Herbal Monograph
Dong Quai
Angelica sinensis (Oliv.) Diels
Apiaceae (Umbelliferae)
Premier blood tonic and emmenagogue for menstrual disorders and blood deficiency
Overview
Plant Description
Perennial herb, 40-100 cm tall, with a stout, aromatic taproot that is thick, fleshy, cylindrical, branching into 3-5 or more lateral rootlets from the main body. Root exterior is yellowish-brown to dark brown with transverse lenticels; interior is yellowish-white with a strongly aromatic, sweet, warm, slightly acrid odor and taste. Stem erect, purplish, glabrous, hollow, with prominent longitudinal ridges. Leaves are 2-3-pinnately compound, broadly triangular in outline, 15-30 cm long; basal leaves are long-petioled; cauline leaves are smaller with sheathing bases. Leaflets are ovate to lanceolate, 2-4 cm long, with serrate to incised margins. Inflorescence is a compound umbel, 4-7 cm in diameter, with 9-30 rays; involucral bracts 1-2, linear. Flowers are small, white to greenish-white, with 5 petals. Fruit is an elliptical, dorsally compressed schizocarp (mericarp), 4-7 mm long, with prominent lateral wings and 3 dorsal ribs containing oil canals (vittae). The entire plant has a strong, characteristic celery-like aromatic scent.
Habitat
Native to cool, moist, high-altitude environments. Grows naturally in mountain meadows and forest margins at elevations of 2,500-3,000 meters in temperate zones. Prefers cool temperatures (annual mean 4-8C), high humidity, and well-drained but moisture-retentive soils rich in humus. Requires partial shade, particularly protection from intense afternoon sun. Does not tolerate waterlogged soil or extreme heat.
Distribution
Endemic to China, with primary production centered in Gansu Province (Min County is the traditional center of production and source of the highest-grade Dang Gui, known as 'Min Gui'). Also cultivated in Sichuan, Yunnan, Hubei, and Shaanxi provinces. Smaller-scale cultivation has been established in Japan (as a substitute for A. acutiloba), Korea, and experimental plantings in Europe and North America. Wild populations are increasingly rare due to over-harvesting; virtually all commercial supply comes from cultivation.
Parts Used
Root (Angelicae sinensis Radix / Dang Gui)
Preferred: Dried root for decoction (traditional TCM); dried root for tincture; powdered root in capsules; dried root slices for formula preparation
The whole root is the primary medicinal part. In TCM, different root sections are traditionally distinguished for their therapeutic emphasis: gui tou (root head/crown) — said to stop bleeding and tonify blood upward; gui shen (root body) — the main tonifying and nourishing part, used to supplement and harmonize blood; gui wei (root tail/rootlets) — said to invigorate blood circulation and break stasis, with stronger blood-moving action; quan gui (whole root) — combines all actions, most commonly used in Western practice. The WHO monograph specifies the dried root as the official drug. The Chinese Pharmacopoeia requires minimum 0.050% ligustilide and 0.020% ferulic acid content.
Key Constituents
Phthalides
The phthalide fraction — particularly Z-ligustilide — is considered the principal pharmacologically active group responsible for the antispasmodic, analgesic, and circulatory effects of Dang Gui. Phthalides relax smooth muscle via inhibition of intracellular calcium mobilization and modulation of calcium channels. They are concentrated in the volatile oil fraction and are best preserved in tincture preparations or short decoctions. Prolonged boiling significantly reduces phthalide content.
Phenolic acids and derivatives
Ferulic acid is the most clinically relevant phenolic compound. Its antiplatelet and antioxidant effects contribute to the cardiovascular and blood-activating actions attributed to Dang Gui in TCM. Ferulic acid is water-soluble and is well extracted in decoctions, complementing the volatile phthalides that are better extracted in alcoholic preparations. The dual presence of phthalides and ferulic acid means that aqueous and alcoholic preparations have different pharmacological profiles.
Polysaccharides (Angelica sinensis polysaccharides — ASP)
ASP is considered the primary constituent responsible for the 'blood-tonifying' (bu xue) action of Dang Gui in TCM — specifically the stimulation of hematopoiesis and red blood cell production. Polysaccharides are water-soluble and are well extracted in decoctions but not in alcoholic tinctures. This may partly explain the traditional preference for decoction as the primary preparation method in TCM. The immunomodulatory effects (enhancing both innate and adaptive immunity) provide a pharmacological basis for the traditional use in immune support.
Coumarins
The coumarin fraction contributes to the anticoagulant and vasodilatory effects of Dang Gui. Furanocoumarins (bergapten, xanthotoxin) are present at low concentrations but are responsible for the photosensitivity risk, which is the basis for the caution regarding sun exposure. The coumarin content is lower than in A. archangelica (European Angelica) but still clinically relevant, particularly in the context of drug interactions with anticoagulants.
Volatile oil (essential oil)
The volatile oil (yield approximately 0.4-0.8% from dried root) is dominated by Z-ligustilide and other phthalides. It is responsible for the characteristic aroma and contributes significantly to the antispasmodic and analgesic effects. Volatile oil content is highest in fresh and recently dried root and decreases with storage and prolonged high-temperature extraction. Short decoction times (under 20 minutes) and covered preparation preserve volatile oil better.
Other constituents
Minor constituents contributing to overall nutritional and pharmacological profile. Not considered primary drivers of therapeutic activity.
Herbal Actions
Stimulates or increases menstrual flow
Dang Gui is one of the most important emmenagogue herbs in both TCM and Western herbalism. Promotes menstrual flow and regulates the menstrual cycle. The mechanism involves both uterine smooth muscle stimulation (at certain doses) and improved pelvic blood flow. In TCM, this action is described as 'nourishing blood and regulating menstruation' (yang xue tiao jing). The phthalide fraction (particularly butylidenephthalide) stimulates uterine contraction at low doses while relaxing the uterus at higher doses — a biphasic dose-response. Commission E recognizes the use of A. sinensis root for dysmenorrhea. WHO Monographs Vol 4 lists menstrual disorders as a supported indication.
[1, 2, 3, 4]The foundational action of Dang Gui in TCM — it is the premier 'blood tonic' (bu xue yao) in the Chinese materia medica. 'Blood tonification' in TCM refers to a cluster of effects including stimulating hematopoiesis, improving red blood cell parameters, and alleviating symptoms of blood deficiency (pallor, dizziness, dry skin, scanty menses, palpitations). The hematopoietic-stimulating effects are primarily attributed to the polysaccharide fraction (ASP), which has been shown to stimulate proliferation and differentiation of hematopoietic progenitor cells in vitro and in vivo. Ferulic acid contributes by improving red blood cell deformability and microcirculation.
[1, 3, 5]Relieves smooth muscle spasm
Potent smooth muscle antispasmodic, active on uterine, intestinal, vascular, and bronchial smooth muscle. The antispasmodic activity is primarily mediated by Z-ligustilide and Z-butylidenephthalide, which inhibit intracellular calcium mobilization and block calcium channel-mediated smooth muscle contraction. Demonstrated in isolated tissue preparations (rat uterus, guinea pig ileum, rabbit aorta). This action provides the pharmacological basis for the traditional use in menstrual cramps (dysmenorrhea) and abdominal pain. Higher doses tend to relax, while very low doses may initially stimulate — a biphasic response documented in isolated uterine tissue.
[1, 2, 3]Reduces inflammation
Multiple constituents contribute to anti-inflammatory activity: ferulic acid inhibits prostaglandin synthesis and NF-kB signaling; ligustilide reduces pro-inflammatory cytokine production (TNF-alpha, IL-1beta, IL-6); polysaccharides modulate macrophage activation. In vivo studies demonstrate reduced edema and inflammatory markers in carrageenan-induced paw edema and adjuvant arthritis models. The anti-inflammatory action supports the traditional use in pain conditions, gynecological inflammation, and traumatic injuries.
[1, 3]Relieves pain
Analgesic activity demonstrated in multiple pain models including acetic acid-induced writhing and hot-plate tests. Mechanism involves both peripheral (anti-inflammatory, antispasmodic) and possible central components. Clinically, the analgesic action is most relevant in the context of menstrual pain (dysmenorrhea) and musculoskeletal pain where it is used in combination formulas. Ligustilide is considered the primary analgesic constituent.
[1, 3]Angelica sinensis polysaccharides (ASP) enhance phagocytic activity of macrophages, stimulate lymphocyte proliferation, modulate cytokine production (increasing IL-2, IFN-gamma while regulating TNF-alpha), and promote hematopoiesis including white blood cell recovery. These effects are demonstrated in vitro and in animal models. The immunomodulatory action is considered bidirectional — stimulating depressed immune function while modulating overactive responses — though clinical evidence in humans remains preliminary.
[1, 3]A gentle laxative effect is attributed to the polysaccharide fraction, which increases intestinal moisture and promotes peristalsis. In TCM, Dang Gui is specifically used for constipation associated with blood deficiency (dry, hard stools in debilitated patients, postpartum constipation, constipation in the elderly). This is a supporting rather than primary action.
[2, 5]Ferulic acid inhibits platelet aggregation by reducing thromboxane A2 synthesis and enhancing prostacyclin production. Additional anticoagulant contribution from the coumarin fraction (osthole). These effects provide pharmacological support for the traditional claim of 'activating blood circulation' (huo xue) in TCM and underlie the important drug interaction caution with anticoagulant medications.
[1, 3, 4]Therapeutic Indications
Reproductive System
Dysmenorrhea (painful menstruation)
One of the most thoroughly documented indications for Dang Gui across all traditions. Used in TCM for centuries as the primary herb in formulas for menstrual pain. WHO Monographs Vol 4 lists treatment of menstrual disorders including dysmenorrhea. The antispasmodic action (via phthalides relaxing uterine smooth muscle) and analgesic effects provide clear pharmacological rationale. Zhu et al. (2008) Cochrane review of Chinese herbal medicine for primary dysmenorrhea found some evidence of benefit from Dang Gui-containing formulas, though quality of individual trials was variable. Note: Dang Gui is traditionally used in COMBINATION formulas for dysmenorrhea, not as a single herb. The classical formula Si Wu Tang (Four Substance Decoction) is the archetypal prescription.
[1, 2, 5, 9]Amenorrhea and oligomenorrhea
Traditional use for absent or scanty menstruation, particularly when attributed to blood deficiency or cold stagnation in TCM. Emmenagogue action promotes menstrual flow. Used in formulas such as Si Wu Tang and Dang Gui Bu Xue Tang. Clinical evidence is from traditional sources and case series; no RCTs specifically for amenorrhea as an isolated indication.
[2, 3, 5]Menopausal symptoms
Widely marketed for menopausal hot flashes, but the clinical evidence as a single agent is negative. Hirata et al. (1997) conducted a double-blind, placebo-controlled RCT of Dong Quai as a single agent for menopausal hot flashes in 71 postmenopausal women and found no significant benefit over placebo for hot flash frequency, endometrial thickness, or vaginal maturation index. However, Dang Gui is traditionally used in COMBINATION with other herbs for menopausal symptoms in TCM (e.g., in modified formulas based on Xiao Yao San or Er Xian Tang), and the negative result for the single herb does not necessarily negate the traditional formula-based approach. The distinction between single-herb and formula use is critical here.
[2, 3, 8]Postpartum recovery and blood deficiency
Traditional TCM use for postpartum blood deficiency, insufficient lactation, and postpartum abdominal pain. Dang Gui is a key ingredient in postpartum recovery formulas (Sheng Hua Tang — Generation and Transformation Decoction). Used to tonify blood, promote uterine involution, and relieve postpartum pain. NOTE: This is a POSTPARTUM use — Dang Gui is contraindicated DURING pregnancy.
[1, 5]Cardiovascular System
Anemia and blood deficiency support
The hematopoietic-stimulating activity of Angelica sinensis polysaccharides (ASP) has been demonstrated in multiple in vivo studies showing increased red blood cell count, hemoglobin, and hematocrit in animal models of blood-deficiency anemia. In vitro, ASP stimulates proliferation and differentiation of hematopoietic stem/progenitor cells. Traditional TCM indication as the premier blood tonic. Clinical evidence in humans is largely from Chinese clinical trials of variable quality; rigorous Western RCTs for anemia as a primary outcome are lacking.
[1, 3, 5]Peripheral circulatory insufficiency
Traditional use for cold extremities, Raynaud's-like symptoms, and poor peripheral circulation. Ferulic acid improves red blood cell deformability and microcirculation; phthalides cause vasodilation. Used in TCM formulas for 'blood stasis' (xue yu) conditions affecting the extremities. Pharmacological rationale is sound; clinical evidence is from traditional reports.
[2, 3]Antiplatelet and cardiovascular protection
Ferulic acid and sodium ferulate demonstrate antiplatelet aggregation and cardioprotective effects in vitro and in animal models. Sodium ferulate is an approved injectable drug in China for cardiovascular conditions. However, oral Dang Gui extract has not been evaluated in rigorous Western RCTs for cardiovascular outcomes. The antiplatelet effect is clinically relevant primarily as a safety concern (interaction with anticoagulant drugs) rather than as a confirmed therapeutic indication in Western evidence-based medicine.
[1, 3]Musculoskeletal System
Musculoskeletal pain and traumatic injuries
Used in TCM formulas for pain from traumatic injuries, arthralgia, and bi syndrome (pain, numbness, and heaviness in the limbs attributed to wind-cold-damp invasion). The analgesic (ligustilide), anti-inflammatory (ferulic acid), and blood-activating actions provide pharmacological rationale. Dang Gui is a common ingredient in trauma recovery formulas (Die Da Yao — hit-fall medicine). Clinical evidence is from traditional Chinese clinical practice.
[1, 5]Rheumatic and arthritic conditions
Traditional use in TCM for bi syndrome (joint pain with blood deficiency component). Used in formulas such as Dang Gui Nian Tong Tang. Anti-inflammatory activity provides pharmacological support. Not used as a primary anti-rheumatic herb in Western herbalism.
[3, 5]gastrointestinal
Constipation associated with blood deficiency or dryness
Traditional TCM use for dry, hard stools in debilitated, blood-deficient, or elderly patients. The polysaccharide fraction provides gentle bulk laxative and stool-moistening effects. Dang Gui is specifically indicated for constipation in the elderly, postpartum, and post-surgical settings where straining should be avoided. Used in the formula Run Chang Wan (Moisten the Intestines Pill). Not used as a primary laxative herb.
[2, 5]lymphatic-immune
Immunomodulation and hematopoietic support
Angelica sinensis polysaccharides (ASP) demonstrate immunomodulatory effects in vitro and in animal models: enhanced macrophage phagocytosis, lymphocyte proliferation, cytokine modulation, and promotion of hematopoietic recovery after chemotherapy or radiation-induced myelosuppression (animal data). Some Chinese clinical studies report improved white blood cell recovery in cancer patients receiving chemotherapy when supplemented with Dang Gui preparations, but these studies lack the rigor of Western RCTs. The immunomodulatory indication remains preliminary by Western evidence standards.
[1, 3]Skin / Integumentary
Dry skin and poor complexion associated with blood deficiency
Traditional TCM use for dry, dull, sallow skin attributed to blood deficiency. Improved skin hydration and complexion are expected secondary benefits of blood tonification. Used internally (not topically) for this indication. Clinical evidence is from traditional observation.
[5]Energetics
Temperature
warm
Moisture
moist
Taste
Tissue States
cold/depression, dry/atrophy, wind/tension
In Western energetic assessment, Dang Gui is warming and moistening — indicated for cold, dry, deficient tissue states characterized by poor circulation, blood deficiency, and tissue atrophy. The sweetness reflects its nourishing, blood-building quality (a 'trophorestorative' for blood); the acrid/pungent taste indicates its circulatory-stimulating and dispersing qualities; the mild bitterness reflects gentle digestive support. In TCM five-phase energetics: flavor is sweet and acrid (xin), nature is warm (wen), and it enters the Heart, Liver, and Spleen channels. Dang Gui is specifically indicated for blood deficiency (xue xu) tissue state — presenting as pallor, dry skin, dizziness, thin/scanty menstruation, and a thin, pale tongue. Hoffmann describes it as warm, sweet, and mildly pungent with blood-nourishing and circulatory-stimulating properties.
Traditional Uses
Traditional Chinese Medicine (TCM)
- Bu Xue (tonify/supplement blood): Premier blood tonic for blood deficiency syndrome (xue xu zheng) — pallor, dizziness, palpitations, dry skin, scanty menstruation, thin pale tongue
- Tiao Jing (regulate menstruation): Used in virtually all gynecological formulas for menstrual irregularity, dysmenorrhea, amenorrhea
- Huo Xue (invigorate blood): Moves blood stasis, resolves abdominal masses and blood stasis pain; especially the gui wei (root tail) section
- Run Chang (moisten intestines): Gentle laxative for constipation in blood-deficient, elderly, or postpartum patients
- Zhi Tong (stop pain): Analgesic for traumatic injuries, headache, abdominal pain, arthralgic pain
- Si Wu Tang (Four Substance Decoction): The foundational blood-tonifying formula — Dang Gui + Shu Di Huang + Bai Shao + Chuan Xiong. Used for blood deficiency with stasis.
- Dang Gui Bu Xue Tang (Dang Gui Decoction to Tonify Blood): Dang Gui + Huang Qi (Astragalus) in a 1:5 ratio. A deceptively simple two-herb formula that is one of the most important blood-tonifying prescriptions. Used for severe blood and qi deficiency with fever.
- Xiao Yao San (Free and Easy Wanderer): Harmonizing formula for liver qi stagnation with blood deficiency — irritability, menstrual irregularity, breast distension, alternating hot and cold
- Sheng Hua Tang (Generation and Transformation Decoction): Postpartum formula for promoting uterine involution, expelling lochia, and relieving postpartum abdominal pain
- Dang Gui Nian Tong Tang: Formula for wind-damp bi syndrome with blood deficiency
"Bensky et al. (2004): 'Dang Gui is sweet, acrid, and warm. It enters the Liver, Heart, and Spleen channels. Its primary functions are to tonify the blood, invigorate the blood, regulate menstruation, and relieve pain... It is the most commonly used herb for treating blood deficiency and is found in a great number of formulas... The head of the root (gui tou) is said to tonify the blood and stop bleeding; the body (gui shen) to tonify and harmonize the blood; and the tails (gui wei) to invigorate the blood and dispel stasis. The whole root (quan gui) has all of these properties.' WHO Monographs Vol 4 (2009): 'Radix Angelicae Sinensis has been used traditionally to treat menstrual disorders, anemia, and constipation in debilitated patients.'"
Kampo medicine (Japanese)
- Toki-shakuyaku-san (Dang Gui Shao Yao San): A principal Kampo formula containing Toki (A. acutiloba or A. sinensis) for menstrual irregularity, infertility, habitual miscarriage (in Kampo, not contraindicated in pregnancy as in Western use), and edema in women with blood deficiency and fluid retention
- Shimotsuto (Si Wu Tang equivalent): Japanese version of the Four Substance Decoction for blood deficiency and menstrual disorders
- Kamishoyosan (Xiao Yao San derivative): For menopausal symptoms, anxiety, and irritability with blood deficiency
- Tokishakuyakusan: Listed in the Japanese Pharmacopoeia as a prescription for gynecological complaints
"The Japanese Pharmacopoeia lists Toki (Angelicae Acutilobae Radix and Angelicae Sinensis Radix) as official drugs. Kampo formulas containing Toki are among the most frequently prescribed herbal medicines in Japan, where they are integrated into the national healthcare system and covered by health insurance."
Western herbalism
- Emmenagogue for delayed, scanty, or painful menstruation
- Blood tonic for anemia and blood deficiency states (adopted from TCM framework)
- Antispasmodic for menstrual cramps and smooth muscle spasm
- Circulatory stimulant for cold extremities and poor peripheral circulation
- Formula herb for menopausal symptoms (typically combined with black cohosh, vitex, or other gynecological herbs)
- Gentle laxative for constipation in elderly or debilitated patients
"Hoffmann (2003): 'Dong Quai is one of the most widely used herbs in Chinese medicine and has been adopted into Western herbalism primarily for gynecological conditions. It is used for menstrual irregularity, painful periods, and menopausal symptoms. Its blood-nourishing and circulatory-stimulating properties make it valuable for anemia and peripheral circulatory insufficiency... It is best used as part of a formula rather than as a single herb.' Mills & Bone (2013) describe Dong Quai as a blood tonic, emmenagogue, and mild analgesic with antispasmodic properties, noting that it 'should be used in combinations consistent with the traditional Chinese approach.'"
Korean traditional medicine (Hanbang)
- Dangkwi (using A. gigas or A. sinensis) for blood tonification and menstrual regulation
- Samul-tang (Korean pronunciation of Si Wu Tang) for blood deficiency
- Used in combination formulas for postpartum recovery and gynecological disorders
"Korean traditional medicine uses both Angelica gigas (Korean Dang Gui) and A. sinensis (Chinese Dang Gui) with similar traditional indications but distinct phytochemical profiles. The Korean Pharmacopoeia lists Angelicae Gigantis Radix as the primary Dangkwi."
[1]
Modern Research
Uterine smooth muscle activity (biphasic response)
Investigation of the effects of Angelica sinensis extracts and isolated phthalides on uterine smooth muscle in vitro.
Findings: Multiple studies using isolated rat and rabbit uterine tissue preparations have demonstrated a biphasic dose-response: the volatile oil fraction and phthalides (particularly Z-butylidenephthalide and Z-ligustilide) initially stimulate uterine contractions at very low concentrations, then produce dose-dependent relaxation at higher concentrations. The non-volatile, water-soluble fraction (including ferulic acid) tends to stimulate uterine contractions. This biphasic pharmacology may partly explain the traditional observation that Dang Gui both 'tonifies' and 'invigorates' blood — the stimulatory and relaxant effects on the uterus depend on dose, extract type, and the balance of volatile vs. non-volatile constituents. WHO Monographs cite this biphasic response as pharmacologically significant.
Limitations: In vitro isolated tissue preparations. Dose extrapolation to oral administration in humans is indirect. The ratio of stimulatory to relaxant constituents varies significantly between preparations (decoctions vs. tinctures vs. essential oil). Clinical significance of the biphasic response in vivo is uncertain.
Dong Quai monotherapy for menopausal hot flashes (negative RCT)
Double-blind, randomized, placebo-controlled trial evaluating Dong Quai as a single agent for menopausal hot flashes.
Findings: Hirata et al. (1997) randomized 71 postmenopausal women to Dong Quai (standardized extract, 4.5 g root equivalent daily) or placebo for 24 weeks. No significant differences were found between Dong Quai and placebo for hot flash frequency, endometrial thickness, vaginal maturation index, or serum levels of estradiol, estrone, or sex hormone-binding globulin. The study concluded that Dong Quai, when used alone in the manner of a Western single-herb supplement, does not produce estrogen-like responses and is no more helpful than placebo for menopausal symptoms.
Limitations: Single-agent use is inconsistent with the traditional TCM approach, which always uses Dang Gui in multi-herb formulas for menopausal complaints. The authors acknowledged this limitation. The study effectively refutes the Western marketing claim that Dong Quai alone is an 'herbal estrogen' for menopause but does not address the validity of the traditional formula-based approach. Sample size was modest (n=71). Single standardized extract used.
[8]
Chinese herbal medicine for primary dysmenorrhea (Cochrane review)
Systematic review assessing the efficacy and safety of Chinese herbal medicine (CHM) for primary dysmenorrhea.
Findings: Zhu et al. (2008) conducted a Cochrane systematic review of 39 RCTs (n=3,475) evaluating various CHM formulas for primary dysmenorrhea. Many of the included formulas contained Dang Gui as a key ingredient (e.g., Si Wu Tang-based formulas). The review found promising evidence that CHM was more effective than pharmaceutical treatments (NSAIDs, oral contraceptives) for pain relief, but the overall quality of evidence was low. The authors concluded there was 'promising evidence for the use of Chinese herbal medicine for primary dysmenorrhea' but called for better-designed RCTs.
Limitations: Most included trials were of poor methodological quality (unclear allocation concealment, no blinding, small sample sizes). High heterogeneity in formulas used — it is not possible to attribute benefits specifically to Dang Gui versus other formula ingredients. Risk of publication bias (Chinese-language journals). The review supports CHM as a system but does not isolate the contribution of any single herb.
[9]
Ferulic acid antiplatelet and cardiovascular pharmacology
Pharmacological evaluation of ferulic acid from Angelica sinensis for antiplatelet and cardiovascular effects.
Findings: Ferulic acid and its sodium salt (sodium ferulate) demonstrate antiplatelet aggregation activity by inhibiting thromboxane A2 (TXA2) synthesis and enhancing prostacyclin (PGI2) production. In animal models, sodium ferulate protects against myocardial ischemia-reperfusion injury, reduces cerebral infarct volume, and improves microcirculation. Sodium ferulate is approved in China as an injectable drug for cardiovascular and cerebrovascular conditions. The antiplatelet mechanism provides a pharmacological basis for the clinically documented interaction with warfarin.
Limitations: Most studies use purified ferulic acid or sodium ferulate (pharmaceutical grade), not crude Dang Gui extract. Bioavailability of ferulic acid from oral Dang Gui preparations is uncertain. The injectable pharmaceutical preparation is not equivalent to oral herbal use. Western RCTs with cardiovascular endpoints using oral Dang Gui are lacking.
Angelica sinensis polysaccharide (ASP) immunomodulation and hematopoiesis
Investigation of immunomodulatory and hematopoietic-stimulating effects of Angelica sinensis polysaccharides.
Findings: Multiple studies demonstrate that ASP stimulates proliferation and differentiation of hematopoietic stem cells and progenitor cells in vitro and in myelosuppressed animal models (radiation-induced, cyclophosphamide-induced). ASP enhances macrophage phagocytosis, promotes lymphocyte proliferation, and modulates cytokine production (increasing IL-2, IFN-gamma; regulating TNF-alpha). In chemotherapy-treated animal models, ASP accelerates recovery of white blood cells, red blood cells, and platelets. These findings provide a pharmacological basis for the traditional 'blood-tonifying' (bu xue) action.
Limitations: Most evidence is from Chinese-language publications and animal studies. Clinical trials in humans are limited in number and quality. Extrapolation from injectable or high-dose oral polysaccharide preparations in animal studies to standard oral decoction doses in humans requires caution. ASP is a complex, heterogeneous mixture and batch-to-batch variation is likely.
Warfarin interaction (case reports)
Documented case reports of clinically significant interaction between Dong Quai and warfarin.
Findings: Page and Lawrence (1999) reported a case of a patient stabilized on warfarin who experienced a significant elevation in INR (to >10) and prothrombin time after self-prescribing Dong Quai supplements. The elevated INR normalized upon discontinuation of Dong Quai. The interaction is attributed to the antiplatelet effects of ferulic acid and the coumarin content (osthole, other coumarins) of the root, which may have additive or potentiating effects on warfarin's anticoagulant action. This case report is widely cited in drug interaction databases and underpins the AHPA Class 2d (drug interaction) classification.
Limitations: Based on individual case reports, not controlled studies. Confounding factors in case reports cannot be fully excluded. The exact mechanism (pharmacokinetic via CYP450 interactions vs. pharmacodynamic via additive anticoagulant/antiplatelet effects) has not been fully delineated in controlled human pharmacokinetic studies.
Preparations & Dosage
Decoction
Strength: 3-15 g dried root per 400-600 mL water
The traditional and preferred preparation method in TCM. Add 3-15 g of dried, sliced Dang Gui root to 400-600 mL water. Bring to a boil, then reduce heat and simmer covered for 15-30 minutes. Strain and divide into 2-3 doses. For maximum phthalide (volatile oil) preservation, keep the lid on throughout and limit decoction time to 15-20 minutes. For polysaccharide extraction (blood-tonifying emphasis), longer decoction (30-45 minutes) is appropriate. In multi-herb formulas, Dang Gui is typically added in the last 15-20 minutes of decoction.
3-15 g dried root per day in decoction (WHO Monographs); commonly 6-12 g in formula; up to 15 g as a larger dose in single-herb use
Divided into 2-3 doses per day, taken warm
Course-dependent; typically 2-4 weeks per course, then reassess. In chronic blood deficiency, may be used long-term as part of formulas under practitioner guidance.
Not typically used in children; consult qualified practitioner
Decoction is the traditional primary preparation and extracts both water-soluble constituents (polysaccharides, ferulic acid) and some volatile phthalides (though significant loss occurs with prolonged boiling). This is the preparation form with the longest historical use record and is the basis for most traditional clinical experience. Dang Gui is most traditionally and effectively used as part of multi-herb decoction formulas, not as a standalone herb.
Tincture
Strength: 1:5 dried root in 45-60% ethanol
Macerate dried Dang Gui root in 45-60% ethanol at a ratio of 1:5 for 2-4 weeks. Shake daily. Press and filter.
3-5 mL of 1:5 tincture, 3 times daily
3 times daily
2-4 weeks, then reassess
Not typically used in children
Tincture is the preferred preparation in Western herbalism and more efficiently extracts the lipophilic phthalide fraction (ligustilide, butylidenephthalide) than water decoction. However, tincture extracts polysaccharides poorly. The pharmacological profile of a tincture (phthalide-dominant, antispasmodic emphasis) differs from that of a decoction (polysaccharide-rich, blood-tonifying emphasis). Mills & Bone recommend the tincture for its antispasmodic and circulatory-stimulating effects.
Capsule / Powder
Strength: Powdered root 500-2000 mg per capsule; some products standardized to 1% ligustilide
Powdered dried root in capsule form. May also be a standardized extract capsule (standardized to ligustilide or ferulic acid content).
500-2000 mg powdered root, 2-3 times daily; or as directed on standardized extract product
2-3 times daily with meals
2-4 weeks, then reassess
Not typically used in children
Capsules are the most common commercial form in Western supplement markets. This is the form used in the Hirata (1997) negative RCT on menopausal hot flashes. Standardization targets vary between products (ligustilide content, ferulic acid content). Quality and efficacy of commercial products vary widely. The capsule form does not replicate the traditional decoction experience and may deliver a different balance of active constituents.
topical
Strength: 1:5 dried root in carrier oil (topical); poultice of warmed dried root
Infused oil or poultice made from dried root. For oil infusion: macerate dried root slices in carrier oil (sesame or olive oil) at a 1:5 ratio for 4-6 weeks or use gentle heat method.
Apply to affected area as needed
2-3 times daily as needed
Until resolution of condition
External use suitable for older children
Topical use is less common than internal use but has traditional precedent in TCM for traumatic injuries, bruising, and arthritic pain. External liniments (die da jiu) frequently contain Dang Gui. The anti-inflammatory phthalides and ferulic acid provide rationale for topical analgesic and anti-inflammatory effects.
[5]
Safety & Interactions
Class 2b
Not to be used during lactation (AHPA Botanical Safety Handbook)
Contraindications
Dang Gui is contraindicated during pregnancy due to its emmenagogue and uterotonic activity. Phthalides (butylidenephthalide) stimulate uterine smooth muscle contraction, which could theoretically provoke miscarriage or premature labor. AHPA classifies Dang Gui as Class 2b: 'Not to be used during pregnancy.' WHO Monographs state: 'Radix Angelicae Sinensis should not be used during pregnancy.' This contraindication is consistent across all authoritative sources. NOTE: Postpartum use (after delivery) is a traditional indication — the contraindication applies to antepartum use only. Some Kampo practitioners use Dang Gui-containing formulas during pregnancy, but this is controversial and not supported in Western herbalism.
Due to antiplatelet (ferulic acid) and blood-activating (huo xue) properties, Dang Gui may exacerbate heavy menstrual bleeding or other active bleeding conditions. In TCM, Dang Gui is traditionally avoided (or used with great caution and specific formula modifications) in cases of flooding and spotting (beng lou) or hemorrhagic conditions. The exception is the gui tou (root head) section, which is traditionally said to stop bleeding, but this distinction is not reliably maintained in Western commerce.
The moistening and mildly laxative properties of Dang Gui may worsen diarrhea or loose stools. In TCM, it is avoided in patterns of spleen qi deficiency with dampness (pi xu shi zheng) where the digestive function is already compromised. This contraindication is from traditional Chinese medical sources.
Drug Interactions
| Drug / Class | Severity | Mechanism |
|---|---|---|
| Warfarin (Coumarin anticoagulants) | major | Multiple mechanisms: (1) Ferulic acid inhibits platelet aggregation via TXA2 inhibition, producing pharmacodynamic additive anticoagulant effect. (2) Coumarin constituents (osthole, bergapten) may have intrinsic anticoagulant activity. (3) Possible CYP450 inhibition affecting warfarin metabolism (not fully characterized). Case reports document clinically significant INR elevation (Page & Lawrence, 1999). |
| Antiplatelet drugs (aspirin, clopidogrel, ticagrelor) (Antiplatelet agents) | moderate | Additive antiplatelet effect. Ferulic acid inhibits platelet aggregation via TXA2 pathway. Concurrent use with pharmaceutical antiplatelet agents may increase bleeding risk. |
| Heparin and low-molecular-weight heparins (Anticoagulants) | moderate | Additive anticoagulant effect via pharmacodynamic potentiation of anticoagulation. |
| Hormone replacement therapy (HRT) and oral contraceptives (Hormonal medications) | theoretical | Some in vitro studies suggest weak estrogenic or anti-estrogenic activity from Dang Gui fractions. Theoretical possibility of interaction with exogenous estrogen preparations. However, the Hirata (1997) clinical trial found no significant estrogenic activity from oral Dong Quai at standard doses. |
Pregnancy & Lactation
Pregnancy
unsafe
Lactation
insufficient data
PREGNANCY: Contraindicated. AHPA Class 2b ('not to be used during pregnancy'). WHO Monographs state that Radix Angelicae Sinensis is contraindicated during pregnancy. Uterotonic activity from phthalides poses risk of uterine stimulation, potentially leading to miscarriage or premature labor. No human safety data in pregnancy. All authoritative Western sources agree on this contraindication. Note: Postpartum use (Sheng Hua Tang formula) is a traditional indication and is distinct from antepartum use. LACTATION: Insufficient data for safety assessment during lactation. While postpartum formulas containing Dang Gui have been used traditionally in TCM, there is no formal safety evaluation of excretion into breast milk or effects on the nursing infant. The AHPA does not specifically restrict lactation use beyond the pregnancy restriction, but in the absence of safety data, caution is appropriate.
Adverse Effects
References
Monograph Sources
- [1] World Health Organization. WHO Monographs on Selected Medicinal Plants, Volume 4 — Radix Angelicae Sinensis. World Health Organization, Geneva (2009) . ISBN: 978-9241547055
- [2] Hoffmann, D.. Medical Herbalism: The Science and Practice of Herbal Medicine. Healing Arts Press (2003) . ISBN: 978-0892817498
- [3] Mills, S., Bone, K.. Principles and Practice of Phytotherapy: Modern Herbal Medicine (2nd edition). Churchill Livingstone / Elsevier (2013) . ISBN: 978-0443069925
- [4] Gardner, Z., McGuffin, M. (eds.). American Herbal Products Association's Botanical Safety Handbook (2nd edition). CRC Press (2013) . ISBN: 978-1466516946
- [5] Bensky, D., Clavey, S., Stoger, E.. Chinese Herbal Medicine: Materia Medica (3rd edition). Eastland Press (2004) . ISBN: 978-0939616428
- [6] British Herbal Medicine Association. British Herbal Pharmacopoeia. BHMA (1983)
- [7] Brinker, F.. Herbal Contraindications and Drug Interactions (4th edition). Eclectic Medical Publications (2010) . ISBN: 978-1888483147
Clinical Studies
- [8] Hirata, J.D., Swiersz, L.M., Zell, B., et al.. Does dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled trial. Fertility and Sterility (1997) ; 68 : 981-986 . DOI: 10.1016/S0015-0282(97)00397-X . PMID: 9418683
- [9] Zhu, X., Proctor, M., Bensoussan, A., et al.. Chinese herbal medicine for primary dysmenorrhoea. Cochrane Database of Systematic Reviews (2008) ; 2 : CD005288 . DOI: 10.1002/14651858.CD005288.pub3 . PMID: 18425916
- [10] Page, R.L., Lawrence, J.D.. Potentiation of warfarin by dong quai. Pharmacotherapy (1999) ; 19 : 870-876 . DOI: 10.1592/phco.19.10.870.31558 . PMID: 10417036
Traditional Texts
- [11] Anonymous (attributed to Shen Nong). Shen Nong Ben Cao Jing (Divine Farmer's Classic of Materia Medica). Traditional Chinese text, compiled approx. 200 CE (various modern editions) (200)
Pharmacopeias & Reviews
- [12] Chinese Pharmacopoeia Commission. Pharmacopoeia of the People's Republic of China (2020 edition) — Angelicae Sinensis Radix. China Medical Science Press (2020)
- [13] Ministry of Health, Labour and Welfare (Japan). Japanese Pharmacopoeia, 18th edition — Angelicae Acutilobae Radix / Angelicae Sinensis Radix. Ministry of Health, Labour and Welfare (2021)
Last updated: 2026-03-02 | Status: review
Unlock the Full Materia Medica
This monograph is part of our complete evidence-based herbal reference. Enter your email to get free, unlimited access to all of our monographs.
No spam, ever. Unsubscribe anytime.
You're In!
You now have full access to all of our herbal monographs.