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• Dang Kwai; Dong Kwai; Dang Quai; Tang Quai
Principal Proposed Uses
• Dysmenorrhea; Menstrual Disorders in General; Premenstrual Syndrome (PMS)
Probably Ineffective Uses
• Menopausal Symptoms
One of the major herbs used in traditional Chinese herbal medicine, Angelica sinensis is closely related to European Angelica archangelica, a common garden herb and the flavoring in Benedictine and Chartreuse liqueurs. The carrot-like roots of this fragrant plant are harvested in the fall after about 3 years of cultivation and stored in airtight containers prior to processing.
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 the late 1800s, an extract of dong quai known as Eumenol became popular in Europe as a "female tonic," and this is how most people consider it in the West.
What Is Dong Quai Used for Today?
Dong quai is often recommended as a treatment for menstrual cramps, premenstrual syndrome (PMS), and other problems related to menstruation, as well as hot flashes and other menopausal symptoms. However, the scientific evidence supporting these uses is very weak, consisting primarily of test tube and animal studies, as well as a few open studies of people.1-5 Only double-blind, placebo-controlled studies can actually show a treatment effective, and a 24-week study that compared the effects of dong quai against a placebo in 71 postmenopausal women found no benefit.6 (For more information on why double-blind studies are so important, see Why Does This Database Rely on Double-blind Studies?)
We recommend using dong quai under the supervision of an herbalist qualified in traditional Chinese herbal medicine, not because the herb is dangerous, but because it is difficult to self-prescribe Chinese herbal formulas.
If you wish to self-treat with dong quai, a typical dosage is 10 to 40 drops of dong quai tincture 1 to 3 times daily, or 1 standard size 00 gelatin capsule, 3 times daily.
Dong quai is generally believed to be nontoxic. According to Chinese studies, which may not have been up to current scientific standards, very large amounts have been given to rats without causing harm.7 Side effects are rare and primarily consist of mild gastrointestinal distress and occasional allergic reactions (such as rash).
Contrary to popular belief, dong quai does not appear to have estrogen-like actions.8,9 However, according to an article in the Singapore Medical Journal, a 35-year-old man who used a prepared herbal formula called Dong Quai pills developed enlargement of his breasts.10 Such enlargement would typically result if a man used estrogen. The authors of the article blamed the dong quai itself. However, a more likely explanation is that the prepared herbal formula was "spiked" with synthetic estrogen. There are numerous reports of prepackaged Asian herb products containing unlabeled constituents, including conventional medications designed to enhance their effect.11,12
Interestingly, in a test-tube study, dong quai was again found to be nonestrogenic, and yet it nonetheless stimulated the growth of breast cancer cells.15 Although the mechanism of this effect is not known, the results suggest that women who have had breast cancer should avoid using dong quai.
Dong quai may interact with the blood-thinning drug warfarin (Coumadin), increasing the risk of bleeding, according to one case report.13 Dong quai might also conceivably interact with other blood-thinning drugs, such as heparin, aspirin, clopidogrel (Plavix), ticlopidine (Ticlid), or pentoxifylline (Trental).
Certain constituents of dong quai can cause photosensitivity (increased sensitivity to the sun), but this has not been observed to occur in people using the whole herb.
Safety in young children, pregnant or nursing women, or those with severe liver or kidney disease has not been established. One case report suggests that dong quai usage by a nursing mother caused elevated blood pressure in both the mother and child.14
Interactions You Should Know About
If you are taking blood-thinning drugs, such as warfarin (Coumadin) , heparin, clopidogrel (Plavix), ticlopidine (Ticlid), pentoxifylline (Trental), or aspirin, dong quai might interact and increase the risk of bleeding.
References [ + ]
1. Chang HM, But PP, eds. Pharmacology and Applications of Chinese Materia Medica. Vol 1. Singapore: World Scientific; 1986.
2. Igarashi M. Efficacy of Kampo medicines in obstetrical and gynecological diseases. In: Satellite Meeting on Kampo (Japanese Herbal) Medicines (1987: Aukland, N.Z.). Recent Advances in the Pharmacology of Kampo (Japanese Herbal) Medicines: Proceedings of the Satellite Meeting on Kampo (Japanese Herbal) Medicines of the 10th International Congress of Pharmacology, Auckland, New Zealand, Aug. 19-21, 1987. New York, NY: Excerpta Medica; 1987:141-143.
3. Bensky D, Gamble A, Kaptchuk TJ. Chinese Herbal Medicine: Materia Medica. Seattle, WA: Eastland Press; 1986.
4. Hsu HY. Oriental Materia Medica: A Concise Guide. Long Beach, CA: Oriental Healing Arts Institute; 1986:540-542
5. Zhu DP. Dong quai. Am J Chin Med. 1987;15:117-125.
6. Hirata JD, Swiersz LM, Zell B, et al. Does dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled trial. Fertil Steril. 1997;68:981-986.
7. Zhu DP. Dong quai. Am J Chin Med. 1987;15:117-125.
8. Zava DT, Dollbaum CM, Blen M. Estrogen and progestin bioactivity of foods, herbs, and spices. Proc Soc Exp Biol Med. 1998;217:369-378.
9. Hirata JD, Swiersz LM, Zell B, et al. Does dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo controlled trial. Fertil Steril. 1997;68:981-986.
10. Goh SY, Loh KC. Gynaecomastia and the herbal tonic "Dong Quai." Singapore Med J. 2001;42:115-116.
11. Nortier JL, Martinez MC, Schmeiser HH, et al. Urothelial carcinoma associated with the use of a Chinese herb (Aristolochia fangchi). N Engl J Med. 2000;342:1686-1692.
13. Page RL II, Lawrence JD. Potentiation of warfarin by dong quai. Pharmacotherapy. 1999;19:870-876.
14. Nambiar S, Schwartz RH, Constantino A. Hypertension in mother and baby linked to ingestion of Chinese herbal medicine [letter]. West J Med. 1999;171:152.
15. Amato P, Christophe S, Mellon P. Estrogenic activity of herbs commonly used as remedies for menopausal symptoms. Menopause. 2002;9:145-150.
Last reviewed December 2015 by EBSCO CAM Review Board
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