Yunnan Baiyao

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Yunnan Baiyao

Common Names

  • Yun Nan Pai Yao

For Patients & Caregivers

Tell your healthcare providers about any dietary supplements you’re taking, such as herbs, vitamins, minerals, and natural or home remedies. This will help them manage your care and keep you safe.


How It Works

Yunnan Baiyao is a traditional Chinese Medicine (TCM) formula used for wound healing, as a pain reliever, and to stop bleeding.

Yunnan Baiyao (YNBY; “White medicine from the Province of Yunnan” in Mandarin) is a well-known proprietary TCM product. The original formula is believed to contain several herbs, with notoginseng as the major ingredient. It is promoted as a dietary supplement that can be used both externally and internally to stop bleeding, or provide relief from minor aches and pains associated with backache, arthritis, strains, bruises, and sprains.

Lab studies suggest that YNBY and notoginseng may help stop bleeding, and have wound-healing, anti-inflammatory, and antimicrobial effects. However, notoginseng may also have blood-thinning properties.

Studies in humans suggest that YNBY may help treat skin or colon ulcers or reduce uterine bleeding. It also reduced blood loss during some surgical procedures. Case reports suggest that topical YNBY used along with conventional treatments may help reduce bleeding in cancer patients, but additional studies are needed to confirm these effects. This product has not been studied as a cancer treatment.

Purported Uses
  • Stop bleeding
    Human studies and case reports suggest YNBY may help decrease blood loss during some surgical procedures and in cancer patients, but additional studies are needed.
  • Relieve pain
    Although claimed to relieve pain, scientific data are not available to support this use.
  • Arthritis
    YNBY showed anti-inflammatory effects in lab studies, but clinical studies in humans have not been conducted to establish this use.
  • Oral health
    Lab studies suggest YNBY can reduce the breakdown of bone tissue. Human studies are needed to confirm this effect.
  • Cancer
    YNBY has not been studied as a cancer treatment. Case reports suggest that topical YNBY used along with standard interventions may help decrease blood loss in cancer patients, but clinical trials are needed.
Patient Warnings

This formula may stimulate the growth of hormone-sensitive breast cancer cells.

Do Not Take If
  • You are pregnant.
  • You have hormone-sensitve breast cancer: Lab studies suggest ginsenosides from notoginseng may have estrogenic effects.
  • You have a bleeding disorder: Lab studies suggest YNBY can increase the bleeding risk.
  • You are taking anticoagulant or antiplatelet drugs: Lab studies suggest notoginseng may increase bleeding risk when used with these drugs.
  • You are taking CYP3A substrate drugs: Lab studies suggest notoginseng may increase the risk of side effects with these drugs.
  • You are taking CYP1A2 or 2E1 substrate drugs: Lab studies suggest notoginseng saponins may decrease effectiveness of these drugs.
  • You are taking drugs that are substrates of Glutathione-S-transferase (GST): Lab studies suggest notoginseng may increase the risk of side effects of these drugs.
Side Effects

Mild: Nausea, vomiting, diarrhea, stomach discomfort, gastroesophageal reflux, and rash

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For Healthcare Professionals

Clinical Summary

Yunnan Baiyao (YNBY; “White medicine from the Province of Yunnan” in Mandarin), is among the well-known proprietary traditional Chinese medicine products. It was formulated a century ago and became a popular remedy for wound healing during the Vietnam War. In the last few decades, the trade name YNBY has been expanded into a product line that includes pills, tinctures, and toothpaste. The original formula is believed to contain multiple herbs with notoginseng as the main ingredient. It is also promoted as a dietary supplement that can be used both externally and internally to stop bleeding and to treat cancer in humans and in animals. Other claims include relief from minor aches and pains associated with backache, arthritis, strains, bruises, and sprains (1).

In vitro and animal studies suggest YNBY and notoginseng have hemostatic (2) (3) (4) (5), anti-inflammatory (8) (9) (10) (11) (12) and antimicrobial (5) effects. Notoginseng by itself demonstrated anticoagulant, antiplatelet (6), and fibrinolytic (7) activities.

Clinical studies suggest that YNBY may help treat uterine hemorrhage, ulcerative colitis and skin ulcers (13). Other preliminary data suggest topical application of a yunnan baiyao paste may reduce hospital-acquired pressure ulcers (31). It also reduced intraoperative blood loss during prostate (14) and oral surgery (15). Case reports suggest that adjunctive topical YNBY may reduce bleeding in cancer patients (29), but it has not been studied as a cancer treatment.

Ginsenosides derived from notoginseng may exert estrogenic effects (16) and stimulate growth of hormone-sensitive breast cancer cells (17) (18).

Purported Uses
  • Stop bleeding
  • Pain
  • Arthritis
  • Oral health
  • Cancer
Mechanism of Action

YNBY demonstrates hemostatic effects when applied topically on open wounds (2). Microscopic examination identified nanofiber components which may help activate blood clotting, act as scaffolding for tissue repair, and prevent infection by wound sealing (4). Preclinical studies suggest anti-inflammatory activity may occur through lymphocyte suppression and proinflammatory cytokine expression (11) and modulation of COX and LOX pathways (30). YNBY extract may also activate intracellular prostaglandin E(2) and thromboxane B(2) in osteoblasts (8).

Anticoagulant and antiplatelet effects by notoginseng may occur via fibrinogen reduction (6) (7). Notoginseng also protected endothelial function and vascular integrity by regulating focal adhesion kinase, integrin expression and NF-kappa B functions (19) (20), and inhibited vascular intimal hyperplasia by lowering expression of proliferating cell nuclear antigen, cyclinE, cyclinD1, FN and MMP-9. (21). Antimicrobial activity has been suggested in a Pseudomonas aeruginosa model, wherein a water extract of YNBY reduced bacterial virulence by affecting quorum-sensing signaling and reducing biofilm formation (5).

In other studies, notoginsenoside Ft1, a saponin constituent, induced platelet aggregation by binding to platelet P2Y12 receptors (3). It demonstrated anti-inflammatory effects by inhibiting neutrophil function and NO and PGE2 production through reduced iNOS and COX-2 expression (10). In peritoneal macrophages, notoginseng had a bidirectional regulatory effect, inhibiting COX-2 expression at an early stage and elevating it at a later stage (22). Data also suggest it can inhibit expression of NF-kappaB activity and TNF-alpha mRNA (12). Notoginseng may play a role in periodontal disease treatment by suppressing MMP-2 expression and by inhibiting breakdown of bone tissue (9). In another study, Ginsenoside-Rd isolated from notoginseng reduced atherosclerosis by inhibiting LDL uptake and cholesterol accumulation in macrophages (23).

Some studies report that notoginseng and constituent ginsenosides mimic estrogen (16) by binding and activating the estrogen receptor (18) and ER-alpha pathway (17). In an animal study, notoginseng selectively sensitized tumor cells to radiation (24). However, this effect has not been demonstrated in humans.

Warnings

May stimulate the growth of hormone-sensitive breast cancer (16)

Contraindications
  • Bleeding disorders
  • Pregnant women should not consume this formula.
Adverse Reactions

Mild: Nausea, vomiting, diarrhea, stomach discomfort, gastroesophageal reflux, and rash (32)

Herb-Drug Interactions
  • Anticoagulant or antiplatelet drugs: Preclinical studies indicate notoginseng has anticoagulant, antiplatelet (6), and fibrinolytic (7) activities, and may increase the risk of bleeding when used with these drugs. Clinical relevance has yet to be determined.
  • CYP3A substrates: Preclinical studies indicate notoginseng saponins can inhibit CYP3A activity and may affect the metabolism of substrate drugs (25). Clinical relevance has yet to be determined.
  • CYP1A2, 2E1 substrates: Preclinical studies indicate notoginseng saponins can induce CYP1A2 and may affect the metabolism of substrate drugs (26) (27). Clinical relevance has yet to be determined.
  • Glutathione-S-transferase (GST) substrates: Preclinical studies indicate notoginseng inhibits the glutathione-S-transferase activity and may interfere with the metabolism of substrate drugs (28). Clinical relevance has yet to be determined.
Herb Lab Interactions

May increase PT, PTT, INR.

Dosage (OneMSK Only)
References
  1. Food and Drug Administration. Correspondence with Manufacturer; 2002.
  2. Fan C, Song J, White CM. A comparison of the hemostatic effects of notoginseng and yun nan bai yao to placebo control. J Herb Pharmacother. 2005;5:1-5.
  3. Gao B, Huang L, Liu H, et al. Platelet P2Y(1)(2) receptors are involved in the haemostatic effect of notoginsenoside Ft1, a saponin isolated from Panax notoginseng. Br J Pharmacol. 2014;171:214-223.
  4. Lenaghan SC, Xia L, Zhang M. Identification of nanofibers in the Chinese herbal medicine: Yunnan Baiyao. J Biomed Nanotechnol. 2009;5:472-476.
  5. Zhao ZG, Yan SS, Yu YM, et al. An aqueous extract of Yunnan Baiyao inhibits the quorum-sensing-related virulence of Pseudomonas aeruginosa. J Microbiol. 2013;51:207-212.
  6. Lau AJ, Toh DF, Chua TK, Pang YK, Woo SO, Koh HL. Antiplatelet and anticoagulant effects of Panax notoginseng: comparison of raw and steamed Panax notoginseng with Panax ginseng and Panax quinquefolium. J Ethnopharmacol. 2009;125:380-386.
  7. Cicero AF, Vitale G, Savino G, Arletti R. Panax notoginseng (Burk.) effects on fibrinogen and lipid plasma level in rats fed on a high-fat diet. Phytother Res. 2003;17:174-178.
  8. He H, Ren X, Wang X, et al. Therapeutic effect of Yunnan Baiyao on rheumatoid arthritis was partially due to regulating arachidonic acid metabolism in osteoblasts. J Pharm Biomed Anal. 2012;59:130-137.
  9. Jang YJ, Kim ME, Ko SY. n-Butanol extracts of Panax notoginseng suppress LPS-induced MMP-2 expression in periodontal ligament fibroblasts and inhibit osteoclastogenesis by suppressing MAPK in LPS-activated RAW264.7 cells. Arch Oral Biol. 2011;56:1319-1327.
  10. Jin UH, Park SG, Suh SJ, et al. Inhibitory effect of Panax notoginseng on nitric oxide synthase, cyclo-oxygenase-2 and neutrophil functions. Phytother Res. 2007;21:142-148.
  11. Li R, Alex P, Ye M, Zhang T, Liu L, Li X. An old herbal medicine with a potentially new therapeutic application in inflammatory bowel disease. Int J Clin Exp Med. 2011;4:309-319.
  12. Wang Y, Peng D, Huang W, Zhou X, Liu J, Fang Y. Mechanism of altered TNF-alpha expression by macrophage and the modulatory effect of Panax notoginseng saponins in scald mice. Burns. 2006;32:846-852.
  13. Yang B, Xu ZQ, Zhang H, et al. The efficacy of Yunnan Baiyao on haemostasis and antiulcer: a systematic review and meta-analysis of randomized controlled trials. Int J Clin Exp Med. 2014;7:461-482.
  14. Li NC, Pan BN, Wang HJ, et al. [The effect of Yunnan Baiyao on reduction of intra-operative bleeding of the patients undergoing transurethral resection of prostate]. Zhonghua Yi Xue Za Zhi. 2007;87:1017-1020.
  15. Tang ZL, Wang X, Yi B, Li ZL, Liang C, Wang XX. [Prophylactic administration of Yunnan Baiyao capsule reduces intra-operative blood loss in orthognathic surgery]. Zhonghua Kou Qiang Yi Xue Za Zhi. 2008;43:542-545.
  16. Chan RY, Chen WF, Dong A, Guo D, Wong MS. Estrogen-like activity of ginsenoside Rg1 derived from Panax notoginseng. J Clin Endocrinol Metab. 2002;87:3691-3695.
  17. Lau WS, Chan RY, Guo DA, Wong MS. Ginsenoside Rg1 exerts estrogen-like activities via ligand-independent activation of ERalpha pathway. J Steroid Biochem Mol Biol. 2008;108:64-71.
  18. Lee YJ, Jin YR, Lim WC, et al. Ginsenoside-Rb1 acts as a weak phytoestrogen in MCF-7 human breast cancer cells. Arch Pharm Res. 2003;26:58-63.
  19. Lin F, Gou X. Panax notoginseng saponins improve the erectile dysfunction in diabetic rats by protecting the endothelial function of the penile corpus cavernosum. Int J Impot Res. 2013;25:206-211.
  20. Yuan Z, Liao Y, Tian G, et al. Panax notoginseng saponins inhibit Zymosan A induced atherosclerosis by suppressing integrin expression, FAK activation and NF-kappaB translocation. J Ethnopharmacol. 2011;138:150-155.
  21. Wu L, Zhang W, Tang YH, et al. Effect of total saponins of “Panax notoginseng root” on aortic intimal hyperplasia and the expressions of cell cycle protein and extracellular matrix in rats. Phytomedicine. 2010;17:233-240.
  22. Yuan ZB, Zhang HG, Jia Y, Cheng YQ, Li XH. Temporal expression of cyclooxygenase-2 in peritoneal macrophages of rats and effects of Panax notoginseng saponins. Inflamm Res. 2009;58:74-80.
  23. Li J, Xie ZZ, Tang YB, Zhou JG, Guan YY. Ginsenoside-Rd, a purified component from Panax notoginseng saponins, prevents atherosclerosis in apoE knockout mice. Eur J Pharmacol. 2011;652:104-110.
  24. Chen FD, Wu MC, Wang HE, et al. Sensitization of a tumor, but not normal tissue, to the cytotoxic effect of ionizing radiation using Panax notoginseng extract. Am J Chin Med. 2001;29:517-524.
  25. Yang ZM, Yang XF. [Inhibitory effect of PNS on drug metabolism enzyme CYP3A in rat livers and its kinetic analysis]. Zhongguo Zhong Yao Za Zhi. 2012;37:3486-3489.
  26. Liu R, Qin M, Hang P, Liu Y, Zhang Z, Liu G. Effects of Panax notoginseng saponins on the activities of CYP1A2, CYP2C9, CYP2D6 and CYP3A4 in rats in vivo. Phytother Res. 2012;26:1113-1118.
  27. Chen YJ, Wang YG, Ma ZC, et al. [Effect of Panax notoginseng saponins on liver drug metablic enzyme activity, mRNA and protein expressions in rats]. Zhongguo Zhong Yao Za Zhi. 2014;39:3824-3828.
  28. Yang Z, Yang X. [Inhibition of glutathione-S-transferase by total saponins of Panax notoginseng and its kinetics analysis in liver of mice]. Zhongguo Zhong Yao Za Zhi. 2011;36:2413-2417.
  29. Ladas EJ, Karlik JB, Rooney D, et al. Topical Yunnan Baiyao administration as an adjunctive therapy for bleeding complications in adolescents with advanced cancer. Support Care Cancer. 2012 Dec;20(12):3379-83.
  30. Ren X, Zhang M, Chen L, et al. The anti-inflammatory effects of Yunnan Baiyao are involved in regulation of the phospholipase A2/arachidonic acid metabolites pathways in acute inflammation rat model. Mol Med Rep. 2017 Oct;16(4):4045-4053.
  31. Liu J, Cai M, Yan H, et al. Yunnan Baiyao reduces hospital-acquired pressure ulcers via suppressing virulence gene expression and biofilm formation of Staphylococcus aureus. Int J Med Sci. 2019;16(8):1078-1088.
  32. Li B, Feng S, Wu ZH, et al. Adverse drug reactions of Yunnan Baiyao capsule: a multi-center intensive monitoring study in China. Ann Transl Med. Mar 2019;7(6):118.
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