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Acanthopanax senticosus, Acetazolamide, Acetazolamide Injection, Acetazolamide Sustained-Release, Agathosma betulina, Agoral Liquid, AK-Zol, Aldactazide, Aldactone, Alder Buckthorn, Alder Dogwood, All Heal, Aloe barbadensis, Aloe species, Aloe vera, Amiloride and Hydrochlorothiazide, Aquatensen, Arrow Wood, Asclepias tuberosa, Asian Ginseng, Atenolol and Chlorthalidone, Barosma betulina, Benicar HCT, Bird Lime, Bitter Bark, Black Dogwood, Black ginger, Black-Draught, Blowball, Bucco, Buchu, Buku, Bumetanide, Bumetanide Injection, Bumex, Bumex Injection, Burn Plant, Butterfly Weed, California Buckthorn, Canada Root, Canker Wort, Canton ginger, Cape Aloe, Cascara, Cassia acutifolia, Cassia angustifolia, Cassia senna, Chinese Ginseng, Chittem Bark, Chlorothiazide, Chlorothiazide Injection, Chlorothiazide Suspension, Chlorthalidone, Ci Wu Jia, Cochin ginger, Common Buckthorn, Common ginger, Corzide, Crataegus laevigata, Crataegus monogyna, Crataegus oxyacantha, Dandelion, Demadex Injection, Demadex Oral, Devil's Bush, Devil's Fuge, Diamox, Diamox Injection, Diamox Sequels, Digitek, Digoxin, Digoxin Injection, Digoxin Liquid, Diosma, Diurigen, Diuril, Diuril Injection, Diuril Suspension, Docusate and Senna, Dog Wood, Dyazide, Dyrenium, Edecrin, Eleuthero, Eleutherococcus senticosus, Enduron, Enebro, Ephedra, Ephedra sinica, Epitonin, Esidrix, Ethacrynic Acid, European Buckthorn, European Mistletoe, Exlax, Exlax Chocolated, Ezide, Flux Root, Frangula Bark, Furosemide, Furosemide Injection, Furosemide Oral Solution, Garden ginger, Genevrier, Ginepro, Gingembre, Ginger, Ginseng, Panax, GlaucTabs, Glossy Buckthorn, Golden Bough, Guigai, Hagedorn, Hartshorn, Haw, Hawthorn, Hedgethorn, Herb de la Croix, Herbal Ecstasy, Highwaythorn, Hydrochlorothiazide, HydroDIURIL, Hygroton, Imber, Indapamide, Irish Daisy, Jamaican ginger, Japanese Ginseng, Juniper, Juniperus communis, Khao Yen, Korean Ginseng, Kuli, Lanoxicaps, Lanoxin, Lanoxin Injection, Lanoxin Liquid, Lasix, Lasix Injection, Lasix Oral Solution, Leonurus cardiaca, Leotodon taraxacum, Lignum Crucis, Lion's Ear, Lion's Tail, Lion's Tooth, Lisinopril and Hydrochlorothiazide, Lopressor HCT, Lozol, Ma Huang, Magnesium Citrate Solution, Mahuang, Maxiumum Relief Exlax, Maxzide, Mayblossom, Maybush, Mayflower, Methazolamide, Methyclothiazide, Metolazone, Metolazone extended-release tablets, Metoprolol and Hydrochlorothiazide, Microzide, Mistal, Mistletoe, Moduretic, Motherwort, Muzei, Mykrox, Nadolol and Bendroflumethiazide, Neptazane, Ninjin, Olmesartan and Hydrochlorothiazide, Orange Milkweed, Orange Swallow-wort, Oretic, Oriental Ginseng, Panax Ginseng, Panax schinseng, Peri-Colace, Pleurisy root, Popptillo, Prinzide, Puffball, Purging Buckthorn, Purshiana Bark, Ramsthorn, Red Ginseng, Rhamnus cathartica, Rhamnus frangula, Rhamnus purshiana, Russian Root, Sacred Bark, Sagrada Bark, Sarsa, Sarsaparilla, Senexon, Seng, Senna, Senna Laxatives, Senna Oral Syrup, Senna Suppositories, Senna-Gen, Senokot, Senokot Suppositories, Senokot Syrup, Senokot XTRA, Senokot-S, Shigoka, Siberian Ginseng, Silkweed, Smilace, Smilax, Smilax aristolochiifolia, Smilax officinalis, Smilax regelii, Smilax sarsaparilla, Spironolactone, Spironolactone and Hydrochlorothiazide, Swallow-wort, Taiga, Taraxacum officinale, Tenoretic, Thalitone, Thorny Pepperbush, Throw-wort, Torsemide Injection, Torsemide Oral, Touch-Me-Not, Triamterene, Triamterene and Hydrochlorothiazide, Tuber Root, Viscum, Viscum album, Vogelmistel, Wacholder, Waythorn, White Root, Whitethorn, Wild Endive, Wild Pepper, Wild Root, Zaroxolyn, Zestoretic, Zingiber officinale.

Application of He Shou Wu

Scientific Name: Fo-Ti

Other Names: Chinese Knotweed, Climbing Knotweed, Flowery Knotweed, He Shou Wu, Polygonum multiflorum

Who is this for?

Note: Fo-ti is available in both unprocessed and processed forms. In the United States, no difference may be made between the two forms, even though they have somewhat different effects.

No fo-ti is included in the brand name product, Fo-ti Tieng(R).

Unprocessed fo-ti (also known as "white" fo-ti, because its color is usually much lighter than the processed form) contains a relatively high percentage of chemicals in the anthraquinone class – particularly one known as emodin. When they are taken orally, these chemicals act as laxatives by slightly irritating the lower gastrointestinal tract. The resulting muscle contractions in the intestines promote the emptying of intestinal contents. In animal studies, unprocessed fo-ti has showed some ability to improve memory, affect immune function, and protect the liver from toxins. All these effects are probably due to antioxidant properties of unprocessed fo-ti. Antioxidants are thought to protect body cells from damage caused by a chemical process called oxidation. Oxidation produces oxygen free radicals, natural chemicals that may alter immune function and damage tissues. Study evidence from laboratory, animal, and human studies and human case reports supports the use of unprocessed fo-ti as a laxative, but evidence for its other oral uses is lacking.

Topically, unprocessed fo-ti is applied to treat skin conditions such as acne, athlete’s foot, dermatitis, razor burn, and scrapes. In laboratory studies, it has shown mild antibacterial and antifungal effects; and related species of plants are known to have anti-inflammatory properties.

Even though processed fo-ti contains smaller amounts of anthraquinones, it is generally considered to be stronger than the unprocessed variety — in part because the other chemicals it contains may be concentrated during processing. Frequently called “red” fo-ti because it is much darker in color than the unprocessed variety, processed fo-ti contains protein-sugar complexes known as lectins. Because they attach to specific arrangements of carbohydrates on cells in the body, lectins act like antibodies, but they do not cause allergy symptoms. The lectins in processed fo-ti may affect fat levels in the blood, helping to prevent or delay heart disease by blocking the formation of plaques in blood vessels. Plaques are accumulations of fat and other cells that restrict the size of blood vessels and limit the flexibility of their walls. In animal studies, processed fo-ti also reduced the amount of fat that deposited in the liver and it may protect the liver from damage by toxins such as dry cleaning fluid. Processed fo-ti may also have immune system effects. Although supported by a small number of animal studies and numerous human case reports from China, where processed fo-ti has been used for centuries as an anti-aging tonic, none of these uses for processed fo-ti has been confirmed by controlled studies in humans.

However, both unprocessed and processed fo-ti have been shown in animal and human studies to lower blood levels of “bad” low-density lipoprotein (LDL) cholesterol and raise the levels of “good” high-density lipoprotein (HDL) cholesterol. It is believed that antioxidant effects are involved, as well as lectin activity. Although early results look promising, more studies are needed to prove the cholesterol-lowering effects of fo-ti. A recent chemical analysis revealed that fo-ti possesses measurable amounts of activity that is similar to the female hormone, estrogen. Although this property has yet to be studied, other herbals with estrogen-like effects may help to relieve the symptoms of menopause.

When should I be careful taking it?

Unprocessed fo-ti works by irritating the lining of the gastrointestinal tract. For most individuals, this irritation is minor. However, it can worsen inflammatory bowel conditions such as Crohn's disease and irritable bowel syndrome. Therefore individuals who have inflammatory bowel conditions should not use unprocessed fo-ti.

The potential effects of either form of fo-ti on the liver make its use inadvisable for individuals with liver conditions.

Precautions

The use of fo-ti is not recommended for women who are pregnant. Breast-feeding women should also avoid fo-ti, which is known to enter breast milk. Taking it while breast-feeding may cause diarrhea in the infant.

Individuals who have unexplained abdominal or stomach pain may have conditions that could be worsened by taking unprocessed fo-ti. Its use should be avoided by individuals with such pain.

What side effects should I watch for?

If unprocessed fo-ti is used in high doses or for prolonged periods of time, it can lead to reduced potassium levels in the body. Low potassium levels can result in muscle weakness and potentially dangerous changes in heart rhythm.

At least one case of cholestatic hepatitis has been documented in an individual who took processed fo-ti. Cholestatic hepatitis involves the build up of bile in the liver's bile ducts. Its symptoms may include intense itching and yellow-colored skin.

Less Severe Side Effects

Unprocessed fo-ti has been associated with abdominal cramping, diarrhea, and nausea.

Isolated cases of rash — possibly related to allergic responses — have been reported in individuals using either form of fo-ti.

What interactions should I watch for?

Prescription Drugs

Diuretics ("water pills") such as furosemide and hydrochlorothiazide, may promote the loss of potassium from the body. Since taking unprocessed fo-ti also may lead to potassium loss, the levels of potassium in the blood may become too low if unprocessed fo-ti is taken at the same time as a water pill. Low blood potassium is called hypokalemia. Symptoms of hypokalemia can include:

  • Abdominal cramps
  • Constipation
  • Low blood pressure
  • Muscle weakness
  • Nausea
  • Vomiting
  • Hallucinations
  • Respiratory failure
  • Cardiac arrest

The possible potassium deficiency caused by the diuretic action of unprocessed fo-ti may also increase the risk of side effects from the drug, digoxin. Digoxin's side effects may include changes in vision, drowsiness, heart rhythm changes, nausea, and vomiting.

Non-prescription Drugs

Taking unprocessed fo-ti at the same time as a commercial laxative may increase the laxative effects as well as the risk of potassium loss from the body. In general, it is not recommended to use both unprocessed fo-ti and another laxative at the same time.

Herbal Products

Unprocessed fo-ti possibly could increase the laxative effects of other herbal laxatives including:

  • Alder Buckthorn
  • Aloe
  • Cascara
  • Rhubarb
  • Senna
  • Yellow Dock

Some interactions between herbal products and medications can be more severe than others. The best way for you to avoid harmful interactions is to tell your doctor and/or pharmacist what medications you are currently taking, including any over-the-counter products, vitamins, and herbals.

Should I take it?

Native to China, fo-ti is also grown in Japan and other parts of Asia. The Asian name for it is he shou wu, which may be spelled many different ways. In western countries, fo-ti is often called Chinese, climbing, or flowery knotweed because it grows in long, knobby vines that look like strings with many bumps or knots in them. Fo-ti grows in warm climate areas as a flat-leafed, but evergreen vine that easily reaches 30 feet or more in length. In late summer and early fall, the vines produce an abundance of tiny white or cream-colored flowers that may make the vine look like it is covered with fluff.

For use in medicine, fo-ti roots and rhizomes are collected in the autumn and dried. Rhizomes are fleshy extensions of plant stems that run along or under the ground and often produce shoots and roots for new plants. Generally, these “underground” parts are harvested from fo-ti plants that are at least 3 years old, but Chinese healers regard older roots as more powerful. Reportedly, fo-ti roots up to 300 years old have been used to prepare anti-aging tonics. Fo-ti may be used in unprocessed form or it may be processed by repeatedly drying and steaming it. Unprocessed fo-ti is light in color, so it may be called white fo-ti, while the darker-colored processed version is frequently sold as red fo-ti. Known as he shou wu in China, fo-ti is sold as an individual product of either the unprocessed or processed kind, but more often it is found as an ingredient in the traditional Chinese 13-herb mixture known as shou xing bu zhi. However, it is not in the brand product known as Fo-ti Tieng (or Fo-ti Teng) which is a combination of herbs mainly used to treat depression.

Dosage and Administration

Note: In the United States, Canada, and other English-speaking countries, no distinction may be made between unprocessed or processed fo-ti. If you decide to use fo-ti, be sure that the product you purchase is appropriate for the condition you intend to treat.

Both types of fo-ti are available individually in a number of oral dosage forms that include bulk powder, capsules, extracts, and syrups. Much more frequently, one or both forms are included in tonics that contain 12 or more herbals. All of these fo-ti products have different dosage recommendations for different conditions. If you decide to use fo-ti, follow the directions on the package you purchase.

As a tonic, fo-ti has been taken daily for lifetimes by millions of individuals. In general, however, laxatives should be used only long enough to correct constipation — never longer than 7 to 10 days because prolonged use has been associated with the loss of potassium from the body. Potassium levels that are too low can cause muscle weakness and potentially dangerous heart rhythm changes.

Summary

Unprocessed fo-ti may be taken by mouth as a laxative. It may also be applied to relieve minor skin conditions. Processed fo-ti is purported to prevent or slow plaque formation in blood vessels and it may protect the liver from damage, as well. Both forms of fo-ti may reduce cholesterol levels.

Risks

Taking fo-ti may worsen bowel, liver, or stomach conditions. Pregnant and breast-feeding women are advised to avoid its use.

Side Effects

Unprocessed fo-ti's laxative effect may lead to hypokalemia (low potassium levels) if it is taken for longer than a few days at a time.Processed fo-ti has been associated with hepatitis in at least one documented case.

Either form of fo-ti may cause an allergic reaction, usually seen as a skin rash.

Interactions

If unprocessed fo-ti is taken with digoxin, diuretics, other laxatives, or drugs or herbal products that promote potassium loss from the body, the chances of hypokalemia may increase.

References

American Herbal Pharmacology Delegation. Herbal pharmacology in the Peoples’ Republic of China. 1975. National Academy of Sciences. Available at: http://www.swsbm.com/Ephemera/China_herbs.pdf. Accessed November 25, 2003.

Anon: Fo-ti. In: DerMarderosian A, Beutler JA, eds. Facts and Comparisons: The Review of Natural Products. St. Louis, MO, Facts and Comparisons. May 1998.

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

Chan YC, Cheng FC, Wang MF. Beneficial effects of different Polygonum multiflorum Thunb. extracts on memory and hippocampus morphology. Journal of Nutritional Science and Vitaminology. (Tokyo). 2002;48(6):491-497.

Chan YC, Wang MF, Chang HC. Polygonum multiflorum extracts improve cognitive performance in senescence accelerated mice. American Journal of Chinese Medicine. 2003;31(2):171-179.

Chan YC, Wang MF, Chen YC, Yang DY, Lee MS, Cheng FC. Long-term administration of Polygonum multiflorum Thunb. reduces cerebral ischemia-induced infarct volume in gerbils. American Journal of Chinese Medicine. 2003;31(1):71-77.

Chen Y, Wang M, Rosen RT, Ho CT. 2,2-Diphenyl-1-picrylhydrazyl radical-scavenging active components from Polygonum multiflorum thunb. Journal of Agricultural and Food Chemistry. 1999;47(6):2226-2228.

Gruenwald J, Brendler T, Jaenicke C, eds. PDR for Herbal Medicines, 2nd edition. Montvale, NJ: Medical Economics Company, Inc; 2000.

Grech JN, Li Q, Roufogalis BD, Duck CC. Novel Ca(2+)-ATPase inhibitors from the dried root tubers of Polygonum Multiflorum. J Nat Prod. 1994 Dec;57(12):1682-1687.

Hong CY, Lo YC, Tan FC, Wei YH, Chen CF. Astragalus membranaceus and Polygonum multiflorum protect rat heart mitochondria against lipid peroxidation. American Journal of Chinese Medicine. 1994;22(1):63-70.

.Huang HC, Chu SH, Chao PD. Vasorelaxants from Chinese herbs, emodin and scoparone, possess immunosuppressive properties. European Journal of Pharmacology. 1991;198(2-3):211-213.

Jellin JM, Gregory P, Batz F, Hitchens K, et al, eds. Pharmacist's Letter/Prescriber's Letter. Natural Medicines Comprehensive Database, 3rd Edition. Stockton CA: Therapeutic Research Facility, 2000.

Jeuken A, Keser BJ, Khan E, Brouwer A, Koeman J, Denison MS. Activation of the Ah receptor by extracts of dietary herbal supplements, vegetables, and fruits. Journal of Agricultural and Food Chemistry. 2003;51(18):5478-5487.

Li RW, David Lin G, Myers SP, Leach DN. Anti-inflammatory activity of Chinese medicinal vine plants. Journal of Ethnopharmacology. 2003;85(1):61-67.

Lin LC, Nalawade SM, Mulabagal V, Yeh MS, Tsay HS. Micropropagation of Polygonum multiflorum THUNB and quantitative analysis of the anthraquinones emodin and physcion formed in vitro propagated shoots and plants. Biology and Pharmacology Bulletin. 2003;26(10):1467-1471.

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. [Article in Chinese] Zhongguo Zhong Yao Za Zhi. 1992;17(10):595-596 and 639.

Oerter Klein K, 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. Journal of Clinical Endocrinology and Metabolism. 2003;88(9):4077-4079.

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(Note: The above information is not intended to replace the advice of your physician, pharmacist, or other healthcare professional. It is not meant to indicate that the use of the product is safe, appropriate, or effective for you.)

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