[toc]As an American, you’ve probably never heard of this before. But in Traditional Chinese Medicine (TCM), it’s well known as being a purported health and longevity tonic.
What is fo ti root good for?
As legend has it, this herb is how to reverse gray hair naturally. That’s its biggest claim to fame. To a lesser extent, fo ti for hair regrowth is also a purported benefit.
Ho Shou Wu (何首乌) which is the Chinese name for the herb, literally translates as: Mr. Ho’s hair is black.
- Ho = last name
- Shou = head
- Wu = black
In the simplified writing system for Mandarin Chinese – known as Pinyin – the man’s full name is He Tianer. That’s why some sources call him Mr. He instead of Mr. Ho.
Supplement summary: There is very limited research on the potential benefit of reversing grey hair. However, the human study that was published is compelling, as well as the research on rodents. It may be for real.
While hard to find at stores, you can buy the certified organic powder on Amazon.
The root’s nutritional value and antioxidant content for vitamin C, vitamin A, and so forth is not well-studied.
Being a foreign ingredient in the west and given that it’s not really used as food, you won’t find nutrition facts for it in the USDA National Nutrient Database, like you would for root vegetables such as carrots and yams.
Nor will you find organic fo ti root powder for sale. Or at least not USDA certified organic.
Being a niche ingredient, there’s not enough demand for manufacturers to bother with that expensive certification process. Even if it’s not officially organic, pesticide use on root foods is often limited.
Monsanto and others would not bother to genetically modify such a specialty supplement. Ho Shou Wu is non-GMO regardless of source or supplier.
Who is Mr. Ho?
So who is this guy and what does his black hair have to do with anything?
Li Ao was a Taoist during the Tang Dynasty (618-907 A.D.). Around the year 813, he wrote Heshouwu Lun (Notes on Ho-Shou-Wu) which tells the following story of Mr. Ho…
Living in the Hebei province, this 58 year old man had suffered from infertility his entire life. Wanting to have children, a monk told him to eat ye jiao teng (首乌藤).
Ye jiao teng is yet another name for Ho Shou Wu. However in the west, it’s often called fo ti.
Fo ti is a shortened, easier to say nickname for the botanical name of the plant; Fallopia multiflora. Other names include:
- Chinese knotweed
- Tuber fleeceflower
- Flowery knotwood stem
- Polygonum multiflorum
- Polygonum vine (this is an umbrella term covering other plants, too)
- Fleeceflower caulis
Whatever you want to call it, a monk recommended that the infertile Mr. Ho harvest this plant from the mountain and eat its tuber root on a normal basis.
Mr. Ho followed that advice and as the story goes, he gradually began to experience anti-aging benefits, turning his grey hair into black naturally. His vision and skin complexion got better, too.
Since those of full Chinese lineage almost always have jet black hair, it’s unclear whether it was historically believed to keep brown hair from fading (or blonde, red, etc.).
As for being infertile? Supposedly he developed a ferocious sexual appetite and his sperm started to work – becoming the father of multiple children. He or the local villagers even changed his name to Neng Si, which translates as being able to have children.
When Mr. Ho/Mr. He/Neng Si died at the age of 130, he wasn’t bald and didn’t have grey or white hair.
Check out the book Medicine in China: History of Pharmaceutics for more info on this story.
So the history of fo ti originates from a legend that’s some 1,200 years old, with only one text written about it at the time, by just one author (Li Ao). Considering that, it’s impossible to know which parts – if any – of this story are true.
Using that story as a basis to spend your hard earned money on an herbal remedy makes absolutely no sense. Rather, you need to turn to reviews of fo ti supplements which are done by modern scientists.
Ginseng, ginkgo biloba, goji berries, and reishi mushrooms are all foods and herbs coming from Traditional Chinese Medicine. Here in the West, those have gone somewhat mainstream and as a result, there’s a fair amount of scientific research on them.
But those are outliers.
The list of TCM herbs is several dozen long. Most of them aren’t formally studied for health, some for good reason.
For example, even without a clinical study, it’s safe to predict that drinking liquefied deer or tiger penis will not work as a natural Viagra for men, right?
For the remedies which seem more plausible, researching those isn’t always a straightforward process.
Much of TCM involves herbal combinations, so in order to figure out what – if anything – is the active ingredient(s) in a given remedy, it would require a series of clinical trials to test each herb out separately.
In the case of the Ho Shou Wu supplement, it’s in the minority in that it is used as a stand-alone. Studying it would be a lot easier, but has anyone done so?
What does research say?
The U.S. government’s PubMed is always the go-to spot to search for legit medical research.
If there’s a clinical study or a paper that’s been published in a peer-reviewed journal, it’s going to almost certainly be found in PubMed. There are now almost 30 million entries in this database.
If you look for fo ti root grey hair, this is what you get…
PubMed is actually quite good at automatically including synonyms and alternate spellings of a word, but to be sure we looked for gray (with an “a”) and got the same. No luck with Ho Shou Wu or Chinese knotweed, either.
Nothing, so let’s go more broad and look simply at fo ti hair. Finally, we get a hit! Just one study (2):
Title: Mechanistic Studies on the Use of Polygonum multiflorum for the Treatment of Hair Graying
Title: Mechanistic Studies on the Use of Polygonum multiflorum for the Treatment of Hair GrayingAuthors: Han MN, Lu JM, Zhang GY, Yu J, and Zhao RH of Yunnan University of Traditional Chinese Medicine (Yunnan, China)
Date Accepted: October 19, 2015
Publisher: BioMed Research International (a peer-reviewed, open access journal)
Probably the reason this didn’t show up in the initial search is because only the word “graying” (versus gray or grey) is in the study’s title and abstract.
Does fo ti root work? To the best of our knowledge, this is the first scientific study for the topic, which was accepted in an English language peer-reviewed journal.
Now around 15 years prior to that – way back in 2002 – there was reportedly a randomized, double-blinded, and placebo-controlled trial which looked at a total of 26 pre and post-menopausal women using fo ti for hair loss. They took it for 3 and 6 months and allegedly:
- 97% (25 of the women) experienced a “significant improvement of hair loss”
- 77% (20) had a “significant” or “dramatic” improvement in “thicker hair”
The type of fo ti used was a branded supplement called NuHair. The 2015 study which mentions this earlier trial actually misspelled it as NeHair. That’s clearly a typo, since they correctly identify the manufacturer as Biotech Corporation. That company (and their product NuHair) was acquired by Natrol in 2006 (3).
The problem is the 2002 trial is nowhere to be found on PubMed. Or anywhere else for that matter.
We are only aware of its existence because the more recent 2015 study mentioned it in passing. It does not appear to be available for public viewing, nor can we find others online discussing it.
The 2015 study also mentioned another trial about using NuHair for men and women. It involved 48 participants who were 30 to 60 years old. Purportedly, 91% and 87% of the men and women, respectively, experienced improvement after one month of use, with no reported side effects.
But once again, that study is not found on PubMed or elsewhere.
To the best of our knowledge, considering that:
- Neither of the NuHair clinical studies are publicly available.
- Neither qualified for inclusion in PubMed.
The only prudent approach is to exclude them from our review, since their study designs and results cannot be verified or scrutinized.
Today, NuHair dietary supplements are still for sale and appear to be fairly popular based on reviews we have read. However their ingredients consist of fo ti root extract along with several botanical ingredients and vitamins.
So even if those two trials could be analyzed and if they passed muster, neither would be helpful for evaluating the P. multiflorum tuber root extract as a stand-alone ingredient for hair loss.
That leaves us with only one study to go off of… the 2015 study which showed up in PubMed. It is peer reviewed and can be viewed in its entirety. One or even several studies cannot prove if the root benefits aging grey hair or promotes hair growth. Regardless, it’s intriguing to hear what they have discovered…
The human clinical study
The intro of the 2015 published study starts out by addressing what causes hair color to change:
- Aging, which is the most obvious cause
- Excess amounts of stress
- Medical conditions, such as diseases of the scalp and others which may cause abnormal hair growth.
- Achromotrichia, which is a term not often used these days. It means reduced or total absence of pigment in the hair follicles. It can be caused by many things including malnutrition, pulling/pressure, radiation, or even selective freezing of the follicles.
While it’s true that your age, genetics, and lifestyle are major factors, they aren’t the only causes.
Cytokine and proteins in the body are emphasized as other factors which can affect melanin regulation in the follicles.
While it’s probably way more than you want to know, the expanded biological explanation includes:
- TYR (tyrosinase)
- TRP-1 (tyrosinase related protein 1)
- TRP-2 (tyrosinase related protein 2)
- POMC (proopiomelanocortin)
- α-MSH (α-melanocyte-stimulating hormone)
- MC1R (melanocortin 1 receptor)
- ASIP (agouti signaling protein)
- MITF (microphthalmia-associated transcription factor)
Not that it’s expected to make sense to you, but the figure on the right is how those things play a role in the regulation of melanin production for human hair or fur in animals.
We promise there’s a good reason why we are listing this technical jargon. You’ll understand in a moment.
These researchers at Yunnan University of TCM claim they have studied fo ti “for decades” and that both the oral and topical uses of it have “promoted hair growth.”
In their 2015 published study, they used pure Polygonum multiflorum root which was harvested from the Yunnan province in China. They used it to create a powder supplement, which was mixed with saline water.
Cured root – This is the preparation method for it in Traditional Chinese Medicine. It is fo ti cured in black bean sauce and wine. Often, these recipes are not gluten free. In the study they called this “Polygonum Multiflorum Radix Preparata processed crude” or PMRP. Many just call this prepared fo ti.
Raw root – They called this “Polygonum Multiflorum Radix raw crude” and abbreviated it as PMR in the study. That’s some fancy language to describe the raw fo ti root extract.
TSG – What they believe to be the primary active ingredient in the root. They isolated it and used a 98% concentration for some tests.
They did way more than Petri dish experiments, but this was only an animal study (not human). Here’s how it worked:
- 50 male mice that were 6 weeks old were used.
- They were randomly divided into 5 groups (10 per group). See below for breakdown.
- For 6 weeks, each group had a different hydrogen peroxide (H2O2) solution swabbed on their back fur, to intentionally turn their red-brown and pure black hair to a white-grey color.
| Group | Hair Color Fading Agent | Treatment | Active Ingredient Dosage (g/kg) | |
|---|---|---|---|---|
| Oral | Topical | |||
| A | none (control group) | saline water | none | none |
| B | hydrogen peroxide | saline water | none | none |
| C | hydrogen peroxide | isolated chemical constituent of root (TSG) | 0.034 | 0.068 |
| D | hydrogen peroxide | raw root (PMR) | 0.576 | 1.152 |
| E | hydrogen peroxide | cured root (PMRP) | 0.576 | 1.152 |
At the end of the 6 weeks, samples of the hair were collected from the backs of the mice and analyzed using various instruments. Next, their skin was harvested (presumably after killing them) and it was analyzed for proteins and growth factors.
Their conclusion?
“Extracts of P. multiflorum, especially from raw crude drug, could completely reverse the hair decolorization induced by H2O2.”
Their claim is that the supplement completely reverses the gray or white hair which was created by the hydrogen peroxide (H2O2).
“Expressions of a-MSH, MC1R, and TYR are upregulated and then more melanin is produced as a consequence.”
That’s the how fo ti works to stop the discoloration, or at least they theorize that based on what they saw with the measurements in mice for:
a-MSH = α-melanocyte-stimulating hormone
MC1R = melanocortin 1 receptor
TYR = tyrosinase
Up above in the introduction, those were 3 of the factors mentioned (and shown in the confusing diagram) which were said to affect melanin regulation in hair.
Group A = no fading, no treatment (placebo group)
Group B = hydrogen peroxide fading, no treatment
Group C = hydrogen peroxide fading, treatment with root’s active ingredient
Group D = hydrogen peroxide fading, raw root extract treatment
Group E = hydrogen peroxide fading, cured root treatment
As you see in the above photos, all 3 groups treated with the plant (C, D, E) show how they restored pigment to more closely resemble the unfaded/untreated mice (A).
“In our research, PMR, but not PMRP, showed better effect on hair blackening. However, further clinical investigations were still needed to provide more solid and scientific evidences.”
PMR = The raw Chinese knotweed which was used.
The other version, PMRP, was the traditional recipe for the fo ti cured root extract. That was apparently less effective for restoring natural hair color.
The verdict
It is said this tuber root tonic has been used for twelve centuries in China, but we don’t even have twelve studies on using it for minimizing or stopping grey hair! We have just one study – with mice at that –which is far from sufficient for drawing any kind of verdict.
That being said, the very preliminary findings are intriguing nonetheless.
They at least suggest that just possibly, there might be some legitimacy to the legend of Ho Shou Wu. Not for the original story of Mr. Ho, but at least for what Traditional Chinese Medicine has reportedly been using the root extract for – hair rejuvenation.
Keep in mind this one study involving mice only looked at discoloration that was not age induced. Yes, the researchers seemed to infer it might mimic the effects of age-related graying, but that’s yet another unknown in the equation.
Potential side effects
Efficacy aside, there’s also the safety which needs to be thoroughly researched according to modern medical standards.
Even though Ho Shou Wu has been used for centuries in China and is considered by many to be safe in moderation, no one can say for sure without proper human clinical trials.
Is it safe to take fo ti root during pregnancy? Or how how about during breastfeeding?
Both scenarios are possibly unsafe.
Since it can have a laxative side effect, that could be passed on through the breast milk (which would be horrible for the baby). But even if not breastfeeding – and not even pregnant – there have been concerns about it causing liver damage. Possibly, enough toxicity to even cause hepatitis (4) (5).
In diabetics, it is said to possibly cause hypoglycemia (low blood sugar). Normally that would probably be a benefit, though in combination with insulin injections it could result in blood glucose that’s too low. (6)
For reasons like these, even as a dietary supplement, it’s something people should speak to their doctor about before using.
Fo ti and estrogen
One side effect which a few bloggers and forum posters have raised concerns about does seem very unlikely.
Some men fear they might experience feminizing side effects due to the root’s phytoestrogen.
How much fo ti should you take for gray hair or thickening is typically advised to be 500 mg capsules, according to numerous manufacturers who sell it. They often list a dosage of 1 or 2 capsules per day. That would hardly provide any phytoestrogen on a relative basis.
Why? Because how much estrogen there is in fo ti is roughly the same as soy, at least for estradiol-like activity according to one study (7) (8). That’s what you see in the bar graph.
As measured in estradiol equivalents [(pmol/liter) per µg herb]:
- Soy = 363.4 ± 124.8
- Ho Shou Wu = 407.5 ± 55.1
Now think about this… they have roughly the same amount of estrogen-like compounds by weight, but what is the serving size of each?
One is a tiny capsule, while the other is a food, which are you are eating up to hundreds of times more by weight in a given day. That is, if you ate some tempeh or tofu during a meal.
It is true that natural Ho Shou Wu powder inside a supplement capsule is more concentrated than fresh root, since its water content has been removed. But the researchers used dry soy extract in this estrogen testing, so it was an apples to apples comparison.
Furthermore, soy is high but it’s by no means the worst. Not even close.
Flax seeds are the real devil, at least for men. This “superfood” is in everything now, but its phytoestrogen content is totally out of control:
- 18x higher than tofu
- 128x higher than soy milk
That’s when comparing flax using equal weight servings. It’s why our list of superfoods for men strongly warns against it and instead, suggests healthy testosterone-promoting foods.
Hair growth vs. color
Also published in 2015 by the same group was a study about the regrowth of hair using Polygonum multiflorum (9).
Why the need to develop new medicines for this? Aside from the fact that they obviously don’t work for everyone,sometimes there are harmful side effects.
The researchers pointed out how finasteride (sold under the brand name Propecia) can cause sexual side effects like impotence and lack of interest in having intercourse. Topical minoxidil (sold as Rogaine) can cause skin irritation. Flutamide (Eulexin) can have feminizing effects for men. Spironolactone (Aldactone) can allegedly even cause gynecomastia in men (male breast tissue growth).
In short, there are both efficacy and safety reasons as to why new hair regrowth treatments need to be developed, which was the motivation for this study.
Like the last one about hair going grey, this study also used male mice but even more of them – 88 in total. They were the same age, 6 weeks old at the start of it.
The researchers removed a patch of hair on their lower backs and then treated the area for a period of 6 weeks. During that time they measured:
- Hair length
- Hair covered skin ratio
- Hair color
Here’s a breakdown of the mice in the oral treatment groups…
| Group | Oral Treatment | Fo Ti Dosage (g/kg) |
|---|---|---|
| A | saline water (placebo) | none |
| B | raw root(PMR) | 0.2925 |
| C | raw root (PMR) | 0.5850 |
| D | raw root (PMR) | 1.1700 |
| E | cured root (PMRP) | 0.2925 |
| F | cured root (PMRP) | 0.5850 |
| G | cured root (PMRP) | 1.1700 |
Those photos were taken 6 weeks after the hair of the mice was removed on their rears.
Groups B, C, and D were treated with oral fo ti dosages of 0.2925/0.5850/1.1700. As you see, all 3 of these dosages resulted in excellent hair regrowth versus the placebo (group A).
Groups, E, F and G were treated with cured root and they did worse than placebo.
Not shown are groups H and I (topical go ti) and groups J and K (who got both oral and topical).
What’s the explanation for the difference in benefit? This is what they concluded…
“…both oral administration of PMR [raw root] and topically given PMRP [cured root] could promote hair growth. The hair growth promotion effect of oral PMR was most probably mediated by the expression of FGF-7, while topical PMRP promotes hair growth by the stimulation of SHH expression.”
SHH = sonic hedgehog.
No, not the 80’s video game for Sega Genesis, but rather the sonic hedgehog protein.
Yep, that really is the name of a protein in humans encoded by the SHH gene (10).
Other theorized pathways with less entertaining names were also discussed.
“In our results, PMR [raw root] was considered to be more suitable orally [pictured above], while PMRP [cured root] showed greater effects in external use.”
So in a nutshell, their conclusion was that:
- When used orally, the raw fo ti supplements worked best for growing hair.
- When used topically, the fo ti cured in black bean sauce was more effective for growth. When you see it for sale, this recipe is simply called prepared Ho Shou Wu.
Keep in mind both of those conclusions are referencing the studied mice.
“This founding enhanced our confidence in natural products application in the field of hair promotion in the future.”
That “future” word is important to remember. In the world of research, this equates to almost nothing. We need a lot more studies – including in humans – to find out if there are fo ti benefits for hair. For now, it remains an unproven supplement for reversing gray and/or hair loss.
That being said, it does seem to be worth a try given that it’s relatively inexpensive. Here’s the brand on Amazon we like.
These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.