Chinese Longevity Herb

Fo-ti is a root herb from traditional Chinese medicine that has been used for centuries as an anti-aging tonic, and has shown promise in limited Western-style analyses.  Interest has been held back by reports of liver toxicity, but there is some indication that the benefits can be separated from the toxic effects. In my readings, I found anecdotal evidence for rejuvenation plus one older study of impressive life extension in quails. I also found many more recent studies documenting beneficial biochemical effects which may be counted indirect evidence that makes life extension more credible.  There were two clinical trials, both with promising results.

I’ve been looking into the effects of a root herb called Fo-ti or He shou wu (何首乌) or Polygonum multiflorum Thunbergia, since a friend emailed me about rejuvenating effects when he fed it to his ancient German shepherd.  I’ll call it PMT for the remainder of this page. I’ve consulted the usual PubMed sources, in addition to books on Traditional Chinese Medicine (TCM), and some scientific articles in Chinese, which I ran through Google Translate, with fair results.  

TCM is based on herbal combinations and formulas.  Each ingredient has many active compounds, and the art of TCM is to combine the combinations.  Western medicine likes to study one compound at a time, based on a scientific tradition (reductionism) that tries to understand each separate piece, then study interactions from that understanding as a foundation.  The reductionist approach was responsible for the explosive success of 19th Century physics, and has been popular ever since, but it is not obviously the best way to make progress in 21st Century biology [Carl Woese philosophy piece].  Another reason for the Western preference for single-compound treatments comes from patent law, which encourages the testing of purified compounds and disallows patents for whole plants. But our bodies are complex, homeostatic systems, and it is rarely true that the combined effect of two drugs is just the sum of the effects of each separately.  Strong interactions are the rule, rather than the exception. I believe that we are not going to find a single Fountain of Youth molecule, so I have been an advocate for high-throughput screening of many combinations of treatments, looking for combinations that stand out as especially effective. If we continue to study purified molecules in isolation, it may be a long time before we get to the point where we understand the biochemistry well enough to identify magic combinations on theoretical grounds.

A curious side-note: It is reasonable to expect some combinations of biochemicals to synergize in the human body.  But why should we expect these combinations to be found regularly in a single plant?  Herbal medicines are unreasonably effective in this regard.

Here [1988] is the one lifespan trial that I was able to find, which reports 50% life extension in Japanese quails.  I looked on Cochrane and, and found nothing. However, Joe Cohen over at Self-Hacked has an extensive article. “More than 100 chemical compounds have been isolated from Fo-ti, and the most biologically relevant components have been determined to be from the families of stilbenes, quinones, flavonoids, and phospholipids…Fo-ti exhibits a wide spectrum of pharmacological effects, including anti-aging, immunologic, neuroprotective, anticancer and anti-inflammatory effects.”  Stilbenes are molecules in the resveratrol family; quinones are like CoQ10, and flavonoids are polycyclic molecules in the quercetin family.

Most of the rest of what I report here comes from this Chinese review [王伽伯, 2016] and this English language review [Bounda & Feng, 2015].

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] — Bounda & Feng

Anti-inflammatory: [13] is a Korean study that found inhibition of inflammatory cytokines in white blood cells of mice.  Other studies [77] show suppression of NFκB.

Liver protection: [23] A Taiwanese study that demonstrated reduced toxicity from CCl4 after mice were treated with PMT extract.  [24] PMT reversed liver cirrhosis in mice.

Antidiabetic: [15] inhibits enzymes that digest starch [26] is an impressive study, that demonstrates inhibition of TGF-β1 and COX-2, and simultaneous enhancement of SOD and glutathione from a chemical extract of PMT called 2,3,5,4′-tetrahydroxystilbene-2-O-β-d-glucoside (TSG).  TSG is chemically similar to resveratrol, and in a worm study was more effective than resveratrol at increasing lifespan (22%).

Anti-atherosclerotic: [29] Mice don’t get heart disease so they work with rabbits.  Large reductions in measures of arterial blockage in rabbits fed a water-extract of PMT.  [30] This is really about anti-inflammatory benefits of TSG fed to mice and rats.

Neurodegeneration: [31] This was about adaptogenic benefit in mice.  Mice were protected from nerve damage by paraquat if they had been prepared with extract of PMT.  [32] worked with a mice that had been genetically modified to give them Alzheimer’s disease.  TSG was found to ameliorate the loss of memory. [33] Older rats lose their memory, as tested in their ability to remember from day to day the location of a hidden platform in a tank of water.  TSG protected memory in older rats. [34] This is a study for people who believe in the Amyloid-β theory of Alzheimer’s disease.  A large number of herbal substances were screened in cell lines that generate Amyloid-β, and the only effective inhibitor was found to be PMT extract. [9] Suppresses lipid peroxidation in response to Amyloid-β in a mouse model and increases glutathione. [116] Another successful trial, this time of TSG in a mouse model of AD. [119, 120 is in Chinese] Two clinical studies found substantial improvement in cognitive performance of AD patients with PMT.

Liver injury from PMT is linked to a certain genetic difference, labeled CYP1A2 * 1C.  I didn’t find anything more about this genetic variant. Curiously, I found several studies that claimed that PMT protects the liver, for example this.

My inclination is to look for empirical evidence and downplay theory (both Western and Chinese theory).  I believe that the emphasis on single compounds is a serious limitation of Western medical research, because the interactions are more important than the individual effects.  For me, it is an attractive feature of TCM that there is so much accumulated wisdom, not just about herbs that contain many active ingredients, but about potions that combine typically a dozen or so herbs that have been found to work well together.  So the maddening thing I’ve found is that the Chinese scientists who have studied PMT and other promising Chinese herbs fall into the Western trap and isolate one compound at a time to study their effects. What is missing is the lifespan studies based on whole herbs, or combinations of herbs, as they would be prescribed by a traditional Chinese herbalist.

I went to a local herbalist this week and asked for advice about He Shou Wu.  She explained to me that in TCM, herbs are always given in combinations. There are classic formulas with 6 or 10 or 20 herbs, and these are adjusted for individual prescription.  The main ingredients are large quantities of the herbs that move the metabolism in some direction, and the lesser ingredients counterbalance the main ingredients by pushing in the opposite direction.  Some of the directions they talk about correspond to observables we might recognize (high or low energy, sexual stimulant), and some of them are more esoteric (wet or dry, hot or cold, yin or yang). She gave me a formula with He Shou Wu as the main ingredient, and I’m going to do some more reading before I decide whether to take it.

In the meantime, I’m taking a gram of He Shou Wu extract processed with black beans each morning before breakfast and I think I detect an increase in aerobic stamina which has not listed anywhere as one of the benefits.

Acknowledgement: The idea for this research came from Jeff Bowles, who is a frequent commenter on this blog.  The Chinese research was kindly supplied by Wen-jun Li, a post-doc in the Beijing lab where I have worked the last 3 summers.

43 thoughts on “Chinese Longevity Herb

  1. Wonder if there is quinones similar to beta lapachone in He shou wu pushing the nad+/nadh balance in a favorable manner. However i do understand that, exactly by doing this, i am missing the main point of the article. ;),

    Great piece

  2. Great research Josh! Thanks for the effort….I think the readers might be interested in the story of my german Shepherd Sasha . And the legend of the general buried in a pit for 8 months or so (an attempt at execution) who could only eat Fo Ti root….One thing I have notcied is that if you look at the reviews of people who have taken Fo Ti root as a supplement..many claim that it changes their gray hairs back to the original color, and it makes hair grow out faster and thicker, and fills in alopecia spots.

  3. Okay I found an email i sent to the head of a major ani-aging / supplement companym which piqued his interest in Fo Ti , he said his staff will look into it. here goes>>>
    Hello B*** I want to tell you an amazing story that you might be able to use….

    I have a German Sheperd named Sasha..for the last 5 years of her life I have been giving her everything known to slow the aging process

    you name it deprenyl, melatonin, sodzyme resverarol, pregnenolone, 7-keto dhea, nad+, resveratrol, etc etc etc lots more- everything I take

    and she has made it to 12 years old which is kind of the end of the road for german sheperds…

    about 12 months ago..she was still getting very bad…I have about 35 feet of stairs to climb to get to my 3rd floor walk up apartment

    she was slowing down climbing the stairs little by little until about 12 months ago she needed to be harnassed and I had to lift about 1/2 her weight

    so she could go up and down the stairs….with quite a struggle

    for the months 12 months ago until about 4 months ago she no longer wanted to go outside for a walk which was okay since I had a dog box I made on the

    back of my outdoor porchdeck where she could go to the bathroom……

    she might decide to go down the stairs maybe once every month at most….

    then I took her to another condo I own in St Louis…..

    there I had a large supply of Fo Ti root which I had experimented with from time to time

    I decided to start giving her 4 pills a day of Fo Ti the brand was Paradise 16:1 500 mg pills

    I came back to Chicago 4 months later to my 3rd floor apartment..and she easily climbed the stairs all by herself….

    now she goes out for a walk and climbs the stairs almost every day and sometimes two times a day with no help from me

    everyone who knew her in Chicago…when I came back from st louis..says she looks great and a lot younger….

    eyes clearer…lost weight her hair looks great they say

    a white age spot on her muzzle seems to be fading away..I think it is a clump of gray hairs.

    Fo Ti root is considered in Chinese medicine to be the # 1 anti aging herb and they have lots of legends about it

    Fo-Ti root is infamous for gray hair reversal. Folklore and legends tell a few different versions of how the Chinese name (He Shou Wu) for this herbal adaptogen came about. One of them describes that a General He was convicted of a serious crime and sentenced to death by confinement to a remote cell that was dug into the ground with no access to food or water. After a year, upon returning to the cell to have his remains removed, his executioners were surprised to find that not only had General He survived, but he had gone through a complete rejuvenation that had been able to reverse gray hair on his head back to black. It turns out he had survived exclusively on a vine that grew in the crevices in his cell walls… the Fo-Ti root.
    Li, Ching Yuen was a master herbalist and baguazhang player (Jiulong Baguazhang) who purportedly lived to be 256 years old (according to an article from the May 15th, 1933 issue of “Time” magazine). He consumed an organic tincture of various herbs, one of which was the Fo-Ti root on a daily basis for the last 100 years of his life. He also included Ginseng, Chinese Licorice and Gotu Kola in his rice wine organic tincture. It is highly unlikely that the life of this famous Taoist will ever be proven as fact or fiction, but we can take his teaching about using lifestyle and diet for longevity as a clue for creating changes in life expectancy within ourselves. Many of the Li family descendants were centenarians and even super-centenarians.

    I looked at the chemcial structure and it is mostly compriced of resveratrol with a large molecule of glucoronic acid sticking out off of it…..

    I did a little more research and discovered that resveratrol binds Dna at various places … the minor groove….

    Binding of resveratrol to the minor groove of DNA sequences with AATT and TTAA segments induces differential stability.
    Nair MS1, D’Mello S2, Pant R2, Poluri KM2.

    I also read the reviews of people taking Fo Ti root..many say that it makes their white hair gorw back in with original color of their youth…
    and makes their hair grow thicker…..

    I too have found this effect in myself., I had a little alopecia patch on the back of my head that filled in……..

    I believe that Fo Ti root binds to dna and might act like lost methyl groups or lost chromatin that prevent the expression of pro-aging genes. kind of like putting the anti aging insulation back on the wire…

    the one drawback is that in some cases it seems like in a few cases that Fo Ti root can cause liver damage……..

    ancient chinese medicine suggests that you take fo ti root in higher and higher doses..until maybe after a month you wake up with the “sweats”
    you then switch to taking it every other day
    I think the “sweats” might be an indication of liver stress……

    keep in mind that chinese medicne has 2,000 years+ of researching medicines……
    and even though they don’t undertand or can explain the effects of their medicines they have a huge number of years more than us in witnessing the outocomes…..
    so that’ s it take a look at Fo Ti root!!!

    • Jeff Bowles:

      Thank you for your intriguing post.

      The liver issue may be a unique to a person’s individual biochemistry.

      The unique biochemistry issue likely applies to any pharmaceutical drug, Herb or nutrient.

      The sweating issue, as a harbinger of liver issues, was an interesting bit of information and likely helpful to readers, here.

      I like that you were giving your dog nutrients and herbs.

      I have experimented in a similar way throughout the years on my dogs.

      I first research to find out if any food or nutrients are uniquely toxic to dogs, while being relatively non-toxic in humans to ensure that I am not giving the dog anything not recommended as safe for dogs, even though it may be safe for humans.

      I had a British Labrador that was given to me by a friend, when he could no longer take care of him, because of his own human health issues.

      At the time, The dog was 10 years old and had a lump on his ear, diagnosed as Fibrosarcoma.

      I had the Fibrosarcoma surgically removed but being as he was already 10 and the Vets told me that the average life span of a British Labrador is 12 years, I opted not to use prescription chemotherapy or radiation or any other treatments following the surgery. I felt it was a quality of life issue.

      Instead I started giving him helpful nutrients and herbs. I also put him on a homemade diet, after ensuring that the food I gave him was not toxic to dogs, such as onions or walnut, chocolate, etc.

      He lived to be 17 & 1/2 years old and he was relatively strong, Strong enough to pull down a 6 ft 2″ adult male, if he saw a squirrel he wanted to chase.

      He was still walking on his own and able to hold his bowels, until the last few months of his life.

      I also had a Malamute that was diagnosed at age 2 with Cushings Disease. She was on Lysodren, the only available treatment, at the time, according to the renowned University animal hospital that diagnosed her.

      I augmented that treatment with nutrients and herbs that were not known to interact negatively with the Lysodren.

      She was predicted to only live to be 5 or six at the most, but made it to 9 years of age.

      I realize this is anecdotal information, but the experiential success with my dogs has convinced a few friends to start judiciously taking nutrients or herbs.

  4. A place with information on first-rate Chinese herbs. I buy alli medicinal mushroom extracts. Their summaries incorporate data from Chinese papers. You can consult their team of chemists as well, I did it twice. They are very kind.

    For longevity always buy the prepared root – red-black color- He shou wu.
    Not to confuse with Polygonatum multiflorum (Solomon’s seal)

  5. The importance of the liver cannot be overstated.

    And here is another alarming point that Westerners do not tend to think about as much as we expats that live in Asia know all to well about: Be very careful of any Chinese product that is orally consumed. Cheating on content and quality is widespread in all foods, medicines, herbs, vitamins, by manufacturers. They just do not care about harming the health of their consumers- it is all about maximizing profit.

  6. Interesting, one of the projects our group in India are working on is just such a (herbal) preparation, but with a very different principle for combining different herbs and chemicals than you suggest – and based on a reductionist platform; in this case turning off those systems that cause or allow damage and turning on repair and maintenance systems. The gene regulatory systems that control aging form a highly evolutionarily conserved network with with multiple, multi-functional control points, the most well known being mTOR. These are the very systems Nature uses. We target those control points. We were actually surprised by how good our results were, it honestly makes me wonder how malleable aging is, and how we really can’t define it except operationally as a greater probability of death, as damage and dysfunction. What about the various epigenetic clocks, if they measure a reversal in aging does that mean that mean that aging was reversed, and if DNA methylation sites are merely keeping a history (say, of metabolism), rather than being causally involved in aging, then is it possible a cell/organism may be rejuvenated without changes to its epigenetic clock? So what happens if you have a rat that shows a spectrum of youthful characteristics in spite of being old- is there a difference between aging and damage. I say there is.

    • Could you elaborate any more on the distinction between age and damage? Do you mean that you can be old and undamaged, or that even when rejuvenated you are still aged in some other way connected to mortality?

      • I think it was Stephen Horvath who commented on the difficulty of linking particular methylation states and phenotypes on the Renaissance Bio video Josh posted a few months ago. So, even if we have a hunch that ageing is mostly driven by epigenetic changes, we cannot demonstrate it by looking at gene expression.

        This is a point that is seldom made, I guess because it is a bit embarrassing to admit we do not know the exact pathways by which a particular epigenetic marker affects a phenotype. I imagine it is the same situation with GWAS studies and individual SNPs. We have strong statistical correlations but no strong empirical proofs.

        So I think the problem is establishing a line of causality, and how difficult it is to do it from gene expression up. Perhaps epigenetic changes associated with the Horvath clock are just a response to hyper-function, but I find that the ‘reset’ of the state all the way down to negative at the embryonic stage is a strong indication that epigenetic changes are the driver. Of course it could also be a feedback loop, and more difficult to establishing a starting point.

        • I don’t think its that hard – the more obvious conclusion from Horvath’s clock is that the methylation changes he is looking at (which tally with chronological age) are just ‘left-over changes’ that the body has not bothered to correct because they are not important to function.

          This does not mean epigenetic changes are not important, far from it, just that his sites are not.

          • I don’t believe that the Horvath clock sites are “left-over” or “not important to function”. His finding was much more limited than that: these sites are not ADJACENT to any of the known genes that rise or fall with age. But the ways in which epigenetic markers control gene expression are complex and various and mostly not understood. Epigenetic markers control the ways in which DNA is spooled (heterochromatin) and exposed (euchromatin), sometimes nearby and sometimes far away from where the markers are located. Also, most genes and RNAs affect the expression of other genes indirectly. In other words, the system is just about as complex as it can be, and we don’t understand any of the details. We are just at the place where we understand how much we don’t understand! In this context, it is hardly surprising that the sites of Horvath’s clock are not adjacent to known genes connected to aging.

          • One thing that occurs to me Josh, is that Horvath’s clock seems to be a measure of development – it advances faster pre adulthood, and also faster in animals with a greater metabolic rate. So it might be a measure of the forces of terminal differentiation in the developing body, telling the cells when to settle down into a specific lineage for example, also depending on other more local factors like inflammation. Once a cell is terminally differentiated the clock continues to tick (as we saw in his in vitro experiments). But it doesn’t seem to be detrimental, atleast in the immortalised line he used.

          • I guess what I am trying to say, is that Horvath’s epigenetic changes might not cause harm on an individual cellular level, but rather reflect a lack of stem cells in the body at large.

    • Hi HArold

      With respect to Fo Ti root….whic I belive your comment is directed..It was my thought that maybe the Fo Ti is acting like a pseudo methylation ..Replacing lost epigentics markers…Hos i this possible? resveratrol binds DNA at various points. including the minor groove? Fo Ti root is a resveratrol molecule, with a large molecule of glucornoic acid sticking off of it. I am thinking maybe the glucoronic acid acts like a replace ment for lost methylation or chromatin…Just a guess

  7. I would also like to add that the herb is supposed to be a MAO inhibitor. So… caution should be taken if one is taking deprenyl or any other MAO inhibitors…. I was unable to find the exact degree of inhibition, if it is reversible or not or the selectivity.

    • Matt –
      I can’t say I’m being prudent in the way I’m experimenting on myself, and I certainly wouldn’t recommend this path to anyone else. I take the issue of liver toxicity seriously, and I’m
      – monitoring my own response
      – planning to take Fo-ti short-term
      – taking Silymarin and other adoptogens that protect the liver

      If I’m not so worried, it’s because I’ve developed a familiarity and a comfort with Chinese products and TCM. I lived in China several months of the year, each of the last 3 years. The air in Beijing was terrible, but the food was better than what I usually eat in America. I was healthy, and lost a little weight each trip to China. Chinese herbalists treat many millions of patients, and have done so for a thousand years or more. That’s a lot of cumulative experience. It is common for doctors in China today to combine herbal treatments with Western medicine, choosing individually for each patient’s condition the treatment their experience tells them is best. There have been a lot of serious cases of liver toxicity from PMT, but as a percentage of the millions of people who have taken PMT, it is tiny.

      • The chinese use Scuttelaria baicalensis instead of sylimarin for liver protection and regeneration. It’s main ingredient, baicalin, is water solluble, instead of fat soluble as sylimarin, and as efficient, or as in some rats studies, even slighly better. Additionally, baicalin has skin anti-fotoaging qualities, that I couldn’t find on pubmed for sylimaryn.

          • You’ve taken american skullcap (leafs) or chinese scullcap (root)? They presumably act differently. I take only root, main dose in the morning, and haven’t seen such effects. But it depends of the mix with other herbs. Colleague who’ve taken chinese skullcap with astragalus noticed the same as you. But for me astragalus lowers blood pressure so much that I’ve move like a drunkard and feel very sleepy when taken with skullcap too, so I only take minimal doses of it and only before sleep in the night.

  8. Hi Josh,

    I always read your posts with great appreciation and awe–and your self-experimentation with admiration, particularly when Chinese herbs are involved.

    As a Chinese American, I grew up being dragged to the Chinese medicine shop for every significant sickness. What appeared to be an effete old man would rest my hand on a comfortable silk pillow, and then he would hold my wrist while ruminating on my holistic condition. After this “analysis,” he would issue a prescription. The herbalist in the front office would scoop twigs, leaves, little nuggets of things, dead insects, etc., onto a sheet of paper. My mother would take that home, boil it into a poisonously bitter sludge, and then feed it to me. I always looked forward to chasing that stuff down with the free candies that were included!

    Today, my wife is a chemistry professor, and she always chortles at these childhood stories. Every year, she has her students perform assays of vitamins and drugs as part of their graduate studies, and the results have informed our deep caution towards unregulated supplements.

    Undoubtedly, there is a genuine treasure trove of cures somewhere in TCM . But how do you reconcile the risks of trying herbs with suspected toxicity, or herbs whose provenance is dependent on trust? Have you developed a trusted relationship with a local herbalist, etc.?

    Thank you for all your invaluably generous writings over the years. We have become much happier and healthier people because of your work.


    • Polygonum cuspidatum, or Hu Zhang is a plant that’s closely related to Polygonum multiflorum. There is some overlap in the chemical constituents, but traditions behind the two herbs are different, and I know of no direct comparison between the two. If there are claims that Hu Zhang contributes to longevity, I haven’t seen them. Read about Hu Zhang.

      • Polygonum cuspidatum is much cheaper source of resveratrol than grapes and is claimed by some sources to be the best cure against arteriosclerosis.

  9. From what I gather, it seems that sometimes the root is used raw (called white) and sometimes cured in a black bean sauce (called red).

    Some report that the worst side-effects are associated with the raw root and that possibly some of the more toxic substances in the root are removed or reduced in the prepared product.

    I would be interested if anybody has any more information on this – risk profiles for the raw vs prepared root.

    • Yes, this is true. And all the reported cases of acute toxicity came from the “white” raw form. But, of course, many of us would want to stop far short of acute liver toxicity, and only a small percentage of toxic cases have been reported.

  10. I understand the reductionist problem. By the combinations will never tell which compound or combination of compounds is responsible for the positive effects (if any).
    The only way out would be to study the components first in separate, then in groups of only two (to look for synergisms), then 3, etc
    That is a huge expenditure of resources and time because the number of combinations would rocket with 20 30 different herbs.

    But this reality. The alternative is to try the whole mix and, if it works, and is safe, use it for health. But in this way we weill never known which componds, or combinations of some (not necessarily all) the combinations was responsible for the positive effect. Checking potential toxicity by the other non effective compounds in the mix would be also necessary

  11. Hello Josh Mitteldorf,
    Yesterday (19-1-2019) a friend brought me directly from China He Shou Wu, 500g, closed with aluminium foil. It is mixed with black bones. Pure=poison. So, I took 1g, mixed it with oats (one of the possibilities mentioned) and will do so for the coming period.
    How are you doing with it? Any new ideas? Experience?
    With friendly greetings

  12. I tried Fo-ti several years ago but like most herbs it seemed estrogenic and my prostate did not react well to it. About the only age reversing compound I take now is melatonin as per the research of Dr. Walter Pierpaoli.

    • It makes sense to use time released melatonin, in order not to disrupt circadian rythm. Ideally, it should be released from 1 am-3 am in the morning. Any thoughts?

  13. Most diseases are either caused by inflammation or are indirectly related so how about experimenting with Boswellia Serrata? I find it to be the best and safest anti-inflammatory herb. It seems that it’s anti-inflammatory properties would aid in life extension.

  14. Here’s another Chinese herb to add to your list. I make tea with it to add to my occasional Fo-Ti beverage. Jiaogulan.
    I love your in depth research. Very informative.

  15. Josh, you should look at Ayurvedic formulation Chyavanprash, whose explicit and only purpose is to rejuvenate an old body into a younger one. Chyavanprash is a jam of Indian Gooseberry fruit which has highest anti-oxidant capability of any edible vegitation. It a mixture of 80 herbs like Ashwagandha, Long pepper, Cinnamon etc which all have been found to have active compounds identified as having profound bioactive effects. And this formulation predates modern clinical methods. My guess is, these traditional medicins are all based on empirical observations, trial and error approaches, so they are effective without a doubt, even if their mode of action may not be known.

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