Dong Quai

Dong Quai

Common Names

  • Chinese angelica
  • dang gui
  • tang kuei
  • tan kue

For Patients & Caregivers

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.

  • 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.
  • You are taking anticoagulants such as warfarin (Dong quai may increase the risk of bleeding. But a human study shows that this effect may be limited).
  • 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)
  • You are taking Lisinopril [angiotensin converting enzyme (ACE) inhibitor]: Simultaneous use with Dong quai worsened anemia in a study of rats. Whether it has the same effect in humans is not known.
  • 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
  • Hypertension

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.
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For Healthcare Professionals

Angelica sinensis

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), pro-apoptotic (40) (41), anti-metastatic (41), 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.

Data from an epidemiologic study suggest that dong quai consumption is associated with reduced risk of subsequent endometrial cancer in breast cancer survivors (39). But 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.

  • Dysmenorrhea
  • Health maintenance
  • Menopausal symptoms
  • Premenstrual syndrome
  • Spasms

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). 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 was reported to have estrogen-agonist activity, and stimulated proliferation of both estrogen receptor-positive and negative breast cancer cells (17). It also afforded protection against radiation-induced pneumonitis by down regulating proinflammatory cytokines such as TNF-alpha and TGF-beta1 in a murine model (14). Subcutaneous injection of dong quai extract protected mice as well 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). Furthermore, dong quai extracts promote angiogenesis by inducing proliferation and migration of endothelial cells by upregulating VEGF expression (26).

  • Pregnant and breastfeeding women should avoid dong quai (27).
  • Patients with hormone-sensitive cancers should avoid dong quai because it has estrogenic effects (15).

Reported adverse events include bloating, loss of apeptite (18), diarrhea, photosensitivity (19), gynecomastia (20), and hypertension (43).

Case report:
Subarachnoid hemorrhage: 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).


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


Elevated PT / INR

  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. 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. 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.

  7. 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.

  8. 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.

  9. 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.

  10. Amato P, Christophe S, Mellon PL. Estrogenic activity of herbs commonly used as remedies for menopausal symptoms. Menopause. 2002;9(2):145-150.

  11. 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.

  12. DerMarderosian A. The Review of Natural Products. St. Louis: Facts and Comparisons; 1999.

  13. Goh SY, Loh KC. Gynaecomastia and the herbal tonic “Dong Quai”. Singapore Med J. 2001;42(3):115-116.

  14. Page RL, 2nd, Lawrence JD. Potentiation of warfarin by dong quai. Pharmacotherapy. 1999;19(7):870-876.

  15. 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.

  16. 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.

  17. Tyler V. The Honest Herbal: A Sensible Guide to Herbs and Related Remedies. Philadelphia: George Stickley Company; 1982.

  18. 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.

  19. 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.

  20. 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]

  21. Wong VC, Lim CE, Luo X, Wong WS. Current alternative and complementary therapies used in menopause. Gynecol Endocrinol. 2009 Mar;25(3):166-74.

  22. 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.

  23. 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.

  24. 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.

  25. 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.

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