Fo-ti

Generic name: Fallopia Multiflora, Polygonum Multiflorum Thunb.
Brand names: Chinese Cornbind, Climbing Knotweed, Flowery Knotweed, Fo-ti, He Shou Wu, Radix Polygoni Multiflori, Shou Wu Pian, Tuber Fleeceflower

Usage of Fo-ti

Extracts of P. multiflorum are commonly used in combination with other herbs (including Buyangahuanw Pill Jiajian Fang and Qishu decoction), rather than alone.(Duke 1992) Clinical trials reporting on efficacy are limited.(Khan 2010)

Anti-aging effects

Purported anti-aging effects mostly rely on in vitro studies of antioxidant and neuroprotective effects.(Lin 2015)

Animal and in vitro data

Emoghrelin, derived from P. multiflorum, stimulated secretion of growth hormone in vitro,(Lo 2015) and tetrahydroxystilbene glucoside protected against the thinning of mice derma associated with aging.(Zhou 2014) Studies evaluating effects of P. multiflorum on lifespan and lipid metabolism in senile Japanese quails have been conducted.(Wang 1988)

Alopecia

Animal and in vitro data

Topical application of P. multiflorum induced follicular keratinocyte proliferation in mice.(Begum 2015, Park 2015) The inhibition of tyrosinase activity in mice melanocytes has also been demonstrated,(Cheung 2014) and compounds isolated from P. multiflorum roots induced a greater proliferation of dermal papilla cells than minoxidil in an in vitro study.(Sun 2013) Multiple mechanisms of action were noted in a human hair follicle organ culture model, including decreases in proteins with apoptotic and catagen-inducing effects and increases in growth factors.(Shin 2020)

Antioxidant activity

In vitro data

In vitro studies have shown that extracts of P. multiflorum possess antioxidant properties.(Hong 1994, Lee 2012, Li 2010, Lv 2014, Shen 2013, Steele 2013, Tao 2011, Zhang 2012)

Cancer

Animal and in vitro data

In vitro studies and limited animal data suggest P. multiflorum components (tetrahydroxystilbene glucoside and emodin) possess anticancer properties.(Chen 2011, Horikawa 1994, Lin 2015, Sun 2015)

Cardiovascular effects/Atherosclerosis

Animal and in vitro data

Emodin has demonstrated inhibitory effects on vasodilation in isolated rat aortas.(Lim 2014) Tetrahydroxystilbene glucoside has been shown to exert a number of actions, including prevention of reperfusion injury in human umbilical endothelial cells,(Liu 2010) prevention of oxidized low-density lipoprotein–induced endothelial dysfunction,(Yao 2013) reduction of vascular smooth muscle cell production in response to cellular injury,(Xu 2015) and antiplatelet activity in response to collagen-induced aggregation.(Xiang 2014)

CNS effects

Animal and in vitro data

In vitro studies of CNS tissues report decreased neuroinflammation via inhibition of microglia activation,(Zhang 2013) promotion of hippocampal synaptic plasticity,(Wang 2011) antioxidant effect in hippocampal and other cells,(Jang 2013, Kim 2013, Qin 2011, Steele 2013) and reduction of amyloid peptide production(Liu 2012) with P. multiflorum or active components extracted from P. multiflorum. In contrast, an in vitro study using cultured mouse cortical neurons showed an extract of P. multiflorum to be neurotoxic.(Shen 2013) In a study conducted in rats, tetrahydroxystilbene glucoside reversed impaired learning and memory; histological changes were observed in the hippocampus.(Zhou 2012)

Clinical data

P. multiflorum extracts are traditionally used in the Ayurvedic medical system and in traditional Chinese medicine for the treatment of cognitive disorders; however, clinical studies are lacking.(Shen 2013) One study conducted among patients with Alzheimer disease (N=209) reported that a P. multiflorum extract was effective compared to control groups; details regarding methodology are unclear.(Chen 2010)

Diabetes

Animal and in vitro data

Reduction in the production of glycation end products in diabetes has been demonstrated in vitro.(Lv 2010) A rat study noted beneficial effects via regulation of gut microbiota in rats with insulin resistance induced by high-fat and high-sugar diets.(Bi 2020)

Dyslipidemia

Both raw and cured fo-ti are used in traditional Chinese medicine for dyslipidemia.(Khan 2010)

Animal and in vitro data

Effects on triglyceride and total cholesterol regulation have been demonstrated by tetrahydroxystilbene glucoside, emodin, and physcion in mice and in vitro.(Li 2010, Liu 1992, Wang 2012, Wang 2014) Raw fo-ti appeared to be more effective than processed fo-ti in 1 study.(Wang 2012)

Hepatic effects

Animal and in vitro data

In contrast to the known hepatotoxicity of P. multiflorum extracts,(Dong 2014, Lei 2015, Teschke 2014) tetrahydroxystilbene glucoside and emodin appear to have hepatoprotective effects.(Kim 2013, Lee 2012, Li 2010, Zhang 2012)

Immunomodulatory/Anti-inflammatory effects

Immunomodulatory and anti-inflammatory effects have been reported.(Lin 2015)

Emodin and Radix polygoni multiflori was reported to block the SARS coronavirus spike protein from interacting at the angiotensin-converting enzyme 2 receptor.(Adhikari 2021, Ho 2007)

Fo-ti side effects

P. multiflorum is widely used in Chinese medicine; however, adverse event reporting under clinical trial conditions is lacking. Hepatotoxicity has been documented.Dong 2014, Lei 2015, Teschke 2014 GI symptoms, including diarrhea, may be due to consuming raw or improperly processed fo-ti.Khan 2010

Data collected between 2004 and 2013 from 8 US centers in the Drug-Induced Liver Injury Network revealed that 15.5% (130) of hepatotoxicity cases were caused by herbals and dietary supplements, whereas 85% (709) of cases were related to prescription medications. Of the 130 cases of liver injury related to supplements, 65% were from non-bodybuilding supplements and occurred most often in Hispanics/Latinos compared with non-Hispanic Whites and non-Hispanic Blacks. Liver transplant was also more frequent with toxicity from non-bodybuilding supplements (13%) than with conventional medications (3%) (P<0.001). Overall, the proportion of severe liver injury cases was significantly higher for supplements than for conventional medications (P=0.02). Of the 217 supplement products implicated in liver injury, 175 had identifiable ingredients, of which fo-ti was among the 32 (18%) single-ingredient products.Navarro 2014 The European Association for the Study of the Liver clinical practice guidelines for drug-induced liver injury (2019) recommend physicians consider herbal and dietary supplements as potential causative agents associated with liver injury (level 4 evidence; grade C recommendation), including fo-ti (P. multiflorum; shou wu pian).EASL 2019

Before taking Fo-ti

Avoid use. Embryonic toxicity has been reported.Chang 2012

How to use Fo-ti

Clinical studies are lacking to provide dosing recommendations for fo-ti.

P. multiflorum is usually used in combination with other products.Khan 2010, Lin 2015

Warnings

Evidence of hepatic injury in humans existsLei 2015; P. multiflorum and its extracts should be considered hepatotoxic. The plant may also be nephro-, neuro-, and embryotoxic.

Reviews of the toxic effects, possibly dose- and duration-related, of P. multiflorum on the liver have been published. Other reviews suggest toxicity of an idiopathic nature, with more than 400 cases reported. Hepatotoxicity is largely reversible; however, deaths have been reported.Dong 2014, Lei 2015, Teschke 2014 Nephrotoxicity and embryonic toxicityChang 2012 have also been reported and attributed to the quinone constituents emodin and rhein.Lin 2015, Shen 2013

Reports also exist of the tetrahydroxystilbene glucoside and emodin constituents appearing to have neuro-, nephro-, and hepatoprotective effects.Kim 2013, Lee 2012, Li 2010, Sun 2011, Zhang 2013 In mice, processing the raw roots increased emodin and decreased tetrahydroxystilbene glucoside content and diminished observed toxicity.Wu 2012

In rats, tetrahydroxystilbene glucoside was detected in the liver and lungs in the highest concentrations, but not in brain and testes tissues.Lv 2011 Mutagenicity and toxicity to lung tissue have also been described.Lin 2015

What other drugs will affect Fo-ti

Case reports are lacking. An in vitro study suggests tetrahydroxystilbene glucoside exerts an inhibitory effect on platelet aggregation.Xiang 2014

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