Members of the genus Paeonia, which consists of globally renowned ornamentals and traditional medicinal plants with a rich history spanning over 1500 years, are widely distributed throughout the Northern Hemisphere. Since 1900, over 2200 new horticultural Paeonia cultivars have been created by the discovery and breeding of wild species. However, information pertaining to Paeonia breeding is considerably fragmented, with fundamental gaps in knowledge, creating a bottleneck in effective breeding strategies. This review systematically introduces Paeonia germplasm resources, including wild species and cultivars, summarizes the breeding strategy and results of each Paeonia cultivar group, and focuses on recent progress in the isolation and functional characterization of structural and regulatory genes related to important horticultural traits. Perspectives pertaining to the resource protection and utilization, breeding and industrialization of Paeonia in the future are also briefly discussed.