Comprehensive Guide to Angelica Species
(Angelica sinesis, e.g. Dong Quai)

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Angelica SpeciesDr. James Meschino DC, MS, ND
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General Features
The Angelica Species is native to China. The plant’s active ingredients are found in the roots and rhizomes. Dong Quai has traditionally been used to treat menstrual cramps or dysmenorrhea and PMS, as well as hot flashes and other menopausal symptoms. The scientific evidence to support these applications is not strong compared to the use of other herbal agents such as Black Cohosh, Gamma Oryzanol and Chasteberry, which have been shown to provide consistently reliable outcomes in the management of these cases
Principle Active Constituents

The primary active constituents for menopausal and menstrual symptoms are coumarin and phytoestrogens. Angelica phytoestrogens exhibit 1:400 the biological activity of animal-based estrogens (i.e., Premarin).

Clinical Application and Mechanism of Action
Menopausal Symptoms and Menstrual Irregularities Phytoestrogens are known to provide hormonal support in the regulation of reproductive tissues and organs, although more research is required to evaluate the effects of Dong Quai in this regard. At present there are no well-controlled studies illustrating that Dong Quai is highly effective in the management of PMS, menopausal symptoms and related female conditions. Its use is based primarily upon historical applications and some animal studies.
As a general statement, phytoestrogens (plant-based estrogens) compete with the body’s own estrogens for binding sites on estrogen receptors on reproductive and other tissues, helping to guard against estrogen over-stimulation, which can exacerbate or cause PMS and related symptoms. During menopause, when the body’s estrogen secretion drops off, phytoestrogens can provide estrogenic support to help reduce hot flashes and other menopausal symptoms.1,2,4,5 (see Black Cohosh, Soy Isoflavones and Red Clover in this document for a more detailed explanation of phytoestrogens).
Angelica may reduce smooth muscle spasm, easing cramping and related menstrual symptoms.
Dosage and Standardized Grade

Management of PMS and Menopausal Symptoms:
Powdered root or as a tea: 1-2 gms, 3 times per day
Tincture (1:5): 4 ml (1 teaspoon), 3 times per day
Fluid extract: 1 ml (1/4 teaspoon), 3 times per day
Solid Extract (capsule) – 200 mg, two times daily, standardized to 0.8-1.1% ligustilide content.

Adverse Side Effects, Toxicity, and Contraindications
Angelica contains coumarins that can react with sunlight to cause photo-sensitivity induced skin rash or severe sunburn upon exposure to sunlight. Therefore, women using this supplement should avoid prolonged exposure to direct sunlight.1 Animal studies reveal Dong Quai is very non toxic. Side effects in humans are rare and consist of mild gastrointestinal distress and occasional allergic reactions (such as rash). 3 However, the use of Dong quai has resulted in several cases of bleeding disorders (in the brain), most likely due to the anti-coagulant effect of Dong Quai’s coumarin content.
Drug-Nutrient Interactions

Anticoagulants (warfarin, coumadin, aspirin etc) – animal studies demonstrate that Angelica Species potentiates the anti-clotting effects of warfarin and thereby, may increase the chance of a serious bleeding disorder. Several reports of this consequence in humans have been reported, even in women not taking concurrent anticoagulant therapy. Therefore, women should not take Dong Quai concurrently with any anticoagulant drug.6,7,8,9 (note that Black Cohosh, Soy Isoflavones, Gamma Oryzanol and Chasteberry are not associated with this risk).

Pregnancy and Lactation
During pregnancy and lactation, the only supplements that are considered safe include standard prenatal vitamin and mineral supplements. All other supplements or dose alterations may pose a threat to the developing fetus and there is generally insufficient evidence at this time to determine an absolute level of safety for most dietary supplements other than a prenatal supplement. Any supplementation practices beyond a prenatal supplement should involve the cooperation of the attending physician (e.g., magnesium and the treatment of preeclampsia.).

Pregnant women - increased risk of birth defects has occurred with maternal intakes as low as 25,000 IU/day.

References: Pregnancy and Lactation
1. Duke JA, Handbook of Medicinal Herbs. Boca Raton, FL. CRC Press. 1985:43-4.
2. Murray MT, The Healing Power of Herbs (2nd edition), Prima Publishing, 1995.
3. Natural Health Products Encyclopedia. www.consumerlab.com: Dong Quai
4. Hikino H: Recent research on Oriental medicinal plants. Econ Med Plant Res. 1985; 1: 53-85
5. Zhu DPQ: Dong Quai. Am J Chin Med. 1985;15: 117-125.
6. Heck A, et al. Potential interactions between alternative therapies and warfarin. Am J Health-Syst Pharm.2000;57 (13): 1221-1227
7. Lo AC, et al. Danggui (Angelica sinensis). Affects the Pharmacodynamics But Not the Pharmacokinetics of Warfarin in Rabbits. Eur J Drug Metab and Pharmacokinet. 1995;20(1): 55-60
8. Ellis GR, Stephens MR. Untitled (brief case report). BMJ 1999;319:650
9. Page RL II, Lawrence JD. Potentiation of Warfarin by Dong Quai.Pharmacotherapy 1999;19(7):870-76
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