He Shou Wu (Fo-Ti) (Reynoutria multiflora (Polygonum multiflorum)): Evidence, Safety and How It Is Used

Safety first: liver injury is documented

He shou wu is one of the herbs most often named in reports of herb-induced liver injury. A systematic review of liver-injury case cohorts listed Polygonum multiflorum among the main herbs causing it [1]. A Chinese review calls it one of the leading causes of herb-induced liver injury in China [2].

In an 18-person case series, the most common symptoms were fatigue, loss of appetite and jaundice (yellowing of the skin or eyes) [3]. Symptoms began a median of 27 days after starting, with a range of 1 to 120 days [3].

If you take or have taken a product containing this root and notice those signs, contact a clinician promptly; for severe symptoms call 911. Ask the prescriber or pharmacist before changing any prescribed medicine. Our guide to liver safety and supplements lists the warning signs.

What it is

He shou wu is the Chinese name of the root of Reynoutria multiflora (Thunb.) Moldenke, family Polygonaceae. GBIF lists Polygonum multiflorum Thunb. as a synonym of this accepted name [4]. "Fo-ti" is a common English trade name. The root is the part used; its pharmacopoeial Latin name is Polygoni Multiflori Radix [5].

Is it an "adaptogen"? The sources we read about this plant do not call it one, and "adaptogen" is a contested term whose use varies between researchers and regulators [6]. Read what the word means before relying on any label. This page covers it because supplements and "longevity" blends sometimes group it with adaptogens.

Traditional use

In Chinese herbal medicine, the plant and its processed products have been used in China for centuries [7]. The traditional-use page in our Therapies section describes this context. Traditional use is not evidence that a product is safe or effective.

What research shows

On the last row: we searched PubMed for randomized controlled trials of the plant under both its names. The only trial record returned used prepared Polygonum multiflorum as one ingredient in a multi-herb formula for kidney disease [9], so its effect cannot be separated. We found no trial of the root alone for hair color, aging or stress.

Why processing is discussed

A review distinguishes raw P. multiflorum from its processed products. It reports that processing can lower toxicity, yet notes a lack of a scientific approach to control the quality of the processed product [7]. The sources we read do not describe how supplement labels handle this, so ask a pharmacist. We do not give preparation instructions: this is a plant with a documented harm, and home processing is not a safe workaround.

Who should be most careful

• Anyone with liver disease, or who takes other medicines handled by the liver. Ask a pharmacist before combining; see how interactions are classified.
• People with a family or personal history of drug-induced liver injury. An immune mechanism is proposed: one review describes the injury as considered immune-mediated and idiosyncratic, meaning it happens in a few susceptible people and not predictably [10].
• Pregnancy, breastfeeding and children. Proper evidence not found in the sources we read. Because of the liver reports, ask a clinician; see pregnancy and breastfeeding.
• Before surgery. Tell the surgical team about every supplement; see supplements before surgery.

Quality and regulation

Product contents may differ from the label; see quality testing and certifications. Statements from the UK MHRA, the European Medicines Agency and other regulators about this plant could not be read for this page, so we do not summarize them. For adaptogen-wide cautions, see adaptogen safety essentials.