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Dong Quai

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Background & General Info

Dong quai refers to Angelica sinensis, a perennial plant native to the mountainous regions of China, Japan, and Korea. [1][2] It is also called dang gui, can qui, and dangdanggui. [3] The plant, most especially its roots, is fondly called the “female ginseng” because of its therapeutic utility as remedy for a range of women-associated conditions such as dysmenorrhea, pelvic pain, and menopausal symptoms, including hot flashes. [4]



Botany

Angelica sinensis has a cylindric, succulent, and strongly aromatic root with several rootlets and a ribbed, purplish-green stem. The roots, which are the plant material of interest, appear yellowish brown to brown externally and possess sweet, pungent, but slightly bitter taste. [3] Each of the plant’s umbellules attached to a slender pedicel consists of around 13–26 white flowers (rarely purplish red). The fruits are ellipsoid or suborbicular in shape and have prominent, filiform dorsal ribs. [5]

History & Traditional Use

For thousands of years, the Chinese have used dong quai as a traditional Far Eastern medicinal herb, particularly as a general tonic for women and spice. Zhu (1987) mentioned that “women especially have used Dong Quai to protect their health, generation after generation”. [6] The Shennong Ben Cao Jing (200–300 AD), a first-century Chinese herbal guide on medicinal plants, first mentioned dong quai as remedy for infertility and vaginal discharges and infections. [1] The Chinese Pharmacopoeia also cited it as among the most widely used alternative medicines in Asia, especially for women’s disorders such anemia, dysmenorrhea, amenorrhea, and premenstrual and menopausal syndromes. [7] Aside from being a traditional medicine, dong quai has now been consumed as a food product for women’s health in Europe and the United States. [8]

General Herbal Uses

In the Chinese medicinal system, the dried roots of Angelica sinensis can be used to enrich the blood, promote blood circulation, and modulate the immune system and can serve as remedy to menstrual disorders (such as dysmenorrhea, menstrual cramping, and irregular menstruation) and chronic constipation, especially in the elderly and debilitated individuals. [9][10] It is usually blended with other herbs in compound formulations and is often sold as a dietary supplement in either powder or tablet form. [2] According to an early study published in the American Journal of Chinese Medicine, dong quai is an antispasmodic capable of toning the uterus, normalizing hormone control, and stabilizing menstrual cycle rhythm. [1]



Constituents/Active Components

Phytochemical analyses of dong quai identified its natural coumarin derivatives and other constituents with antithrombotic, antiarrhythmic, phototoxic, and carcinogenic effects. [10] To date, more than 70 compounds have been isolated and identified from dong quai, including ferulic acid, Z-ligustilide, butylidenephthalide, and a variety of polysaccharides. [11]

Lao et al. (2004) employed gas chromatography–mass spectrometry (GC–MS) coupled with pressurized liquid extraction (PLE) to determine and quantify major compounds of Angelica sinensis. The thirteen main components identified are provided in the table below together with their corresponding contents, with their percentage enclosed in parentheses. [8]

Dong Quai Compounds

Medicinal/Scientific Research

Cardiovascular

A number of scientific studies had shown the antiatherosclerotic, antihypertensive, antioxidant, antithrombotic, antiarrhythmic, and anti-inflammatory properties of dried roots of Angelica sinensis and their constituents. [9][10] These effects limit platelet aggregation and can therefore help in effectively decreasing the size of cerebral infarction and in ameliorating neurological deficit scores. [9] In a number of animal models, Z-ligustilide, which is a constituent of dong quai essential oil, had been revealed to significantly protect neurons against cerebral ischemic damage and to dose-dependently decrease the weight of arterial thrombus in an arteriovenous shunt thrombosis and the platelet aggregation induced by adenosine diphosphate in rats ex vivo. [12]

Antioxidant

Based on the result of Filipiak-Szok, Kurzawa, and Szłyk (2014), dong quai aqueous extracts possess antioxidant activity with values of 1330.45 ± 1.30 μmol and 1813.9 ± 2.0 μmol Trolox equivalent per 100 g of dry mass, as determined through cupric ion reducing antioxidant capacity (CUPRAC) and ferric reducing antioxidant power (FRAP) methods, respectively. In this study, the aqueous and ethanol extracts of dong quai had the highest values for total phenolic content and total flavonoid content, respectively, with rutin being the most abundant among the flavonols detected. [13]

Immunomodulatory

A survey of ten commonly used herbal products with immunomodulatory properties by Wilasrusmee et al. (2002) determined the immunostimulatory property of dong quai in vitro, as evaluated through lymphocyte proliferation assays. [14] Moreover, the study of Yang et al. (2006) indicated that polysaccharides isolated from dong quai encouraged the proliferation of total spleen cells, macrophages, and T cells; augmented the production of interleukin-2 and interferon-gamma; but reduced the production of interleukin-4. These polysaccharides in general exert their immunomodulatory activity via regulation of expression of Th1- and Th2-related cytokines. [15]

Anticancer

Studies had validated the efficacy of dong quai in the treatment of chronic myelogenous leukemia, glioblastoma multiforme, and high-grade astrocytomas. It appears that dong quai impedes the growth of these tumors by decreasing the level of vascular endothelial growth factor (VEGF) and cathepsin B, a proapoptotic protein. Treatment using lipid-soluble dong quai constituents extracted with acetone or chlorophenol had been shown to considerably inhibit the proliferative activity of the human brain malignant glioma GBM 8401 cells by 30–50%. At concentrations of 20 mg/k and 60 mg/kg, dong quai in acetone or chlorophenol suppressed the growth of tumors by 30 % and 60 %, respectively, in nude mice. [16]

Antituberculosis

Deng et al. (2008) investigated the antituberculosis activity of petroleum ether and chloroform extracts of dong quai and demonstrated the in vitro antibacterial activity of polyynes isolated from dong quai against two pathogenic strains of Mycobacterium tuberculosis in a microplate Alamar Blue assay. Reaching minimum inhibitory concentration (MIC) values of 1.4–26.7 μg/mL, falcarindiol and 9Z,17-octadecadiene-12,14-diyne-1,11,16-triol,1-acetate were considered in this study as the most potent constituents against Mycobacterium tuberculosis, followed by oplopandiol, which showed moderate inhibitory action. The five polyynes identified were not cytotoxic against VERO cells. [17]

Menstrual Migraine

A 2002 randomized, controlled trial confirmed the effectiveness of a phytoestrogen combination consisting of 60 mg soy isoflavones, 100 mg dong quai, and 50 mg black cohosh as prophylactic treatment of menstrual migraine. In this study, the phytoestrogen preparation was administered to patients for 24 weeks. This treatment resulted in a reduction of average frequency of migraine attacks related to menstruation, from 10.3 ± 2.4 in placebo-treated patients to 4.7 ± 1.8 in patients treated with the phytoestrogen preparation. [18]

Menopausal Symptoms

There has been so far diversified views on the efficiency of dong quai against menopausal symptoms. [1] A 2007 randomized, placebo-controlled, double-blind pilot study determined the efficacy and safety of Phyto-Female Complex, which is an herbal formula containing standardized extracts of dong quai, in relieving hot flushes and sleep disturbances in premenopausal and postmenopausal women. This trial involved 50 healthy women who orally took Phyto-Female Complex or placebo twice daily for 3 months. The treatment led to better mean reduction in menopausal symptoms in treated women than in women belonging to placebo group and resulted in gradually accumulative improvements in menopausal symptoms. Hot flushes and night sweats diminished by 73% and 69% by 3 months, and quality of sleep significantly improved. Moreover, 47% of treated women experienced complete absence of hot flushes. [19]

Osteoporosis

Extract from dong quai can also prevent bone loss according to a 2014 study in ovariectomized rats. Daily oral administration of Angelica sinensis extract at doses of 30, 100, and 300 mg/kg for 4 weeks led to a significantly higher bone mineral density of the femur and a reduction of markers of bone turnover in osteoporosis, including serum alkaline phosphatase, collagen type I C-telopeptide, and osteocalcin. [20] APS-3c, an acidic glycan from polysaccharides of Angelica sinensis, was determined to exert anti-osteoarthritic activity by stimulating IGF-1 and IGF1R gene expression and by protecting the cartilage against osteoarthritic damage in chondrocytes. [21]

Contraindications, Interactions, And Safety

The use of dong quai, especially in appropriate amounts, is considered safe, but there is a lack of clinical data that strongly establishes its potential safety in humans. Adverse effects such as loss of appetite, diarrhea, bloating, photosensitivity, and gynecomastia had been documented. [2]

Worthy of mention is the fact that dong quai stimulates the uterus, and therefore, pregnant women and individuals with endometriosis should avoid its use. [1] Additionally, dong quai can also thin the blood owing to its coumarin content and should never be taken with any blood-thinning drug or anticoagulant. Page and Lawrence reported a case of potentiation of warfarin’s effects due to dong quai in a 46-year-old African-American woman with atrial fibrillation. Concurrent intake of dong quai and warfarin for 4 weeks led to more than twofold elevation in prothrombin time and international normalized ratio. [10] Another potential adverse effect of dong quai is gynecomastia in men, which was reported by Goh and Loh (2001) in a man who developed the condition following ingestion of dong quai pills. Such adverse effect had been attributed to the significantly higher levels of phytoestrogen in processed dong quai pills than in the original herbal product. [22]

References:

[1] H. C. Wuh and M. M. Fox, Sexual Fitness, London: Penguin, 2002.

[2] B. R. Cassileth, "Dong Quai (Angelica sinensis)," Cancer Network, 20 January 2011. http://www.cancernetwork.com/integrative-oncology/dong-quai-angelica-sinensis

[3] "WHO Monographs on Selected Medicinal Plants - Volume 2," WHO Essential Medicines and Health Products Information Portal, 2004. http://apps.who.int/medicinedocs/en/d/Js4927e/5.html

[4] R. J. Al-Bareeq, A. Ray, et al., "Dong Quai (angelica sinensis) in the treatment of hot flashes for men on androgen deprivation therapy: results of a randomized double-blind placebo controlled trial," Canadian Urological Association Journal, vol. 4, no. 1, p. 49–53, 2010. https://www.ncbi.nlm.nih.gov/pubmed/20165579

[5] "Angelica sinensis (Oliver) Diels," Flora of China. http://www.efloras.org/florataxon.aspx?flora_id=2&taxon_id=200015389

[6] D. Zhu, "Dong quai," The American Journal of Chinese Medicine, vol. 15, no. 3–4, p. 117–125, 1987. https://www.ncbi.nlm.nih.gov/pubmed/3425569

[7] China Pharmacopoeia Committee. Pharmacopoeia of the People’s Republic of China: Radix Angelica sinensis, Beijing, 2000.

[8] S. Lao, S. Li, K. K. Kan, et al., "Identification and quantification of 13 components in Angelica sinensis (Danggui) by gas chromatography–mass spectrometry coupled with pressurized liquid extraction," Analytica Chimica Acta, vol. 526, p. 131–137, 2004. http://www.sciencedirect.com/science/article/pii/S0003267004012577

[9] Y.-C. Wu and C.-L. Hsieh, "Pharmacological effects of Radix Angelica Sinensis (Danggui) on cerebral infarction," Chinese Medicine, vol. 6, p. 32, 2011. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3174116/

[10] R. 2. Page and J. Lawrence, "Potentiation of warfarin by dong quai," Pharmacotherapy, vol. 19, no. 7, p. 870–876, 1999. https://www.ncbi.nlm.nih.gov/pubmed/10417036

[11] W.-W. Chao and B.-F. Lin, "Bioactivities of major constituents isolated from Angelica sinensis (Danggui)," Chinese Medicine, vol. 6, p. 29, 2011. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3170324/

[12] L. Zhang, J. Du, J. Wang, et al., "Z-ligustilide extracted from Radix Angelica Sinensis decreased platelet aggregation induced by ADP ex vivo and arterio-venous shunt thrombosis in vivo in rats," Yakugaku Zasshi, vol. 129, no. 7, p. 855–859, 2009. https://www.ncbi.nlm.nih.gov/pubmed/19571521

[13] A. Filipiak-Szok, M. Kurzawa and E. Szłyk, "Evaluation of antioxidants in Dong quai (Angelica sinensis) and its dietary supplements," Chemical Papers, vol. 68, no. 4, p. 493–503, 2014. https://link.springer.com/article/10.2478/s11696-013-0485-7

[14] C. Wilasrusmee, S. Kittur, J. Siddiqui, et al., "In vitro immunomodulatory effects of ten commonly used herbs on murine lymphocytes," Journal of Alternative and Complementary Medicine, vol. 8, no. 4, p. 467–475, 2002. https://www.ncbi.nlm.nih.gov/pubmed/12230907

[15] T. Yang, M. Jia, J. Meng, et al., "Immunomodulatory activity of polysaccharide isolated from Angelica sinensis," International Journal of Biological Macromolecules, vol. 39, no. 4–5, p. 179–184, 2006. http://www.sciencedirect.com/science/article/pii/S0141813006000687

[16] W. Lee, J. Jin, et al., "Biological inhibitory effects of the Chinese herb danggui on brain astrocytoma," Pathobiology, vol. 73, no. 3, p. 141–148, 2006. https://www.ncbi.nlm.nih.gov/pubmed/17085958

[17] S. Deng, Y. Wang, et al., "Anti-TB polyynes from the roots of Angelica sinensis," Phytotherapy Research, vol. 22, no. 7, p. 878–882, 2008. https://www.ncbi.nlm.nih.gov/pubmed/18567055

[18] B. Burke, R. Olson and B. Cusack, "Randomized, controlled trial of phytoestrogen in the prophylactic treatment of menstrual migraine," Biomedicine & Pharmacotherapy, vol. 56, no. 6, p. 283–288, 2002. https://www.ncbi.nlm.nih.gov/pubmed/12224599

[19] C. Rotem and B. Kaplan, "Phyto-Female Complex for the relief of hot flushes, night sweats and quality of sleep: randomized, controlled, double-blind pilot study," Gynecological Endocrinology, vol. 23, no. 2, p. 117–122, 2007. https://www.ncbi.nlm.nih.gov/pubmed/17454163

[20] "Anti-osteoporotic effects of Angelica sinensis (Oliv.) Diels extract on ovariectomized rats and its oral toxicity in rats," Nutrients, vol. 6, p. 4362–4372, 2014. https://www.ncbi.nlm.nih.gov/pubmed/25325255

[21] Y. Wen, J. Li, et al., "Angelica sinensis polysaccharides stimulated udp-sugar synthase genes through promoting gene expression of IGF-1 and IGF1R in chondrocytes: promoting anti-osteoarthritic activity," PLoS One, vol. 9, no. 9, p. e107024, 2014. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0107024

[22] S. Goh and K. Loh, "Gynaecomastia and the herbal tonic "Dong Quai"," Singapore Medical Journal, vol. 42, no. 3, p. 115–116, 2001. https://www.ncbi.nlm.nih.gov/pubmed/11405562

Article researched and created by Dan Albir for herbs-info.com. © herbs-info.com 2018

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