Evidence Based
7

Benefits of Fo-Ti (Polygonum Multiflorum) + Side Effects

Written by Aleksa Ristic, MS (Pharmacy) | Last updated:
Jonathan Ritter
Puya Yazdi
Medically reviewed by
Jonathan Ritter, PharmD, PhD (Pharmacology), Puya Yazdi, MD | Written by Aleksa Ristic, MS (Pharmacy) | Last updated:

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Fo-ti

Polygonum multiflorum (Fo-ti) is a popular herb in traditional Chinese medicine. Folks have used it to relieve insomnia, combat diabetes, stimulate hair growth, and more. Modern science casts doubt on some traditional uses and warns about liver toxicity but also suggests some surprising benefits. Read on to learn the potential uses and side effects of Fo-ti.

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 medicine [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 are long and arrowhead-shaped, white or greenish-white flowers, and an achene fruit [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, help with diabetes, stimulate the immune system, and more [3, 4].

Snapshot

Proponents:

  • May prevent cognitive decline
  • Supports heart health
  • May help with diabetes
  • May strengthen the bones
  • Supports the immune system

Skeptics:

  • Not well studied in humans
  • Can be toxic to the liver
  • May harm the kidneys
  • Potentially dangerous for pregnant women

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 [5, 6].

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 [7].

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.

Potential Health Benefits of Fo-Ti

Anecdotally, 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.

Insufficient Evidence:

No valid clinical evidence supports the use of Fo-ti for any of the conditions in this section. Below is a summary of up-to-date animal studies, cell-based research, or low-quality clinical trials which should spark further investigation. However, you shouldn’t interpret them as supportive of any health benefit.

1) Cognitive Impairment

A Chinese clinical trial of 209 Alzheimer’s disease patients found significant benefits of Fo-ti extract for cognitive decline, but it lacked a placebo control [8].

In another Chinese study (166 participants), a combination of Korean ginseng and Fo-ti improved mild cognitive impairment [9].

Tetrahydroxystilbene glucoside from Fo-ti helped with memory deficit in mouse models of Alzheimer’s [10, 11].

In test tubes, Fo-ti root extract reduced amyloid plaque that can cause Alzheimer‘s disease [12].

Emodin, a chemical found in Fo-ti, inhibits the enzyme that breaks down acetylcholine, which might contribute to its pro-cognitive effects [2].

2) Heart Disease

An herbal mixture containing Fo-ti significantly reduced LDL cholesterol and triglycerides in a study of 42 participants. Other ingredients have likely contributed to the results [13].

In rats, TSG protected the heart from squeezing pressure around the abdomen [14].

TSG prevented atherosclerosis by reducing lipid levels in the blood and suppressing inflammation (via the MMP-2 and MMP-9 genes) in another study on rats [15].

In a cellular model of a heart attack, Fo-ti stilbene glycoside prevented heart cell injury and boosted antioxidants such as superoxide dismutase, glutathione peroxidase, and the nitric oxide pathways [16].

Further research is required to understand the potential heart-friendly effects of Fo-ti.

Animal and Cellular Research (Lacking Evidence)

No clinical evidence supports the use of Fo-ti for any of the conditions listed in this section. Below is a summary of the existing animal and cell-based studies; they should guide further investigational efforts but should not be interpreted as supportive of any health benefit.

3) Anti-Inflammatory Effects

TSG and emodin in Fo-ti decreased inflammation and helped with colitis in mouse models by increasing PPAR-gamma and decreasing NF-kB [2, 3, 17].

In test tubes, a methanol extract of Fo-ti had an anti-inflammatory effect on the immune cells stimulated by bacterial toxins. It inhibited NF-kB activation and thus reduced nitric oxide, COX-2 enzyme, and inflammatory cytokines like TNF-alpha and IL-6 [18].

Emodin protects microglia cells in the brain from inflammation through AMPK/Nrf2 activation [19].

4) Immune-Stimulating Effects

Strengthening of the immune system is one of the traditional Fo-ti uses.

The sugars (rhamnose, arabinose, xylose, and glucose) and anthraquinone glycosides from Fo-ti have immune-stimulating properties [2].

In test tubes, scientists observed the potential of Fo-ti to stimulate the production and activity of T cells, B cells, and natural killer (NK) cells [20, 2].

5) Antimicrobial Effects

MRSA

Fo-ti had anti-bacterial activity against methicillin-resistant Staphylococcus aureus (MRSA) in one cell-based study [21].

Viruses

Fo-ti prevented the HIV virus from entering lymphocytes in a cell-based study [22].

Emodin blocked the binding of SARS coronavirus to human cells in test tubes [23].

6) Asthma

In a mouse model of asthma, researchers observed the ability of Fo-ti to reduce airway inflammation and constriction [24].

7) Bone Health

Hot water extract of Fo-ti prevented bone loss (osteopenia) in a study on menopausal mice [25].

TSG from Fo-ti extract protected the bone-making cells (osteoblasts) from oxidative stress in a cell-based study [26].

8) Diabetes Complications

TSG protected diabetic mice against kidney damage from high blood sugar through SIRT1 and TGF-beta pathways [27, 28].

In test tubes, stilbene glucoside from Fo-ti inhibited tissue aging due to high blood sugar [29].

9) Parkinson’s Disease

In mouse models of Parkinson’s Disease, TSG and an ethanol extract of Fo-ti protected dopaminergic neurons from chemical-induced damage [30, 31].

10) Brain Protection

Extracts of Fo-ti prevented brain tissue damage following a stroke in one study on mice [32].

In a cell-based study, Fo-ti protected neuronal cells from the hippocampus against high glutamate toxicity [33].

11) Metabolic Syndrome

Fo-ti, together with red ginseng, helped with metabolic syndrome in a study on rats by improving [34]:

12) Anticancer Effects

Scientists observed the potential of emodin from Fo-ti to suppress the growth of colon and gallbladder cancer in mice [35, 36].

Fo-ti components showed inhibitory effects against various types of cancer cells in test tubes, but this doesn’t reveal much about their potential anticancer effects in living beings [2, 37, 2].

Much more research is needed to evaluate the potential anticancer effects of Fo-ti. According to the available evidence, it can not be suggested as a complementary approach for cancer treatment or prevention.

13) Hair Growth

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

In a study on mice, P. multiflorum extracts promoted hair growth by stimulating hair follicles [38].

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 [39].

Fo-ti Side Effects and Toxicity

Keep in mind that the safety profile of Fo-ti is relatively unknown, given the lack of well-designed clinical studies. The list of side effects below is not a definite one, and you should consult your doctor about other potential side effects, based on your health condition and possible drug or supplement interactions.

Liver Toxicity

The best-known toxicity of P. multiflorum is liver or hepatotoxicity. Hepatotoxicity induced by P. multiflorum can be severe and leave permanent damage [40].

Multiple 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, 41, 42, 43].

The main chemicals responsible for the hepatotoxicity of P. multiflorum are free anthraquinones such as emodin and physcion [44].

The hepatotoxicity of the water extract is higher than that of the ethanol and acetone extracts of P. multiflorum. Processing may decrease hepatotoxicity, but the evidence is mixed [3, 2].

Kidney and Lung Toxicity

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

P. multiflorum may cause 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].

Fo-ti may have significant interactions with other drugs that are metabolized by the liver, anti-diabetes drugs, laxatives, and more. Make sure to consult your doctor before supplementing [45, 46, 47].

Other names for Polygonum multiflorum:

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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About the Author

Aleksa Ristic

Aleksa Ristic

MS (Pharmacy)
Aleksa received his MS in Pharmacy from the University of Belgrade, his master thesis focusing on protein sources in plant-based diets. 
Aleksa is passionate about herbal pharmacy, nutrition, and functional medicine. He found a way to merge his two biggest passions—writing and health—and use them for noble purposes. His mission is to bridge the gap between science and everyday life, helping readers improve their health and feel better.

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