Bai ji

Bai Ji (Bletilla striata): A Comprehensive Reference

1. Identity and Botanical Description

Names and Taxonomy

Bletilla striata (Thunb.) Rchb.f., belonging to the genus Bletilla in the family Orchidaceae, is known as "Bai-Ji" according to traditional Chinese medicine. Other common names include hardy orchid, Chinese ground orchid, urn orchid, hyacinth bletilla, Japanorchidee (German), mikadoblomst (Danish), and shiran (Japanese). The Chinese characters are written 白及. In Korea it is called jaran, and in Sweden mikadoblomma.

The genus Bletilla contains five species: Bletilla striata (Thunb.) Rchb.f., Bletilla ochracea Schltr., Bletilla formosana (Hayata) Schltr., Bletilla foliosa (King & Pantl.) Tang & F.T.Wang, and Bletilla chartacea (King & Pantl.) Tang & F.T.Wang. Bletilla striata is an officially recognized medicinal herb in Traditional Chinese Medicine (TCM) according to the Chinese Pharmacopoeia.

The drug material is derived from the dried tuber of Bletilla striata (Thunb.) Rchb.f., a perennial terrestrial herb belonging to the family Orchidaceae. B. striata has been utilized in traditional Chinese medicine for over 2,000 years. The plant is characterized by a bitter, sweet, and astringent taste.

Distribution and Habitat

B. striata is widely distributed in China, Japan, Korea, Mongolia, and Myanmar, and is important because of its use in traditional Chinese medicine (TCM). It is primarily distributed in the humid mountainous regions of southwestern China—including Sichuan, Yunnan, and Guizhou provinces—with smaller populations found in Anhui, Zhejiang, and Jiangsu provinces along the southeastern coast. B. striata typically thrives in the understory of broad-leaved evergreen forests, coniferous forests, roadside shrubs, or rock crevices at altitudes ranging from 100 to 3,200 m.

Zheng'an County in Guizhou Province is accepted as the most optimal location to produce the crude tubers of B. striata in China. The B. striata produced there is called "Zheng'an Bai Ji." In Europe and the United States, it is grown primarily as an ornamental garden or pot plant.

Plant Morphology and the Medicinal Part

The rhizome produces lanceolate, folded leaves that are light green. From the center of each mound rises a curving flower stalk 25 cm long or more that extends over the leaves. The medicinal material consists of the dried tuber (pseudobulb), sometimes rendered in pharmacopeial sources as Bletillae Rhizoma.

Common Forms and Preparations

The medicinal material known as "baiji" in TCM is usually the dried tuber of B. striata, the authentic product included in the Chinese Pharmacopoeia. According to the Chinese Pharmacopoeia (2020), TCM baiji is sliced, dried, and crushed into a powder that can be used topically or internally, with a recommended dosage of 3–6 g at a time, offering astringent, hemostatic, detumescence, and myogenic effects. It is often used for conditions such as hemoptysis, hematemesis, traumatic bleeding, sores, and skin chaps.

Beyond basic powder and decoction forms, B. striata can be used as a mucosa-protective agent alone or in combination with other Chinese herbal medicines. It can be administered by gastroscopic spraying, injection through a gastric tube, oral administration, or enemas. In modern biomaterial applications, BSP (Bletilla striata polysaccharide) has been prepared into a series of preparations such as nanoparticles, microspheres, microneedles, and hydrogels.

2. Traditional and Historical Use

Earliest Records

Medicinal use was first recorded in Shennong's Classic of Materia Medica (Shennong Bencao Jing), where it was classified as a lower-grade herb: "Bletilla striata has a bitter and neutral nature; it treats abscesses, malignant sores, necrotic ulcers, damaged yin, dead tissue, and pathogenic factors in the stomach. It also addresses wind-induced injuries and paralysis. Alternate names include Gan Gen and Lian Ji Cao. It grows in valleys." This early record briefly outlined its properties, therapeutic indications, aliases, and habitat.

According to the earliest pharmacopeia of TCM, Shennong's Materia Medica Classic, Chinese scholars were the first to describe the morphologic features and medicinal value of B. striata. Historically significant in traditional medicine, B. striata is classified among the "seven white" medicinal herbs in traditional Chinese medicine.

Scope of Traditional Applications

B. striata has been widely used for the treatment of hematemesis, hemoptysis, and traumatic bleeding due to the efficacy of arresting bleeding with astringent action; it has also been applied topically to overcome ulcers, sores, swellings, and chapped skin due to the efficacy of dispersing swelling and promoting tissue regeneration. Additional medical applications include the treatment of tuberculosis, malignant ulcers, hemorrhoids, anthrax, eye diseases, and silicosis.

According to TCM theory, bai ji possesses bitter, sweet, astringent, and slightly cold properties, offering astringent, hemostatic, swelling-reducing, and tissue-regenerative effects. It has been clinically applied to treat hemoptysis, hematemesis, traumatic hemorrhage, cutaneous ulcers, dermal toxicity, and xerosis.

The medicinal material has a long history of ethnobotanical application in Asia, especially China, and ethnic groups in Southwest China still use Bletilla as medicine to treat cough, dermatitis, and pneumonia.

Classical Formulary Context

One classical preparation, documented in Tai Ping Sheng Hui Fang (medical literature edited by the Song Dynasty government), combines Bai Ji (Bletilla striata) with Asarum sieboldii (Xi Xin), Saposhnikovia divaricata (Fang Feng), and Semen Platycladi (Bai Zi Ren). Another formula, Qu Huo Wai Xiao Tang (decoction for purging fire), used to treat skin scalding, is composed of Bai Ji, Sanguisorba officinalis (Di Yu), Cacumen Platycladi (Bai Ye), stir-baked Fructus Gardeniae, Cynanchum otophyllum, Angelica sinensis, and Radix Glycyrrhizae, as recorded in Dong Tian Ao Zhi (Practical Surgical and Clinical Experiences).

Historical materials such as "Ben Cao Feng Yuan" and "Ben Jing" document Bletilla striata as a folk medicine used to stop bleeding, promote tissue regeneration, and accelerate wound healing.

3. Key Chemical Constituents and Active Compounds

Overall Phytochemical Profile

A comprehensive 2025 review identified 294 compounds from B. striata, including 272 non-polysaccharide compounds and 22 polysaccharides. An earlier 2019 review counted approximately 158 compounds with clarified molecular structures. These were classified as glucosides, bibenzyls, phenanthrenes, quinones, biphenanthrenes, dihydrophenanthrenes, anthocyanins, steroids, triterpenoids, and phenolic acids.

Phytochemical investigation has resulted in the identification of 192 monomeric compounds, including bibenzyls, phenanthrene derivatives, triterpenoids and their saponins, steroids and their saponins, malic acid derivatives, and anthocyanins.

Bletilla striata Polysaccharide (BSP)

BSP, the major bioactive component of Bletilla striata, is a water-soluble heteropolysaccharide composed primarily of mannose and glucose. The primary active ingredient is mainly composed of mannose and glucose, with a mannose to glucose ratio of 2.4:1 or 3:1. Its chemical composition is glucomannan, comprising D-glucose and D-mannose.

BSP is the main active ingredient, exhibiting biological functions of anti-inflammatory, anti-oxidant, anti-fibrotic, immune modulation, and anti-glycation activities. In addition, BSP has exhibited the characteristics of an excipient such as bio-adhesion, bio-degradability, and bio-safety, and has been prepared into a series of preparations such as nanoparticles, microspheres, microneedles, and hydrogels.

Bibenzyl and Phenanthrene Compounds

Although the skeleton of bibenzyl compounds is simple, the bridge chain substituents attached to the aromatic ring are diverse, leading to various structural types and biological activities. The structure of bibenzyl compounds is unique, and this is of considerable practical importance for finding benzyl compounds with potential medicinal value. B. striata is rich in benzyl compounds, containing 28 types.

Testing of the antibacterial activity of B. striata has revealed that bibenzyls (compounds 40, 42) and biphenanthrenes (compounds 76–78, 83–86) are active against Gram-positive and Gram-negative strains.

Phenanthrene compounds from Bletilla striata exert selective cytotoxicity against HL-60 leukemia and A549 lung cancer cells.

Anthocyanins

A novel acylated anthocyanin was identified from the violet flowers of Bletilla striata 'Murasaki Shikibu' as a major floral anthocyanin. This pigment is based on cyanidin 3,7-diglucoside as its deacylanthocyanin, acylated with two molecules of caffeic acid, and its structure was unambiguously elucidated by chemical and spectroscopic methods.

4. Mechanisms of Action

Hemostasis

Approximately 158 compounds have been extracted from B. striata tubers with clarified molecular structures, and these chemicals support the pharmacological properties of hemostasis and wound healing, while also exhibiting anti-oxidation, anti-cancer, anti-viral, and anti-bacterial activities. The astringent polysaccharides are particularly central to the hemostatic effect; the BSP sponge formulation has been shown to promote platelet aggregation and coagulation, regulate cytokines and inflammatory factors, and accelerate healing while absorbing blood and exudate.

Wound Healing

BSP's mechanism in wound healing may be through promoting the formation of new blood vessels, regulating inflammation, and promoting the process of epithelialization. Accumulating evidence suggests that BSP exerts multiple activities including anti-inflammatory, antioxidant, immunomodulatory, anti-aging, and enhanced wound and ulcer healing effects.

At the molecular level, compounds in B. striata exert anti-inflammatory effects through coordinated modulation of the NF-κB, MAPK (suppression of p38 and JNK phosphorylation), and NLRP3 inflammasome (inhibition of caspase-1 activation and GSDMD-mediated pyroptosis) signaling pathways. These pathway-level effects translate into reduced production of pro-inflammatory mediators (NO, PGE2, TNF-α, IL-1β, IL-6) across multiple in vitro and in vivo models, including acute lung injury, gastric ulcers, colitis, skin wounds, and metabolic dysfunction.

Embolization

B. striata polysaccharide microspheres (BSPMs) have been investigated as transarterial chemoembolization carriers for cancer treatment. BSPMs show favorable drug-loading, swelling, suspension, drug-entrapment, and release characteristics in vitro, which are conducive to long-term targeted chemotherapy. Studies have shown that BSPMs can embolize the blood supply of hepatic arteries and the hepatic portal vein, and completely inhibit the growth of tumors and surrounding microvessels by stopping the binding of VEGF to its receptor.

Anticancer Mechanisms

Low-molecular-weight BSP (low-temperature extraction) shows stronger antitumor potential; it exhibits higher anticancer activity in H22 liver cancer-bearing mice, likely due to improved bioavailability. Herbal polysaccharides regulate humoral and cellular immunity via enhanced cytokine expression, CD4+/CD8+ T cell activation, and NK cell activity.

5. Scientific Evidence by Area of Use

5.1 Hemostasis and Bleeding Control

Evidence summary: Hemostasis represents the most historically supported and scientifically studied application of bai ji. Preliminary pharmacological investigations on B. striata have shown that B. striata is an outstanding astringent hemostatic medicinal; BSP as the major bioactive component is not only capable of promoting wound healing, but also shows good performance as a kind of promising natural biomaterial.

Both in vitro and in vivo experiments have demonstrated that BSP sponges possess excellent hemostatic, antibacterial, and anti-inflammatory properties, and exhibit good stimulation of cell growth and wound healing. BSP is a natural polysaccharide renowned for its hemostatic properties and holds promising applications in biomedical fields.

Evidence strength: Most evidence in this area is preclinical (in vitro and animal studies). Insufficient studies on clinical properties mean that efficacy and safety cannot be established from a scientific point of view based on current evidence alone. Controlled human trials specifically isolating bai ji's hemostatic effect are limited.

5.2 Wound Healing and Tissue Regeneration

Preclinical evidence: Some studies have shown that Bletilla polysaccharide hydrogel can promote the repair of wounds in diabetic mice, and its mechanism may be through promoting the formation of new blood vessels, regulating inflammation, and promoting the process of epithelialization. A study published in Frontiers in Pharmacology evaluated BSP's effects on diabetic wound healing: the therapeutic effects of BSP on wound healing in diabetes mellitus were evaluated using DM mouse models induced by high fat-diet feeding combined with low-dose streptozocin injection. Diabetic foot ulcer models were established by wounding DM mice on the dorsal surface. Mice were treated with vehicle or BSP for 12 days, and wound healing was monitored. The effects of BSP on the production of IL-1β, TNF-α, macrophage infiltration, angiogenesis, NLRP3 inflammasome activation, and insulin sensitivity in wound tissues were evaluated.

Evidence strength: Evidence is primarily preclinical (animal models, cell culture). The bioavailability of BSP in the body and property evaluation for the best therapeutic function requires deeper investigation. It is necessary to find main active compounds for wound healing with B. striata by advanced chemical and pharmacological studies. Human clinical trials on wound healing as a primary endpoint are sparse.

5.3 Gastrointestinal Ulcers (Peptic Ulcer Disease)

Rationale and traditional basis: Bletilla striata, a traditional Chinese medicinal herb, contains diverse chemical constituents and exhibits multiple pharmacological effects. As a key component in various TCM compound formulations, it has demonstrated notable clinical efficacy, and has a solid research foundation and broad application prospects in the treatment of gastrointestinal diseases.

Clinical/RCT evidence: A randomized controlled trial evaluated a multi-herb formula, Yuyang Powder, containing Bletilla striata among other herbs (including Panax notoginseng, Taraxacum mongolicum, and Astragalus membranaceus), versus conventional Western medications (omeprazole capsules, clarithromycin, and metronidazole): The results revealed similar ulcer healing rates between the two groups, with total efficacy rates of 90% in the Yuyang Powder group and 87.5% in the control group. Notably, the H. pylori eradication rate was significantly higher in the Yuyang Powder group (95%) than in the control group (82.5%). These findings suggest that Yuyang Powder provides comparable ulcer-healing efficacy to conventional therapy while offering superior H. pylori clearance.

A second randomized controlled trial of 110 gastric ulcer patients examined Shugan Yuyang Decoction (which includes Bletilla striata among multiple herbs) versus conventional Western medications: The results demonstrated that the total effective rate in the observation group was 89.09%, significantly higher than the 72.73% observed in the control group.

Regarding the mechanism in gastrointestinal disease, outcomes included a significant reduction in ulcer area, suppression of gastric acid secretion, and marked attenuation of tissue damage and apoptosis. Biochemical analyses demonstrated modulation of oxidative stress markers—superoxide dismutase (SOD) and malondialdehyde (MDA)—and inflammatory cytokines (IL-6 and TNF-α) in ulcer-induced rat models. These findings indicate that BSP-based systems represent a promising therapeutic approach for gastric ulcer treatment, exerting anti-secretory, tissue-protective, and anti-apoptotic effects.

Evidence strength: Clinical trials in this area generally involve bai ji as one ingredient within multi-herb formulas (polyherbacy), making it impossible to attribute observed effects to bai ji alone. Although clinical evidence remains limited, preliminary studies support its efficacy in conditions such as peptic ulcer disease and postoperative wound healing.

5.4 Transcatheter Arterial Embolization (Hepatic Carcinoma)

Clinical evidence: One of the most directly documented clinical applications of bai ji involves its use as an embolizing agent in interventional oncology. A Chinese herb, Bletilla striata, was used as an embolizing agent to improve the therapeutic results of intervention treatment of liver cancer. From October 1991 to January 1995, 56 cases of hepatic carcinoma were treated with Bletilla striata by hepatic artery embolization, with conventional gelfoam embolization in 50 cases as control. Patients were followed up for 10–48 months. Embolization with Bletilla striata led to extensive and permanent vascular obstruction, accompanied by marked shrinkage of tumor size and significant decrease in serum AFP levels.

Collaterals were few in number and collateral circulation was established late, so that treatment intervals could be prolonged with an average of 7 months. The 1-, 2-, and 3-year survival rates were 81.9%, 44.9%, and 33.6%, respectively, with a median survival time of 19.8 months. All clinical parameters were better than those treated with conventional gelfoam embolization.

The results of the implantation test and transcatheter renal embolization indicated that BSMs had good tissue biocompatibility and no adverse effects, such as hepatotoxicity and renal toxicity. BSMs caused neither hemolysis nor cytotoxicity.

Evidence strength: This clinical evidence, while promising, comes from relatively small, older clinical series, primarily conducted at Chinese institutions, and does not yet meet the standard of modern randomized controlled trials. It should be regarded as preliminary but noteworthy.

5.5 Anticancer Activity (In Vitro and Animal Studies)

Studies have demonstrated that the extracts and compounds from B. striata exhibit a wide range of pharmacological activities including anti-cancer, antiviral, anti-melanin, antibacterial, anti-ulcer, anti-aging, anti-fibrosis, anti-inflammatory, antioxidant, immunomodulatory, wound-healing, neuroprotective, and haemostasis effects.

Compounds isolated from B. striata showed significant cytotoxicity against A549, SK-OV-3, SK-MEL-2, and HCT-15 cells, with IC50 values ranging from 3.98 μM to 12.10 μM.

Evidence strength: All anticancer evidence except the hepatic embolization clinical series is from in vitro (cell line) and animal model studies. No human clinical trials specifically testing bai ji as an oral anticancer agent have been identified in the peer-reviewed literature.

5.6 Anti-inflammatory and Antioxidant Activity

Integrated mechanistic analyses demonstrate that compounds in B. striata exert anti-inflammatory effects through coordinated modulation of NF-κB, MAPK (suppression of p38 and JNK phosphorylation), and the NLRP3 inflammasome (inhibition of caspase-1 activation and GSDMD-mediated pyroptosis). These pathway-level effects translate into reduced production of pro-inflammatory mediators across multiple in vitro and in vivo models, including acute lung injury, gastric ulcers, colitis, skin wounds, and metabolic dysfunction.

Evidence strength: Essentially all current anti-inflammatory and antioxidant evidence is preclinical. While the chemical basis for the anti-inflammatory effects of B. striata has been increasingly well-characterized, significant knowledge gaps persist regarding in vivo metabolism.

5.7 Antibacterial Activity

Testing of the antibacterial activity of B. striata has revealed that bibenzyls (compounds 40, 42) and biphenanthrenes (compounds 76–78, 83–86) are active against Gram-positive and Gram-negative strains. Evidence strength: This evidence is from in vitro studies only.

5.8 Antiviral Activity

Modern pharmacological studies confirm that crude extracts and bioactive constituents of B. striata exhibit antiviral activities. Stilbene derivatives isolated from B. striata tubers have been investigated for antiviral properties in laboratory studies. Evidence strength: Antiviral evidence is preclinical.

5.9 Pulmonary Disease (Tuberculosis and Silicosis)

B. striata has been used in TCM to treat tuberculosis, whooping cough, bleeding of the stomach/duodenal ulcers, abscesses, swellings, and parasitic diseases. Bletilla striata is a traditional Chinese medicine used to treat hemorrhage, scald, gastric ulcer, pulmonary diseases, and inflammations. In a laboratory study, the effective fraction of B. striata (EFB) was investigated for its bioactivity in reducing the inflammatory cytokine production induced by water or organic extracts of PM2.5 airborne particulates. Cell viability, flow cytometry, ELISA, and qRT-PCR were used in cultured mouse macrophage cell line RAW264.7. Expressions of NF-κB and MAPK signaling pathway were measured by Western blot.

Evidence strength: Human clinical evidence for pulmonary applications is absent from the peer-reviewed literature; available evidence is limited to traditional use records and preclinical studies.

6. Body Systems and Health Areas of Association

• Hemostasis and vascular system: B. striata is used in TCM for hemostasis, detumescence, and tissue regeneration.
• Integumentary system (skin and wound healing): BSP exerts multiple activities including anti-inflammatory, antioxidant, immunomodulatory, anti-aging, and enhanced wound and ulcer healing effects.
• Gastrointestinal tract: B. striata has been used for millennia to treat tuberculosis, hemoptysis, gastric and duodenal ulcers, and bleeding of the stomach.
• Respiratory system: Bletilla striata is used in mixtures intended to treat chronic cough, tuberculosis, and inflammation of the trachea associated with bronchitis.
• Immune system: B. striata has high medicinal value, including immune regulation and promoting bone marrow hematopoietic effects.
• Oncology (interventional): Various clinical trials have demonstrated its marked activities as an embolizing and mucosa-protective agent.

7. Dosage Forms and Reported Dosages

According to the Chinese Pharmacopoeia (2020), TCM baiji is sliced, dried, and crushed into a powder that can be used topically or internally, with a recommended dosage of 3–6 g at a time.

In one multi-herb RCT for peptic ulcer, the TCM decoction included Bletilla striata at a dose of 10 g per decoction preparation.

Various extraction techniques—including hot water, ultrasonic-assisted, and microbial fermentation methods—have been developed to isolate BSPs, with extraction parameters significantly influencing its structural features.

In experimental drug delivery contexts, bai ji-derived microspheres and hydrogels have been formulated at varying concentrations, but no standardized oral dosage for the isolated polysaccharide has been established in human clinical trials. Despite extensive studies, the structure–activity relationships and toxicological profile of BSPs remain incompletely understood.

8. Safety Considerations and Interactions

General Toxicology

The existing literature indicates that the biological safety profile of B. striata is relatively favorable. Acute oral toxicity studies in mice have shown that the LD50 in female Kunming mice exceeded 10.0 g/kg, suggesting a high level of oral safety. Furthermore, no skin irritation, allergic reactions, or phototoxic responses have been observed, and no significant adverse effects were reported in human skin tests.

Although preclinical studies on BSPs have not reported significant toxicity, formal, comparative safety, and toxicology studies are necessary to fully characterize their profile relative to established agents.

Classical Incompatibility: Interaction with Aconite

In classical Chinese pharmacology, the theory of the "Eighteen Incompatibilities" (Shiba Fanfan) notes an incompatibility between Bletilla striata and Aconite (Wutou). Modern research suggests that when Bletilla striata is co-administered with Aconite-based medicinal substances, it may inhibit hepatic drug-metabolizing enzymes such as CYP3A and CYP1A2. This inhibition can slow the metabolic clearance of aconitine, thereby increasing systemic exposure and enhancing toxicity. Therefore, although Bletilla striata is generally safe when used at therapeutic doses, special attention must be paid to avoid its combination with Aconite-derived compounds to prevent adverse interactions.

Traditional Contraindications

The bletilla root should not be used with any preparations that include plant species of the genus Aconitum. Also, the herb should not be applied for chronic lung inflammation. If the herb is used in large doses for a long period of time, it is reported to be toxic.

Conservation Status and Adulteration Risk

Recent breakthroughs in artificial cultivation have transformed bai ji from an endangered species into a more abundantly available resource. Prior to increased cultivation, wild populations were significantly over-harvested. Other species of Bletilla are also used as substitutes in folk medicine. Quality control measures, including thin-layer chromatography, microscopy, and HPLC, are outlined in the Chinese Pharmacopoeia to verify authenticity and distinguish genuine B. striata from adulterants. The Chinese Pharmacopoeia recommends identifying the geo-genuine properties of B. striata according to morphologic, microscopic, and thin-layer chromatography approaches, and by ensuring that the residual inorganic components after ashing are ≤15.0%.

Limitations of Current Evidence

B. striata has been used as a medicinal herb in China for thousands of years. However, due to the high degree of personalization of the diagnosis and treatment of TCM, its clinical efficacy cannot be comprehensively evaluated by evidence-based medicine. Various clinical trials conducted on B. striata have demonstrated its marked activities as an embolizing and mucosa-protective agent, and its application for use in novel biomaterials, quality control, and toxicology. It also has been widely used as a constituent of many preparations in TCM formulations, but because there are insufficient studies on its clinical properties, its efficacy and safety cannot be established from a scientific point of view.

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