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Bai shao is one of Chinese medicine’s leading herbs for women’s health

Bai Shao

Paeoniae radix alba/ Paeonia lactiflora Pallas Ranunculaceae

So much more than a simple blood tonic, bai shao’s calming and harmonising qualities make it an indispensable herb in TCM for treating a wide array of ailments, in particular, those associated with menstruation and pain.

  • How does it feel?

    Bai shao has a somewhat bland, slightly sour and bitter taste, the latter owing to its major constituent paeoniflorin, a monoterpene glycoside. The sourness, according to the classics, allows it to ‘enter the tendons and the liver’. In the hand, prepared bai shao is pleasing to hold; smooth with a soft, powdery feel, reminding one of its ability to soften, smooth and harmonise on both a physical and emotional level.

  • What can I use it for?

    Bai shao’s primary actions are to tonify Blood and ‘soften’ the Liver. In TCM, the Liver is responsible for storing blood, supplying blood to the Uterus and regulating the smooth flow of qi (and, thus, Blood and emotions). It is, therefore, integral to menstrual function and physiology and bai shao, being such an excellent tonic and liver support, is indispensable for conditions relating to menstrual health and a chief herb in cases of absent periods or period pain where blood deficiency has led to stagnation and pain.

    In TCM, the Liver governs the tendons. Where blood is deficient, the muscles and tendons lack nourishment and contraction and pain ensue. Bai shao, with its wonderful analgesic, anti-inflammatory and sedative properties, is a primary herb for nourishing Liver blood to alleviate this type of cramping, spasmodic pain. Aside from period pain, bai shao also excels in treating pain in the flank, chest, abdomen (including dysenteric cramps), calves, hands and feet.

    Entering both the Liver and Spleen, bai shao exerts its harmonising effect on this organ relationship. When Liver qi stagnates, as it so readily does in modern life, it can impact our digestion (Spleen/ Stomach) causing abdominal cramping and diarrhoea. Bai shao is a principle herb in addressing digestive issues, with their root in Liver qi constraint.

    While categorised as a blood tonic, bai shao is also an important yin tonic. In particular, Liver yin. Liver yin acts as an anchor for Liver yang which, if unrestrained, becomes ascendant leading to symptoms such as pressure headaches, hypertension, dizziness, tinnitus and agitation. Bai shao has a lovely sedating action on the Liver; strengthening Liver yin to descend and quell irascible Liver yang.

    Being a sour and, therefore, astringent herb, bai shao is also used in cases of irregular sweating such as spontaneous daytime sweats and night sweats. These can be from effulgent yang qi, deficient yin qi or an imbalance of the ying and wei qi – the interior, nourishing and exterior, defensive qi, respectively. When these lose harmony, the opening and closing of the pores is affected and improper sweating can occur. This astringent quality also makes it a common choice for conditions such as abnormal vaginal discharge or bleeding and involuntary ejaculation.

  • Into the heart of Bai Shao

    Bitter, sour and cool in nature, bai shao tonifies, harmonises, sedates and astringes to alleviate a wide range of ailments. Specifically, it nourishes the Blood, tonifies and preserves yin, regulates the menses, calms the liver and curbs Liver yang, harmonises ying and wei qi and stops pain.

    While numerous constituents have been isolated from the Paeonia lactiflora root, the primary component is paeoniflorin, a widely researched monoterpene glycoside. It is likely that some of bai shao’s many actions and applications may be attributable to paeoniflorin, which has demonstrated sedative, antispasmodic, anti-inflammatory, antipyretic, antioxidant, immunomodulatory, anti-neoplastic, anti-hyperglycaemic and neuroprotective effects.

    It has also been found to contain phytoestrogens and decrease testosterone levels, going some way to explain its ability to regulate the menses and ease symptoms of the menopause.

  • Traditional uses

    The peony plant has been cultivated and coveted for the great beauty of its blooms for thousands of years. The lords of Henan province in central China gave peony flowers as offerings to their king almost 4,000 years ago.

    In its long history as a medicinal substance, bai shao has had many faces. Historically, it has been used as a tonifying, thickening and flavouring agent in cooking (Confucius claimed himself a fan), a ritual fasting aid for its ability to stabilise blood sugar and as a therapy for toxicity from food and drink (an application used in early Daoist alchemical practices where it was used to protect against heavy metal poisoning).

    Bai shao was first listed in the Shennong Bencao Jing (The Divine Farmer’s Materia Medica) (ca. 100 A.D.) as a bitter medicinal for treating ‘evil qi’, abdominal pain, blood stasis, masses, urinary difficulty and qi deficiency. It is also believed to have been used medicinally by the ancient Greeks and was, up to the 19th Century, featured in the European Pharmacopoeia.

  • Traditional actions

    • Alterative
    • Analgesic
    • Antimicrobial
    • Anti-inflammatory
    • Astringent
    • Carminative
    • Diuretic
    • Emmenagogue
    • Immunomodulant
    • Nervine
    • Sedative
    • Uterine Tonic
  • What practitioners say

    MenstrualBai shao is an instrumental TCM herb for regulating menstruation. It may, and often is, used at any stage of the menstrual cycle, but is most important in the follicular phase (the yin half of the cycle; menstruation and post-menstruation) where it helps to supplement and support Blood and yin during and after the period when they and naturally depleted. It is also useful to include in the second half of the cycle (the yang phase; ovulation and pre-menses) in cases of Liver qi and Blood stagnation, where its harmonising and sedating effects are drawn on to address conditions such as anovulation from hyperprolactinemia and PMT.

    It is often used for absent, light, irregular (both late and early) or painful periods and bleeding between periods. Accompanying symptoms indicating bai shao for use in these instances will tend to be those of Liver Blood deficiency (dry skin, hair and nails, tingling in the limbs, insomnia, blurred vision, pale tongue, thin pulse) with or without the often consequent Liver qi stagnation (period pain that is paired with a pale tongue and thin pulse tells us that this particular qi stagnation is a result of blood deficiency). It is also often used in formulas where heat from ongoing Liver qi stagnation or yin deficiency has led to the ‘reckless’ movement of blood such as that seen in bleeding between the periods and early periods.

    Bai shao is also invaluable (with the appropriate pattern of symptoms) for helping issues that plague women at the time of their periods, including breast distension, headaches, diarrhoea, fever and skin outbreaks.

    Musculoskeletal: Any pain – in particular, abdominal, chest or flank pain – that is cramping and contracting in nature and due to Blood deficiency or qi stagnation will lend itself to this herb. For this purpose, it is often combined with gan cao (Licorice). Indeed, the formula Shao Yao Gan Cao Tang is simply bai shao and gan cao combined in equal parts to treat a vast array of pain conditions (everything from sciatic pain to bronchial spasms) and is especially useful for cramps in the calf muscles.

    Gynaecological: Bai shao is indicated in any number of gynaecological conditions where its abilities to tonify Blood and yin, calm the Liver, stop pain and astringe are required. These can include endometriosis, pelvic inflammatory disease, abdominal masses and excessive vaginal discharge.

    Reproductive: Bai shao is used as a supportive medicinal and often prescribed in formulas where a woman’sfertility issues are believed to be linked to underlying patterns of Blood deficiency, Blood stagnation, qi stagnation and/ or Liver and Kidney yin deficiencyIt is also included in formulas for men experiencing fertility issues such as low sperm count and quality, erectile dysfunction related to Kidney deficiency or qi and Blood stagnation.

    Obstetric: Given for morning sickness where Liver qi invades the Stomach, abdominal pain from Blood deficiency (a common condition in pregnancy), Liver qi stagnation or Cold, edema from qi stagnation and dizziness from Liver yang rising. Post-partum, where qi, Blood and yin deficiencies are very common, bai shao is readily included in formulae for post-natal depression, abdominal pain, constipation and absent or insufficient lactation.

    Digestive: A primary herb for treating abdominal pain owing to the Spleen/ Stomach (digestion) being ‘attacked’ by errant Liver qi. This is a common clinical presentation (think, IBS) and occurs where emotional issues (notably, anger, stress, resentment or pent-up emotions) have led to Liver qi stagnation which has then gone wayward. It often occurs against a backdrop of weak digestion, which allows the invasion to occur and, therefore, treatment involves supporting Earth (Spleen/ Stomach) while controlling Wood (Liver). To this end, bai zhu (white Atractylodes) will typically be combined with bai shao to nourish Earth and control Wood, respectively. Also used in cases of dysenteric pain.

    Nervous: Used for headaches, dizziness and insomnia from either Blood or yin deficiency or Liver yang rising. Calms irritability from ascendant Liver yang and nourishes Blood and calms the Liver, generally, to alleviate tension, depression and mood swings. In western herbalism, bai shao is used for epilepsy and spasms. Research has explored bai shao’s neuroprotective potential – as seen in Parkinson’s disease, for which it is a chief herb – attributing it to a reduction in neuroinflammation.

    Immune: Bai shao’s antiinflammatory and immunmodulatory properties lend it to use in a range of inflammatory autoimmune conditions such as rheumatoid arthritis and systemic lupus erythematosus.

    Cardiovascular: Used as an antihypertensive in western herbalism, bai shao is also included in TCM formulas to descend Liver yang in cases of high blood pressure.

    Skin: Bai shao is used for spontaneous day or night sweats from deficient yin and excessive Liver yang. It also regulates sweating in cases of wind-cold (colds and flue) where sweating has failed to alleviate symptoms because of an underlying deficiency. In such case it will be combined with gui zhi (Cinnamon) to harmonise the ying and wei qi. This combination is also used in formulas to treat skin conditions, such as itching and hives, caused by wind-cold trapped in the body’s exterior. As a yin and Blood tonic, bai shao may also be used to treat skin conditions with yin and Blood deficiency at the root, including chronic dryness, itching, carbuncles, dermatitis and lupus.    

  • Research

    Research into the use of bai shao tends to focus on the water/ethanol extract TGP (total glucosides of Peony) of which paeoniflorin is the major constituent. While further large scale randomized control tests are needed to explore bai shao, TGP and paeoniflorin’s therapeutic benefits, the following pre-clinical in vivo trials have yielded promising results.

    Paeoniflorin has shown anti-inflammatory and immunosuppressive actions in a large number of studies yet the exact mechanisms of which are not clearly understood.

    In a review of twelve trials exploring the mechanisms behind TGP’s anti-inflammatory and immunomodulatory activity, it was concluded that TGP inhibits the production of inflammatory mediators and proinflammatory cytokines. In other studies, the same review also determined that TGP may dampen heightened immune responses by inhibiting lymphocyte proliferation, balancing the differentiation of T helper and T suppressor cells and increasing lymphocyte apoptosis. TGP was also found to protect cells against oxidative stress. Anti-inflammatory effects were also seen in a recent study into using white peony root for cholestasis.

    In a study looking in to the potential neuroprotective qualities of white peony root, it was found that the TNF signalling pathway was a key pathway for its therapeutic effects and that it inhibited neurodegeneration by reducing neuroinflammation, slowing neural apoptosis and regulating neurotransmitter levels.

    In a later study, TGP decreased oxidative stress and protected against neurotoxicity by reducing the absorption of toxic alkaloids into the brain. Neuroprotective, along with anti-depressant effects, were also observed in another recent study.

    TGP’s analgesic effect was verified in numerous studies where it was found, in part, to involve adenosine A1 receptor and not opiate receptors.

    In a recent review of TCM use for menopausal hot flushes, bai shao was found to be the most commonly prescribed individual herb, likely owing to it containing phytoestrogens and displaying phytoestrogenic effects.

  • Did you know?

    Another important TCM herb, chi shao (red peony root), is derived from the root of Paeonia lactiflora. By leaving the red skin of the root on, the function changes to make it slightly colder and, therefore, better at clearing heat as in cases of Blood heat and Liver fire. It also has the ability to invigorate Blood. Where bai shao treats pain from deficiency and qi stagnation, chi shao eases pain from Blood stagnation. They are often used together to complement and enhance their effects.

Additional information

  • Safety

    Because of its cool nature, use with caution in individuals with weak yang qi and in diarrhoea from deficient cold. Incompatible with li lu (Veratrum root and rhizome).

  • Interactions

    Caution is advised in combination with blood thinning medications

  • Contraindications

    Due to its effects upon the female reproductive system it is best to avoid use during pregnancy and lactation. 

    Because of its cool nature, use with caution in individuals with weak yang qi and with diarrhoea from deficient cold. Incompatible with Li Lu (Veratrum root and rhizome).

  • Preparation

    Traditionally, soaked in water for at least 20-30 minutes then decocted in non-metallic pots in a formula of two or more herbs on a low-moderate heat for around 20-30 mins. Nowadays, also prepared in powder and tincture form.

  • Dosage

    Dried or powdered herb: 6-15g – very large doses may be up to 30g.

    Liquid extract (1:2): weekly dose – 25-75 ml

    Tincture (1:3 25%): Take 2-4ml three times daily.

  • Plant parts used

    Root

  • Constituents

    • Paeoniflorin
    • Paeonol
    • Paeonin
    • Albiflorin
    • Triterpenoids
    • Sistosterol
  • Habitat

    This plant is from the rocky slopes, woodland edges and riverbanks of its native soils (south-east Siberia to north and east China) the root of the white peony plant is now largely cultivated in agricultural regions of mainland China, in particular, Zhejiang, Anhui, Sichuan, Guizhou and Shandong provinces.

  • Sustainability

    The IUCN Red List of Threatened Plants database doe not yet include endangered rating for this plant.

  • Quality control

    Herbal Medicines are often extremely safe to take, however it is important to supply herbal medicines from a reputed supplier. Sometimes herbs bought from unreputable sources are contaminated, adulterated or substituted with incorrect plant matter.

    Some important markers for quality to look for would be to look for certified organic labelling, ensuring that the correct scientific / botanical name is used. 

    A supplier should also be able to tell you where the herbs have come from. There is more space for contamination and adulteration where supply chain is unknown.

  • How to grow

    • Peony is bought as potted plants or as bare-root plant. Growing Peony from seed can take around 3- 5 years, however it is doable. 
    • Best in a deep, fertile, humus-rich soil that is moist but well-drained in a sheltered position in full sun or partial shade. Peony is long-lived but resents disturbance. 
    • Bare-root peony plants should be planted as soon as they arrive.
    • Peonies are best planted in autumn or spring. Ensure you don’t plant them too deeply, as this will yield poor results. 
    • Mix in plenty of well-rotted organic matter before planting. 
    • Apply a balanced fertiliser in spring.
    • NOTE: Avoid overwatering newly planted peonies as this is a common cause of plant failure.
  • Recipe

    Herbal Soup for the premenstrual phase

    This soup helps to alleviate constraint and promote the downward flow of qi and blood in preparation for menstruation.

    Servings: 6 (1 per day)

    Ingredients:

    • 1 oz. bai shao
    • 1 oz. corn silk
    • ½ cup of sheng jiang pi (fresh ginger peel)
    • ½ oz. chuan xiong (Ligisticum rhizome)
    • ½ cup of pearl barley
    • 6 cups vegetable/ chicken stock
    • 1 cup of chopped parsley
    • 1 cup diced radish
    • 1 sliced carrot
    • 1 whole sliced leek
    • ¼ cup of sweet vinegar

    Method:

    • Place corn silk and sheng jiang pi in muslin bag
    • Simmer all of the herbs and pearl barley in the stock for 1 hour
    • Add the vegetables and simmer for 15 mins more
    • Remove the muslin bag, add the vinegar and serve

    Note: not to be consumed if pregnancy has or may have occurred. Caution with significant pre-menstrual heat signs.

    Source: Beinfield H, Korngold E. Between Heaven and Earth: A Guide to Chinese Medicine. New York: Ballantine Books; 1991.

Aromatic
An ‘aromatic’ remedy, high in volatile essential oils, was most often associated with calming and sometimes ‘warming’ the digestion. Most kitchen spices and herbs have this quality: they were used both as flavouring and to ease the digestion of sometimes challenging pre-industrial foods. Many aromatics are classed as ‘carminatives’ and are used to reduce colic, bloating and agitated digestion. They also often feature in respiratory remedies for colds, chest and other airway infections. They are also classic calming inhalants and massage oils, and are the basis of aromatherapy for their mental benefits.
Astringent taste
The puckering taste you get with many plants (the most familiar is black tea after being stewed too long, or some red wines) is produced by complex polyphenols such as tannins. Tannins are used in concentrated form (eg from oak bark) to make leather from animal skins. The process of ‘tanning’ involves the coagulation of relatively fluid proteins in living tissues into tight clotted fibres (similar to the process of boiling an egg). Tannins in effect turn exposed surfaces on the body into leather. In the case of the lining of mouth and upper digestive tract this is only temporary as new mucosa are replenished, but in the meantime can calm inflamed or irritated surfaces. In the case of open wounds tannins can be a life-saver – when strong (as in the bark of broadleaved trees) they can seal a damaged surface. One group of tannins, the reddish-brown ‘condensed tannins’ are procyanidins, which can reduce inflammation and oxidative damage.
Bitter
Bitters are a very complex group of phytochemicals that stimulate the bitter receptors in the mouth. They were some of the most valuable remedies in ancient medicine. They were experienced as stimulating appetite and switching on a wide range of key digestive functions, including increasing bile clearance from the liver (as bile is a key factor in bowel health this can be translated into improving bowel functions and the microbiome). Many of these reputations are being supported by new research on the role of bitter receptors in the mouth and elsewhere round the body. Bitters were also seen as ‘cooling’ reducing the intensity of some fevers and inflammatory diseases.
Blue-purple colouring
Any fruits with a blue-purple colouring contain high levels of the polyphenols known as anthocyanins. These work 1) on the walls of small blood vessels, helping to maintain capillary structure to reduce a key stage in inflammation, and improving the microcirculation to the tissues; 2) to improve retinal function and vision; 3) to support connective tissue repair around the body.
Cooling
Traditional ‘cold’ or cooling’ remedies often contain bitter phytonutrients such a iridoids (gentian), sesiquterpenes (chamomile), anthraquinones (rhubarb root), mucilages (marshmallow), some alkaloids and flavonoids. They tend to influence the digestive system, liver and kidneys. Cooling herbs do just that; they diffuse, drain and clear heat from areas of inflammation, redness and irritation. Sweet, bitter and astringent herbs tend to be cooling.
Hot
Traditional ‘hot’ or ‘heating’ remedies, often containing spice ingredients like capsaicin, the gingerols (ginger), piperine (black or long pepper), curcumin (turmeric) or the sulfurous isothiocyanates from mustard, horseradich or wasabi, generate warmth when taken. In modern times this might translate as thermogenic and circulatory stimulant effects. There is evidence of improved tissue blood flow with such remedies: this would lead to a reduction in build-up of metabolites and tissue damage. Heating remedies were used to counter the impact of cold, reducing any symptoms made worse in the cold. .
Mucilaginous
Mucilages are complex carbohydrate based plant constituents with a slimy or ‘unctuous’ feel especially when chewed or macerated in water. Their effect is due simply to their physical coating exposed surfaces. From prehistory they were most often used as wound remedies for their soothing and healing effects on damaged tissues. Nowadays they are used more for these effects on the digestive lining, from the throat to the stomach, where they can relieve irritation and inflammation such as pharyngitis and gastritis. Some of the prominent mucilaginous remedies like slippery elm, aloe vera and the seaweeds can be used as physical buffers to reduce the harm and pain caused by reflux of excess stomach acid. Mucilages are also widely used to reduce dry coughing. Here the effect seems to be by reflex through embryonic nerve connections: reduced signals from the upper digestive wall appear to translate as reduced activity of airway muscles and increased activity of airway mucus cells. Some seed mucilages, such as in psyllium seed, flaxseed (linseed) or guar bean survive digestion to provide bulking laxative effects in the bowel. These can also reduce rate of absorption of sugar and cholesterol. .
New-mown hay aroma
The familiar country odour of haymaking, of drying grass and other plants, is largely produced by coumarins (originally isolated from tonka beans – in French coumarou) and widely used in perfumery. They are chemically categorised as benzopyrone lactones and are important phytochemicals, with strong antioxidant activity in the laboratory and likely effects in modulating inflammation. They were most often associated with the calming effect linked to their use in stuffing mattresses and pillows and plants, high In coumarins were commonly used for these properties.
Resinous
Resins are most familiar as tacky discharges from pine trees (and as the substance in amber, and rosin for violin bows). They were most valued however as the basis of ancient commodities like frankincense and myrrh (two of the three gifts of the Three Wise Men to the baby Jesus) and getting access to their source was one benefit to Solomon for marrying the Queen of Sheba (now Ethiopia). Resins were the original antiseptic remedies, ground and applied as powders or pastes to wounds or inflamed tissues, and were also used for mummification. With alcohol distillation it was found that they could be dissolved in 90% alcohol and in this form they remain a most powerful mouthwash and gargle, for infected sore throats and gum disease. They never attracted much early research interest because they permanently coat expensive glassware! For use in the mouth, gums and throat hey are best combined with concentrated licorice extracts to keep the resins in suspension and add extra soothing properties. It appears that they work both as local antiseptics and by stimulating white blood cell activity under the mucosal surface. They feel extremely effective!
Salty
The salty flavour is immediately distinctive. A grain dropped onto the tongue is instantly moistening and a sprinkle on food enkindles digestion. This easily recognisable flavour has its receptors right at the front of the tongue. The salty flavor creates moisture and heat, a sinking and heavy effect which is very grounding for the nervous system and encourages stability. People who are solid and reliable become known as ‘the salt of the earth'.
Sharpness
The sharp taste of some fruits, and almost all unripe fruits, as well as vinegar and fermented foods, is produced by weak acids (the taste is generated by H+ ions from acids stimulating the sour taste buds). Sour taste buds are hard-wired to generate immediate reflex responses elsewhere in the body. Anyone who likes the refreshing taste of lemon or other citrus in the morning will know that one reflex effect is increased saliva production. Other effects are subjective rather than confirmed by research but there is a consistent view that they include increased digestive activity and contraction of the gallbladder.
Sweet
In the days when most people never tasted sugar, ‘sweetness’ was associated with the taste of basic foods: that of cooked vegetables, cereals and meat. In other words sweet was the quality of nourishment, and ‘tonic’ remedies. Describing a remedy as sweet generally led to that remedy being used in convalescence or recovery from illness. Interestingly, the plant constituents most often found in classic tonics like licorice, ginseng are plant steroids including saponins, which also have a sweet taste.

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