DONG QUAI

BACKGROUND

Ingredient Type: Botanical

Also Known As: Dong quai, Angelica sinensis, Angelica polymorpha var. sinensis, Chinese angelica, Dang gui, Toki, Danguia, Angelica china (1)

Dong quai root is the root of the angelica plant from the Umbelliferae or Apiaceae family. There are over sixty varieties of Angelica found all around the world. The don quai variety is native to the Gansu Province in China. Its use dates back to 400 BCE and is still commonly used today (2).

Don quai is made up of over seventy compounds such as: ferulic acid, Z-ligustilide, butylidenephthalide and polysaccharides. Ferulic acid shows anti-inflammatory and immunostimulatory effects among other bioactivities. Butylidenephthalide has anti-inflammatory, anti-cancer, and anti-cardiovascular properties. Z-ligustilide can protect against liver damage and displays neuroprotective, anti-cancer, and anti-inflammatory effects (3).

Don quai root is commonly used as an aqueous extract or ground into a fine powder and put into pill form. Topical preparations can also be used.

TRADITIONAL USES

For at least twenty centuries, don quai has been used as a menstrual regulator, a remedy for:

• Amenorrhea (abnormal absence of menstruation)
• Pain during menstruation
• Blood deficiencies (4)
• Uterine disorders (4)
• A female reproductive tonic (5,6,7)
• A tonic for women with fatigue or low vitality (5,6,7)

Traditionally, it was used in teas or the root was chewed on and the juices were swallowed (5,6,7).

WHAT DOES SCIENCE TELL US?

The study of don quai root in humans is very limited, with more extensive research on human cells and animals. The possible benefits shown below support the necessity of more research in this area.

Don Quai Root Might Support Healthy Cell Growth:

Three main Angelica sinensis compounds were studied: butylidenephyhalide (BLP), senkyunolide A (SKA), and z-ligustilide (LGT). The cytotoxicity and anti-proliferative effects of these phthalides and their cooperation on colon cancer cells were tested. Researchers compared the results of both human colon cancer cells and normal colon cells. These compounds decreased cell viability more significantly in colon cancer cells than in normal colon cells dose-dependently. Moreover, BLP, SKA, and LGT show even more anti-cancer potential when combined with other components of Angelica sinensis extract (8).

The chloroform extract of don quai has been studied on fast-growing glioma brain tumors (GBM) in vitro and in vivo. In vitro, fast-growing glioma cells were treated with don quai. The changes in the cell cycle, including cell proliferation and apoptosis, were determined. In vivo, rat RG2 glioblastoma and human brain glioblastoma tumor cells were injected into the skin or into the eye cavity and treated with don quai. The effects on tumor growth were decided by magnetic resonance imaging and the microscopic study of diseased tissue determined the effects on tumor volume and survival rate. Don quai arrested the cell cycle at the G0-G1 checkpoint which stops the cell cycle of the tumor cell from progressing. Don quai also increased the proteins that are involved in apoptosis which increases programmed cancer cell death. In vitro, don quai triggered both the intrinsic and extrinsic pathways for apoptosis. In vivo, don quai was able to suppress malignant brain tumor growth without cytotoxicity to fibroblasts. In addition, don quai has proven to shrink in situ GBM, prolonging survival (9).

Don Quai Root Possibly Helps Balance Women’s Hormones:

Researchers performed a double-blind, randomized, placebo-controlled clinical trial to evaluate the possibility of don quai’s estrogenic effects on vaginal cells and on endometrial thickness in postmenopausal women. Seventy-one postmenopausal women who had follicle-stimulating hormone levels with hot flashes were tested with either don quai or a placebo for twenty-four weeks. Researchers observed no statistically significant differences between groups in endometrial thickness, vaginal maturation index, number of vasomotor flushes, or in the Kupperman Index (a scaled indicator of the most important menopause-associated discomforts) (10).

It must be noted that in the study below don quai was used in combination with another medicinal herb (chamomile), so it may not be relevant in determining the efficacy of don quai on menopausal symptoms.

The extract of don quai and chamomile (Climex) were studied in their efficacy in the treatment of menopausal symptoms. Researchers conducted a twelve-week, placebo-controlled experiment on fifty-five postmenopausal women who refused hormonal therapy and complained of hot flashes. The women were randomly divided into two groups. One group was given five chewable tablets of Climex daily between meals and the other received a placebo. The women completed a daily Kupperman Index questionnaire one week prior to the beginning of treatment to assess the frequency and intensity of their symptoms. Before and after the study, all women received hormone profile measurements and transvaginal ultrasonography evaluations. A significant decrease (p < 0.001) in the frequency and intensity of hot flashes was found between the group given Climex (90-96%) and the placebo group (15-25%). Women in the Climex group also noticed an alleviation of sleep disturbances and fatigue (11).

Don Quai Root Possibly Helps Alleviate Cramping:

Researchers performed a double-blind test of the analgesic effect of don quai in women who were suffering from pain during menstruation. A diagnostic scoring system was used to determine the severity of this condition. The women were treated with either don quai or a placebo during two menstrual cycles and followed for two additional cycles. A significant alleviation of dysmenorrhea was observed in patients treated with don quai compared to those treated with the placebo (12).

Don Quai Root Possibly Supports a Healthy Blood Pressure:

There is a deficit of studies on don quai root’s effect on the condition of increased blood pressure within the arteries of the lungs, but one study shows it can be helpful in improving the dynamics of blood flow.

Researchers studied the effect of 25% Angelic sinensis injection on hemodynamics, vasoconstrictors, pulmonary function and arterial blood gas in patients with chronic obstructive pulmonary disease (COPD) complicated by pulmonary hypertension. Sixty COPD patients with pulmonary hypertension in the remission stage were randomly divided into two equal groups: one group treated with the Angelica sinensis and the other treated with 5% glucose injection. This was applied through a 250-ml intravenous dripping each day for ten days. The results showed that Angelica Sinensis can improve hemodynamics by influencing the metabolism of endothelin-1, angiotensin-II, and endogenous digitalis-like factor as well as increased (P < 0.05 or P < 0.01) arterial partial pressure of oxygen (PaO2) of the body (13).

Forty chronic obstructive pulmonary disease patients with remissive pulmonary hypertension were studied. They were divided into four equal groups. One given a 250-milliliter IV drip of don quai (group 1), one given 10 milligrams of nifedipine orally (group 2), one given both don quai and nifedipine (group 3), and one control group given nothing (group 4). Researchers investigated hemodynamics, blood gas, and pulmonary function before and after treatments using pneumography, lung function examination, and blood gas analysis. Results showed that in the group given nifedipine (group 2) PaO2 was lowered, while in the group given both don quai and nifedipine (group 3) cardiac output and PaO2 were significantly increased (P < 0.05 or P < 0.01) and pulmonary arterial pressure was decreased. Don quai overcame the PaO2 lowering side effect of nifedipine (13).

Don Quai Root Possibly Supports Healthy Bones:

Only one study assessed don quai’s ability to help with bone injuries. The evidence that does exist from this shows that don quai may be helpful in stimulating bone cell growth.

Angelica sinensis frequently appears as the main ingredient in prescriptions for bone injuries. This study shows the effect of the aqueous extract of Angelica sinensis on bone cells in vitro. Human osteoprecursor cells (OPC-1) were incubated in varying concentrations of aqueous Angelica sinensis extract. OPC-1 showed enhanced proliferation at concentrations less than 125 micrograms per milliliter. However, at concentrations greater than 250 micrograms per milliliter OPC-1 was inhibited. The aqueous extract of Angelica sinensis directly stimulated cell proliferation, alkaline phosphatase (ALP) activity, protein secretion, and particularly type I collagen synthesis of OPC-1 (14).

Don Quai Root Possibly Supports a Healthy Brain:

The protective effects of an alcohol extract of don quai root on beta-amyloid plaques were investigated. Dose-dependently, don quai resulted in anti-amyloid toxicity according to a colorimetric assay for assessing cell metabolic activity. The extract weakened the malfunction of Neuro 2A cells caused by beta-amyloid. The extract also protected cell vitality against alphabeta-induced oxidative damage. At dosages of 25, 50, 100, and 200 milliliters, mitochondrial membrane potential was recovered at 77%, 87%, 102%, and 105%, respectively. In addition, the extract showed the ability to prevent the neurotoxicity induced by amyloid-associated oxidative stress (15).

Don Quai Root Possibly Supports Healthy Circulatory System:

In connection with the risk of ulcerative colitis (UC), there is evidence showing a relationship between don quai and the prevention of platelet activation, the improvement of microcirculation, and the relief of vascular endothelial cell injury (16).

Researchers studied thirty-nine patients with active UC and twenty-five patients with UC in remission. Thirty healthy people were enrolled as a control group. The sixty-four patients with UC were divided into two groups. One given normal routine treatment and one group given normal routine treatment plus 40-milliliter injections of don quai added into 250 milliliters 10% glucose IV drip once a day for 3 weeks. Researchers then tested for levels of α-granule membrane protein (GMP-140), thromboxane B2 (TXB2), 6-keto-prostaglandin F1a (6-keto-PGF1a) and Von Willebrand factor related antigen (vWF:Ag). These tests were done by taking 2 milliliters of blood from the 64 patients without breakfast in the morning twenty-four hours after being admitted as a base evaluation. The same tests were repeated after being treated for three weeks. The base evaluation after twenty-four hours showed that compared with the healthy control group, 1 min PAR, and levels of GMP-140, TXB2, and vWF:AG in the active UC group was remarkably higher (P<0.05-0.01) than the remissive UC group; both the remissive and active group displayed higher levels than the healthy control group. There was very little difference in 6-keto-PGF1a levels between the active and remissive UC groups, but both were lower than the control group. There was no significant difference between the PC in the remissive UC group and the control group, whereas the PC in the active UC group were significantly higher than the two other groups. After three weeks of treatment, the group receiving routine therapy showed no obvious changes in the parameters being tested. Compared with the base evaluation, the raised PC, 1 min PAR and levels of GMP-140, TXB2, vWF:AG were noticeably lowered in the don quai therapy group. The level of 6-keto-PGF1a still had no significant difference (16). This study concluded that don quai help inhibit platelet activation, relieve vascular endothelial cell injury, and improve microcirculation.

SAFETY

• Don quai is possibly unsafe when used long-term in large amounts because it contains carcinogenic constituents such as safrole, bergapten, and isosafrole (17).
• Don quai should not be taken if pregnant.

Interactions:

Major

• Don quai should not be taken in combination with Warfarin (Coumadin). This combination has shown to increase the risk of bleeding due to the increased prothrombin time (18,19).

Moderate

• Don quai is possibly unsafe to take alongside anticoagulant/antiplatelet drugs such as aspirin, dalteparin (Fragmin), enoxaparin, clopidogrel (Plavix), and others. These combinations may hinder platelet aggregation in the blood.
• Don quai is possibly unsafe to take alongside estrogens. Due to don quai having estrogenic effects, it may compete with estrogens for estrogen receptors. Therefore, it may interfere with hormone replacement therapy (20).

Side-Effects:

• May increase bleeding risk (21)
• Can cause nausea, dizziness, and an increase or decrease of menstrual flow (22)
• Can cause photosensitization and dermatitis (21)
• May cause gynecomastia (the enlargement of a man’s breasts) (18)

REFERENCES

1. Dong Quai [Angelica sinensis (Oliv.) Diels]. In: Medical Toxicology of Natural Substances. Hoboken, NJ, USA: John Wiley & Sons, Inc.; :461-464. doi:10.1002/9780470330319.ch64
2. Angelica – Herbal Encyclopedia. Cloverleaf farm. http://www.cloverleaffarmherbs.com/angelica/. Accessed March 14, 2018.
3. Chao W-W, Lin B-F. Bioactivities of major constituents isolated from Angelica sinensis (Danggui). Chin Med. 2011;6(1):29. doi:10.1186/1749-8546-6-29
4. Chan N, Li S, Perez E. Interactions between Chinese Nutraceuticals and Western Medicines. In: Nutraceuticals. Elsevier; 2016:875-882. doi:10.1016/B978-0-12-802147-7.00061-9
5. Romm A, Clare B, Stansbury JE, et al. Menstrual Wellness and Menstrual Problems. In: Botanical Medicine for Women’s Health. Elsevier; 2010:97-185. doi:10.1016/B978-0-443-07277-2.00007-6
6. Romm A, Burgess I, Winston D, et al. Conditions of the Reproductive Organs. In: Botanical Medicine for Women’s Health. Elsevier; 2010:211-255. doi:10.1016/B978-0-443-07277-2.00009-X
7. Hywood AJ, Hardy ML, Mills S, Hywood AJ. Fertility Challenges. In: Botanical Medicine for Women’s Health. Elsevier; 2010:334-346. doi:10.1016/B978-0-443-07277-2.00014-3
8. Kan WLT, Cho CH, Rudd JA, Lin G. Study of the anti-proliferative effects and synergy of phthalides from Angelica sinensis on colon cancer cells. J Ethnopharmacol. 2008;120(1):36-43. doi:10.1016/j.jep.2008.07.027
9. Tsai N-M, Lin S-Z, Lee C-C, et al. The antitumor effects of Angelica sinensis on malignant brain tumors in vitro and in vivo. Clin Cancer Res. 2005;11(9):3475-3484. doi:10.1158/1078-0432.CCR-04-1827
10. Hirata JD, Swiersz LM, Zell B, Small R, Ettinger B. Does dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled trial. Fertil Steril. 1997;68(6):981-986.
11. Kupfersztain C, Rotem C, Fagot R, Kaplan B. The Immediate Effect of Natural Plant Extract, Angelica Sinensis and Matricaria Chamomilla (Climex) for the Treatment of Hot Flushes during Menopause. A Preliminary Report. Vol 30.; 2003.
12. Kotani N, Oyama T, Sakai I, et al. Analgesic Effect of a Herbal Medicine for Treatment of Primary Dysmenorrhea – A Double-blind Study. Am J Chin Med. 1997;25(2):205-212. doi:10.1142/S0192415X9700024X
13. Xu J, Li G. [Observation on short-term effects of Angelica injection on chronic obstructive pulmonary disease patients with pulmonary hypertension]. Zhongguo Zhong xi yi jie he za zhi Zhongguo Zhongxiyi jiehe zazhi = Chinese J Integr Tradit West Med. 2000;20(3):187-189.
14. Yang Q, Populo SM, Zhang J, Yang G, Kodama H. Effect of Angelica sinensis on the proliferation of human bone cells. Clin Chim Acta. 2002;324(1-2):89-97.
15. Huang S-H, Lin C-M, Chiang B-H. Protective effects of Angelica sinensis extract on amyloid β-peptide-induced neurotoxicity. Phytomedicine. 2008;15(9):710-721. doi:10.1016/J.PHYMED.2008.02.022
16. Dong W-G, Liu S-P, Zhu H-H, Luo H-S, Yu J-P. Abnormal function of platelets and role of angelica sinensis in patients with ulcerative colitis. World J Gastroenterol. 2004;10(4):606-609. doi:10.3748/WJG.V10.I4.606
17. Dymowski RW. Assessment report on Angelica sinensis (Oliv.) Diels, radix. Comm Herb Med Prod. 2013. http://www.ema.europa.eu/docs/en_GB/document_library/Herbal_-_HMPC_assessment_report/2013/11/WC500155549.pdf. Accessed April 10, 2018.
18. Page RL, Lawrence JD. Potentiation of warfarin by dong quai. Pharmacotherapy. 1999;19(7):870-876.
19. Heck AM, DeWitt BA, Lukes AL. Potential interactions between alternative therapies and warfarin. Am J Health Syst Pharm. 2000;57(13):1221-7-30.
20. Amato P, Christophe S, Mellon PL. Estrogenic activity of herbs commonly used as remedies for menopausal symptoms. Menopause. 9(2):145-150.
21. Scott Moses M. Don Quai. Family Practice Notebook. https://fpnotebook.com/Pharm/Alternative/DnQ.htm. Published 2018. Accessed March 14, 2018.
22. Hywood A j. Angelica sinensis – an overview | ScienceDirect Topics. Botanical medicine for women’s health. https://www.sciencedirect.com/topics/medicine-and-dentistry/angelica-sinensis. Published 2010. Accessed March 14, 2018.

See the MedlinePlus entry for dong quai, this European Medicines Agency monograph on Angelica sinensis, the Michigan Medicine Health Library entry for dong quai, or the WebMD entry for dong quai for more information.