Polygonum multiflorum / Fo-ti-tieng

Fo-ti is native to central and southern China and is distributed in Japan and Taiwan. It is a perennial climbing herb, which can grow to 30 feet in height. The plant has red stems, heart-shaped leaves and white or pink flowers. The roots of 3- to 4-year-old plants are dried in autumn. The stems and leaves are used also. 1 , 2

History
Fo-ti is a popular Chinese tonic herb, dating back to 713 A.D. 1 It is considered one of the country's great four herbal tonics (along with angelica, lycium and panax). 3 Regarded as a rejuvenating plant, fo-ti has been thought to prevent aging and to promote longevity. According to folklore, the older and larger roots have the most power. 1 One source quotes “...300-year-old (root) product makes one immortal.” 3

Chemistry
Fo-ti contains chrysophanic acid, chrysophanic acid anthrone and chrysophanol. Anthraquinones emodin and rhein are also present. Lecithin has also been found in the plant. 1 , 3 A stilbene glucoside from fo-ti has been identified. 4 A spectrophotometric assay of stilbene glucoside in another report may be used for quality control in the plant's processing. 5 Qualitative analysis and content determination of phospholipids in fo-ti drug vs four processed products have been performed. 6 An alcoholic extract from fo-ti roots yielded three bioactive compounds: E-2,3,5,4′-tetrahydroxystilbene, 2-O-beta-D-glucopyranoside and cis- and trans-E-3-butylidene-4,5,6,7-tetrahydro-6,7-dihydroxy-1(3H)-isobenzofuranone. Two of these compounds were found to be calcium-ATPase inhibitors. 7

Fo-ti Uses and Pharmacology

Rejuvenating and toning properties
In China, millions take fo-ti regularly for its rejuvenating and toning properties. It is used to increase liver and kidney function and to cleanse the blood. The plant is also prescribed for symptoms of premature aging such as gray hair. 1

Animal data
A Chinese-13-herb mixture (“shou xing bu zhi”) that includes fo-ti has been studied for its antisenility effects in mice. Results showed this mixture was effective in slowing the aging process. 8 It is also indicated for insomnia, weak bones, constipation and atherosclerosis. 2 Lifespan and lipid studies of fo-ti in quails have been performed. 9 Fo-ti also has been shown to reduce blood cholesterol levels in animals. 1 The root portion of the plant has exhibited an inhibitory effect on triglyceride accumulation and has reduced enlargement of mice livers. 10

Clinical data
In a clinical trial in humans, fo-ti had similar cholesterol-lowering effects. 1

Other uses
Emodin exhibited vasodilation and immunosuppressive effects in rats, suggesting its usefulness against transplantation rejection and autoimmune disease. Extract of he shou wu significantly reduced tumor incidence in rats in another report. 11 The Chinese use the root of the plant for cancer as well. 3
Stilbenes isolated from polygonum species have been evaluated on rat peritoneal polymorphonuclear leukocyte lipoxygenase and cyclooxygenase activity. 12 A mixture including fo-ti has been studied for its effects on glucocorticoid receptor in senile rat thymocyte. 13 The plant has also been shown to inhibit lipid peroxidation in isolated rat heart mitochondria. 14 Fo-ti also exhibits antimicrobial properties against mycobacteria and malaria. 1

Other uses of the plant include: To increase fertility, 1 to increase blood sugar levels, 1 to treat anemia and to relieve muscle aches. 3

Dosage
Fo-ti is used at daily doses of 9 to 15 g of raw herb; however, there do not appear to be any clinical studies supporting this dosage.

Pregnancy/Lactation
Information regarding safety and efficacy in pregnancy and lactation is lacking.

Interactions
None well documented.

Adverse Reactions
One case report describes herb-induced hepatitis in a 31-year-old pregnant Chinese woman from medicine prepared from the plant. 15 The use of these compounds in pregnant women should be discouraged.

Toxicology
There is little information in the area of toxicology from fo-ti. However, all plants that contain anthraquinone cathartic compounds should be used cautiously to prevent developing dependence on their laxative effects.

Bibliography
1. Chevallier A. Encyclopedia of Medicinal Plants . New York, NY: DK Publishing, 1996;121.
2. Reid D. Chinese Herbal Medicine . Boston, MA: Shambhala Publishing, Inc., 1994;150.
3. Duke J. CRC Handbook of Medicinal Herbs . Boca Raton, FL: CRC Press, Inc., 1989;163-164.
4. Hata K, et al. Yakugaku Zasshi . 1975;95:211-213.
5. Liu C, et al. Chung Kuo Chung Yao Tsa Chih . 1991;16:469-472.
6. Ma C, et al. Chung Kuo Chung Yao Tsa Chih . 1991;16:662-664.
7. Grech J, et al. J Nat Prod . 1994;57:1682-1687.
8. Chen J. Chung Hsi I Chieh Ho Tsa Chih . 1989;9:226-227.
9. Wang W, et al. Chung Hsi I Chieh Ho Tsa Chih . 1988;8:223-224.
10. Liu C, et al. Chung Kuo Chung Yao Tsa Chih . 1992;17:595-596.
11. Horikawa K, et al. Mutagenesis . 1994;9:523-526.
12. Kimura Y, et al. Biochim Biophys Acta . 1985;834:275-278.
13. Zhao W, et al. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih . 1995;15:92-94.
14. Hong, et al. Am J Chin Med . 1994;22:63-70.
15. But P, et al. Vet Hum Toxicol . 1996;38:280-282.

Polygonum multiflorum Thunb. (PMT, Polygonaceae family, Figure 1)), well known as He shou wu in China and Fo-ti in North America,[5] is one of the most popular perennial Chinese traditional medicinal vine-like herbs, officially listed in the Chinese Pharmacopoeia.[6] Various parts of the plants were utilized for different medicinal purposes. The leaves [Figure 2a], root tuber [Figure 2b] and rhizomes [Figure 2c] of this plant have been used as tonic and anti-aging agents[7,8,9,10,11,12] whereas the stem [Figure 2d] is used to alleviate insomnia and even to have an antidiabetic therapeutic activity as well.[13,14,15]

Laboratory studies and clinical practice have demonstrated that PMT possesses various biological and therapeutic actions, including anti-tumor,[16,17] antibacterial,[18] anti-inflammatory,[13] anti-oxidant,[19,20,21] anti-HIV,[22] liver protection,[23,24] nephroprotection,[25] antidiabetic,[15,26] anti-alopecia,[27,28] and anti-atherosclerotic activities.[29,30] It has been also reported to exert preventive activity against neurodegenerative diseases,[31,32,33,34,35] cardiovascular diseases and to reduce hyperlipidemia as well.[36,37]

The clinical efficacy, as well as the safety of PMT and its bioactive products, has attracted much attention in the recent years; due to the increasing reports of various cases on hepatotoxicity,[38,39,40,41,42] published worldwide. In the present review, the advancements in thorough investigation of clinical studies and pharmacokinetics (PKs)-pharmacodynamics (PDs) profile of P. multiflorum are discussed, meanwhile describing the clinical features of this particular herbal-induced liver injury. This report will enlighten the broad understanding on the clinical therapeutic evaluation of PMT or other herbal drug containing quite the same phytochemical components.

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