Paeoniae Lactiflorae
Also known as: Paeonia lactiflora Pall., Chinese peony, white peony root, TGP, Total glucosides of paeony, Paeonia lactiflora
Overview
Paeonia lactiflora, commonly known as Chinese peony or white peony root, is a traditional Chinese medicinal herb. Its dried roots are processed to extract total glucosides of paeony (TGP), with paeoniflorin being the primary active constituent. This herbal extract is primarily recognized for its immunomodulatory and anti-inflammatory properties, making it a subject of significant research, particularly in the context of autoimmune and inflammatory diseases. TGP is often used as an adjunct therapy to conventional treatments. Research, including randomized controlled trials and meta-analyses, supports its role in managing conditions like systemic lupus erythematosus (SLE). The evidence base for TGP's efficacy and safety in these applications is considered moderately mature, with varying but often medium to high certainty for specific outcomes.
Benefits
Paeonia lactiflora, primarily in the form of Total Glucosides of Paeony (TGP), offers several evidence-based benefits. Its most significant effect is the reduction of autoimmune disease activity, particularly in Systemic Lupus Erythematosus (SLE). Meta-analyses of randomized controlled trials indicate that TGP, when combined with conventional therapies, significantly reduces SLE Disease Activity Index (SLEDAI) scores by approximately 3.5 points, representing a clinically meaningful improvement. This benefit is supported by medium to high certainty evidence. Furthermore, TGP has been shown to reduce the incidence of adverse reactions associated with standard SLE treatments and may lower the recurrence rate of disease flare-ups, suggesting an improved safety profile when used adjunctively. Preclinical studies also suggest neuroprotective effects, with paeoniflorin reducing neurological deficits, infarct size, apoptosis, and inflammatory markers like IL-1β in models of cerebral ischemia-reperfusion injury. While less established, some systematic reviews indicate that Chinese herbal formulas containing Paeonia lactiflora may alleviate menopausal hot flashes, though direct evidence for Paeonia lactiflora alone is limited and of lower certainty. Benefits in SLE patients can be observed within one month of treatment.
How it works
Paeonia lactiflora exerts its therapeutic effects primarily through its active component, paeoniflorin, and other total glucosides of paeony (TGP). These compounds modulate immune function by regulating inflammatory cytokines and immune cell activity, thereby contributing to reduced autoimmune inflammation. Specifically, paeoniflorin has been shown to inhibit pro-inflammatory cytokines such as IL-1β and reduce apoptosis. It also interacts with various immune cell signaling pathways implicated in the pathogenesis of autoimmune diseases and ischemic injury. After oral administration, paeoniflorin exhibits moderate oral bioavailability, allowing for systemic immunomodulatory effects. This mechanism of action helps to rebalance the immune system and mitigate the excessive inflammatory responses characteristic of autoimmune conditions.
Side effects
Total Glucosides of Paeony (TGP) from Paeonia lactiflora is generally well tolerated and possesses a favorable safety profile, particularly when used in clinical trials for autoimmune conditions like SLE. The most commonly reported side effects are mild gastrointestinal symptoms, which occur infrequently and are generally less severe than those associated with conventional immunosuppressants. High-quality randomized controlled trials have not reported any significant serious adverse events. While potential interactions with immunosuppressive drugs exist, clinical studies have shown that TGP combined with standard therapies can actually reduce the incidence of adverse events, suggesting a possible synergistic safety effect rather than increased risk. Specific contraindications are not well-defined, but caution is advised for pregnant and lactating individuals due to a lack of sufficient research data in these populations. Most safety data are derived from adult autoimmune patients, and there is limited evidence regarding its use in pediatric populations.
Dosage
For autoimmune conditions, clinical trials typically utilize standardized Total Glucosides of Paeony (TGP) extracts. A common dosage observed in studies is around 600 mg/day of TGP, usually administered in divided doses. While an optimal range is not fully established, dosages in trials have varied, generally falling between 600 mg/day and 1200 mg/day. There is no clearly defined maximum safe dose, as doses used in clinical trials have been well tolerated without significant adverse effects. Oral administration is the standard route, often taken twice daily. It is recommended to use standardized TGP extracts to ensure consistency in the active components. While food may influence absorption, no specific cofactors are known to be required for its efficacy.
FAQs
Is Paeonia lactiflora safe to use with conventional autoimmune drugs?
Yes, randomized controlled trials indicate that TGP combined with standard therapies for autoimmune conditions is safe and may even reduce the incidence of adverse effects associated with conventional treatments.
How soon can benefits be expected when taking Paeonia lactiflora for autoimmune conditions?
Improvements in disease activity, particularly in Systemic Lupus Erythematosus (SLE), have been observed within one month of treatment in clinical trials.
Can Paeonia lactiflora be used for neurological conditions?
Preclinical evidence supports neuroprotective effects of paeoniflorin, a key component, but clinical data in humans for neurological conditions are currently lacking.
Is Paeonia lactiflora effective for menopausal symptoms?
Some systematic reviews suggest that Chinese herbal formulas containing Paeonia lactiflora may help alleviate hot flashes, but more rigorous trials focusing on Paeonia lactiflora alone are needed to confirm this benefit.
Research Sources
- https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2022.932874/full – This systematic review and meta-analysis of 14 RCTs involving 978 SLE patients found that TGP combined with conventional therapy significantly reduced SLEDAI scores and adverse reactions. The study concluded that TGP is a safe and effective adjunctive treatment for SLE, with moderate certainty of evidence.
- https://pubmed.ncbi.nlm.nih.gov/35173622/ – This systematic review and meta-analysis, also encompassing 14 RCTs and 978 SLE patients, confirmed a significant reduction in disease activity (MD SLEDAI -3.54) and an improved safety profile when TGP was used alongside conventional treatments. It highlighted TGP's potential as an effective and safe adjunct for SLE, with medium-high quality evidence.
- https://pubmed.ncbi.nlm.nih.gov/35462929/ – This preclinical meta-analysis of 13 animal studies involving 282 rodents demonstrated that paeoniflorin reduced neurological deficits, infarct size, and inflammation in acute ischemia models. While promising for neuroprotection, the study noted that these findings are from animal models and human translation is uncertain.
- https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0222383 – This systematic review and meta-analysis on menopausal symptoms found that herbal formulas containing Paeonia lactiflora might reduce hot flashes. However, it noted heterogeneity in the formulas and limited direct evidence for Paeonia lactiflora alone, suggesting low-moderate quality evidence for this specific application.
