HeShouWu

He Shou Wu (Polygonum multiflorum) exerts its biological effects through multiple mechanisms, primarily attributed to its rich content of stilbenes (particularly 2,3,5,4′-tetrahydroxystilbene-2-O-β-D-glucoside, or TSG), anthraquinones (including emodin, physcion, and rhein), flavonoids, and other polyphenolic compounds. The primary mechanism underlying He Shou Wu’s anti-aging effects is its potent antioxidant activity. TSG and other stilbenes directly neutralize reactive oxygen species (ROS) and reactive nitrogen species (RNS), protecting cells from oxidative damage. This direct scavenging activity is complemented by He Shou Wu’s ability to enhance endogenous antioxidant defenses by increasing the activity and expression of antioxidant enzymes including superoxide dismutase (SOD), glutathione peroxidase (GPx), and catalase.

This occurs primarily through activation of the Nrf2 (Nuclear factor erythroid 2-related factor 2) pathway, a master regulator of cellular antioxidant responses. He Shou Wu demonstrates significant effects on hair growth and pigmentation through multiple pathways. It stimulates the proliferation of dermal papilla cells, which are crucial for hair follicle development and cycling. TSG has been shown to upregulate the expression of tyrosinase, the rate-limiting enzyme in melanin synthesis, thereby promoting hair pigmentation.

Additionally, He Shou Wu inhibits 5α-reductase activity, potentially reducing the conversion of testosterone to dihydrotestosterone (DHT), a hormone associated with androgenic alopecia. In the context of cardiovascular protection, He Shou Wu enhances endothelial function by increasing the production of nitric oxide (NO), a potent vasodilator. This occurs through multiple mechanisms, including increased expression and activity of endothelial nitric oxide synthase (eNOS) and protection of NO from degradation by free radicals. He Shou Wu also improves lipid metabolism, reducing total cholesterol and low-density lipoprotein (LDL) levels while increasing high-density lipoprotein (HDL) cholesterol.

This lipid-regulating effect is partially mediated through modulation of the expression of key enzymes involved in cholesterol metabolism, including HMG-CoA reductase and LDL receptor. For neuroprotection, He Shou Wu, particularly TSG, crosses the blood-brain barrier and exerts multiple beneficial effects. It protects neurons from apoptosis induced by various neurotoxins, including β-amyloid and glutamate, through inhibition of caspase activation and preservation of mitochondrial membrane potential. TSG also enhances the expression of neurotrophic factors, including brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF), which promote neuronal survival and differentiation.

Additionally, He Shou Wu modulates neurotransmitter systems, particularly dopamine and acetylcholine, which may contribute to its cognitive-enhancing effects. In the context of liver protection, He Shou Wu exhibits complex and sometimes paradoxical effects. While some studies suggest hepatoprotective properties through antioxidant mechanisms, others have identified potential hepatotoxicity, particularly with unprocessed roots and high doses. The traditional processing method (steaming with black bean juice) appears to reduce the content of potentially hepatotoxic compounds while preserving beneficial components.

For immune modulation, He Shou Wu exhibits bidirectional effects, enhancing immune function in immunocompromised states while suppressing excessive immune responses in inflammatory conditions. It increases the activity of natural killer (NK) cells and macrophages while modulating cytokine production, reducing pro-inflammatory cytokines such as TNF-α and IL-6 while increasing anti-inflammatory cytokines like IL-10. In reproductive health, He Shou Wu regulates the hypothalamic-pituitary-gonadal (HPG) axis, influencing the production of sex hormones. It increases testosterone levels in males by enhancing the expression of steroidogenic enzymes in the testes.

In females, it may modulate estrogen and progesterone levels, contributing to its traditional use for fertility enhancement. At the molecular level, He Shou Wu influences gene expression through epigenetic mechanisms, including modulation of microRNA expression and histone modifications. It affects cell signaling pathways involved in cell survival, proliferation, and differentiation, including MAPK, PI3K/Akt, and Wnt signaling. These diverse mechanisms work synergistically to produce He Shou Wu’s wide range of health benefits, from anti-aging and hair-darkening effects to cardiovascular protection and cognitive enhancement.

The optimal dosage of He Shou Wu varies significantly depending on the specific preparation (raw vs. processed), extraction method, and intended therapeutic purpose. In traditional Chinese medicine (TCM), the typical daily dosage of processed He Shou Wu (Zhi He Shou Wu) ranges from 9-15 grams when prepared as a decoction. Raw, unprocessed He Shou Wu is typically used at lower doses (3-9 grams) due to its stronger laxative effects and potential hepatotoxicity concerns.

For modern standardized extracts, the dosage is typically based on the content of active compounds, particularly 2,3,5,4′-tetrahydroxystilbene-2-O-β-D-glucoside (TSG). Standardized extracts containing 1-3% TSG are commonly used at dosages of 500-2,000 mg per day. For general health maintenance and preventive purposes, lower dosages (500-1,000 mg of standardized extract) are typically sufficient. For specific therapeutic applications, higher dosages (1,000-2,000 mg of standardized extract) may be more appropriate, though caution is warranted due to potential hepatotoxicity at higher doses.

The onset of effects varies by condition, with some acute effects (such as mild laxative action) observable within hours, while other benefits (such as hair darkening or cognitive enhancement) may require consistent supplementation for 3-6 months.

The bioavailability of He Shou Wu’s active compounds varies significantly based on their chemical structure, with the major bioactive components showing distinct absorption profiles. 2,3,5,4′-tetrahydroxystilbene-2-O-β-D-glucoside (TSG), the primary stilbene glycoside, demonstrates relatively limited oral bioavailability (approximately 2-5%) due to its large molecular size, high polarity, and susceptibility to degradation in the gastrointestinal tract. After oral administration, TSG undergoes extensive metabolism in the intestine and liver, with intestinal bacteria playing a crucial role in cleaving the sugar moiety to release the aglycone, which may then be absorbed more readily. Peak plasma concentrations of TSG typically occur 1-3 hours after oral administration, indicating relatively slow absorption.

Anthraquinones (including emodin, physcion, and rhein) generally show better bioavailability than TSG, with absorption rates estimated between 10-30%. These compounds are primarily absorbed in the large intestine after bacterial metabolism. Emodin, one of the major anthraquinones, reaches peak plasma concentrations approximately 2-4 hours after oral administration. The traditional processing method of steaming He Shou Wu with black bean juice (to produce ‘Zhi He Shou Wu’) appears to alter the chemical composition and potentially enhance the bioavailability of certain compounds while reducing others.

This processing reduces the content of anthraquinones (potentially reducing hepatotoxicity) while increasing the content of stilbene glycosides through chemical transformation. Despite the relatively low systemic bioavailability of many compounds, He Shou Wu demonstrates significant biological activity, suggesting several possible mechanisms: 1) The metabolites of the parent compounds, rather than the original molecules, may be responsible for many of the biological effects; 2) Local effects in the gastrointestinal tract may trigger systemic responses; 3) Small amounts of absorbed compounds may exert potent effects at their target tissues; 4) Cumulative effects with long-term administration may compensate for low single-dose bioavailability. The elimination half-life of TSG and its metabolites ranges from approximately 2-6 hours, while anthraquinones typically show longer half-lives of 8-12 hours. Excretion occurs primarily through the urine, with some elimination via the biliary route into feces.

Traditional processing with black bean juice (Zhi He Shou Wu) alters the chemical composition and may enhance the bioavailability of certain compounds, Consumption with a small amount of fat may improve the absorption of lipophilic components like anthraquinones, Micronization of He Shou Wu powder increases the surface area available for absorption, Standardized extracts with higher concentrations of active compounds may overcome the low bioavailability through dose effect, Fermentation by probiotic bacteria can pre-metabolize glycosides into more bioavailable forms, Liposomal formulations may enhance cellular uptake and improve systemic bioavailability, Combining with piperine (black pepper extract) may inhibit glucuronidation and increase bioavailability of certain compounds, Enteric-coated formulations can protect sensitive compounds from degradation in the stomach, Cyclodextrin complexation improves aqueous solubility while protecting compounds from degradation, Decoction with other herbs in traditional formulas may enhance extraction and absorption of active compounds

For optimal absorption and effectiveness, He Shou Wu supplementation should follow specific timing considerations. Taking He Shou Wu with meals, particularly those containing some fat, may enhance the absorption of lipophilic components like anthraquinones, though the water-soluble glycosides that constitute many of the active compounds may not be significantly affected by food intake. Morning administration is traditionally recommended in Chinese medicine for general tonic effects, aligning with the body’s natural energy cycle. This timing may be particularly appropriate for He Shou Wu’s energy-enhancing and anti-aging effects.

However, when using He Shou Wu primarily for its mild laxative properties (particularly the raw, unprocessed form), evening administration may be more practical and comfortable. For hair-darkening and growth-promoting effects, consistent daily timing is more important than specific time of day, as benefits accumulate with regular use over months. In traditional Chinese medicine, He Shou Wu is often taken as part of a decoction, which typically requires simmering the herbs for 30-60 minutes. These decoctions are usually consumed in divided doses throughout the day, often 30 minutes before meals.

For modern extract formulations, dividing the daily dose into two administrations (morning and evening) may provide more consistent levels of active compounds throughout the day, particularly for higher doses. When using He Shou Wu as part of a formula with other herbs, traditional Chinese medicine principles suggest specific preparation methods and timing based on the overall formula composition and therapeutic goal. Due to the potential for hepatotoxicity, particularly with higher doses or unprocessed He Shou Wu, some practitioners recommend cycling protocols (e.g., 3 weeks on, 1 week off) to reduce the risk of liver injury, though scientific evidence for this approach is limited. Consistency in daily administration is generally more important than precise timing for most of He Shou Wu’s health benefits, as many effects build cumulatively with regular use over time.

• Hepatotoxicity (liver injury) – ranging from mild elevation of liver enzymes to severe hepatitis and liver failure – uncommon but serious
• Gastrointestinal discomfort (diarrhea, abdominal pain, nausea) – common, particularly with raw/unprocessed He Shou Wu
• Skin rash or itching – uncommon
• Dizziness or headache – rare
• Numbness in extremities – rare
• Increased menstrual flow in women – uncommon

• Pre-existing liver disease or compromised liver function
• History of adverse reactions to He Shou Wu or other herbs containing anthraquinones
• Pregnancy and lactation (due to potential stimulating effects on the uterus and risk of hepatotoxicity)
• Diarrhea or loose stools (particularly for raw/unprocessed He Shou Wu)
• Concurrent use of hepatotoxic medications
• Bleeding disorders (due to potential anticoagulant effects)
• Hormone-sensitive conditions such as estrogen-receptor-positive breast cancer, endometriosis, or uterine fibroids (theoretical concern due to potential hormonal effects)
• Scheduled surgery (discontinue at least 2 weeks before due to theoretical anticoagulant effects)

• Hepatotoxic medications (increased risk of liver injury) – major concern
• Anticoagulant and antiplatelet medications (potential enhanced effect due to mild antiplatelet properties) – moderate concern
• Laxatives (additive effect with raw/unprocessed He Shou Wu) – moderate concern
• Diuretics (potential additive effect) – minor concern
• Antidiabetic medications (potential hypoglycemic effect) – minor concern
• Medications metabolized by cytochrome P450 enzymes, particularly CYP1A2, CYP2C9, CYP2D6, and CYP3A4 (potential inhibition or induction) – moderate concern
• Digoxin and other P-glycoprotein substrates (potential interference with transport) – moderate concern
• Hormone replacement therapy (potential interference with hormonal effects) – minor concern

He Shou Wu has been associated with numerous cases of hepatotoxicity (liver injury) reported worldwide, making safety considerations particularly important. The risk of hepatotoxicity appears to be dose-dependent, with higher doses carrying greater risk. Raw, unprocessed He Shou Wu (Sheng He Shou Wu) carries a significantly higher risk of hepatotoxicity compared to the processed form (Zhi He Shou Wu), which is traditionally prepared by steaming with black bean juice. This processing method reduces the content of potentially hepatotoxic compounds, particularly anthraquinones like emodin.

Based on traditional use and available research, the following safety considerations can be noted: For processed He Shou Wu (Zhi He Shou Wu), traditional dosages range from 9-15 grams daily as a decoction, with no reported significant toxicity at these levels when used appropriately for the correct conditions and in properly processed material. For modern standardized extracts, dosages up to 1,000 mg daily appear to have a reasonable safety profile in most individuals, though cases of hepatotoxicity have been reported even at this level. For raw, unprocessed He Shou Wu (Sheng He Shou Wu), traditional dosages are lower (3-9 grams daily) due to stronger purgative effects and higher risk of hepatotoxicity. Modern extracts of raw He Shou Wu should be used with extreme caution, if at all.

Based on the available evidence and the significant number of hepatotoxicity cases reported, a conservative upper limit for long-term daily consumption would be approximately 1,000 mg of standardized extract of processed He Shou Wu for most healthy adults. Higher doses should only be used under professional supervision with regular monitoring of liver function. Individuals with pre-existing liver conditions, those taking hepatotoxic medications, and those with a history of sensitivity to herbs containing anthraquinones should avoid He Shou Wu entirely. The exact compounds responsible for He Shou Wu’s hepatotoxicity remain under investigation.

While anthraquinones (particularly emodin) have been implicated, other compounds or combinations of compounds may also contribute. The mechanism appears to involve both direct hepatotoxicity and idiosyncratic reactions that may have a genetic component. Due to the unpredictable nature of He Shou Wu-induced liver injury, even individuals using moderate doses should be vigilant for symptoms of liver problems, including fatigue, jaundice, dark urine, light-colored stools, nausea, vomiting, and abdominal pain. Regular monitoring of liver function tests is advisable for those using He Shou Wu long-term, particularly at higher doses.

In the United States, He Shou Wu (Polygonum multiflorum) is regulated as a dietary supplement under the Dietary Supplement Health and Education Act (DSHEA) of 1994. As a dietary supplement ingredient, it is not subject to the same pre-market approval process as pharmaceuticals. Manufacturers are responsible for ensuring their products are safe before marketing and that product labels are truthful and not misleading. He Shou Wu does not have Generally Recognized as Safe (GRAS) status for use in conventional foods.

The FDA has not approved any specific health claims for He Shou Wu supplements. Any claims made must be limited to general structure/function claims rather than disease treatment claims. For example, manufacturers can claim that He Shou Wu ‘supports healthy hair’ but not that it ‘treats baldness.’ The FDA has not established a specific upper limit for He Shou Wu consumption. However, the FDA has issued safety alerts regarding the potential for liver injury associated with He Shou Wu products.

In 2014, the FDA included He Shou Wu in a list of ingredients that may cause liver injury in its guidance for the dietary supplement industry. While the FDA has not banned He Shou Wu, it has increased scrutiny of products containing this ingredient and has taken enforcement actions against companies making unsubstantiated health claims or failing to report adverse events associated with their products.

Eu: In the European Union, He Shou Wu is not included in the list of approved novel foods or food supplements under Regulation (EC) No 258/97 or Regulation (EU) 2015/2283. This means that its regulatory status varies by member state, with some countries permitting its use in food supplements and others restricting it. The European Food Safety Authority (EFSA) has not evaluated or approved any health claims for He Shou Wu. In some EU countries, He Shou Wu may be available as a traditional herbal medicinal product under Directive 2004/24/EC, which provides a simplified registration procedure for traditional herbal medicinal products with a long history of use. However, specific approved products vary by country. Due to safety concerns, particularly regarding hepatotoxicity, several EU member states have implemented specific warnings or restrictions on He Shou Wu products.

China: In China, He Shou Wu (He Shou Wu) is officially recognized as a medicinal herb in the Chinese Pharmacopoeia. Both raw (Sheng He Shou Wu) and processed (Zhi He Shou Wu) forms are listed as official medicinal materials, with different indications and dosage recommendations. As a traditional Chinese medicine, it is approved for use in various formulations and preparations for treating conditions such as premature graying of hair, weakness, constipation, and hyperlipidemia. The China Food and Drug Administration (now National Medical Products Administration) regulates He Shou Wu-containing products as traditional Chinese medicines rather than as food supplements. In recent years, the Chinese regulatory authorities have increased warnings about the potential hepatotoxicity of He Shou Wu, requiring stronger labeling and emphasizing the importance of proper processing to reduce toxicity.

Australia: The Therapeutic Goods Administration (TGA) in Australia has issued specific warnings about the potential hepatotoxicity of He Shou Wu. While it is not banned, products containing He Shou Wu are subject to increased scrutiny. He Shou Wu-containing products may be listed on the Australian Register of Therapeutic Goods (ARTG) as AUST L products if they meet quality and safety standards, but they must carry appropriate warnings about potential liver injury. The TGA has not approved specific health claims for He Shou Wu beyond general health maintenance claims. The TGA has not established a specific upper limit for He Shou Wu consumption but generally recommends that it be used under professional guidance.

Canada: Health Canada regulates He Shou Wu as a Natural Health Product (NHP). It may be issued a Natural Product Number (NPN) if the product meets the requirements for safety, efficacy, and quality. Health Canada has approved certain claims for He Shou Wu, primarily related to its traditional use in Chinese medicine for blood nourishment and hair health. These approved claims are more specific than those allowed in the United States. Health Canada has issued safety alerts regarding the potential for liver injury associated with He Shou Wu products and requires appropriate warning statements on product labels. Health Canada has not established a specific upper limit for He Shou Wu consumption but generally recommends doses consistent with traditional use.

Japan: In Japan, He Shou Wu may be regulated as a non-pharmaceutical ingredient that can be used in foods with health claims under the Foods for Specified Health Uses (FOSHU) or Foods with Function Claims (FFC) systems, depending on the available evidence for its effects. Some He Shou Wu products may be marketed as ‘Kampo’ medicines (traditional herbal medicines), which have a separate regulatory pathway in Japan. The Japanese Ministry of Health, Labour and Welfare has issued safety alerts regarding the potential for liver injury associated with He Shou Wu products. The Japanese Ministry of Health, Labour and Welfare has not established a specific upper limit for He Shou Wu consumption.

Moderate to High

He Shou Wu supplements vary significantly in cost depending on several factors, including processing method (raw vs. processed), extraction method, standardization level, and brand reputation. Raw He Shou Wu herb for traditional decoction typically costs $15-30 per pound, translating to approximately $0.50-2.00 per daily dose (3-15 grams). Processed He Shou Wu (Zhi He Shou Wu) typically commands a higher price, ranging from $20-45 per pound, or approximately $0.75-3.00 per daily dose.

Standardized extracts in capsule or tablet form range from $0.50 to $2.50 per day for an effective dose (500-1,500 mg of extract standardized to 1-3% 2,3,5,4′-tetrahydroxystilbene-2-O-β-D-glucoside). Premium products from established brands, particularly those with higher standardization levels or additional testing for purity and safety, may cost $2-4 per day. The higher cost of quality He Shou Wu products is primarily due to several factors: the relatively slow growth rate (3-4 years to reach optimal harvest size), the labor-intensive traditional processing method (steaming with black bean juice), the complex extraction and standardization processes required to concentrate active compounds while reducing potentially toxic ones, and the increasing demand coupled with concerns about sustainable harvesting of wild populations.

The value proposition of He Shou Wu varies significantly depending on the specific health application, product quality, and individual factors. For hair health (darkening and growth), He Shou Wu offers moderate value despite its higher cost, with traditional use and some preliminary studies supporting its effects at doses of 1,000-1,500 mg of standardized extract daily for 3-6 months. However, results are highly variable between individuals, and the long duration required for noticeable effects increases the overall cost. For hyperlipidemia, He Shou Wu provides moderate value, with clinical studies showing improvements in lipid profiles at doses of 1,000-2,000 mg daily for 8-12 weeks.

These effects are comparable to some other natural approaches but generally less potent than pharmaceutical interventions. The potential for hepatotoxicity also reduces the overall value proposition for this application. For cognitive health, He Shou Wu offers potential value based on preliminary research, but the evidence is not yet strong enough to justify the cost for most individuals. More research is needed to establish optimal dosing and confirm efficacy for this application.

For general anti-aging and longevity purposes, the value assessment is highly subjective and depends on individual priorities. The traditional reputation and preliminary research on antioxidant and anti-inflammatory effects provide some basis for these applications, but concrete outcomes are difficult to measure and may take years to manifest. When comparing He Shou Wu to other herbs with similar traditional uses, such as Goji berry or Astragalus, He Shou Wu is generally more expensive and carries greater safety concerns, potentially offering lower overall value unless specifically targeting its unique properties for hair health. The value proposition is significantly enhanced when using properly processed He Shou Wu (Zhi He Shou Wu) rather than raw/unprocessed forms, as the processing reduces toxicity risks while preserving most beneficial effects.

For cost-conscious consumers, starting with lower effective doses (500 mg daily of standardized extract) and gradually increasing if needed may optimize the cost-benefit ratio. Additionally, using He Shou Wu cyclically (e.g., 3 weeks on, 1 week off) rather than continuously may extend its value while potentially reducing hepatotoxicity risks. Overall, while He Shou Wu is moderately expensive compared to many other herbal supplements and carries unique safety concerns, its specific benefits for certain conditions (particularly hair health) may provide reasonable value for those specifically seeking these effects, provided that quality products with proper processing and safety testing are selected.

The shelf life of He Shou Wu products varies significantly depending on the preparation method, processing, storage conditions, and specific formulation. Dried, raw He Shou Wu roots, when properly stored, typically maintain their quality for 3-5 years according to traditional Chinese medicine practices. Processed He Shou Wu (Zhi He Shou Wu) may have a slightly shorter shelf life of 2-3 years due to the processing with black bean juice, which introduces additional compounds that may be subject to degradation. Modern standardized extracts in powder form generally have a shelf life of 2-3 years when stored properly in sealed containers.

Encapsulated or tablet forms of He Shou Wu extracts typically maintain stability for 2-3 years, with manufacturers often providing a buffer period in their expiration dating to ensure potency throughout the labeled shelf life. Liquid extracts and tinctures generally have shorter shelf lives (1-2 years) due to increased exposure to oxygen and potential microbial growth, even with preservatives. Traditional decoctions should be consumed within 1-2 days, even when refrigerated, as they lack preservatives and are highly susceptible to microbial contamination. Stability studies have shown that the stilbene glycoside content, particularly 2,3,5,4′-tetrahydroxystilbene-2-O-β-D-glucoside (TSG), may decrease by approximately 10-15% per year under typical storage conditions, with higher degradation rates in environments with elevated temperature, humidity, or light exposure.

The anthraquinone components (including emodin and physcion) tend to be more stable than the stilbene glycosides, maintaining their structural integrity for longer periods under proper storage conditions. Interestingly, some research suggests that certain degradation products of TSG may retain biological activity, meaning that even with some chemical changes over time, the product may maintain some efficacy beyond the optimal shelf life.

Store He Shou Wu products in their original containers with lids tightly closed to protect from moisture, oxygen exposure, and light. Keep in a cool, dry place away from direct sunlight and heat sources. The optimal temperature range is 59-77°F (15-25°C), with relative humidity below 60%. Avoid storing in bathrooms, kitchens, or other areas with fluctuating temperatures and high humidity.

Refrigeration is not necessary for dried herb or extract powders and may actually introduce moisture through condensation when the container is opened. However, liquid extracts may benefit from refrigeration after opening to slow microbial growth and enzymatic degradation. Protect from light by keeping in the original opaque container, as extended exposure to light can accelerate degradation of stilbene glycosides and other active compounds. Minimize exposure to air by keeping the container closed when not in use and avoiding transferring to different containers unless necessary.

If transferring is required, use an airtight, opaque container. For bulk powders, use a clean, dry utensil to remove the product and reseal the container immediately after use to minimize exposure to air and moisture. Traditional Chinese medicine practitioners recommend storing dried He Shou Wu roots in breathable paper bags or cotton pouches rather than plastic containers, which may trap moisture and promote mold growth. For processed He Shou Wu (Zhi He Shou Wu), which has been steamed with black bean juice, extra care should be taken to prevent moisture absorption, as the processing may make it more hygroscopic than the raw form.

If the product changes color significantly (becoming much darker), develops an unusual odor, or shows visible signs of mold or degradation, it should be discarded regardless of the expiration date.

Exposure to oxygen (oxidation is a primary degradation pathway for stilbene glycosides), Exposure to light, particularly UV light, which accelerates oxidation reactions, High temperatures (above 86°F/30°C) significantly accelerate degradation, High humidity, which can promote hydrolysis of glycosidic bonds and microbial growth, Enzymatic degradation due to residual plant enzymes or microbial contamination, Extreme pH conditions (either highly acidic or alkaline), Presence of metal ions, particularly iron and copper, which catalyze oxidation reactions, Microbial contamination, particularly in liquid formulations or products with high moisture content, Freeze-thaw cycles, which can affect the physical stability of some formulations, Chemical interactions with other compounds in complex formulations, Prolonged exposure to air after opening the container, Improper drying of raw material, leading to residual moisture and accelerated degradation

Synthesis Methods

Natural Sources

Quality Considerations

He Shou Wu (Polygonum multiflorum) has a rich history in traditional Chinese medicine spanning over 2,000 years. Its name, which translates to ‘Black-haired Mr. He,’ derives from a legendary tale of an elderly man named He who restored his youth, vitality, and black hair by consuming this herb. This story, while likely apocryphal, reflects the herb’s traditional reputation for promoting longevity and reversing signs of aging.

The first documented medicinal use of He Shou Wu appears in the Shen Nong Ben Cao Jing (Divine Farmer’s Materia Medica), compiled around 200 CE, where it was classified as a superior tonic herb that could be taken long-term without toxicity. In this foundational text, He Shou Wu was described as having a bitter, sweet, and astringent taste, with a slightly warming nature, entering the liver and kidney meridians. It was recommended for strengthening the tendons and bones, tonifying the blood and essence, blackening the hair, and extending lifespan. During the Tang Dynasty (618-907 CE), the famous physician Sun Simiao further elaborated on He Shou Wu’s properties in his work ‘Thousand Golden Prescriptions’ (Qian Jin Yao Fang), emphasizing its value for treating premature aging, hair loss, and weakness.

By the Ming Dynasty (1368-1644 CE), Li Shizhen’s monumental ‘Compendium of Materia Medica’ (Ben Cao Gang Mu) provided detailed descriptions of He Shou Wu’s appearance, habitat, harvesting methods, and medicinal applications. Li Shizhen also documented the traditional processing method of steaming the roots with black bean juice, which was believed to enhance its blood-tonifying properties while reducing its harsh laxative effects. This processing method remains standard practice today and is now known to reduce potential hepatotoxicity. Throughout Chinese history, He Shou Wu was often included in formulas for the emperor and nobility, valued for its purported life-extending and vitality-enhancing properties.

It was frequently combined with other tonic herbs like Rehmannia, Goji berry, and Dang Gui in classical formulas such as ‘Shou Wu Wan’ (He Shou Wu Pills) and ‘Qi Bao Mei Ran Dan’ (Seven Treasures for Beautiful Whiskers Pill). Beyond China, He Shou Wu was also incorporated into traditional medicine systems in other East Asian countries, including Japan (where it is known as Kazensokou), Korea (Hasuo), and Vietnam (Hà thủ ô). In these traditions, it was similarly valued for its blood-tonifying, anti-aging, and hair-darkening properties. In the modern era, He Shou Wu gained popularity in Western countries in the late 20th century, initially through Chinese immigrant communities and later through the broader natural health movement.

It became particularly known for its purported benefits for hair health and as an anti-aging tonic. However, this period also saw the emergence of concerns about potential hepatotoxicity, with numerous case reports of liver injury associated with He Shou Wu consumption appearing in medical literature from the 1990s onward. These safety concerns have led to increased regulatory scrutiny in many countries and a greater emphasis on proper processing and quality control. Today, while He Shou Wu remains an important herb in traditional Chinese medicine practice, it is increasingly being studied through modern scientific methods to validate its traditional uses, understand its mechanisms of action, and address safety concerns.

The traditional processing method (steaming with black bean juice) has been shown to reduce the content of potentially hepatotoxic compounds, aligning ancient wisdom with modern safety considerations. Contemporary research focuses particularly on its active compounds, especially 2,3,5,4′-tetrahydroxystilbene-2-O-β-D-glucoside (TSG), and their potential applications in conditions ranging from hyperlipidemia to neurodegenerative diseases.

No comprehensive meta-analyses specifically focused on He Shou Wu supplementation are currently available. The limited number of high-quality clinical studies and their heterogeneity in terms of preparations, dosages, and outcome measures makes meta-analysis challenging., Dong H, et al. Eighteen cases of liver injury following ingestion of Polygonum multiflorum. Complementary Therapies in Medicine. 2014;22(1):70-74. This review analyzed 18 cases of liver injury associated with He Shou Wu, finding that both raw and processed forms can cause hepatotoxicity, with onset typically within 1 month of starting the herb. The authors concluded that He Shou Wu should be used with caution and that liver function should be monitored during treatment., Jung KA, et al. Drug-induced liver injury: Twenty five cases of acute hepatitis following ingestion of Polygonum multiflorum Thunb. Gut and Liver. 2011;5(4):493-499. This case series analyzed 25 patients with liver injury associated with He Shou Wu, finding that the pattern of injury was predominantly hepatocellular and that most patients recovered after discontinuation of the herb. The authors emphasized the importance of recognizing He Shou Wu as a potential cause of liver injury.

Note: As of 2024, there are very few registered clinical trials specifically investigating He Shou Wu for health purposes. Most research remains at the preclinical stage or involves traditional medicine practices rather than controlled clinical trials., Investigation of the Hepatoprotective Effects of Modified He Shou Wu Preparations (hypothetical – no actual registered trial), Evaluation of 2,3,5,4′-tetrahydroxystilbene-2-O-β-D-glucoside for Mild Cognitive Impairment (hypothetical – no actual registered trial), Comparative Study of Raw versus Processed He Shou Wu on Lipid Profiles (hypothetical – no actual registered trial), Safety Monitoring Protocol for Long-term He Shou Wu Administration (hypothetical – no actual registered trial)