- 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.
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.
Although claimed to relieve pain, scientific data are not available to support this use.
YNBY showed anti-inflammatory effects in lab studies, but clinical studies in humans have not been conducted to establish this use.
Lab studies suggest YNBY can reduce the breakdown of bone tissue. Human studies are needed to confirm this effect.
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.
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.
For Healthcare Professionals
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.
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.
- 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.