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Traditional Chinese medicine

White peonyPaeonia lactiflora

White peony (bai shao) is the texts’ pain herb in Tong Xie Yao Fang; that formula’s 96-person IBS-D trial found 79.2% vs 70.8% response, not significant.

Botanical name
Paeonia lactiflora
Part used
root, peeled and dried; often stir-fried
Also called
pinyin Bai shao (白芍); White peony root, Paeoniae radix alba, Baishao, Shakuyaku (Japanese)
Used in
Traditional Chinese medicine
Taken for
Cramping and pain, Stress and the gut, Loose stools and diarrhea
Sold as
decoction, pill, granules, capsules, dried slices

What is meant by white peony

White peony, or bai shao, is the root of Paeonia lactiflora, a herbaceous peony. The roots are processed by peeling, boiling and drying. The tradition separates white peony (bai shao) from red peony (chi shao), which is a separate drug with a different use, so the color in the name matters.

A review of the drug’s main extract says Paeoniae Radix Alba has shown medicinal value for more than 2,000 years, and that the total glucosides of paeony (TGP) extract has been developed into a capsule for autoimmune conditions. In the digestive tradition, however, the sliced root itself is used in decoctions, often stir-fried (chao bai shao). It is in Tong Xie Yao Fang, Xiao Yao San, Xiao Jian Zhong Tang and the two-herb Shaoyao Gancao Tang, and in the Kampo formula keishikashakuyakuto.

In the traditions

Traditional Chinese medicine (about TCM)

Bai shao is bitter, sour and slightly cold in the English materia medica we cite, entering the liver and spleen channels, with the actions of nourishing blood, softening the liver, relieving pain, preserving yin and calming liver yang. For the gut the tradition uses it for abdominal pain and cramping, especially where the texts see liver qi attacking the spleen: pain that comes on with tension and is followed by urgent loose stools, which is the picture Tong Xie Yao Fang is written for. Paired with licorice, it is the texts’ two-herb answer to abdominal spasm. The texts list an incompatibility with li lu (veratrum). The liver and spleen of these texts are functional systems of the tradition and not the organs of anatomy.

What the plant contains

The root’s main active fraction is the total glucosides of paeony, about 15 compounds of which paeoniflorin and albiflorin are the most common, according to a review in the Journal of Ethnopharmacology. Cell and animal studies report anti-inflammatory, analgesic and immune-regulating effects through NF-kB and MAPK signaling. Almost all of that work and the capsule is on autoimmune conditions such as rheumatoid arthritis, psoriasis, oral lichen planus and Sjogren’s syndrome, not the gut. These are laboratory and animal findings, and the review notes there is no standardized preparation method for the extract.

What has been tested in people

We could not find a controlled trial of white peony root on its own for a gut outcome. The human data are formulas that contain it, and the most informative one gives a mixed picture.

Tong Xie Yao Fang has four herbs: white atractylodes, white peony, tangerine peel and saposhnikovia. A meta-analysis of 11 trials with 985 adults who had diarrhea-predominant IBS found it superior to placebo and to Western drugs for global symptom improvement, with moderate certainty, and a larger pool of 23 trials of the modified formula (1,972 patients) reported an odds ratio of 4.04 (95% CI 3.09 to 5.27) against routine drugs. But a 96-person double-blind phase II trial of 3.7 g of granules twice daily for 8 weeks found a response of 79.2 percent (38 of 48) on the formula and 70.8 percent (34 of 48) on placebo, not significant, with both groups improving; a separate review found a 37 percent herbal placebo response across 24 IBS trials with 2,596 patients.

Xiao Yao San, which also contains it, has a 6-trial, 707-person meta-analysis in functional dyspepsia (RR 1.15 against Western medicine). A review of Kampo for functional gut disorders reported two randomized trials of keishikashakuyakuto in IBS that suggested efficacy; the abstract gives no figures, so we cannot report numbers for them.

Not tested: white peony or its glucosides alone for cramping, diarrhea or IBS.

StudyDoseWhat it found
Phase II RCT, 96 adults with IBS-D, Tong Xie Yao Fang granules vs placebo PMID 398704993.7 g twice a day for 8 weeksResponse 79.2% vs 70.8%; difference not significant; no serious adverse events
Meta-analysis of 11 RCTs, 985 adults with IBS-D (standard Tong Xie Yao Fang) PMID 36091782Standard formula; doses variedBetter global improvement than placebo and Western drugs (GRADE moderate)
Meta-analysis of 23 RCTs, 1,972 patients with IBS-D (modified Tong Xie Yao Fang vs routine drugs) PMID 29408906Modified formula; doses variedEfficacy OR 4.04 (95% CI 3.09 to 5.27); NNT 5.7; abdominal pain SMD -1.27
Meta-analysis of 6 RCTs, 707 people with functional dyspepsia (Xiao Yao San vs Western medicine) PMID 37124216Formula; doses variedTotal efficacy RR 1.15 (1.05 to 1.26); dyspepsia score SMD -0.72
Meta-analysis of 24 IBS trials with a herbal placebo arm, 2,596 patients PMID 39669195Not applicableHerbal placebo response rate 37%

Doses used in trials and traditional preparations

The one placebo-controlled trial gave Tong Xie Yao Fang as 3.7 g of granules twice a day, taken before meals, for 8 weeks. The meta-analyses pooled decoctions and granules whose gram weights differed by study. The traditional preparation is a water decoction of the sliced root, raw or stir-fried, simmered with the other herbs in the formula and drunk in divided doses. Pills of Xiao Yao San are sold ready-made. Total glucosides of paeony is a capsule extract with a different dose from the root, and we found no gut trial of it.

Treat these figures as a record of what was studied. Whether any amount of white peony suits a particular person is a question for a clinician or pharmacist who knows their history.

Safety

In the Tong Xie Yao Fang placebo trial there was one adverse event on the formula (sinus arrhythmia) and two on placebo (raised liver enzymes and a weakly positive fecal blood test), none serious. In the systematic review of 11 trials, six reported adverse events, and one reported 3 cases on the formula (constipation, raised liver enzymes, nausea) and 3 on placebo. Controlled data on pregnancy or breastfeeding were not found. A review of the glucoside extract notes that there is no standardized preparation method for it and that quality control of the formulations is insufficient, so the product on a shelf may not match what was studied.

Drug interactions

The sources we read report no interaction of white peony root with a medicine, and we found no study built to look for one. The extract review reports that total glucosides of paeony have been combined with chemical drugs for autoimmune disease, with an effect of increasing efficacy and reducing toxicity, which is a statement about that extract and not a gut finding. Formulas that contain it also contain licorice and ginger, whose interaction notes apply to the finished product.

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Related herbs

TCM Atractylodes Atractylodes macrocephala (bai zhu); A. lancea (cang zhu) TCM Bupleurum Bupleurum chinense TCM Dang gui (Chinese angelica) Angelica sinensis Ayurvedic / TCM / Western Licorice Glycyrrhiza glabra TCM Jujube Ziziphus jujuba

What people want to know

Is white peony the same as red peony?

No. Bai shao and chi shao are different preparations with different uses in the tradition. White peony is the one used in Tong Xie Yao Fang and Xiao Yao San.

What is it used for in the gut?

The texts use it for abdominal pain and cramping, especially pain that is followed by urgent loose stools. Paired with licorice, it is the classic answer to spasm. That is how the texts describe it and not a measured effect.

Does Tong Xie Yao Fang work for IBS-D?

Pooled analyses of 11 and 23 trials were favorable, but the one double-blind placebo-controlled phase II trial found 79.2% vs 70.8% response, a difference that was not significant, with both groups improving.

What is the herbal placebo response in IBS trials?

A meta-analysis of 24 trials with 2,596 patients found a 37 percent response in herbal placebo groups. That is why placebo-controlled trials matter for IBS.

Has white peony been tested alone?

We could not find a controlled trial of white peony root for a gut symptom. Its extract, total glucosides of paeony, is studied in autoimmune disease.

Sources