Polygonum Multiflorum & Liver Health: What You Need to Know

systematic-review PMID: 30639232

Quick Summary: Research suggests that the herb Polygonum multiflorum is linked to liver problems. This review of existing studies found it was one of the most common herbs associated with liver injury, especially in women.

What The Research Found

This study looked at many other studies to understand how herbs can affect the liver. It found that Polygonum multiflorum was one of the top herbs linked to liver injury. The study also showed:

More Women Affected: Liver injury from herbs was more common in women than men.

Liver Damage Type: Herbal liver injury was more likely to cause a specific type of liver damage called hepatocellular injury.

Study Details

Who was studied: The researchers looked at data from 7,511 cases of liver injury.

How long: The study reviewed 31 different studies.

What they took: The study did not specify dosages of Polygonum multiflorum. It looked at cases where people had liver problems and were also using herbs.

What This Means For You

Be Careful with Herbs: If you're taking Polygonum multiflorum or products containing it, be aware of the potential risk to your liver.

Talk to Your Doctor: Discuss any herbal supplements you're taking with your doctor, especially if you have liver problems or take other medications.

Watch for Symptoms: If you experience symptoms like yellowing of the skin or eyes (jaundice), dark urine, or abdominal pain while taking herbs, see a doctor immediately.

Study Limitations

Not a Perfect Picture: The study looked at many different studies, so the information wasn't always consistent.

Other Factors: It can be hard to know for sure if the herb caused the liver problem, as people may have been taking other medications or herbs at the same time.

Dosage Unknown: The study didn't provide specific information on how much Polygonum multiflorum people were taking.

Key Findings

This systematic review identified Polygonum multiflorum as one of the top four herbs associated with herb-induced liver injury (HILI), accounting for 25.0% (1,874/7,511) of all liver injury cases analyzed. HILI showed a stronger female predominance (69.8%) compared to drug-induced liver injury (DILI) (57.3%, p < 0.01). Herbal injuries were more likely to cause hepatocellular damage (78.8%) versus cholestatic (8.9%) or mixed (12.3%) types, contrasting with DILI (56.7% hepatocellular, p < 0.01).

Study Design

A systematic review of 31 studies (9 prospective, 22 retrospective) from PubMed, Cochrane, and Embase databases. The analysis included 7,511 total liver injury cases (2,819 males, 3,669 females, 1,023 unknown). Studies were categorized by causality (herbs, drugs, or mixed), and clinical features (e.g., injury type, demographics) were compared.

Dosage & Administration

The review did not analyze specific dosages or administration methods of Polygonum multiflorum, as it aggregated data from heterogeneous studies. Most included studies likely relied on self-reported herb use or case reports, limiting detailed pharmacological insights.

Results & Efficacy

HILI prevalence: 25.0% of liver injury cases (1,874/7,511).
Gender disparity: HILI occurred in 69.8% females vs. 30.2% males (p < 0.01 vs. DILI).
Injury type: HILI predominantly hepatocellular (78.8%), compared to DILI (56.7% hepatocellular, p < 0.01).
Top hepatotoxic herbs: Polygonum multiflorum, Psoralea corylifolia, Corydalis yanhusuo, and Rheum officinale.

Limitations

Heterogeneity: Retrospective studies (n=22) may lack standardized causality assessments.
Bias risk: Publication bias (positive results overreported) and underrepresentation of mild HILI cases.
Causality challenges: Concomitant drug/herb use in some studies complicates attribution.
No dose-response analysis: Lack of dosage data limits understanding of toxicity thresholds.
Geographic focus: Likely skewed toward regions with higher herb usage (e.g., Asia).

Clinical Relevance

This review highlights Polygonum multiflorum as a significant contributor to HILI, particularly in females. Supplement users should be aware of potential hepatotoxicity and prioritize medical supervision, especially for prolonged or high-dose use. Clinicians are advised to consider herbal causes in liver injury cases and monitor liver enzymes in patients using traditional medicines. The findings underscore the need for robust pharmacovigilance systems to track herbal safety, as HILI differs mechanistically and epidemiologically from DILI.

Takeaway: While not establishing causality, this study provides critical evidence for risk awareness and regulatory oversight of Polygonum multiflorum and related herbs.