He Shou Wu (Polygonum Multiflorum) & Liver Health: What You Need to Know

Key Findings

The study identified Polygonum multiflorum (He Shou Wu) as a significant contributor to herbal and dietary supplement (HDS)-induced liver injury, accounting for 10–20% of cases across global case reports. Hepatotoxicity was most commonly associated with raw or improperly processed forms of the herb, with symptoms including jaundice, elevated liver enzymes (ALT, AST), and in severe cases, acute liver failure. The analysis emphasized that liver injury from HDSs, including Polygonum multiflorum, is often idiosyncratic and unpredictable, with no clear dose-response relationship in most cases.

Study Design

This was a systematic review and pooled analysis of case reports published up to 2022, sourced from PubMed and other databases. The methodology included qualitative synthesis of clinical data from individual cases and quantitative pooling where possible. The study did not specify a total sample size for Polygonum multiflorum but aggregated findings from multiple case reports across diverse populations. No controlled trials or longitudinal data were included, limiting causal inference.

Dosage & Administration

The study noted that Polygonum multiflorum was typically administered in raw or unprocessed forms (e.g., teas, powders, or capsules) rather than standardized extracts. Doses varied widely across case reports, with some patients consuming 5–10 g/day of raw herb and others using concentrated formulations. Administration duration ranged from acute exposure (≤1 week) to chronic use (months to years) before liver injury onset.

Results & Efficacy

The pooled analysis found that Polygonum multiflorum-induced liver injury occurred in both sexes, with a higher prevalence in middle-aged women (median age 45–60 years). Liver enzyme elevations were severe, with ALT levels exceeding 10× the upper limit of normal (ULN) in 60% of cases. Recovery occurred after discontinuation in most instances, but 10% of cases resulted in acute liver failure, requiring hospitalization. Statistical significance was not explicitly calculated for individual herbs due to heterogeneity in case reporting; however, the association was highlighted as clinically relevant based on frequency and causality assessments (e.g., Naranjo scores ≥6 indicating probable causality).

Limitations

1. Case report bias: Reliance on published case reports introduces selection and publication bias, as mild or unreported cases are excluded.
2. Lack of standardized dosing: Variability in formulations, dosages, and processing methods limited quantitative analysis.
3. Confounding factors: Many cases involved concomitant use of other supplements or medications, complicating attribution to Polygonum multiflorum alone.
4. No control group: As a review of single-case studies, causality cannot be definitively established.
5. Geographic skew: Most cases originated from China or Asian diaspora populations, limiting generalizability to other ethnic groups.

Clinical Relevance

The findings underscore that Polygonum multiflorum poses a non-negligible risk of hepatotoxicity, particularly when consumed in raw or unprocessed forms. Supplement users and clinicians should be aware that even herbs marketed as "natural" can cause severe liver damage, often within 1–3 months of initiation. Monitoring liver enzymes during use is advised, and products containing Polygonum multiflorum should be labeled with hepatotoxicity warnings. Regulatory agencies may need to enforce stricter processing standards (e.g., anthraquinone content limits) to mitigate risks. Patients presenting with unexplained liver injury should be questioned about HDS use, including traditional remedies like He Shou Wu.

Takeaway: While Polygonum multiflorum has traditional uses in Chinese medicine, this review highlights its association with liver injury, emphasizing the need for cautious, supervised consumption and further research into safe dosing and processing methods.