Peony is alterative, analgesic, anodyne, antibacterial, anti-inflammatory, antiseptic, antispasmodic, astringent, carminative, diuretic, emmenagogue, expectorant, febrifuge, hypotensive, nervine tonic and treats women’s complaints. The root of Chinese peony has been used for over 1,500 years in Chinese medicine. It is known most widely as one of the herbs used to make 'Four Things Soup', a woman's tonic, and it is also a remedy for gynaecological problems and for cramp, pain and giddiness (1).
In Traditional Chinese Medicine (TCM) white peony root is called Bái Sháo 白芍. Bái Sháo is bitter, sour and cool and enters the Liver and Spleen channels. Bái Sháo nourishes the Blood and regulates menses due to Blood deficiency, calms Liver Yang to alleviate pain from constrained Liver Qi or Liver and Spleen Qi disharmony due to Liver Yang rising, such as cramping and spasms (limbs and abdomen), abdominal pain from dysentery, headache and dizziness and preserves Yin by adjusting Ying & Wei levels and is used to treat vaginal discharge and spermatorrhoea (2).
Active constituents in Bai Shao (Paeonia lactiflora) include paeoniflorin and albiflorin (3).
Paeonia lactiflora and its constituents paeoniflorin and paeonol are antiallergic and can improve IgE-induced anaphylaxis (4).
Paeonia lactiflora displays both anti-inflammatory and immunomodulatory effects (5).
The effects of paeoniflorin and albiflorin (the principal components of peony) on cytochrome P450 (CYP) 3A4 and CYP2D6 (Phase I Liver modification enzymes) were analyzed in human hepatoma and it was found that both paeoniflorin and albiflorin could regulate CYP3A4 and CYP2D6 with varying degrees (6).
A Cochrane Collaboration Meta-analysis study supported the complementary use of herbal medicine including that of Peony lactifora as paratherapy for Parkinson disease patients (7).
Bai Shao / Paeonia lactiflora is part of Chinese herbal formula called Shi Quan Da Bu Tang, traditionally used to tonify the Blood and Qi to treat anaemia, anorexia, extreme exhaustion, fatigue, kidney and spleen insufficiency and general weakness, particularly after illness and after chemotherapy. It has been found to potentiate (make it work better) chemotherapy and radiotherapy and inhibit malignant recurrences, prolong survival and prevent and ameliorate adverse toxicities in cancer treatment (8). In Japanese herbal medicine (Kampo) the formula is known Juzen Taiho To and has been shown to increase expression of heavy metal chelating metallothioneins (MTs) (9). Shi Quan Da Bu Tang also increases transcription factor Nrf2 to support phase II detoxification thus regulate the body's detoxification and antioxidant system (10).
Paeoniflorin is the major active component extracted from white peony root and red peony root/ Chi Shao (Radix Paeoniae Rubra). Xuebijing (XBJ) is an important form of therapy in traditional Chinese medicine (TCM). Approved to treat COVID-19 in China, XBJ was effective in managing moderate and severe COVID-19. XBJ consists of safflower /Hong hua (Carthamus tinctorius), red peony root/ Chi Shao (Radix Paeoniae Rubra) Ligusticum /Chuan xiong (Ligusticum wallichii), Red Sage/ Dang shen (Salvia miltiorrhiza), and Chinese angelica/ Dang gui (Angelica sinensis). A retrospective case-control study in the treatment of COVID-19 found that XBJ has been shown to good affinity with SARS-CoV-2 Mpro/3CLpro and ACE2 (11).
1. PFAF. Paeonia lactiflora 2019 [Available from: https://pfaf.org/USER/Plant.aspx?LatinName=Paeonia+lactiflora.
2. Qi Ma. White peony roots. 2019.
3. Lee S, Khoo CS, Hennell JR, Pearson JL, Jarouche M, Halstead CW, et al. LC determination of albiflorin and paeoniflorin in Bai Shao (Paeonia lactiflora) as a raw herb and dried aqueous extract. Journal of AOAC International. 2009;92(4):1027-34.
4. Lee B, Shin Y-W, Bae E-A, Han S-J, Kim J-S, Kang S-S, et al. Antiallergic effect of the root of Paeonia lactiflora and its constituents paeoniflorin and paeonol. Archives of Pharmacal Research. 2008;31(4):445-50.
5. He D-Y, Dai S-M. Anti-inflammatory and immunomodulatory effects of paeonia lactiflora pall., a traditional chinese herbal medicine. Frontiers in pharmacology. 2011;2:10-.
6. Gao L-N, Zhang Y, Cui Y-L, Akinyi OM. Comparison of Paeoniflorin and Albiflorin on Human CYP3A4 and CYP2D6. Evidence-based complementary and alternative medicine : eCAM. 2015;2015:470219-.
7. Shan C-S, Zhang H-F, Xu Q-Q, Shi Y-H, Wang Y, Li Y, et al. Herbal Medicine Formulas for Parkinson's Disease: A Systematic Review and Meta-Analysis of Randomized Double-Blind Placebo-Controlled Clinical Trials. Frontiers in aging neuroscience. 2018;10:349-.
8. Chang I-M. Juzen-taiho-to (Shi-Quan-Da-Bu-Tang): Scientific Evaluation and Clinical Application. Evidence-based Complementary and Alternative Medicine. 2006;3(3):393-4.
9. Anjiki N, Hoshino R, Ohnishi Y, Hioki K, Irie Y, Ishige A, et al. A kampo formula Juzen-taiho-to induces expression of metallothioneins in mice. 2005;19(10):915-7.
10. Wu Q, Zhang D, Tao N, Zhu QN, Jin T, Shi JS, et al. Induction of Nrf2 and metallothionein as a common mechanism of hepatoprotective medicinal herbs. Am J Chin Med. 2014;42(1):207-21.
11. Guo H, Zheng J, Huang G, Xiang Y, Lang C, Li B, et al. Xuebijing injection in the treatment of COVID-19: a retrospective case-control study. Annals of Palliative Medicine. 2020;9(5):3235-48.