Peony

Common name: moutan (mu dan), red peony (chi shao), white peony (bai shao)

Botanical names: Paeonia suffruticosa, Paeonia lactiflora, Paeonia veitchii

Parts used and where grown

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 colour indicated does not refer to flower colour. An important formula used in Chinese and Japanese herbal medicine called shakuyaku-kanzo-to contains white peony root and liquorice 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

Peony has been used in connection with the following conditions (refer to the individual health concern for complete information):

Science Ratings

Health Concerns

Chronic viral hepatitis

Liver cirrhosis (shakuyaku-kanzo-to formula)

Muscle cramps (shakuyaku-kanzo-to formula)

Atherosclerosis (red peony root)

Dysmenorrhoea (painful menses)

Fever (moutan bark)

Polycystic ovary syndrome (shakuyaku-kanzo-to)

Premenstrual Syndrome (PMS)

Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars

Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star

For a herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

Historical or traditional use (may or 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 dysmenorrhoea (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 characterised by bleeding, such as nosebleeds, bleeding wounds, or menorrhagia (excessive menstrual bleeding).⁷

Active constituents

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 liquorice) for relieving muscle cramps due to cirrhosis of the liver, diabetes, and dialysis.⁸ 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 dysmenorrhoea (painful menses).⁹

Paeoniflorin and peony extracts also enhance mental function in animal studies,¹⁰ 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.¹¹ Polysaccharides found in peony bark and root have shown an ability to stimulate immune cells in the test tube.¹² ¹³

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.¹⁴ 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.¹⁵ Other case studies published in Chinese have found red peony root helpful for people with viral hepatitis.¹⁶

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.¹⁷ ¹⁸ A rabbit study found that peony was effective at lowering cholesterol levels in the aorta.¹⁹ A preliminary human study confirmed that peony could inhibit platelet clumping.²⁰ 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.²¹

Peony shows some weak oestrogen-like effects, acting like a very weak anti-oestrogen, 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.²²

How much is usually taken?

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.²³ Capsules of shakuyaku-kanzo-to formula are used in the amount of 2.5 grams three times per day.²⁴

Are there any side effects or interactions?

If used in the amounts listed above, 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.²⁵

Shakuyaku-kanzo-to should be taken only while under the care of a healthcare professional trained in herbal medicine.

Are there any drug interactions?
Certain medicines may interact with peony. Refer to drug interactions for a list of those medicines.

References
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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. 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.

9. 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.

10. 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.

11. 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.

12. 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.

13. 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.

14. 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].

15. 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].

16. 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].

17. 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].

18. 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].

19. 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].

20. 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].

21. Bensky D, Gamble A, Kaptchuk T. Chinese Herbal Medicine Materia Medica, rev ed. Seattle: Eastland Press, 1993:70–1.

22. Takahashi K, Kitao M. Effect of TJ-68 (shakuyaku-kanzo-to) on polycystic ovarian disease. Int J Fertil Menopausal Stud 1994;39:69–76.

23. Foster S, Yue CX. Herbal Emissaries: Bringing Chinese Herbs to the West. Rochester, VT: Healing Arts Press, 1992:200–7.

24. Takahashi K, Kitao M. Effect of TJ-68 (shakuyaku-kanzo-to) on polycystic ovarian disease. Int J Fertil Menopausal Stud 1994;39:69–76.

25. 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].

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The information presented in Healthnotes 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 chemist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires March 2007.