How It Works
Bottom Line: The anticancer effects of Dong quai have been tested in the labs but not in humans. There is insufficient data to show dong quai alone is an effective treatment for menopausal and menstrual symptoms.
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 is lacking. A few studies have been done to test effectiveness of dong quai for menopause symptoms but results are inconclusive. Dong quai has weak estrogen like effects and it was shown to increase growth of breast cancer cells in laboratory experiments. It may also contains compounds that can cause cancer in high doses. So caution is advised before use.
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.
Warnings
This product is regulated by the FDA as a dietary supplement. Unlike approved drugs, supplements are not required to be manufactured under specific standardized conditions. The product may not contain the labeled amount or may be contaminated. In addition, it may not have been tested for safety or effectiveness.
Dong quai may contain compounds that can cause cancer in high doses.
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).
Side Effects
Photosensitivity (sensitivity of the eyes to light)
Photodermatitis (skin sensitivity to light, causing swelling, itching, and/or redness)
Gynecomastia (One man taking dong quai had breast enlargement)
Excessive bleeding due to the blood thinning effect
Diarrhea
Fever
Special Point
In traditional Chinese medicine, Dong quai is an important herb that is used in combination with other herbs or food. High doses of Dong quai, when used alone, can cause adverse effects. Patients should consult with qualified professionals before using this supplement.
Scientific Name
Common Name
Chinese angelica, dang gui, tang kuei, tan kue
Clinical Summary
Dong quai is an herb used in traditional Chinese medicine for thousands of years. It is often combined with other herbs to 'tonify' blood. It is also used as a dietary supplement and promoted as 'women's herb' to treat menstrual and menopausal symptoms. Data regarding efficacy of dong quai for menopausal symptoms are inconclusive (9) (10) (11) (12) (13) (14). Extracts of dong quai demonstrated antitumor (2) (3) (4) (5) activity in vitro. In animal studies, the polysaccharides extracted from dong quai root showed protective effects against cyclophosphamide induced toxicity (6) and radiation induced pneumonitis (7). But these effects have not been evaluated in humans. Dong quai exhibited weak estrogenic activity in vitro (15) and was found to stimulate proliferation of MCF-7 cells (16) (17). Therefore, until definitive efficacy and safety data are available, patients with hormonal-sensitive cancers should use this herb with caution. Reported adverse events include bloating, loss of apetite (18), diarrhea, photosensitivity (8), and gynecomastia (19). Due to the coumarin content, the activity of anticoagulants may be potentiated (20). Psoralens and safrole, the active constituents, are thought to be carcinogenic in high doses (8).
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
(1)
Mechanism of Action
Water extract from Dong quai was shown to have a weak estrogen-agonist activity and can stimulate 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 (7). Subcutaneous injection of dong quai extract also protected mice against cyclophosphamide induced cytotoxicity by promoting recovery from leukopenia (6). The antitumor effects of dong quai may be due to its inhibitory effects on invasion and metastatic of carcinoma cells (5) and by suppression of tumor growth (2) (3) (4).
Pharmacokinetics
Unknown
Warnings
Psoralens can cause photosensitization, and safrole is carcinogenic (8).
Pregnant and breastfeeding women should avoid Dong quai (21).
Adverse Reactions
Reported: Reported adverse events include bloating, loss of apetite
(18), diarrhea, photosensitivity
(8), and gynecomastia
(19).
Herb-Drug Interactions
Anticoagulants: Dong quai may have additive anticoagulant effect.
(20)
Lab Interactions
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.
References
1. Bone K. Clinical Applications of Ayurvedic and Chinese Herbs. Queensland (Australia): Phytotherapy Press; 1997.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.
7. 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.
8. DerMarderosian A. The Review of Natural Products. St. Louis: Facts and Comparisons; 1999.
9. 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.
10. 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.
11. Carroll DG.
Nonhormonal therapies for hot flashes in menopause. Am Fam Physician. 2006;73(3):457-464.
12. 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.
13. Fugate SE, Church CO.
Nonestrogen treatment modalities for vasomotor symptoms associated with menopause. Ann Pharmacother. 2004;38(9):1482-1499.
14. Treatment of menopause-associated vasomotor symptoms: position statement of The North American Menopause Society.
Menopause. 2004;11(1):11-33.
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, et al. Tyler's Honest Herbal: A Sensible Guide to the use of Herbs and related remedies. 3rd ed. New York: Haworth Herbal Press; 1993.
19. Goh SY, Loh KC.
Gynaecomastia and the herbal tonic "Dong Quai". Singapore Med J. 2001;42(3):115-116.
20. Page RL, 2nd, Lawrence JD.
Potentiation of warfarin by dong quai. Pharmacotherapy. 1999;19(7):870-876.
21. Tyler V. The Honest Herbal: A Sensible Guide to Herbs and Related Remedies. Philadelphia (PA): George Stickley Company; 1982.
