Polygonum multiflorum (Fo-ti) is a popular herb in traditional Chinese medicine. Commonly known as He shou wu in China and Fo-ti in North America, studies have shown this herb to be beneficial in the treatment of cancer, diabetes, hair loss, hardening of the arteries, and neurodegenerative diseases.

What is Fo-Ti?

Polygonum multiflorum Thunb. (P. multiflorum) or Fallopia multiflora is officially listed in the Chinese Pharmacopoeia and is one of the most popular herbs in Chinese medicines [1].

In North America, it is commonly known as Fo-ti.

It is widely cultivated throughout China and other countries such as Japan, where it grows in valley shrubs, hillside forests, gutter rock crevices and other locations at altitudes of 200 – 3,000 m [2].

The plant grows to be 2 – 4 m tall consisting of a woody tuber, leaves that are 3 – 7 cm long and arrowhead-shaped, white or greenish-white flowers that are 6 – 7 mm in diameter and an achene fruit 2.5 – 3 mm in length [2].

Over the years, parts of Fo-ti have been used for different medicinal purposes.

The leaves, root tuber, and rhizomes have been used as a tonic in the anti-aging formula while the stem has been used to alleviate insomnia and to help treat diabetes [3].

Chemical Constituents

More than 100 chemical compounds have been isolated from Fo-ti, and the most biologically relevant components have been determined to be from the families of stilbenes, quinones, flavonoids, and phospholipids.

Processing Fo-ti, as opposed to using the raw herb, influences the amount and type of chemical constituents found in the plant [45].

The toxicity of processed Fo-ti is lower than that of the crude herb and this may be associated with the decreased levels of some of the components after processing [6].

Additionally, processing of Fo-ti resulted in the formation of five new chemicals that were not identified in the crude herb [2].

Two of the best-studied constituents of Fo-ti include 2,3,5,40-tetrahydroxystilbene-2-O-β-D-glucoside (TSG) and emodin.


Only limited data about certain constituents of Fo-ti is available.

Rats rapidly absorb TSG into its bodily fluid and quickly eliminated, distributing through the liver and lung but hardly through the blood-brain and blood-testicle barriers [7].

Emodin is found primarily in the liver and brain [8].

Health Benefits

Fo-ti exhibits a wide spectrum of pharmacological effects, including anti-aging, immunologic, neuroprotective, anticancer and anti-inflammatory effects.

However, few clinical studies have been conducted to evaluate the traditional therapeutic claims and to understand the medical potential of its bioactive compounds.

Immune-Supporting Effects

1) Anti-inflammatory Effects

TSG and emodin in Fo-ti can decrease inflammation and help with colitis in mouse models by increasing PPAR-gamma and decreasing NF-kB [2, 3, 9].

In mice, A methanol extract of Fo-ti has an anti-inflammatory effect on mouse macrophage cells that are stimulated by lipopolysaccharide (a bacterial toxin from harmful bacteria).

This Fo-ti extract inhibited NF-kB activation and thus reduced nitric oxide, COX-2 enzyme, and inflammatory cytokines like TNF-alpha and IL-6 [10].

Emodin protects microglia cells in the brain from inflammation due to lipopolysaccharides through AMPK/Nrf2 activation [11].

2) Promotes Good Immune Function

The sugars (rhamnose, arabinose, xylose, and glucose) and anthraquinone glycosides found within Fo-ti can improve immune response and overall immune system function (immunomodulatory effect).

Fo-ti boosts the immune system by increasing the production of T and B cells, and improving the activities of the immune cells, as well as increasing the secretion of the inflammatory tumor necrosis factor.

Further, Fo-ti increases the activity of natural killer (NK) cells [12, 2].

3) May be Effective against MRSA

Fo-ti has anti-bacterial activity against methicillin-resistant Staphylococcus aureus (MRSA) in a cell-based study [13].

4) Has Antiviral activities

Fo-ti exhibited anti-HIV by preventing the virus from entering lymphocytes in a cell-based study [14].

Emodin blocks binding of SARS coronavirus human cells in a cell-based study [15].

5) May Help with Asthma

In a mouse model of asthma, Fo-ti decreases airway allergic symptoms [16].

Antioxidant Activities

6) Protects the Liver

The anthraquinones and polysaccharides found in Fo-ti protect the liver by reducing inflammation, preventing fat oxidation, and increasing antioxidant effects [17, 2].

Pre-treating rats with 200 mg/kg water extract of Fo-ti protect the rats against chloroform-induced liver toxicity and significantly reduced plasma ALT (a liver enzyme that indicates liver damage) as well as improved glutathione levels and other oxidative stress markers. However, increasing the dose to 400 mg/kg did not protect the liver against chloroform toxicity, and at 4,000 mg/kg, Fo-ti damaged the liver [18].

7) May Protect the Bone from Oxidative Stress

TSG from Fo-ti extract protects the bone-making cells (osteoblasts) from oxidative damage in a cell-based study, suggesting that TSG may protect against osteoporosis due to oxidative stress [19].

Hot water extract of Fo-ti prevents bone loss (osteopenia) from mice with that lose bone mass from having their ovaries removed [20].

8) Protects Tissues Oxidation in Diabetes

2,3,5,4′-Tetrahydroxystilbene-2-O-β-d-glucoside protects against kidney damage from high blood sugar in diabetic mice through SIRT1 and TGF-beta1 pathways [21, 22].

Stilbene glucoside from Fo-ti inhibits tissue aging due to high blood sugar (formation of advanced glycation end product) [23].

Neuroprotective effects

9) May Help with Alzheimer’s Disease

In a mouse model of Alzheimer’s, tetrahydroxystilbene glucoside from Fo-ti helps with memory deficit [24].

A small Chinese clinical trial found that Fo-ti extract is effective against Alzheimer’s disease [25].

Tetrahydroxystilbene glucoside helps slow down age-related memory loss in rats [26].

In a cell-based study, treatment with a Fo-ti root extract reduced amyloid plaque that can cause Alzheimer‘s disease [27].

Emodin, a chemical found in Fo-ti, inhibits the enzyme that breaks down acetylcholine, which might be how it helps with cognitive function in a similar manner to Huperzine A and some Alzheimer‘s drugs [2].

10) May Help with Parkinson’s Disease

In mouse models of Parkinson’s Disease, TSG and an ethanol extract of Fo-ti protects dopaminergic neurons from chemical-induced damage [2829].

11) Protects the Brain from Stroke

Hexane extracts of Fo-ti can protect against tissue damage following a stroke in mice and thus may have clinical applications as a protective agent against neurological injury [30].

12) Protects Against Glutamate-Induced Toxicity

In a cell-based study, Fo-ti protects neuronal cells from the hippocampus against glutamate toxicity, suggesting that it can help with cognitive disorders, especially ones that involve memory loss [31].

Cardiovascular Risks

13) Helps Reduces Cholesterol

Fo-ti can reduce cholesterol and triglycerides in people with high cholesterol [32, 3, 33].

However, further research is required to understand how Fo-ti helps reduce cholesterol.

14) Helps Prevent Hardening of the Arteries

TSG can prevent hardening of the arteries by reducing lipid levels in the blood, reduce inflammation and normalize the structure of the blood vessel via a reduction in the expression of MMP-2 and MMP-9 genes [34].

15) Has Protective Effects in Blood-Clotting Disorders

Thromboembolic (blood-clotting) disorders are caused by loose blood clots that form in a blood vessel and are carried by the bloodstream into another vessel that subsequently becomes blocked.

This often happens in the lungs (pulmonary embolism), brain (stroke), gastrointestinal tract, kidneys, or leg. This phenomenon is known as thromboembolism.

The chemical 2,3,5,4′-tetrahydroxystilbene-2-O-β-D-glucoside isolated from Fo-ti can prevent abnormal blood clotting [35].

16) Protects the Heart

In rats, TSG protected the heart from squeezing pressure around the abdomen [36].

In a heart attack model, Fo-ti stilbene glycoside can protect against cell injury from lack of oxygen or blood flow by increasing the levels of cellular antioxidants such as superoxide dismutase, glutathione peroxidase, and the nitric oxide pathways [37].

17) Helps with Fructose-Induced Metabolic Syndrome

Fo-ti, together with red ginseng, helps with fructose-induced metabolic syndrome by improving high blood pressure, obesity, high blood lipids, inflammation of the blood vessels, and insulin sensitivity [38].


18) Helps Prevent Cancer

These anthraquinones induce apoptosis (cell death) in cancer cells and activate the PI3K/AKT/mTOR pathways which are abnormal in many human cancers [2, 39].

Emodin and aloe-emodin can inhibit cell growth (by inhibiting apoptosis) of human cervical cancer cells, human tongue cancer cells, neuroblastoma cells, and melanoma cells [2].

It could significantly reduce colon tumor volume and weight in mice [40].

Emodin enhanced tumor cell death of gallbladder cancer cells that are injected into mice [41].

19) May Help with Insomnia

Fo-ti extracts are commonly prescribed in Taiwan for the treatment of insomnia [42].

More research is needed to confirm this benefit.

20) Helps With Hair Growth

Fo-ti has traditionally been used to treat patients suffering from baldness and hair loss throughout East Asia.

This traditional use of the herb has been substantiated by a study conducted in mice showing that P. multiflorum extracts promote hair growth by inducing the anagen phase in resting hair follicles [43].

Torachrysone-8-O-β-D-glucoside, a compound found in P. multiflorum, can significantly increase the number of dermal papilla cells which play a role in hair growth and hair fiber length [44].

Potential Side Effects and Toxicity

Liver Toxicity

The best-known toxicity of P. multiflorum is the induction of hepatotoxicity [45]. Hepatotoxicity induced by P. multiflorum can be severe and even result in death.

Several cases of hepatotoxicity due to P. multiflorum have been reported in patients from Australia, China, Italy, Japan, the Netherlands and Slovakia who were taking the product for hair loss, chronic prostatitis or to boost the immune system [3, 46, 47, 48].

The main chemicals responsible for the hepatotoxicity of P. multiflorum are free anthraquinones such as emodin and physcion [49]. The toxicity of emodin has been detailed by the U.S. National Toxicology Program [50].

The hepatotoxicity of the water extract is higher than that of the ethanol and acetone extracts of P. multiflorum. Processing of P. multiflorum also decreased hepatotoxicity [3, 2].

Kidney and Lung Toxicity

P. multiflorum is also toxic to the kidneys (nephrotoxicity) and the lungs (pulmonary toxicity), particularly after long-term use.

P. multiflorum causes embryonic toxicity in mice and may affect embryonic development, suggesting that it may not be safe for pregnant women.

Warfarin (prescribed to prevent the formation of blood clots) may interact negatively with P. multiflorum resulting in bone marrow suppression [2].

Other names for P. multiflorum include:

Chinese Cornbind, Chinese Knotweed, Climbing Knotweed, Fallopia multiflora, Flowery Knotweed, Fo Ti Tieng, Fo-Ti, He Shou Wu, Ho Shou Wu, Multiflora Preparata, Polygonum, Polygonum Multiflorum, Polygonum,Polygonum Multiflorum Thunberg, Racine de Renouée Multiflora, Radix Polygoni Multiflori, Radix Polygoni Shen Min, Renouée, Renouée à Fleurs Nombreuses, Renouée de Chine, Renouée Multiflora, Reynoutria multiflora (Thunb), Rhizoma Polygonata, Shen Min, Shou Wu, Shou Wu Pian, Tuber Fleeceflower, Zhihe Shou Wu, Zi Shou Wu

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