Hong Hua
StarCarthamus tinctorius
Synonyms: Calcitrapa tinctoria, Centaurea carthamus, Carthamus glaber, Carthamus tinctorius var. spinosus
Traditionally used for
- Digestion
- Menstrual & women's health
- Skin
Cautions & contraindications
- Pregnancy
- Bleeding disorders
☯ TCM Properties
Invigorates the Blood, dispels Blood Stasis, opens the channels, unblocks menstruation and alleviates pain
Traditional Chinese Uses
Hong Hua (红花) is the dried floret of Carthamus tinctorius L. (Asteraceae), Flos Carthami, safflower. It is acrid and warm, entering the Heart and Liver channels. It invigorates the Blood and dispels Blood stasis, opens the channels, unblocks menstruation, and alleviates pain.
It is one of the most-used Blood-invigorating herbs. It treats amenorrhoea and painful menstruation from stasis, retained lochia and postpartum abdominal pain, abdominal masses, and the fixed, stabbing pain of Blood stasis in the chest — where it is paired with Tao Ren in Xue Fu Zhu Yu Tang. It is a standard herb for traumatic injury with bruising, swelling and pain, and it is used for dark, poorly erupting measles rash.
Dose changes its character: a small amount is said to nourish and harmonise the Blood, a larger amount to break stasis. It is contraindicated in pregnancy, and used with caution in patients with bleeding tendencies or heavy menstrual flow. It should not be confused with Xi Hong Hua (saffron, Crocus sativus), a different and far more costly drug with a related but stronger Blood-cooling action.
Western Herbalism Properties
Used In Formulas (6)
Relationships
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Botanical Description
Carthamus tinctorius is an annual thistle-like herb in the daisy family (Asteraceae), growing 30-150 cm tall. Stems are stout, erect, and branched above. Leaves are alternate, sessile, oblong to lance-shaped, 3-10 cm long, with spiny teeth. Flower heads are 2-4 cm across, initially bearing bright yellow flowers that deepen to orange-red as they mature; these are the medicinal part (Hong Hua). Bracts are spiny. Seeds (white achenes) are a source of safflower oil. The red pigment (carthamin) gives the flowers their characteristic color.
Cultivated in dry, warm climates throughout the world; native to southern Asia or the Middle East, widely grown for its seed oil, dye, and medicinal flowers.
Carthamus tinctorius is a cultivated annual crop with long history of use for its seeds, oil, and dye. No wild populations are definitively known. Widely grown throughout China, India, and the Middle East. No conservation concerns.
Active Constituents
Hydroxysafflor yellow A
Quinochalcone C-glycosideConcentration: the Chinese Pharmacopoeia requires not less than 1.0% in the dried flower; it makes up roughly 80% of the safflor yellow used in Safflower Injection
The principal water-soluble active of the flower and the compound behind almost all of the modern cardiovascular and cerebrovascular evidence. It inhibits platelet aggregation, is anti-inflammatory, antioxidant and neuroprotective, and is the basis of the safflor yellow injection approved in China for angina pectoris and studied for acute ischaemic stroke. It is also the constituent that makes the antiplatelet interaction with warfarin pharmacologically expected rather than speculative.
Anhydrosafflor yellow B
Quinochalcone C-glycosideConcentration: the second major quinochalcone of the flower; not a Pharmacopoeia assay marker
Studied alongside hydroxysafflor yellow A using preparative HPLC and selective knock-out approaches in safflower herb pairs. Contributes to the yellow pigment fraction and to its cardiovascular activity, but is far less characterised than hydroxysafflor yellow A.
Carthamin
Quinochalcone (red pigment)Concentration: the red pigment of the petal; content rises as the flower matures and the petals turn from yellow to red
The water-insoluble red dye of safflower, historically the commercial reason the crop was grown. Its abundance relative to the yellow pigments tracks harvest timing, which is one reason petal colour is used as a crude quality indicator for the drug.
Kaempferol and its glycosides (including kaempferol-3-O-rutinoside)
Flavonol and flavonol glycosidesConcentration: kaempferol is the second Chinese Pharmacopoeia assay marker for the drug, determined after acid hydrolysis of the methanol extract
The flavonol fraction of the flower and one of the two official quality markers. Kaempferol-3-O-rutinoside is also, with scutellarin, one of the two components identified by chemical fingerprinting combined with bioassay as a probable cause of the adverse reactions seen with Safflower Injection, so it is simultaneously a quality marker and a safety signal for the injectable route.
Scutellarin
Flavone glucuronideConcentration: a minor flavonoid of the flower, present in Safflower Injection
Identified together with kaempferol-3-O-rutinoside as a component likely responsible for the clinical adverse reactions of Safflower Injection when chemical fingerprinting was combined with bioassay. Relevant to the injectable form, not to oral decoction.
Luteolin
FlavoneConcentration: present in the petal flavonoid fraction
One of the constituent flavones of the flower with anti-inflammatory and antioxidant activity in preclinical assays; not specific to safflower.
Serotonin (5-HT) derivatives and spermidine conjugates, including N-feruloylserotonin
Hydroxycinnamic acid amides of serotonin and spermidineConcentration: concentrated in the SEED, not the flower; a spermidine extraction yield of 2.894 mg/g has been reported
Antioxidant amide conjugates that are the signature of safflower SEED rather than of Flos Carthami. They are frequently quoted in reviews of the species and should not be attributed to the flower drug that this record describes.
Linoleic acid
Polyunsaturated fatty acidConcentration: the dominant fatty acid of safflower SEED oil; effectively absent from the flower drug
The constituent of safflower cooking oil. Human data on safflower oil and platelet aggregation do not transfer to Flos Carthami, and the regulatory conclusion that safflower oil as a food has no demonstrated abortifacient effect applies to the oil only, not to the flower.
⚠ Drug Interactions
Warfarin
A 74-year-old man stable on warfarin 1.25 mg/day with a therapeutic INR developed haematuria after 14 days of taking safflower 20 g daily, with an INR of 5.31. On restarting the same warfarin dose without safflower his INR returned to 1.64-2.57. He had been taking twice the recommended maximum daily dose of 10 g. The mechanism appears to be pharmacodynamic rather than pharmacokinetic: in rats, combining Carthamus tinctorius with warfarin significantly prolonged prothrombin time and bleeding time WITHOUT changing the blood concentration of warfarin. Safflor yellow inhibits platelet adhesion and 5-HT release and raises free intracellular calcium. Safflower is one of the Chinese herbs assessed as having strong evidence of interaction with warfarin.
Clinical note: Treat as a real, dose-related interaction. Do not exceed 10 g daily, keep the dose constant, and check INR within one to two weeks of starting or stopping. Stop the herb and check INR urgently if haematuria, epistaxis or unexplained bruising appears.
Aspirin, clopidogrel, ticagrelor, dipyridamole and NSAIDs
Hydroxysafflor yellow A and the safflor yellow fraction inhibit platelet aggregation, inhibit platelet adhesion and suppress 5-HT release; this is the pharmacology behind the herb's approved cardiovascular use. Combining it with pharmaceutical antiplatelet agents is additive by design rather than by accident. In the acute cerebral infarction trial, safflower yellow injection given on top of standard antiplatelet therapy prolonged prothrombin time and lowered fibrinogen, which is direct evidence that the effects stack.
Clinical note: Usable with single antiplatelet therapy under monitoring, but be cautious on dual antiplatelet therapy, before surgery, or in a patient with peptic ulcer disease or any bleeding disorder. Stop at least one week before elective surgery.
Pregnancy: abortifacient, and additive with oxytocin, misoprostol and other uterotonics
Hong Hua is a genuine abortifacient, not merely a precautionary contraindication. Safflower decoction excites uterine and intestinal smooth muscle, it has documented traditional use for fertility regulation and termination, and Carthamus tinctorius extract in mice produced toxic changes in placental structure and significantly reduced neonatal survival. Blood-invigorating herbs of this class stimulate uterine contraction and threaten an established pregnancy. The distinction that must be preserved: this applies to the FLOWER drug at medicinal doses, whereas safflower seed OIL used as a food has no clinical evidence of abortifacient effect.
Clinical note: Absolutely contraindicated in pregnancy at any stage. State this plainly to patients of childbearing potential and check pregnancy status before prescribing. Do not use it as an adjunct to pharmacological uterotonics outside a controlled obstetric setting.
Safflower Injection / safflor yellow injection (intravenous route)
The injectable preparation is a different risk article from the oral herb and must be kept separate. China's National Centre for ADR Monitoring collected 3,306 adverse reaction reports for Safflower Injection in 2012 alone, 154 of them (4.66%) classed as serious, predominantly skin and respiratory allergic reactions and arrhythmia. A pooled analysis of 14 published cases of anaphylactic shock found 57.14% occurred within ten minutes of administration and 78.57% within thirty minutes, the fastest at about two minutes; women accounted for 64.29% of cases and most patients were over 40. All 14 survived with oxygen, epinephrine and vasopressors. Chemical fingerprinting combined with bioassay identified scutellarin and kaempferol-3-O-rutinoside as probable causative components. Single overdose administration is an identified risk factor.
Clinical note: This hazard belongs to the injection, not to decocted Hong Hua. Never extrapolate the injection safety record onto oral use, and never extrapolate oral tolerance onto the injection. Where the injection is used, it must be given with resuscitation facilities and the patient observed for at least 30 minutes.
Anticoagulant and antiplatelet drugs in peptic ulcer disease or active bleeding
Safflower is specifically cautioned in peptic ulcer disease and in bleeding disorders on the basis of its antiplatelet and anticoagulant pharmacology. There is no trial evidence quantifying gastrointestinal bleeding risk, but the combination of a mucosal lesion, an antiplatelet herb and an NSAID or anticoagulant is a recognised additive hazard.
Clinical note: Avoid in active peptic ulceration, recent gastrointestinal bleed, or thrombocytopenia. Take a bleeding history before prescribing.
Dosage
| Form | Amount | Frequency | Duration | Population | Notes |
|---|---|---|---|---|---|
| decoction | 3–10 g | daily | — | adult | 中国药典 2020年版 一部 【红花】【用法与用量】3～10g。 【注意】孕妇慎用。 — Chinese Pharmacopoeia 2020, Vol. I. Contraindicated in pregnancy; smaller doses nourish and harmonize Blood, larger doses invigorate and break Blood stasis. |
Dui Yao — Herb Pairs
The classical two-herb combinations this herb appears in, each with an action neither herb has alone.
The pair invigorates blood and breaks up stasis more powerfully than either herb alone, acting on both the upper and lower body.
Amenorrhea, dysmenorrhea and abdominal masses from blood stasis, and traumatic pain; the basis of Tao Hong Si Wu Tang (Yi Zong Jin Jian). Contraindicated in pregnancy.
Named pairing — Lü Jingshan, Shi Jinmo Dui Yao
Evidence Tier
Moderate evidence · 4 studiesRecorded studies by study design, strongest design at the top. This is a study-design tier only, not a GRADE rating: it does not weigh risk of bias, consistency or precision.
Systematic review / meta-analysis
0
Randomized controlled trial
2
1 verified · 1 unverified
Show 2 studies
- Effect and Safety of Hydroxysafflor Yellow A for Injection in Patients with Acute Ischemic Stroke of Blood Stasis Syndrome: A Phase II, Multicenter, Randomized, Double-Blind, Multiple-Dose, Active-Controlled Clinical Trial
- The Value of Safflower Yellow Injection for the Treatment of Acute Cerebral Infarction: A Randomized Controlled Trial
Other clinical trial
0
Observational / case report
0
In vitro / animal
1
0 verified · 1 unverified
Other / unclassified
1
1 verified · 0 unverified
Verified: design read from PubMed for a DOI that resolves to the cited paper Unverified: taken from the study's recorded description
Clinical Studies
Effect and Safety of Hydroxysafflor Yellow A for Injection in Patients with Acute Ischemic Stroke of Blood Stasis Syndrome: A Phase II, Multicenter, Randomized, Double-Blind, Multiple-Dose, Active-Controlled Clinical Trial
A nine-centre Chinese phase II trial run from July 2013 to September 2015 in patients with moderate or severe acute ischaemic stroke of Blood Stasis syndrome. Patients were randomised to low-, medium- or high-dose hydroxysafflor yellow A injection (25, 50 or 70 mg/day intravenously) or to Dengzhan Xixin Injection 30 mL/day as active control, each for 14 consecutive days. The proportions achieving a modified Rankin Scale score of 1 or less at day 90 were significantly larger in the medium- and high-dose groups than in the control group, and the drug was safe and well tolerated at all doses. This is the strongest controlled evidence for the isolated main constituent, by the intravenous route, in a Chinese-syndrome-selected population.
The Value of Safflower Yellow Injection for the Treatment of Acute Cerebral Infarction: A Randomized Controlled Trial
A prospective single-blinded randomised controlled trial in 97 patients with acute ischaemic stroke (66 treatment, 31 control) given safflower yellow injection 80 mg daily or placebo for 14 days on top of standard antiplatelet and neuroprotective therapy. NIHSS scores fell significantly by days 7 and 14 in the treatment arm, red cell deformability and aggregation improved, prothrombin time lengthened, fibrinogen fell, and TNF-alpha, IL-1beta and IL-6 were significantly reduced. The authors acknowledged the small sample and incomplete blinding. A corrigendum was published in 2016 correcting the author list only; the paper itself has not been retracted. Note the haemostatic findings: this is direct trial evidence that the drug prolongs PT and lowers fibrinogen on top of antiplatelet therapy.
A literature analysis on 14 cases of allergic shock caused by safflower injection
A pooled literature analysis of 14 published Chinese case reports of anaphylactic shock following clinical use of safflower injection. Women made up 64.29% of cases and most patients were over 40. Onset was rapid: 57.14% within ten minutes of administration and 78.57% within thirty minutes, the fastest at about two minutes. Reactions occurred mainly during treatment of cardiovascular and cerebrovascular disease. All patients were managed with oxygen, epinephrine and vasopressors, and no patient died: six recovered within thirty minutes, five within two hours and three within a day. This is a case-series review, not a controlled study, so it establishes that the hazard is real and fast in onset but cannot give an incidence.
Combination of chemical fingerprinting with bioassay, a preferable approach for quality control of Safflower Injection
Chemical fingerprinting of Safflower Injection identified 33 compounds, and coupling the fingerprint to a bioassay pinned scutellarin and kaempferol-3-O-rutinoside as the components most likely responsible for the clinical adverse reactions reported with the preparation. Directly relevant to why the injectable route carries an allergy risk that oral Hong Hua does not.
⚠ Rule-Based Cautions
These entries come from the deterministic rule tables that gate Verscienta's formula tools — classical pair prohibitions, pregnancy and lactation contraindications, and dose ceilings.
Pregnancy
Avoid blood-invigorator
Historical Texts
Jin Gui Yao Lue
Eastern Han dynasty, Zhang Zhongjing, c. 200 CEKai Bao Ben Cao
Northern Song dynasty, 973-974 CEBen Cao Gang Mu
Ming dynasty, 1596References
- YT Chua, XL Ang, XM Zhong, KS Khoo. Interaction between warfarin and Chinese herbal medicines . Singapore Medical Journal (2015) [DOI]
- Wei Zhuang, Shaoli Liu, Xusheng Zhao, Nan Sun, Tao He, Yali Wang, Beibei Jia, Xiaolan Lin. Interaction Between Chinese Medicine and Warfarin: Clinical and Research Update . Frontiers in Pharmacology (2021) [DOI]
- Haotian Bai, Jing Yang, Rui Wang. Carthamus tinctorius L.: a comprehensive review of its ethnomedicine, phytochemistry, pharmacology, and clinical applications . Frontiers in Pharmacology (2025) [DOI]
- Jinous Asgarpanah, Nastaran Kazemivash. Phytochemistry, pharmacology and medicinal properties of Carthamus tinctorius L. . Chinese Journal of Integrative Medicine (2013) [DOI]
- Paula Mendonca Leite, Maria Auxiliadora Parreiras Martins, Maria das Gracas Carvalho, Rachel Oliveira Castilho. Mechanisms and interactions in concomitant use of herbs and warfarin therapy: An updated review . Biomedicine and Pharmacotherapy (2021) [DOI]
This information is for educational purposes only and is not intended to replace professional medical advice. Always consult a qualified healthcare provider before using any herbal remedy, especially if you are pregnant, nursing, or taking medications.
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