Herb & supplement monograph

Fo-ti Drug Interactions, Uses, Effectiveness, Safety & More

Medically reviewed by ·Updated July 2026
What is this page for?

First and foremost: how Fo-ti interacts with medications. The heart of this page is the interaction list — every drug Fo-ti is known to interact with, and how serious each one is.

But these pages have grown well beyond that into a full monograph — what Fo-ti is, what people use it for and how strong the evidence is, its safety and side effects, and answers to the questions we’re asked most — written and reviewed by the clinical staff at HelloPharmacist. It’s educational information from our licensed clinical databases, not medical advice, and we don’t sell or endorse products. Our editorial policy

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On this page

Fo-ti Drug Interactions: The Bottom Line

From the HelloPharmacist Editorial Team · Updated July 2026

Based on the available evidence, the overall risk of a clinically significant Fo-ti drug interaction appears low for most people, though a few combinations deserve real caution. None of the listed interactions are rated major, and nearly all rest on lab or animal findings rather than confirmed effects in people.

Interactions deserving the most attention

The clearest concern is warfarin: in one report, a person taking fo-ti developed liver injury and a sharply elevated INR, which raises bleeding risk. Fo-ti itself has been tied to liver damage in many reports, so pairing it with medications that can harm the liver adds to that worry. There is also lab evidence that fo-ti acts somewhat like estrogen, so large amounts might work against birth control pills or hormone replacement therapy.

What the rest of the list means

The long list of interactions mostly reflects theory rather than proven harm. Fo-ti may affect enzymes the body uses to clear many medications, so every drug processed by those enzymes shows up as a possible interaction. In most cases, these effects have only appeared in lab or animal studies and have not been reported in people.

Check your medications against Fo-ti

Based on HelloPharmacist’s Fo-ti interaction data and reviewed under our editorial standards.

Interaction report

Drugs that interact with Fo-ti

1259 medications have a known interaction with Fo-ti, graded by severity. Select any drug for the full evidence-based detail.

2,830 drugs
6-mercaptopurinePurinethol› Ado-trastuzumab EmtansineKadcyla› Abacavir Sulfate, Dolutegravir, LamivudineTriumeq› Abacavir, LamivudineEpzicom› AbciximabReoPro› AbemaciclibVerzenio› Abiraterone› Abiraterone AcetateYonsa, Zytiga› AbrocitinibCibinqo› AcalabrutinibCalquence› AcarboseGlucobay, Prandase, Precose› AcebutololRhotral, Sectral› AcenocoumarolSintrom› AcetaminophenChildren's Tylenol, Children's Tylenol Meltaways, Tylenol, Tylenol Ex Strength› Acetaminophen, AspirinGemnisyn› Acetaminophen, Aspirin, CaffeineExcedrin, Excedrin Extra Strength, Excedrin Migraine› Acetaminophen, Brompheniramine, PhenylpropanolamineDimetapp Cold and Flu› Acetaminophen, ButalbitalAxocet, Bancap, Bucet, Butex Forte, Esgic CF, Orbivan CF +5 more› Acetaminophen, Butalbital, CaffeineEsgic, Esgic Plus, Fiogesic, Fioricet, Repan, Tecnal +1 more› Acetaminophen, Butalbital, Caffeine, CodeineEsgic with Codeine, Fioricet w/ Codeine› Acetaminophen, Butalbital, CodeineBancap w/ Codeine› Acetaminophen, Butalbital, Codeine PhosphatePhrenilin #3› Acetaminophen, Caffeine, Chlorpheniramine, Hydrocodone, PhenylephrineHycomine Compound› Acetaminophen, Caffeine, CodeineGesic C15, Gesic C30, Gesic C8, Lenoltec 1, Lenoltec 2, Lenoltec 3 +1 more› Acetaminophen, Caffeine, Codeine, SalicylamideCodalan No.1, Codalan No.2, Codalan No.3› Acetaminophen, Caffeine, DihydrocodeineDHC Plus, Panlor DC, Panlor SS› Acetaminophen, Caffeine, IsomethepteneMigralam› Acetaminophen, Caffeine, PyrilamineMidol Max Strength Menstrual› Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan HbrVicks Formula 44M Cough, Cold & Flu Relief› Acetaminophen, Chlorpheniramine, Codeine, PhenylephrineColrex›
Read The List Like a Pharmacist

What Severity, Likelihood & Evidence Mean

Severity — How Serious It Can Be

  • Major. Clinically significant; generally best avoided, or used only under direct professional supervision.
  • Moderate. May need monitoring, a dose adjustment, or separating the times you take each one.
  • Minor. Generally not clinically significant, but still worth noting and mentioning to your pharmacist.
  • No known interaction. Checked against our sources with nothing documented — not the same as proven safety.

Likelihood — How Well It’s Documented

  • Likely. Well-controlled human studies have demonstrated the likely existence of this interaction
  • Probable. Interaction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • Possible. Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists
  • Unlikely. Interaction has been demonstrated in animal or in lab research but has been shown not to occur in humans.

Where This Data Comes From

  • Interaction records are evidence-graded and sourced from the Natural Medicines database (TRC Healthcare), the same reference used by pharmacists and hospitals.
  • Each drug listed above links to the full report for that exact Fo-ti combination — clinical detail, likelihood, evidence level, and citations.
  • Content is reviewed by licensed HelloPharmacist pharmacists — see our data sources and editorial standards.
The big picture

The kinds of drugs Fo-ti affects

Every type of medication (drug category) Fo-ti is known to interact with. Open any category for the detail — or search your exact drug in the checker above.

All 17 drug categories Fo-ti interacts with
Anticoagulant/antiplatelet DrugsAntidiabetes DrugsContraceptive DrugsCytochrome P450 1a2 (cyp1a2) SubstratesCytochrome P450 2b6 (cyp2b6) SubstratesCytochrome P450 2c19 (cyp2c19) SubstratesCytochrome P450 2c8 (cyp2c8) SubstratesCytochrome P450 2c9 (cyp2c9) SubstratesCytochrome P450 2d6 (cyp2d6) SubstratesCytochrome P450 3a4 (cyp3a4) SubstratesDigoxin (lanoxin)Diuretic DrugsEstrogensHepatotoxic DrugsStimulant LaxativesSulindac (clinoril)Warfarin (coumadin)
Anticoagulant/Antiplatelet Drugs

Fo-ti has been linked to cases of acute liver failure which can decrease clotting factor production and increase the effects of anticoagulants. In one case, a patient who had been stable on warfarin presented with acute hepatitis and an INR elevated to 14.98. The patient had been taking fo-ti for 90 days prior to admission. Discontinuation of warfarin and fo-ti lead to a decrease in the INR and full recovery. Theoretically, concomitant use of fo-ti with anticoagulant or antiplatelet drugs may increase the risk of bleeding in some patients. Until more is known, monitor patients taking fo-ti and drugs that affect bleeding.
Some of these drugs include aspirin, clopidogrel (Plavix), dalteparin (Fragmin), dipyridamole (Persantine), enoxaparin (Lovenox), heparin, ticlopidine (Ticlid), warfarin (Coumadin), and others.

Likelihood Possible Evidence D
Antidiabetes Drugs

Theoretically, fo-ti might increase the risk of hypoglycemia when taken with antidiabetes drugs.
Fo-ti reportedly has hypoglycemic effects.

Likelihood Possible Evidence D
Contraceptive Drugs

Theoretically, taking large amounts of fo-ti might interfere with contraceptive drugs due to competition for estrogen receptors.
In vitro research suggests that fo-ti extract has estrogenic activity.

Likelihood Probable Evidence D
Cytochrome P450 1A2 (Cyp1A2) Substrates

Theoretically, fo-ti might increase or decrease the levels and clinical effects of drugs metabolized by CYP1A2.
In vitro research suggests that fo-ti might inhibit CYP1A2. Additionally, in vitro research suggests that the degree of CYP1A2 inhibition depends on the type of fo-ti extract (i.e., the raw plant leads to greater inhibition than extensively processed extracts). However, in an animal study, an aqueous extract of fo-ti inhibited CYP1A2 while an alcoholic extract of fo-ti induced CYP1A2. Induction or inhibition of CYP1A2 by fo-ti has not been reported in humans.

Likelihood Possible Evidence D
Cytochrome P450 2B6 (Cyp2B6) Substrates

Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP2B6.
Animal research suggests that fo-ti might inhibit CYP2B6. One in vitro study suggests that the degree of CYP2B6 inhibition may depend on the type of fo-ti extract (i.e., the raw plant leads to greater inhibition than extensively processed extracts). However, this interaction has not been reported in humans.

Likelihood Possible Evidence D
Cytochrome P450 2C19 (Cyp2C19) Substrates

Theoretically, fo-ti may increase the levels and clinical effects of drugs metabolized by CYP2C19.
Animal and in vitro research suggests that fo-ti may inhibit CYP2C19. An in vitro study suggests that the degree of CYP2C19 inhibition may depend on the type of fo-ti extract (i.e., the raw plant leads to greater inhibition than extensively processed extracts). However, this interaction has not been reported in humans.

Likelihood Possible Evidence D
Cytochrome P450 2C8 (Cyp2C8) Substrates

Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP2C8.
In vitro research suggests that fo-ti might inhibit CYP2C8. However, this interaction has not been reported in humans.

Likelihood Possible Evidence D
Cytochrome P450 2C9 (Cyp2C9) Substrates

Theoretically, fo-ti may increase the levels and clinical effects of drugs metabolized by CYP2C9.
Animal and in vitro research suggests that fo-ti may inhibit CYP2C9. However, this interaction has not been reported in humans.

Likelihood Possible Evidence D
Cytochrome P450 2D6 (Cyp2D6) Substrates

Theoretically, fo-ti may increase the levels and clinical effects of drugs metabolized by CYP2D6.
Animal research suggests that fo-ti might inhibit CYP2D6. Additionally, an in vitro study suggests that the degree of CYP2D6 inhibition may depend on the type of fo-ti extract (i.e., the raw plant leads to greater inhibition than extensively processed extracts). However, this interaction has not been reported in humans.

Likelihood Possible Evidence D
Cytochrome P450 3A4 (Cyp3A4) Substrates

Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP3A4.
In vitro research suggests that fo-ti might inhibit CYP3A4. One in vitro study suggests that the degree of CYP3A4 inhibition may depend on the type of fo-ti extract (i.e., the raw plant leads to greater inhibition than extensively processed extracts). However, this evidence conflicts with animal research suggesting that fo-ti does not inhibit CYP3A4. This interaction has not been reported in humans.

Likelihood Possible Evidence D
Digoxin (Lanoxin)

Theoretically, fo-ti, particularly raw fo-ti root, might increase the risk of hypokalemia and cardiotoxicity when taken with digoxin.
Raw fo-ti root contains anthraquinone derivatives, which might have stimulant laxative effects. In vitro research shows that fermented and processed fo-ti root have reduced laxative effects compared with raw fo-ti root.

Likelihood Possible Evidence D
Diuretic Drugs

Theoretically, fo-ti, particularly raw fo-ti root, might increase the risk of hypokalemia when taken with diuretic drugs.
Raw fo-ti root contains anthraquinone derivatives, which might have stimulant laxative effects and compound diuretic-induced potassium loss. In vitro research shows that fermented and processed fo-ti root have reduced laxative effects compared with raw fo-ti root.

Likelihood Possible Evidence D
Estrogens

Theoretically, taking large amounts of fo-ti might interfere with hormone replacement therapy through competition for estrogen receptors.
In vitro research suggests that fo-ti extract has estrogenic activity.

Likelihood Probable Evidence D
Hepatotoxic Drugs

Theoretically, fo-ti might increase the risk of liver damage when taken with hepatotoxic drugs.
Fo-ti has been linked to liver damage in many reports.

Likelihood Possible Evidence D
Stimulant Laxatives

Theoretically, fo-ti, particularly raw fo-ti root, might increase the risk of fluid and electrolyte depletion when taken with stimulant laxatives.
Raw fo-ti root contains anthraquinone derivatives, which might have stimulant laxative effects. However, in vitro research shows that fermented and processed fo-ti root have reduced laxative effects compared with raw fo-ti root.

Likelihood Possible Evidence D
Sulindac (Clinoril)

Theoretically, fo-ti might increase or decrease the levels and clinical effects of sulindac.
Animal research suggests that the type of fo-ti extract might affect the levels of sulindac differently; the raw plant may increase levels, but processed parts may decrease levels. Induction or inhibition of CYP1A2 by fo-ti has not been reported in humans.

Likelihood Possible Evidence D
Warfarin (Coumadin)

Theoretically, fo-ti might increase the effects and adverse effects of warfarin.
Fo-ti may have stimulant laxative effects and cause diarrhea, especially when the raw or unprocessed fo-ti root is used. Diarrhea can increase the effects of warfarin, increase international normalized ratio (INR), and increase the risk of bleeding. Also, fo-ti has been linked to cases of acute liver failure which can decrease clotting factor production and increase the effects of warfarin. In one case, a patient who had been stable on warfarin presented with acute hepatitis and an INR elevated to 14.98. The patient had been taking fo-ti for 90 days prior to admission. Discontinuation of warfarin and fo-ti lead to a decrease in the INR and full recovery.

Likelihood Possible Evidence D
Monograph

Fo-ti: Uses, Safety & Side Effects

Medically reviewed by · Reviewed July 2026 ·
The bottom line

Fo-ti (He Shou Wu) is a root used in traditional Chinese medicine, often promoted for healthy aging and hair. High-quality human evidence for these benefits is limited, and processed Fo-ti has been linked to reports of liver injury, so caution and professional guidance are important.

Scientific name
Reynoutria multiflora
Family
Polygonaceae
Part used
Root (often prepared/processed)
Common forms
Capsules, tablets, dried root, tea, tinctures, powders
People commonly use it for
  • Anti-aging and longevity
  • Hair graying and hair loss
  • General tonic for vitality
  • Constipation
  • High cholesterol

Popular and traditional uses — not proof it works. See “Uses & effectiveness” below for the evidence.

Safety at a glance
OverallUse caution

It has been linked to cases of liver injury and should be used carefully and under professional guidance.

PregnancyPossibly Unsafe

When used orally. Fo-ti contains anthraquinone constituents, which can exert a stimulant laxative effect. Bulk-forming or emollient laxatives are pref...

Read the full pregnancy detail
BreastfeedingPossibly Unsafe

When used orally. Anthraquinone constituents can cross into breast milk and might cause loose stools in some breast-fed infants. Fo-ti has also been l...

Read the full breastfeeding detail

Pregnancy & breastfeeding ratings are from Natural Medicines (Therapeutic Research Center). Safety guidance is general; always confirm with your pharmacist or doctor for your situation.

Jump to a section

Overview

Fo-ti is the root of a climbing plant native to China and also grown in parts of East Asia. In traditional Chinese medicine it is widely known as He Shou Wu, which roughly means "black-haired Mr. He," reflecting its long-standing reputation as a tonic linked to youthful hair and vitality.

The root is used in two main ways. The "raw" or unprocessed root is traditionally used for its laxative effect, while the "prepared" root (cured with black bean liquid) is the form most often promoted as a tonic for aging, hair, and overall wellness. Today it is sold as capsules, powders, teas, and tinctures.

How it works

Fo-ti contains several plant compounds, including stilbenes (such as a resveratrol-related compound), anthraquinones (like emodin), and various antioxidants. Anthraquinones can stimulate the bowel, which may explain the laxative effect of the raw root.

In laboratory and animal research, the antioxidant compounds have shown effects on cells related to inflammation and aging, and some studies have looked at effects on cholesterol and nerve cells. These findings are preliminary and do not prove the same effects happen in the human body at the amounts found in supplements.

Effectiveness

Does Fo-ti work?

Here’s what the research actually shows for each use — graded by Natural Medicines and reviewed by .

Evidence overview · 12 uses evaluated
12 Insufficient evidence
How to read these evidence grades

Natural Medicines’ 7-point scale. We show each rating’s label word-for-word.

1EffectiveStrong, consistent evidence it works.
2Likely EffectiveGood evidence, though not yet conclusive.
3Possibly EffectiveSome evidence suggests a benefit.
4Possibly IneffectiveSome evidence it may not help.
5Likely IneffectiveFairly strong evidence it doesn’t help.
6IneffectiveStrong evidence it doesn’t work.
7Insufficient Reliable Evidence to RateToo little research to say either way.

For Fo-ti, current evidence isn’t strong enough to rate any specific use. The conditions it has been studied for are listed below.

Also studied for 12 conditions — evidence insufficient to rate
Insufficient Reliable Evidence To Rate Age-related cognitive decline
Rating & evidence shown verbatim from Natural Medicines

Oral fo-ti has only been evaluated in combination with other ingredients; its effect when used alone is unclear.

Insufficient Reliable Evidence To Rate Aging
Rating & evidence shown verbatim from Natural Medicines

Although there has been interest in using oral fo-ti for aging, there is insufficient reliable information about the clinical effects of fo-ti for this purpose.

Insufficient Reliable Evidence To Rate Alopecia areata
Rating & evidence shown verbatim from Natural Medicines

Although there has been interest in using oral fo-ti for alopecia areata, there is insufficient reliable information about the clinical effects of fo-ti for this purpose.

Insufficient Reliable Evidence To Rate Alzheimer disease
Rating & evidence shown verbatim from Natural Medicines

Although there has been interest in using oral fo-ti for Alzheimer disease, there is insufficient reliable information about the clinical effects of fo-ti for this purpose.

Insufficient Reliable Evidence To Rate Androgenic alopecia
Rating & evidence shown verbatim from Natural Medicines

Although there has been interest in using oral fo-ti for androgenic alopecia, there is insufficient reliable information about the clinical effects of fo-ti for this purpose.

Insufficient Reliable Evidence To Rate Cardiovascular disease (CVD)
Rating & evidence shown verbatim from Natural Medicines

Although there has been interest in using oral fo-ti for CVD, there is insufficient reliable information about the clinical effects of fo-ti for this purpose.

Insufficient Reliable Evidence To Rate Dyslipidemia
Rating & evidence shown verbatim from Natural Medicines

Oral fo-ti has only been evaluated in combination with other ingredients; its effect when used alone is unclear.

Insufficient Reliable Evidence To Rate Insomnia
Rating & evidence shown verbatim from Natural Medicines

Although there has been interest in using oral fo-ti for insomnia, there is insufficient reliable information about the clinical effects of fo-ti for this purpose.

Insufficient Reliable Evidence To Rate Osteoarthritis
Rating & evidence shown verbatim from Natural Medicines

Although there has been interest in using oral fo-ti for osteoarthritis, there is insufficient reliable information about the clinical effects of fo-ti for this purpose.

Insufficient Reliable Evidence To Rate Osteoporosis
Rating & evidence shown verbatim from Natural Medicines

Although there has been interest in using oral fo-ti for osteoporosis, there is insufficient reliable information about the clinical effects of fo-ti for this purpose.

Insufficient Reliable Evidence To Rate Parkinson disease
Rating & evidence shown verbatim from Natural Medicines

Although there has been interest in using oral fo-ti for Parkinson disease, there is insufficient reliable information about the clinical effects of fo-ti for this purpose.

Insufficient Reliable Evidence To Rate Wrinkled skin
Rating & evidence shown verbatim from Natural Medicines

Although there has been interest in using topical fo-ti for wrinkled skin, there is insufficient reliable information about the clinical effects of fo-ti for this purpose.

Source & disclaimer. Effectiveness ratings and evidence summaries are provided by Natural Medicines (Therapeutic Research Center) and shown as licensed. Where Natural Medicines hasn’t rated a use, HelloPharmacist’s pharmacists may add their own reviewed rating and evidence (each such entry is labeled). This is educational information, not medical advice — talk with your pharmacist or doctor before starting, stopping, or changing a supplement.

Safety & precautions

The biggest safety concern with Fo-ti is the risk of liver injury. There have been multiple published case reports of liver damage (hepatotoxicity) in people taking Fo-ti or He Shou Wu products. Symptoms can include yellowing of the skin or eyes, dark urine, nausea, severe tiredness, and belly pain. Stop the product and seek medical care if these occur.

People with liver disease, or those who take other products that can affect the liver, should be especially careful and talk with a healthcare provider first. Quality and contamination of herbal products can also vary, so choose reputable brands.

Pregnancy and breastfeeding: Because safety has not been established and the root has laxative and hormone-related concerns, Fo-ti should be avoided during pregnancy and while breastfeeding.

Side effects

The most commonly reported side effects relate to the digestive system, such as loose stools, diarrhea, and abdominal cramping, especially with the raw (unprocessed) root.

More seriously, Fo-ti has been associated with liver injury, which is rare but potentially serious. Some people may also experience skin reactions. Stop use and contact a healthcare professional if you notice signs of a liver problem or an allergic reaction.

Fo-ti: Reported Adverse Effects

Documented safety reports on Fo-ti from the evidence-graded Natural Medicines (TRC Healthcare) database, shown word-for-word from the licensed record.

Orally, fo-ti may be unsafe.

Most Common Adverse Effects:

Orally: Abdominal pain, diarrhea, nausea, and vomiting with use of unprocessed fo-ti.

Serious Adverse Effects (Rare):

Orally: Hepatotoxicity with processed or unprocessed fo-ti.

Reports by condition
Cirrhosis Hepatic

Orally, cases of liver damage due to both processed and unprocessed fo-ti have been well documented in the medical literature..

In a systematic review, around 450 cases of hepatitis associated with fo-ti were identified. These cases occurred in patients 5-78 years of age. Liver damage occurred at a wide range of doses, formulations, and durations of intake. The type of liver injury ranged from hepatocellular, to cholestatic, or mixed. Outcomes ranged from full recovery to cirrhosis, liver transplantation, and/or death. The evidence suggests that when the daily fo-ti dose is less than 12 grams, the median time to occurrence of liver damage is 60 days. When the daily fo-ti dose is more than 12 grams, the median time to liver damage is 30 days. Presenting signs and symptoms may include jaundice, abdominal pain, nausea, fatigue, loss of appetite, dark urine, myalgias, and elevations in liver function tests (LFTs), ferritin, transferrin, prothrombin time, and INR. Other manifestations may include fever, skin rash, thrombocytopenia, pancytopenia, and arthralgias. Symptoms and increased LFTs usually seem to resolve within a month after discontinuing fo-ti. In one case series, liver enzymes began to normalize 48 hours after discontinuation of fo-ti and treatment with S-adenosylmethionine, compound glycyrrhizin injection, polyene phosphatidylcholine, and reduced glutathione. All patients were eventually discharged home in stable condition. Rechallenge with fo-ti should not be attempted. A patient who had recovered from hepatitis associated with fo-ti use presented with myalgias and markedly elevated LFTs after a single dose of the herb.

It is thought that this idiosyncratic reaction leading to liver damage is at least partially related to genetic polymorphisms. Cytochrome P450 1A2 (CYP1A2) is the predominant enzyme involved in biotransformation of emodin, a constituent of fo-ti thought to play a role in liver damage. In one genetic study, the frequency of CYP1A2*1C mutation in fo-ti induced drug-induced liver injury patients was 46.5%, which is significantly higher than the 27.9% frequency of liver injury reported in healthy patients without the mutation. Patients with a CYP1A2*1C mutation may have decreased activity of the CYP1A2 enzyme, which could inhibit the metabolism of fo-ti, causing an accumulation of toxic substances.

  1. Park GJ, Mann SP, Ngu MC. Acute hepatitis induced by Shou-Wu-Pian, a herbal product derived from Polygonum multiflorum. J Gastroenterol Hepatol 2001;16:115-7.
  2. But PP, Tomlinson B, Lee KL. Hepatitis related to the Chinese medicine Shou-wu-pian manufactured from Polygonum multiflorum. Vet Hum Toxicol 1996;38:280-2.
  3. UK Medicines and Healthcare Products Regulatory Agency. Polygonum multiflorum and liver reactions. April 2006. Available at: www.mhra.gov.uk/home/idcplg?IdcService= SS_GET_PAGE&useSecondary=true&ssDocName= CON2023590&ssTargetNodeId= 833 (Accessed 10 May 2
  4. Panis B, Wong DR, Hooymans PM, De Smet PA, Rosias PP. Recurrent toxic hepatitis in a Caucasian girl related to the use of Shou-Wu-Pian, a Chinese herbal preparation. J Pediatr Gastroenterol Nutr 2005;41:256-8.
  5. 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 2004;140:E589-90.
  6. Cardenas A, Restrepo JC, Sierra F, Correa G. Acute hepatitis due to shen-min: a herbal product derived from Polygonum multiflorum. J Clin Gastroenterol 2006;40:629-32.
  7. Laird AR, Ramchandani N, deGoma EM, et al. Acute hepatitis associated with the use of an herbal supplement (Polygonum multiflorum) mimicking iron-overload syndrome. J Clin Gastroenterol 2008;42:861-2.
  8. Jung KA, Min HJ, Yoo SS, et al. Drug-Induced Liver Injury: Twenty Five Cases of Acute Hepatitis Following Ingestion of Polygonum multiflorum Thunb. Gut Liver 2011;5(4):493-9.
  9. Yuen, M. F., Tam, S., Fung, J., Wong, D. K., Wong, B. C., and Lai, C. L. Traditional Chinese medicine causing hepatotoxicity in patients with chronic hepatitis B infection: a 1-year prospective study. Aliment.Pharmacol.Ther 10-15-2006;24(8):1179-1186.
  10. Zhang, L., Yang, X., Sun, Z., and Qu, Y. [Retrospective study of adverse events of Polygonum multiflorum and risk control]. Zhongguo Zhong.Yao Za Zhi. 2009;34(13):1724-1729.
  11. Bae, S. H., Kim, D. H., Bae, Y. S., Lee, K. J., Kim, D. W., Yoon, J. B., Hong, J. H., and Kim, S. H. [Toxic hepatitis associated with Polygoni multiflori]. Korean J.Hepatol. 2010;16(2):182-186.
  12. Furukawa, M., Kasajima, S., Nakamura, Y., Shouzushima, M., Nagatani, N., Takinishi, A., Taguchi, A., Fujita, M., Niimi, A., Misaka, R., and Nagahara, H. Toxic hepatitis induced by show-wu-pian, a Chinese herbal preparation. Intern.Med. 2010;49(15):1537-1
  13. Dong H, Slain D, Cheng J, Ma W, Liang W. Eighteen cases of liver injury following ingestion of Polygonum multiflorum. Complement Ther Med 2014;22(1):70-4.
  14. Lei X, Chen J, Ren J, et al. Liver damage associated with Polygonum multiflorum Thunb.: a systematic review of case reports and case series. Evid Based Complement Alternat Med 2015;2015:459749.
  15. Shao YL, Ma CM, Wu JM, Guo FC, Zhang SC. Concurrent severe hepatotoxicity and agranulocytosis induced by Polygonum multiflorum: A case report. World J Clin Cases 2022;10(27):9921-9928.
  16. Ma KF, Zhang XG, Jia HY. CYP1A2 polymorphism in Chinese patients with acute liver injury induced by Polygonum multiflorum. Genet Mol Res 2014;13(3):5637-43.
Diarrhea Gastrointestinal

Orally, unprocessed fo-ti may cause diarrhea, abdominal pain, nausea, and vomiting.

  1. McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.
  2. McGuffin, M., Hobbs, C., Upton, R., and Goldberg, A. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC;1997.
DISCLAIMER: This tool is intended for informational purposes only, and should not be interpreted as specific medical advice. Patients should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.

Adverse-effects data: Natural Medicines, Therapeutic Research Center

Dosing

There is no well-established, standardized dose of Fo-ti, and products vary widely in strength and preparation (raw versus prepared root). Because of this and the liver concerns, it is best not to guess at an amount on your own.

If you choose to use it, follow the directions on the product label and do not exceed them. Talk with a pharmacist or doctor first, especially if you take other medicines or have any health conditions.

Pregnancy & Breastfeeding

Fo-ti & Pregnancy

Possibly Unsafe

When used orally. Fo-ti contains anthraquinone constituents, which can exert a stimulant laxative effect. Bulk-forming or emollient laxatives are preferred in pregnancy. Fo-ti has also been linked to several cases of liver damage. There is insufficient reliable information available about the safety of fo-ti when used topically during pregnancy.

  1. Covington TR, et al. Handbook of Nonprescription Drugs. 11th ed. Washington, DC: American Pharmaceutical Association, 1996.
  2. Park GJ, Mann SP, Ngu MC. Acute hepatitis induced by Shou-Wu-Pian, a herbal product derived from Polygonum multiflorum. J Gastroenterol Hepatol 2001;16:115-7.
  3. But PP, Tomlinson B, Lee KL. Hepatitis related to the Chinese medicine Shou-wu-pian manufactured from Polygonum multiflorum. Vet Hum Toxicol 1996;38:280-2.
  4. UK Medicines and Healthcare Products Regulatory Agency. Polygonum multiflorum and liver reactions. April 2006. Available at: www.mhra.gov.uk/home/idcplg?IdcService= SS_GET_PAGE&useSecondary=true&ssDocName= CON2023590&ssTargetNodeId= 833 (Accessed 10 May 2

Fo-ti & Breastfeeding

Possibly Unsafe

When used orally. Anthraquinone constituents can cross into breast milk and might cause loose stools in some breast-fed infants. Fo-ti has also been linked to several cases of liver damage. There is insufficient reliable information available about the safety of fo-ti when used topically during lactation.

  1. Covington TR, et al. Handbook of Nonprescription Drugs. 11th ed. Washington, DC: American Pharmaceutical Association, 1996.
  2. Park GJ, Mann SP, Ngu MC. Acute hepatitis induced by Shou-Wu-Pian, a herbal product derived from Polygonum multiflorum. J Gastroenterol Hepatol 2001;16:115-7.
  3. But PP, Tomlinson B, Lee KL. Hepatitis related to the Chinese medicine Shou-wu-pian manufactured from Polygonum multiflorum. Vet Hum Toxicol 1996;38:280-2.
  4. UK Medicines and Healthcare Products Regulatory Agency. Polygonum multiflorum and liver reactions. April 2006. Available at: www.mhra.gov.uk/home/idcplg?IdcService= SS_GET_PAGE&useSecondary=true&ssDocName= CON2023590&ssTargetNodeId= 833 (Accessed 10 May 2
DISCLAIMER: This tool is intended for informational purposes only, and should not be interpreted as specific medical advice. Patients should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.

© 2026 Therapeutic Research Center

Pregnancy & lactation ratings: Natural Medicines, Therapeutic Research Center

References & further reading

The 28 references that drive our Fo-ti monograph and interaction data, from the evidence-graded Natural Medicines (TRC Healthcare) database. Citations with a link open the study on PubMed or the publisher’s site.

  1. Foster S, Tyler VE. Tyler's Honest Herbal: A Sensible Guide to the Use of Herbs and Related Remedies. 3rd ed., Binghamton, NY: Haworth Herbal Press, 1993.
  2. McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.
  3. Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications, 1998.
  4. Covington TR, et al. Handbook of Nonprescription Drugs. 11th ed. Washington, DC: American Pharmaceutical Association, 1996.
  5. Park GJ, Mann SP, Ngu MC. Acute hepatitis induced by Shou-Wu-Pian, a herbal product derived from Polygonum multiflorum. J Gastroenterol Hepatol 2001;16:115-7.
  6. But PP, Tomlinson B, Lee KL. Hepatitis related to the Chinese medicine Shou-wu-pian manufactured from Polygonum multiflorum. Vet Hum Toxicol 1996;38:280-2.
  7. Oerter Klein KO, Janfaza M, Wong JA, Chang RJ. 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;88:4077-9.. PubMed
  8. 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;1 PubMed
  9. UK Medicines and Healthcare Products Regulatory Agency. Polygonum multiflorum and liver reactions. April 2006. Available at: www.mhra.gov.uk/home/idcplg?IdcService= SS_GET_PAGE&useSecondary=true&ssDocName= CON2023590&ssTargetNodeId= 833 (Accessed 10 May 2
  10. Panis B, Wong DR, Hooymans PM, De Smet PA, Rosias PP. Recurrent toxic hepatitis in a Caucasian girl related to the use of Shou-Wu-Pian, a Chinese herbal preparation. J Pediatr Gastroenterol Nutr 2005;41:256-8. PubMed
  11. 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 2004;140:E589-90.
  12. Cardenas A, Restrepo JC, Sierra F, Correa G. Acute hepatitis due to shen-min: a herbal product derived from Polygonum multiflorum. J Clin Gastroenterol 2006;40:629-32. PubMed
  13. 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 2005;98:295-300. PubMed
  14. Laird AR, Ramchandani N, deGoma EM, et al. Acute hepatitis associated with the use of an herbal supplement (Polygonum multiflorum) mimicking iron-overload syndrome. J Clin Gastroenterol 2008;42:861-2. PubMed
  15. Jung KA, Min HJ, Yoo SS, et al. Drug-Induced Liver Injury: Twenty Five Cases of Acute Hepatitis Following Ingestion of Polygonum multiflorum Thunb. Gut Liver 2011;5(4):493-9. PubMed
Keep reading

This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Brand directory

Brands that make products with Fo-ti

238 brands in our database make a supplement containing Fo-ti.

Product directory

Supplement products with Fo-ti

985 products in our database contain Fo-ti. Open any to see its full ingredient list and every drug interaction we check.

30 Day Beauty Regimen by Bronson Tablet Or Pill 30 Packet(s) View ingredients & interactions 8 Immortals by Ron Teeguarden's Dragon Herbs Liquid 2 Fluid Ounce(s) · 60 mL View ingredients & interactions 8 Immortals by Ron Teeguarden's Dragon Herbs Liquid 2 Fluid Ounce(s) · 60 mL View ingredients & interactions 8 Immortals by Ron Teeguarden's Dragon Herbs Liquid 2 Fluid Ounce(s) · 60 mL View ingredients & interactions 8 Immortals Drops by Ron Teeguarden's Dragon Herbs Liquid 60 Milliliter(s) · 2 Fluid Ounce(s) View ingredients & interactions 80 Hour Energy Spray by Kickers Liquid 0.7 fl. Oz. · 20 mL View ingredients & interactions A.J.'s Ultra Multi without Iron by Altrum Nutrition Tablet Or Pill 180 Tablet(s) View ingredients & interactions AC-Q by Health Concerns Capsule 90 Capsule(s) View ingredients & interactions AC-Q by Health Concerns Capsule 90 Capsule(s) View ingredients & interactions AC-Q Tabs Siler by Health Concerns Tablet Or Pill 90 Tablet(s) View ingredients & interactions Adren-L Aid by Mountain Meadow Herbs Liquid 4 Fluid Ounce(s) · 120 mL View ingredients & interactions Adrenal Aid by Mountain Meadow Herbs Liquid 4 Fluid Ounce(s) · 120 mL View ingredients & interactions Adrenal Aid by Mountain Meadow Herbs Liquid 2 Fluid Ounce(s) · 60 Milliliter(s) View ingredients & interactions Adrenal Support by Crystal Star Capsule 60 Vegetarian Capsule(s) View ingredients & interactions Adrenal Support Capsules by Dr. Morse's Cellular Botanicals Capsule 90 Veggiecap(s) View ingredients & interactions Adrenal Support Capsules 450 mg by Doctor Morse's Healing Herbs Capsule 90 Veggiecap(s) View ingredients & interactions Adrenal Support Glycerin by Dr. Morse's Cellular Botanicals Liquid 2 Ounce(s) · 59 mL View ingredients & interactions Adrenal Support Tincture by Dr. Morse's Cellular Botanicals Liquid 2 Ounce(s) · 59 mL View ingredients & interactions Adrenal-Ease by Earth Friend Herb Co. Liquid 1 Fluid Ounce · 30 mL View ingredients & interactions Adrenal-Ease by Earth Friend Herb Co. Liquid 4 Fluid Ounce(s) · 120 mL View ingredients & interactions Adrenotonic by Herbs Etc. Liquid 1 fl. Oz. · 29.6 mL View ingredients & interactions Adrenotonic by Herbs, Etc. Softgel Capsule 60 Fast-Acting Softgel(s) View ingredients & interactions Adrenotonic by Herbs Etc. Softgel Capsule 60 Softgel(s) View ingredients & interactions Adrenotonic by Herbs Etc. Softgel Capsule 60 Softgel(s) View ingredients & interactions
Pharmacist Counseling Corner

Fo-ti: Common Questions

What is Fo-ti used for, and does it work?
People use Fo-ti for a range of reasons, but according to the Natural Medicines database the current clinical evidence is insufficient to confirm it works for the specific conditions it has been studied for. See the graded list on this page, and talk to your pharmacist or doctor before relying on it for any condition.
Does Fo-ti interact with prescription medications?
Yes. We list 1259 medications with a known interaction with Fo-ti. Use the checker above to see how Fo-ti interacts with a specific drug.
How are Fo-ti interactions rated?
Each interaction is graded major, moderate, or minor based on how clinically significant it is and the strength of the evidence behind it. Major interactions are the most serious and are best avoided, or used only under close professional supervision.
Is it safe to take Fo-ti with my medications?
It depends on the specific medication. Some combinations are fine, while others call for monitoring, timing changes, or should be avoided. Check your exact drug above and confirm with your pharmacist or doctor before starting, stopping, or changing anything.
Where does this Fo-ti interaction information come from?
Our interaction data is built on the Natural Medicines database — an evidence-graded reference for vitamins, herbs, and supplements — and is reviewed by licensed HelloPharmacist pharmacists, who may add clinical context.
What is Fo-ti used for?
It is traditionally used as a tonic for aging, gray hair, hair loss, energy, and sometimes constipation, but strong human evidence supporting these uses is lacking.
Is Fo-ti safe?
It may be reasonably tolerated by some people, but it has been linked to reports of liver injury, so it should be used cautiously and with professional guidance.
Can I take Fo-ti while pregnant or breastfeeding?
No. Its safety has not been established in these situations, so it is best to avoid it during pregnancy and breastfeeding.
What is the difference between raw and prepared Fo-ti?
Raw (unprocessed) root is more likely to cause a laxative effect, while the prepared root is cured with black bean liquid and is the form usually sold as a tonic.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

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