Dong Quai Root (Angelica sinensis): A Comprehensive Reference
1. Identity and Botanical Classification
1.1 Botanical and Chemical Names
Dong quai, scientifically known as Angelica sinensis, is commonly written in simplified Chinese as 当归, traditional Chinese as 當歸, romanized in pinyin as dāngguī, and is also referred to colloquially as "female ginseng." Its accepted botanical names include Angelica sinensis and Angelica polymorpha, and it belongs to the plant family Umbelliferae (Apiaceae). Common names in various languages and traditions include Bai zhi, Chinese Angelica, Dang gui, Dong Quai, Tan kue, Tang kuei, and Tang kwei.
While botanically related, the various species of Angelica differ in chemistry, pharmacology, and toxicology and should not be confused. Three species of Angelica are monographed separately in the Pharmacopoeia of the People's Republic of China: dong quai is the root of A. sinensis; in Korea, A. gigas Nakai is used medicinally, while in Japan, A. acutiloba Kitagawa is used. Dong quai (Angelica sinensis) is closely related to A. archangelica, a common European garden herb and the flavoring in Benedictine and Chartreuse liqueurs.
1.2 Botanical Description and Cultivation
Dong quai (Angelica sinensis) is a perennial herb native to China. It is indigenous to China, Japan, and Korea. The carrot-like roots of this fragrant plant are harvested in the fall after about three years of cultivation and are stored in airtight containers before processing. Dong quai preparations usually include the plant's root, which contains the highest concentration of the bioactive compounds responsible for its therapeutic effects.
1.3 Common Forms and Preparations
Dong quai is normally taken orally as pills, tablets, decoctions, and tinctures. In both traditional Chinese medicine and Western herbology, dong quai is usually taken as a decoction (a type of tea) or tincture (an extract that is mixed with alcohol). In the West, it can be taken orally in capsule form or applied topically as an oil or cream. Danggui root can also be used as a "medicinal food" cooked with meat and taken as soup, or as a medicine, frequently combined with other herbs.
Different preparation methods alter the phytochemical profile of the final product. Decoctions are common and likely safe, but have less ligustilide and ferulic acid (anti-inflammatory and antioxidant compounds) and more phenolic acids (antioxidants). Products made from boiling, baking, or stir-frying the root with alcohol are considered likely safe; this process increases ferulic acid but decreases ligustilide. Products smoke-dried with sulfur should be avoided, as this process reduces some active compounds and increases heavy metals.
Dong quai is an official herb in the pharmacopeia of the People's Republic of China.
2. Traditional and Historical Use
2.1 Chinese Medicine: Origins and Earliest Records
Danggui (Chinese Angelica root; Dong Quai; Angelica sinensis (Oliv.) Diels) is a traditional Chinese herbal remedy with a long history of use in China, Korea, and Japan. Its root has been used for centuries as a spice, tonic, and medicine. Dong quai is mentioned in Shen Nong Ben Cao Jing, the second-century Chinese herbal treatise, as a treatment for gynecologic disorders. The history of dong quai dates back to the first century AD when it was described in Shennong Ben Cao Jing (the Classic of the Materia Medica), an ancient Chinese book on farming and medicinal plants, and was listed as one of the 50 fundamental herbs for treating various illnesses.
2.2 Traditional Classification and Uses in TCM
In traditional Chinese medicine, dong quai is classified as one of the "tonic herbs for blood deficiency" because of its potential to nourish the blood and promote healthy blood circulation. Traditionally, dong quai is said to be one of the most important herbs for strengthening the xue. The Chinese term xue is often translated as "blood," but it actually refers to a complex concept in traditional Chinese medicine, of which the Western notion of blood is only a part.
In TCM, it is recommended for anaemia, to promote blood circulation, relieve pain, and treat constipation, but is used mainly for the treatment of women's reproductive problems, such as dysmenorrhea, amenorrhoea, and to "enrich the blood" as an aid to recovery from blood loss after childbirth or surgery. Chinese herbalists have used Angelica for thousands of years to strengthen heart, lung, and liver meridians, as well as lubricate the bowel.
Dong quai is used most often in combination with other herbs to treat irregular menstruation, absence of menstruation, and menstrual cramps. It is also prescribed by Chinese herbalists to relieve symptoms of anemia, arthritis, and constipation. A. sinensis is most commonly administered as a multi-ingredient preparation (often combined with Astragalus membranaceus), making both attribution of effect and comparison of traditional Chinese medicine applications with Western medicine difficult.
2.3 Postpartum and Culinary Traditions
Dong quai is thought to nourish the blood in TCM and is included in recipes for post-partum nourishment, to be cooked with other herbs and food into a stew. It is often used as part of a postpartum herbal mixture in Asia and is used as a "women's herb" in Chinese medicine for symptoms associated with menstruation and menopause. It is also used in some postpartum mixtures as galactogogues in Taiwan.
2.4 Introduction to the West
In the late nineteenth century, an extract of dong quai known as Eumenol became popular in Europe as a "female tonic," which is how most people consider it in the West. Dong quai is widely promoted as a "woman's herb" and is sometimes referred to as "female ginseng" because Asian ginseng is used as a tonic for men. Even today it is still one of the herbs most commonly used by Traditional Chinese Medicine (TCM) practitioners in China, as well as Europe.
3. Key Constituents and Active Compounds
3.1 Primary Phytochemical Classes
Compounds in dong quai include alkyl phthalides (ligustilides, angelicide, and butylphthalide), furanocoumarins (archangelicin, bergapten, and imperatorin), coumarins (angelol G and angelicone), terpenes (cadinene and carvacrol), phytosterols (beta-sitosterol and stigmasterol), organic acids (ferulic, succinic, and myristic), and an immune-stimulating polysaccharide.
Significant amounts of vitamin A and carotenoids (0.675%), vitamin B12 (0.25–0.40 mcg/100 g), vitamin E, ascorbic acid, folinic acid, biotin, various phytosterols (e.g., beta-sitosterol), calcium, magnesium, and other essential macrominerals are also found in dong quai root.
The main chemical constituents of A. sinensis roots are ferulic acid, ligustilide, polysaccharides, saponins, flavonoids, amino acid, nicotinic acid, uracil, and adenine. Ferulic acid has various pharmacological activities and is used as a quality-control marker component of A. sinensis in the Chinese Pharmacopoeia.
3.2 Principal Bioactive Compounds
Ligustilide and ferulic acid are the main active compounds of dong quai. These two compounds are widely used to evaluate the quality of dong quai products. The enzymes that contribute the most to their breakdown in the body are CYP3A4, CYP1A2, CYP2C8, and CYP2C9.
3.2.1 Z-Ligustilide
Z-Ligustilide (3-butylidene-4,5-dihydrophthalide), a component of danggui, inhibits the spontaneous contraction of isolated rat uterus in a dose-dependent manner. Moreover, Z-Ligustilide may also inhibit prostaglandin F-2α, oxytocin, acetylcholine chloride, and potassium depolarization-induced uterine contraction, suggesting that ligustilide modulates the function of uterine tissue and has a non-specific anti-spasmodic effect. Z-Ligustilide has also been shown to enhance recovery of conjunctival capillary and venule diameter and increase the number of opened capillaries as well as blood flow, suggesting that Z-Ligustilide improves microcirculation.
3.2.2 Ferulic Acid
In rabbits on a high-lipid diet, treatment with ferulic acid, an active component of danggui, increases the generation of NO, thereby inhibiting platelet aggregation on endothelium and proliferation of smooth muscles and preventing leucocytes adhering to the endothelium. Ferulic acid has also been shown to attenuate oxidative stress by up-regulating glutathione (GSH), NADPH, Nrf2, NQO1, and HO-1, and reducing reactive oxygen species (ROS).
3.2.3 Polysaccharides
Angelica polysaccharide has strong hematopoietic biological activity, and can enhance immunity, promote anti-oxidation, exert anti-tumor effects, and protect the liver. Studies have shown that angelica polysaccharide can up-regulate expression of eNOS, NO, VEGF, and Akt and down-regulate expression of LDH at the gene level.
3.2.4 Coumarins and Furanocoumarins
The coumarin content in dong quai does not promote phototoxic, carcinogenic, or mutagenic effects, but exerts antispasmodic and vasodilatory effects. Furanocoumarins, such as bergapten and psoralen, have been widely studied for their photoactivated toxicity; however, only A. gigas (Korean angelica) has caused photodermatitis. The risk of phototoxicity should be correlated with the content of specific toxic furocoumarins; in the case of A. sinensis, the risk appears to be limited.
3.3 Primary Mechanisms of Action
The organic acids (ferulic acid), volatile oil (ligustilide, senkyunolide H, and butylidenephthalide), and polysaccharides in A. sinensis are the main chemical components that play a role in preventing cardiovascular and cerebrovascular diseases.
Pharmacological characteristics attributed to dong quai include anticoagulation and antiplatelet activity, as well as hematopoiesis and immune modulation.
Although it was originally thought that some of the chemicals in dong quai could copy the effects of estrogen in the body, this does not seem to be the case. Instead, these chemicals may mimic the effects of certain brain chemicals, such as serotonin. Results from studies evaluating dong quai's estrogenic effects have been conflicting, possibly due to differences in the preparations studied, and there is some data to suggest serotonergic activity.
4. Scientific Evidence by Area of Use
4.1 Menopausal Symptoms and Vasomotor Complaints
4.1.1 Evidence Overview
Dong quai is widely used in the United States to treat hot flashes and other symptoms of menopause, despite a lack of clinical data. Scientific studies evaluating dong quai for menopause have yielded mixed and generally inconclusive results. Systematic reviews and randomized controlled trials typically find little to no evidence that dong quai alone is effective in significantly reducing menopausal symptoms compared to placebo. Some studies have explored dong quai in combination with other herbs, but the effects are difficult to attribute to dong quai specifically.
4.1.2 The Hirata et al. (1997) Randomized Trial — Postmenopausal Women
The most frequently cited randomized trial of dong quai as a monotherapy for menopausal symptoms is the 1997 study by Hirata and colleagues. The objective was to evaluate possible estrogenic effects of dong quai on vaginal cells and on endometrial thickness in postmenopausal women. The design was a double-blind, randomized, placebo-controlled clinical trial, conducted at the Department of Obstetrics and Gynecology in a large health maintenance organization. Seventy-one postmenopausal women (mean age 52.4 ± 6 years) who had follicle-stimulating hormone levels of >30 mIU/mL with hot flashes were enrolled, and subjects were randomized to treatment with either dong quai or placebo for 24 weeks. Dong quai used alone did not produce significant estrogenic effects on endometrial thickness or vaginal maturation and was not significantly more effective than placebo for menopausal symptoms. Combination herbal formulas may be more effective.
4.1.3 Hot Flashes in Men on Androgen Deprivation Therapy
A randomized double-blind placebo-controlled trial was conducted to determine whether dong quai has a therapeutic benefit in treating hot flashes among prostate cancer patients receiving androgen deprivation therapy. The trial involved 22 men receiving luteinizing hormone-releasing hormone agonist therapy for prostate cancer with bothersome hot flashes. After recording a baseline log of the frequency, duration, and severity of daily hot flashes, patients were randomly assigned in a 1:1 ratio to receive daily placebo or dong quai for three months. Adverse effects related to the use of dong quai appeared to be very rare in this study.
4.1.4 Evidence Strength — Menopause
The overall evidence for dong quai as a standalone treatment for menopausal symptoms is weak. Preclinical studies have shown dong quai extracts have anti-inflammatory, estrogenic, anticancer, and neuroprotective effects. However, clinical evidence is limited and it can interact with drugs or cause side effects like headaches. More research is still needed to validate its therapeutic potential and safety. Products are used for menopause symptoms, menstrual cramps, and premenstrual syndrome (PMS), although their benefits are not well defined.
4.2 Dysmenorrhea and Menstrual Disorders
Dong quai has been used extensively for the treatment of gynecological disorders for thousands of years in traditional Chinese, Korean, and Japanese medicine, including dysmenorrhea, pelvic pain, and recovery from childbirth. Dong quai is extensively used in traditional healing for menstrual regulation and dysmenorrhea. Scientific investigation supports pharmacologically active constituents, but clinical trial evidence remains limited for standalone use.
The antispasmodic action of Z-ligustilide on uterine tissue is the most plausible preclinical mechanism for its traditional use in dysmenorrhea. Z-Ligustilide inhibits the spontaneous contraction of isolated rat uterus in a dose-dependent manner, and may also inhibit prostaglandin F-2α, oxytocin, acetylcholine chloride, and potassium depolarization-induced uterine contraction, suggesting that ligustilide modulates the function of uterine tissue and has a non-specific anti-spasmodic effect. These findings remain preclinical; robust human clinical trials specifically for dysmenorrhea using dong quai as a single agent are lacking.
4.3 Hematopoiesis and Blood-Related Effects
In vitro and in vivo studies have elucidated various pharmacological activities of A. sinensis, including stimulating the secretion of erythropoietin, preventing cardiovascular diseases, and having antioxidative and immune modulation activities. Ferulic acid, ligustilide, and eugenol in Angelica sinensis activate blood circulation, though the material basis of their blood-tonic effects needs to be further investigated.
A systematic review determined benefits of dong quai against amenorrhea induced by antipsychotic drugs. The polysaccharide fraction in particular has attracted considerable research interest in the hematopoiesis context. Dong quai extracts demonstrated antitumor, pro-apoptotic, anti-metastatic, anti-tuberculosis (TB), neuroprotective, and hematopoietic effects in vitro. In animal models, polysaccharides extracted from dong quai root showed protective effects against cyclophosphamide-induced toxicity, doxorubicin-induced cardiotoxicity, and radiation-induced pneumonitis. These findings are preclinical in nature and have not been confirmed in large human trials.
4.4 Cardiovascular and Cerebrovascular Effects
Research shows that A. sinensis and its polysaccharides can be used to reduce and prevent myocardial infarction (MI) and myocardial fibrosis, mainly by down-regulating miR-22 expression in hypoxia-treated H9c2 cells, reducing attenuated hypoxia-induced H9c2 cell injury, enhancing antioxidant capacity in vivo, reducing the expression level of pro-inflammatory factors, and regulating the expression of the AMPK-PGC1α pathway and the expression levels of Bcl-2 and Bax. These findings are from animal and cell studies.
Formulas containing dong quai have improved clinical outcomes in patients with acute coronary syndrome and mild-to-moderate renal insufficiency, and prevented radiation-induced dermatitis in breast cancer patients. However, these outcomes pertain to multi-herb formulas, and the attribution of effect specifically to dong quai is uncertain. In vitro and in vivo animal experiments suggest that A. sinensis possesses angiogenic activity. Experiments on human periodontal and bone tissue have been conducted. The clinical relevance of these findings has yet to be confirmed.
4.5 Renal Protection
Based on their anti-oxidative and anti-fibrotic properties, Angelica sinensis (Oliv.) Diels roots (Danggui) are studied as potential renoprotective Chinese herbal medicines. A 2023 longitudinal cohort study retrospectively analyzed national health insurance claims data from 2001–2017 examining dose- and time-dependent renoprotection, though this study was observational in design and the use was as part of multi-herb formulas, limiting causal attribution to dong quai alone.
4.6 Anti-Inflammatory Effects
Investigation of the anti-inflammatory activity of Angelica sinensis extract through cytokine modulation has been conducted, at various concentrations of A. sinensis extract. Preclinical data support anti-inflammatory properties, particularly for ferulic acid; translation to confirmed human clinical benefit remains unestablished.
4.7 Antitumor and Oncological Areas
Dong quai extracts have demonstrated antitumor, pro-apoptotic, anti-metastatic, and anti-tuberculosis effects in vitro. These findings are based on laboratory cell models. Angelica sinensis has been shown to contain antioxidants, inhibit the growth of cancer cells in vitro, and stimulate immune function in experimental animals. Human clinical evidence for any oncological benefit directly attributable to dong quai does not currently exist at a level that supports definitive conclusions.
4.8 Exercise Performance and Anti-Fatigue
Animal research has explored the potential of A. sinensis to improve exercise performance. Danggui Buxue Tang (DBT), a Chinese herbal decoction that is a simple combination of two herbs, A. sinensis and Astragalus membranaceus, can ameliorate exercise-induced oxidative stress by modulating numerous immune pathways. These findings are from animal studies; human clinical evidence in this area is absent.
5. Body Systems and Health Areas of Association
Based on the combined traditional and preclinical/clinical literature, dong quai has been studied or used in association with the following body systems and health areas:
- Female reproductive system: Including dysmenorrhea, pelvic pain, recovery from childbirth, and menopausal symptoms such as hot flashes.
- Hematological system: Including anticoagulation and antiplatelet activity, as well as hematopoiesis.
- Cardiovascular and circulatory system: Its active compounds, including ferulic acid and ligustilide, may support vascular health including circulation, platelet activity, and blood pressure.
- Gastrointestinal system: It is recommended to treat constipation and promote bowel regularity in TCM practice.
- Immune system: Angelica polysaccharide has strong hematopoietic biological activity and can enhance immunity.
- Neurological system: Dong quai extracts have demonstrated neuroprotective effects in vitro.
- Renal system: Based on its anti-oxidative and anti-fibrotic properties, A. sinensis is under investigation as a potential renoprotective agent.
6. Dosage Forms and Reported Doses
6.1 Forms Available
Dong quai is an herb used in traditional Chinese medicine to treat menstrual cramps and menopausal symptoms; it can be taken in supplemental form as a pill or liquid extract. Dietary supplements and teas that contain dong quai are made from the roots of the plant.
6.2 Doses Reported in Studies and Monographs
The therapeutic dose is uncertain, with studies in the gynecologic literature using varying dosages from 75 mg to 1 g. Several forms of the plant exist and dosages vary widely: crude root extract by decoction ranges from 3 to 15 g/day; while in combination, preparations of 75 mg to 500 mg may be taken up to 6 times a day.
The European Medicines Agency's assessment report on Angelica sinensis (Oliv.) Diels, radix, evaluated the Hirata et al. (1997) randomized trial, which enrolled postmenopausal women with vasomotor symptoms. There are no available dose-response data in humans. There is no pharmacokinetic data from humans.
A. sinensis is most commonly administered as a multi-ingredient preparation, often combined with Astragalus membranaceus. The preparation-dependent variation in active constituent content — particularly the ratio of ferulic acid to ligustilide — means that dose equivalencies across different product forms cannot be assumed.
7. Safety Considerations and Drug Interactions
7.1 General Tolerability
Dong quai (Angelica sinensis) root contains a number of chemicals, including ligustilide, ferulic acid, and angelicide. Dong quai has no generally recognized lactation-related uses, although some midwives in the United States reportedly have used it for postpartum blues or depression. Although it is usually well tolerated in general use, it may increase the risk of bleeding in patients taking warfarin and antiplatelet drugs and cause photosensitivity reactions.
7.2 Reported Adverse Effects
Reported adverse events include bloating, loss of appetite, diarrhea, photosensitivity, and gynecomastia. Common side effects include nausea and an upset stomach.
Case reports exist of fever, gynecomastia, and bleeding with concurrent warfarin use. A risk of photosensitization exists. In the case of A. sinensis specifically, the risk of phototoxicity from its furocoumarins appears to be limited, in contrast to A. gigas, which has caused photodermatitis.
7.3 Warfarin and Anticoagulant Interactions
Dong quai can potentiate the effects of anticoagulants because of its coumarin content. A classic case report describes potentiation of warfarin after concurrent dong quai use, with elevated coagulation measures and improvement after stopping the herb, published as PubMed PMID: 10417036. Warfarin: dong quai may enhance the anticoagulant effect of warfarin; therapy should be monitored.
As one component of dong quai includes furanocoumarins, the potential exists for potentiation of bleeding complications for those patients receiving concomitant anticoagulant therapy.
7.4 Photosensitivity Interactions
Dong quai may increase the photosensitizing effect of photosensitizing medications. Clinical-style herb references list photosensitivity/photodermatitis as a potential adverse effect, and people with high sun exposure or photosensitizing medications should be cautious.
7.5 Antiplatelet Effects
Observations in patients with significantly activated platelets found that Angelica sinensis injection can significantly inhibit platelet activation, relieve vascular endothelial cell injury, and improve microcirculation. This antiplatelet mechanism, mediated in part by ferulic acid, means that concurrent use with antiplatelet drugs (e.g., aspirin, clopidogrel) warrants attention. Nabumetone and dong quai both increase anticoagulation, requiring caution and monitoring.
7.6 Use in Pregnancy and Lactation
Uterine stimulant and relaxant activity have been reported with A. sinensis, while a related species, Angelica archangelica L., was a reported abortifacient and affected the menstrual cycle. LactMed notes that dong quai has no generally recognized lactation-related uses and is best avoided during breastfeeding, also highlighting bleeding risk and photosensitivity concerns.
7.7 Potential Estrogenic Considerations in Hormone-Sensitive Conditions
It had been believed that many of dong quai's effects were related to a phytoestrogenic effect; however, this assumption is now questioned. Animal studies have failed to identify any estrogenic activity. Dong quai alone may have had a weaker activity and even blocked estrogen effects in one study. This may be due to the different composition of the extracts, since those with the highest ferulic acid or lowest ligustilide content were more active. The clinical implications for individuals with hormone-sensitive conditions remain unclear.
7.8 Quality and Contamination Concerns
Some dong quai products may be contaminated, adulterated, or low-potency. Smoke drying of the roots differs from the method used in Europe, where underground plant organs are usually washed with water before drying, for removing microbiological and mineral pollution. The variance in preparation method substantially alters active constituent content, making standardization across commercial products a persistent challenge.
References
Go back