Three similar plants are all called peony, and different parts are used in some cases. The bark of the root of Paeonia suffruticosa is called moutan or mu dan in China, where it naturally grows. Red peony root comes from wild harvested Paeonia lactiflora or Paeonia veitchii. White peony root comes from cultivated Paeonia lactiflora. The bark, red peony root, and white peony root all have somewhat different properties. Dried versus charred roots also have different properties. The color indicated does not refer to flower color. An important formula used in Chinese and Japanese herbal medicine called shakuyaku-kanzo-to contains white peony root and licorice root. The roots and flowers of Paeonia officinalis have been used in European herbal medicine. However, the German Commission E did not approve this plant for medicinal use.1
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3 StarsReliable and relatively consistent scientific data showing a substantial health benefit.
2 StarsContradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1 StarFor an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.
This supplement has been used in connection with the following health conditions:
2.5 grams a day of sho-saiko-to or saiko-keishi-to in tea or capsules
The Chinese herb bupleurum is included in two similar Chinese herbal formulae known as sho-saiko-to and saiko-keishi-to; these combinations contain the same herbs but in different proportions. The other ingredients are peony root, pinellia root, cassia bark, ginger root, jujube fruit, Asian ginseng root, Asian scullcap root, and licorice root. Both formulas have been shown in preliminary trials to be helpful for people with epilepsy.8, 9, 10 No negative interactions with a variety of anticonvulsant drugs were noted in these trials. The usual amount taken of these formulas is 2.5 grams three times per day as capsules or tea. People with epilepsy should not use either formula without first consulting with a healthcare professional.
Take 2.5 grams of sho-saiko-to three times per day
Preliminary trials have shown that the bupleurum-containing formula sho-saiko-to can help reduce symptoms and blood liver enzyme levels in children and adults with chronic active viral hepatitis.11, 12, 13, 14 Most of theses trials were in people with hepatitis B infection, though one preliminary trial has also shown a benefit in people with hepatitis C.15 Sho-saiko-to was also found, in a large preliminary trial to decrease the risk of people with chronic viral hepatitis developing liver cancer. However, people who had a sign of recent hepatitis B infection were not as strongly protected in this trial.16 The usual amount of sho-saiko-to used is 2.5 grams three times daily. Sho-saiko-to should not be used together with interferon drug therapy as it may increase risk of pneumonitis - a potentially dangerous inflammation in the lungs.17
1 to 3 grams three times per day
A crude extract of red peony root was shown in a small, preliminary trial to reduce cirrhosis in some people with chronic viral hepatitis.18 Other preliminary trials published in Chinese demonstrated that red peony root was helpful (by reducing liver enzyme levels or symptoms or both) for people with viral hepatitis.19
Under medical supervision: take the Chinese herbal formula shakuyaku-kanzo-to
One double-blind trial showed that the Chinese formula shakuyaku-kanzo-to (containing white peony and licorice roots) effectively relieved muscle cramps due to cirrhosis of the liver.20 This formula is approved by the Japanese Ministry of Health and Welfare for cirrhosis-induced muscle cramps.
2.5 grams of the Chinese herbal formula sho-saiko-to three times daily
The Chinese herb bupleurum is an important component of the formula known as sho-saiko-to. Sho-saiko-to was shown in one preliminary trial to reduce the risk of liver cancer in people with liver cirrhosis.21 The amount of this formula used was 2.5 grams three times daily.
Refer to label instructions
Turmeric’s active compound curcumin has shown potent anti-platelet activity in animal studies.22 It has also demonstrated this effect in preliminary human studies.23 In a similar vein, bilberry has been shown to prevent platelet aggregation24 as has peony.25 However, none of these three herbs has been documented to help atherosclerosis in human trials.
Refer to label instructions
Dong quai has been used either alone or in combination with other Traditional Chinese Medicine herbs to help relieve painful menstrual cramps. Many women take 3–4 grams per day. A Japanese herbal formulation known as toki-shakuyaku-san combines peony root (Paeonia spp.) with dong quai and four other herbs and has been found to effectively reduce symptoms of cramping and pain associated with dysmenorrhea.26
Hay Fever (Asiasarum Root, Cassia Bark, Ginger, Licorice, Ma Huang, Pinellia, Schisandra)
Refer to label instructions
The Japanese herbal formula known as sho-seiryu-to has been shown to reduce symptom, such as sneezing, for people with hay fever.27 Sho-seiryu-to contains licorice, cassia bark, schisandra, ma huang, ginger, peony root, pinellia, and asiasarum root.
HIV and AIDS Support (Asian Ginseng, Bupleurum, Cassia Bark, Chinese Scullcap, Ginger, Jujube, Licorice, Pinellia)
Refer to label instructions
The Chinese herb bupleurum, as part of the herbal formula sho-saiko-to, has been shown to have beneficial immune effects on white blood cells taken from people infected with HIV.28 Sho-saiko-to has also been shown to improve the efficacy of the anti-HIV drug lamivudine in the test tube.29 One preliminary study found that 7 of 13 people with HIV given sho-saiko-to had improvements in immune function.30 Double-blind trials are needed to determine whether bupleurum or sho-saiko-to might benefit people with HIV infection or AIDS. Other herbs in sho-saiko-to have also been shown to have anti-HIV activity in the test tube, most notably Asian scullcap.31 Therefore studies on sho-saiko-to cannot be taken to mean that bupleurum is the only active herb involved. The other ingredients are peony root, pinellia root, cassia bark, ginger root, jujube fruit, Asian ginseng root, Asian scullcap root, and licorice root.
Polycystic Ovary Syndrome
Refer to label instructions
Peony shows some weak estrogen-like effects, acting like a very weak anti-estrogen, particularly as part of the formula shakuyaku-kanzo-to. In a preliminary study, this formula was shown to improve fertility in women affected by polycystic ovary syndrome.32
Refer to label instructions
In Traditional Chinese Medicine, dong quai is rarely used alone and is typically used in combination with herbs such as peony (Paeonia officinalis) and osha (Ligusticum porteri) for menopausal symptoms as well as for menstrual cramps.33 However, no clinical trials have been completed to determine the effectiveness of dong quai for PMS.
Traditional Use (May Not Be Supported by Scientific Studies)
Peony is an ancient, traditional Chinese herbal medicine.2 The plant was and is extensively cultivated as an ornamental plant as well. Peony is named for the mythical Greek figure Paeon, who was said to be a student of Aesculapius, the great physician.3 Paeon used the peony plant (various species also grow in Europe) to heal a wound for the god Pluto. This earned Aesculapius’s jealous wrath, but Pluto saved Paeon from death by turning him into a peony plant.
Bai shao or white peony was considered useful for hypertension, chest pain, muscle cramping and spasms, and fever.4 It was an important remedy for female reproductive conditions ranging from dysmenorrhea (painful menstruation) to irregular menses.5 Chi shao or red peony was used for bleeding or lack of blood movement, depending on how it was prepared.6 Moutan was also considered helpful for problems characterized by bleeding, such as nosebleeds, bleeding wounds, or menorrhagia (excessive menstrual bleeding).7
How It Works
Bai Shao, Chi Shao, Moutan, Red Peony, White Peony
Peony contains a unique glycoside called paeoniflorin. Proanthocyanidins, flavonoids, tannins, polysaccharides, and paeoniflorin are all considered to contribute to the medicinal activity of various forms of peony. Paeoniflorin’s major effect seems to be to calm nerves and alleviate spasm. One study has confirmed the efficacy of shakuyaku-kanzo-to (formula with peony and licorice) for relieving muscle cramps due to cirrhosis of the liver, diabetes, and dialysis.34 Shakuyaku-kanzo-to is approved by the Japanese Ministry of Health and Welfare for treatment of muscle cramps. Another Japanese formulation known as toki-shakuyaku-san combines peony root with dong quai and four other herbs and has been found to effectively reduce symptoms of cramping and pain associated with dysmenorrhea (painful menses).35
Paeoniflorin and peony extracts also enhance mental function in animal studies,36 suggesting a potential benefit for dementia. Human studies have not yet been conducted to confirm this theory.
Red peony root and moutan bark have both shown antioxidant activity in test tubes, likely due to the presence of paeoniflorin, proanthocyanidins, and flavonoids.37 Polysaccharides found in peony bark and root have shown an ability to stimulate immune cells in the test tube.38, 39
Animal studies have found that red peony root, alone or in combination with other Chinese herbs, could help prevent liver damage due to various chemical toxins.40 A crude extract of red peony root was shown in a small, preliminary trial to reduce liver fibrosis in some patients with chronic viral hepatitis.41 Other case studies published in Chinese have found red peony root helpful for people with viral hepatitis.42
Crude red peony root extracts and combinations of these extracts with other Chinese herbs inhibit platelet aggregation, thrombosis, and excessive clotting in the test tube and in animals.43, 44 A rabbit study found that peony was effective at lowering cholesterol levels in the aorta.45 A preliminary human study confirmed that peony could inhibit platelet clumping.46 This suggests that peony might be helpful for prevention of atherosclerosis. However, clinical studies are needed to confirm this effect.
One uncontrolled clinical trial reported that moutan bark could significantly lower blood pressure in people with hypertension.47
Peony shows some weak estrogen-like effects, acting like a very weak anti-estrogen, particularly as part of the formula shakuyaku-kanzo-to. In a preliminary study, this formula was shown to improve fertility in women affected by polycystic ovary syndrome.48
How to Use It
White peony capsules are used in the amount of 1.5 to 4 grams three times per day. Red peony and moutan capsules are used in the amount of 1 to 3 grams three times per day.49 Capsules of shakuyaku-kanzo-to formula are used in the amount of 2.5 grams three times per day.50
Bai Shao, Chi Shao, Moutan, Red Peony, White Peony
An Oriental herb formula containing Glycyrrhiza radix (licorice root) and Paeoniae radix (white peony root) successfully restored menses in a 28-year-old woman who had developed amenorrhea (lack of menstruation) while taking risperidone.51 Discontinuation of these herbs while the woman continued taking risperidone again led to disruption of her menses. In another study, treatment with this same formula restored menses in 6 of 18 women who had developed amenorrhea or oligomenorrhea (infrequent menstruation) from taking risperidone.52 Controlled research is needed to determine whether supplementation with licorice and peony might help prevent amenorrhea in women taking risperidone.
The Drug-Nutrient Interactions table may not include every possible interaction. Taking medicines with meals, on an empty stomach, or with alcohol may influence their effects. For details, refer to the manufacturers’ package information as these are not covered in this table. If you take medications, always discuss the potential risks and benefits of adding a supplement with your doctor or pharmacist.
Bai Shao, Chi Shao, Moutan, Red Peony, White Peony
If used in the recommended amounts, peony is not associated with side effects. It is not known whether peony is safe for use during pregnancy, though there is an uncontrolled study showing it could safely be used to lower blood pressure in pregnant women.53
Shakuyaku-kanzo-to should be taken only while under the care of a healthcare professional trained in herbal medicine.
1. Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Newton, MA: Integrative Medicine Communications, 1998, 364.
2. Foster S, Yue CX. Herbal Emissaries: Bringing Chinese Herbs to the West. Rochester, VT: Healing Arts Press, 1992:200–7.
3. Foster S, Yue CX. Herbal Emissaries: Bringing Chinese Herbs to the West. Rochester, VT: Healing Arts Press, 1992:200–7.
4. Foster S, Yue CX. Herbal Emissaries: Bringing Chinese Herbs to the West. Rochester, VT: Healing Arts Press, 1992:200–7.
5. Bensky D, Gamble A, Kaptchuk T. Chinese Herbal Medicine Materia Medica, rev ed, Seattle: Eastland Press, 1993:331–2.
6. Bensky D, Gamble A, Kaptchuk T. Chinese Herbal Medicine Materia Medica, rev ed, Seattle: Eastland Press, 1993:277–8.
7. Bensky D, Gamble A, Kaptchuk T. Chinese Herbal Medicine Materia Medica, rev ed, Seattle: Eastland Press, 1993:70–1.
8. Yarnell EY, Abascal K. An herbal formula for treating intractable epilepsy: a review of the literature. Alt Compl Ther 2000;6:203–6 [review].
9. Narita Y, Satowa H, Kokubu T, et al. Treatment of epileptic patients with the Chinese herbal medicine “saiko-keishi-to” (SK). IRCS Med Sci 1982;10:88–9.
10. Nagakubo S, Niwa S-I, Kumagai N, et al. Effects of TJ-960 on Sternberg’s paradigm results in epileptic patients. Jpn J Psych Neur 1993;47:609–19.
11. Hirayama C, Okumura M, Tanikawa K, et al. A multicenter randomized controlled clinical trial of Shosaiko-to in chronic active hepatitis. Gastroent Jap 1989;24:715–9.
12. Fujiwara K, Ohta Y, Ogata I, et al. Treatment trial of traditional Oriental medicine in chronic viral hepatitis. In: Ohta Y (ed) New Trends in Peptic Ulcer and Chronic Hepatitis: Part II. Chronic Hepatitis. Tokyo: Excerpta Medica, 1987, 141–6.
13. Tajiri H, Kozaiwa K, Osaki Y, et al. The study of the effect of sho-saiko-to on HBeAg clearance in children with chronic HBV infection and with abnormal liver function tests. Acta Paediatr Jpn 1991;94:1811–5.
14. Gibo Y, Nakamura Y, Takahashi N, et al. Clinical study of sho-saiko-to therapy for Japanese patients with chronic hepatitis C (CH-C). Prog Med 1994;14:217–9.
15. Gibo Y, Nakamura Y, Takahashi N, et al. Clinical study of sho-saiko-to therapy for Japanese patients with chronic hepatitis C (CH-C). Prog Med 1994;14:217–9.
16. Oka H, Yamamoto S, Kuroki T, et al. Prospective study of chemoprevention of hepatocellular carcinoma with sho-saiko-to (TJ-9). Cancer 1995;76:743–9.
17. Mizushima Y, Oosaki R, Kobayashi M. Clinical features of pneumonitis induced by herbal drugs. Phytother Res 1997;11:295–8.
18. Yang DG. Comparison of pre- and post-treatmental hepatohistology with heavy dosage of Paeonia rubra on chronic active hepatitis caused liver fibrosis. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih 1994;14:195,207–9 [in Chinese].
19. Wang CB, Chang AM. Plasma thromboxane B2 changes in severe icteric hepatitis treated by traditional Chinese medicine—dispelling the pathogenic heat from blood, promoting blood circulation and administrating large doses of radix Paeoniae—a report of 6 cases. Chung Hsi I Chieh Ho Tsa Chih 1985;5:322,326–8 [in Chinese].
20. Kumada T, et al. Effect of shakuyaku-kanzo-to (Tsumura TJ-68) on muscle cramps accompanying cirrhosis in a placebo-controlled double-blind parallel study. J Clin Ther Med 1999;15:499–523.
21. Yamamoto M, Oka H, Kanno T, et al. Controlled prospective trial to evaluate sho-saiko-to for the prevention of hepatotcellular carcinoma in patients with cirrhosis of the liver. Gan To Kagaku Ryoho (Jpn J Cancer Chemother) 1989;16:1519–24 [in Japanese].
22. Srivastava R, Dikshit M, Srimal RC, Dhawan BN. Anti-thrombotic action of curcumin. Throm Res 1985;404:413–7.
23. Srivastava KC, Bordia A, Verma SK. Curcumin, a major component of food spice turmeric (Curcuma longa) inhibits aggregation and alters eicosanoid metabolism in human blood platelets. Prost Leuk Essen Fat Acids. 1995;52:223–7.
24. Pulliero G, Montin S, et al. Ex vivo study of the inhibitory effects of Vaccinium myrtillus (bilberry) anthocyanosides on human platelet aggregation. Fitoterapia 1989;60:69–75.
25. Liu J. Effect of Paeonia obovata 801 on metabolism of thromboxane B2 and arachidonic acid and on platelet aggregation in patients with coronary heart disease and cerebral thrombosis. Chin Med J 1983;63:477–81 [in Chinese].
26. Kotani N, Oyama T, Hashimoto H, et al. Analgesic effect of a herbal medicine for treatment of primary dysmenorrhea—a double-blind study. Am J Chinese Med 1997;25:205–12.
27. Baba S, Takasaka T. Double-blind clinical trial of sho-seiryu-to (TJ-19) for perennial nasal allergy. Clin Otolaryngol 1995;88:389–405.
28. Inada Y, Watanabe K, Kamiyama M, et al. In vitro immunomodulatory effects of traditional Kampo medicine (sho-saiko-to: SST) on peripheral mononuclear cells in patients with AIDS. Biomed Pharmacother 1990;44:17–9.
29. Piras G, Makino M, Baba M. Sho-saiko-to, a traditional kampo medicine, enhances the anti-HIV-1 activity of lamivudine (3TC) in vitro. Microbiol Immunol 1997;41:435–9.
30. Fujimaki M, Hada M, Ikematsu S, et al. Clinical efficacy of two kinds of kampo medicine on HIV infected patients. Int Conf AIDS 1989;5:400 [abstract no. W.B.P.292].
31. Li BQ, Fu T, Yan YD, et al. Inhibition of HIV infection by baicalin—a flavonoid compound purified from Chinese herbal medicine. Cell Mol Biol Res 1993;39:119–24.
32. Takahashi K, Kitao M. Effect of TJ-68 (shakuyaku-kanzo-to) on polycystic ovarian disease. Int J Fertil Menopausal Stud 1994;39:69–76.
33. Qi-bing M, Jing-yi T, Bo C. Advance in the pharmacological studies of radix Angelica sinensis (oliv) diels (Chinese danggui). Chin Med J 1991;104:776–81.
34. Yamashita JI. Effect of Tsumura skakuyaku-kanzo-to on pain at muscle twitch during and after dialysis in the patients undergoing dialysis. Pain and Kampo Medicine 1992;2:18–20.
35. Kotani N, Oyama T, Hashimoto H, et al. Analgesic effect of a herbal medicine for treatment of primary dysmenorrhea—a double-blind study. Am J Chin Med 1997;25:205–12.
36. Ohta H, Ni JW, Matsumoto K, et al. Paeony and its major constituent, paeoniflorin, improve radial maze performance impaired by scopolamine in rats. Pharmacol Biochem Behav 1993;45:719–23.
37. Okubo T, Nagai F, Seto T, et al. The inhibition of phenylhydroquinone-induced oxidative DNA cleavage by constituents of Moutan Cortex and Paeoniae Radix. Biol Pharm Bull 2000;23:199–203.
38. Tomoda M, Matsumoto K, Shimizu N, et al. Characterization of a neutral and an acidic polysaccharide having immunological activities from the root of Paeonia lactiflora.Biol Pharm Bull 1993;16:1207–10.
39. Tomoda M, Matsumoto K, Shimizu N, et al. An acidic polysaccharide with immunological activities from the root of Paeonia lactiflora.Biol Pharm Bull 1994;17:1161–4.
40. Qi XG. Protective mechanism of Salvia miltiorrhiza and Paeonia lactiflora for experimental liver damage. Chung Hsi I Chieh Ho Tsa Chih 1991;11:69, 102–4 [in Chinese].
41. Yang DG. Comparison of pre- and post-treatmental hepatohistology with heavy dosage of Paeonia rubra on chronic active hepatitis caused liver fibrosis. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih 1994;14:195, 207–9 [in Chinese].
42. Wang CB, Chang AM. Plasma thromboxane B2 changes in severe icteric hepatitis treated by traditional Chinese medicine—dispelling the pathogenic heat from blood, promoting blood circulation and administrating large doses of radix Paeoniae—a report of 6 cases. Chung Hsi I Chieh Ho Tsa Chih 1985;5:326–8, 322 [in Chinese].
43. Wang Y, Ma R. Effect of an extract of Paeonia lactiflora on the blood coagulative and fibrinolytic enzymes. Chung Hsi I Chieh Ho Tsa Chih 1990;10:70, 101–2 [in Chinese].
44. Xue JX, Jiang Y, Yan YQ. Effects of the combination of Astragalus membranaceus (Fisch.) Bge. (AM), root of Angelica sinensis (Oliv.) Diels. (TAS), Cyperus rotundus L. (CR), Ligusticum chuanxiong Hort. (LC) and Paeonia veitchii Lynch (PV) on the hemorrheological changes in normal rats. Chung Kuo Chung Yao Tsa Chih 1993;18:621–3, 640 [in Chinese].
45. Zhang Y. The effects of nifedipine, diltiazem, and Paeonia lactiflora Pall. on atherogenesis in rabbits. Chung Hua Hsin Hsueh Kuan Ping Tsa Chih 1991;19:100–3 [in Chinese].
46. Liu J. Effect of Paeonia obovata 801 on metabolism of thromboxane B2 and arachidonic acid and on platelet aggregation in patients with coronary heart disease and cerebral thrombosis. Chung Hua I Hsueh Tsa Chih (Chin Med J) 1983;63:477–81 [in Chinese].
47. Bensky D, Gamble A, Kaptchuk T. Chinese Herbal Medicine Materia Medica, rev ed. Seattle: Eastland Press, 1993:70–1.
48. Takahashi K, Kitao M. Effect of TJ-68 (shakuyaku-kanzo-to) on polycystic ovarian disease. Int J Fertil Menopausal Stud 1994;39:69–76.
49. Foster S, Yue CX. Herbal Emissaries: Bringing Chinese Herbs to the West. Rochester, VT: Healing Arts Press, 1992:200–7.
50. Takahashi K, Kitao M. Effect of TJ-68 (shakuyaku-kanzo-to) on polycystic ovarian disease. Int J Fertil Menopausal Stud 1994;39:69–76.
51. Yamada K, Kanba S, Yagi G, Asai M. Herbal medicine (shakuyaku-kanzo-to) in the treatment of risperidone-induced amenorrhea. J Clin Psychopharmacol 1999;19:380–1.
52. Yuan HN, Wang CY, Sze CW, et al. A randomized, crossover comparison of herbal medicine and bromocriptine against resperidone-induced hyperprolactinemia in patients with schizophrenia. J Clin Psychopharmacol 2008; 28:264–70.
53. Guo TL, Zhou XW. Clinical observations on the treatment of the gestational hypertension syndrome with angelica and paeonia powder. Chung Hsi I Chieh Ho Tsa Chih 1986;6:714–6, 707 [in Chinese].
The information presented in Aisle7 is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires June 2014.
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