Dong quai (Angelica sinensis [Oliv.] Diels), Chinese angelica
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| Dong quai, Chinese angelica |
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- Dong quai ( Angelica sinensis ), also known as Chinese Angelica, has been used for thousands of years in traditional Chinese, Korean, and Japanese medicine. It remains one of the most popular plants in Chinese medicine, and is used primarily for health conditions in women. Dong quai has been called "female ginseng," based on its use for gynecological disorders (such as painful menstruation or pelvic pain), recovery from childbirth or illness, and fatigue/low vitality. It is also given for strengthening xue (loosely translated as "the blood"), for cardiovascular conditions/high blood pressure, inflammation, headache, infections, and nerve pain.
- In the late 1800s, an extract of Dong quai called Eumenol became popular in Europe as a treatment for gynecological complaints. Recently, interest in Dong quai has resurged due to its proposed weak estrogen-like properties. However, it remains unclear if Dong quai has the same effects on the body as estrogens, blocks the activity of estrogens, or has no significant hormonal effects. Additional research is necessary in this area before a firm conclusion can be drawn.
- In Chinese medicine, Dong quai is most often used in combination with other herbs, and is used as a component of formulas for liver qi stasis and spleen deficiency. It is believed to work best in patients with a yin profile, and is considered to be a mildly warming herb. Dong quai is thought to return the body to proper order by nourishing the blood and harmonizing vital energy. The name Dong quai translates as "return to order" based on its alleged restorative properties.
- Although Dong quai has many historical and theoretical uses based on animal studies, there is little human evidence supporting the effects of Dong quai for any condition. Most of the available clinical studies have either been poorly designed or reported insignificant results. Also, most have examined combination formulas containing multiple ingredients in addition to Dong quai, making it difficult to determine which ingredient may cause certain effects.
- American angelica, Angelica acutiloba , Angelica archangelica , Angelica atropurpurea , Angelica dahurica , Angelica edulis , Angelica gigas , Angelica keiskei , Angelica koreana , Angelica polymorpha var. sinensis Oliv. , Angelica pubescens , Angelica radix, Angelica root, Angelica silvestris , Angelique, Archangelica officinalis Moench or Hoffm, beta-sitosterol, Chinese Angelica, Chinese Danggui, Danggui, Dang Gui®, Danggui-Nian-Tong-Tang (DGNTT), Dang quai, Dong Kwai, Dong qua, Dong quai extract, Dong quai root, Dong qui, dry-kuei, engelwurzel, European angelica, European Dong quai, Female ginseng, FP3340010, FP334015, FT334010, garden angelica, Heiligenwurzel, Japanese angelica, Kinesisk Kvan (Danish), Kinesisk Kvanurt (Danish), Ligusticum glaucescens franch, Ligusticum officinale Koch, Ligustilides, phytoestrogen, Qingui, radix Angelica sinensis , root of the Holy Ghost, Tan Kue Bai Zhi, Tang Kuei, Tang Kuei Root®, Tang kwei, Tang quai, Tanggui (Korean), Tanggwi (Korean), Toki (Japanese), wild angelica, wild Chin quai, women's ginseng, Yuan Nan wild Dong quai, Yungui.
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
| Uses based on scientific evidence | Grade* |
| Amenorrhea (lack of menstrual period)
There is limited poor-quality study of Dong quai as a part of herbal combinations given for amenorrhea. Additional research is necessary before a firm conclusion can be drawn.
| C |
| Angina pectoris / coronary artery disease
There is insufficient evidence to support the use of Dong quai for the treatment of heart disease.
| C |
| Arthritis
Dong quai is traditionally used in the treatment of arthritis. However, there is insufficient reliable human evidence to recommend the use of Dong quai alone or in combination with other herbs for osteoarthritis or rheumatoid arthritis.
| C |
| Dysmenorrhea (painful menstruation)
There are unclear results of preliminary, poor-quality human research of Dong quai in combination with other herbs for dysmenorrhea. Reliable scientific evidence for Dong quai alone in humans with dysmenorrhea is currently not available.
| C |
| Glomerulonephritis
There is insufficient evidence to support the use of Dong quai as a treatment for kidney diseases such as glomerulonephritis. Preliminary poor-quality research of Dong quai in combination with other herbs reports unclear results.
| C |
| Idiopathic thrombocytopenic purpura (ITP)
A poor-quality study reports benefits of Dong quai in patients diagnosed with idiopathic thrombocytopenic purpura (ITP). However, these patients were not compared to individuals who were not receiving Dong quai, and therefore the results can only be considered preliminary.
| C |
| Menstrual migraine headache
The effects of Dong quai alone for this condition are not clear, and further research is necessary before a clear conclusion can be reached.
| C |
| Nerve pain
There is insufficient evidence to support the use of Dong quai as a treatment for nerve pain. High-quality human research is lacking.
| C |
| Pulmonary hypertension
It remains unclear if Dong quai is beneficial for other causes of pulmonary hypertension. Further research is needed before a strong recommendation can be made.
| C |
| Menopausal symptoms
Dong quai is used in traditional Chinese formulas for menopausal symptoms. It has been proposed that Dong quai may contain "phytoestrogens" (chemicals with estrogen-like effects in the body). However, it remains unclear from laboratory studies if Dong quai has the same effects on the body as estrogens, blocks the activity of estrogens, or has no significant effect on estrogens.
| D |
*Key to grades
A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use;
F: Strong scientific evidence against this use.
Grading rationale
Uses based on tradition or theory
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Abdominal pain, abnormal fetal movement, abnormal heart rhythms, abscesses, age-related nerve damage, AIDS, allergy, anemia, anorexia nervosa, anti-aging, antibacterial, antifungal, antioxidant, antiseptic, antispasmodic, anti-tumor (brain tumors), antiviral, anxiety, asthma, back pain, bleomycin-induced lung damage, blood flow disorders, blood purifier, blurred vision, body pain, boils, bone growth, breast enlargement, bronchitis, Buerger's disease, cancer, central nervous system disorders, cervicitis (inflammation of the cervix), chilblains, chronic hepatitis, chronic obstructive pulmonary disease (COPD), chronic rhinitis, cholagogue (promotes the flow of bile), cirrhosis, colchicine-induced learning impairment, congestive heart failure (CHF), constipation, cough, cramps, dermatitis, diabetes, digestion disorders, dysentery, eczema, emotional instability, endometritis, expectorant, fatigue, fibrocystic breast disease, flatulence (gas), fluid retention, gastric ulcer, glaucoma, headache, heartburn, hematopoiesis (stimulation of blood cell production), hemorrhoids (bleeding), hemolytic disease of the newborn, hernia, high cholesterol, hormonal abnormalities, immune cytopenias, immune suppressant, infections, infertility, irritable bowel syndrome, joint pain, labor aid, laxative, leukorrhea (vaginal discharge), liver protection, lung disease, malaria, menorrhagia (heavy menstrual bleeding), menstrual cramping, miscarriage prevention, morning sickness, muscle relaxant, osteoporosis, ovulation abnormalities, pain, pain from bruises, palpitations, pelvic congestion syndrome, pelvic inflammatory disease, peritoneal dialysis, pleurisy, post-partum weakness, pregnancy support, premenstrual syndrome (PMS), psoriasis, prolapsed uterus, pulmonary fibrosis, Raynaud's disease, reperfusion injury, respiratory tract infection, rheumatic diseases, sciatica, sedative, sepsis, shingles (herpes zoster), skin pigmentation disorders, skin ulcers, stiffness, stomach cancer, stress, stroke, tinnitus (ringing in the ear), toothache, uterine fibroids, vaginal atrophy, vitamin E deficiency, wound healing.
The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.
Adults (18 years and older)
- Dong quai is used in numerous herbal combinations, and various doses have been used both traditionally and in research in China. Because of this variation and lack of high-quality studies, no specific recommendations can be made. Safety and effectiveness are not established for most herbal combinations, and the amounts of Dong quai present from batch to batch may vary.
- Powdered or dried root/root slices, fluid extracts, tinctures, decoctions, and dried leaf preparations of Dong quai are available to be taken orally. Topical preparations are available to be applied to the skin. Safety of intravenous use is not established, although it has been reported in research.
Children (younger than 18 years)
- There is not enough scientific data to recommend Dong quai for use in children, and it is not recommended due to potential side effects.
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.
Allergies
- People with known allergy/hypersensitivity to Angelica radix or members of the Apiaceae/Umbelliferae family (anise, caraway, carrot, celery, dill, parsley) should avoid Dong quai. Skin rash has been reported with the use of Dong quai, although it is not clear if this was an allergic response. An asthma response has occurred after breathing in Dong quai powder.
Side Effects and Warnings
- Although Dong quai is accepted as being safe as a food additive in the United States and Europe, its safety in medicinal doses is not known. There are no reliable long-term studies of side effects. Most precautions are based on theory, laboratory research, tradition, or isolated case reports.
- Components of Dong quai may increase the risk of bleeding due to anticoagulant and anti-platelet effects. Caution is advised in patients with bleeding disorders or taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary. Discontinue use prior to surgical or major dental procedures.
- It remains unclear if Dong quai has the same effects on the body as estrogens, if it blocks the activity of estrogens, or if it has no significant hormonal effects. It remains unclear if Dong quai is safe in individuals with hormone-sensitive conditions such as breast cancer, uterine cancer, ovarian cancer, or endometriosis. It is not known if Dong quai possesses the beneficial effects that estrogen is believed to have on bone mass or potential harmful effects such as increased risk of stroke or hormone-sensitive cancers.
- Increased sun sensitivity with a risk of severe skin reactions (photosensitivity) may occur due to chemicals in Dong quai. Prolonged exposure to sunlight or ultraviolet light should be avoided while taking Dong quai.
- Safrole, a volatile oil in Dong quai, may be carcinogenic (cancer-causing). Long-term use should therefore be avoided, and suntan lotions that contain Dong quai often limit the amount of Dong quai to less than one percent.
- Dong quai has traditionally been associated with gastrointestinal symptoms (particularly with prolonged use), including laxative effects/diarrhea, upset stomach, nausea, vomiting, loss of appetite, burping, or bloating. Published literature is limited in this area.
- Dong quai preparations may contain high levels of sucrose, and should be used cautiously by patients with diabetes or glucose intolerance.
- Various other side effects have rarely been reported with Dong quai taken alone or in combination with other herbs. However, side effects have not been evaluated in well-designed studies. These include: headache, lightheadedness/dizziness, sedation/drowsiness, insomnia, irritability, fever, sweating, weakness, abnormal heart rhythms, blood pressure abnormalities, wheezing/asthma, hot flashes, worsening premenstrual symptoms, reduced menstrual flow, increased male breast size (gynecomastia), kidney problems (nephrosis), or skin rash.
- The safety of Dong quai injected into the skin, muscles, or veins is not known and should be avoided.
Pregnancy and Breastfeeding
- Dong quai is not recommended during pregnancy due to possible hormonal and anticoagulant/anti-platelet properties. Animal research has noted conflicting effects on the uterus, with reports of both stimulation and relaxation. There is a published report of miscarriage in a woman taking Dong quai, although it is not clear that Dong quai was the cause. Dong quai is traditionally viewed as increasing the risk of abortion. There is insufficient evidence regarding the safety of Dong quai during breastfeeding.
Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.
Interactions with Drugs
- Dong quai may increase the risk of bleeding due to anticoagulant and anti-platelet effects, and may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin®) or heparin, anti-platelet drugs such as clopidogrel (Plavix®), and nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).
- It remains unclear if Dong quai has the same effects on the body as estrogens, if it blocks the activity of estrogens, or has no significant hormonal effects. It is not known if taking Dong quai increases or decreases the effects of birth control pills or hormone replacement therapy such as Premarin®, which contains estrogen, or the anti-tumor effects of selective estrogen receptor modulators (SERMs) such as tamoxifen.
- Chemicals in Dong quai may cause increased sun sensitivity with a risk of severe skin reactions (photosensitivity), and Dong quai should be avoided with other drugs that cause photosensitivity, such as tretinoin (Retin-A®, Renova®), and some types of anti-depressants, cancer drugs, antibiotics, or anti-psychotic medications. Patients taking medications should check with their doctor or pharmacist before starting Dong quai.
- Based on laboratory research, Dong quai may increase the effects of drugs that affect heart rhythms, such as digoxin, beta-blockers such as metoprolol (Lopressor®, Toprol®), calcium channel blockers such as nifedipine (Procardia®), or other anti-arrhythmic drugs.
- Based on laboratory research, some compounds in Dong quai may increase the effects of anti-cancer drugs and antidepressant drugs called selective serotonin reuptake inhibitors (SSRIs).
Interactions with Herbs and Dietary Supplements
- In theory, due to anticoagulant and anti-platelet effects, components of Dong quai may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba , and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.
- It remains unclear if Dong quai has the same effects on the body as estrogens, blocks the activity of estrogens, or has no significant hormonal effects. The effects of agents believed to have estrogen-like properties may be altered.
- Chemicals in Dong quai may cause increased sun sensitivity with a risk of severe skin reactions (photosensitivity), and Dong quai should not be taken with products containing Hypericum perforatum (St. John's wort) or capsaicin, which are also reported to cause photosensitivity.
- Based on laboratory research, some compounds in Dong quai may increase the effects of anti-cancer herbs or supplements and antidepressants.
- Dong quai may increase the effects of antioxidants.
- This information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): Ethan Basch, MD, MSc, MPhil (Memorial Sloan-Kettering Cancer Center); Sefah Bediakoh, PharmD (Northeastern University); Dawn Costa, BA, BS (Natural Standard Research Collaboration); Cynthia Dacey, PharmD (Northeastern University); Shaina Tanguay-Colucci, BS (Natural Standard Research Collaboration); Catherine Ulbricht, PharmD (Massachusetts General Hospital); Wendy Weissner, BA (Natural Standard Research Collaboration); Jen Woods, BS (Natural Standard Research Collaboration); Monica Zangwill, MD, MPH, (Tufts University School of Medicine).
Methodology details
- Burke BE, Olson RD. Cusack BJ. Randomized, controlled trial of phytoestrogen in the prophylactic treatment of menstrual migraine. Biomed Pharmacother 2002;56(6):283-288.
- Chen QC, Lee J, Jin W, et al. Cytotoxic constituents from angelicae sinensis radix. Arch Pharm Res 2007 May;30(5):565-9.
- Deng S, Chen SN, Yao P, et al. Serotonergic activity-guided phytochemical investigation of the roots of Angelica sinensis. J Nat Prod 2006 Apr;69(4):536-41.
- Friedman JA, Taylor SA, McDermott W, et al. Multifocal and recurrent subarachnoid hemorrhage due to an herbal supplement containing natural coumarins. Neurocrit Care. 2007;7(1):76-80.
- Hirata JD, Swiersz LM, Zell B, et al. Does dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled trial. Fertil Steril 1997;68(6):981-986.
- Jia M, Yang TH, Yao XJ, et al.[Anti-oxidative effect of Angelica polysaccharide sulphate] [Article in Chinese] Zhong Yao Cai 2007 Feb;30(2):185-8.
- Kotani N, Oyama T, Sakai I, et al. Analgesic effect of a herbal medicine for treatment of primary dysmenorrhea--a double-blind study. Am.J Chin Med 1997;25(2):205-212.
- Kronenberg F, Fugh-Berman A. Complementary and alternative medicine for menopausal symptoms: a review of randomized, controlled trials. Ann Intern Med 11-19-2002;137(10):805-813.
- Li KX, You ZL, Zhang H, et al. Clinical study on "Yi-Qi-Hua-Yu" method in treatment of pelvis congestion syndrome. Journal of Hunan College of Traditional Chinese Medicine 1997;17(2):11-13.
- Luo H, Lin S, Ren F, et al. Antioxidant and antimicrobial capacity of Chinese medicinal herb extracts in raw sheep meat. J Food Prot 2007 Jun;70(6):1440-5.
- Page RL, Lawrence JD. Potentiation of warfarin by dong quai. Pharmacotherapy 1999;19(7):870-876.
- Shang P, Qian AR, Yang TH, et al. Experimental study of anti-tumor effects of polysaccharides from Angelica sinensis. World J Gastroenterol 2003;9(9):1963-1967.
- Tsai NM, Chen YL, Lee CC, et al. The natural compound n-butylidenephthalide derived from Angelica sinensis inhibits malignant brain tumor growth in vitro and in vivo. J Neurochem 2006 Nov;99(4):1251-62.
- Xuan GC, Feng QF, Xue FM. Clinical observation on treating 400 cases of cerebral infarction with traditional Chinese herb power. Henan Journal of Traditional Chinese Medicine and Pharmacy 1997;12(4):28-29.
- Zhiping H, Dazeng W, Lingyi S, et al. Treating amenorrhea in vital energy-deficient patients with angelica sinensis-astralagus membranaceus menstruation-regulating decoction. J Trad Chin Med 2002;6(3):187-190.
January 01, 2008.
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This evidence-based monograph was prepared by the Natural Standard Research Collaboration. The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Talk to your health care provider before taking any prescription or over the counter drugs (including any herbal medicines or supplements) or following any treatment or regimen. Copyright© 2009 Natural Standard (www.naturalstandard.com). All Rights Reserved.
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