☯ TCM Properties

Category: calming spirit

Temperature: neutral

Taste: sweet, bitter

Meridians: heart, liver

Functions:

Nourishes the Heart and Calms the Spirit; Nourishes Blood; Disperses Wind; Unblocks the Channels and Collaterals; Relieves Itching

Traditional Chinese Uses

Ye Jiao Teng (polygonum vine, fleeceflower vine) is a sweet, neutral herb used in Chinese medicine to nourish Blood, calm the Spirit, and open the channels to relieve itching skin conditions. It is particularly well suited for insomnia from Blood deficiency with an empty, restless quality, and for anxiety and palpitations from Heart and Liver Blood deficiency. Its channel-opening properties also address numbness, pain, and stiffness from Blood deficiency failing to nourish the sinew and channels, as well as itchy, deficiency-type skin conditions.

Western Herbalism Properties

Actions:

sedativenervine

Used In Formulas (1)

Tian Ma Gou Teng Yin

天麻钩藤饮 · Tian Ma Gou Teng Yin

Za Bing Zheng Zhi Xin Yi (New Meanings in Diagnosis and Treatment of Miscellaneous Diseases)

Assistant (Zuo) 9g

Relationships

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Botanical Description

Ye Jiao Teng is the dried aerial stem (caulis) of Polygonum multiflorum (syn. Reynoutria multiflora, Fallopia multiflora), a perennial twining vine in the Polygonaceae family native to central and southern China and Japan. The vine climbs 2-4 m via slender, glabrous, often reddish stems arising from large tuberous roots (the source of He Shou Wu). Leaves are alternate, ovate to cordate, 3-7 cm long, with entire margins and a basal ocrea. Small whitish flowers are borne in terminal panicles in late summer, followed by three-winged achenes. Stems are harvested in autumn, cut into segments, and dried.

Active Constituents

2,3,5,4'-Tetrahydroxystilbene-2-O-beta-D-glucoside (THSG)

Stilbene glucoside

Concentration: 0.268-41.361 mg/g across 15 commercial batches of the vine (Polygoni Multiflori Caulis), a more than hundredfold range between batches

THSG is the Pharmacopoeial marker for both the root and the vine and carries much of the antioxidant and lipid-lowering activity attributed to the drug. It is also the compound at the centre of the hepatotoxicity problem: its deglycosylated metabolite tetrahydroxystilbene acts as a hapten, binding covalently to proteins and triggering a T-cell response in susceptible individuals. The enormous batch-to-batch range in the vine means the dose of this compound a patient actually receives is effectively unknown without assay.

Emodin

Anthraquinone

Concentration: 0.010-1.295 mg/g in the vine

A stimulant-laxative anthraquinone that also contributes to the mitochondrial and cholestatic toxicity described in Polygonum multiflorum liver injury models. Its presence explains loose stools at higher doses and is one reason the drug is not a benign sedative.

Physcion

Anthraquinone (emodin 3-methyl ether)

Concentration: 0.013-1.394 mg/g in the vine

The second major free anthraquinone of the drug, occurring alongside emodin and its 8-O-glucoside. Physcion and emodin together are the anthraquinone fraction quantified in quality control of both root and vine.

Emodin-8-O-beta-D-glucoside

Anthraquinone glycoside

The bound form of emodin, hydrolysed by gut flora to release the free aglycone. Because release depends on the microbiome, the effective anthraquinone exposure from a given weight of herb varies between patients.

Physcion-8-O-beta-D-glucoside

Anthraquinone glycoside

The bound form of physcion, reported together with emodin-8-O-glucoside in comparative LC-MS profiling of the vine against the root.

Resveratrol and resveratrol glucoside (polydatin)

Stilbene

Minor stilbenes reported in the drug alongside THSG. They are antioxidant in vitro but occur at low levels and are not the basis of the traditional indication.

Gallic acid and catechin-type tannins

Phenolic acid and condensed tannins

The astringent phenolic fraction, more abundant in the root than the vine. Tannins bind alkaloids, iron and some drugs in the gut lumen, which is the basis of the generic advice to separate tannin-rich decoctions from oral medicines.

⚠ Drug Interactions

Any hepatotoxic drug or supplement (paracetamol/acetaminophen, isoniazid and other anti-tuberculous drugs, methotrexate, statins, azole antifungals, anabolic steroids, green tea extract)

Major Evidence: Established

Polygonum multiflorum is one of the best-documented causes of herb-induced liver injury worldwide. A systematic review found 450 published cases in 76 articles, with two liver transplants and seven deaths; injury is hepatocellular or mixed and typically appears within about a month, though latency ranges from days to six months, and rechallenge produces a faster onset. The injury is now understood as immune-mediated and idiosyncratic rather than simple dose-dependent toxicity: HLA-B*35:01 was carried by 45.4% of Chinese patients with Polygonum multiflorum liver injury versus 2.7% of the general Han population (OR 30.4, 95% CI 11.7-77.8), and in a prospective cohort of 72 outpatients taking the herb for four weeks, transaminase rises occurred in 37.5% of HLA-B*35:01 carriers versus 4.7% of non-carriers. Adding a second hepatotoxin removes any reserve. Critically for this record, essentially all of this evidence concerns the ROOT (He Shou Wu, Polygoni Multiflori Radix), raw and processed. There is no comparable case series for the vine, Ye Jiao Teng. The vine is the same species and contains the same stilbene glucoside and anthraquinones, generally at lower but extremely variable levels, so the risk should be treated as reduced and unquantified, not as absent.

Clinical note: Do not prescribe alongside another hepatotoxic drug or supplement without a reason. Baseline LFTs and a repeat at four to six weeks are proportionate for courses beyond a few weeks, and mandatory if the patient is also taking a known hepatotoxin. Stop immediately and check LFTs on fatigue, anorexia, nausea, right upper quadrant pain, dark urine or jaundice. Never rechallenge a patient who has had a hepatic reaction to this species in any form. Warn the patient explicitly that this vine is the same plant as He Shou Wu.

Polygoni Multiflori Radix (He Shou Wu) taken concurrently or substituted for the vine

Major Evidence: Established

Ye Jiao Teng and He Shou Wu are the vine and the root of one species, sold under different names and at very different prices, and patients routinely take He Shou Wu as a self-prescribed hair and anti-ageing supplement without regarding it as a drug. A patient on the vine may therefore be receiving the far better documented hepatotoxic root at the same time. LC-MS profiling of the vine against the root confirms the same stilbene and anthraquinone constituent classes in both, and Chinese regulators have responded by capping raw He Shou Wu at 1.5 g/day and processed at 3.0 g/day in health foods and by excluding people with liver dysfunction or a family history of liver disease.

Clinical note: Ask directly about He Shou Wu, Fo-Ti and 'shou wu' hair supplements when prescribing Ye Jiao Teng, in those words. Count the two together when judging total exposure, and do not run both.

Immune checkpoint inhibitors and other immunomodulating therapy

Moderate Evidence: Theoretical

The current mechanistic model of Polygonum multiflorum liver injury is loss of hepatic immune tolerance, with adaptive T-cell activation against a haptenated stilbene metabolite in HLA-B*35:01 carriers, and reviews of the mechanism explicitly discuss immune checkpoint molecules and regulatory immune cells as determinants of susceptibility. Drugs that remove checkpoint restraint are therefore a theoretical route to converting a subclinical response into hepatitis. No case series has tested this combination.

Clinical note: Avoid in patients on checkpoint inhibitors, where immune hepatitis is already a recognised and consequential toxicity and attribution would be impossible.

Digoxin, loop and thiazide diuretics, and corticosteroids (via anthraquinone laxative effect)

Moderate Evidence: Possible

The drug contains free and bound emodin and physcion, which are stimulant laxative anthraquinones. Prolonged use at high dose can cause diarrhoea and potassium loss, which is additive with potassium-wasting diuretics and corticosteroids and increases sensitivity to digoxin. The anthraquinone content of the vine is low and variable, so this matters mainly for long courses.

Clinical note: Check potassium in patients on digoxin or diuretics who take the herb for more than a few weeks, and reduce the dose if stools loosen.

Sedatives and hypnotics

Theoretical Evidence: Theoretical

The vine is prescribed traditionally for insomnia from blood deficiency, but there is no controlled human or animal evidence that it has hypnotic activity of its own, and no pharmacological mechanism has been identified. Any additive sedation is speculative and should be described to patients as such.

Clinical note: No specific action. Do not present the herb to a patient as a reliable sleep agent on current evidence.

Evidence Tier

Limited evidence · 2 studies

Recorded 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

1

0 verified · 1 unverified

Show the study

HLA‐B*35:01 Allele Is a Potential Biomarker for Predicting Polygonum multiflorum–Induced Liver Injury in Humans

In vitro / animal

0

Other / unclassified

1

1 verified · 0 unverified

Show the study

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

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

Li C, Rao T, Chen X, Zou Z, Wei A, Tang J, Xiong P, Li P, Jing J, He T, Bai Z, Yin J, Tan Z, Yu P, Zhou H, Wang J, Xiao X, Ouyang D (2019) Hepatology cohort

MHC sequencing in 11 patients with Polygonum multiflorum drug-induced liver injury, replication in 15 further cases against 33 other-DILI patients and 99 population controls, and a prospective cohort of 72 outpatients taking the herb for four weeks. HLA-B*35:01 frequency was 45.4% in cases versus 2.7% in the Han Chinese population (OR 30.4, 95% CI 11.7-77.8, p = 1.9e-10); logistic regression confirmed the association against other DILI (OR 86.5) and population controls (OR 143.9). Prospectively, asymptomatic transaminase rises occurred in 37.5% of HLA-B*35:01 carriers versus 4.7% of non-carriers (relative risk 8.0, 95% CI 1.9-33.2). The exposure studied was the root preparation, not the vine.

DOI: 10.1002/hep.30660 Link

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

Lei X, Chen J, Ren J, Li Y, Zhai J, Mu W, Zhang L, Zheng W, Tian G, Shang H (2015) Evidence-Based Complementary and Alternative Medicine systematic review Verified: Other / unclassified

Systematic review of six databases to June 2014, covering 450 cases of liver damage in 76 articles, involving raw and processed decoction pieces and Chinese patent medicines containing the herb. Symptoms typically began about a month after starting, with jaundice, fatigue, anorexia and dark urine. Two patients received liver transplants and seven died; the remaining 441 recovered or improved after stopping the product. The authors link most cases to long-term use and overdose. All cases concern the root, not the vine.

DOI: 10.1155/2015/459749 Link

Historical Texts

Kai Bao Ben Cao

Song dynasty

The first official materia medica to admit He Shou Wu, the root of this species, into the canon. The vine enters the literature attached to that entry rather than as an independent early drug, which is why the classical record for Ye Jiao Teng is thin compared with the root.

Ben Cao Gang Mu

Ming dynasty

Li Shizhen's He Shou Wu entry treats the vine as well as the root, recording the vine as a wash for wind-sores and itching skin and for postpartum sweating. The insomnia indication is not the earliest use.

Ben Cao Zheng Yi

Republican period, early twentieth century

Zhang Shanlei is the source usually cited for the modern indication, giving the vine for sleeplessness arising from heart blood deficiency. Almost the whole modern clinical profile of Ye Jiao Teng rests on this late reading rather than on classical authority.

References

Rao T, Liu YT, Zeng XC, Li CP, Ou-Yang DS. The hepatotoxicity of Polygonum multiflorum: The emerging role of the immune-mediated liver injury . Acta Pharmacologica Sinica (2021) [DOI]
Liu Y, Wang W, Sun M, Ma B, Pang L, Du Y, Dong X, Yin X, et al.. Polygonum multiflorum-Induced Liver Injury: Clinical Characteristics, Risk Factors, Material Basis, Action Mechanism and Current Challenges . Frontiers in Pharmacology (2019) [DOI]
Liu Y, Wang Q, Yang J, Guo X, Liu W, Ma S, Li S. Polygonum multiflorum Thunb.: A Review on Chemical Analysis, Processing Mechanism, Quality Evaluation, and Hepatotoxicity . Frontiers in Pharmacology (2018) [DOI]
Zhao Y, Kao CP, Chang YS, Ho YL. Quality assessment on Polygoni Multiflori Caulis using HPLC/UV/MS combined with principle component analysis . Chemistry Central Journal (2013) [DOI]
Wang GY, Shang J, Wu Y, Ding G, Xiao W. Rapid Characterization of the major chemical constituents from Polygoni Multiflori Caulis by liquid chromatography tandem mass spectrometry and comparative analysis with Polygoni Multiflori Radix . Journal of Separation Science (2017) [DOI]

Ye Jiao Teng

Traditionally used for

Cautions & contraindications