Dong Quai

Dong quai (dang gui) is a blood tonic, used both to nourish the blood and to move it. It is traditionally used to tonify and invigorate the blood, relieve pain, moisten the intestines and treat irregular menstruation and absent periods ^{25Reference 25Wei et al. · 2016ReviewAngelica sinensis in China — a review of botanical profile, ethnopharmacology, phytochemistry and chemical analysis — reviewView study →}.

It is very rarely given alone. Its classical place is inside formulas: Si Wu Tang (“Four Substance Decoction”), the base gynaecological prescription; Dang Gui Shao Yao San, for menstrual pain; and Dang Gui Buxue Tang, dong quai with astragalus in a 1:5 ratio, which has itself been tested in a clinical trial ^{2Reference 2Haines et al. · 2008RCTA randomised, double-blind, placebo-controlled study of Dang Gui Buxue Tang on menopausal symptoms — RCTView study →}.

Different parts of the root are used for different purposes: the head to tonify and the tail to move and disperse. The root is often prepared in wine to strengthen its blood-moving action.

The main indications are absent or irregular periods, period pain, recovery after childbirth, anaemia and pallor, and constipation from dryness. It is also used for pain from blood stasis.

The active fraction is Angelica sinensis polysaccharide (ASP), not the small-molecule constituents. When a crude extract was split into fractions, the polysaccharide carried the blood-cell-stimulating activity, working by inducing spleen cells to secrete interleukin-6 and GM-CSF ^{6Reference 6Liu et al. · 2010AnimalHaematopoietic effect of water-soluble polysaccharides from Angelica sinensis on mice with acute blood loss — animal modelView study →}.

In mice bled to cause acute anaemia, a low dose of ASP (2.3 mg/kg a day) sped the recovery of haemoglobin ^{6Reference 6Liu et al. · 2010AnimalHaematopoietic effect of water-soluble polysaccharides from Angelica sinensis on mice with acute blood loss — animal modelView study →}.

In a 5-fluorouracil chemotherapy-anaemia model, ASP 100 mg/kg a day by injection sped the recovery of red-cell count, haemoglobin and haematocrit, acting on red-cell production in the spleen ^{8Reference 8Wang et al. · 2024AnimalAngelica sinensis polysaccharides ameliorate 5-FU-induced stress anaemia via extramedullary erythropoiesis — mouse in vivoView study →}.

A study reporting that ASP restored blood counts in irradiated mice with aplastic anaemia ^{9Reference 9Chen et al. · 2020AnimalAngelica sinensis polysaccharide prevents mitochondrial apoptosis by regulating the Treg/Th17 ratio in aplastic anaemia — mouse in vivoView study →} was later retracted.

Human data are limited to cells. An acidic ASP fraction protected human CD34⁺ cord-blood stem cells from a chemotherapy drug in vitro ^{7Reference 7Lee et al. · 2012In vitroHaematopoietic and myeloprotective activities of an acidic Angelica sinensis polysaccharide on human CD34⁺ stem cells — in vitroView study →}.

Gap: all in-vivo efficacy is in rodents and uses purified polysaccharide by injection; there is no human trial and no evidence the orally-taken tincture or decoction delivers a hematopoietically relevant polysaccharide dose.

Anti-inflammatory activity comes mainly from the phthalide Z-ligustilide and from ferulic acid. In rats with endotoxin-induced uveitis, an oral Z-ligustilide nanoemulsion lowered TNF-α, IL-1β, VEGF and IL-17 ^{16Reference 16Ma et al. · 2013AnimalAnti-inflammatory effects of Z-ligustilide nanoemulsion — rat in vivoView study →}.

In cell work, ligustilide, butylidenephthalide and a supercritical-fluid root extract activated Nrf2 antioxidant signalling, and the extract suppressed IL-1β and TNF-α in macrophages ^{18Reference 18Saw et al. · 2013In vitroEffects of Angelica sinensis phytochemicals on Nrf2-mediated phase-II enzyme expression and anti-inflammation — in vitroView study →}.

A 2:1 extract of dong quai and chuanxiong (Ligusticum) reduced ear and paw swelling in rodents and lowered COX-2, PGE2 and TNF-α ^{19Reference 19Zhang et al. · 2024In vitroAntioxidant and anti-inflammatory effects of different ratios of Angelica sinensis and Chuanxiong rhizoma extracts — in vitro / rodent in vivoView study →}. Sodium ferulate blunted TNF/TNFR signalling in cartilage models ^{22Reference 22Magdalou et al. · 2015ReviewAngelica sinensis and osteoarthritis: a natural therapeutic link? — reviewView study →}.

The nanoemulsion was designed to raise ligustilide’s low oral bioavailability, and it produced much higher blood levels than plain ligustilide ^{16Reference 16Ma et al. · 2013AnimalAnti-inflammatory effects of Z-ligustilide nanoemulsion — rat in vivoView study →}.

There is no human anti-inflammatory data, and ligustilide’s poor oral bioavailability limits how much of this transfers to the whole root.

Antioxidant capacity comes largely from ferulic acid. Removing ferulic acid from the root by preparative HPLC reduced its DPPH radical-scavenging activity, showing it to be one of the main antioxidant constituents ^{20Reference 20Wang et al. · 2015In vitroEffects of ferulic acid on antioxidant activity in Angelicae Sinensis Radix and Chuanxiong Rhizoma — in vitroView study →}.

A dong quai and chuanxiong extract scavenged DPPH and ABTS radicals and protected endothelial cells from hydrogen-peroxide damage ^{19Reference 19Zhang et al. · 2024In vitroAntioxidant and anti-inflammatory effects of different ratios of Angelica sinensis and Chuanxiong rhizoma extracts — in vitro / rodent in vivoView study →}.

Ferulic acid also increased antioxidant-enzyme synthesis and reduced oxidative protein products in a mouse model of membranous nephropathy ^{24Reference 24Cheng et al. · 2012AnimalFerulic acid, an Angelica sinensis-derived polyphenol, slows the progression of membranous nephropathy in a mouse model — animal modelView study →}. Nrf2-driven induction of protective phase-II enzymes offers a cellular mechanism ^{18Reference 18Saw et al. · 2013In vitroEffects of Angelica sinensis phytochemicals on Nrf2-mediated phase-II enzyme expression and anti-inflammation — in vitroView study →}.

The evidence is in vitro and at the constituent level, with no human biomarker data, and ferulic-acid content varies with cultivar, growing region and processing.

A PRISMA-guided review of the preclinical literature found A. sinensis extracts and compounds, among them Z-ligustilide, 3-n-butylphthalide and ferulic acid, protective in ischaemic-stroke models through anti-inflammatory, antioxidant and antiplatelet actions ^{21Reference 21Han et al. · 2021Systematic reviewOverview of the therapeutic potential of Angelica sinensis for ischaemic stroke — systematic review (preclinical)View study →}.

Much of this work used injectable Angelica preparations rather than oral root ^{21Reference 21Han et al. · 2021Systematic reviewOverview of the therapeutic potential of Angelica sinensis for ischaemic stroke — systematic review (preclinical)View study →}. It is entirely preclinical.

Butylidenephthalide is a non-specific antispasmodic. In the original study it inhibited rat uterine contractions induced by prostaglandin F2α, oxytocin and acetylcholine, and relaxed guinea-pig gut smooth muscle, though less potently than papaverine ^{13Reference 13Ko · 1980A newly isolated antispasmodic — butylidenephthalide, isolated from Ligusticum wallichii (isolated-tissue study)View study →}.

That compound was isolated from Ligusticum wallichii (chuanxiong), a related plant, not from dong quai ^{13Reference 13Ko · 1980A newly isolated antispasmodic — butylidenephthalide, isolated from Ligusticum wallichii (isolated-tissue study)View study →}. Butylidenephthalide and ligustilide are also constituents of dong quai root ^{18Reference 18Saw et al. · 2013In vitroEffects of Angelica sinensis phytochemicals on Nrf2-mediated phase-II enzyme expression and anti-inflammation — in vitroView study →}.

The evidence is old and entirely on isolated tissue. There is no controlled human trial of dong quai on its own for period pain.

The polysaccharide fraction again carries the activity. In mice with carbon-tetrachloride liver fibrosis, ASP lowered ALT by about half and the fibrotic area by about 70%, through the IL-22/STAT3 pathway ^{15Reference 15Wang et al. · 2020AnimalAngelica sinensis polysaccharide attenuates CCl₄-induced liver fibrosis — mouse in vivoView study →}.

This rests on one animal model, with no human liver-disease data.

Dong quai’s cardiovascular reputation rests on ferulic acid, and specifically its sodium salt. Sodium ferulate has antithrombotic, platelet-aggregation-inhibiting and antioxidant activity, and is approved in China as a drug for cardiovascular and cerebrovascular disease ^{14Reference 14Wang et al. · 2005ReviewPharmacological actions of sodium ferulate in the cardiovascular system — reviewView study →}.

The concentrations reached with a licensed sodium-ferulate product are not comparable to those from a dong quai tincture. This antiplatelet activity is the likely basis of the bleeding interaction with warfarin ^{11,12Reference 11Fugh-Berman · 2000ReviewHerb-drug interactions — reviewView study →Reference 12Milić et al. · 2014ReviewWarfarin interactions with medicinal herbs — reviewView study →}.

Gap: the evidence is for an isolated pharmaceutical constituent, not the whole herb as consumed; no herb-level human cardiovascular trial.

Ligustilide promoted osteoblast differentiation in the MC3T3-E1 pre-osteoblast line and in bone-marrow mesenchymal stem cells, and rescued prednisolone-impaired bone formation in zebrafish, acting through the GPR30/EGFR pathway ^{17Reference 17Yang et al. · 2019In vitroLigustilide promotes bone formation via the GPR30/EGFR pathway — in vitro / zebrafishView study →}.

Angelica polysaccharide promoted mesenchymal-stem-cell proliferation and osteoblast differentiation through lncRNA H19, PI3K/AKT and Wnt/β-catenin signalling, and an animal experiment in the same study found better bone formation ^{23Reference 23Xie et al. · 2019Angelica polysaccharide promotes proliferation and osteoblast differentiation of mesenchymal stem cells via lncRNA H19 — animal studyView study →}.

In osteoarthritis models, sodium ferulate was anti-inflammatory in cartilage, and the polysaccharide fraction promoted proteoglycan synthesis in cartilage matrix ^{22Reference 22Magdalou et al. · 2015ReviewAngelica sinensis and osteoarthritis: a natural therapeutic link? — reviewView study →}.

There are no human data.

This is the use behind the “female ginseng” name, and the trials of dong quai alone do not support it. A 24-week double-blind, randomised, placebo-controlled trial in 71 postmenopausal women found no difference from placebo in hot flashes, menopausal symptom score, endometrial thickness or vaginal cell maturation, and no oestrogen-like effect ^{1Reference 1Hirata et al. · 1997RCTDoes dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled randomised trial (RCT)View study →}.

A randomised, double-blind, placebo-controlled trial in 22 men with hot flashes from androgen-deprivation therapy found no difference in flash frequency, duration or severity ^{5Reference 5Al-Bareeq et al. · 2010RCTDong Quai for hot flashes in men on androgen-deprivation therapy: randomised double-blind placebo-controlled trial (RCT)View study →}.

Positive results come only from multi-herb products. A six-herb complex containing black cohosh, dong quai and red clover ^{3Reference 3Rotem et al. · 2007RCTPhyto-Female Complex for hot flushes, night sweats and sleep quality: randomised, controlled, double-blind pilot study (RCT)View study →} and a dong quai and chamomile preparation ^{4Reference 4Kupfersztain et al. · 2003RCTImmediate effect of Angelica sinensis and Matricaria chamomilla (Climex) for hot flushes — placebo-controlled RCTView study →} each reduced hot flashes against placebo. Dang Gui Buxue Tang, dong quai with astragalus, did no better than placebo overall and was better only for mild flushes ^{2Reference 2Haines et al. · 2008RCTA randomised, double-blind, placebo-controlled study of Dang Gui Buxue Tang on menopausal symptoms — RCTView study →}.

A 2026 systematic review of non-soy herbal supplements for menopause reported no measurable effect in the trials of black cohosh and dong quai ^{27Reference 27Jing et al. · 2026Systematic reviewThe effectiveness of non-soy oral herbal supplements for menopausal symptoms — systematic review. https://pubmed.ncbi.nlm.nih.gov/42451042/View study →}.

Gap: the single-herb RCTs are negative; every positive result is a combination product, so dong quai’s independent efficacy for hot flashes is unproven.

Bleeding. Ferulic acid has antithrombotic and antiplatelet activity, and its sodium salt is licensed in China as a cardiovascular drug on that basis ^{14Reference 14Wang et al. · 2005ReviewPharmacological actions of sodium ferulate in the cardiovascular system — reviewView study →}. Interaction reviews name dong quai among the herbs linked to bleeding in people taking warfarin, from case reports ^{11,12Reference 11Fugh-Berman · 2000ReviewHerb-drug interactions — reviewView study →Reference 12Milić et al. · 2014ReviewWarfarin interactions with medicinal herbs — reviewView study →}. Avoid it alongside warfarin and other anticoagulant or antiplatelet drugs, and stop it before surgery or dental work.

Hormone-sensitive cancers. A water extract of dong quai stimulated the growth of both oestrogen-receptor-positive (MCF-7) and oestrogen-receptor-negative (BT-20) breast-cancer cells in vitro ^{10Reference 10Lau et al. · 2005In vitroUse of dong quai (Angelica sinensis) in women with breast cancer: effect on ER-positive (MCF-7) and ER-negative (BT-20) cell proliferation — in vitroView study →}. This is a cell-culture finding. In postmenopausal women the herb had no oestrogen-like effect on the endometrium or vaginal cells ^{1Reference 1Hirata et al. · 1997RCTDoes dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled randomised trial (RCT)View study →}. It is best avoided with hormone-sensitive cancers until human data exist.

Photosensitivity. The root contains furanocoumarins ^{26Reference 26Han et al. · 2022The chromosome-level genome of female ginseng (Angelica sinensis) provides insights into molecular mechanisms and evolution of coumarin biosynthesisView study →}, so topical or high-dose use carries a possible photosensitivity risk, as with other plants in the carrot family.

Drug metabolism. In laboratory tests on human liver enzymes, a dong quai extract inhibited CYP2C19, which clears several common drugs, though no study has measured this in people ^{32Reference 32Sevior et al. · 2010In vitroRapid screening of commercially available herbal products for the inhibition of major human hepatic cytochrome P450 enzymes using the N-in-one cocktail — in vitro (human liver microsomes)View study →}. In rats, a water extract raised CYP3A and CYP2D activity ^{33Reference 33Tang et al. · 2006AnimalEffect of the water extract and ethanol extract from traditional Chinese medicines Angelica sinensis (Oliv.) Diels, Ligusticum chuanxiong Hort. and Rheum palmatum L. on rat liver cytochrome P450 activity — rat in vivoView study →}.

The warfarin interaction appears to work through clotting rather than drug levels. In rabbits, dong quai changed the clotting response to warfarin without changing warfarin levels in the blood ^{34Reference 34Lo et al. · 1995AnimalDanggui (Angelica sinensis) affects the pharmacodynamics but not the pharmacokinetics of warfarin in rabbits — rabbit in vivoView study →}.