He shou wu (fo-ti) for hair: the safety question

In many Malaysian Chinese households, he shou wu (何首乌), also sold as fo-ti, has a long reputation. It appears in tonics, soups, capsules and hair products, often with the promise of black hair and slower greying. Before taking it for hair loss, it is worth knowing what is known about its benefits, and especially about its safety.

What is he shou wu?

He shou wu is the root of a climbing plant, *Polygonum multiflorum* (also classified as *Reynoutria multiflora*). It is a well-known Chinese herbal medicine ¹. Traditionally it is prepared in different ways, raw or processed, and used in many combination formulas.

Does it help hair loss?

The traditional reputation is strong, but good-quality human trials showing that he shou wu reduces hair loss are lacking.

A 2025 review of herbal remedies for hair loss looked at many plants, including rosemary, saw palmetto, onion juice, Korean red ginseng and pumpkin seed oil. It concluded that some herbal remedies show promise, but that many studies were small, short and lacked long-term follow-up, and that larger well-designed trials are needed ². This is the general state of evidence for herbal hair remedies. A long history of use is not the same as evidence that a product works.

It is also worth remembering that hair loss has many causes. Pattern hair loss, shedding after illness or stress, thyroid problems, low iron and alopecia areata all need different approaches. An herb cannot be the right answer for all of them. See what to do first when you notice hair loss.

The safety question: liver injury

The main concern with he shou wu is the liver.

Liver injury caused by herbal and dietary supplements has become a worldwide concern, and *Polygonum multiflorum* has attracted increasing attention because of reports of liver toxicity ¹. A 2021 review describes most liver injury from this herb as idiosyncratic and immune-mediated ¹. In plain terms, this means:

• Most people who take it may have no problem, but a small number react unpredictably.
• The reaction is not simply about taking "too much". It may depend on the individual's immune system.
• The exact mechanisms are not yet fully understood, and reliable tests to predict who is at risk are still being researched ¹.

Because the reaction is unpredictable, it is hard for any person to know in advance whether they are at risk.

Signs of liver problems to watch for

If you take any herbal product and notice the following, stop and see a doctor promptly:

• yellowing of the skin or the whites of the eyes
• dark urine or pale stools
• unusual tiredness, loss of appetite or nausea
• pain in the upper right side of the abdomen
• itching all over the body

"Natural" does not mean risk-free

Many people choose herbs because they want to avoid medicine side effects. That is understandable, but herbs are biologically active, which is exactly why they can have effects, wanted and unwanted. Other points to consider:

• Product quality varies. The amount of active substance can differ between batches and brands, and products may be mixed with other herbs.
• Combination formulas can make it unclear what you are actually taking.
• Interactions with other medicines are possible.
• Existing liver conditions, regular alcohol use, or other medicines that affect the liver may add to the risk.

If you are still considering it

• Talk to a doctor or pharmacist first, especially if you have liver disease, drink alcohol regularly, are pregnant or breastfeeding, or take other medicines. See what to ask the pharmacist.
• Tell your doctor you are taking it, even if you think it is "just a tonic".
• Do not give it to children without medical advice.
• Ask about a blood test if you have been taking it for some time. See blood tests for hair loss.
• Avoid products that make strong promises about hair.

Safer first steps for hair loss

Before turning to herbs, consider:

• finding the cause with a doctor
• checking for treatable problems such as low iron or thyroid issues
• discussing treatments with evidence behind them for your type of hair loss ³

The NHS advises seeing a GP about hair loss before going to a commercial hair clinic, and notes that no treatment works for everyone ³.

The bottom line

He shou wu has a long tradition but limited evidence for hair loss, and a recognised, unpredictable risk of liver injury. For most people, the balance of benefit and risk does not favour using it for hair. If you choose to, involve a doctor and know the warning signs.

Frequently asked questions

Is he shou wu proven to help hair loss?

No. Good-quality human trials are lacking, and reviews of herbal hair remedies call for larger, longer trials ².

Why is he shou wu linked with liver problems?

Researchers have reported liver injury from Polygonum multiflorum, mostly an unpredictable, immune-mediated reaction in some individuals ¹.

Is processed he shou wu safe?

There is not enough evidence to say any form is free of risk. Discuss with a doctor or pharmacist before using it ¹.

What should I do instead?

See a doctor to find the cause of hair loss and discuss treatments suited to that cause ³.

Educational content. Not medical advice.