Evidence Level
Preliminary
He shou wu has extensive traditional use but limited modern clinical evidence and notable safety concerns. The bioactive compound TSG has shown promising antioxidant and neuroprotective effects in preclinical studies (Sun et al., 2016 review). However, the herb has been associated with significant hepatotoxicity. Lei et al. (2015) documented over 450 cases of Polygonum multiflorum-induced liver injury in China, leading to regulatory warnings. The processed (zhi) form has lower anthraquinone content and reduced hepatotoxicity risk compared to raw root, but liver monitoring is still recommended. This herb should be used under professional guidance.