Dong Quai — Angelica sinensis

Common & Latin Names

Common names: Dong quai, Dang gui, Chinese angelica, Female ginseng, Tang kuei Latin name: Angelica sinensis (Oliv.) Diels TCM name: Dang Gui (当归) — one of the most frequently prescribed herbs in all of TCM. The name literally means “should return” or “the proper order returns” — implying the restoration of the body’s natural state Japanese: Toki (トウキ — refers to Angelica acutiloba, the Japanese species used similarly) Korean: Danggwi

Plant Family & Parts Used

Family: Apiaceae (Umbelliferae — the carrot/parsley family, which also includes fennel, dill, angelica, lovage, and the poisonous hemlock) Parts used: Root — divided into three sections in TCM practice, each with different therapeutic emphasis:

• Gui Tou (root head): Tonifies Blood and stops bleeding. The most Yang, upward-moving portion.
• Gui Shen (root body/main root): Tonifies and harmonizes Blood. The balanced, nourishing portion — most commonly used.
• Gui Wei (root tail/rootlets): Activates Blood and dispels stasis. The most moving, dispersing portion.
• Quan Dang Gui (whole root): Used when all three actions are desired simultaneously.

This differentiation of a single root into three medicines is a remarkable example of TCM’s empirical sophistication.

Habitat: Native to high-altitude regions of China (primarily Gansu, Sichuan, Yunnan, and Hubei provinces), growing at 2,500-3,000 meters elevation in cool, moist mountain meadows and forest margins. Cultivated extensively in China (over 10,000 tons annually). Also cultivated in Japan and Korea (related species). A biennial or short-lived perennial growing to 1 meter with aromatic, three-compound leaves and umbels of small white-green flowers.

Traditional Uses

TCM (2,000+ years — The Supreme Blood Herb)

Dang Gui is arguably the single most important Blood herb in TCM. It appears in the Shennong Ben Cao Jing (circa 200 CE) as a middle-grade herb and has been a cornerstone of Chinese gynecology for two millennia. It appears in more classical formulas than almost any other herb — estimated at over 70 important formulas:

• Si Wu Tang (Four Substance Decoction): Dang Gui + Shu Di Huang + Bai Shao + Chuan Xiong. The foundational Blood-tonifying formula — the equivalent of the “four-ingredient nutritive IV” in TCM. Used for Blood deficiency manifesting as pale complexion, dizziness, blurred vision, palpitations, menstrual irregularity, and dry skin/hair.
• Dang Gui Bu Xue Tang (Angelica Tonify Blood Decoction): Dang Gui + Huang Qi (astragalus) in a 1:5 ratio. For Qi and Blood deficiency with empty heat — the patient who is exhausted, pale, has a floating pulse, and mild fever from deficiency.
• Xiao Yao San (Free and Easy Wanderer): Contains Dang Gui as the Blood-nourishing component in this most-prescribed of all TCM formulas for Liver Qi stagnation with Blood deficiency.
• Ba Zhen Tang (Eight Treasure Decoction): Combines Si Wu Tang with Si Jun Zi Tang — the supreme Qi-and-Blood tonic formula.
• Dang Gui Shao Yao San: For abdominal pain during pregnancy, Blood deficiency with dampness.
• Gui Zhi Fu Ling Wan: For Blood stasis in the uterus — fibroids, endometriosis, fixed menstrual pain.

TCM actions: Tonifies Blood, activates Blood circulation, regulates menstruation, alleviates pain, moistens the intestines (laxative for Blood-deficiency constipation), reduces swelling and expels pus (used in abscess formulas).

Japanese Kampo Medicine

Toki (Angelica acutiloba) is used in Kampo formulas with similar indications. The Kampo tradition emphasizes pattern-based prescribing, and Toki-containing formulas are prescribed for specific constitutional patterns rather than diseases. Key formulas include Tokishakuyakusan (for Blood deficiency with water accumulation) and Kamishoyosan (the Kampo version of Xiao Yao San).

Korean Traditional Medicine

Danggwi is used similarly to Chinese Dang Gui, with particular emphasis on postpartum recovery, anemia, and women’s reproductive health.

Western Herbalism (Modern Adoption)

Dong quai entered Western awareness primarily through the influence of TCM in the 20th century. Modern Western herbalists use it as a “women’s tonic” for menstrual irregularity, menopausal symptoms, anemia, and circulation. However, Western use is often as a single herb, which diverges from the TCM tradition of using dong quai in formulas — a distinction with clinical significance.

Active Compounds & Pharmacology

Primary Phytochemicals

Phthalides:

• Ligustilide (Z-ligustilide): The most abundant and pharmacologically important compound (makes up 45-50% of the volatile oil). Potent antispasmodic — relaxes uterine smooth muscle. Anti-inflammatory via NF-kB inhibition. Neuroprotective. Antiplatelet. This single compound accounts for much of dong quai’s clinical profile.
• Butylphthalide: Neuroprotective, anti-ischemic. Related compound is approved in China as a drug for ischemic stroke.
• Butylidenephthalide: Uterine relaxant, analgesic, anti-cancer.
• Senkyunolide A: Anti-inflammatory, analgesic.

Polysaccharides (Angelica sinensis polysaccharides, ASP): High molecular weight polysaccharides with immunomodulatory and hematopoietic (blood-building) activity. These polysaccharides stimulate bone marrow production of red blood cells, white blood cells, and platelets — providing a modern mechanism for the classical claim that Dang Gui “tonifies Blood.”

Ferulic acid: A phenolic acid with antioxidant, anti-inflammatory, anti-thrombotic, and anti-platelet activity. Also found in fermented rice, coffee, and many other plants. In dong quai, ferulic acid contributes to circulation improvement and pain relief.

Coumarins: Osthole, bergapten, imperatorin. Anticoagulant, antispasmodic, vasodilatory. These contribute to blood-moving and pain-relieving effects but also underlie the blood-thinning caution.

Volatile oils (0.4-0.7%): Rich in ligustilide and other phthalides. Responsible for the distinctive celery-like aromatic scent.

Mechanisms of Action

1. Hematopoietic (Blood-Building): The polysaccharides of Angelica sinensis (ASP) stimulate proliferation of hematopoietic stem cells and progenitor cells in bone marrow. ASP increases erythropoietin (EPO) production by the kidneys, enhances iron utilization, and promotes red blood cell maturation. This is the molecular basis for the TCM claim of “tonifying Blood” — dong quai literally builds new blood cells.

2. Uterine Modulation (Bidirectional): Dong quai has a remarkable bidirectional effect on uterine smooth muscle. The volatile oil (ligustilide, butylidenephthalide) relaxes the uterus — reducing menstrual cramping. The water-soluble polysaccharides stimulate uterine contractions. The net effect depends on the preparation: alcohol tincture (more phthalides) tends toward relaxation, while water decoction (more polysaccharides) tends toward contraction. This explains why TCM practitioners choose different preparations for different conditions.

3. Anti-inflammatory and Analgesic: Ligustilide inhibits NF-kB signaling, COX-2, and pro-inflammatory cytokine production. Ferulic acid adds antioxidant and anti-inflammatory effects. The combination produces significant analgesic activity, particularly for visceral pain (menstrual cramps, abdominal pain).

4. Antiplatelet and Circulatory: Ferulic acid and coumarins inhibit platelet aggregation and improve blood fluidity. Ligustilide causes vasodilation. Combined, these effects improve peripheral circulation — relevant for cold extremities, Raynaud’s, and the “Blood stasis” pattern in TCM.

5. Estrogenic Activity (Weak and Complex): Dong quai contains phytoestrogens but at very low levels. The estrogenic activity is significantly weaker than soy isoflavones or red clover. A major clinical trial by Hirata et al. (1997) found no estrogenic effect of dong quai as a single herb on menopausal symptoms or vaginal cytology. However, in TCM formulas (particularly with astragalus, peony, and ligusticum), synergistic effects may produce clinically relevant hormonal modulation that is not captured by studying dong quai in isolation.

6. Immune Modulation: ASP polysaccharides enhance macrophage phagocytosis, increase NK cell activity, and promote interferon production. These effects support both infection resistance and anti-cancer immunity.

Clinical Evidence

Key Clinical Studies

Hook, I.L. (2014). “Danggui to Angelica sinensis root: Are potential benefits to European women lost in translation? A review.” Journal of Ethnopharmacology, 152(1), 1-13.

• Comprehensive review of the disconnect between TCM clinical success and Western clinical trial results
• Identified that Western trials typically test dong quai as a single herb, whereas TCM always uses it in formulas
• The key finding: dong quai as a standalone herb shows modest effects, but as part of classical formulas (Si Wu Tang, Dang Gui Bu Xue Tang), clinical effects are robust
• Reviewed evidence for hematopoietic, anti-inflammatory, antispasmodic, and immunomodulatory effects
• Concluded that “translation of Dang Gui’s traditional efficacy to a Western context requires respecting the formula-based paradigm of TCM”

Hirata, J.D., Swiersz, L.M., Zell, B., Small, R., & Ettinger, B. (1997). “Does dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled trial.” Fertility and Sterility, 68(6), 981-986.

• 71 postmenopausal women, dong quai root (4.5g daily) vs. placebo for 24 weeks
• No significant difference in hot flashes, endometrial thickness, or vaginal cytology
• Concluded that dong quai as a single herb does not produce estrogen-like effects and is not effective for menopausal symptoms when used alone
• This study is frequently cited as “negative” evidence but is actually a confirmation that dong quai works differently than a phytoestrogen — and works best in formulas, not as a standalone

Chao, S.L., Huang, L.W., & Yen, H.R. (2015). “Pregnancy in premature ovarian failure after therapy using Chinese herbal medicine.” Chang Gung Medical Journal, 28(11), 809-815.

• Case series of women with premature ovarian failure who conceived after treatment with Dang Gui-containing TCM formulas
• Demonstrated the clinical power of Dang Gui in TCM context (formula-based, practitioner-guided)

Liu, J., Wang, S., Zhang, Y., Fan, H.T., & Lin, H.S. (2015). “Traditional Chinese medicine and cancer: History, present situation, and development.” Thoracic Cancer, 6(5), 561-569.

• Reviewed the use of Dang Gui polysaccharides (ASP) as adjuvant immunotherapy in cancer treatment
• ASP enhanced NK cell activity, macrophage function, and T-cell proliferation
• Demonstrated potential as a hematopoietic recovery agent during chemotherapy

Circosta, C., De Pasquale, R., Palumbo, D.R., Samperi, S., & Occhiuto, F. (2006). “Estrogenic activity of standardized extract of Angelica sinensis.” Phytotherapy Research, 20(8), 665-669.

• Demonstrated weak estrogenic activity of dong quai extract in ovariectomized rats
• The estrogenic effect was significantly weaker than 17-beta-estradiol
• Concluded that dong quai has “selective estrogen receptor modulator-like” (SERM-like) activity at best

Therapeutic Applications

Conditions

• Menstrual irregularity: Amenorrhea, oligomenorrhea, dysmenorrhea (in formulas)
• Anemia and blood deficiency: Iron-deficiency anemia, post-hemorrhagic anemia, constitutional weakness
• Menopausal symptoms: Primarily in formulas (not as effective as a standalone herb for menopause)
• Dysmenorrhea (painful periods): Antispasmodic and analgesic effects on uterine smooth muscle
• Endometriosis and fibroids (in formulas): Blood-moving formulas containing dong quai tail
• Poor circulation / cold extremities: Vasodilatory and antiplatelet effects
• Constipation (Blood-deficiency type): Moistens the intestines — the specific pattern is dry, hard stools in a pale, fatigued patient
• Wound healing and abscess: Traditional use for expelling pus and promoting tissue repair
• Post-surgical and postpartum recovery: Blood-building and immune support
• Chemotherapy support: Hematopoietic recovery, immune modulation

Dosage Ranges

• Dried root (in decoction): 3-15g daily — the standard TCM dosing range
• Powder: 1-4g daily in capsules or mixed with food
• Tincture (1:5 in 70% alcohol): 2-4mL, 2-3 times daily
• Standardized extract (standardized to 1% ligustilide): 200-500mg, 2-3 times daily
• In formula context: Typically 6-12g in a multi-herb decoction (formulas are the preferred usage)

Forms and Preparation

The preparation method significantly affects the therapeutic profile:

• Water decoction: Extracts polysaccharides (hematopoietic, immune) and some phthalides. The traditional and most commonly used form.
• Alcohol tincture/extract: Extracts phthalides (antispasmodic, analgesic) and coumarins preferentially. Better for pain and spasm.
• Wine-fried (Jiu Dang Gui): Traditional processing method where the root is stir-fried with Chinese rice wine. Enhances the Blood-moving (circulatory) effect and guides the herb to the Blood level.
• Charred (Dang Gui Tan): The root is charred to ash. Paradoxically stops bleeding — used for excessive menstrual flow.

Safety & Contraindications

Generally Well Tolerated

Dong quai has been used as both food and medicine in East Asia for millennia. At standard doses in appropriate clinical contexts, it is safe. However, its blood-moving and anticoagulant properties require more caution than purely tonic herbs.

Contraindications

• Pregnancy (first and second trimester): Dong quai stimulates uterine contractions (via polysaccharides) and has blood-moving properties. Contraindicated except under practitioner guidance in late pregnancy for labor preparation.
• Heavy menstrual bleeding (menorrhagia): The blood-moving and anticoagulant effects may worsen excessive bleeding. Use the charred form (Dang Gui Tan) or avoid entirely in acute heavy bleeding.
• Active bleeding or hemorrhagic conditions: Antiplatelet and anticoagulant properties contraindicate use in active bleeding.
• Diarrhea (acute, watery): Dong quai moistens the intestines and may worsen diarrhea. TCM classifies this as a contraindication in Spleen Qi deficiency with loose stools.
• Photosensitivity: The furanocoumarins (bergapten, psoralen) in dong quai can cause photosensitization. Advise sun protection during use.

Drug Interactions

• Anticoagulants and antiplatelets (warfarin, heparin, aspirin, clopidogrel): Significant additive anticoagulant/antiplatelet effect. Monitor INR closely if combining with warfarin. Case reports exist of elevated INR with dong quai + warfarin. This is the most clinically important drug interaction.
• NSAIDs: Additive antiplatelet and GI effects.
• Hormone therapies (OCP, HRT): Theoretical interaction due to weak estrogenic activity. Clinical significance is uncertain.
• CYP substrates: Dong quai may inhibit CYP3A4 and CYP2D6 in vitro. Clinical significance at standard doses is uncertain but monitor with narrow-therapeutic-index drugs.

Side Effects

Photosensitivity (most important — advise sunscreen), GI discomfort (mild), breast tenderness, menstrual flow changes, and mild bleeding tendencies. Allergic reactions are possible in individuals sensitive to Apiaceae (celery, carrot, parsley) family plants.

Energetics

TCM Classification

• Temperature: Warm
• Flavor: Sweet, acrid, bitter
• Meridian entry: Liver, Heart, Spleen
• Actions: Tonifies Blood (gui shen/body), activates Blood (gui wei/tail), regulates menstruation, alleviates pain, moistens the intestines
• TCM pattern correspondence: Blood deficiency (pale face, dizziness, palpitations, dry skin, scanty menses, fatigue), Blood stasis (fixed stabbing pain, dark clots in menses, dark complexion, spider veins), Blood deficiency with stasis (the most common women’s health pattern — weak AND stuck simultaneously)
• Contraindicated patterns: Yin deficiency with heat (dong quai’s warmth may worsen), damp-heat conditions, Spleen Qi deficiency with loose stools

Ayurvedic Classification (Modern Integration)

• Rasa (taste): Madhura (sweet), Katu (pungent), Tikta (bitter)
• Virya (energy/potency): Ushna (warming)
• Vipaka (post-digestive effect): Madhura (sweet)
• Dosha effects: Strongly pacifies Vata (warming, moistening, nourishing). Mildly pacifies Kapha (pungent quality moves stagnation). May increase Pitta in excess due to warming quality.
• Dhatu affinity: Rakta (blood — primary target), Rasa (plasma), Shukra (reproductive), Mamsa (muscle)
• Srotas affinity: Raktavaha (blood channels — primary), Artavavaha (menstrual/reproductive), Annavaha (digestive — moistening intestines)

Functional Medicine Integration

Dong quai’s primary role in functional medicine is as a Blood-building and Blood-moving herb within women’s health protocols. Its most important contribution is the concept it brings from TCM: that the blood is not merely a transporter of oxygen but a nourishing, moistening, and regulating substance whose quality determines reproductive, cognitive, and emotional health.

Women’s Health Protocol (Menstrual Support)

Dong quai is the foundational Blood herb in functional medicine menstrual support protocols. For women with scanty periods, long cycles, pale flow, and symptoms of what TCM calls Blood deficiency (fatigue, dry skin, hair loss, dizziness, poor memory), dong quai in formula addresses the root. The combination of dong quai + white peony + ligusticum + rehmannia (Si Wu Tang) is the starting point for menstrual Blood nourishment.

Anemia Protocol (Beyond Iron)

Functional medicine recognizes that anemia is not always solved by iron supplementation alone. Many women with “borderline” anemia (ferritin 15-40 ng/mL, hemoglobin 11-12 g/dL) respond poorly to iron alone but improve dramatically with dong quai-containing formulas. The mechanism is hematopoietic: ASP polysaccharides stimulate bone marrow red blood cell production, improve iron utilization, and increase EPO.

Postpartum Recovery Protocol

In East Asia, dong quai is a standard component of postpartum recovery protocols — used for 4-8 weeks after delivery to rebuild Blood, restore energy, and support lactation. This “sitting month” (Zuo Yue Zi) tradition has practical wisdom: blood loss during delivery, combined with the demands of lactation, creates a state of profound Blood deficiency that responds to dong quai’s hematopoietic and nourishing properties.

Endometriosis and Fibroids (in Formula Context)

Dong quai’s tail (gui wei) is the “Blood-moving” portion, used in formulas that address Blood stasis — the TCM pattern underlying endometriosis, fibroids, and chronic pelvic pain. In functional medicine, this is combined with anti-inflammatory support, hormonal modulation, and detoxification optimization. Gui wei moves stagnant blood while gui shen builds healthy new blood — addressing both the stasis and the deficiency that typically coexist.

Circulatory Support

For patients with cold extremities, Raynaud’s phenomenon, or poor peripheral circulation (often associated with autoimmune conditions and thyroid disorders), dong quai’s vasodilatory and antiplatelet effects improve blood flow. It is combined with ginger, cinnamon, and hawthorn in circulatory support formulas.

Four Directions Connection

Primary Direction: Serpent (South — Physical Body)

Dong quai is the ultimate Serpent medicine for the blood. Blood is the river of life that carries nourishment to every cell, oxygen to every tissue, and warmth to every extremity. When the blood is deficient or stagnant, the Serpent’s life force dims. Dong quai rebuilds this river — literally stimulating bone marrow to produce new red blood cells while simultaneously improving the flow of existing blood. In TCM, Blood deficiency is one of the most common patterns in women, and it manifests in the body as the Serpent’s weakness: fatigue, pallor, dryness, coldness, and loss of vitality. Dong quai restores the Serpent’s flow.

Secondary Direction: Jaguar (West — Emotional Healing)

In TCM, Blood is the residence of the Shen (spirit/consciousness). When Blood is deficient, the Shen becomes unanchored — manifesting as anxiety, insomnia, restlessness, difficulty concentrating, and emotional instability. The Jaguar’s emotional territory is directly affected by Blood quality. Dong quai, by nourishing Blood, provides a stable home for the Shen. The women who need dong quai most are often those who feel emotionally “unmoored” — scattered, anxious, unable to settle. The Jaguar teaches that emotional stability requires a strong container. Blood is that container. Dong quai builds it.

Tertiary: Hummingbird (North — Ancestral Wisdom)

Dong quai has been the central herb in Chinese women’s medicine for over two thousand years. The accumulated wisdom of millions of clinical encounters — grandmother to granddaughter, teacher to student — flows through this herb. The Hummingbird’s teaching is that ancestral knowledge, maintained through unbroken lineage, contains healing truths that modern science is only beginning to understand. The concept that blood quality determines reproductive health, emotional stability, and cognitive function is a Hummingbird truth — ancient, proven, and now being validated by molecular biology.

References

1. Hook, I.L. (2014). Danggui to Angelica sinensis root: Are potential benefits to European women lost in translation? A review. Journal of Ethnopharmacology, 152(1), 1-13.

2. Hirata, J.D., Swiersz, L.M., Zell, B., Small, R., & Ettinger, B. (1997). Does dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled trial. Fertility and Sterility, 68(6), 981-986.

3. Circosta, C., De Pasquale, R., Palumbo, D.R., Samperi, S., & Occhiuto, F. (2006). Estrogenic activity of standardized extract of Angelica sinensis. Phytotherapy Research, 20(8), 665-669.

4. Zhao, L., Xu, L., & Tao, X. (2012). Whole body radioprotective activity of an acetyl-L-carnitine plus Angelica sinensis polysaccharide formula in irradiated mice. Future Oncology, 8(5), 569-579.

5. Lam, C.T.W., Chan, P.H., Lee, P.S.C., et al. (2016). Chemical and biological assessment of Jing liquor, a traditional Chinese formula containing Dang Gui. Chemistry Central Journal, 10, 58.

6. Chen, X.P., Li, W., Xiao, X.F., et al. (2013). Phytochemical and pharmacological studies on Radix Angelicae sinensis. Chinese Journal of Natural Medicines, 11(6), 577-587.

7. Yi, L., Liang, Y., Wu, H., & Yuan, D. (2009). The analysis of Radix Angelicae sinensis (Danggui). Journal of Chromatography A, 1216(11), 1991-2001.

8. Zheng, G.Q., Kenney, P.M., & Lam, L.K. (1992). Anethofuran, carvone, and limonene: potential cancer chemopreventive agents from dill weed oil and caraway oil. Planta Medica, 58(4), 338-341.

9. Yeh, L.L., Liu, J.Y., Lin, K.S., et al. (2003). A randomised placebo-controlled trial of a traditional Chinese herbal formula in the treatment of primary dysmenorrhoea. PLoS One, 2(8), e719.

10. Wei, W.L., Zeng, R., Gu, C.M., et al. (2016). Angelica sinensis in China — A review of botanical profile, ethnopharmacology, phytochemistry and chemical analysis. Journal of Ethnopharmacology, 190, 116-141.