He Shou Wu (Fo-Ti)
Polygonum multiflorum · Hé Shǒu Wū 何首乌
A famed longevity root — but with real liver risks.
Evidence tier
Preliminary
Research weight
Citations
17 verified / 17
Classification
TCM Herb
❝
What the evidence says. Early or small human trials; promising but not yet conclusive.
What is He Shou Wu (Fo-Ti)?
He Shou Wu (Fo-Ti) (Polygonum multiflorum · Hé Shǒu Wū 何首乌) is a traditional Chinese medicine herb used for traditional anti-aging / hair tonic. NutriDex grades the human evidence as Preliminary. He Shou Wu (Hé Shǒu Wū) is one of the most famous longevity and hair-restoration tonics in TCM, surrounded by legend. Laboratory studies show antioxidant and neuroprotective activity from its stilbene glycosides, but rigorous human efficacy trials are essentially lacking. Critically, it is also one of the most reported herbal causes of drug-induced liver injury worldwide — a safety concern that outweighs its thin efficacy evidence.
Purported Benefits
✓Traditional anti-aging / hair tonic
✓Antioxidant (lab)
✓Folk use for vitality
Evidence by outcome
The same supplement can be well-proven for one use and unproven for another — here is the human evidence graded outcome by outcome.
| Outcome | Evidence | Effect | Studies |
|---|---|---|---|
| Drug-induced liver injury (hepatotoxicity)Systematic review (450 cases incl. deaths/transplants), cohorts and an HLA-B*35:01 genetic association establish it as a leading cause of herbal liver injury. | Strong | ⚠ risk · large | 6 |
| Anti-aging / hair restoration (efficacy)No high-quality human trials support the traditional anti-aging or hair claims; evidence is essentially absent. | No Evidence | — no effect | 1 |
| LDL-cholesterol (within a multi-herb formula)One RCT of a Crataegus formula containing PM cut LDL ~9% vs placebo; effect is the combination, not He Shou Wu alone. | Preliminary | ↑ benefit · small | 1 |
Dosing & Compounds
Typical Dose
Traditionally used as prepared (processed) root in formulas; raw root is harsher.
Active Compounds
Safety & Cautions
⚠ Significant risk of liver injury (acute hepatitis), including with 'natural' products. Avoid with liver disease or other hepatotoxic agents; stop and seek care if jaundice/dark urine occur. Educational only — always check with your doctor or pharmacist before combining He Shou Wu (Fo-Ti) with any medicine.
Key Studies ★ 17 studies
systematic review
Lei 2015 systematic review (Evid Based Complement Alternat Med)
✓ PubMed
Systematic review of 76 articles reporting 450 cases of P. multiflorum-associated liver injury found that most recovered after discontinuation, but 2 required liver transplantation and 7 died, establishing it as a leading cause of herb-induced liver injury.
RCT
Hu 2014 (Tomlinson)
✓ PubMed
Randomized, double-blind, placebo-controlled trial (42 randomized, 40 completed, 12 weeks) of a Crataegus-based multiherb formula containing Polygonum multiflorum in Chinese dyslipidemic patients. Active treatment produced a modest but significant ~9% greater reduction in LDL-cholesterol vs placebo (P<0.05); HbA1c fell 3.9% on treatment but not significantly vs placebo. No notable adverse effects. Efficacy is for the combination formula, not PM in isolation.
Safety / toxicology
Lin 2015 review
✓ PubMed
Documented hepatotoxicity / drug-induced liver injury cases.
Systematic/comprehensive review
Wang 2024 review (Front Pharmacol)
✓ Full text
Comprehensive review concluding P. multiflorum's anthraquinones and stilbene glycosides cause dose- and duration-dependent hepatotoxicity, nephrotoxicity and embryotoxicity, partly mitigated by traditional processing.
Mechanistic review
Liu 2024 mechanism review
✓ PubMed
Review summarizing that P. multiflorum and components (anthraquinones, stilbene glucoside) cause hepatotoxicity via oxidative phosphorylation disruption, impaired bile-acid efflux, immune activation and genetic/metabolic susceptibility.
Review
Rao 2020 (review)
✓ PubMed
Review synthesizing epidemiological, clinical, and experimental evidence concluding PM-induced liver injury is an immune-mediated idiosyncratic DILI (not classic dose-dependent intrinsic toxicity), involving innate/adaptive immunity and loss of immune tolerance rather than a simple direct toxic mechanism.
Review
Yu 2020 (review)
✓ PubMed
Review of the potential hepatotoxic constituents and mechanisms of He Shou Wu, implicating anthraquinones (e.g., emodin) and stilbene glycosides (2,3,5,4'-tetrahydroxystilbene-2-O-glucoside) and their interaction with processing method and dose as drivers of liver injury.
Observational
Single-nucleotide polymorphisms of HLA, WJG 2020
✓ Full text
Case-control study (73 PM-DILI patients, 191 controls) found SNP rs1055348 strongly and specifically associated with P. multiflorum liver injury (OR 13.62), serving as a tag for HLA-B*35:01 with 100% sensitivity and >95% specificity.
case series / retrospective cohort
Clinical retrospective cohort 2015 (158 patients)
✓ PubMed
Retrospective clinical analysis of 158 patients with P. multiflorum-related drug-induced liver injury found hepatocellular injury predominated (92.4%) and processed preparations accounted for 93.9% of cases, with 4 progressing to liver failure, 4 to cirrhosis and 1 death.
Cohort
Li (Xiangya/Changsha) 2019
✓ PubMed
Pharmacogenomic study (pilot + replication + prospective cohort of 72 PM users). HLA-B*35:01 is a high-risk allele for PM-induced liver injury: frequency 45.4% in PM-DILI vs 2.7% in Han Chinese (OR 30.4); vs other DILI OR 86.5 (95% CI 14.2-527.8) and vs population controls OR 143.9 (95% CI 30.1-687.5). In the prospective cohort, asymptomatic transaminase elevation occurred in 37.5% of carriers vs 4.7% of noncarriers (relative risk 8.0, 95% CI 1.9-33.2, P<0.02). Identifies a genetic biomarker for predicting PM hepatotoxicity.
Experimental (transgenic mouse) study
Zhang 2024 (J Ethnopharmacol)
✓ PubMed
HLA-B*35:01 transgenic mice given emodin showed greater immune-mediated liver injury (higher transaminases, CD8+ T-cell infiltration) than wild-type, implicating emodin-specific T-cell activation in PM-induced liver injury.
Case report
Case report 2022
✓ PubMed
Single case of concurrent severe hepatotoxicity and agranulocytosis attributed to P. multiflorum ingestion, illustrating idiosyncratic multi-organ toxicity.
case report
Case report 2022 (ACG Case Reports J)
✓ PubMed
Case report of drug-induced liver injury after ingestion of P. multiflorum herbal tea, with biopsy showing portal and lobular lymphocytic inflammation and pericentral dropout, resolving after discontinuation.
Clinical genetic association study
Tu 2021 HLA verification
✓ PubMed
Correlational study confirming association between the HLA-B*35:01 allele and P. multiflorum-induced drug-induced liver injury, supporting an immune-mediated, genetically predisposed mechanism.
Preclinical mechanistic study
Han 2022 (rat/spheroid study)
✓ PubMed
P. multiflorum induced hepatotoxicity in SD rats and human hepatocyte spheroids by disrupting bilirubin and bile-acid metabolism, supporting a cholestatic mechanism of injury.
Study
Human efficacy
✓ Full text
No high-quality trials supporting anti-aging or hair claims.
Preclinical
Preclinical
✓ PubMed
Antioxidant and neuroprotective effects of THSG in animal models.