Health Care Professional Information

Scientific Name
Angelica sinensis
Common Name

Chinese angelica, dang gui, tang kuei, tan kue

Clinical Summary

Dong quai is an herb the root of which has been used in traditional Chinese medicine for thousands of years. It is often combined with other herbs in formulations. Dong quai is also available as a dietary supplement and promoted as a woman's herb to treat menstrual and menopausal symptoms.
Extracts of dong quai demonstrated antitumor (7) (8) (9) (10), anti-tuberculosis (TB) (11), neuroprotective (32), and hematopoeitic (34) effects in vitro. In animal studies, the polysaccharides extracted from dong quai root showed protective effects against cyclophosphamide-induced toxicity (12), doxorubicin-induced cardiotoxicity (13), and radiation-induced pneumonitis (14). But these effects have not been evaluated in humans.
Clinical trial data regarding efficacy of dong quai for menopausal symptoms are inconclusive (1) (2) (3) (4) (5) (6) (29) (33). A small study done in men with hot flashes did not find dong quai effective (31).

Dong quai exhibits estrogenic activity in vitro (15) and stimulates proliferation of MCF-7 cells (16) (17). Until definitive efficacy and safety data are available, patients with hormonal-sensitive cancers should avoid this herb.

Purported Uses
  • Dysmenorrhea
  • Health maintenance
  • Menopausal symptoms
  • Premenstrual syndrome
  • Spasms
Constituents
  • Volatile oils: Safrole, isosafrole, and n-butylphthalide
  • Coumarin derivatives: Psoralens, bergapten, osthol, imperatorin, and oxypeucedanin
  • Ferulic acid
    (22)
Mechanism of Action

Ferulic acid, one of the constituents of Dong quai, may play an important role in the treatment of osteoarthritis by reducing the 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).
In another study, Dong quai polysaccharides demonstrated anti-osteoarthritic activity by stimulating Insulin like growth factor 1 (IGF1) and IGF1 receptor gene expression, which resulted in promoting UDP-sugars and glycosaminoglycan synthesis due to up-regulation of gene expression of UDP-sugar synthases (37).
A component isolated from dong quai promotes wound healing and bone regeneration by inducing osteoblast proliferation and hyaluronic acid deposition (25).
The water extract from dong quai was shown to have estrogen-agonist activity and stimulated proliferation of both estrogen receptor-positive and negative breast cancer cells (17). It exerts a protective effect in mice with radiation-induced pneumonitis by down regulating proinflammatory cytokines such as TNF-alpha and TGF-beta1 (14). Subcutaneous injection of dong quai extract also 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) which may be mediated by Nur77-dependent apoptosis (23) (24). Furthermore, dong quai extracts promote angiogenesis by inducing proliferation and migration of endothelial cells by upregulating VEGF expression (26).

Pharmacokinetics

Unknown

Contraindications
  • Pregnant and breastfeeding women should avoid dong quai (27).
  • Patients taking anticoagulants should avoid dong quai as it can potentiate their effects (21).
  • Patients with hormone-sensitive cancers should avoid dong quai because it has estrogenic effects (15).
Adverse Reactions

Reported adverse events include bloating, loss of apeptite (18), diarrhea, photosensitivity (19), and gynecomastia (20).
Case report: Subarachnoid hemorrhage was reported in a 53-year-old woman following use of a herbal supplement containing red clover, dong quai, and Siberian ginseng for hot flashes associated with perimenopause. Her symptoms resolved after discontinuing use of the supplement (30).

Herb-Drug Interactions

Anticoagulants: Dong quai may have additive anticoagulant effect (21).
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.

Herb Lab Interactions

Elevated PT / INR
(21)

Literature Summary and Critique

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):117-22.
Fifty healthy pre and postmenopausal women (aged 44-65 years) were randomized to receive Phyto-Female Complex (an herbal formula of black cohosh, dong quai, milk thistle, red clover, American ginseng, and chaste-tree berry extracts) or a placebo twice daily for 3 months. Women who took Phyto-Female Complex reported a decrease in hot flushes, reduction in night sweat, and improved sleep quality compared to those in the placebo group. However, it is not clear if dong quai alone would have similar effects. Further studies are needed.

Dosage (Inside MSKCC Only)
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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. Bone K. Clinical Applications of Ayurvedic and Chinese Herbs. Queensland (Australia): Phytotherapy Press; 1997.
  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.

Consumer Information

How It Works

Bottom Line: Dong quai has not been shown to treat or prevent cancer.

Dong quai is an herb used in traditional Chinese medicine to treat menstrual and menopausal symptoms and to 'tonify' blood. Root extracts of dong quai were shown to stop growth of cancer cells in laboratory studies but human data are lacking. A few studies have been done to test effectiveness of dong quai for menopausal symptoms but results are inconclusive.
Dong quai has estrogen like effects and it was shown to increase growth of breast cancer cells in laboratory experiments. It may also contain compounds that can cause cancer in high doses.

Purported Uses
  • To relieve symptoms of menopause
    Results from a few studies done in postmenopausal women are inconclusive.
  • To treat dysmenorrhea
    Traditional medicine uses dong quai to treat dysmenorrhea but there is no scientific basis to support this use.
  • To treat premenstrual syndrome
    Although traditionally used to treat premenstrual symptoms, there are no clinical studies to support this claim.
Research Evidence

Menopausal symptoms
Fifty healthy pre- and postmenopausal women (aged 44-65 years) were randomized to receive Phyto-Female Complex (an herbal formula of black cohosh, dong quai, milk thistle, red clover, American ginseng, and chaste-tree berry extracts) or a placebo twice daily for 3 months. Women who took Phyto-Female Complex reported a decrease in hot flushes, reduction in night sweat, and improved sleep quality compared to those in the placebo group. However, it is not clear if dong quai alone would have similar effects.

Do Not Take If
  • You are taking anticoagulants such as warfarin (Dong quai may increase the risk of bleeding).
  • You are pregnant or breastfeeding.
  • You are undergoing radiation therapy (Dong quai can cause photodermatitis, and therefore might worsen the effects of radiation therapy on the skin).
  • You have hormone-sensitive cancer (Dong quai has estrogenic effects and can further stimulate growth of cancer cells)
Side Effects
  • Photosensitivity (sensitivity of the eyes to light)
  • Photodermatitis (skin sensitivity to light, causing swelling, itching, and/or redness)
  • Gynecomastia (excessive development of breasts in men)
  • Excessive bleeding due to the blood thinning effect
  • Diarrhea
  • Fever
  • Case report: Intracranial hemorrhage was reported in a 53-year-old woman following use of an herbal supplement containing red clover, dong quai, and Siberian ginseng for hot flashes associated with perimenopause. Her symptoms resolved after discontinuing use of the supplement.
E-mail your questions and comments to aboutherbs@mskcc.org.