Dong quai (Angelica sinensis)

• Background
• Related terms
• Evidence
• Dosing
• Safety
• Methodology
• Selected references

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Dong quai (Angelica sinensis)

Background

Dong quai ( Angelica sinensis ) is a member of the plant family Apiaceae, which includes parsley, celery, carrots, and poison hemlock. Dong quai has been used in traditional Chinese, Korean, and Japanese medicine. One of the most popular plants in traditional Chinese medicine, dong quai is often used in combination with other herbs primarily for health conditions in women, especially painful menstruation, anemia associated with menstruation, pregnancy, premenstrual syndrome, pelvic pain, recovery from childbirth or illness, and fatigue or low vitality. In both sexes, it is used for strengthening xue , or blood, for heart conditions, high blood pressure, inflammation, headache, infections, and nerve pain.

Herbal combinations of dong quai are used as a part of formulas for liver and spleen problems. 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, there is little human evidence supporting these uses. 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. Better-designed studies are needed before conclusions can be made regarding taking dong quai for any health condition.

Related terms

Acidic polysaccharides, American angelica, 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 , Angelica sinensis (Oliv.) Diels, angelique, anodynes, Apiaceae (family), Archangelica officinalis Moench or Hoffm., beta-sitosterol, Chinese angelica, Chinese danggui, coumarins, dang gui, dang gui ku shen wan, dang quai, d?nggu? (pinyin), Danggui-Nian-Tong-Tang (DGNTT), danggwi (Korean), dong kwai, dong qua, dong qui, dry-kuei, empress of the herbs, Engelwurzel (German), eumenol, European angelica, female ginseng, flavescent sophora root, flavonoids, furanocoumarins, garden angelica, Heiligenwurzel (German), Japanese angelica, kinesisk kvan (Danish), kinesisk kvanurt (Danish), lactones, Ligusticum glaucescens Franch., Ligusticum officinale Koch, ligustilides, Moon Cycle™ tea, phytoestrogen, psoralens, qingui, radix Angelica sinensis , root of the Holy Ghost, sodium ferulate (SF), sovereign herb for women, 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 Energy™ tea, women's ginseng, yuan nan wild dong quai, yungui.

Selected combination products : Angelica-alunite solution, angelica-paeonia powder, Bloussant® breast enhancement tablets, Bust Plus®, danggui huoxue tang (blood stimulant decoction of dong quai), danggui buxue tang (dong quai hematinic decoction), hormonal and immune system tonic, Four Things Soup (dong quai, Rehmannia glutinosa , Ligusticum wallichii , and Paeonia lactiflora ), koo sar pills (containing 11 ingredients, including dong quai), Phyto-Female Complex (SupHerb®, Netanya, Israel; ingredients: standardized extracts of black cohosh, dong quai, milk thistle, red clover, American ginseng, and chaste-tree berry), shou wu chih, dong quai four, shenyan huayu tang (decoction for nephritis and stasis), Sini decoction, Siwu tang, shimotus to, tokishakuyakusan, xiao yao powder, xiao yao wan ("free and easy wanderer," Bupleurum , and dong quai), yishen tang (kidney tonic decoction).

Evidence

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.

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, abscess (pus collection), acne vulgaris, age-related nerve damage, AIDS, allergy, amnesia, analgesia (pain killing), anemia, anorexia nervosa, antiaging, antibacterial, anticoagulant, antifungal, anti-inflammatory, antioxidant, antiseptic, antispasmodic (muscle spasm-reducing), antiviral, anxiety, aphrodisiac, arrhythmia (abnormal heart rhythm), asthma, atherosclerosis (cholesterol plaque in the heart arteries), back pain, bladder disorders, bleeding, bleomycin-induced lung damage, blood clot prevention (menstruation), blood flow disorders, blood purifier, blood stagnation, boils, bone loss, bowel disorders, breast enhancement, bronchitis, cancer, central nervous system disorders, cervicitis (inflammation of the cervix), chilblains (inflammation of toes, fingers, ears, or face with exposure to cold), cholagogue (promoting bile flow), chronic obstructive pulmonary disease, chronic pelvic pain, chronic rhinitis (long-term nasal allergies), cirrhosis (a type of liver disease), colchicine-induced learning impairment, congestion (chronic nasal and sinus), congestive heart failure, constipation, cough, cramps, dermatitis (skin inflammation), diabetes, digestive disorders, diuretic (urine promoting), dysentery (inflammation of the intestines), dyspepsia (heartburn), eczema, edema (swelling), emmenagogue (increased menstruation), emotional instability, endometriosis (growth of endometrial tissue outside the uterus), estrogenic effects, expectorant (dissolves mucus), eye problems, fatigue, fibrocystic breast disease, flatulence (gas), fluid retention, gastric ulcer, glaucoma (eye disorder), hay fever, headache, healing time reduction, heart conditions, heartburn, hematopoiesis (stimulation of blood cell production), hemolytic disease of the newborn (blood disease of the newborn), hemorrhoids, hepatitis (long-term), hepatoprotection (protection of the liver), hernia, herpes zoster (chicken pox), hormonal abnormalities, hyperlipidemia (cholesterol-lowering), hypertension (high blood pressure), immune cytopenias (decreased number of immune cells in the blood), immunomodulator, infections, infertility, irritable bowel syndrome, joint pain, kidney problems, labor, laxative, leukorrhea (vaginal discharge), lung disease, malaria, menorrhagia (excessive menstruation), menstrual cramping, metrorrhagia (painful menstruation), miscarriage prevention, muscle relaxant, myocardial ischemia (decreased blood flow to the heart), nerve pain, neurodermatitis (long-term itching or scaling of skin), osteoporosis, ovarian cysts, ovulation abnormalities, pain, palpitations (abnormal heart beats), pelvic congestion syndrome, pelvic inflammatory disease, peripheral edema (leg swelling from fluid accumulation), peritoneal dialysis (treatment for severe kidney disease), pernicious anemia (decrease in red blood cells), phytoestrogen, placental detachment, pleurisy (inflamed lungs), pneumonia (infants), postpartum weakness, pregnancy, premenstrual syndrome, prepare uterus for labor, prolapsed uterus, psoriasis (an inflammatory skin condition), pulmonary fibrosis (scarring or thickening of the lungs), Raynaud's disease, reperfusion injury (damage to tissue caused by increased blood supply after a lack of oxygen), reproductive organ problems, renal impairment (kidney dysfunction), respiratory disorders (breathing disorders), rheumatic diseases (joint disorders), sciatica (back and leg pain), sedative, sepsis (infections), shingles, skin pigmentation disorders, skin ulcers, stiffness, stress, stroke, thrombosis (blood clot), tinnitus (ringing in the ears), tonic (blood purifier), toothache, urticaria (severe hives), uterine fibroids (noncancerous tumors of the uterus), uterine tonic, vaginal atrophy (thinning and inflammation of vaginal walls), vaginal dryness, vascular disorders (disorders of the blood vessels), vasodilation (widening of the blood vessels), vision problems, vitamin B12 deficiency, vitamin E deficiency, vitiligo (loss of skin pigmentation), wound healing.

Dosing

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)

Three doses of dong quai may be taken by mouth daily based on body weight, with people under 100 pounds taking 520 milligrams per dose, patients between 100-175 pounds taking 1,040 milligrams per dose, and patients over 175 pounds taking 1,560 milligrams per dose. A decoction may be prepared by mixing one teaspoon or tablespoon of cut dong quai root in one cup of hot water, simmering for 2-5 minutes, and letting it stand for 5-10 minutes before taking by mouth. One to three cups (3-15 grams of dried root) may be taken by mouth daily. The dried leaf (2-5 grams by infusion three times daily), the dried root (1-2 grams three times daily or 1-5 grams by infusion three times daily), the fluid extract (0.5-2 milliliters three times daily), the leaf liquid extract (205 milliliters,1:1 in 25 percent alcohol, three times daily), and a leaf tincture (0.5-20 milliliters three times daily, 1:5 in 45 percent alcohol) have been taken by mouth. A cup of dong quai tea may be taken by mouth 2-4 times daily (4.5-9 grams of root daily in divided doses, steeped covered for 10-20 minutes). Candied dong quai stems have been taken by mouth. A 1-15 gram dose of the whole root or root slices of dong quai has been boiled or soaked in wine and then taken by mouth daily. A 0.5-2 milliliter root tincture (1:5 in 50 percent alcohol) or 3-80 drops (1:5 concentration) have been taken by mouth up to three times daily. However, there is no proven safe or effective dose for dong quai in adults.

For general gynecological conditions, three grams of dong quai root has been taken by mouth 2-3 times daily. A dose of 1-5 grams of dong quai has been taken by mouth three times daily with meals. A dose of 3-15 grams of dong quai root has been taken by mouth daily. A dose of 4-6 fluid extract tablets (containing 0.5 grams of dong quai extract) has been taken by mouth 2-3 times daily. A dose of 1-5 milliliters of dong quai has been taken by mouth three times daily. A dose of 5-8 milliliters of 1:5 dong quai tincture has been taken by mouth three times daily. A dose of 10-40 drops of 70 percent alcohol tincture of dong quai has been taken by mouth up to three times daily. Dong quai has been taken by mouth as a 2-5 milliliter dose of 55-65 percent alcohol in a 1:5 ratio three times daily. A dose of 1-2 grams of powdered dong quai root has been taken by mouth three times daily. A 1-2 gram dose of dong quai in a tea has been taken by mouth three times daily. There is no proven safe or effective dose for dong quai in for treating gynecological conditions.

For menopausal symptoms, 4.5 grams of dong quai has been taken by mouth daily in three divided capsule doses for 24 weeks. A 3-4 gram dose of powdered dong quai root has been taken by mouth daily as an herbal extract, capsules, tablets, or a tea. A one milliliter dose of fluid extract of dong quai has been taken by mouth three times daily. A 1-2 gram dose of powdered dong quai root has been taken by mouth three times daily. However, there is no proven safe or effective dose for dong quai in for treating menopausal symptoms.

For treating menstrual cramps, one teaspoon of dong quai tincture has been taken by mouth twice daily, starting one day after menstruation ends, and discontinued as soon as menstrual bleeding commences. With a very light menstrual flow, one teaspoon of dong quai tincture has been taken by mouth every two hours. However, there is no proven safe or effective dose for dong quai in for treating menstrual cramps.

For treating premenstrual syndrome, dong quai therapy has been initiated on day 14 of the cycle and continued until menstruation begins. A 0.5 gram dose of dong quai extract has been taken by mouth twice daily. A 2-3 gram dose of dong quai capsules or tablets has been taken by mouth daily. A 4-8 milliliter dose of a 1:2 fluid extract of dong quai has been taken by mouth daily. A 1-2 gram dose of dong quai has been taken by mouth as a tea three times daily. A 2-4 milliliter dose of dong quai tincture in a 1:5 dilution has been taken by mouth up to three times daily. One-half teaspoon of dong quai has been mixed with water and taken by mouth up to four times daily. There is no proven safe or effective dose for dong quai in for treating premenstrual syndrome symptoms.

For poor circulation, one teaspoon dong quai has been mixed with one cup of water and taken by mouth 1-2 times daily. There is no proven safe or effective dose for dong quai in for treating poor circulation.

For inflammation, 10-15 drops diluted dong quai essential oil has been applied to inflamed areas. There is no proven safe or effective dose for dong quai in for treating inflammation.

For lichen planus (itchy rash on the skin or in the mouth), 1.5-2 milliliters of a 50 percent solution of dong quai has been applied to the vulva 1-2 times weekly for a total of eight doses.

Ten percent dong quai (20-40 milliliters) has been injected into the vein or artery. Five or 10 percent dong quai (0.5-1.0 milliliters) has been given at acupuncture points. There is no proven safe or effective dose for dong quai to be injected into the vein.

For cerebral ischemia (lack of blood flow to the brain), 200 milliliters of 25 percent dong quai has been injected into the vein daily for 20 days.

For high blood pressure in the lungs, 250 milliliter drippings of dong quai and 5 percent glucose have been injected into the vein daily for 10 days. A 250 milliliter dose of 25 percent dong quai has been injected into the vein daily.

For ulcerative colitis (a type of inflammatory bowel disease), 40 milliliters of dong quai produced by Pharmaceutical Factory of Zhongnan Hospital of Wuhan University has been added to 250 milliliters of 10 percent glucose drip and given by vein once daily for three weeks.

Children (under 18 years old)

There is no proven safe or effective dose for dong quai in children.

Safety

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

Avoid in people with a known allergy or sensitivity to dong quai, its parts, or members of the Apiaceae or Umbelliferae families, including anise, caraway, carrot, celery, dill, and parsley. Skin rashes, possible due to an allergic reaction, have been reported with the use of dong quai. An asthma response has occurred after inhaling dong quai powder.

Side Effects and Warnings

Like all Chinese herbs, different quality dong quai exists, and lower-quality dong quai may be contaminated with heavy metals, prescription drugs, or other undesirable substances. There is a risk of dangerous side effects when herbal preparations are mixed together or when taken with prescription drugs. Liquid preparations of dong quai may contain alcohol.

Dong quai may cause low or increased blood pressure. Caution is advised in people taking drugs, herbs, or supplements that affect blood pressure.

Dong quai may increase the risk of bleeding. Caution is advised in people with bleeding disorders or those taking drugs, herbs, or supplements that may increase the risk of bleeding. Dosing adjustments may be necessary.

Dong quai may affect blood sugar levels. Caution is advised in people with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Blood glucose levels may need to be monitored by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.

Drowsiness or sedation may occur. Use caution if driving or operating heavy machinery.

Use cautiously in children or people with alcohol dependence or intolerance, anemia, breathing problems, cancer, heart problems, liver disease, sensitive skin, or stomach or intestinal distress.

Avoid using dong quai in people with acute viral infections such as a cold or the flu, hemorrhagic disease (a bleeding disorder), hypermenorrhea (abnormally heavy menstruation), or scheduled surgical or major dental procedures.

Avoid prolonged exposure to sunlight or other sources of UV light while taking dong quai, due to potential photosensitivity. Taking dong quai in combination with tretinoin or St. John's wort may increase sun sensitivity. Avoid suntan oils with high concentrations of dong quai (greater than one percent), due to the theoretical risk of cancer after long-term use.

Avoid in women with hormone-sensitive conditions (including breast, uterine, endometrial, and ovarian cancer), endometriosis or uterine fibroids, thromboembolic disease, or stroke, or those using hormone replacement therapy or oral contraceptives.

Avoid during pregnancy, due to its uterine-stimulant effects, relaxant effects, and anticoagulant properties in humans and animals. Dong quai may increase the risk of miscarriage. Avoid in breastfeeding mothers, because information on its safety is lacking and it may have estrogenic effects.

Use cautiously in people taking agents affected by alcohol, agents for heart conditions, or oral contraceptives.

Dong quai may cause anemia, anorexia, asthma, bloating, burping, cancer, chills, diarrhea, dizziness, dry mouth, sexual hyperfunction (excessive sexual function), fever, gynecomastia (male breast enlargement), headache, hot flushes, impaired breathing, increased heart rate, increased premenstrual syndrome (PMS) symptoms, insomnia, irregular heart rhythms, irritability, kidney failure, laxative effect, loss of appetite, mild tiredness, nausea, pain, photosensitivity (sensitivity to light), reduced or increased menstrual flow, skin cancer, skin rash, stomach distress, sweating, thickening of the lining of the uterus, upset stomach, vaginal bleeding, vomiting, weakness, and wheezing.

Pregnancy and Breastfeeding

The American Herbal Products Association classified dong quai as a Class 2b/2d herb, which is not to be used during pregnancy, unless directed to by an expert trained to use the herb. Canadian regulations require a bilingual label warning on dong quai products against their use during pregnancy.

Avoid using dong quai during pregnancy, due to its uterine-stimulant, relaxant, and anticoagulant properties in humans and animals. Dong quai may increase the risk of miscarriage. Also, many tinctures contain high levels of alcohol and should be avoided during pregnancy.

There is currently a lack of scientific evidence on the use of dong quai during breastfeeding. Nursing mothers should avoid using dong quai.

Methodology

This patient information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Monograph methodology

Selected references

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3. Cheema D, Coomarasamy A, El Toukhy T. Non-hormonal therapy of post-menopausal vasomotor symptoms: a structured evidence-based review. Arch Gynecol.Obstet 2007;276(5):463-469.
4. Chou CT, Kuo SC. The anti-inflammatory and anti-hyperuricemic effects of Chinese herbal formula danggui-nian-tong-tang on acute gouty arthritis: a comparative study with indomethacin and allopurinol. Am.J Chin Med 1995;23(3-4):261-271.
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7. Huntley AL, Ernst E. A systematic review of herbal medicinal products for the treatment of menopausal symptoms. Menopause 2003;10(5):465-476.
8. Johns J. What is dong quai and what health problems can it help relieve? Nebr Mortar Pestle 1996;59:18.
9. 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.
10. 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.
11. Li L. Literature research on point injection with Chinese Angelica liquor. J Tradit Chin Med 1998;18(4):308-312.
12. Liao JZ, Chen JJ, Wu ZM, et al. R. Clinical and experimental studies of coronary heart disease treated with yi-qi huo-xue injection. J Tradit.Chin Med 1989;9(3):193-198.
13. Low DT. Menopause: a review of botanical dietary supplements. Am J Med 12-19-2005;118 Suppl 12B:98-108.
14. Mei QB, Tao JY, Cui B. Advances in the pharmacological studies of radix Angelica sinensis (Oliv) Diels (Chinese Danggui). Chin Med J (Engl.) 1991;104(9):776-781.
15. Napoli M. Soy & dong quai for hot flashes: latest studies. HealthFacts 1998;23(2):5.

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