Dong Quai

Purported Benefits, Side Effects & More
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Dong Quai

Purported Benefits, Side Effects & More
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Dong Quai

Common Names

  • Chinese angelica
  • Dang gui
  • Tang kuei
  • Tan kue
  • Female ginseng

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For Patients & Caregivers

Tell your healthcare providers about any dietary supplements you’re taking, such as herbs, vitamins, minerals, and natural or home remedies. This will help them manage your care and keep you safe.

What is it?

Dong quai is an herb used in traditional Chinese medicine to treat menstrual (monthly period) cramps and menopausal (permanent end to your menstrual cycle) symptoms such as hot flashes.

You can take dong quai in supplemental form as a pill or liquid extract.

What are the potential uses and benefits?

Dong quai is used to:

  • Treat premenstrual symptoms such as breast swelling and tenderness, mood swings, bloating and headache
  • Treat menstrual cramps
  • Treat symptoms of menopause (permanent end of menstrual cycles) such as hot flashes

Dong quai also has other uses that haven’t been studied by doctors to see if they work.

Talk with your healthcare provider before taking dong quai supplements. Herbal supplements can interact with some medications and affect how they work.

For more information, read the “What else do I need to know?” section below.

What are the side effects?

Side effects of using dong quai may include:

  • Photosensitivity (sensitivity to light)
  • Photodermatitis (skin sensitivity to light, causing swelling, itching, or redness)
  • Loss of appetite
  • Feeling bloated
  • Diarrhea (loose or watery bowel movements)
  • Fever (temperature is 100.4° F (38° C) or higher)
What else do I need to know?
  • Talk with your healthcare provider if you’re taking blood thinners such as warfarin (Coumadin®, Jantoven®). Dong quai may increase your risk of bleeding.
  • Avoid dong quai if you’re pregnant. Dong quai can raise your risk of miscarriage (when a pregnancy ends on its own).
  • Avoid dong quai if you’re breastfeeding.
  • Talk to your healthcare provider if you have a hormone-sensitive cancer (like some breast or prostate cancers). Dong quai may worsen your condition.
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For Healthcare Professionals

Scientific Name
Angelica sinensis
Clinical Summary

Dong quai is an herb, the root of which has a long history of use in traditional Chinese medicine. It is often combined with other herbs in formulations. Dong quai is also available as a dietary supplement and is promoted as a woman’s herb for menstrual and menopausal symptoms. 

Dong quai extracts demonstrated antitumor (7) (8) (9) (10), pro-apoptotic (40) (41), anti-metastatic (41), anti-tuberculosis (TB) (11), neuroprotective (32), and hematopoeitic (34) effects in vitro. In animal models, polysaccharides extracted from dong quai root showed protective effects against cyclophosphamide-induced toxicity (12), doxorubicin-induced cardiotoxicity (13), and radiation-induced pneumonitis (14). 

Formulas containing dong quai improved clinical outcomes in patients with acute coronary syndrome and mild-to-moderate renal insufficiency (46), and prevented radiation-induced dermatitis in breast cancer patients (49). A systematic review determined benefits of dong quai against amenorrhea induced by antipsychotic drugs (47). 

Epidemiological data suggest positive associations between dong quai use and reduced risks of overall  diabetes-related mortalities (50), and subsequent endometrial cancer in breast cancer survivors (39). It may also be useful in long-term management of post-operative ovarian endometriotic cysts (51) but findings of its effectiveness against menopausal symptoms are inconclusive (1) (2) (3) (4) (5) (6) (29) (33). Dong quai was also ineffective against hot flashes in men (31). 

Of note, dong quai showed estrogenic activity in vitro (15), stimulated proliferation of MCF-7 cells (16) (17) (48), and promoted growth of estrogen receptor-positive breast tumors in a murine model (48). Patients with hormone-sensitive cancers should consult with their physicians before using this herb.

Purported Uses and Benefits
  • Premenstrual syndrome
  • Dysmenorrhea
  • Menopausal symptoms
Mechanism of Action

Ferulic acid, a constituent of dong quai, may play an important role in treating osteoarthritis by reducing hydrogen peroxide-induced interleukin IL-1beta, tumor necrosis factor TNF-alpha, matrix metalloproteinases MMP-1 and MMP-13, and by increasing SOX9 gene expression. SOX9 is a protein involved in the establishment and maintenance of the phenotype of chondrocytes  (35). Dong quai polysaccharides demonstrated anti-osteoarthritic activity by stimulating insulin-like growth factor 1 (IGF1) and IGF1 receptor gene expression, thereby promoting UDP-sugars and glycosaminoglycan synthesis (37). Another compound promotes wound healing and bone regeneration by inducing osteoblast proliferation and hyaluronic acid deposition (25).

An aqueous extract from dong quai showed estrogen-agonist activity, and stimulated proliferation of both estrogen receptor-positive and -negative breast cancer cells (17). It also protected against radiation-induced pneumonitis by downregulating proinflammatory cytokines such as TNF-alpha and TGF-beta1 in a murine model (14). Subcutaneous injection of dong quai extract protected mice against cyclophosphamide-induced cytotoxicity by promoting recovery from leukopenia (12). The antitumor effects of dong quai may be due to its inhibitory effects on invasion and metastasis of carcinoma cells (9) and by suppression of tumor growth (7) (8) (10) that may be mediated by Nur77-dependent apoptosis (23) (24). However, dong quai extracts also promoted angiogenesis – which plays a key role in both physiologic and disease processes – by inducing proliferation and migration of endothelial cells by upregulating VEGF expression (26).

Contraindications
  • Pregnant and breastfeeding women should avoid dong quai (27).
Adverse Reactions

Bloating, apetite loss (18), diarrhea, photosensitivity (19), gynecomastia (20), and hypertension (43).

Case Report
Subarachnoid hemorrhage: In a 53-year-old woman following use of an herbal supplement containing red clover, dong quai, and Siberian ginseng for hot flashes. Her symptoms resolved after discontinuing use of the supplement (30).
Acute hydroxychloroquine retinopathy: In a 37-year-old woman after using hydroxychloroquine as a reproduction-facilitating medication along with herbal medicines including dong quai. Her symptoms improved after stopping both hydrochloroquine and dong quai (52).

Herb-Drug Interactions

Anticoagulants: Dong quai may have additive anticoagulant effect (21). However, this appears to be limited in a human study (44).
Cytochrome P450 substrates: Prolonged use of dong quai can induce CYP3A4 by activating pregnane X receptor (36). This may reduce the blood levels and effectiveness of substrate drugs. Clinical relevance is not known.
Lisinopril [angiotensin converting enzyme (ACE) inhibitor]: Concurrent use with dong quai exacerbated anemia in a murine model (42). Clinical relevance has yet to be determined.
Dual antiplatelet therapy (DAPT) with aspirin (ASA) and clopidogrel (CLP): Coadministration with dong quai significantly altered the pharmacokinetics of DAPT with increased systemic exposure in a murine model. Clinical relevance is not known. (45)
Clozapine: Dong quai was found to be a moderate-to-strong inducer of clozapine metabolism in two case reports (53).

Herb Lab Interactions

Elevated PT / INR  (21)

Dosage (OneMSK Only)
References
  1. Carroll DG. Nonhormonal therapies for hot flashes in menopause. Am Fam Physician. 2006;73(3):457-464.
  2. 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.
  3. Fugate SE, Church CO. Nonestrogen treatment modalities for vasomotor symptoms associated with menopause. Ann Pharmacother. 2004;38(9):1482-1499.
  4. Kupfersztain C, Rotem C, Fagot R, Kaplan B. The immediate effect of natural plant extract, Angelica sinensis and Matricaria chamomilla (Climex) for the treatment of hot flushes during menopause. A preliminary report. Clin Exp Obstet Gynecol. 2003;30(4):203-206.
  5. Rotem C, Kaplan B. Phyto-Female Complex for the relief of hot flushes, night sweats and quality of sleep: randomized, controlled, double-blind pilot study. Gynecol Endocrinol. 2007;23(2):117-122.
  6. TNAM Society. Treatment of menopause-associated vasomotor symptoms: position statement of The North American Menopause Society. Menopause. 2004;11(1):11-33.
  7. Lee WH, Jin JS, Tsai WC, et al. Biological inhibitory effects of the Chinese herb danggui on brain astrocytoma. Pathobiology. 2006;73(3):141-148.
  8. Ng SS, Figg WD. Antitumor activity of herbal supplements in human prostate cancer xenografts implanted in immunodeficient mice. Anticancer Res. 2003;23(5A):3585-3590.
  9. 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.
  10. Tsai NM, Lin SZ, Lee CC, et al. The antitumor effects of Angelica sinensis on malignant brain tumors in vitro and in vivo. Clin Cancer Res. 2005;11(9):3475-3484.
  11. Deng S, Wang Y, Inui T, et al. Anti-TB polyynes from the roots of Angelica sinensis. Phytother Res. Jul 2008;22(7):878-882.
  12. Hui MK, Wu WK, Shin VY, et al. Polysaccharides from the root of Angelica sinensis protect bone marrow and gastrointestinal tissues against the cytotoxicity of cyclophosphamide in mice. Int J Med Sci. 2006;3(1):1-6.
  13. Xin YF, Zhou GL, Shen M, et al. Angelica sinensis: a novel adjunct to prevent doxorubicin-induced chronic cardiotoxicity. Basic Clin Pharmacol Toxicol. Dec 2007;101(6):421-426.
  14. Xie CH, Zhang MS, Zhou YF, et al. Chinese medicine Angelica sinensis suppresses radiation-induced expression of TNF-alpha and TGF-beta1 in mice. Oncol Rep. 2006;15(6):1429-1436.
  15. Liu J, Burdette JE, Xu H, et al. Evaluation of estrogenic activity of plant extracts for the potential treatment of menopausal symptoms. J Agric Food Chem. 2001;49(5):2472-2479.
  16. Amato P, Christophe S, Mellon PL. Estrogenic activity of herbs commonly used as remedies for menopausal symptoms. Menopause. 2002;9(2):145-150.
  17. Lau CB, Ho TC, Chan TW, Kim SC. Use of dong quai (Angelica sinensis) to treat peri- or postmenopausal symptoms in women with breast cancer: is it appropriate? Menopause. 2005;12(6):734-740.
  18. Foster S, Tyler VE. Tyler’s Honest Herbal: A Sensible Guide to the use of Herbs and related remedies. 3rd ed. New York: Haworth Herbal Press; 1993.
  19. DerMarderosian A. The Review of Natural Products. St. Louis: Facts and Comparisons; 1999.
  20. Goh SY, Loh KC. Gynaecomastia and the herbal tonic “Dong Quai”. Singapore Med J. 2001;42(3):115-116.
  21. Page RL, 2nd, Lawrence JD. Potentiation of warfarin by dong quai. Pharmacotherapy. 1999;19(7):870-876.
  22. Chao WW, Lin BF. Bioactivities of major constituents isolated from Angelica sinensis (Danggui). Chin Med. 2011 Aug 19;6:29.
  23. Chen YL, Jian MH, Lin CC, et al. The induction of orphan nuclear receptor Nur77 expression by n-butylenephthalide as pharmaceuticals on hepatocellular carcinoma (HCC) cells therapy. Mol Pharmacol. Jun 24 2008.
  24. Lin PC, Chen YL, Chiu SC, et al. Orphan nuclear receptor, Nurr-77 was a possible target gene of butylidenephthalide chemotherapy on glioblastoma multiform brain tumor.J Neurochem. Aug 2008;106(3):1017-1026.
  25. Zhao H, Alexeev A, Sharma V, Guzman LD, Bojanowski K. Effect of SBD.4A—a defined multicomponent preparation of Angelica sinensis—in periodontal regeneration models. Phytother Res. Jul 2008;22(7):923-928.
  26. Lam HW, Lin HC, Lao SC, et al. The angiogenic effects of Angelica sinensis extract on HUVEC in vitro and zebrafish in vivo. J Cell Biochem. Jan 1 2008;103(1):195-211.
  27. Tyler V. The Honest Herbal: A Sensible Guide to Herbs and Related Remedies. Philadelphia: George Stickley Company; 1982.
  28. Hirata JD, Swiersz LM, Zell B, Small R, Ettinger B. Does dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled trial. Fertil Steril. Dec 1997;68(6):981-986.
  29. Haines CJ, Lam PM, Chung TK, et al. A randomized, double-blind, placebo-controlled study of the effect of a Chinese herbal medicine preparation (Dang Gui Buxue Tang) on menopausal symptoms in Hong Kong Chinese women. Climacteric 2008 Jun;11(3):244-51.
  30. Friedman JA, Taylor SA, McDermott W, Alikhani P. Multifocal and recurrent subarachnoid hemorrhage due to an herbal supplement containing natural coumarins. Neurocrit Care. 2007;7(1):76-80.
  31. Al-Bareeq RJ, Ray AA, Nott L, Pautler SE, Razvi H. Dong Quai (Angelica sinensis) in the treatment of hot flashes for men on androgen deprivation therapy: results of a randomized double-blind placebo controlled trial. Can Urol Assoc J. 2010 Feb;4(1):49-53.
  32. Bu Y, Kwon S, Kim YT, Kim MY, et al. Neuroprotective effect of HT008-1, a prescription of traditional Korean medicine, on transient focal cerebral ischemia model in rats. Phytother Res. 2010 Feb 10. [Epub ahead of print]
  33. Wong VC, Lim CE, Luo X, Wong WS. Current alternative and complementary therapies used in menopause. Gynecol Endocrinol. 2009 Mar;25(3):166-74.
  34. Liu PJ, Hsieh WT, Huang SH, Liao HF, Chiang BH. Hematopoietic effect of water-soluble polysaccharides from Angelica sinensis on mice with acute blood loss. Exp Hematol. 2010 Jun;38(6):437-45.
  35. Chen MP, Yang SH, Chou CH, et al. The chondroprotective effects of ferulic acid on hydrogen peroxide-stimulated chondrocytes: inhibition of hydrogen peroxide-induced pro-inflammatory cytokines and metalloproteinase gene expression at the mRNA level. Inflamm Res. 2010 Aug;59(8):587-95.
  36. Yu C, Chai X, Yu L, Chen S, Zeng S. Identification of novel pregnane X receptor activators from traditional Chinese medicines. J Ethnopharmacol. 2011 Jun 14;136(1):137-43.
  37. Wen Y, Li J, Tan Y, et al. Angelica sinensis Polysaccharides Stimulated UDP-Sugar Synthase Genes through Promoting Gene Expression of IGF-1 and IGF1R in Chondrocytes: Promoting Anti-Osteoarthritic Activity. PLoS One. 2014 Sep 9;9(9):e107024.
  38. Hook IL. Danggui to Angelica sinensis root: Are potential benefits to European women lost in translation? A review. J Ethnopharmacol. 2014 Feb 27;152(1):1-13.
  39. Wu CT, Lai JN, Tsai YT.The prescription pattern of Chinese herbal products that contain dang-qui and risk of endometrial cancer among tamoxifen-treated female breast cancer survivors in Taiwan: a population-based study. PLoS One. 2014 Dec 8;9(12):e113887.
  40. Zhang WF, Yang Y, Li X, et al. Angelica polysaccharides inhibit the growth and promote the apoptosis of U251 glioma cells in vitro and in vivo. Phytomedicine. 2017 Sep 15;33:21-27.
  41. Chiu SC, Chiu TL, Huang SY, et al. Potential therapeutic effects of N-butylidenephthalide from Radix Angelica sinensis (Danggui) in human bladder cancer cells. BMC Complement Altern Med. 2017 Dec 6;17(1):523.
  42. Younas F, Aslam B, Muhammad F, et al. Haematopoietic effects of Angelica sinensis root cap polysaccharides against lisinopril-induced anaemia in albino rats. Pharm Biol. 2017 Dec;55(1):108-113.
  43. Nambiar S, Schwartz RH, Constantino A. Hypertension in mother and baby linked to ingestion of Chinese herbal medicine. West J Med. 1999 Sep;171(3):152.
  44. Fung FY, Wong WH, Ang SK, et al. A randomized, double-blind, placebo- controlled study on the anti-haemostatic effects of Curcuma longa, Angelica sinensis and Panax ginseng. Phytomedicine. 2017 Aug 15;32:88-96.
  45. Xiao M, Qian C, Luo X, et al. Impact of the Chinese herbal medicines on dual antiplatelet therapy with clopidogrel and aspirin: Pharmacokinetics and pharmacodynamics outcomes and related mechanisms in rats. J Ethnopharmacol. 2019 May 10;235:100-110.
  46. Zhang DW, Wang SL, Wang PL, et al. The efficacy of Chinese herbal medicines on acute coronary syndrome with renal insufficiency after percutaneous coronary intervention. J Ethnopharmacol. 2020 Feb 10;248:112354.
  47. Liu L, Li H, Tan G, Ma Z. Traditional Chinese herbal medicine in treating amenorrhea caused by antipsychotic drugs: Meta-analysis and systematic review. J Ethnopharmacol. 2022 May 10;289:115044.
  48. Zhu H, You J, Wen Y, et al. Tumorigenic risk of Angelica sinensis on ER-positive breast cancer growth through ER-induced stemness in vitro and in vivo.  J Ethnopharmacol. 2021 Nov 15;280:114415.
  49. Kim EH, Park SB, Jin H, Chung WK, Yoon SW. Comparative efficacy of Jaungo, a traditional herbal ointment, and a water-in-oil type non-steroidal moisturizer for radiation-induced dermatitis in patients with breast cancer: a prospective, randomized, single-blind, pilot study. Front Pharmacol. 2023 Jul 3;14:1216668.
  50. Chiu ML, Chiou JS, Chen CJ, et al. Effect of Chinese Herbal Medicine Therapy on Risks of Overall, Diabetes-Related, and Cardiovascular Diseases-Related Mortalities in Taiwanese Patients With Hereditary Hemolytic Anemias. Front Pharmacol. 2022 May 30;13:891729. 
  51. Ding D, Liu S, Liu F, et al. Exploring the role of Chinese herbal medicine in the long-term management of postoperative ovarian endometriotic cysts: a systematic review and meta-analysis.  Front Pharmacol. 2024 Jun 7;15:1376037. 
  52. Lian YY, Ma YC, Cheng CK. Unusual Presentation of Acute Hydroxychloroquine Retinopathy.  Ocul Immunol Inflamm. 2023 Oct;31(8):1720-1723.
  53. Jia F, Zang YN, Ruan CJ, et al. A Chinese medicine called Danggui Longhui may be a new clinically relevant clozapine inducer: Two case reports identified by therapeutic drug monitoring.  Schizophr Res. 2024 Jun;268:308-311.
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