White Peony Root

• Hormonal balance
• Anti-inflammatory
• Immune modulation
• Liver support

• Menstrual health
• Mood support
• Antioxidant protection
• Cardiovascular support
• Pain relief
• Skin health
• Neuroprotection

White Peony Root (Paeonia lactiflora) exerts its biological effects through multiple pathways, with paeoniflorin and other monoterpene glycosides being the primary bioactive compounds responsible for its diverse health benefits. One of the most significant mechanisms of white peony root is its ability to modulate hormone levels, particularly in women. Research suggests that it may inhibit the activity of the enzyme aromatase, which converts testosterone to estrogen, while simultaneously promoting the activity of aromatase in conditions of estrogen deficiency. This bidirectional regulation helps explain its traditional use for various women’s health conditions and its potential benefits for hormonal imbalances like polycystic ovary syndrome (PCOS).

White peony root also appears to inhibit testosterone production and increase the binding of testosterone to sex hormone-binding globulin (SHBG), effectively reducing free testosterone levels. This mechanism is particularly relevant for conditions characterized by excess androgens, such as PCOS and certain types of female hirsutism. The anti-inflammatory properties of white peony root are attributed to paeoniflorin and other compounds that inhibit various inflammatory pathways. Paeoniflorin has been shown to suppress the production of pro-inflammatory cytokines, including tumor necrosis factor-alpha (TNF-α), interleukin-1beta (IL-1β), and interleukin-6 (IL-6).

It also inhibits the activation of nuclear factor-kappa B (NF-κB), a key regulator of inflammatory responses. These anti-inflammatory effects help explain white peony’s traditional use for conditions involving inflammation, including arthritis, menstrual pain, and certain skin disorders. White peony root demonstrates significant immunomodulatory effects, primarily through its impact on T-cell function and cytokine production. Paeoniflorin appears to promote a balance between different types of immune responses, potentially beneficial for autoimmune conditions.

It may inhibit the proliferation of activated T-cells and regulate the balance between T-helper 1 (Th1) and T-helper 2 (Th2) responses, which is crucial for proper immune function. The antispasmodic effects of white peony root are attributed to its ability to relax smooth muscle tissue. This mechanism helps explain its traditional use for menstrual cramps, abdominal pain, and muscle spasms. Paeoniflorin and other compounds appear to modulate calcium channels and inhibit acetylcholine-induced contractions in smooth muscle.

White peony root contains various antioxidant compounds that neutralize free radicals and reduce oxidative stress at the cellular level. These antioxidants help protect cellular DNA, proteins, and lipids from oxidative damage, potentially contributing to its anti-aging and neuroprotective effects. The liver-protective effects of white peony root are attributed to paeoniflorin’s ability to enhance liver detoxification pathways, protect hepatocytes from damage, and reduce liver inflammation. This hepatoprotective action supports white peony’s traditional use in formulas for liver-related conditions and may contribute to its overall detoxification benefits.

Additionally, white peony root contains compounds that may support cardiovascular health through vasodilation, improved microcirculation, and potential anti-thrombotic effects. These mechanisms help explain its inclusion in traditional formulas for blood stagnation and cardiovascular support.

Dosage recommendations for white peony root vary based on the form used, preparation method, and the intended purpose. In Traditional Chinese Medicine (TCM), typical dosages range from 6-15 grams of dried root per day, usually prepared as a decoction (simmered in water). For standardized extracts (typically standardized to paeoniflorin content), 500-1,000 mg taken 1-3 times daily is common. When used in TCM formulas, white peony is almost always combined with other herbs, which may affect appropriate dosing.

The most important factor in dosing is the standardization level, as the paeoniflorin content can vary significantly between products.

For hormonal conditions, consistent daily use is more important than specific timing. Dividing the daily dose into 2-3 administrations helps maintain more consistent blood levels of active compounds. For menstrual pain, starting 7-10 days before expected menstruation provides preventive benefits. Taking with food may reduce potential digestive discomfort.

In TCM, white peony decoctions are typically taken between meals for optimal absorption, though this may vary based on the specific formula and condition being treated.

For hormonal applications, continuous use for 3-6 months is typically recommended to evaluate effectiveness, followed by maintenance dosing if beneficial. Some practitioners recommend periodic breaks (e.g., 1 month off after 3-4 months of use) to prevent adaptation, though

this is based more on general herbal principles than white peony-specific research. For acute conditions like menstrual pain, cyclical use aligned with the menstrual cycle is common (higher doses around menstruation, lower or no doses at other times).

For those new to white peony root, starting with approximately 50% of the target dose for the first week and gradually increasing over 2-3 weeks can help minimize potential digestive adjustment and allow assessment of individual response.

This is particularly important

when using for hormonal or autoimmune conditions, as individual responses can vary significantly. If using a formula containing white peony with licorice (as in the traditional combination for PCOS), more gradual titration is advisable due to potential blood pressure effects of licorice.

The bioavailability of white peony root’s active compounds varies significantly based on the specific compounds, preparation method, and individual digestive factors. Paeoniflorin, the primary bioactive compound, has relatively poor oral bioavailability (approximately 3-4% in animal studies) due to its large molecular size, poor lipid solubility, and susceptibility to degradation by intestinal bacteria. After oral administration, paeoniflorin reaches peak plasma concentrations within 0.5-1 hour, suggesting relatively rapid absorption of the limited amount that does get absorbed. Other monoterpene glycosides in white peony have variable bioavailability, generally in the range of 1-10%.

The albiflorin in white peony appears to have better bioavailability than paeoniflorin in some studies. Traditional preparation methods, particularly decoction (simmering in water) and combination with other herbs, may significantly affect the extraction and bioavailability of active compounds. For example, the traditional combination with licorice root may enhance the bioavailability of certain compounds through effects on intestinal transport and metabolism.

Traditional decoction (simmering in water for 20-30 minutes) enhances extraction of water-soluble compounds compared to simple infusion, Combining with licorice root (traditional method) may enhance bioavailability through effects on intestinal transport and metabolism, Adding ginger to preparations (traditional method) may enhance absorption through increased circulation and digestive effects, Alcohol-based extractions (tinctures) may extract a broader spectrum of compounds than water alone, Standardized extracts with higher paeoniflorin content may provide more consistent bioavailability compared to whole root preparations, Combining with black pepper extract (piperine) may enhance absorption of certain compounds through inhibition of metabolic enzymes, Micronization (reducing particle size) increases surface area and may improve absorption, Liposomal formulations can significantly improve bioavailability by protecting compounds from degradation and enhancing cellular uptake

In Traditional Chinese Medicine, white peony decoctions are typically taken between meals for optimal absorption, though

this may vary based on the specific formula and condition being treated. For modern extract formulations, taking with a small meal may enhance absorption of certain compounds

while reducing potential digestive discomfort. For hormonal conditions, consistent timing each day helps maintain more stable blood levels of active compounds. For menstrual pain, starting 7-10 days before expected menstruation provides preventive benefits through cumulative effects.

Traditional decoctions (simmering the root in water for 20-30 minutes) generally provide better extraction of water-soluble compounds than simple infusions or powdered root, though the overall bioavailability remains relatively low for compounds like paeoniflorin. Alcohol-based tinctures may extract a broader spectrum of compounds than water-based preparations, potentially offering different therapeutic effects. Standardized extracts offer more consistent levels of specific active compounds compared to whole root preparations, though they may lack the full spectrum of compounds found in traditional decoctions. Modern liposomal or phytosomal formulations, though less common for white peony, may offer significantly enhanced bioavailability compared to conventional preparations, particularly for poorly absorbed compounds like paeoniflorin.

Traditional Chinese Medicine formulations that combine white peony with other herbs (such as the classic combination with licorice root) may have different bioavailability profiles than white peony alone, potentially enhancing the absorption and effectiveness of certain compounds through synergistic effects.

• Digestive discomfort (mild nausea, bloating, or diarrhea)
• Allergic reactions (rare, but possible, particularly in those with allergies to plants in the Paeoniaceae family)
• Headache (uncommon)
• Dizziness (rare)
• Drowsiness (uncommon)
• Mild changes in menstrual flow or timing (due to hormonal effects)
• Hypoglycemia (rare, primarily in sensitive individuals or when combined with diabetes medications)
• Skin rash (rare allergic reaction)

• Known allergy to white peony or plants in the Paeoniaceae family
• Pregnancy (traditional contraindication due to potential hormonal effects and uterine stimulation)
• Excessive menstrual bleeding (may potentially increase flow in some individuals)
• Bleeding disorders (theoretical concern due to potential mild anticoagulant effects)
• Scheduled surgery (discontinue 2 weeks before due to potential effects on blood glucose and potential mild anticoagulant effects)
• Severe diarrhea (may exacerbate in sensitive individuals)

• Anticoagulant and antiplatelet medications (theoretical mild additive effect, though clinical significance appears minimal)
• Hormone therapies (potential interference with therapeutic goals due to hormonal modulating effects)
• Antidiabetic medications (potential additive effect on blood sugar levels)
• Sedative medications (potential mild additive effect)
• Medications metabolized by cytochrome P450 enzymes (potential mild interactions)
• Immunosuppressant drugs (potential interference due to immune-modulating properties)
• Medications with narrow therapeutic windows (warfarin, digoxin) – monitor closely due to theoretical interactions

No official upper limit has been established for white peony root supplements. In Traditional Chinese Medicine, doses up to 15-30 grams of dried root daily have been used for short periods without significant reported adverse effects in healthy adults. For standardized extracts, doses up to 1,500-2,000 mg daily divided into 2-3 doses appear to be well-tolerated in clinical studies.

However , conservative upper limits of 15 grams daily for dried root and 1,500 mg daily for standardized extracts are generally recommended for long-term use due to limited long-term safety data.

Pregnancy And Breastfeeding: White peony root is traditionally contraindicated during pregnancy due to potential hormonal effects and uterine stimulation. Limited data exists on safety during breastfeeding; use only under qualified practitioner supervision if deemed necessary.

Children: Limited research on safety in children. Traditional use in children exists in TCM but should only be under qualified practitioner supervision with adjusted dosing based on age and weight.

Elderly: Generally well-tolerated in elderly populations, but start with lower doses and monitor for potential interactions with medications common in this age group. May be particularly beneficial for inflammatory conditions common in this population.

Liver Disease: Despite its potential hepatoprotective effects, use with caution in those with severe liver disease, as the liver metabolizes many of white peony’s compounds. Start with lower doses and monitor liver function.

Kidney Disease: Limited data on safety in kidney disease. Use with caution and at reduced doses due to potential accumulation of metabolites.

Autoimmune Conditions: While white peony has immunomodulatory effects that may benefit some autoimmune conditions, individual responses can vary. Use under healthcare provider supervision with careful monitoring of disease activity and medication needs.

Quality and standardization are important considerations with white peony products. The paeoniflorin content can vary significantly based on growing conditions, harvest time, processing methods, and storage. Traditional processing of white peony root involves peeling and sun-drying, which affects its properties and safety profile compared to unprocessed root. Potential for contamination with pesticides, heavy metals, or microbial contaminants is possible, particularly with products harvested from areas with environmental pollution.

Adulteration with other Paeonia species or even unrelated plants is possible, though less common than with many herbs due to white peony’s distinctive appearance. Third-party testing is recommended to ensure purity, potency, and correct species identification.

Long-term safety data from clinical trials is limited, with most studies lasting 3-6 months. However, traditional use in Chinese medicine spans thousands of years, suggesting good tolerability for extended periods when used appropriately. A European post-marketing surveillance study of a formula containing white peony showed a very low incidence of adverse effects over a 6-month period. No cumulative toxicity concerns have been identified in available research. Regular monitoring of relevant health parameters (hormonal levels, blood glucose, liver function) is advisable for those using white peony long-term, particularly at higher doses or for specific therapeutic purposes.

White peony root is regulated as a dietary supplement in the United States under the Dietary Supplement Health and Education Act (DSHEA) of 1994. It is not approved to treat, cure, or prevent any disease. Manufacturers must ensure product safety and are prohibited from making specific disease claims. The FDA does not review or approve white peony supplements before they enter the market but can take action against unsafe products or those making unsubstantiated health claims.

White peony does not have Generally Recognized as Safe (GRAS) status for use as a food ingredient, limiting its use to dietary supplements rather than conventional foods.

China: In China, white peony root (Bai Shao) is officially listed in the Chinese Pharmacopoeia as a traditional Chinese medicine. It is regulated as a medicinal herb rather than a supplement, with established quality standards, approved therapeutic uses, and traditional preparation methods. It is commonly prescribed by Traditional Chinese Medicine practitioners and is available in pharmacies and traditional medicine shops.

Eu: In the European Union, white peony is regulated primarily as a food supplement under the Food Supplements Directive (2002/46/EC). Products must comply with general food safety regulations and specific supplement regulations regarding maximum/minimum doses, purity criteria, and labeling requirements. Health claims are strictly regulated under Regulation (EC) No 1924/2006 and must be scientifically substantiated and pre-approved. Some EU member states may have additional national regulations affecting white peony products.

Canada: Health Canada regulates white peony as a Natural Health Product (NHP). Products require a Natural Product Number (NPN) before marketing, which involves assessment of safety, efficacy, and quality. Health Canada’s Natural Health Products Ingredients Database lists white peony with limited approved claims based on its traditional use.

Australia: The Therapeutic Goods Administration (TGA) regulates white peony as a complementary medicine. Products must be included in the Australian Register of Therapeutic Goods (ARTG) before marketing. Claims are limited to general health maintenance and traditional uses unless specific evidence is provided for stronger claims.

Japan: In Japan, white peony is recognized as a component of Kampo medicine (traditional Japanese herbal medicine) and is regulated accordingly. It may be prescribed by physicians trained in Kampo medicine and is covered by national health insurance when used in approved Kampo formulations.

Korea: In South Korea, white peony is recognized as a component of traditional Korean medicine (Hanbang) and is regulated by the Ministry of Food and Drug Safety. It may be prescribed by traditional Korean medicine practitioners and is available in pharmacies and traditional medicine shops.

Labeling Requirements: Must include standard supplement facts panel, ingredient list, and species identification. Cannot make disease treatment or prevention claims in most jurisdictions without appropriate drug/medicine registration. Claims related to women’s health, hormonal effects, and autoimmune conditions are particularly scrutinized in most markets.

Testing Requirements: While specific testing is not universally mandated for supplements, responsible manufacturers conduct testing for species identification, paeoniflorin content, microbial contamination, heavy metals, and pesticide residues. In China, the Pharmacopoeia specifies minimum paeoniflorin content and other quality parameters for medicinal use.

Import Export Considerations: Cross-border trade of white peony products may face additional scrutiny in some countries due to concerns about proper species identification, processing methods, and potential contamination. Some countries may have specific requirements for documentation of botanical identity and standardization.

The primary regulatory controversies surrounding white peony relate to the appropriate classification of products containing

this herb. In some markets,

there is debate about whether products containing white peony should be regulated as traditional medicines (with more stringent requirements but broader permitted claims) or as dietary supplements (with fewer pre-market requirements but more limited permitted claims). Another area of regulatory interest is the appropriate standardization parameters, as different markers (paeoniflorin, total glycosides, etc.) may be used in different markets, creating potential confusion about product quality and comparability. The lack of standardization requirements for supplements in some markets has led to significant variation in product quality and potency, with some products containing minimal amounts of active compounds

despite premium pricing.

No significant recent regulatory changes

specifically targeting white peony have occurred in major markets.

However , general trends toward increased scrutiny of supplement quality, enhanced requirements for supply chain transparency, and stricter enforcement of health claim regulations affect all botanical supplements including white peony products. In China, recent updates to the Pharmacopoeia have refined quality standards for white peony used in traditional medicine, including specifications for processing methods and active compound content.

In the United States, Canada, Australia, and most European countries, white peony is available without prescription as an over-the-counter supplement. In China, Japan, and Korea, white peony may be prescribed by licensed practitioners of traditional medicine, though

it is also available without prescription in many traditional medicine shops and pharmacies. The total glucosides of peony (TGP) extract, a specialized preparation used for autoimmune conditions, is available as a prescription medication in China under the brand name Paifulle.

Low to Medium

Vs Pharmaceutical Hormone Treatments: White peony (particularly in combination with licorice) is typically 80-95% less expensive than prescription medications for hormonal conditions like PCOS. However, it generally has milder effects and may not be sufficient for more severe cases.

Vs Pharmaceutical Autoimmune Treatments: White peony is typically 90-98% less expensive than biological or immunosuppressive drugs for autoimmune conditions. However, it generally has milder effects and may be more appropriate as a complementary approach or for mild cases.

Vs Other Women’s Health Supplements: White peony is generally comparable in price to dong quai, slightly less expensive than chaste tree berry, and significantly less expensive than specialty ingredients like maca or black cohosh.

Vs Other Liver Support Supplements: White peony is typically 20-40% less expensive than milk thistle extracts of comparable quality, though the two are often used for slightly different aspects of liver support.

White peony offers good cost efficiency for its primary traditional applications, particularly hormonal balance and inflammatory conditions. The cost-benefit ratio is most favorable for mild to moderate conditions where its gentle, multi-faceted approach may prevent progression to more severe conditions requiring pharmaceutical intervention. For hormonal applications, the traditional combination with licorice root provides particularly good value, as this relatively inexpensive formula has demonstrated effectiveness for conditions like PCOS in clinical studies. For autoimmune conditions, white peony may provide value as a complementary approach alongside conventional treatments, potentially allowing for lower doses of pharmaceuticals with their associated side effects and costs.

The premium paid for properly processed white peony (traditionally peeled and sun-dried) is generally justified by reduced side effects and potentially enhanced effectiveness for certain applications. For standardized extracts, the higher cost typically correlates with more consistent potency and potentially enhanced effectiveness, justifying the premium for those seeking more predictable results.

Purchasing dried root slices in bulk and preparing traditional decoctions at home can reduce cost by 40-60% compared to pre-made extracts or capsules, Purchasing larger bottles (90-180 capsules) typically reduces cost per dose by 15-30% compared to smaller packages, Subscription services offered by many supplement companies typically provide 10-15% savings, Traditional formulas containing white peony with complementary herbs may provide better value than white peony alone for specific conditions, For preventive use or maintenance after symptom improvement, lower doses may be sufficient, Seasonal or promotional discounts of 15-40% are common in the supplement industry

When evaluating long-term cost efficiency, consideration should be given to white peony’s potential preventive benefits. Regular use may help prevent progression of hormonal imbalances or inflammatory conditions, potentially avoiding more expensive pharmaceutical treatments or surgical interventions. For ongoing management of chronic conditions like PCOS or autoimmune disorders, the relatively low cost of white peony compared to prescription medications makes it economically viable for long-term use, particularly for those without comprehensive prescription drug coverage. The generally favorable side effect profile of white peony compared to many pharmaceutical treatments may reduce healthcare costs associated with managing medication side effects.

For women’s health applications, the multi-faceted effects of white peony on hormonal balance, inflammation, and liver function may provide comprehensive benefits that would otherwise require multiple interventions.

The market for white peony has seen moderate growth of 5-8% annually in recent years, driven by increasing interest in traditional Asian medicine and natural approaches to women’s health and autoimmune conditions. This growth has led to increased competition and more options at various price points. The trend toward standardized extracts with guaranteed paeoniflorin content represents a shift toward more consistent products, though at higher price points than traditional preparations. There has been increased emphasis on sustainable sourcing and traditional processing methods as quality markers, with corresponding price premiums.

Direct-to-consumer brands have disrupted traditional retail channels, often offering better value through reduced supply chain costs. The integration of white peony into more sophisticated formulations targeting specific health concerns represents a shift away from single-herb supplements toward more comprehensive (and typically more expensive) solutions.

Properly processed and stored white peony root slices typically have a shelf life of 2-3 years from date of processing. Ground root powder has a shorter shelf life of approximately 1-2 years due to increased surface area exposure. Standardized extracts in capsule or tablet form generally maintain potency for 2-3 years when stored properly. Liquid extracts and tinctures typically have a shelf life of 2-5 years, with alcohol-based preparations having longer stability than glycerin-based ones.

Traditional decoctions should be consumed within 24-48 hours, even when refrigerated.

Temperature: Store at cool room temperature (59-77°F or 15-25°C). Avoid exposure to temperatures exceeding 86°F (30°C) as this can accelerate degradation of bioactive compounds, particularly glycosides like paeoniflorin. Refrigeration is not necessary for dried products but may extend shelf life of liquid preparations after opening.

Humidity: Keep in a dry environment with relative humidity below 60%. Moisture exposure can lead to degradation of compounds, potential microbial growth, and clumping of powder formulations. White peony root is particularly susceptible to mold growth if exposed to moisture.

Light: Store in opaque containers or away from direct light, as certain compounds in white peony (particularly glycosides and phenolic compounds) are light-sensitive and can degrade with prolonged exposure.

Container Type: Traditional storage in China uses breathable paper or cloth bags for whole or sliced roots, allowing minimal air circulation while protecting from light and moisture. For modern preparations, amber glass bottles provide optimal protection for liquid preparations and powders. If packaged in plastic, HDPE (high-density polyethylene) with desiccant packets is preferred for powders.

Sealing: Airtight containers with moisture-resistant seals help maintain potency for processed products like powders and extracts. Once opened, ensure container is tightly resealed after each use. Consider transferring to smaller containers as product is used to minimize air exposure.

Exposure to oxygen (oxidation affects glycosides, phenolic compounds, and other active constituents), Moisture (promotes enzymatic breakdown, microbial growth, and clumping), Heat (accelerates chemical reactions and degradation of thermolabile compounds), Light exposure (particularly damaging to glycosides and phenolic compounds), Microbial contamination (if product becomes exposed to moisture), Enzymatic activity (if not properly deactivated during processing), pH fluctuations (particularly relevant for liquid preparations)

Paeoniflorin: Moderately stable in properly stored products; can degrade with exposure to heat, moisture, and prolonged storage. Typically retains 75-85% potency through shelf life in properly stored products.

Other Monoterpene Glycosides: Variable stability depending on specific compounds; generally moderately stable under proper storage conditions. May retain 70-80% potency through shelf life.

Phenolic Compounds: More susceptible to degradation from light, heat, and oxygen exposure. May retain only 60-75% potency through shelf life depending on storage conditions.

Polysaccharides: Relatively stable components when properly dried and stored, typically retaining 80-90% integrity throughout shelf life.

Change in color (typically darkening from white/light tan to darker brown), Development of off odors (musty or sour smells indicate degradation or contamination), Loss of characteristic bitter-sweet taste (indicates degradation of active compounds), Clumping or caking of powder formulations (indicates moisture exposure), Visible mold growth (indicates significant moisture exposure), Capsules becoming soft, sticky, or discolored, Tinctures becoming cloudy or developing unusual sediment, Insect infestation (particularly in whole or sliced roots stored improperly)

For travel, maintain in original container when possible. For extended trips, consider transferring only needed amount to a smaller airtight container. Avoid leaving in hot vehicles or exposing to temperature extremes during travel. Tinctures generally have better stability during travel than powder forms. Pre-measured capsules offer convenient and stable options for travel. Traditional decoctions should not be transported for extended periods unless properly refrigerated.

Traditional processing (peeling and sun-drying) is believed to enhance stability and reduce potential side effects compared to unprocessed root. Standardized extracts typically have better stability of target compounds compared to whole root powder. Alcohol-based extracts (tinctures) generally have better stability than water-based preparations due to the preservative effect of alcohol. Some premium products utilize natural antioxidants like vitamin E or rosemary extract to enhance stability of oxidation-prone components.

The traditional combination with licorice root (as in Shaoyao-Gancao Tang) may enhance stability of certain compounds through synergistic effects. Total glucosides of peony (TGP), a specialized extract used in some clinical applications, typically has better stability than crude extracts due to more refined processing and standardization.

Synthesis Methods

Natural Sources

Processing Methods

Quality Considerations

Geographical Considerations

Sustainability Considerations

Adulteration Concerns

Cultivation Challenges

White Peony Root (Bai Shao) has a rich history of medicinal use spanning over 2,000 years in Traditional Chinese Medicine (TCM). The first documented medicinal use of peony root appears in the ‘Shennong Ben Cao Jing’ (Divine Farmer’s Classic of Materia Medica), compiled around 200 BCE during the Han Dynasty. In this foundational text, peony root was classified as a middle-grade herb, indicating it was considered safe for long-term use when properly prescribed. Initially, TCM did not distinguish between ‘white’ peony (processed by peeling and sun-drying) and ‘red’ peony (unprocessed root).

This distinction emerged during the Tang Dynasty (618-907 CE), with different properties and applications attributed to each preparation. The processed white peony root became associated with ‘nourishing blood, softening the liver, and alleviating pain,’ while the unprocessed red peony was considered better for ‘clearing heat and cooling blood.’ The Tang Dynasty medical classic ‘Qian Jin Fang’ (Thousand Golden Prescriptions) by Sun Simiao (circa 652 CE) included numerous formulas containing white peony for women’s health conditions, pain syndromes, and liver-related disorders. During the Song Dynasty (960-1279 CE), the famous physician and alchemist Zhang Yuansu further developed theories about white peony’s ability to ‘soften the liver’ and regulate its function, establishing its importance in treating liver-related conditions. The Ming Dynasty medical text ‘Ben Cao Gang Mu’ (Compendium of Materia Medica, 1578 CE) by Li Shizhen provided detailed information about white peony’s properties, distinguishing it clearly from red peony and elaborating on its clinical applications.

Throughout Chinese history, white peony was rarely used alone but rather as a key ingredient in numerous classical formulas. Some of the most famous formulas containing white peony include Shaoyao-Gancao Tang (Peony and Licorice Decoction) for pain and muscle spasms, Si Wu Tang (Four-Substance Decoction) for women’s health and blood nourishment, and Xiao Yao San (Free and Easy Wanderer) for liver qi stagnation and associated symptoms. Traditional preparation methods included decoctions (simmering in water), often with specific processing instructions such as pre-soaking or combining with other herbs to enhance effectiveness or reduce side effects. White peony was traditionally used for a wide range of conditions, including menstrual irregularities, abdominal pain, muscle cramps, headaches, dizziness, irritability, night sweats, and inflammatory conditions.

Its use was particularly prominent in women’s health formulations. In Korean traditional medicine (Hanbang), white peony was similarly valued for women’s health and liver-related conditions. Japanese Kampo medicine also incorporated white peony in many classical formulations adapted from Chinese medicine. Western awareness of white peony’s medicinal properties remained limited until the 20th century, when increased interest in Asian traditional medicine brought many Chinese herbs to global attention.

Scientific research on white peony began in earnest in the 1970s and 1980s, with Japanese and Chinese researchers isolating and identifying key compounds like paeoniflorin and investigating their pharmacological properties. In recent decades, research has expanded to investigate white peony’s potential benefits for autoimmune conditions, hormonal imbalances, and inflammatory disorders, providing scientific validation for many of its traditional uses. Today, white peony remains an important herb in TCM practice worldwide and is increasingly incorporated into integrative medicine approaches for women’s health, autoimmune conditions, and liver support.

Scientific evidence for white peony root is moderate, with a substantial body of preclinical research but more limited high-quality human clinical trials. The strongest evidence supports its benefits for autoimmune conditions (particularly when combined with other herbs in traditional formulas), hormonal balance in women with PCOS or excess androgens, and inflammatory conditions. Most human studies have used white peony as part of traditional formulations rather than as a single herb, making it challenging to isolate its specific effects. Laboratory and animal studies provide strong mechanistic evidence for white peony’s effects on hormone modulation, inflammation, and immune function, supporting many of its traditional uses.

Traditional use in Chinese medicine provides empirical evidence for various applications, spanning over 2,000 years of documented use. While promising for several applications, more large-scale, long-term human studies using standardized preparations are needed to fully establish efficacy and optimal dosing for most conditions.

Arentz S, et al. (2014) conducted a systematic review and meta-analysis of Chinese herbal medicine for PCOS, finding that formulas containing white peony (particularly in combination with licorice) showed benefits for reducing testosterone levels and improving menstrual regularity., Zhang W, et al. (2012) performed a systematic review of total glucosides of peony (TGP) for rheumatoid arthritis, finding significant benefits for reducing inflammation, pain, and swelling compared to placebo and comparable effects to some conventional medications.

Clinical trial on white peony and licorice combination for women with PCOS (multiple centers in China), Investigation of total glucosides of peony for autoimmune hepatitis (university hospital in China), Study on white peony extract for inflammatory skin conditions (dermatology research center)

White peony root has been used in Traditional Chinese Medicine for over 2,000 years, first documented in the ‘Shennong Ben Cao Jing’ (Divine Farmer’s Classic of Materia Medica) around 200 BCE.

It was traditionally classified as an herb that ‘nourishes blood, regulates menstruation, softens the liver, alleviates pain, and calms the spirit.’ Historical medical texts from various Chinese dynasties document its use for women’s health conditions, liver disorders, pain syndromes, and inflammatory conditions. The processing method of peeling and sun-drying the root to produce ‘white’ peony (as opposed to the unprocessed ‘red’ peony) has been documented since at least the Tang Dynasty (618-907 CE), with different properties attributed to each preparation.

Traditional uses of white peony in Chinese medicine primarily focused on women’s health, including menstrual irregularities, excessive menstrual pain, abnormal uterine bleeding, and symptoms of hormonal imbalance. It was also used for liver-related disorders, characterized by symptoms such as irritability, hypochondriac pain, headaches, and dizziness. White peony was rarely used alone in traditional practice, but rather as part of formulas tailored to specific presentations. Classic combinations include white peony with licorice for hormonal balance, with angelica (dang gui) for blood nourishment, and with various herbs for liver-related conditions.

Traditional preparation methods included decoctions (simmering in water) and occasionally wine extractions.

Laboratory studies provide strong evidence for several mechanisms of action. Hormonal modulating effects have been demonstrated in multiple in vitro and animal studies, with identified mechanisms including inhibition of testosterone synthesis, promotion of aromatase activity, and increased testosterone binding to sex hormone-binding globulin. Anti-inflammatory effects have been well-documented, showing inhibition of various inflammatory pathways including NF-κB signaling and pro-inflammatory cytokine production. Immunomodulatory properties have been confirmed in numerous studies, demonstrating effects on T-cell function, cytokine production, and autoimmune processes.

Antispasmodic effects on smooth muscle have been observed in experimental models, supporting traditional use for menstrual pain and abdominal discomfort.

Significant research gaps include a lack of large-scale, well-designed human clinical trials using standardized white peony preparations alone (rather than in traditional formulas). Optimal dosing, extraction methods, and standardization parameters require further clarification. The bioavailability and metabolism of key compounds like paeoniflorin in humans need more thorough characterization. Long-term safety and efficacy data beyond 6 months is limited.

More research is needed on potential interactions with medications, particularly hormonal therapies and immunomodulating drugs. The specific compounds responsible for certain effects, beyond paeoniflorin, require further elucidation. Research on applications for specific women’s health conditions beyond PCOS, such as endometriosis and perimenopausal symptoms, represents a promising but underdeveloped area.