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Peer-reviewedCC BY 4.0Frontiers in Pharmacology

Traditional Paeonia radix alba formulas and their bioactive metabolites: a narrative review focusing on hepatoprotection in chronic liver diseases

  • Yanqi Li1
  • Jinmin Shen2
  • Xiaozhong He1
  • Tianyi Zhang3
  • Fengli Lin4
  • Hui Wang1
  • Yunshun Qiu1
  • Junwei Jia5
  • Guimin Zhang5,6
  • Zhong Feng1,4,5
6 affiliations
  1. 1Graduate School, Tianjin University of Traditional Chinese Medicine
  2. 2School of Foreign Languages, Jilin University of Chemical Technology
  3. 3School of Pharmacy, Shandong University of Traditional Chinese Medicine
  4. 4Lunan Pharmaceutical Group Co., Ltd.
  5. 5National Engineering and Technology Research Center of Chirality Pharmaceutical, Lunan Pharmaceutical Group Co., Ltd.
  6. 6State Key Laboratory of Integration and Innovation of Classic Formula and Modern Chinese Medicine, Lunan Pharmaceutical Group Co., Ltd.
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Abstract

Aim of the Review: Paeoniae radix alba (PRA), a traditional Chinese medicine used for centuries to “soothe the liver” and relieve pain, has attracted increasing attention for its potential role in liver diseases. Emerging pharmacological evidence indicates that PRA exerts hepatoprotective, anti-inflammatory, antioxidant, and immunomodulatory effects. This paper reviews traditional Chinese medicine prescriptions containing PRA, its main active metabolites, and their underlying mechanisms in the treatment of liver diseases, and preliminarily summarizes its hepatotoxicity-attenuating mechanisms, to provide directions for further multifaceted research.

Materials and Methods: We searched Web of Science using the following strategies: AB=(xiaoyaosan OR XYS) AND AB = liver, with analogous searches for the other formulas; AB=(paeoniflorin OR PF OR PAE) AND AB=(“Paeonia lactiflora Pall” OR “Paeoniae radix alba” OR PRA) AND AB = liver, with analogous searches for the other metabolites; AB = process* AND AB=(“Paeonia lactiflora Pall” OR “Paeoniae radix alba” OR PRA) AND AB = liver; and AB=(hepatotoxicity OR detoxification) AND AB=(“Paeonia lactiflora Pall” OR “Paeoniae radix alba” OR PRA). We prioritized studies published within the past 5 years and those with more complete methodological details.

Results: PRA and its classic prescriptions, including Xiaoyao San, Shaoyao Gancao Tang, Danggui Shaoyao San and Sini San, have made significant contributions to the treatment of liver diseases. Notably, despite limited current research, PRA can effectively attenuate the hepatotoxicity of other botanical drugs, which is closely associated with its multiple protective effects against liver injury. Therefore, rational and cautious combination therapy should be considered in the clinical application of PRA to maximize its unique advantages and minimize potential risks.

Conclusion: Within the framework of TCM theory, PRA and its metabolites appear promising for the management of liver diseases and may also mitigate hepatotoxicity associated with certain herbal medicines. Further mechanistic investigations and clinical studies are needed to validate these findings.

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Cite

BibTeXRIS
BibTeX
@article{li2026traditional,
  title = {{Traditional Paeonia radix alba formulas and their bioactive metabolites: a narrative review focusing on hepatoprotection in chronic liver diseases}},
  author = {Yanqi Li and Jinmin Shen and Xiaozhong He and Tianyi Zhang and Fengli Lin and Hui Wang and Yunshun Qiu and Junwei Jia and Guimin Zhang and Zhong Feng},
  journal = {Frontiers in Pharmacology},
  year = {2026},
  month = nov,
  doi = {10.3389/fphar.2026.1958930},
  url = {https://www.frontiersin.org/articles/10.3389/fphar.2026.1958930/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Traditional Paeonia radix alba formulas and their bioactive metabolites: a narrative review focusing on hepatoprotection in chronic liver diseases
AU  - Yanqi Li
AU  - Jinmin Shen
AU  - Xiaozhong He
AU  - Tianyi Zhang
AU  - Fengli Lin
AU  - Hui Wang
AU  - Yunshun Qiu
AU  - Junwei Jia
AU  - Guimin Zhang
AU  - Zhong Feng
PY  - 2026
DA  - 2026/11/04
JO  - Frontiers in Pharmacology
DO  - 10.3389/fphar.2026.1958930
UR  - https://www.frontiersin.org/articles/10.3389/fphar.2026.1958930/full
AB  - Aim of the Review: Paeoniae radix alba (PRA), a traditional Chinese medicine used for centuries to “soothe the liver” and relieve pain, has attracted increasing attention for its potential role in liver diseases. Emerging pharmacological evidence indicates that PRA exerts hepatoprotective, anti-inflammatory, antioxidant, and immunomodulatory effects. This paper reviews traditional Chinese medicine prescriptions containing PRA, its main active metabolites, and their underlying mechanisms in the treatment of liver diseases, and preliminarily summarizes its hepatotoxicity-attenuating mechanisms, to provide directions for further multifaceted research.  Materials and Methods: We searched Web of Science using the following strategies: AB=(xiaoyaosan OR XYS) AND AB = liver, with analogous searches for the other formulas; AB=(paeoniflorin OR PF OR PAE) AND AB=(“Paeonia lactiflora Pall” OR “Paeoniae radix alba” OR PRA) AND AB = liver, with analogous searches for the other metabolites; AB = process* AND AB=(“Paeonia lactiflora Pall” OR “Paeoniae radix alba” OR PRA) AND AB = liver; and AB=(hepatotoxicity OR detoxification) AND AB=(“Paeonia lactiflora Pall” OR “Paeoniae radix alba” OR PRA). We prioritized studies published within the past 5 years and those with more complete methodological details.  Results: PRA and its classic prescriptions, including Xiaoyao San, Shaoyao Gancao Tang, Danggui Shaoyao San and Sini San, have made significant contributions to the treatment of liver diseases. Notably, despite limited current research, PRA can effectively attenuate the hepatotoxicity of other botanical drugs, which is closely associated with its multiple protective effects against liver injury. Therefore, rational and cautious combination therapy should be considered in the clinical application of PRA to maximize its unique advantages and minimize potential risks.  Conclusion: Within the framework of TCM theory, PRA and its metabolites appear promising for the management of liver diseases and may also mitigate hepatotoxicity associated with certain herbal medicines. Further mechanistic investigations and clinical studies are needed to validate these findings.
SN  - 1663-9812
ER  -