Fo-ti (Polygonum multiflorum)

Category

Herbs & Supplements

Synonyms

Chinese climbing knotweed, Chinese cornbind, Chinese flowery knotweed, Chinese knotweed, fo ti, fo-ti-tient, fo-ti root, foti, he shou wu (Chinese), heshouwu (Chinese), ho shou wu (Chinese), Hoshouwu (Chinese), Multiflora preparata, multiflori, Polygonum, Polygonum multiflorum,radix polygoni, radix polygoni multiflori, radix Polygoni Shen Min, "red" fo-ti, Shen Min, Shou Wu, Shou-Wu, Shouwu, shou-wu-pian, shou xing bu zhi, "white" fo-ti, zhihe shou wu, Zhihe Shou Wu, Zhihe-Shou-Wu, zhiheshouwu, zi shou wu, Zi-Shou-Wu, zishouwu.

Note: No fo-ti is contained in the product Fo-ti-Tieng®.

Background

Fo-ti (Chinese name: he-shou-wu) is a plant native to China, where it continues to be widely grown. It also grows extensively in Japan and Taiwan. Fo-ti has a history of reversing and preventing the effects of aging.

Fo-ti is available in both unprocessed and processed forms. Unprocessed fo-ti (also known as "white" fo-ti because its color is usually much lighter than the processed form) is taken by mouth for its laxative effect. Topically (applied on the skin), unprocessed fo-ti is used to treat skin conditions such as acne, athlete's foot, dermatitis, razor burn, and scrapes. Processed fo-ti, also known as "red" fo-ti because it is much darker in color than the unprocessed variety, is used to prevent or delay heart disease by blocking the formation of plaque in blood vessels.

Currently, there are no high-quality human trials available supporting the use of fo-ti for any indication.

Evidence

DISCLAIMER: These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Tradition

WARNING: DISCLAIMER: The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.
Acne, anemia (low red blood cell count resulting in weakness, fatigue and paleness), angina pectoris (chest pain), antioxidant, atherosclerosis (hardening of the arteries), athlete's foot, autoimmune diseases, blood purification, cancer, carbuncles (clusters of boils on the skin), cerebral ischemia (inadequate blood flow to the brain), constipation, dermatitis, diabetes, dizziness (vertigo), energy, enhanced immune function, erectile dysfunction, hormone replacement therapy (HRT), hypercholesterolemia (high cholesterol), hypertension (high blood pressure), impotence (inability to develop or maintain an erection of the penis), infections, infertility, insomnia, itchiness, laxative, liver enlargement or disease, longevity/anti-aging, low back pain, memory (learning), muscle soreness, muscle strength, scrapes, skin eruptions, stomach disorders, tonic (liver, kidney), tuberculosis, vaginal discharge, weakness.

Dosing

Adults (over 18 years old):

There is no proven safe or effective dose for fo-ti. Capsules, dried herb preparations, teas and topical creams or ointments are all commercially available. Doses of 560 milligrams (capsules) 2-3 times a day, and 9-15 grams of the dried herb daily have been taken.

Children (under 18 years old):

There is no proven safe or effective dose for fo-ti in children.

Safety

DISCLAIMER: Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

Allergies

Avoid in individuals with a known allergy or hypersensitivity to unprocessed or processed forms of fo-ti.

Side Effects and Warnings

Although not well studied in humans, fo-ti has been taken daily as a tonic by millions of individuals with no known severe adverse effects. Although rare, skin rash may be a sign of hypersensitivity to both forms of fo-ti.

In some individuals, fo-ti may cause hepatitis. Avoid in patients with liver disease because it has been associated with hepatitis.

High doses of unprocessed fo-ti may also lead to hypokalemia (potassium deficiency), muscle weakness, numbness in the arms or legs, and hallucinations.

Use cautiously in patients with low iron levels. Theoretically, chronic use of anthraquinone laxatives may increase the risk for hypokalemia (potassium deficiency) and digoxin cardiotoxicity.

Unprocessed fo-ti may cause diarrhea, abdominal pain, nausea, and vomiting. Avoid unprocessed fo-ti in patients with diarrhea, intestinal obstruction, acute intestinal inflammation (Crohn's disease, ulcerative colitis, appendicitis), ulcer, abdominal pain of unknown origin, nausea, and vomiting due to the probable mechanism of it irritating the lining of the gastrointestinal tract. Although the irritation is minor for most individuals, it can worsen inflammatory bowel conditions.

Use cautiously in patients with constipation since anthraquinone compounds may lead to laxative dependency.

Pregnancy and Breastfeeding

Fo-ti is not recommended in pregnancy due to a lack of sufficient data. Breastfeeding women should also avoid fo-ti since it is known to enter breast milk. Taking it while breastfeeding may cause diarrhea in the infant(s).

Interactions

Interactions with Drugs

Fo-ti may lower blood sugar levels. Caution is advised when using medications that may also lower blood sugar. Patients taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.

Since fo-ti contains compounds that were found to inhibit the calcium channel, theoretically, it may produce a synergistic effect when taken with these drugs. The effect may be beneficial in some cases, but studies need to be done to further investigate this effect.

The possible effect of fo-ti in causing hypokalemia (potassium deficiency) may increase the risk of side effects from the use of digoxin. There are no documented cases of this interaction in the available literature.

The effects of potassium loss may be enhanced if diuretics are used with fo-ti. This may lead to worsening of the symptoms of hypokalemia (potassium deficiency). However, there are no reports available in literature.

Theoretically, fo-ti may interact with estrogen-containing drugs due to its estrogen content. Caution is advised in patients taking hormone replacement therapy or birth control pills.

Theoretically, concomitant use of fo-ti with other laxatives can increase the risk of fluid and electrolyte depletion.

Fo-ti may interfere with the way the body processes certain drugs using the liver's "cytochrome P450" enzyme system. As a result, the levels of these drugs may be increased in the blood, and may cause increased effects or potentially serious adverse reactions. Patients using any medications should check the package insert, and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.

Interactions with Herbs & Dietary Supplements

Theoretically, fo-ti may cause hypokalemia (potassium deficiency) and increase the risk of side effects from the use of herbs such as foxglove and oleander that contain cardiac glycosides that behave similarly to digoxin.

Fo-ti may act as a weak diuretic and may reduce potassium levels. Use of fo-ti with other diuretic herbs and supplements may lead to hypokalemia (potassium deficiency). However, there are no reports available in literature.

Theoretically, fo-ti may interact with estrogen-containing herbs and supplements due to its estrogen content.

Fo-ti may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.

Taking fo-ti with other laxative herbs such as alder buckhorn, aloe, cascara, rhubarb, senna, and yellow dock, may contribute additively to the laxative effects of fo-ti.

Licorice and fo-ti both have potassium-depleting properties and, theoretically, may increase the risk of hypokalemia (potassium deficiency).

Fo-ti may interfere with the way the body processes certain herbs or supplements using the liver's "cytochrome P450" enzyme system. As a result, the levels of other herbs or supplements may become too high in the blood. It may also alter the effects that other herbs or supplements possibly have on the P450 system.

Attribution

This information is based on a systematic review of scientific literature, and was peer-reviewed and edited by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): Erica Seamon, PharmD (Nova Southeastern University); Shaina Tanguay-Colucci, BS (Natural Standard Research Collaboration); Catherine Ulbricht, PharmD (Massachusetts General Hospital); Wendy Weissner, BA (Natural Standard Research Collaboration); Jen Woods, BS (Northeastern University); Sophanna K. Yong, PharmD (Massachusetts College of Pharmacy).

Bibliography

DISCLAIMER: Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

But PP, Tomlinson B, Lee KL. Hepatitis related to the Chinese medicine Shou-wu-pian manufactured from Polygonum multiflorum. Vet.Hum.Toxicol. 1996;38(4):280-282.

Chan YC, Wang MF, Chang HC. Polygonum multiflorum extracts improve cognitive performance in senescence accelerated mice. Am.J.Chin Med. 2003;31(2):171-179.

Chan YC, Wang MF, Chen YC, et al. Long-term administration of Polygonum multiflorum Thunb. reduces cerebral ischemia-induced infarct volume in gerbils. Am.J.Chin Med. 2003;31(1):71-77.

Chen J. [An experimental study on the anti-senility effects of shou xing bu zhi]. Zhong.Xi.Yi.Jie.He.Za Zhi. 1989;9(4):226-7, 198.

Horikawa, K., Mohri, T., Tanaka, Y., and Tokiwa, H. Moderate inhibition of mutagenicity and carcinogenicity of benzo[a]pyrene, 1,6-dinitropyrene and 3,9-dinitrofluoranthene by Chinese medicinal herbs. Mutagenesis 1994;9(6):523-526.

Liu C, Zhang Q, Lin J. [Effect of the root of Polygonum multiflorum Thunb. and its processed products on fat accumulation in the liver of mice]. Zhongguo Zhong.Yao Za Zhi. 1992;17(10):595-6, 639.

Mazzanti G, Battinelli L, Daniele C, et al. New case of acute hepatitis following the consumption of Shou Wu Pian, a Chinese herbal product derived from Polygonum multiflorum. Ann.Intern.Med. 4-6-2004;140(7):W30.

Oerter Klein K, Janfaza M, et al. Estrogen bioactivity in fo-ti and other herbs used for their estrogen-like effects as determined by a recombinant cell bioassay. J Clin Endocrinol.Metab 2003;88(9):4077-4079.

Park GJ, Mann SP, Ngu MC. Acute hepatitis induced by Shou-Wu-Pian, a herbal product derived from Polygonum multiflorum. J.Gastroenterol.Hepatol. 2001;16(1):115-117.

Unger M, Frank A. Simultaneous determination of the inhibitory potency of herbal extracts on the activity of six major cytochrome P450 enzymes using liquid chromatography/mass spectrometry and automated online extraction. Rapid Commun.Mass Spectrom. 2004;18(19):2273-2281.

Zhang CZ, Wang SX, Zhang Y, et al. In vitro estrogenic activities of Chinese medicinal plants traditionally used for the management of menopausal symptoms. J Ethnopharmacol 4-26-2005;98(3):295-300.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.