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Scientific Name(s): Fallopia multiflora, Polygonum multiflorum Thunb.
Common Name(s): Chinese cornbind, Climbing knotweed, Flowery knotweed, Fo-ti, He shou wu, Radix polygoni multiflori, Shou wu pian, Tuber fleeceflower

Medically reviewed by Last updated on Sep 13, 2021.

Clinical Overview


Evidence exists of hepatic injury in humans with use of P. multiflorum. P. multiflorum and its extracts should be considered hepatotoxic; however, the plant is widely used in traditional Chinese medicine and the traditional Ayurvedic medical system for various conditions. Animal and/or in vitro studies have examined potential effects on aging, alopecia, neurodegenerative diseases, atherosclerosis, diabetes, and dyslipidemia. Clinical trials are lacking to support claims of therapeutic benefits.


Clinical studies are lacking to provide dosing recommendations for fo-ti.


Use is contraindicated in individuals with liver disease.


Avoid use. Embryonic toxicity has been reported.


None well documented.

Adverse Reactions

P. multiflorum is widely used in Chinese medicine; however, adverse event reporting under clinical trial conditions is lacking. Hepatotoxicity has been documented.


Evidence of hepatic injury in humans exists; P. multiflorum and its extracts should be considered hepatotoxic. The plant may also be nephro-, neuro-, and embryotoxic.

Scientific Family

  • Polygonaceae (buckwheat)


P. multiflorum is native to central and southern China and is also distributed in Japan and Taiwan. It is a perennial climbing herb that can grow to 9 m in height. The plant has red stems, heart-shaped leaves, and white or pink flowers. The roots are the main plant part of interest and are harvested and dried in autumn when they are 3 to 4 years of age, but the stems and leaves are also used. Raw, wine- or steam-processed, or cured fo-ti is available in the United States.Chevallier 1996, Khan 2010, Reid 1994, USDA 2020


Radix polygoni multiflori (he shou wu) is a popular Chinese tonic herb, with use dating to 713 AD.Chevallier 1996 "Fo-ti" appears to be a name given to the preparation for use in areas where Chinese is not the primary language.Khan 2010 It is considered one of China's most common herbal tonics and is used to increase liver and kidney function and to cleanse the blood.Reid 1994 The plant is also prescribed for symptoms of premature aging, such as gray hair, and is commonly found in hair care products in China.Chevallier 1996, Khan 2010 It is also used to treat insomnia, weak bones, constipation, and atherosclerosis.Chevallier 1996 Regarded as a rejuvenating plant, fo-ti has been thought to prevent aging and promote longevity. According to folklore, the older and larger roots have the most power, potentially offering immortality.Chevallier 1996, Khan 2010, Reid 1994


Major chemical constituents include stilbenes, quinones, flavonoids, phospholipids, and others. More than 100 chemical compounds have been identified, and analytical techniques are described.Duke 1992, Lin 2015, Liu 1991, Lv 2011, Ma 1991

Chemicals of interest include the anthraquinones emodin, physcion, and rhein; stilbenes; and a tetrahydroxystilbene glucoside.Duke 1992, Grech 1994, Oerter Klein 2003, Sun 2015 Minerals and vitamins in the root have also been described.Duke 1992 Studies have found that raw and processed roots have different chemical constituents, supporting traditional Chinese medicine claims of differing properties.Liang 2010, Lin 2015, Wu 2012

Uses and Pharmacology

Extracts of P. multiflorum are commonly used in combination with other herbs (including Buyangahuanw Pill Jiajian Fang and Qishu decoction), rather than alone.(Duke 1992) Clinical trials reporting on efficacy are limited.(Khan 2010)

Anti-aging effects

Purported anti-aging effects mostly rely on in vitro studies of antioxidant and neuroprotective effects.(Lin 2015)

Animal and in vitro data

Emoghrelin, derived from P. multiflorum, stimulated secretion of growth hormone in vitro,(Lo 2015) and tetrahydroxystilbene glucoside protected against the thinning of mice derma associated with aging.(Zhou 2014) Studies evaluating effects of P. multiflorum on lifespan and lipid metabolism in senile Japanese quails have been conducted.(Wang 1988)


Animal and in vitro data

Topical application of P. multiflorum induced follicular keratinocyte proliferation in mice.(Begum 2015, Park 2015) The inhibition of tyrosinase activity in mice melanocytes has also been demonstrated,(Cheung 2014) and compounds isolated from P. multiflorum roots induced a greater proliferation of dermal papilla cells than minoxidil in an in vitro study.(Sun 2013) Multiple mechanisms of action were noted in a human hair follicle organ culture model, including decreases in proteins with apoptotic and catagen-inducing effects and increases in growth factors.(Shin 2020)

Antioxidant activity

In vitro data

In vitro studies have shown that extracts of P. multiflorum possess antioxidant properties.(Hong 1994, Lee 2012, Li 2010, Lv 2014, Shen 2013, Steele 2013, Tao 2011, Zhang 2012)


Animal and in vitro data

In vitro studies and limited animal data suggest P. multiflorum components (tetrahydroxystilbene glucoside and emodin) possess anticancer properties.(Chen 2011, Horikawa 1994, Lin 2015, Sun 2015)

Cardiovascular effects/Atherosclerosis

Animal and in vitro data

Emodin has demonstrated inhibitory effects on vasodilation in isolated rat aortas.(Lim 2014) Tetrahydroxystilbene glucoside has been shown to exert a number of actions, including prevention of reperfusion injury in human umbilical endothelial cells,(Liu 2010) prevention of oxidized low-density lipoprotein–induced endothelial dysfunction,(Yao 2013) reduction of vascular smooth muscle cell production in response to cellular injury,(Xu 2015) and antiplatelet activity in response to collagen-induced aggregation.(Xiang 2014)

CNS effects

Animal and in vitro data

In vitro studies of CNS tissues report decreased neuroinflammation via inhibition of microglia activation,(Zhang 2013) promotion of hippocampal synaptic plasticity,(Wang 2011) antioxidant effect in hippocampal and other cells,(Jang 2013, Kim 2013, Qin 2011, Steele 2013) and reduction of amyloid peptide production(Liu 2012) with P. multiflorum or active components extracted from P. multiflorum. In contrast, an in vitro study using cultured mouse cortical neurons showed an extract of P. multiflorum to be neurotoxic.(Shen 2013) In a study conducted in rats, tetrahydroxystilbene glucoside reversed impaired learning and memory; histological changes were observed in the hippocampus.(Zhou 2012)

Clinical data

P. multiflorum extracts are traditionally used in the Ayurvedic medical system and in traditional Chinese medicine for the treatment of cognitive disorders; however, clinical studies are lacking.(Shen 2013) One study conducted among patients with Alzheimer disease (N=209) reported that a P. multiflorum extract was effective compared to control groups; details regarding methodology are unclear.(Chen 2010)


Animal and in vitro data

Reduction in the production of glycation end products in diabetes has been demonstrated in vitro.(Lv 2010) A rat study noted beneficial effects via regulation of gut microbiota in rats with insulin resistance induced by high-fat and high-sugar diets.(Bi 2020)


Both raw and cured fo-ti are used in traditional Chinese medicine for dyslipidemia.(Khan 2010)

Animal and in vitro data

Effects on triglyceride and total cholesterol regulation have been demonstrated by tetrahydroxystilbene glucoside, emodin, and physcion in mice and in vitro.(Li 2010, Liu 1992, Wang 2012, Wang 2014) Raw fo-ti appeared to be more effective than processed fo-ti in 1 study.(Wang 2012)

Hepatic effects

Animal and in vitro data

In contrast to the known hepatotoxicity of P. multiflorum extracts,(Dong 2014, Lei 2015, Teschke 2014) tetrahydroxystilbene glucoside and emodin appear to have hepatoprotective effects.(Kim 2013, Lee 2012, Li 2010, Zhang 2012)

Immunomodulatory/Anti-inflammatory effects

Immunomodulatory and anti-inflammatory effects have been reported.(Lin 2015)

Emodin and Radix polygoni multiflori was reported to block the SARS coronavirus spike protein from interacting at the angiotensin-converting enzyme 2 receptor.(Adhikari 2021, Ho 2007)


Clinical studies are lacking to provide dosing recommendations for fo-ti.

P. multiflorum is usually used in combination with other products.Khan 2010, Lin 2015

Pregnancy / Lactation

Avoid use. Embryonic toxicity has been reported.Chang 2012


Case reports are lacking. An in vitro study suggests tetrahydroxystilbene glucoside exerts an inhibitory effect on platelet aggregation.Xiang 2014

Adverse Reactions

P. multiflorum is widely used in Chinese medicine; however, adverse event reporting under clinical trial conditions is lacking. Hepatotoxicity has been documented.Dong 2014, Lei 2015, Teschke 2014 GI symptoms, including diarrhea, may be due to consuming raw or improperly processed fo-ti.Khan 2010

Data collected between 2004 and 2013 from 8 US centers in the Drug-Induced Liver Injury Network revealed that 15.5% (130) of hepatotoxicity cases were caused by herbals and dietary supplements, whereas 85% (709) of cases were related to prescription medications. Of the 130 cases of liver injury related to supplements, 65% were from non-bodybuilding supplements and occurred most often in Hispanics/Latinos compared with non-Hispanic Whites and non-Hispanic Blacks. Liver transplant was also more frequent with toxicity from non-bodybuilding supplements (13%) than with conventional medications (3%) (P<0.001). Overall, the proportion of severe liver injury cases was significantly higher for supplements than for conventional medications (P=0.02). Of the 217 supplement products implicated in liver injury, 175 had identifiable ingredients, of which fo-ti was among the 32 (18%) single-ingredient products.Navarro 2014 The European Association for the Study of the Liver clinical practice guidelines for drug-induced liver injury (2019) recommend physicians consider herbal and dietary supplements as potential causative agents associated with liver injury (level 4 evidence; grade C recommendation), including fo-ti (P. multiflorum; shou wu pian).EASL 2019


Evidence of hepatic injury in humans existsLei 2015; P. multiflorum and its extracts should be considered hepatotoxic. The plant may also be nephro-, neuro-, and embryotoxic.

Reviews of the toxic effects, possibly dose- and duration-related, of P. multiflorum on the liver have been published. Other reviews suggest toxicity of an idiopathic nature, with more than 400 cases reported. Hepatotoxicity is largely reversible; however, deaths have been reported.Dong 2014, Lei 2015, Teschke 2014 Nephrotoxicity and embryonic toxicityChang 2012 have also been reported and attributed to the quinone constituents emodin and rhein.Lin 2015, Shen 2013

Reports also exist of the tetrahydroxystilbene glucoside and emodin constituents appearing to have neuro-, nephro-, and hepatoprotective effects.Kim 2013, Lee 2012, Li 2010, Sun 2011, Zhang 2013 In mice, processing the raw roots increased emodin and decreased tetrahydroxystilbene glucoside content and diminished observed toxicity.Wu 2012

In rats, tetrahydroxystilbene glucoside was detected in the liver and lungs in the highest concentrations, but not in brain and testes tissues.Lv 2011 Mutagenicity and toxicity to lung tissue have also been described.Lin 2015



This information relates to an herbal, vitamin, mineral or other dietary supplement. This product has not been reviewed by the FDA to determine whether it is safe or effective and is not subject to the quality standards and safety information collection standards that are applicable to most prescription drugs. This information should not be used to decide whether or not to take this product. This information does not endorse this product as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this product. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this product. This information is not specific medical advice and does not replace information you receive from your health care provider. You should talk with your health care provider for complete information about the risks and benefits of using this product.

This product may adversely interact with certain health and medical conditions, other prescription and over-the-counter drugs, foods, or other dietary supplements. This product may be unsafe when used before surgery or other medical procedures. It is important to fully inform your doctor about the herbal, vitamins, mineral or any other supplements you are taking before any kind of surgery or medical procedure. With the exception of certain products that are generally recognized as safe in normal quantities, including use of folic acid and prenatal vitamins during pregnancy, this product has not been sufficiently studied to determine whether it is safe to use during pregnancy or nursing or by persons younger than 2 years of age.

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