Yunnan Baiyao: Facts & Myths

Yunnan baiyao, sometimes referred to as a miracle herb¹ or must for first aid,²  has become more recognized today among general practitioners and even board-certified oncologists, who may be considering it to avert the risk for hemorrhage in animals with hemangiosarcoma and nasal adenocarcinoma.^3,4 Yunnan baiyao may also hold clinical value for patients with inflammatory bowel disease,² aphthous stomatitis,⁵ and rheumatoid arthritis.⁶

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What Is It?

Yunnan baiyao, also called Yunnan paiyao, Yun Nan bai yao, or simply YNBY, dates back to the early 20th century Yunnan Province of China; translated, Yunnan baiyao means white medicine from Yunnan.

The main active ingredient appears to be pseudoginseng root, known also as Panax notoginseng or simply notoginseng.^7,8 Notoginseng has a high concentration of hemostatic constituents as compared with other ginsengs,⁹ exhibits cytotoxic effects on cancer cells,¹⁰ and can sensitize those cells to ionizing radiation.¹¹ Other potentially active plant and animal constituents may include myrrh, ox bile, Chinese yam, sweet geranium, lesser galangal root, and other antiseptics or astringent compounds.

Related Article: Evidence-Based Chinese Herbal Medicine

Does It Work?

Mechanistic research suggests that the herb exhibits properties that may in fact inhibit bleeding.⁹ Pharmacologic investigations have shown that YNBY may facilitate platelet agglutination, balance cytokine profiles, stimulate cortisol release, and activate macrophages.⁶ It may also inhibit infection and serve as an effective antimicrobial agent against Pseudomonas aeruginosa.¹²

A systematic review and meta-analysis from China concluded that YNBY aids in controlling uterine hemorrhage and bleeding from both colonic and dermal ulceration.¹³ Human patients that received YNBY orally for 3 consecutive days before bimaxillary orthognathic surgery bled significantly less than did those receiving a placebo.¹⁴ In contrast, a randomized, controlled trial of YNBY (along with another hemostatic herb) showed that neither YNBY nor the other hemostatic herb was more effective than a placebo in reducing the severity of exercise-induced pulmonary hemorrhage (EIPH) in horses.¹⁵

Is It Clinically Safe to Use?

One study found that high doses of notoginseng were toxic to bone marrow stem cells.¹¹ A case report of cerebral venous sinus thrombosis underscored the need for vigilance surrounding Chinese herbs, especially those with hemostatic properties.¹⁶ Chinese herbs, including YNBY, may also cause contact dermatitis when applied topically.¹⁷ Furthermore, Chinese herbs may be contaminated with heavy metals, mycotoxins, microbial agents, and pesticide residues.¹⁸

Despite YNBY having potential clinical value in general and specialty venues, practitioners must remain cautious when using it. To date, there has been little to no definitive evidence of the safety and effectiveness in target species. Furthermore, manufacturers keep the ingredients of their Chinese herbs a trade secret, refusing to fully disclose the identity and/or quantity of those ingredients. The content of the small red pill included in capsule foil packs that sometimes accompany the product likewise is not listed on the product label but has been advocated as an emergency measure in cases of severe internal hemorrhage or after trauma. Clinically, when using remedies based on ancient (or modern) Chinese secrets, a drug’s pharmacokinetic or pharmacodynamics impact remain unknown and practitioners cannot anticipate potential herb–drug interactions.

Because the contents of YNBY seemingly vary among manufacturers, even between batches of the same product, practitioners cannot rely on the promises of purveyors that these products are safe, effective, and free of contamination and adulterating pharmaceuticals. Until manufacturers fully disclose product contents, validation by controlled scientific studies and clinical trials will remain limited, leaving veterinarians who use these proprietary products in a difficult ethical and medicolegal position.