Natural Standard® Patient Monograph, Copyright © 2014 (www.naturalstandard.com). All Rights Reserved. Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.

Background

Dong quai is also known as Chinese angelica. It belongs to the same plant family as parsley, celery, carrots, and poison hemlock. Dong quai has been used for thousands of years in traditional Chinese, Korean, and Japanese medicine. It is one of the most popular plants in Chinese medicine.

Dong quai has been called "female ginseng" because it is commonly used for health conditions in women. The plant has been used for menstrual cramps, anemia associated with menstruation, pregnancy, premenstrual syndrome (PMS), pelvic pain, recovery from childbirth or illness, and fatigue or low energy. Dong quai is used in both men and women for heart conditions, high blood pressure, inflammation, headache, infections, and nerve pain.

It has been suggested that dong quai has weak estrogen-like effects. However, it remains unclear whether dong quai has the same effects as estrogens, blocks estrogen activity, or lacks significant hormonal effects.

Dong quai is often used in combination with other herbs for liver and spleen problems. It is thought to work best in people who have a calm, reserved profile, and is thought to be a mildly warming herb. Dong quai is believed to help nourish the blood and balance energy.

There is little human evidence to support the medical use of dong quai. Dong quai has been studied for many conditions, including absent menstrual periods, arthritis, blood circulation, brain disorders, heart disease, immune problems, and sexual dysfunction. More high-quality research is needed to confirm the use of dong quai for any condition.

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)

Dong quai has been taken by mouth three times daily in the following doses: 520 milligrams per dose in people under 100 pounds; 1,040 milligrams per dose in people 100-175 pounds; and 1,560 milligrams per dose in people over 175 pounds. Dong quai has been taken by mouth in the following forms: a decoction (a teaspoon or tablespoon of cut root simmered in one cup of hot water); dried leaf (taken in an infusion); dried root (taken directly by mouth or in an infusion); a fluid extract; a leaf liquid extract; a leaf tincture; dong quai tea (root steeped in hot water); candied dong quai stems; whole root or root slices (boiled or soaked in wine); and a root tincture. Dong quai has been injected into the vein or artery in doses of 20-40 milliliters, and has been injected into acupuncture points in doses of 0.5-1.0 milliliters. There is a lack of evidence in support of these and the following doses.

For reproductive conditions (including menstrual cramps and menopause), dong quai has been taken by mouth in the following doses and forms: 1-15 grams of dong quai root 1-3 times daily; 4-6 fluid extract tablets 2-3 times daily; 1-8 milliliters or 10-40 drops of tincture up to three times daily; 1-2 grams of powdered root three times daily; and 1-2 grams of dong quai in tea three times daily.

For symptoms of menopause, dong quai has been taken by mouth in the following doses and forms: three capsules containing 4.5 grams of dong quai, three times daily for 24 weeks without benefit; 1-4 grams of powdered root as an extract, capsules, tablets, or tea, for up to three times daily; and 1 milliliter of fluid extract three times daily.

For menstrual cramps, a teaspoon of dong quai tincture has been taken by mouth twice daily, one day after the end of menstruation, and discontinued when menstrual bleeding begins. With a light menstrual flow, one teaspoon of tincture has been taken every two hours.

For premenstrual syndrome (PMS), dong quai has been taken by mouth in the following doses and forms: 0.5 grams of extract twice daily; 2-3 grams of dong quai capsules or tablets daily; 4-8 milliliters of a fluid extract daily; 1-2 grams as a tea three times daily; 2-4 milliliters of tincture up to three times daily; and one-half teaspoon of dong quai mixed with water up to four times daily.

For poor circulation, one teaspoon of dong quai mixed with one cup of water has been taken by mouth 1-2 times daily.

For inflammation, 10-15 drops of diluted dong quai essential oil have been applied to the skin.

For reduced blood flow to the brain, 200 milliliters of dong quai has been injected into the veins daily for 20 days.

For lichen planus (itchy skin rash), 1.5-2 milliliters of dong quai have been injected into acupuncture points once weekly for eight weeks.

For high blood pressure in the lungs, dong quai has been injected into the vein with glucose (250 milliliters daily) for 10 days.

For ulcerative colitis (a type of inflammatory bowel disease), 40 milliliters of dong quai added to 250 milliliters of glucose have been injected into the vein once daily for three weeks.

Children (under 18 years old)

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

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.

Key to grades

A
Strong scientific evidence for this use
B
Good scientific evidence for this use
C
Unclear scientific evidence for this use
D
Fair scientific evidence against this use (it may not work)
F
Strong scientific evidence against this use (it likely does not work)

Grading rationale

Evidence gradeCondition to which grade level applies
C

Amenorrhea (lack of menstrual period)

There is limited evidence to support the use of dong quai for a lack of menstrual period. More research is needed before a firm conclusion can be made.
C

Arthritis

Dong quai has been traditionally used for arthritis. However, there is a lack of evidence to support its use for this condition. Further research is needed.
C

Blood circulation

A combination Chinese product containing dong quai may reduce limb swelling and promote blood circulation. However, the effect of dong quai alone is unclear and more research is needed.
C

Death and dying

There is a lack of evidence to support the use of dong quai as a treatment for rhesus incompatibility (a condition in which a woman and her unborn child have incompatible blood types).
C

Decreased blood platelets

There is promising early evidence to support the use of dong quai as part of a combination treatment for idiopathic thrombocytopenic purpura (a bleeding disorder in which the immune system destroys platelets). Further research is needed.
C

Heart disease

Early study suggests that dong quai in combination with other herbs may have protective heart health benefits, reduce cholesterol levels, and improve coronary heart disease symptoms. However, there is a lack of human research on the possible effects of dong quai alone. Further studies are needed.
C

Immune function

Dong quai extract has been shown to stimulate the immune system in people undergoing chemotherapy or radiation therapy for breast cancer. However, further research is needed in this area.
C

Kidney disease (Glomerulonephritis)

There is a lack of evidence to support the use of dong quai as a treatment for glomerulonephritis (in which kidney damage affects the filtering of waste and fluids from blood). Further study is needed.
C

Lichen planus (itchy skin rash)

There is a lack of evidence to support the use of dong quai to treat lichen planus in the vagina. High-quality research is needed in this area.
C

Menstrual cramps

Early study has found promising results for the use of dong quai in combination with other herbs to treat menstrual cramps. More high-quality human evidence is needed.
C

Menstrual migraine headache

There is promising early evidence to support the use of dong quai as part of a combination therapy for menstrual migraine headache. However, further research is needed on the possible benefits of dong quai alone.
C

Pulmonary hypertension (high blood pressure in the lungs)

Dong quai may improve high blood pressure in the lungs, blood thickness, and red blood cell volume. Further research is needed.
C

Sexual dysfunction

A cream containing dong quai and other herbs has been shown to improve sexual function and satisfaction. Early study suggests that dong quai in combination with other herbs may also improve or reduce hot flashes, as well as decrease fatigue and sleep problems. More studies are needed to confirm these findings.
C

Stroke

Dong quai has been studied for benefits on blood flow and memory in people who have had a stroke. A combination product containing dong quai has been studied for the prevention of blood clots in the brain. Further research is needed.
C

Ulcerative colitis (inflammatory bowel disease)

Dong quai may benefit people who have blood disorders associated with ulcerative colitis. More research is needed to confirm these early results.
D

Menopause

Dong quai has been used as part of traditional Chinese formulas to treat menopause symptoms. Dong quai may have estrogen-like effects and has been studied for the treatment of hot flashes. However, the only study using dong quai alone found a lack of effectiveness on menopause symptoms. High-quality research is still needed in this area.

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.

Abnormal fetal movement, abnormal heart rhythms, abscess (pus build-up), acne, age-related nerve damage, AIDS, allergy, amnesia, anemia, anorexia, anti-aging, antibacterial, antifungal, anti-inflammatory, antioxidant, antiseptic, antispasmodic (prevent muscle spasms), antiviral, anxiety, asthma, back pain, bile flow improvement, bladder disorders, bleeding, blood clot prevention (menstruation), blood flow disorders, blood purifier, blood thinner, boils, bone loss, bowel disorders, breast disease, breast enhancement, bronchitis, cancer, central nervous system disorders, cervicitis (inflammation of the cervix), chemotherapy side effects, chicken pox, chilblains (skin damage caused by cold exposure), chronic lung conditions, chronic pelvic pain, chronic rhinitis (long-term nasal allergies), clogged arteries, colchicine-induced learning impairment, congestion (chronic nasal and sinus), constipation, cough, cramps, dermatitis (skin inflammation), diabetes, digestive disorders, dysentery (bloody diarrhea), eczema (chronic skin inflammation), emotional instability, endometriosis (uterine cells grow outside the uterus), estrogen-like activity, excessive menstrual flow, expectorant (promotes mucus), eye problems, fatigue, fluid retention (fluid build-up), gas, glaucoma (increased eye pressure), hay fever, headache, healing time reduction, heart conditions, heartburn, heart failure, hematopoiesis (stimulation of blood cell production), hemolytic disease of the newborn (blood disease in babies), hemorrhoids, hernia (part of an organ bulging through a muscle), high blood pressure, high cholesterol, hives, hormonal disorders, immune cytopenias (decreased number of immune cells in the blood), improving urine flow, indigestion, infertility, irregular heartbeat, irritable bowel syndrome (IBS), joint pain, kidney problems, labor, laxative, leg swelling, liver damage, liver inflammation (long-term), liver protection, lung disease, lung disorders, lung inflammation, malaria, menstrual flow stimulant, metrorrhagia (bleeding in between menstrual periods), miscarriage prevention, muscle relaxant, myocardial ischemia (reduced blood flow to the heart), nerve damage, nerve pain, neurodermatitis (long-term skin itching), osteoporosis, ovarian cysts, ovulation disorders, pain, pain relief, pelvic cramps, pelvic inflammatory disease, peritoneal dialysis (treatment to remove waste after kidney dysfunction), pernicious anemia (low red blood cell levels due to problems absorbing vitamin B12), phytoestrogen, placental detachment (pregnancy complication in which placenta and uterus separate), pneumonia (infants), post-partum weakness (fatigue after giving birth), pregnancy, premenstrual syndrome (PMS), prepare uterus for labor, psoriasis (skin redness and irritation), pulmonary fibrosis (scarring of the lungs), Raynaud's disease (reduced blood flow caused by cold or stress), reperfusion injury (tissue damage caused by lack of oxygen), rheumatism or joint diseases, ringing in the ears, sciatica (back and leg pain), sedative, sepsis (severe response to infection), shingles, skin pigmentation disorders, skin ulcers, stiffness, stomach pain, stomach ulcer, stress, swelling, tonic, toothache, uterine disorders, uterine fibroids (non-cancer growths in the uterus), uterine tonic, vaginal atrophy (thinning of vagina walls), vaginal discharge, vaginal dryness, vasodilatation (widens blood vessels), vein clots, vision problems, vitamin B12 deficiency, vitamin E deficiency, vitiligo (irregular white patches on skin), wound healing.

Interactions

Interactions with Drugs

Dong quai may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin®) or heparin, anti-platelet drugs such as clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).

Caution is advised when using medications that may lower blood sugar. People taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.

Dong quai may affect blood pressure. Caution is advised in people taking drugs that lower blood pressure.

Dong quai may increase the amount of drowsiness caused by some drugs. Examples include benzodiazepines such as lorazepam (Ativan®) or diazepam (Valium®), barbiturates such as phenobarbital, narcotics such as codeine, some antidepressants, and alcohol. Caution is advised while driving or operating machinery.

Dong quai may also interact with acetaminophen, agents that increase sun sensitivity, agents that stimulate or treat disorders of the nervous system, agents that treat abnormal heart rhythms, agents that treat muscle spasms, agents that treat stomach and intestine disorders, agents that widen blood vessels, antibiotics, anticancer agents, antidepressants (selective serotonin reuptake inhibitors, SSRIs), birth control, bleomycin, calcium channel blockers, disulfiram (Antabuse®), hormonal agents, laxatives, lung agents, metronidazole (Flagyl®), nonsteroidal anti-inflammatory agents (NSAIDs), and pain relievers.

Interactions with Herbs and Dietary Supplements

Dong quai may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.

Caution is advised when using herbs or supplements that may lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.

Dong quai may increase the amount of drowsiness caused by some herbs or supplements.

Dong quai may affect blood pressure. Caution is advised in people taking herbs or supplements that lower blood pressure.

Dong quai may interact with antibacterial herbs and supplements, anticancer herbs and supplements, antidepressant herbs and supplements (selective serotonin reuptake inhibitors, SSRIs), antioxidants, birth control, herbs and supplements that affect or treat disorders of the central nervous system, herbs and supplements that increase sun sensitivity, herbs and supplements that prevent muscle spasms, herbs and supplements that treat abnormal heart rhythms, herbs and supplements that treat stomach and intestine disorders, hormonal herbs and supplements, laxatives, pain relievers, St. John's wort, and vitamin E.

Methodology

This information is based on a systematic review of scientific literature and was peer-reviewed and edited by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Monograph methodology

Related terms

Acidic polysaccharides, American angelica, angelol, angelica, Angelica acutiloba, Angelica archangelica, Angelica atropurpurea, Angelica dahurica, Angelica edulis, Angelica gigas, Angelica keiskei, Angelica koreana, Angelicapolymorpha var. sinensis Oliv., Angelica pubescens, Angelica radix, Angelica root, Angelica silvestris, Angelica sinensis (Oliv.) Diels, angelicide, angelicin, angelicone, angelique, anodynes, Apiaceae (family), Archangelica officinalis Moench or Hoffm., bergapten, beta-sitosterol, Chinese angelica, Chinese danggui, coumarins, dang gui, dang gui ku shen wan, dang quai, dāngguī (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, ferulic acid, 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 CycleTM 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 EnergyTM 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).

Note: Angelica dahurica is commonly known as Chinese angelica; however, it is not included in this bottom line.

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 plant family that includes anise, caraway, carrot, celery, dill, and parsley.

Side Effects and Warnings

Like all Chinese herbs, there are many different grades and qualities of dong quai. Chinese herbal products 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.

Dong quai is likely safe when taken by mouth in recommended doses, under the care of a medical professional.

Dong quai may affect blood pressure. Caution is advised in people taking drugs or herbs and supplements that lower blood pressure.

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

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

Use cautiously in amounts higher than recommended doses.

Use cautiously in people who have alcohol dependence or intolerance, anemia, cancer, eye disorders, heart problems, liver disease, lung problems, sensitive skin, and stomach problems.

Use cautiously in people taking agents that are affected by alcohol, agents that widen blood vessels, and heart agents.

Use cautiously in children.

Dong quai may increase the risk of bleeding. Avoid in people with bleeding disorders (including abnormally heavy menstrual periods) or taking drugs that may increase the risk of bleeding (such as warfarin (Coumadin®)). Dosing adjustments may be necessary.

Avoid before surgery or major dental procedures, and during prolonged exposure to sunlight or other sources of ultraviolet light, menstrual periods in women with heavy menstrual flow, and viral infections such as the cold or flu.

Avoid in people who have hormone-sensitive conditions (such as breast cancer, endometrial cancer or endometriosis, ovarian cancer, and uterine cancer or uterine growths), stroke, and thromboembolism (clotting that blocks blood vessels).

Avoid in people who are taking birth control by mouth, hormone replacement therapy, St. John's wort, and tretinoin.

Avoid in pregnant and breastfeeding women.

Avoid using suntan oils with concentrations of greater than 1 percent dong quai.

Avoid in people with a known allergy or sensitivity to dong quai, its parts, or members of the plant family that includes anise, caraway, carrot, celery, dill, and parsley.

Dong quai may cause abnormal heart rhythms, anorexia, asthma or difficulty breathing, bloating, burping, changes in menstrual flow, changes in sex drive, chills, diarrhea, dizziness, dry mouth, estrogen-like effects, excess breast growth in males, fever, headache, hot flushes, increased cancer risk, increased risk of miscarriage, irritability, kidney problems, loss of appetite, low energy, nausea, relaxant effects, sensitivity to sunlight, skin irritation (burning, pain, or rash), sleep difficulty, sweating, upset stomach, uterus stimulation, vision loss, vomiting, weakness, wheezing, and widened blood vessels.

Pregnancy and Breastfeeding

There is a lack of scientific evidence on the use of dong quai during pregnancy or breastfeeding. Avoid in pregnant or breastfeeding women.

Selected references

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  3. Haimov-Kochman R, Brzezinski A, and Hochner-Celnikier D. Herbal remedies for menopausal symptoms: are we cautious enough? Eur J Contracept.Reprod.Health Care 2008;13(2):133-137.
  4. Jalili J, Askeroglu U, Alleyne B, et al. Herbal products that may contribute to hypertension. Plast.Reconstr.Surg. 2013;131(1):168-173.
  5. Kan WL, Cho CH, Rudd JA, et al. Study of the anti-proliferative effects and synergy of phthalides from Angelica sinensis on colon cancer cells. J Ethnopharmacol. 10-30-2008;120(1):36-43.
  6. Kelley KW and Carroll DG. Evaluating the evidence for over-the-counter alternatives for relief of hot flashes in menopausal women. J.Am.Pharm.Assoc.(2003.) 2010;50(5):e106-e115.
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  8. Majewska I and Gendaszewska-Darmach E. Proangiogenic activity of plant extracts in accelerating wound healing - a new face of old phytomedicines. Acta Biochim.Pol. 2011;58(4):449-460.
  9. Mazaro-Costa R, Andersen ML, Hachul H, et al. Medicinal plants as alternative treatments for female sexual dysfunction: utopian vision or possible treatment in climacteric women? J.Sex Med. 2010;7(11):3695-3714.
  10. Mousa SA. Antithrombotic effects of naturally derived products on coagulation and platelet function. Methods Mol.Biol. 2010;663:229-240.
  11. Wang C, Wan Y, Luo X, et al. [Regulative mechanism of Chinese herbal medicine on cell signaling pathway in kidney]. Zhongguo Zhong.Yao Za Zhi. 2011;36(1):85-91.
  12. Wong VC, Lim CE, Luo X, et al. Current alternative and complementary therapies used in menopause. Gynecol.Endocrinol. 2009;25(3):166-174.
  13. Xu RS, Zong XH, and Li XG. [Controlled clinical trials of therapeutic effects of Chinese herbs promoting blood circulation and removing blood stasis on the treatment of reflex sympathetic dystrophy with type of stagnation of vital energy and blood stasis]. Zhongguo Gu.Shang 2009;22(12):920-922.
  14. Zhuang SR, Chiu HF, Chen SL, et al. Effects of a Chinese medical herbs complex on cellular immunity and toxicity-related conditions of breast cancer patients. Br.J.Nutr. 2012;107(5):712-718.
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This evidence-based monograph was prepared by The Natural Standard Research Collaboration

www.naturalstandard.com