He Shou Wu (Fleeceflower Root, Ho Shou Wu, Polygonum)

Chinese Herb Actions

Chinese Herb Dosage

• What is the typical dosage of He Shou Wu?

  9–30 g in decoction. The owner’s notes give roughly 3–10 qian (mace), i.e. about 9–30 g, and advise a longer cook when a stronger tonifying (prepared-root) effect is wanted. The raw root is more laxative, so lower amounts are typical when only the intestine-moistening or toxin-resolving action is intended.

  Source: owner’s Five Branches notes; standard materia medica ranges. Reference only — not a prescription, and see Toxicity below regarding duration.

Chinese Herb Contraindications & Cautions

• Are there cautions or contraindications for He Shou Wu?

  Use with care in Spleen deficiency with dampness, loose stools, or diarrhea, and in phlegm-damp patterns — the raw root in particular is laxative and can loosen the stool. The classical dietary caution is to avoid taking it with garlic, onions, and chives.

  Most importantly, He Shou Wu carries a documented idiosyncratic liver-injury signal (see Toxicity and Drug interactions). As a reference point for clinicians, prolonged or high-dose use — especially of the raw form — and concurrent use with other liver-stressing agents warrant caution and liver-function monitoring.

  Source: owner’s Five Branches notes (contraindications: Spleen deficiency, damp diarrhea; dietary incompatibilities); modern pharmacovigilance (cited under Toxicity).

Chinese Herb Toxicity & Overdose

• He Shou Wu has a well-documented idiosyncratic drug-induced liver injury (DILI) signal — this is a critical safety reference fact, not a usage instruction. The US NIH LiverTox monograph rates it a Likelihood Category A agent (a “well established cause of clinically apparent liver injury”), describing injury that is typically hepatocellular or mixed, resembling acute hepatitis, and immune-mediated; the HLA-B*35:01 allele is a major reported risk factor, and in China it is reported as the most common cause of herbal-product-related liver injury.

  A systematic review of 450 cases across 76 articles found a “dose-time-toxicity” relationship: median onset about 30 days after starting the herb (range 1–240 days), sooner at daily doses above ~12 g; most patients recovered after stopping, but a small number progressed to transplantation or death. Regulators in several countries — including the UK (MHRA) and Australia (TGA) — have issued public warnings about liver reactions linked to Polygonum multiflorum products.

  Discrepancy (flagged): Most reviews hold that processing (the prepared root) reduces hepatotoxic risk relative to the raw root; however, the LiverTox monograph notes injury has been reported with both forms and does not sharply differentiate them. We present the raw > prepared risk pattern as the weight-of-evidence view while flagging that idiosyncratic injury can occur with either.

  Sources: LiverTox (NCBI Bookshelf NBK548795); Lei et al., Evid Based Complement Alternat Med 2015 (PMID 25648693; systematic review, 450 cases); Wang et al., Front Pharmacol 2019 (10.3389/fphar.2019.01467). Reference fact; not medical advice.

• This herb is considered slightly toxic.
  (while some Chinese herbs are toxic, it must be noted that many come prepared, or are combined, to mitigate their toxicity)

Herb-Drug Interactions

• The principal documented concern is additive liver stress: He Shou Wu should not be stacked with other hepatotoxic agents. Because its injury signal is idiosyncratic and immune-mediated (see Toxicity), the reference-level caution is to avoid concurrent use with drugs and substances that also burden the liver — for example acetaminophen (paracetamol), statins, methotrexate, isoniazid, azole antifungals, and alcohol — and to monitor liver function during use.

  No large, well-characterized pharmacokinetic herb–drug interaction dataset exists beyond this hepatic-safety signal; anthraquinone constituents are laxative, so effects may compound other stimulant laxatives. (Flagged for practitioner confirmation — absence of catalogued interactions is not proof of safety.)

  Sources: LiverTox (NCBI Bookshelf NBK548795); Lei et al. 2015 (PMID 25648693). Clinical reference framing; not a prescription or medical advice.

Western / Biomedical Research

Chinese Herb Clinical Studies & Research

Provided as research context — a summary of published biomedical study, not a therapeutic or medical claim.

• What does modern research say about He Shou Wu (Polygonum multiflorum)?

  Research centers on two constituent groups: the stilbene glucoside TSG (2,3,5,4′-tetrahydroxystilbene-2-O-β-D-glucoside) and the anthraquinones (emodin, rhein, physcion, chrysophanol). TSG is the most-studied marker and shows antioxidant, neuroprotective and lipid-modulating activity in preclinical (cell and animal) models; human clinical evidence remains limited.

  Importantly, the same chemistry underlies the liver signal: reviews implicate the anthraquinones and a cis-isomer of the stilbene glucoside (cis-SG) in the idiosyncratic hepatotoxicity, the latter shown to trigger immune-mediated liver injury via PPAR-γ suppression in a rat model. Processing (black-soybean preparation) alters this constituent profile and is generally reported to lower toxicity, consistent with the traditional raw-vs-prepared distinction.

  Discrepancy (flagged): The plant’s botanical name is unsettled across sources — historically Polygonum multiflorum Thunb. (as in our Sacred Lotus’s Radix Polygoni Multiflori), reassigned by some taxonomists to Fallopia multiflora or Reynoutria multiflora. These refer to the same species; we retain the pharmacopeial Polygonum naming and note the synonyms.

  Sources: Lin et al., J Ethnopharmacol 2015 (PMID 25449462, phytochemistry/pharmacology/toxicology review); Wang et al., Acta Pharmacol Sin 2017 (cis-SG immunological idiosyncratic hepatotoxicity, 10.1038/aps.2017.32). Research context, not a therapeutic claim.

Chinese Herb Notes

• How does prepared He Shou Wu differ from the raw root, from Shu Di Huang, and from Ye Jiao Teng?

  Prepared He Shou Wu is the blood-and-essence tonic; the raw root moistens the intestines and resolves toxicity; and Ye Jiao Teng, though from the same plant, is a different part with different actions. Processing with black soybean shifts the raw, moving, toxin-resolving root into a warm, astringent Liver–Kidney tonic.

  Key comparisons from the notes:

  • vs Shu Di Huang — both nourish blood and essence, but He Shou Wu tonifies more toward the Liver and is not cloying, whereas Shu Di Huang tonifies the Kidney and is greasy/cloying; E Jiao is more moistening still and is preferred for blood deficiency with active blood loss.
  • vs Ye Jiao Teng — Ye Jiao Teng (Caulis Polygoni Multiflori) is the vine/stem of the same plant, a distinct medicinal that calms the shen, nourishes Heart blood, and unblocks the channels for insomnia and painful obstruction — it is not interchangeable with the root.

  Common combinations: it is the lead herb in He Ren Yin and in Qi Bao Mei Ran Dan (Seven-Treasure Special Pill for Beautiful Whiskers), the classic prepared-He-Shou-Wu formula for premature graying and Liver–Kidney/blood deficiency.

  Source: owner’s Five Branches notes (comparative set & formulas); current Sacred Lotus (formula appearances).

This herb is considered toxic