Dong quai (Angelica sinensis, Chinese angelica, danggui, dong qua, and tang kuei) is widely used in traditional Chinese medicine and is typically combined with other herbs. The plant’s roots are used medicinally. The chemical constituents include alkyl phthalides (ligustilides, angelicide, and butylphthalide), furanocoumarin (archangelicin, bergapten, and imperatorin), coumarins (angelol G and angelicone), terpenes (cadinene and carvacrol), phytosterols (beta-sitosterol and stigmasterol), organic acids (ferulic, succinic, and myristic), and an immune-stimulating polysaccharide. Phthalides and coumarins are believed to act as antispasmodics, vasodilators, and central nervous system stimulants. Dong quai is taken orally for gynecologic complaints, including menstrual cramps, irregularity, retarded flow, weakness during menstrual period, and symptoms of menopause. It has also been used as a “blood purifier,” to manage hypertension, rheumatism, ulcers, anemia, and constipation, and for the prevention and treatment of allergic attacks.

Clinical trials of dong quai have not demonstrated its efficacy for treating menopausal symptoms. One study found that dong quai had no effect upon endometrial wall thickness or menopausal symptoms when used alone. Dong quai is believed to act by competitively inhibiting estradiol binding to estrogen receptors and inducing transcriptional activity in estrogen-responsive cells. There is a need for human studies evaluating the efficacy of dong quai used in combination with other ingredients for treating menopausal symptoms.

Dong quai is available alone and in combination with other herbs, vitamins, and minerals. Some examples are Dong Quai­Single Herb Capsules, Dong Quai­Standardized Extract Tablets, Avlimil, Phyto Estrogen Power, Menopausal Formula, and Menstrual-Ease.

The use of dong quai has been associated with photosensitivity and photodermatitis. The use of dong quai with anticoagulant and antiplatelet drugs may cause potentiation of their therapeutic and adverse effects. Concomitant use with warfarin causes an increase in anticoagulant effect and risk of bleeding. Because dong quai contains coumarins, it should be used cautiously with herbs that have an anticoagulant or antiplatelet action (e.g., angelica, anise, capsicum, chamomile, celery, garlic, ginkgo, ginseng, licorice, passionflower, red clover), as concomitant use may increase the risk of bleeding. Women with hormone-sensitive cancers or conditions should avoid the use of dong quai, as it may have estrogenic effects.

The recommended dosage of dong quai depends upon the manufacturer. The pharmacist should counsel the patient to follow the dosing instructions on the package label and not to exceed the dosage for any reason. There are many dong quai species, and they differ in their chemical, pharmacological, and toxicological actions. When making recommendations, the pharmacist should be aware of which species is under discussion.

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1. DONG QUAI Botanical name: Angelica sinensis Family name: Apiaceae Synonyms: Dang gui, Tang kuei Part used: Root (whole root, root head, root body, root tail) MAJOR CHEMICAL CONSTITUENTS Important compounds in dong quai include alkylphthalides present in the essential oil fractions of the plant and ferulic acid. The plant also contains additional essential oils, amino acids, lipids,...
2. RED CLOVER Botanical name: Trifolium pratense Family name: Leguminosae Synonyms: Meadow clover, purple clover, trefoil Part used: Flowering tops and leaf MAJOR CHEMICAL CONSTITUENTS Isoflavondoids including biochanin A, daidzein, formo-nonetin, genistein, and others; flavonoids including kaempferol, quercetin and others; coumarins; carbohydrates, saponins, salicylic acid, and trace vitamins and minerals. PRINCIPAL USES • Prevention and treatment of menopausal...
3. WILD YAM Botanical name: Dioscorea villosa Family name: Dioscoreacaea Synonyms: Colic root, rheumatism root Part used: Root and rhizome MAJOR CHEMICAL CONSTITUENTS Glycoside and steroidal saponins, including diosgenin and dioscin, alkaloids, tannins, phytosterols, and starch PRINCIPAL USES • Spasmolytic in the treatment of uterine cramping, dysmenorrhea, and chronic pelvic pain • Spasmolytic in cases of urinary tract...