared to raw roots. The Maillard reaction products from processing may also contribute to altered biological activity.
Limitations: In vitro cytotoxicity does not perfectly predict in vivo hepatotoxicity. The extent of processing varies between manufacturers, and there is no standardized minimum processing requirement enforced globally. Some 'processed' products may be inadequately processed.
Hair pigmentation — melanogenesis promotion by THSG
THSG has been studied for effects on melanocyte function and melanin production, addressing the traditional hair-blackening claim.
Findings: THSG increases melanin content in B16 melanoma cells and human melanocyte cultures in a dose-dependent manner. The mechanism involves upregulation of tyrosinase expression and activity (the rate-limiting enzyme in melanin biosynthesis), increased MITF (microphthalmia-associated transcription factor) expression, and activation of the p38 MAPK signaling pathway. These findings provide a plausible molecular mechanism for the traditional hair-blackening indication, though the translation from cell culture to clinical efficacy in reversing gray hair is undemonstrated.
Limitations: Cell culture studies only. No human clinical trials demonstrating reversal of gray hair. The concentration of THSG achieving melanogenesis effects in vitro may not be achievable in hair follicle melanocytes after oral dosing.
[4]
Antioxidant and anti-aging effects — in vivo evidence
Multiple animal studies have evaluated the anti-aging properties of processed He Shou Wu and its principal constituents.
Findings: Processed He Shou Wu extracts extend lifespan in model organisms (Drosophila melanogaster, Caenorhabditis elegans), reduce markers of oxidative stress in aged animal tissues (increase SOD, GSH-Px, catalase; reduce MDA), improve immune function in aged mice, and reduce lipofuscin accumulation (a marker of cellular aging). THSG alone demonstrates many of these effects, suggesting it is the primary anti-aging constituent. Oral administration in aged mice improved learning, memory, and physical endurance compared to age-matched controls.
Limitations: Animal and model organism data — human anti-aging RCTs have not been conducted. Lifespan extension in flies and worms does not directly predict human longevity effects. Doses in animal studies may not correspond to typical human doses.
[4]
Preparations & Dosage
Decoction
Strength: 9–15 g per 400 mL
PROCESSED (Zhi He Shou Wu): Add 9–15 g of processed, sliced root to 400–500 mL water. Bring to a boil, reduce heat, and simmer for 30–45 minutes (the root is dense and requires extended decoction). Strain and divide into 2–3 doses. For stronger tonic effects, combine with other tonic herbs as part of a formula. RAW (Sheng He Shou Wu): Add 6–12 g of raw sliced root; decoct similarly but use only for short-term laxative or detoxifying indications.
Processed: 9–15 g dried root per day in decoction (standard TCM dosage). Raw: 6–12 g for short-term laxative use only.
Divided into 2–3 doses daily.
Processed: May be used for extended periods (weeks to months) under practitioner supervision with periodic liver function monitoring. Raw: Limit to 1–2 weeks maximum.
Not recommended for children under 12.
Decoction is the classical TCM preparation method. Always specify whether processed or raw He Shou Wu is intended. Processing is NOT optional — raw and processed roots have different clinical applications and safety profiles.
Capsule / Powder
Strength: Crude powder or concentrated extract (DER 5:1 to 10:1). Look for products standardized to THSG content (minimum 1%).
Processed (Zhi) He Shou Wu root powder or concentrated extract in capsules. Ensure the product clearly states 'processed' or 'Zhi' He Shou Wu and is from a reputable manufacturer with quality control for emodin content and THSG minimum.
Powdered root: 500–1000 mg per capsule, 2–4 capsules daily (1–4 g total). Concentrated extract (5:1 or 10:1): 250–500 mg per capsule, 1–2 capsules daily. Follow manufacturer's recommendations for specific extract concentrations.
1–3 times daily with meals.
Limit to 3 months without liver function monitoring. Periodic reassessment advisable.
Not recommended.
Many commercial fo-ti supplements do NOT specify whether the root is processed or raw. This is a serious quality concern. Only purchase products that explicitly state 'processed' (Zhi/prepared) He Shou Wu. Products should ideally provide THSG content and free emodin levels. The supplement industry's lack of processing standardization is a significant contributor to adverse hepatic events.
[4]
Tincture
Strength: 1:5, 50–60% ethanol (processed root)
Macerate processed He Shou Wu root in 50–60% ethanol. Standard ratio 1:5. Macerate 4–6 weeks, shaking regularly.
3–5 mL, 2–3 times daily.
2–3 times daily.
Limit to 8–12 weeks without liver function assessment.
Not recommended.
Tincture is not a traditional TCM preparation form but is used in Western herbal practice. Ethanol extraction may extract a different constituent profile than water decoction. Ensure the root is properly processed before tincturing.
[3]
Glycerite
Strength: 1:5, 60% glycerin
Macerate processed He Shou Wu in 60% vegetable glycerin, 40% water. Steep 6–8 weeks.
3–5 mL, 2–3 times daily.
2–3 times daily.
Limit to 8–12 weeks.
Not recommended.
Alcohol-free alternative. Glycerin is less efficient at extracting some constituents. Use only processed root material.
[3]
Standardized Extract
Strength: Variable DER. Standardized to THSG ≥1.0%. Free emodin levels should be reported.
Commercially prepared concentrated extracts, ideally standardized to THSG content (≥1.0% per Chinese Pharmacopoeia) and tested for free emodin levels (lower is better, indicating adequate processing).
Per manufacturer's recommendations. Typical concentrated extract (10:1): 250–500 mg, 1–2 times daily.
1–2 times daily.
Monitor liver function if used longer than 3 months.
Not recommended.
Standardized extracts provide the best quality control for He Shou Wu products. Look for: (1) explicit 'processed' designation, (2) THSG content specified, (3) free emodin/anthraquinone levels reported, (4) heavy metal and contaminant testing. Reputable TCM extract manufacturers (e.g., those producing GMP-certified concentrated granules) generally provide superior quality control.
[2]
Safety & Interactions
Class 2d
Other specific use restrictions apply (AHPA Botanical Safety Handbook)
Contraindications
He Shou Wu is associated with documented cases of drug-induced liver injury (DILI). Patients with compromised liver function are at increased risk. The Chinese CFDA issued a safety warning in 2014 regarding He Shou Wu hepatotoxicity.
Additive hepatotoxic risk with drugs including acetaminophen (high-dose), methotrexate, isoniazid, valproic acid, and statins. Concurrent use increases risk of cumulative liver injury.
Anthraquinone content (emodin) may have genotoxic and embryotoxic potential. Stimulant laxative anthraquinones are generally contraindicated in pregnancy. The safety of THSG in pregnancy is not established.
Anthraquinones may be excreted in breast milk and cause laxative effects in nursing infants. Hepatotoxicity risk to infant liver is a concern.
Raw He Shou Wu is a stimulant laxative. Contraindicated in patients with diarrhea, inflammatory bowel disease, or loose stools. Processed root has reduced laxative effect but may still cause loose stools in sensitive individuals.
Drug Interactions
| Drug / Class | Severity | Mechanism |
|---|---|---|
| Hepatotoxic medications (acetaminophen, methotrexate, isoniazid, valproic acid, ketoconazole) (Hepatotoxic drugs) | major | Additive hepatotoxic risk. Both He Shou Wu anthraquinones and hepatotoxic drugs stress liver detoxification pathways, increasing cumulative risk of liver injury. |
| Warfarin and other coumarin anticoagulants (Anticoagulants) | moderate | He Shou Wu may potentiate anticoagulant effects. Emodin has demonstrated antiplatelet activity in vitro. Case reports in Chinese literature have noted increased INR in patients combining He Shou Wu with warfarin. |
| Statins (atorvastatin, simvastatin, lovastatin, rosuvastatin) (HMG-CoA reductase inhibitors) | moderate | Both He Shou Wu and statins carry hepatotoxic potential. Additive risk of liver injury. Additionally, the lipid-lowering effects may be additive, though this could be seen as potentially beneficial if monitored. |
| Stimulant laxatives (senna, cascara, bisacodyl, aloe latex) (Stimulant laxatives) | moderate | Additive stimulant laxative effect from anthraquinone content (particularly with raw He Shou Wu). Risk of excessive diarrhea, electrolyte depletion (hypokalemia), and colonic dependency. |
| Digoxin (Cardiac glycosides) | moderate | The laxative effect of He Shou Wu (particularly raw form) may cause hypokalemia through excessive fluid loss. Hypokalemia increases sensitivity to digoxin, raising risk of digoxin toxicity (arrhythmias). |
| Diabetes medications (metformin, sulfonylureas, insulin) (Hypoglycemic agents) | minor | Some preclinical evidence suggests He Shou Wu extracts may have mild blood glucose-lowering effects. Potential for additive hypoglycemia with diabetes medications. |
Pregnancy & Lactation
Pregnancy
unsafe
Lactation
unsafe
CONTRAINDICATED in pregnancy and lactation. Anthraquinones (emodin, chrysophanol) have demonstrated genotoxic potential in vitro and may be teratogenic. Emodin is excreted in breast milk and can cause laxative effects in nursing infants. The hepatotoxicity risk extends to both mother and fetus/infant. The AHPA Botanical Safety Handbook classifies He Shou Wu as not to be used during pregnancy or lactation.
Adverse Effects
References
Monograph Sources
- [1] Gardner Z, McGuffin M (eds.). American Herbal Products Association's Botanical Safety Handbook, Second Edition: Polygonum multiflorum. CRC Press, Boca Raton (2013)
- [2] Chinese Pharmacopoeia Commission. Pharmacopoeia of the People's Republic of China, Volume I: He Shou Wu (Polygoni Multiflori Radix) and Zhi He Shou Wu (Polygoni Multiflori Radix Praeparata). China Medical Science Press, Beijing (2020)
- [3] Hoffmann D. Medical Herbalism: The Science and Practice of Herbal Medicine. Healing Arts Press, Rochester, VT (2003)
Clinical Studies
- [4] Lin L, Ni B, Lin H, Zhang M, Li X, Yin X, Qu C, Ni J. Traditional usages, botany, phytochemistry, pharmacology and toxicology of Polygonum multiflorum Thunb.: a review. Journal of Ethnopharmacology (2015) ; 159 : 158-183 . DOI: 10.1016/j.jep.2014.11.009
Traditional Texts
- [5] Bensky D, Clavey S, Stöger E. Chinese Herbal Medicine: Materia Medica, Third Edition. Eastland Press, Seattle (2004)
Last updated: 2026-03-23 | Status: review
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