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Limited evidenceLongevity & antioxidants

He Shou Wu (Fo-Ti)

He shou wu (Polygonum/Reynoutria multiflora) is sold for hair regrowth and longevity on the strength of a folk legend, not clinical trials. It is one of the best-documented causes of herb-induced liver injury worldwide, has triggered regulatory action in several countries, and we do not consider the risk-benefit balance favorable.

What the science says

  • Causes idiosyncratic, immune-mediated liver injury — this is the main thing to know Strong evidence

    He shou wu is among the most frequently implicated single herbs in herb-induced liver injury (HILI) case series from China, and cases are also reported from Europe, North America, Korea and Australia. Injury is typically hepatocellular, appears after weeks to months of use, and mechanistic work shows an immune-mediated idiosyncratic pattern linked to the HLA-B*35:01 allele plus the stilbene glycoside TSG and its metabolites. Most patients recover after stopping, but acute liver failure, transplant and death have occurred.

  • No controlled human evidence that it restores hair color or reverses graying Limited evidence

    The flagship claim — that he shou wu returns gray hair to black — traces to a Tang dynasty legend, not data. There is no placebo-controlled trial measuring hair pigmentation, hair density, or hair growth in humans. Some in vitro work shows effects on melanocyte and dermal papilla cells, which is many steps short of a human result.

  • Anti-aging and cholesterol claims are preclinical only Limited evidence

    Rodent and cell studies report antioxidant, anti-atherosclerotic and neuroprotective effects of TSG and anthraquinones. No adequately controlled human trial has shown he shou wu lowers LDL, improves cognition, or extends any measurable aging biomarker in people.

Dosage & safety

Studied doseTraditional use is 9-15 g/day of the processed (steamed, black-bean-prepared) root in decoction; raw root is used at lower doses as a laxative. Western capsules typically supply 500-1,000 mg of root powder or extract. Because there is no demonstrated benefit and a documented hepatotoxicity signal, we do not recommend a dose. Note that raw and processed forms differ substantially in TSG and anthraquinone content, and product labels frequently do not specify which was used.
SafetyHepatotoxicity is the dominant concern: dozens of published cases, some fatal or requiring transplant, with a recognized immune-mediated idiosyncratic mechanism and an HLA-B*35:01 genetic risk factor. The UK MHRA and health authorities in Australia, Canada, Japan and China have issued warnings or restrictions; China requires liver-injury labeling. Raw (unprocessed) root contains anthraquinones and causes cramping and diarrhea. Avoid entirely if you have any liver disease, are on hepatotoxic medications, or drink heavily. Anyone using it should have baseline and periodic liver enzymes and stop immediately at the first sign of fatigue, nausea, dark urine, right upper quadrant pain, or jaundice. Avoid in pregnancy and breastfeeding.

How to take it

TimingNo timing is worth recommending given the liver-injury signal and the absence of demonstrated benefit.
With food?With food.
Worth knowingIf you use it anyway, get liver enzymes at baseline and stop at the first sign of fatigue, nausea, dark urine, right-upper-quadrant pain or jaundice.

Interactions

With medications

  • medications that stress the liver (methotrexate, isoniazid, statins, regular high-dose paracetamol/acetaminophen)

    He shou wu causes idiosyncratic liver injury on its own; another hepatic stressor makes injury more likely and harder to attribute. do not combine, and avoid it entirely if you have any liver disease

With other supplements

  • other botanicals with hepatotoxicity signals (green tea extract, kava, garcinia)

    Stacking liver-risk herbs multiplies the chance of injury. avoid combining them

Well-established interactions only — this is not a complete list. Always tell your doctor and pharmacist what you take.

Frequently asked questions

Is he shou wu (fo-ti) safe?

He shou wu is one of the best-documented causes of herb-induced liver injury worldwide (strong evidence): injury typically appears after weeks to months of use and has led to acute liver failure, transplant and death. Health authorities in the UK, Australia, Canada, Japan and China have issued warnings or restrictions, and supp.science does not consider its risk-benefit balance favorable.

Does he shou wu reverse grey hair?

No placebo-controlled human trial has shown he shou wu restores hair color or reverses greying (limited evidence); the claim traces to a Tang dynasty legend. Some cell studies show effects on hair-related cells, which is many steps short of a human result.

What are the warning signs of liver damage from he shou wu?

Stop he shou wu immediately at the first sign of fatigue, nausea, dark urine, right upper quadrant pain or jaundice. Anyone using it should have liver enzymes checked at baseline and periodically, and should avoid it entirely with liver disease, heavy drinking or liver-stressing medications.

Does fo-ti lower cholesterol or slow aging?

He shou wu's anti-aging and cholesterol claims are preclinical only (limited evidence): no adequately controlled human trial has shown it lowers LDL, improves cognition or changes any aging biomarker. Given its liver-injury signal, there is no dose we recommend.

Scientific references

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