He Shou Wu
StarPolygonum multiflorum Thunb.
Traditionally used for
- Dizziness
- Eye health
- Bowel health
- Energy & fatigue
- Skin
Cautions & contraindications
- Liver conditions
- Seizure disorders
☯ TCM Properties
Resolves Toxicity; Checks Malaria; Moistens the Intestines and Unblocks the Bowels; Dispels Wind and Stops Itching
Traditional Chinese Uses
He Shou Wu (fleeceflower root, polygonum root) is a tonic herb that in its processed form nourishes Liver and Kidney to address premature greying, hair thinning, dizziness, blurred vision, and lower back weakness from deficiency. It tonifies without excessive drying or warming, making it suitable for long-term supplementation. The raw, unprocessed form acts differently — primarily gently relieving constipation and clearing sores. Professional guidance on which form is appropriate is important.
Western Herbalism Properties
Pharmacological Effects
- Immunologic / adrenocorticotropic: Increased thymus, lymph node and adrenal weights and macrophage phagocytosis in mice; antagonized prednisolone immunosuppression; raised hepatic glycogen in adrenalectomized mice.
- Lipid / atherosclerosis: Extract increased lipoprotein lipase activity and lowered plasma cholesterol in rats; milder atherogenesis in cholesterol-fed rabbits.
- Antimutagenic: Ethyl acetate extract and its tannins inhibited benzo(a)pyrene mutagenicity in Salmonella TA98; water extract lowered B(a)P tumor incidence in rats.
- Antioxidant: Aqueous extract protected against CCl4 hepatotoxicity in rats and scavenged ferri-heme oxidants; activity in ethyl acetate fraction.
- Other: Reduced heart rate, slightly increased coronary flow; 0.2 g/mouse for 14 days reduced cold-exposure mortality; laxative due to anthraquinones.
Source: Zhu YP. Chinese Materia Medica: Chemistry, Pharmacology and Applications. Harwood Academic, 1998, p. 584.
Relationships
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Botanical Description
Polygonum multiflorum (accepted name Reynoutria multiflora, also placed in Fallopia multiflora) is a perennial twining herbaceous vine in the family Polygonaceae, native to forest margins, thickets, valleys, and rocky slopes of central and southern China, Taiwan, and northern Vietnam at elevations of 200-3000 m. The plant produces a swollen, tuberous, dark reddish-brown root that may reach 15 cm in diameter. The slender, hollow, reddish stems twine 2-4 m over surrounding vegetation, bearing alternate, ovate-cordate leaves 3-7 cm long with entire margins and a characteristic sheathing ocrea at each node typical of the family. Small white to greenish-white flowers about 2 mm across are borne in much-branched terminal and axillary panicles in late summer and autumn, each tepal becoming winged in fruit. The fruit is a small, three-angled, dark brown achene enclosed by the persistent winged perianth.
Active Constituents
2,3,5,4'-Tetrahydroxystilbene-2-O-beta-D-glucoside (trans-isomer, THSG)
Stilbene glucosideConcentration: The Chinese Pharmacopoeia sets a minimum of 1.0% of the dried raw root; content falls during black-bean steaming, so the processed drug assays lower
The official quality marker of the root and its most abundant single constituent. It is the compound most often credited with the antioxidant and lipid-lowering activity claimed for the herb, but it is also implicated in liver injury: in mice it induced hepatic CYP2E1, CYP3A4 and CYP1A2 and markedly worsened acetaminophen hepatotoxicity, and its deglycosylated aglycone forms reactive metabolites that covalently modify hepatic protein.
cis-2,3,5,4'-Tetrahydroxystilbene-2-O-beta-D-glucoside (cis-stilbene glucoside)
Stilbene glucoside (cis geometric isomer)Concentration: A minor isomer in fresh material that accumulates on exposure to ultraviolet light or sunlight during drying and storage, so its content is a function of handling rather than of the plant
This is the single most important chemical finding in the hepatotoxicity literature. Using a constituent knock-out and knock-in strategy in lipopolysaccharide-primed rats, the isolated cis isomer reproduced the idiosyncratic liver injury of the whole extract while the far more abundant trans isomer did not. It acts by suppressing PPAR-gamma and unleashing an inflammatory response. Because the cis form is generated from the trans form by light, a batch's hazard can be created after harvest, which is why light-protected drying and storage is a genuine safety measure and not a quality nicety.
Emodin
AnthraquinoneConcentration: Counted with physcion toward the Pharmacopoeial minimum of 0.10% combined anthraquinones in the dried root; emodin decreases with nine-cycle black-bean processing
Directly cytotoxic to hepatocytes and among the most potent of the herb's components in zebrafish lethality screens; it accumulates in hepatocytes on repeated high dosing. It is also the antigenic partner in the immune mechanism: emodin-specific CD8+ T cells activated in an HLA-B*35:01-restricted manner drive liver injury in humanised mice, which links the chemistry to the human genetic risk factor.
Physcion (emodin monomethyl ether)
AnthraquinoneConcentration: Assayed together with emodin against the 0.10% combined-anthraquinone minimum; its share rises during processing as emodin is methylated
Contributes to the purgative action of the raw root and to its anthraquinone burden. The shift from emodin toward physcion is one of the chemical signatures used to confirm that a batch has actually been processed.
Emodin-8-O-beta-D-glucoside
Anthraquinone glycosideConcentration: Present in the raw root and hydrolysed toward free emodin during processing and by gut flora
A latent source of free emodin: deglycosylation in the gut releases the aglycone, so glycoside content contributes to systemic emodin exposure rather than being inert.
Rhein and chrysophanol
AnthraquinonesConcentration: Minor anthraquinones alongside emodin and physcion
Both showed dose-related hepatotoxic effects in screening studies, adding to the anthraquinone load rather than acting as the primary culprits.
Gallic acid
Phenolic acidConcentration: Rises substantially during nine-cycle steaming as the root's tannins hydrolyse
One of the clearest markers of correct processing. Its increase tracks the breakdown of the astringent tannin fraction and is used analytically to distinguish processed from raw root.
Condensed tannins and catechin
Flavan-3-ols and proanthocyanidinsConcentration: Abundant in the raw root and depleted by processing
Responsible for the astringency of the raw drug and for its tendency to bind dietary and medicinal minerals and alkaloids in the gut.
Polysaccharides
PolysaccharideConcentration: Yield reported roughly sevenfold higher in the processed root than in the raw root
Largely generated or liberated by the steaming process rather than being a feature of the raw drug, and part of why the processed root is the tonifying form in classical practice while the raw root is used to move the bowels and resolve toxicity.
Phospholipids (chiefly lecithin)
PhospholipidConcentration: A minor lipid fraction of the root
Historically invoked to explain the herb's reputed effect on hair colour and on serum lipids, though the human evidence for either claim is weak.
⚠ Drug Interactions
Acetaminophen (paracetamol)
The root's principal stilbene glucoside induced hepatic CYP2E1, CYP3A4 and CYP1A2 in mice and thereby increased the flux of acetaminophen through the pathway that generates the reactive metabolite NAPQI, markedly exacerbating acetaminophen liver injury. The interaction is mechanistic and reproducible in animals, and it operates on top of the herb's own, independent capacity to injure the liver.
Clinical note: Do not combine. Patients using He Shou Wu who take paracetamol for any reason should be told to stop the herb. This combination is a plausible explanation for a proportion of the severe cases in the literature and should be actively asked about when a patient on the herb presents with raised transaminases.
Hepatotoxic drugs and herbs generally (isoniazid, rifampicin, methotrexate, azole antifungals, high-dose statins, anabolic steroids)
Polygonum multiflorum root is a LiverTox likelihood-score A agent, meaning a well established cause of clinically apparent liver injury. Adding a second hepatotoxin raises the joint probability of injury and, because the herb's own injury is idiosyncratic and unpredictable, makes dechallenge interpretation impossible. Patients with pre-existing liver disease fare distinctly worse: one hospital series reported mortality of about 9% in that group versus about 1% in those with normal baseline livers.
Clinical note: Avoid the herb entirely in anyone on a known hepatotoxic drug, in anyone with chronic hepatitis B or C, cirrhosis, fatty liver disease or unexplained transaminase elevation, and in anyone with a previous reaction to it. If it is used at all, check baseline ALT, AST, ALP and bilirubin and repeat at two to four weeks.
Substituted or adulterated root material: Cynanchum wilfordii and Cynanchum auriculatum (Bai Shou Wu), Dioscorea bulbifera (Huang Yao Zi), Pteroxygonum giraldii, Stephania cepharantha
Adulterants of He Shou Wu from at least nine species in six families have been documented, and dried root slices are the form most often substituted. Cynanchum wilfordii and C. auriculatum confusion has been serious enough in Korea to prompt the development of species-specific PCR primers. Dioscorea bulbifera matters most, because it is itself a recognised cause of severe herb-induced liver injury, so an adulterated batch can carry two unrelated liver hazards at once. Note separately that the vine of this same species, Ye Jiao Teng (Caulis Polygoni Multiflori), is a distinct drug used to calm the spirit and is not interchangeable with the root; essentially the whole hepatotoxicity literature, including every case series and the HLA association, concerns the root tuber (Radix Polygoni Multiflori), which is the drug described in this record.
Clinical note: Buy only authenticated, batch-tested root from a supplier that can show identity testing, and confirm the material is the root tuber rather than vine or a Cynanchum species. Reject slices that cannot be traced. Adulteration is not a theoretical concern for this herb, it is the market norm at the low-cost end.
CYP3A4, CYP2E1 and CYP1A2 substrates (for example midazolam, ciclosporin, tacrolimus, theophylline)
The root's stilbene glucoside induced hepatic CYP2E1, CYP3A4 and CYP1A2 expression in mice, and constituents of the root have been shown to interfere with drug-metabolising enzymes including CYP450 isoforms and UGTs. Human pharmacokinetic interaction studies are lacking, so the direction and size of the effect in patients is unknown.
Clinical note: Avoid with transplant immunosuppressants, antiretrovirals, anticonvulsants and other narrow-therapeutic-index CYP3A4 substrates. If unavoidable, monitor drug levels.
Digoxin and other drugs whose toxicity is increased by hypokalaemia
The raw root is a stimulant laxative by virtue of its anthraquinones, and prolonged anthraquinone laxative use is a recognised cause of potassium depletion. No case reports of this specific interaction with He Shou Wu were found, so the concern is extrapolated from the class rather than documented.
Clinical note: Relevant chiefly to the raw root used at purgative doses for constipation. Avoid prolonged use with digoxin, loop or thiazide diuretics, or corticosteroids; check potassium if the combination is used.
Dosage
| Form | Amount | Frequency | Duration | Population | Notes |
|---|---|---|---|---|---|
| decoction | 3–6 g | Daily | — | — | 中国药典 2020 【用法与用量】3～6g。 【性味与归经】苦、甘、涩，微温。归肝、心、肾经。 — 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.
Essence and blood are nourished while qi is tonified, supporting the righteous qi to stop chronic deficiency malaria.
Core pair of a classical formula — He Ren Yin, Jing Yue Quan Shu (Zhang Jingyue)
Evidence Tier
Moderate evidence · 6 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
2
0 verified · 2 unverified
In vitro / animal
4
3 verified · 1 unverified
Show 4 studies
- Screening for main components associated with the idiosyncratic hepatotoxicity of a tonic herb, Polygonum multiflorum
- Cis-stilbene glucoside in Polygonum multiflorum induces immunological idiosyncratic hepatotoxicity in LPS-treated rats by suppressing PPAR-γ
- 2,3,4′,5-tetrahydroxystilbene-2-O-β-D-glucoside exacerbates acetaminophen-induced hepatotoxicity by inducing hepatic expression of CYP2E1, CYP3A4 and CYP1A2
- HLA-B*35:01-mediated activation of emodin-specific T cells contributes to Polygonum multiflorum thunb. -induced liver injury in mice
Other / unclassified
0
Verified: design read from PubMed for a DOI that resolves to the cited paper Unverified: taken from the study's recorded description
Clinical Studies
HLA‐B*35:01 Allele Is a Potential Biomarker for Predicting Polygonum multiflorum–Induced Liver Injury in Humans
The landmark genetic association study for this herb. Among patients with Polygonum multiflorum-induced liver injury, the great majority carried at least one copy of HLA-B*35:01, against a small minority of patients with liver injury from other agents and about 5% of population controls. The finding establishes the injury as immunologically mediated and idiosyncratic rather than simply dose-related, and it identifies a testable susceptibility allele. A tag single-nucleotide polymorphism, rs1055348, was reported to track the allele with high sensitivity and specificity.
Single-nucleotide polymorphisms of HLA and Polygonum multiflorum-induced liver injury in the Han Chinese population
An independent Han Chinese association study of HLA variants in Polygonum multiflorum-induced liver injury, examining single-nucleotide polymorphisms as practical surrogates for HLA typing. It supports the HLA-linked immune basis of the injury and the use of a tag polymorphism as a screening marker where full HLA genotyping is not available.
Screening for main components associated with the idiosyncratic hepatotoxicity of a tonic herb, Polygonum multiflorum
Identified the responsible constituent by subtraction and reconstitution. The ethyl acetate fraction reproduced the idiosyncratic hepatotoxicity of the whole extract in lipopolysaccharide-treated rats, and within it the isolated cis-stilbene glucoside, not the much more abundant trans isomer, carried the toxicity. The authors also showed that ultraviolet light or sunlight converts the trans form to the cis form, meaning post-harvest handling changes the hazard of a batch. A published erratum exists for this paper; it has not been retracted.
Cis-stilbene glucoside in Polygonum multiflorum induces immunological idiosyncratic hepatotoxicity in LPS-treated rats by suppressing PPAR-γ
Defined the mechanism of the cis isomer's toxicity. In lipopolysaccharide-primed rats the cis-stilbene glucoside produced immune-mediated idiosyncratic liver injury by suppressing PPAR-gamma, which removed a brake on hepatic inflammatory signalling. The model reproduces the key clinical feature of the human injury, namely that it appears in a minority of exposed people and not in proportion to dose.
2,3,4′,5-tetrahydroxystilbene-2-O-β-D-glucoside exacerbates acetaminophen-induced hepatotoxicity by inducing hepatic expression of CYP2E1, CYP3A4 and CYP1A2
Showed that the herb's main marker compound is not hepatoprotective in this setting but the opposite: it induced CYP2E1, CYP3A4 and CYP1A2 in mouse liver and thereby worsened acetaminophen-induced hepatotoxicity. This is the mechanistic basis for treating concurrent paracetamol use as a major interaction.
HLA-B*35:01-mediated activation of emodin-specific T cells contributes to Polygonum multiflorum thunb. -induced liver injury in mice
Closes the loop between the human risk allele and a specific molecule: emodin-specific T cell activation restricted by HLA-B*35:01 contributed to Polygonum multiflorum liver injury in mice, identifying emodin as the antigenic partner for the susceptibility allele found in patients. It takes the HLA finding from a statistical association to a mechanism.
⚠ Safety & Contraindications
- Liver conditions
- Seizure disorders
Side Effects
- Loose stools are common; nausea and vomiting in a few patients.
Source: Zhu YP. Chinese Materia Medica: Chemistry, Pharmacology and Applications. Harwood Academic, 1998, p. 584.
Historical Texts
He Shou Wu Zhuan
Tang dynasty, early 9th centuryKai Bao Ben Cao
Northern Song dynasty, 973 CEBen Cao Gang Mu
Ming dynasty, 1596References
- Yi Liu, Wenping Wang, Mingyi Sun, Baorui Ma, Linnuo Pang, Yuanyuan Du, Xiaoxv Dong, Xingbin Yin, Jian Ni. Polygonum multiflorum-Induced Liver Injury: Clinical Characteristics, Risk Factors, Material Basis, Action Mechanism and Current Challenges . Frontiers in Pharmacology (2019) [DOI]
- Longfei Lin, Boran Ni, Hongmei Lin, Miao Zhang, Xuechun Li, Xingbin Yin, Changhai Qu, Jian Ni. Traditional usages, botany, phytochemistry, pharmacology and toxicology of Polygonum multiflorum Thunb.: A review . Journal of Ethnopharmacology (2015) [DOI]
- Yue Liu, Qi Wang, Jianbo Yang, Xiaohan Guo, Wenxi Liu, Shuangcheng Ma, Shaoping Li. Polygonum multiflorum Thunb.: A Review on Chemical Analysis, Processing Mechanism, Quality Evaluation, and Hepatotoxicity . Frontiers in Pharmacology (2018) [DOI]
- National Institute of Diabetes and Digestive and Kidney Diseases. Polygonum Multiflorum . LiverTox: Clinical and Research Information on Drug-Induced Liver Injury, Bethesda, Maryland (2020)
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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