<p><i>Paeoniae Radix Rubra</i> (PRR) is the dried root of <i>Paeonia lactilora</i> Pall. or <i>Paeonia veitchii</i> Lynch in the <i>Ranunculaceae Juss.</i> family. PRR primarily acts on the liver channel, exhibiting therapeutic effects in clearing heat, cooling blood, dispersing blood stasis, and relieving pain. It has long been valued for its better clinical therapeutic effects. This article offers a comprehensive review of the botany, phytochemistry, pharmacology, pharmacokinetics, pharmacodynamics, and clinical applications of PRR, with the objective of serving as a reference for future research and practical use of PRR in medical and health fields. PRR is primarily utilized for the treatment of cardiovascular and hepatic disorders in traditional medicinal applications. To date, various compounds such as terpenoids and their glycosides, flavonoids and their glycosides, tannins, phenolic acids, lignans, and volatile oils have been isolated and identified from PRR. Among these components, Totalpaeony glucosides are believed to be the main active ingredient of PRR. In terms of pharmacological activity, the traditional application of PRR has been substantiated by contemporary in vitro and in vivo experiments. This study aims to provide a scientific foundation for future research endeavors and rational utilization of PRR. Due to its extensive and significant pharmacological effects, PRR plays a crucial role in the market circulation of medicinal materials and their application in hospital pharmacy. While some traditional effects have been validated, the mechanism of action, material basis of efficacy, and quality evaluation are still at an early stage of research. This could potentially hinder modern research and further development of PRR. Therefore, future studies should focus on advancing research in these areas.</p> Graphical abstract <p></p>