Polygonum multiflorum engages four distinct biological pathways tied to androgenetic alopecia (AGA), according to a peer-reviewed review published in Volume 6, Issue 4 of the Journal of Holistic Integrative Pharmacy (December 2025).

The herb—also catalogued as Pleuropterus multiflorus—has appeared in historical Chinese herbal writings for more than a millennium, where practitioners recommended it to "blacken hair and nourish essence." The new review synthesizes laboratory, clinical, and historical sources to map its mechanism against the most common form of progressive hair loss, which affects millions of adults worldwide.

How does the herb differ from finasteride and minoxidil?

Standard AGA prescriptions each act on a single pathway. Oral finasteride blocks 5-alpha reductase, the enzyme that converts testosterone to dihydrotestosterone (DHT, the androgen that miniaturizes follicles). Topical minoxidil extends anagen, the active growth phase of the hair cycle. Both carry documented adverse effects: clinical data link finasteride to sexual dysfunction in a subset of users, while minoxidil can produce scalp irritation and, occasionally, unwanted facial hair.

P. multiflorum, by contrast, hits four targets in parallel. The authors frame that multi-target profile as the rationale for a next-generation AGA regimen.

Which four pathways does P. multiflorum engage?

• Lowers DHT activity, slowing follicle miniaturization
• Reduces apoptosis (programmed cell death) in dermal papilla cells, the cell cluster at the base of each follicle that directs growth
• Activates the Wnt and Shh signaling cascades, two molecular pathways that drive anagen in published in vitro (cell-culture) studies
• Improves scalp microcirculation, increasing blood flow through the smallest vessels and potentially raising oxygen and nutrient delivery to follicles

That broad signature could make the herb more effective than treatments that focus on a single biological target, the authors write. The review does not yet quantify effect sizes in human subjects.

What did the historical record add?

The team aligned pre-modern herbal texts—stretching back to the Tang Dynasty—with modern laboratory and clinical observations.

"Our analysis bridges ancient wisdom and modern science," said first author Han Bixian. "What surprised us was how consistently historical texts—from the Tang Dynasty onward—described effects that align perfectly with today's understanding of hair biology. Modern studies now confirm that this isn't folklore; it's pharmacology."

Han co-authored the review with Mingzhu Xiao, Tianze Xin, Hui Hu, Quansheng Liu, and Bingqiang Xu. The paper carries DOI 10.1016/j.jhip.2025.12.005 and appears on page 443 of Volume 6, Issue 4 of the journal.

Is the safety profile favorable?

"When properly processed—a key step in traditional preparation—the herb shows a favorable safety profile, making it more acceptable to patients wary of side effects like sexual dysfunction or scalp irritation linked to current medications," the review states.

The authors caution, however, that hepatotoxicity (liver toxicity) has surfaced in case reports of poorly processed or adulterated preparations.

What remains untested?

The authors call for randomized controlled trials using standardized extracts rather than raw root, paired with controlled processing protocols. They identify AGA patient populations and the dose-response curve as two data points still missing. Long-term safety monitoring, an open question for any chronic-use hair drug, also falls into the gap.

Until that evidence arrives, finasteride and minoxidil remain the two AGA regimens with regulatory-grade efficacy data for clinicians to weigh.

The peer-reviewed paper sets the research agenda; standardizing extract preparation and confirming the four-pathway signature in human tissue will be the first hurdles before clinical efficacy claims can be benchmarked against finasteride and minoxidil.