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Chi Shao

Q: Is Chi Shao effective alone or only in formulas?

Most clinical evidence supports the efficacy of Chi Shao when used as part of multi-herb formulas, rather than as an isolated ingredient. Its benefits are often synergistic with other herbs.

Q: Is Chi Shao safe for long-term use?

Limited long-term safety data exist for isolated Chi Shao. However, traditional use and clinical trials involving formulas containing Chi Shao suggest good tolerability over extended periods.

Q: Can Chi Shao be used with conventional medicine?

Yes, Chi Shao is often used adjunctively with conventional medicine. However, caution is advised, especially when combined with anticoagulants, due to its potential blood-thinning effects. Medical supervision is recommended.

Also known as: Chi Shao, Red Peony Root, Paeonia lactiflora

Overview

Chi Shao, scientifically known as *Paeonia lactiflora*, is the dried root of the peony plant, widely recognized and utilized in Traditional Chinese Medicine (TCM). It is primarily valued for its purported blood-invigorating, anti-inflammatory, and pain-relieving properties. This botanical supplement is frequently incorporated into complex multi-herb formulas to address a range of conditions, including menstrual disorders, cardiovascular issues, and various inflammatory states. Its applications also extend to improving circulation, providing pain relief, and serving as an adjunctive therapy in certain cancer care regimens and neurological conditions. While research on Chi Shao is ongoing, much of the evidence for its efficacy comes from studies on multi-herb formulations rather than isolated Chi Shao, leading to varying levels of evidence quality and some challenges in attributing specific benefits solely to this ingredient.

Benefits

Chi Shao, predominantly as part of multi-herb formulas, has demonstrated several evidence-based benefits. A meta-analysis of 11 studies on Xiangshao granules, which contain Chi Shao, showed significant improvement in menopausal syndrome symptoms, including anxiety and depression, with an odds ratio of 2.78 (95% CI 1.65–4.68, p<0.05). This suggests a moderate clinical benefit for menopausal women. Furthermore, Chi Shao has been correlated with improved survival in stage IV breast cancer patients when used within TCM regimens, with hazard ratios indicating a protective effect (HR ~0.34, 95% CI 0.13–0.89), though this evidence is from observational studies and is hypothesis-generating. For post-stroke spasticity, Chinese herbal medicine formulas containing Chi Shao have shown additive benefits in improving functional outcomes, as indicated by an increase in Barthel Index scores (MD 13.15, 95% CI 4.37–21.93). While these findings suggest promising applications, the strength of evidence is often limited by the use of multi-herb formulas and heterogeneity in study designs, making it challenging to isolate the precise contribution of Chi Shao.

How it works

The therapeutic effects of Chi Shao are primarily attributed to its bioactive compounds, particularly paeoniflorin. This compound, along with others, exhibits anti-inflammatory, antioxidant, and vasodilatory properties. Chi Shao is believed to modulate blood circulation by inhibiting platelet aggregation and enhancing microcirculation, which contributes to its benefits in vascular and gynecological conditions. At a molecular level, it interacts with various biological pathways, including those involved in inflammatory cytokine production and oxidative stress. While these mechanisms are understood, the precise molecular targets and comprehensive pathways in humans are still being elucidated. The oral bioavailability of paeoniflorin is moderate, and its absorption and metabolism can be influenced by other herbs when taken in combination.

Side effects

Chi Shao is generally considered safe when used within traditional dosages as part of herbal formulas. Adverse effects are rare and typically mild, with occasional reports of gastrointestinal discomfort. There are no robustly documented significant drug interactions or contraindications. However, due to its potential blood-thinning effects, caution is advised when Chi Shao is combined with anticoagulant medications, and monitoring by a healthcare professional is recommended. Specific safety data for use during pregnancy and lactation are not well established, and therefore, its use in these populations should be approached with caution and under medical guidance. Long-term safety data for isolated Chi Shao are limited, but traditional use and clinical trials of formulas containing it suggest good tolerability.

Dosage

The specific dosage of Chi Shao when used as a standalone ingredient is not well standardized in modern clinical practice, as it is most commonly administered within multi-herb formulas. In such formulations, typical daily doses of the dried root range from 3 to 10 grams. The optimal dosage is highly dependent on the specific formulation, the intended therapeutic purpose, and individual patient factors. Clinical trials predominantly utilize multi-herb preparations rather than isolated Chi Shao, making it difficult to establish precise dosing for single-ingredient use. The timing of administration and absorption characteristics may be influenced by co-administered herbs, which can enhance bioavailability. There are no clearly defined upper limits or safety thresholds for isolated Chi Shao, but adherence to traditional dosages within established formulas is generally recommended.

FAQs

Is Chi Shao effective alone or only in formulas?

Most clinical evidence supports the efficacy of Chi Shao when used as part of multi-herb formulas, rather than as an isolated ingredient. Its benefits are often synergistic with other herbs.

Is Chi Shao safe for long-term use?

Limited long-term safety data exist for isolated Chi Shao. However, traditional use and clinical trials involving formulas containing Chi Shao suggest good tolerability over extended periods.

Can Chi Shao be used with conventional medicine?

Yes, Chi Shao is often used adjunctively with conventional medicine. However, caution is advised, especially when combined with anticoagulants, due to its potential blood-thinning effects. Medical supervision is recommended.

Research Sources

https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2025.1546200/full – This meta-analysis of 11 RCTs on Xiangshao granules (containing Chi Shao) for menopausal syndrome found a significant improvement in total effective rate (OR=2.78). Despite high heterogeneity, it suggests benefit over placebo and other Chinese medicines for menopausal symptoms like anxiety and depression.
https://pmc.ncbi.nlm.nih.gov/articles/PMC6610255/ – This systematic review and meta-analysis of 7 RCTs indicated that Chinese Herbal Medicine (CHM) including Chi Shao improved functional outcomes (Barthel Index MD 13.15) in patients with post-stroke spasticity. High heterogeneity was noted, suggesting additive effects are difficult to isolate from combination therapies.
https://journals.sagepub.com/doi/10.1177/15347354231178898 – A retrospective cohort study on CHM in stage IV breast cancer patients identified Chi Shao among herbs linked to improved survival (HR 0.34). This observational study provides hypothesis-generating evidence for Chi Shao's role in adjunctive cancer care, though it has limitations due to its design.