Chi Shao
StarPaeonia lactiflora Pall. / Paeonia veitchii Lynch
Traditionally used for
- Digestion
- Menstrual & women's health
☯ TCM Properties
Clears Heat and Cools the Blood; Invigorates Blood and Dispels Stasis; Clears Liver Fire; Alleviates Pain; Disperses Swelling and Dissipates Abscesses
Traditional Chinese Uses
Chi Shao (red peony root) is a cool, Blood-activating herb that also cools the Blood, making it effective for both excess and heat-related Blood pathology. It invigorates Blood and reduces stasis for amenorrhea, dysmenorrhea, abdominal masses, and pain from Blood stagnation. Its Blood-cooling action addresses bleeding from Heat in the Blood and inflammatory conditions with a heat component. Unlike white peony (Bai Shao), which primarily nourishes Blood, red peony primarily moves and cools.
Pharmacological Effects
- Antiinflammatory and antiallergic: Paeoniflorin inhibited carrageenin paw edema in rats; paeoniflorin and desbenzoylpaeoniflorin suppressed contact hypersensitivity and passive cutaneous anaphylaxis.
- Cardiovascular: Decoction increased coronary and myocardial blood flow; paeoniflorin was hypotensive in guinea pigs, vasodilated coronary and limb vessels in dogs; paeoniflorin and benzoylpaeoniflorin inhibited platelet coagulation; paeoniflorin relaxed gastric and uterine smooth muscle in rats.
- CNS: Paeoniflorin was sedative in rats, prolonged hexobarbital sleep, analgesic in writhing test, weakly hypothermic and anticonvulsant.
- Other: Paeoniflorin prevented stress ulcer in rats and antagonized acetylcholine-induced intestinal spasm.
Source: Zhu YP. Chinese Materia Medica: Chemistry, Pharmacology and Applications. Harwood Academic, 1998, p. 166.
Used In Formulas (79)
Relationships
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Botanical Description
Paeonia lactiflora is a herbaceous perennial in the family Paeoniaceae, native to central and eastern Asia, including northern China, Mongolia, eastern Siberia, and parts of Tibet, where it grows on grassy slopes, in open woodlands, and along forest margins. The plant produces a clump of erect, glabrous stems 50-100 cm tall arising from thick, spindle-shaped, brownish tuberous roots. The leaves are biternate or pinnately compound, with lanceolate to elliptic leaflets having entire, sometimes red-margined edges. Solitary or few-flowered terminal blossoms appear in late spring to early summer, 8-12 cm across, with fragrant white to pale pink petals and numerous yellow stamens in the wild form; numerous cultivated forms exist. The fruits are follicles containing dark seeds. Chi Shao is prepared from the unpeeled root of wild-collected or cultivated plants, distinguishing it from the peeled white root (Bai Shao).
Active Constituents
Paeoniflorin
Monoterpene glycoside (pinane-type cage skeleton)Concentration: Chinese Pharmacopoeia minimum 1.8% of the dried root; measured at roughly 76 mg/g in Radix Paeoniae Rubra against roughly 28 mg/g in the boiled-and-peeled Bai Shao drug
The principal marker and the compound most of the pharmacology is attributed to; it inhibits platelet aggregation, has anticoagulant activity in vitro and contributes to the hepatoprotective and anti-inflammatory profile of the crude drug.
Note that paeoniflorin content is roughly 2.7 times higher in Chi Shao than in Bai Shao, which is one reason the two drugs are not clinically interchangeable despite coming from the same species.
Albiflorin
Monoterpene glycosideConcentration: roughly 2.2 mg/g in Radix Paeoniae Rubra, markedly lower than the roughly 12.6 mg/g reported for Radix Paeoniae Alba
An isomer of paeoniflorin that survives the boiling-and-peeling step used to make Bai Shao and is largely absent from the directly dried Chi Shao root. Reported anticoagulant activity in vitro.
Oxypaeoniflorin
Monoterpene glycosideA hydroxylated paeoniflorin analogue present in the root and one of the constituents recovered as circulating metabolites after oral dosing of the crude drug.
Benzoylpaeoniflorin
Monoterpene glycoside (benzoyl ester)A more lipophilic paeoniflorin ester; contributes to the monoterpene glycoside fraction collectively described as total paeony glycosides.
Gallic acid
Phenolic acid (hydroxybenzoic acid)Concentration: roughly 3.4 mg/g of the dried root, higher than in Radix Paeoniae Alba
One of the polyphenols that is enriched in Chi Shao relative to Bai Shao because the root is dried without boiling or peeling. Antioxidant and antiplatelet in vitro.
Methyl gallate
Phenolic esterConcentration: roughly 7.3 mg/g of the dried root, against roughly 2.6 mg/g in Radix Paeoniae Alba
A gallic acid ester enriched in the unprocessed red peony root; contributes antioxidant and anti-inflammatory activity.
Galloylglucoses (including 1,2,3,4,6-penta-O-galloylglucose)
Hydrolysable tannin (gallotannin)Concentration: roughly 21.5 mg/g total in Radix Paeoniae Rubra, roughly double the level in Radix Paeoniae Alba
Pentagalloylglucose is one of the constituents shown to have direct anticoagulant activity in vitro and is a plausible contributor to the blood-invigorating action ascribed to Chi Shao.
Catechin and catechin gallate
Flavan-3-olPart of the tannin-rich polyphenol fraction of the unpeeled root; recovered along with epicatechin gallate among the constituents metabolised after oral administration.
Protocatechuic acid
Phenolic acid (dihydroxybenzoic acid)Identified as one of four Radix Paeoniae Rubra constituents with measurable anticoagulant activity in vitro, alongside paeoniflorin, albiflorin and pentagalloylglucose.
Paeonol
Phenolic ketone (acetophenone)A minor component of the red peony root, reported at higher levels than in Bai Shao. Paeonol inhibits ADP-, arachidonic-acid- and collagen-induced platelet aggregation through suppression of thromboxane A2 and prostaglandin D2 formation.
Practitioners should note that paeonol is chiefly a marker of Mu Dan Pi (Moutan Cortex), not of Chi Shao; a high paeonol reading in a Chi Shao sample is a reason to question the identity of the material.
⚠ Drug Interactions
Warfarin and other oral anticoagulants
Radix Paeoniae Rubra extract and four of its isolated constituents (paeoniflorin, albiflorin, pentagalloylglucose and protocatechuic acid) show anticoagulant activity in vitro, and total paeony glycosides prolong prothrombin time and lower blood viscosity in animal models. The drug is used in Chinese practice specifically to invigorate blood and disperse stasis, which is the traditional description of the same pharmacology.
No controlled human interaction study has been published, so the level of evidence is mechanistic and preclinical rather than clinical.
Clinical note: Check INR more frequently when Chi Shao is started, stopped or its dose changed, particularly at the high doses (30 g/day and above) used for jaundice. Stop before elective surgery.
Antiplatelet drugs (aspirin, clopidogrel, ticagrelor)
Paeonia constituents, notably paeonol, inhibit ADP-, arachidonic-acid- and collagen-induced platelet aggregation via suppression of thromboxane A2 formation, and whole Radix Paeoniae Rubra extract is antithrombotic in animal thrombosis models. Combining it with a pharmacological platelet inhibitor is expected to be additive.
Clinical note: Usable with monitoring in most patients, but ask about easy bruising, gum bleeding and melaena, and avoid stacking with a second blood-invigorating herb at high dose.
Bai Shao (Paeoniae Radix Alba) and total glucosides of paeony (TGP) preparations
Chi Shao and Bai Shao are the same botanical species. Chi Shao is the root dried directly, usually from wild-collected material and permitting Paeonia veitchii as well as P. lactiflora; Bai Shao is cultivated P. lactiflora root that is boiled and peeled, in either order, before drying. That processing difference is chemically substantial: paeoniflorin is roughly 76 mg/g in Chi Shao against roughly 28 mg/g in Bai Shao, gallotannins and gallate esters are about double in Chi Shao, while albiflorin is roughly six times higher in Bai Shao.
The practical consequence is that the marketed drug Total Glucosides of Paeony, and the large rheumatoid-arthritis and hepatitis literature attached to it, is manufactured from Paeoniae Radix Alba. That evidence does not transfer to Chi Shao, and citing it as Chi Shao evidence is a common error.
Clinical note: Confirm which peony the prescription and the supplied material actually are. Do not substitute one for the other, and do not read Bai Shao or TGP trial data across to Chi Shao.
Li Lu (Veratrum nigrum) and other Veratrum-containing preparations
Shao Yao (peony, covering both Chi Shao and Bai Shao) is one of the drugs listed as incompatible with Li Lu in the classical Eighteen Incompatibilities (Shi Ba Fan), and the pairing is avoided in Chinese pharmacy practice on that basis. The classical prohibition has no modern pharmacokinetic study behind it, so it is recorded here as traditional doctrine.
The independent hazard is not theoretical: Veratrum species contain steroidal alkaloids that block cardiac and vascular sodium-channel handling and cause bradycardia, hypotension and protracted vomiting in overdose.
Clinical note: Do not combine. The prohibition is observed in Chinese hospital pharmacy and a combined prescription will usually be rejected at dispensing.
Dosage
| Form | Amount | Frequency | Duration | Population | Notes |
|---|---|---|---|---|---|
| decoction | 6–12 g | Daily | — | — | 中国药典 2020 【用法与用量】6～12g。 【注意】不宜与藜芦同用。 【性味与归经】苦，微寒。归肝经。 — Chinese Pharmacopoeia 2020, quoted verbatim; route and cautions preserved. Replaces a cleared category-filler value. |
Dui Yao — Herb Pairs
The classical two-herb combinations this herb appears in, each with an action neither herb has alone.
Together one invigorates and cools the blood while the other nourishes blood and softens the Liver, so they both tonify and move blood and relieve pain.
Named pairing — Lu Jingshan, Shi Jinmo Dui Yao
Together they cool the blood and invigorate blood, clearing heat from the blood level while dispersing stasis so that bleeding stops without leaving stagnation.
Named pairing — Bensky et al., Chinese Herbal Medicine: Materia Medica (3rd ed., 2004)
Evidence Tier
Moderate evidence · 3 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
0
Other clinical trial
0
Observational / case report
0
In vitro / animal
2
1 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
Therapeutic Efficacy and Safety of Paeoniae Radix Rubra Formulae in Relieving Hyperbilirubinemia Induced by Viral Hepatitis: A Meta-Analysis
Fifteen randomised controlled trials covering 1,323 patients with viral-hepatitis hyperbilirubinaemia (729 treated, 594 control). Paeoniae Radix Rubra was given at 30 to 200 g per day, stratified into 30-60 g, 60-120 g and above 120 g. Total bilirubin fell by 75.57 micromol/L (95% CI -94.88 to -56.26) against control, with significant reductions in ALT and AST as well; odds ratios for response were about 4 whether the drug was used alone or in a formula.
Two of the included papers reported no side effects and three reported mild digestive symptoms with no clinical consequence. The authors judged the trials methodologically weak and called for multicentre double-blind studies. The doses studied are an order of magnitude above the 12 g/day Pharmacopoeia maximum, which is the key practical caveat.
Antithrombotic Effect and Mechanism of Radix Paeoniae Rubra
Screened Radix Paeoniae Rubra extract and its isolated constituents for anticoagulant activity. Paeoniflorin, pentagalloylglucose, albiflorin and protocatechuic acid were each active, and the antithrombotic effect of the whole extract was linked to regulation of vascular endothelial mediators together with direct anticoagulation.
This is the main mechanistic basis for treating Chi Shao as a bleeding-risk herb when it is combined with warfarin or an antiplatelet drug.
Chishao (Paeoniae Radix Rubra) alleviates intra-hepatic cholestasis by modulating NTCP in rats
In a rat model of intrahepatic cholestasis, Chishao improved cholestatic biochemistry, and the authors attribute the effect to modulation of NTCP, the sodium-taurocholate co-transporting polypeptide that governs hepatocyte uptake of bile acids.
This is the mechanistic counterpart to the clinical use of high-dose Chi Shao in cholestatic hepatitis and severe jaundice, but it is a rodent study and does not by itself justify supra-Pharmacopoeial dosing.
⚠ Safety & Contraindications
Contraindications
Its use is cautious in patients with carbuncle-abscess broken, blood deficiency, and no blood stasis. It should not be used together with Radix et Rhizoma Veratri Nigri ( li lu ).
Source: Xi S, Gong Y. Essentials of Chinese Materia Medica and Medical Formulas. Academic Press/Elsevier, 2017, pp. 81–84.
Side Effects
- Acute toxicity of paeoniflorin is very low
Source: Zhu YP. Chinese Materia Medica: Chemistry, Pharmacology and Applications. Harwood Academic, 1998, p. 166.
⚠ 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.
Incompatibilities (十八反 / 十九畏)
- 十八反: Li Lu × Shao Yao — avoid combining with Li Lu / Veratrum
Historical Texts
Wu Shi Er Bing Fang (Prescriptions for Fifty-Two Ailments)
Warring States to Western Han, excavated Mawangdui manuscriptShen Nong Ben Cao Jing
Han dynastyBen Cao Jing Ji Zhu (Tao Hongjing)
Northern and Southern Dynasties, c. 480-498 ADKai Bao Ben Cao
Song dynasty, 973 ADDian Nan Ben Cao (Lan Mao) and Yi Xue Ru Men
Ming dynastyReferences
- Yu-Qing Tan, Heng-Wen Chen, Jun Li, Qing-Juan Wu. Efficacy, Chemical Constituents, and Pharmacological Actions of Radix Paeoniae Rubra and Radix Paeoniae Alba . Frontiers in Pharmacology (2020) [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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