Herb

    Fo-Ti

    Reynoutria multiflora (Polygonum multiflorum)

    TL;DR

    Fo-Ti (he shou wu) is a traditional tonic root sold for grey hair and longevity. Human efficacy evidence is essentially absent, while the liver-injury signal is not: multiple countries have issued warnings and there are dozens of published hepatotoxicity cases. The risk-benefit here does not favour use.

    Ideal For

    • Nobody, on current evidence — the documented liver risk is not offset by any controlled benefit

    Avoid If

    • You have any liver condition or raised liver enzymes
    • You drink alcohol regularly
    • You take other hepatotoxic medication
    • You are pregnant or breastfeeding

    Frequently Asked Questions

    Overview

    Fo-Ti is the root of Reynoutria multiflora, known in Chinese medicine as he shou wu and traditionally processed with black bean broth before use. Marketing leans on the legend of restored black hair; the pharmacology mostly points at stilbene glycosides and anthraquinones. What the modern literature actually contains is a substantial hepatotoxicity case series — idiosyncratic drug-induced liver injury with a hepatocellular pattern, documented in China, Korea, Japan, Australia and Europe, sometimes requiring transplant. Raw (unprocessed) root carries more anthraquinone and appears riskier, but processed preparations have also been implicated. There is no controlled human trial showing hair or longevity benefit that would offset this.

    How It Works

    • Stilbene glycoside (TSG) shows antioxidant activity in cell and rodent models
    • Anthraquinone content contributes a laxative effect and is implicated in liver toxicity
    • Proposed 5-alpha-reductase and hair-follicle effects rest on rodent and in-vitro work
    • Idiosyncratic hepatotoxicity is not dose-predictable

    Benefits & Outcomes

    No linked outcomes yet. Research is ongoing.

    Health Concerns Addressed

    Hair Thinning & Loss

    symptom
    Not supported
    Preliminary
    Effectiveness 1/5

    No controlled human evidence that Fo-Ti restores hair colour or reverses hair loss, set against a substantial published record of liver injury.

    Supporting Research
    9 studies

    HLA-B*35:01 allele is a potential biomarker for predicting Polygonum multiflorum-induced liver injury in humans

    Score: 8/10
    2019
    cohort
    n=230

    Li C, Rao T, Chen X +2 more

    This study aimed to identify the genetic basis of susceptibility to PM-drug-induced liver injury (PM-DILI) and to develop biological markers for predicting the risk of PM-DILI in humans.

    View source

    Liver Damage Associated with Polygonum multiflorum Thunb.: A Systematic Review of Case Reports and Case Series

    Score: 7/10
    2015
    systematic_review
    n=450

    Lei X, Chen J, Ren J +7 more

    Hepatocellular injury predominated among reported cases of liver damage associated with Polygonum multiflorum.

    View source

    Single-nucleotide polymorphisms of HLA and Polygonum multiflorum-induced liver injury in the Han Chinese population

    Score: 7/10
    2020
    observational
    n=382

    Yang WN, Pang LL, Zhou JY +2 more

    We conducted a systematic study enrolling 382 participants from four independent hospitals, including 73 PM-DILI patients, 118 patients with other drug-induced liver injury (other-DILI) and 191 healthy controls.

    View source

    Polygonum multiflorum-Induced Liver Injury: Clinical Characteristics, Risk Factors, Material Basis, Action Mechanism and Current Challenges

    Score: 6/10
    2019
    systematic_review
    0

    Wang Y, Wang L, Saxena R +6 more

    Polygonum multiflorum liver injury is largely idiosyncratic and immune-mediated, with a strong association to the HLA-B*35:01 allele.

    View source

    The hepatotoxicity of Polygonum multiflorum: the emerging role of the immune-mediated liver injury

    Score: 7/10
    2021
    systematic_review

    Rao T, Liu YT, Zeng XC +2 more

    However, most epidemiological and clinical evidence demonstrate that PM-DILI is immune-mediated idiosyncratic liver injury.

    View source

    Drug-Induced Liver Injury: Twenty Five Cases of Acute Hepatitis Following Ingestion of Polygonum multiflorum Thunb

    Score: 5/10
    2011
    case_study
    n=25

    Jung KA, Min HJ, Yoo SS +7 more

    Twenty-five patients developed acute hepatocellular hepatitis after ingesting Polygonum multiflorum, with a mean latency of about 30 days.

    View source

    Overview of pharmacokinetics and liver toxicities of Radix Polygoni Multiflori

    Score: 7/10
    2020
    systematic_review

    Li D, Yang M, Zuo Z

    However, its safe and effective application in clinical practice could be hindered by its liver injury potential and lack of investigations on its hepatotoxicity mechanism.

    View source

    Phytochemistry, pharmacology, toxicology and detoxification of Polygonum multiflorum Thunb.

    Score: 6/10
    2024
    systematic_review

    Qian J, Feng C, Wu Z +2 more

    While, PM also has some toxicity, its clinical drug safety has been concerned.

    View source

    Hair growth promotion activity and its mechanism of Polygonum multiflorum

    Score: 4/10
    2015
    observational

    Li Y, Han M, Lin P +2 more

    However, several crucial problems in its clinic usage and mechanisms are still unsolved or lack scientific evidences.

    View source

    Safety Information

    Potential Side Effects

    Loose stools and abdominal cramping from anthraquinones. Most importantly, idiosyncratic drug-induced liver injury: jaundice, dark urine, fatigue and raised transaminases, occasionally severe.

    Contraindications

    Any existing liver disease, pregnancy, breastfeeding, children, concurrent hepatotoxic drugs, or heavy alcohol use.

    Drug Interactions

    • Any hepatotoxic drug (methotrexate, isoniazid, high-dose paracetamol) — additive liver risk
    • Warfarin (anthraquinone effect on transit and reported bleeding cases)

    Pregnancy & Breastfeeding

    Pregnancy: likely_unsafe

    Breastfeeding: likely_unsafe

    Dosage Guidelines

    Dosage Used in Studies

    Consult healthcare provider

    Best Time to Take

    Not applicable — use is not recommended

    Best Form

    If used at all under practitioner supervision, processed root with baseline and follow-up liver enzymes

    Bioavailability

    Stilbene glycosides are absorbed and rapidly conjugated; anthraquinones act mainly in the gut

    Dosing by Goal

    GoalDoseNotes
    Historically 3-15 g/day of processed root as decoctionWe do not recommend a dose; hepatotoxicity is idiosyncratic, not dose-dependent

    Forms Compared

    Traditional black-bean processing; still implicated in liver injury cases

    Higher anthraquinone content; greater reported risk

    Concentrates the studied stilbene but not shown safe long term

    Food & Timing

    Not applicable

    Medical Disclaimer

    The information provided on this website is for educational and informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any supplement regimen.

    Individual results may vary. The statements on this website have not been evaluated by the Food and Drug Administration. Products and information are not intended to diagnose, treat, cure, or prevent any disease.