Angelica (Dong Quai)

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Dong Quai Root: Traditional Uses, Side Effects, and Contraindications Based on Published Research

Dong quai (Angelica sinensis), known as "dang gui" in Chinese medicine, represents one of the most extensively used traditional herbs for women's health, with documented therapeutic applications spanning over two millennia. This comprehensive analysis examines the traditional medicinal uses of dong quai root alongside current scientific evidence regarding its safety profile, adverse effects, and clinical contraindications. While traditional Chinese medicine practitioners have long utilized dong quai for blood deficiency, menstrual disorders, and various systemic conditions, emerging research reveals significant safety concerns including photosensitivity reactions, anticoagulant interactions, and potential carcinogenic compounds that necessitate careful clinical consideration^[1][2][3].

Traditional Medicinal Uses

Historical Context and Fundamental Applications

Dong quai's medicinal legacy traces back to the first century AD, when it was documented in the Shennong Ben Cao Jing (Classic of the Materia Medica) as one of the 50 fundamental herbs for treating various ailments^[4]. In traditional Chinese medicine (TCM), dong quai is classified as a premier "tonic herb for blood deficiency," earning titles such as "female ginseng" and "empress of herbs" due to its reputation for nourishing blood and promoting healthy circulation^[1][4]. The yellowish-brown root, harvested in fall from plants growing in cool, high-altitude mountains of East Asia, contains the highest concentration of bioactive compounds responsible for its therapeutic effects^[1][2].

Licensed practitioners in Oriental medicine utilize dong quai primarily for "tonifying" or nourishing blood, with applications extending beyond reproductive health to address systemic conditions characterized by blood deficiency patterns^[1]. According to clinical experience documented by board-certified practitioners, dong quai serves as an invaluable treatment for conditions including anemia, dizziness, limb numbness, and palpitations, particularly when these symptoms manifest during the menstrual cycle^[1]. The herb's therapeutic scope also encompasses treatment of men presenting with "blood deficient" patterns, demonstrating its utility beyond gender-specific applications^[1].

Reproductive and Gynecological Applications

Traditional practitioners predominantly recommend dong quai for female reproductive disorders, where it functions to regulate estrogen levels whether they are elevated or diminished, strengthening the uterus and improving uterine tone while regulating menstrual cycles^[5]. The herb addresses menstrual irregularities including painful periods (dysmenorrhea), heavy bleeding, and irregular cycles, serving as a cornerstone treatment in TCM gynecology^[1][6]. For menopausal symptoms, traditional applications target hot flashes and mood changes, though scientific validation for these uses remains limited^[1].

Dong quai's role in treating premenstrual syndrome encompasses management of breast swelling, tenderness, mood swings, bloating, and headaches, reflecting its traditional classification as a blood-moving herb that addresses stagnation patterns^[7][5]. Traditional Chinese medicine theory recognizes different therapeutic effects from various parts of the root, with the whole root (quan dong quai) indicated for enriching blood and promoting blood flow, while specific root portions target distinct therapeutic outcomes^[8].

Systemic and General Health Applications

Beyond reproductive health, traditional uses encompass cardiovascular conditions, with practitioners employing dong quai to treat high blood pressure, anemia, high blood sugar, poor circulation, and heart disease^[5]. The herb's traditional gastroprotective applications include treatment of digestive disorders, where it protects the mucous layer covering the digestive tract from excess stomach acid production^[5]. Historical applications also include treatment of rheumatism as an analgesic, allergy suppression, and wound healing enhancement through its ability to tonify and invigorate blood while reducing swelling^[1][9].

Side Effects and Contraindications Based on Published Research

Photosensitivity and Dermatological Reactions

Published research consistently identifies photosensitivity as a primary adverse effect associated with dong quai consumption. The European Medicines Agency assessment report documents that dong quai contains furocoumarins, including bergapten (5-MOP), which in the presence of UV light demonstrates probable carcinogenic properties in humans^[10]. Clinical manifestations of photosensitivity include photodermatitis characterized by skin sensitivity to light, causing swelling, itching, or redness^[11][7]. Healthcare providers specifically warn patients that dong quai can make skin extra sensitive to sunlight, potentially increasing the risk for skin cancer^[12][13].

The furocoumarins responsible for these phototoxic effects create symptoms including skin rash, irritation, and extreme sensitivity to sun exposure or sunburn^[11]. Medical literature recommends that individuals using dong quai wear sunblock when outdoors, particularly those with light skin, due to the increased photosensitization risk^[14]. The European regulatory assessment emphasizes that while a quantity of furocoumarins in roots has not been definitively determined, such determination would allow for safe usage according to the 1.5 mg acceptable daily intake of these substances^[10].

Anticoagulant Interactions and Bleeding Risks

Extensive published research documents significant interactions between dong quai and anticoagulant medications, particularly warfarin. A case report published in PubMed describes a 46-year-old African-American woman with atrial fibrillation who experienced a greater than two-fold elevation in prothrombin time and international normalized ratio after taking dong quai concurrently with warfarin for four weeks^[15]. The patient's coagulation values returned to acceptable levels one month after discontinuing the herb, with dong quai being the only identifiable cause for the increase^[15].

The anticoagulant effects stem from dong quai's coumarin content, which may potentiate the effects of warfarin and consequently increase bleeding risk^[2][15]. Research indicates caution is needed when dong quai is consumed with other herbs such as ginkgo or garlic that may affect blood clotting^[2]. Multiple medical sources classify the interaction between dong quai and warfarin as "major," recommending against this combination due to increased chances of bruising and bleeding^[14][16]. The Memorial Sloan Kettering Cancer Center specifically advises healthcare providers to monitor patients taking blood thinners, as dong quai may increase bleeding risk^[7].

Carcinogenic Compounds and Long-term Safety Concerns

Research has identified potentially carcinogenic compounds within dong quai's essential oil composition. The European Medicines Agency assessment report documents the presence of safrole, described by the European Food Safety Authority as a weak carcinogen in rats and mice and a known genotoxic carcinogen^[10]. Additionally, the essential oil contains isosafrole, identified as a weak hepatocarcinogen in rats and mice^[10]. While quantitative data on the content of these substances in herbal preparations remains limited, regulatory bodies express concern about long-term exposure risks.

Taking dong quai in large amounts for extended periods is classified as "possibly unsafe" due to the presence of chemicals considered carcinogenic^[14][13]. The European assessment emphasizes that while general estimations exist for population exposure to genotoxic and potentially carcinogenic substances in food and spices, these models do not adequately consider herbal medicinal product usage^[10]. This gap in safety evaluation data represents a significant concern for long-term therapeutic applications.

Pregnancy and Reproductive Safety Contraindications

Published research consistently contraindicate dong quai use during pregnancy due to documented uterine effects. Multiple medical sources classify dong quai as "possibly unsafe" for babies when taken by pregnant women, as the herb appears to affect uterine muscles^[13][14]. A specific case report links an herbal combination containing dong quai with birth defects in a baby whose mother consumed the preparation during the first three months of pregnancy^[14].

Research demonstrates that dong quai possesses both uterine stimulant and relaxant activities, with related Angelica species documented as abortifacients that affect the menstrual cycle^[9]. The Memorial Sloan Kettering Cancer Center specifically advises avoiding dong quai during pregnancy due to increased miscarriage risk^[7]. Breastfeeding represents another contraindication, as insufficient safety data exists regarding dong quai's effects during lactation^[13][14].

Cardiovascular and Metabolic Effects

Clinical research documents various cardiovascular side effects associated with dong quai consumption. Common adverse effects include high blood pressure, representing a paradox given traditional uses for hypertension treatment^[12][13]. Additional documented side effects include burping, gas, and gastrointestinal disturbances^[12][13]. Some patients experience loss of appetite, bloating, diarrhea, and fever as documented adverse reactions^[7].

Research conducted on dong quai's cardiovascular effects reveals complex dose-dependent responses. A published study examining endothelial cell toxicity found that Angelica sinensis demonstrates inherent toxicity at high concentrations while potentially protecting vascular endothelium from oxidative stress-induced injury at moderate concentrations^[17]. This biphasic response pattern underscores the importance of appropriate dosing and clinical monitoring.

Hormonal and Cancer-Related Contraindications

Published research indicates dong quai may act similarly to estrogen, creating specific contraindications for hormone-sensitive conditions. Medical literature specifically warns against dong quai use in patients with hormone-sensitive cancers including breast cancer, uterine cancer, ovarian cancer, endometriosis, or uterine fibroids^[14][7]. The potential estrogenic activity could theoretically worsen conditions that might be exacerbated by estrogen exposure^[14].

Research on dong quai's interaction with estrogen medications suggests increased risk for estrogenic side effects when used concurrently^[11][14]. However, one double-blind, placebo-controlled study found that dong quai alone does not demonstrate estrogenic effects, suggesting limited impact on post-menopausal symptoms when used as monotherapy^[11]. This finding contrasts with traditional beliefs about dong quai's hormonal activities and highlights the need for additional research.

Research Evidence and Clinical Studies

Limited Clinical Trial Data

Despite extensive traditional use, published research reveals limited high-quality clinical trials supporting dong quai's therapeutic efficacy. A comprehensive review published in PubMed notes that while numerous reports exist regarding analytical methods and pharmacological activities of Angelica sinensis, well-designed Western-style clinical trials remain scarce^[3]. The European Medicines Agency assessment concluded that clinical trials and case studies are limited, with adverse events and serious adverse events inadequately documented^[10].

However, some combination therapy studies show promise. Research examining dong quai combined with chamomile found significant differences in hot flash relief, insomnia, and fatigue between treatment and placebo groups, with researchers concluding that menopausal symptom treatment was effective without side effects^[5]. Additionally, a specific product containing American ginseng, black cohosh, dong quai, milk thistle, red clover, and vitex agnus-castus demonstrated reduction in hot flashes and night sweats while improving sleep quality in pre- and post-menopausal women^[12].

Pharmacological Research Findings

Published pharmacological studies reveal dong quai possesses diverse bioactive properties including anti-inflammatory, antispasmodic, antioxidant, and neuroprotective actions, along with cardiovascular and cerebrovascular effects^[3]. Research on dong quai's polysaccharide components demonstrates hepatoprotective effects, with studies showing reduced expression of liver injury markers including aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase in ethanol-induced acute liver injury models^[18].

Cardioprotective research using mouse models found that Angelica sinensis significantly reduced mortality and improved heart performance in doxorubicin-treated animals, suggesting potential as an adjunct in chemotherapy^[19]. The study demonstrated normalization of antioxidative activity, prevention of myofibril loss, and improvement of arrhythmias and conduction abnormalities without compromising doxorubicin's antitumor activity^[19]. These findings support traditional cardiovascular applications while highlighting dong quai's potential in modern therapeutic contexts.

Conclusion

This comprehensive analysis reveals dong quai as a traditionally significant medicinal herb with documented applications spanning women's reproductive health, cardiovascular conditions, and blood deficiency syndromes over more than two millennia of use. However, published research identifies substantial safety concerns that necessitate careful clinical consideration, particularly regarding photosensitivity reactions, anticoagulant interactions, and potential carcinogenic compound exposure. The documented contraindications during pregnancy, hormone-sensitive cancers, and concurrent anticoagulant therapy represent absolute clinical restrictions based on available evidence.

While traditional applications remain culturally and historically significant, the limited availability of high-quality clinical trials supporting efficacy claims, combined with documented safety risks, suggests that dong quai should be used with appropriate medical supervision and patient counseling. Future research priorities should focus on establishing safe dosing parameters, quantifying potentially harmful constituents, and conducting well-designed clinical trials to validate traditional therapeutic claims. Healthcare providers must balance respect for traditional knowledge with evidence-based safety considerations when advising patients about dong quai use.

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1.       https://www.medicalnewstoday.com/articles/dong-quai        

2.       https://en.wikipedia.org/wiki/Angelica_sinensis   

3.       https://pubmed.ncbi.nlm.nih.gov/27211015/  

4.       https://www.gaiaherbs.com/blogs/seeds-of-knowledge/dong-quai-overview 

5.       https://www.indigo-herbs.co.uk/natural-health-guide/benefits/dong-quai    

6.       https://www.meandqi.com/herb-database/dong-quai

7.       https://www.mskcc.org/cancer-care/integrative-medicine/herbs/dong-quai     

8.       https://www.healthline.com/health/dong-quai-ancient-mystery

9.       https://www.drugs.com/npp/dong-quai.html 

10.    https://www.ema.europa.eu/en/documents/herbal-report/final-assessment-report-angelica-sinensis-oliv-diels-radix-first-version_en.pdf     

11.    https://sanfordhealth.staywellsolutionsonline.com/Coronavirus/19,DongQuai   

12.    https://www.webmd.com/vitamins/ai/ingredientmono-936/dong-quai   

13.    https://medlineplus.gov/druginfo/natural/936.html     

14.    https://www.rxlist.com/supplements/dong_quai.htm        

15.    https://pubmed.ncbi.nlm.nih.gov/10417036/  

16.    https://www.drugs.com/mtm/dong-quai.html

17.    https://www.pagepress.org/journals/index.php/ams/article/view/ams.2011.e8

18.    https://pubmed.ncbi.nlm.nih.gov/38220331/

19.    https://pubmed.ncbi.nlm.nih.gov/17971065/ 

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