Mostly known in the Western world as a remedy for menopausal and menstrual complaints, dong quai has been used in traditional Chinese medicine for these and other conditions since ancient times. Read on to understand if this tonic herb can help balance your hormones, and find out where its traditional uses and modern science intersect.

What Is Dong Quai?

Dong quai (當歸, also spelled danggui) is the dried root of Angelica sinensis, a plant belonging to the same family as carrots, parsley, and celery (Umbelliferae). It’s also known as Chinese angelica. The plant is native to the northwestern Chinese province of Gansu and also grows wild in mountainous areas of China, Korea, and Japan [1+, 2+, 3+].

Dong quai has been used in traditional Chinese medicine for over 2,000 years [4+, 1+].

Today, dong quai is used both in Eastern and Western countries. Dong quai is often called “female ginseng” due to its most common use for gynecological and hormonal imbalances in women, such as [2+, 5]:

  • Menopausal complaints (hot flashes, sweating, sleep disturbances, mood swings)
  • Menstrual cycle disorders (menstrual cramps, absent or irregular periods)
  • Premenstrual syndrome
  • Recovery from blood loss after childbirth

Snapshot of Dong Quai

PROS

  • May help with menopausal and menstrual symptoms
  • May improve anemia
  • Antioxidant and anti-inflammatory
  • Mostly positive reviews online
  • Few adverse effects reported

CONS

  • Often used only in multi-herbal formulas
  • Low quality of some studies
  • Insufficient evidence for many benefits
  • Obtained from an endangered species
  • Low quality of some supplements
  • May increase the risk of bleeding and bruises

Dong Quai vs Other Similar Plants

It’s important not to confuse dong quai, which is Angelica sinensis, with two closely related plants also called danggui and used in traditional Asian medicine: Angelica gigas and Angelica acutiloba. Both have lower levels of some active compounds (ligustilide, ferulic acid, and coniferyl ferulate) and more coumarins than dong quai, so their uses may differ [2+, 3+].

Unfortunately, these and other plants (Levisticum officinale and other Angelica species such as A. nitida, valid, and megaphylla) are sometimes also used to adulterate dong quai products [2+, 3+].

Active Compounds

The main active compounds of dong quai include [6+, 7, 8+, 3+, 9]:

  • Ferulic and other organic acids
  • Ligustilide (and other similar phthalides)
  • Complex sugars
  • Vitamins, amino acids, and nucleosides

Of these, ferulic acid and ligustilide are the most active ones and are widely used to evaluate the quality of dong quai products. Products should contain at least 0.05% ferulic acid and 0.1 – 0.6% ligustilide [2+, 1+].

Product Quality

Since the species is endangered due to its excessive wild harvesting, give preference to dong quai that has been prepared from cultivated plants. Additionally, this plant should be obtained from reputable sources to ensure its quality and reduce the presence of contaminants such as pesticides, fungal toxins, dangerous plant alkaloids, and heavy metals [1+, 10, 11, 12].

The composition of the roots (and thus their health benefits) varies depending on the time and site of collection, as well as on the processing method [2+]:

  • Decoctions are common and likely safe. They have less ligustilide and ferulic acid (anti-inflammatory and antioxidant compounds) but more phenolic acids (antioxidant) [13, 14+, 15].
  • Products made from boiling, baking, or stir-frying the root with alcohol are likely safe. This process increases ferulic acid but decreases ligustilide [16+, 17+].
  • Avoid products that have been smoke-dried with sulfur. This speeds up the drying process but reduces some active compounds and increases heavy metals [18, 2+].

To make sure you’re not buying a contaminated, adulterated, or low-potency product, stick to trusted brands that hold quality certificates and follow good manufacturing practices.

Use in Traditional Chinese Medicine (TCM)

The Basics of TCM

Dong quai inevitably brings us to Traditional Chinese medicine (TCM). Although some Western medicine practitioners now also use this herb, its true roots are in TCM. This system of medicine may be hard to grasp for some, but understanding its basics can broaden our perspective about the use of dong quai in modern times.

An Energy System

Essentially, TCM is based on ancient philosophical concepts. According to its principles, the body is a miniature universe where a disease is caused by the imbalance of two opposing forces (yin and yang). The inner vital energy (qi) is thought to circulate through channels (meridians) to sustain health in the different organs [19+, 20, 2+].

Multi-Herbal Formulas

TCM uses a holistic approach to disease in which the diagnosis and prescription are tailored to the patient’s constitution. A remedy (mostly obtained from plants, but some are animal and mineralbased) is not prescribed alone but in combination with up to 15 other ingredients for synergistic effects. Much to the shock of Western doctors and scientists, a single formula can be used for seemingly unrelated conditions and the same condition can be improved with different formulas [19+, 1+].

TCM Uses

Historical uses of dong quai in TCM include [4+, 1+]:

  • Replenishing, invigorating, and moving blood
  • Relieving pain
  • Laxative
  • Improving cold limbs and hemorrhoids
  • Slowing aging
  • Improving malaria, fever, chills, and low vital energy

This herb is commonly used for many other conditions, including all the following [1+, 3+]:

Some specific to TCM include expelling “wind”, clearing “heat”, dissipating “cold”, and tonifying “middle-jiao” and “qi”.

Western Skepticism

Although TCM advocates claim that its effectiveness and safety are backed by its use over thousands of years, Western doctors and scientists generally view it with skepticism. Evidently, concepts such as qi or meridians haven’t been scientifically proven. Additional reasons for concern include the low quality of most clinical trials, the use of ingredients from endangered plant and animal species, and the potential toxicity of some remedies [20, 21, 22, 23].

Hormonal Balance & How Dong Quai Works

To understand to potential health benefits of dong quai for hormonal balance, we’ll first take a closer look at how hormones are produced in women throughout different phases of the menstrual cycle and what happens in menopause, once menstrual cycles cease.

Women’s Reproductive Health and Hormones

The following hormones are essential during each menstrual cycle [24+]:

  • FSH stimulates ovarian follicles to mature; once the follicle matures, it will produce estradiol
  • Estradiol spikes toward ovulation, which causes FSH to drop. Estradiol helps the egg mature and causes LH to surge
  • LH spikes, which releases the egg, causing ovulation. During ovulation, progesterone will also slightly increase
  • Progesterone prepares the uterus for pregnancy; if conception doesn’t occur, its levels will gradually fall and hormonal changes will repeat with the next cycle
hormonal fluctuations during the female menstrual cycle
Fluctuation in female sex hormone levels during the menstrual cycle. Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2129154/

In premenopausal women, various factors (including stress, eating disorders, dietary habits, intense exercise, and others) may block FSH and LH release, which prevents ovarian follicle maturation. These and other factors can affect both estrogen and progesterone levels and activity. In turn, hormonal imbalances can cause irregular menstrual cycles [25].

In menopausal women, as ovulation ceases, estradiol and progesterone levels drop while FSH increases. As mentioned, the preovulatory spike in estrogen is needed to block FSH release – and this feedback loop no longer happens after menopause. As the female body undergoes hormonal changes, the uterus and vagina will start thinning. Symptoms such as hot flashes and mood imbalances are also common [26+].

Therefore, different sex hormone changes are behind both irregular menstrual cycles and menopausal symptoms. All involved hormones are important including progesterone, LH, and FSH but estradiol plays a key role as the main female sex hormone.

Dong Quai and Estrogen

Herbs like dong quai may be able to mimic the effects of estrogen, potentially making up for its lack or imbalance. They may also increase sensitivity to estrogen, which can help compensate for its low levels. But despite its widespread use, the estrogen-like benefits of dong quai are far from evident.

In one study, an herbal mix with dong quai (QiBaoMeiRan) increased the production of estrogen receptors in rats, which may enhance the response to estradiol [27].

Dong quai combined with astragalus (Danggui Buxue Tang) activated estrogen receptors in cells, suggesting it may increase the response to estradiol. However, the benefit was mostly due to a specific flavonoid from astragalus (calycosin) [28, 29].

In turn, dong quai alone had a weaker activity and even blocked estrogen effects in one study. This may be due to the different composition of the extracts, since those with the highest ferulic acid or lowest ligustilide content were more active [30, 31, 32, 33, 34, 35].

One more study leaves us with encouraging results. In menopausal rats, different dong quai herbal mixes prevented osteoporosis, reduced the thinning of the uterus, vagina and breast glands, and restored hormone balances by increasing estradiol and reducing FSH and LH levels [36, 37, 38, 39, 40].

Health Benefits

1) Hormonal Issues in Women

Menopausal Symptoms

Chinese texts prescribe dong quai for “deficient blood energy”, with symptoms similar to common menopausal complaints: irregular menstrual flow, nervousness, dizziness, insomnia, and forgetfulness [41+].

However, dong quai did not improve these symptoms in several studies. In a clinical trial on 71 postmenopausal women, it had no effect. It was equally ineffective in a clinical trial on 22 men with menopause-like symptoms (hot flashes) caused by a therapy with luteinizing hormone (LH) for prostate cancer [42, 43].

The downside is that these studies looked at dong quai alone, as it is used in Western countries. In traditional Chinese medicine, however, it is always prescribed in combination with other herbs.

In a recent meta-analysis of 16 studies and almost 1,600 menopausal women, a Chinese herbal formulation containing dong quai (Er-Xian Tang) was more effective than placebo and hormone therapy at improving menopausal symptoms but only in some studies [44].

Another Chinese remedy (Danggui Buxue Tang, 3 g/day) only improved mild hot flashes in a clinical trial on 100 postmenopausal women. In turn, three other herbal supplements with dong quai reduced hot flashes and sleep disturbances in 3 clinical trials on almost 150 postmenopausal women [45, 46, 47, 48].

In premenopausal women, the surgical removal of the ovaries causes menopausal symptoms by dramatically reducing estrogen and progesterone levels. A Chinese herbal mix with dong quai (Geng Nian An, 2x/day) improved menopausal symptoms and restored normal hormone (estradiol, LH, and FSH) levels in a clinical trial on 69 women who had undergone ovarian removal [49].

Menstrual Complaints

In addition to other factors, menstrual cramps can be caused by high levels of inflammatory chemicals (prostaglandins and leukotrienes) [50+].

A traditional Chinese herbal remedy with dong quai (Danggui Shaoyao San) relieved menstrual cramps better than placebo and painkillers in an analysis of 4 clinical trials involving over 400 women. 4 g/day of this remedy also normalized irregular menstrual cycles in one small trial on 20 women [51, 52+].

Two other Chinese herbal mixes with dong quai reduced menstrual pain in 2 trials on over 100 women, although they were ineffective during the 3 first menstrual cycles [53+, 54].

Dong quai’s component ligustilide prevented uterine contractions in rats, which could explain its role in relieving menstrual cramps [55].

Endometriosis is the growth of a tissue similar to the uterine lining on other pelvic organs such as the ovaries and Fallopian tubes. It causes menstrual cramps and infertility. A Chinese traditional remedy with dong quai (Fubao Danggui Jiao) helped clear this unwanted tissue in rats [56].

2) Anemia

The traditional Chinese medicine prescription with dong quai most commonly used for anemia (Danggui Buxue Tag) is recommended to reinforce the “qi” (vital energy) and nourish “blood” (body circulation) [57].

Two herbal mixes with dong quai promoted blood formation by increasing the production of the blood-forming hormone erythropoietin (EPO) [58, 59, 60].

Additionally, its complex sugars protected blood cells and reduced the production of hepcidin, a hormone that works to trap iron inside cells [61, 62, 63].

As a result, this herb may increase red blood cells, white blood cells, platelets, iron, and hemoglobin [64, 64, 63, 65, 61, 66, 67].

TCM formulas with dong quai are often only used as an add on to typical therapies for anemia. In a meta-analysis of 7 clinical trials including 460 people with anemia, this TCM formula improved the effectiveness of conventional therapy [68].

Strenuous physical exercise may cause iron deficiency by increasing the production of the hormone that traps iron into cells (hepcidin). In a clinical trial on 36 men, the same TCM formula decreased iron deficit after a long run [57].

This formula also improved anemia in rats and mice [69, 67, 66, 70, 65, 64, 63].

However, two different Chinese remedies with dong quai had little or no effect on preventing the anemia caused by chemotherapy in two clinical trials on almost 150 women with breast cancer, [71, 72].

3) Lowering Inflammation and Free Radicals

Excessive inflammation and oxidative stress underlie numerous diseases. Dong quai’s anti-inflammatory effects may help with diverse issues such as menstrual cramps, arthritis, and ulcerative colitis. Its antioxidant properties synergize with these and may contribute to its benefits for reproductive, bone, skin, and health, as well as mood balance.

It mainly works by preventing the activation of the body’s inflammatory hub, the NF-kB pathway. Beyond this, it affects many other important pathways, which reduces the production of the following inflammatory substances [73, 74, 75, 76, 77+, 78, 79]:

What’s more, it also blocks key enzymes that trigger and sustain inflammation in the body (COX-1, COX-2, MMP1, MMP13, iNOS). In this sense, it is similar to commonly-used NSAID painkillers, but its effects are wider-ranging [77, 75, 80, 78].

Free radicals damage tissues by breaking down and damaging the building blocks of cells. Dong quai prevents this damage by increasing the activity and production of antioxidant enzymes (NQO1, SOD, and CAT). Additionally, it triggers the production of a compound that helps cells survive under oxidative stress (phosphatidylinositol) [82+, 83, 84, 85, 86, 87, 88, 89].

The main components with anti-inflammatory activity are ferulic acid, ligustilide, and complex sugars [73, 78, 90, 77].

On the other hand, its main antioxidants are its phenolic compounds, while its complex sugars and proteins also contribute to the benefits [84, 85, 87, 89, 86, 88, 83, 88].

4) Ulcerative colitis

To add to its anti-inflammatory potential, a couple of studies suggest dong quai may be beneficial for ulcerative colitis, an inflammatory bowel disease (IBD). People with ulcerative colitis have chronic inflammation and ulcers in the gut inner lining. Dong quai injections relieved the symptoms in a clinical trial on 64 people [91].

In rats, this herb and its complex sugars improved ulcerative colitis and injuries in the stomach and bowel [92, 93, 94, 95].

5) Brain Function

In a clinical trial on over 1k people with stroke, injected dong quai reduced brain damage and improved brain function [96].

In animal studies, dong quai and herbal mixes with this herb prevented and improved the brain dysfunction caused by:

Clinical studies are needed to further explore these potential benefits in humans. Currently, it’s unknown if this herb may help with brain disorders. On the upside, there’s no evidence of any kind of negative effects of dong quai on the brain.

6) Energy Levels

According to TCM, fatigue is caused by internal injuries from excessive emotions, overstrain, or an improper diet. The symptoms are similar to those of “qi-deficiency” and “blood stasis”: lack of appetite, weakness, and a failure to use and transport food nutrients [119+].

In a clinical trial on 36 men doing a long run, a Chinese traditional medicine with dong quai (Danggui Buxue Tang, 7.5 g/day) shortened finish times by 14% [57].

In mice and rats, dong quai increased physical endurance and improved sugar, protein, and energy use [120, 119, 121].

7) Boosting Mood

In an observational study on over 1k people using traditional Chinese medicine for depression and sleep disorders, an herbal blend whose main component is dong quai (Jia-Wei-Xiao-Yao-San) was most commonly prescribed [122+].

In rats and mice with depression caused by chronic stress, dong quai and ferulic acid improved low mood. They reduced depressive behaviors such as drowsiness and immobility and restored normal neurotransmitter levels (noradrenaline and dopamine) [123, 124, 125, 126, 127, 128].

8) Improving Blood Circulation

According to traditional Chinese Medicine, “blood stasis” is the slowing or pooling of blood due to the disruption of the heart “qi”. This syndrome is often understood as a blood disorder that may develop into serious conditions such as heart disease, heart failure, stroke, and clogged arteries [129+, 129+].

Blood Clotting

Free radical build-up may trigger excessive platelet clumping. This is because free radicals activate the release of arachidonic acid that is converted to a molecule that clumps platelets (thromboxane A2). By scavenging free radicals, a herbal mix with dong quai (Danggui Shaoyao San) prevented the excessive platelet clumping [130+, 131, 132, 133].

Additionally, dong quai reduces the production of fibrinogen, a protein that forms blood clots. Many active components in dong quai have proven anti-blood clotting activity [134, 135, 136, 137, 134].

Dong quai and several of its components reduced blood clotting in rats and mice and prevented platelets from clumping together. However, this herb was less efficient than a conventional blood thinner (clopidogrel) [136, 138, 133, 132, 135, 137, 134].

This herb improved blood circulation by reducing blood thickness, which helps blood flow more freely. It worked both alone and as part of two Chinese medicines (Danggui Sini Tang and Danggui Honghua) [139, 140, 141, 129, 142].

Blood Flow & Heart Protection

Raynaud’s is a syndrome in which blood vessels become extremely narrow in response to cold temperatures. This causes poor blood circulation, numbness, and color changes in the fingers. A Chinese formula with dong quai is traditionally used for this syndrome based on the belief that it “warms the interior”. In mice, this formula reduced blood vessel tightening in response to cold [143].

What’s more, this herb and its complex sugars protected rat and mouse heart tissues from the damage caused by:

9) Bone and Cartilage Health

In menopausal rats, dong quai reduced bone loss that leads to osteoporosis. It had beneficial effects both alone and as part of two Chinese herbal prescriptions [151, 152, 153].

A traditional Chinese remedy with dong quai (Danggui Sini Tang) and this herb’s active components reduced cartilage damage and promoted its repair in mice and rats with both osteoarthritis and rheumatoid arthritis. However, a different traditional remedy with dong quai failed to improve gouty arthritis in rats [154, 155, 156, 157, 158, 159].

Gum disease may destroy the tooth-supporting cartilages and bones. Two herbal formulas with dong quai promoted the regeneration of bone and cartilage tissues while preventing their destruction in rats and mice with gum disease [160, 161].

10) Kidney Support

In animal studies, dong quai prevented and improved kidney damage caused by:

  • Diabetes [162, 163, 164, 165, 166]
  • Poor blood supply [167]
  • An autoimmune disease (membranous nephropathy) [168]
  • An anticancer drug (cisplatin) [169, 170]

These studies used several active components of dong quai and two Chinese medicines with this herb (Danggui Buxue Tang and Danggui Shaoyao San). The effects of dong quai on kidney health in humans are less known.

11) Liver Support

Dong quai’s complex sugars protected mice and rats from liver damage caused by:

  • Tylenol [171, 172]
  • Toxins (carbon tetrachloride) [173, 174, 175]
  • A harmful bean lectin [176]
  • A TCM herb that can damage the liver (air yam) [177]

Although TCM use supports this benefit, dong quai’s effects on the liver need to be determined in clinical trials.

12) Tissue Scarring

When the body attempts to repair an organ damaged by chronic diseases, drugs, or surgery, it creates tissue scars. If proteins that form soft tissues build up in excess, they may cause the organ to malfunction [178+].

In animal studies, Danggui Buxue Tang and other Chinese traditional medicines with dong quai prevented and improved tissue scarring in the:

13) Skin Health & Wound Healing

Dong quai may speed up wound healing and reduce skin inflammation. It increased collagen production and helped create new blood vessels, both of which are required for proper wound healing. Numerous studies in mice, rats, fish, and cells attest to its ability to heal damaged skin, either alone or in combination with astragalus (as part of the herbal mix Danggui Buxue Tang) [192, 193, 194].

Additionally, dong quai improved skin allergic reactions and psoriasis in mice as part of two Chinese remedies (Danggui Buxue Tang and Danggui Liu Hang Tang) [195, 196, 197, 198].

14) Fighting Diabetes

A diet high in sugars and fats may lead to obesity and insulin resistance, ultimately causing health conditions such as metabolic syndrome and type 2 diabetes. Dong quai and a Chinese remedy containing it (Danggui Buxue Tang) reduced weight, insulin resistance, and blood sugar and fat levels in rats and mice on high-sugar and high-fat diets. [199, 200, 201, 202].

In diabetic mice and rats, dong quai reduced blood sugar levels and complications such as clogged arteries and pancreas, liver, kidney, and eye damage. It helped both alone and as part of the Chinese medicines Danggui Buxue Tang and Naoxintong [203, 204, 205, 206, 162, 207].

15) Preventing Infections

A severe complication of infections is sepsis, a life-threatening condition in which the body damages its own tissues. A traditional Chinese medicine injection for sepsis with dong quai (Xuebijing) combined with conventional therapy reduced death from sepsis in a meta-analysis of 16 clinical trials with over 1k people. Dong quai also prevented death from sepsis in mice [208, 209].

A Chinese herbal complex with dong quai (Burdock Complex, 10 mL 2x/day) reduced infections with a bacterium that commonly causes ulcers (Helicobacter pylori) in a clinical trial on 36 people [210].

In rats with pneumonia, dong quai reduced infection symptoms. However, it failed to kill the bacteria causing this disease in an antimicrobial test [211].

In combination with another herbal extract, dong quai prevented the growth of 2 bacterial species that cause infectious diseases (E. coli and Staphylococcus aureus) [212].

The complex sugars in this herb prevented the division of a virus belonging to the same class as HIV in mice. It also enhanced their immune response, increasing their blood levels of T cells (CD4+ and CD8+) [213].

Insufficient Evidence for Fighting Cancer

Dong quai and its components helped kill cancer in cell-based studies. They could block cancer growth, maturation, and spreading to healthy tissues. This herb had a beneficial effect in the following cancer types:

Additionally, two phthalides from this herb may increase the response to cancer drugs. These compounds blocked an antioxidant enzyme (glutathione S-transferase), the excessive production of which makes cancer cells resistant to chemotherapy [244].

Not all components in this herb have anti-cancer activity. While its complex sugars and phthalides killed breast cancer cells, ferulic acid stimulated their growth. This acid may have female sex hormone activity, which may feed breast cancer [229, 245, 246, 247, 248, 249].

Overall, little is known about the effects of dong quai on cancer. The current findings are limited to cellular studies, based on which no conclusions about its effects in humans can be drawn.

Side Effects & Precautions

Due to the low toxicity observed in animal studies, the FDA regards dong quai as generally safe. However, the following adverse effects have been reported in clinical trials [1+, 54]:

  • Headaches
  • Irregular heart rate
  • Low blood pressure
  • Menstrual disorders (PMS symptoms, irregular cycles)
  • Digestive issues

In a review of over 50 liver toxicity cases caused by traditional Chinese medicine remedies, 7 involved herbal blends with dong quai. However, it’s difficult to establish which ingredient was responsible for the damage in each case [250].

One man developed enlarged breasts after taking dong quai pills. The herb is not high in compounds similar to female sex hormones. However, these compounds can be concentrated in some formulations or even adulterated with synthetic hormones [251].

A pharmacist exposed to multiple herbal remedies developed allergic asthma in response to several of them, including dong quai [252].

A woman who may have overdosed by eating a soup made with dong quai had high blood pressure, headaches, weakness, lightheadedness, and vomiting [253].

Although no cases have been reported, dong quai may increase the skin sensitivity to sunlight due to its furanocoumarins content [254+].

Precautions

Due to a lack of safety information, dong quai should be avoided during pregnancy and breastfeeding. In one case, a breastfeeding mother passed dong quai to her baby who developed high blood pressure. However, she most likely took in a much higher dose than the amount usually contained in herbal remedies [255, 256].

Although the female sex hormone activity of dong quai remedies greatly varies, women with hormone-sensitive cancers (breast, uterus, ovarian) should be cautious with dong quai. Indeed, this herb and its component ferulic acid promoted the growth of breast cancer in cellular studies [29, 33, 39, 247, 28, 248, 249].

Some compounds in dong quai slow blood clotting, which may increase the risk of bleeding and bruises in people with bleeding disorders and is not recommended in those with a scheduled operation [135, 136, 257].

If you take prescription medications or have a serious health condition, talk to your healthcare provider before taking dong quai.

Drug Interactions

Dong quai slows blood clotting, so it shouldn’t be combined with drugs with similar effects such as [135+]:

  • NSAID painkillers (aspirin, ibuprofen, diclofenac, naproxen)
  • Blood thinners (clopidogrel, dalteparin, enoxaparin, heparin, warfarin)

Indeed, blood clotting was dramatically reduced in a woman on warfarin for irregular heart rate who started taking dong quai for menopausal symptoms. It also increased the anti-blood-clotting effect of warfarin in rabbits [258, 259].

Dong quai didn’t enhance the anti-blood-clotting effects of aspirin and clopidogrel in 2 studies on over 1,200 people. However, it did increase bleeding in rats and mice given clopidogrel [260, 261, 138].

Dong quai interacts with several enzymes responsible for breaking down drugs and toxins. It increases the production or activity of some enzymes (CYP1A2, CYP2D6, CYP3A1, and CYP3A4) and has the opposite effects on some others (CYP2E1, CYP2C11, and carboxylesterases). It may alter the effects of numerous drugs broken down by these enzymes [262+, 263, 264].

Limitations and Caveats

The quality of many studies included in meta-analyses was low. They generally had small populations, design flaws (such as lack of controls, randomization, or blinding), and inaccessible data. Additionally, a lot of the studies were only available in Chinese.

Except for menopausal symptoms, menstrual complaints, and anemia (the results of which are contradicting), very few uses of dong quai have been widely tested in humans. The studies for the following conditions included only one clinical trial: sepsis, digestive infections, brain stroke, ulcerative colitis, and fatigue. The remaining health benefits have only been evaluated in animals and cells. Therefore, more trials in humans are required to validate these results.

A lot of studies used traditional Chinese medicine herbal blends combining dong quai with several other ingredients, so the contribution of dong quai to the effects observed is difficult to estimate.

Genetics

Female Sex Hormone Activity

Dong quai preparations, especially in combination with astragalus, exert their female sex hormone effects by:

Women with mutated variants of these receptors (e.g., mutations in the S118 and S167 activation sites of ESR1) may have altered sensitivity to dong quai.

Anti-inflammatory Activity

Dong quai and its active components reduce inflammation by:

Mutated variants of all these proteins may alter the response to dong quai.

Antioxidant Activity

Dong quai and its active components protect cells from oxidative damage by activating the NFE2L2 and ATF6 pathways and increasing the activity of the antioxidant enzymes SOD and CAT. The antioxidant effects of dong quai may be altered in people with mutated versions of these genes [87, 88, 86].

Blood-Forming Activity

Herbal mixes with dong quai increase HIF1A, triggering the production of the blood-forming hormone erythropoietin [60, 59].

Its complex sugars preserve blood cell formation by blocking IKBKB production and prevent hepcidin formation by reducing the production of SMAD4 and CEBPA and the activation of STAT3 [63, 62].

Mutations in these genes may alter the effects of dong quai on blood formation.

Wound-Healing Activity

Dong quai increases the production of the blood vessel-forming protein VEGF. Its combination with astragalus also increases the production of a protein that triggers collagen formation (TGFB1). Dong quai may have altered effects on wound healing in people with mutated variants of these proteins [193, 194].

Breakdown of Active Compounds

Ligustilide and ferulic acid are the main active compounds of dong quai. The enzymes that contribute the most to their breakdown in the body are CYP3A4, CYP1A2, CYP2C8, and CYP2C9. People may be more or less susceptible to dong quai’s effects depending on their variants of these enzymes [265, 266+].

Supplementation & Dosing

Dong quai is normally taken orally as pills, tablets, decoctions, and tinctures. Other forms of supplementation include [1+]:

  • Injections (under medical supervision only)
  • Topical creams and pastes
  • Eye drops

While this herb is available alone in Western countries, traditional Chinese medicine always prescribes it combined with other herbs. Some popular combinations with dong quai include

  • Danggui Buxue Tang: used for menopausal complaints, anemia, osteoporosis, and infertility [267+, 68]
  • Danggui Shaoyao San: used for menstrual cramps, irregular menstrual cycles, depression, and dementia [51+, 268+]
  • Danggui Sini Tang: used for blood circulation, heart failure, diarrhea, infectious diseases, and arthritis [269, 155+]
  • Danggui Honghua: used for blood circulation [141]
  • Er-Xian Tang: used for menopausal complaints, osteoporosis, and delayed puberty [270]

Dosage

Typical dong quai oral doses when used alone are [254+]:

  • Dried root: 3 – 15 g/day by decoction
  • Powdered root: 1 – 2 g, 3x/day
  • Tea: 1 cup (containing 1 g dong quai), 1x – 3x/day
  • Tincture (diluted to 1:2): 4 – 8 mL/day
  • Capsules and tablets: 500 mg, 1x – 6x/day

The normal dose of injected dong quai is 40 – 100 mL, 1x – 2x/day [91, 208+].

User Experiences

Most dong quai users were women looking for an alternative to hormones to cope with menopausal or menstrual symptoms. Those taking it for menopausal symptoms usually reported satisfactory reductions of hot flashes, night sweats, and mood swings. Dong quai was also effective at improving PMS symptoms, reducing menstrual cramps, and regularizing menstrual cycles in non-menopausal women.

However, a few users didn’t notice any effects and one even reported that her periods had got worse after taking dong quai. Side effects were very rare and mostly consisted of digestive issues (indigestion, gases, diarrhea). Additionally, several users complained about the taste of the supplement.

A few users took in dong quai for other purposes such as reducing fatigue, fighting anxiety, and boosting testosterone. They were generally satisfied with its effects.

Buy Dong Quai

Take-Away:

Dong quai is widely used in traditional Chinese medicine (TCM), typically as a tonic herb in combination products. Although its TCM uses depend on different principles than those used in Western medicine, research supports its benefits for menopausal complaints and anemia as an add on to conventional therapies.

It may also help lower excessive inflammation, support mood balance, and boost energy levels. Due to its antioxidant properties and effects on blood circulation, it may be helpful for protecting the blood vessels, the heart, liver, and kidneys.

Overall, dong quai appears to be safe. Its side effects are mild when used within the recommended doses.

However, much of the evidence spans from low-quality studies and various herbal combinations. Dong quai may interact with medications, especially blood thinners. Talk to your doctor before using dong quai to avoid any dangerous drug interactions. Do not use this herb if you are pregnant, breastfeeding, or have hormone-sensitive cancer (such as breast or ovarian cancer).

If you’re seeking to buy dong quai supplements, it’s important to look for reputable products. Low-quality supplements may be contaminated with toxins, other herbs, or prepared from wild dong quai, which is an endangered species.

About the Author

Carlos Tello, PhD (Molecular Biology)

PhD (Molecular Biology)

Carlos received his PhD and MS from the Universidad de Sevilla.

Carlos spent 9 years in the laboratory investigating mineral transport in plants. He then started working as a freelancer, mainly in science writing, editing, and consulting. Carlos is passionate about learning the mechanisms behind biological processes and communicating science to both academic and non-academic audiences. He strongly believes that scientific literacy is crucial to maintain a healthy lifestyle and avoid falling for scams.

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