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Dang Gui

Botanical Name: Angelica sinensis (Oliv.) Diels.
Pharmacopoeial Name: Angelicae radix.
Synonym: Angelica polymorpha Maxim. var sinensis Oliv.
Common Names: Dang gui, dong quai, tang kuei, tang kwei, Chinese angelica.
Note: The phonetic “dong quai” Romanization is not the correct Pinyin transliteration, which is “dang gui.” “Tang kuei” is the earlier Wade Giles transliteration, less used today.

herb characteristics

Family

Apiaceae.

Related Species

In East Asian commerce, several species may be traded as substitutes. Levisticum officinale Koch., or lovage, sometimes known as “European dang gui,” is a recorded adulterant, not a substitute.

Parts Used

Root; in East Asian traditional medicine, the head, body, and tail of the root are regarded as having different medicinal properties.

Common Forms

Dried: Prepared root, smoke-dried; baked in wine.

Fluid Extract: 1:1 70% ethanol, according to the Pharmacopoeia of the People's Republic of China (PPRC) .

Standardized Extract: Liquid or dry extracts may be standardized to ligustilide content (0.8%-1.0%) and to ferulic acid (0.05%-0.01%).

interactions review

Strategic Considerations

One of the better known herbs from the materia medica of classical Chinese medicine, dang gui (in traditional terms) supplements (nourishes) xue (blood), moves and dispels blood stasis, and regulates menses. It is also used for moistening dry conditions, dispersing swelling, and promoting the discharge of pus. ¹ The herb has been incorporated into Western herbal medicine, primarily as a women's tonic herb for menstrual disorders and infertility. Dang gui use for menopausal issues is not currently supported by clinical trial data. ² The herb is also used for its cardioprotective, hepatoprotective, and mild immunomodulatory effects. In the contemporary practice of Chinese medicine, it is widely used in many herbal formulae, as well as in combination with conventional treatments, such as myelosuppressive chemotherapy. ³

Much of the literature on dang gui is in Chinese-language journals, and many reports relate to formulae involving several ingredients, including dang gui. Few controlled trials are available, but there is a large body of traditional-use data, as well as a considerable number of uncontrolled trials in the East Asian medical literature. Many of the available studies, animal and human, involve parenteral administration, which cannot be readily extrapolated to oral administration used in the West. The herb is not referenced in official Western pharmacopoeias (although it was briefly in the USD in 1937) but has been official in the PPRC since 1977. The American Herbal Pharmacopoeia has produced a Western-oriented monograph, including a supplement on traditional Chinese usage, ⁴ and McKenna et al. ⁵ have reviewed much of the literature. Chen and Chen ⁶ have reviewed both the pharmacology and the traditional uses of the herb.

Interactions concerns about dang gui are largely the result of extrapolations from experimental pharmacological data of isolated ingredients, such as ferulic acid, ligustilide, or polysaccharide fractions of the herb, and usually stress the risks of concomitant use with anticoagulants. The traditional precautions and contraindications for dang gui, which include bleeding disorders, hemorrhagic disease, excessive menses, and first-trimester pregnancy, may be seen as equally appropriate in Western contexts.

Effects on Drug Metabolism and Bioavailability

Minimal data are available on the effects of dang gui on the different aspects of drug detoxification. Two Japanese studies are available. One screened a number of umbelliferous crude drugs in vitro for general cytochrome P450 (CYP450) inhibitory effects and found weak but measurable inhibition by dang gui, as well as other Angelica spp. After high-performance liquid chromatography analysis, the authors attributed this to the activity of a coumarin-derivative constituent, imperatorin. ⁷ A more specific in vitro study using rodent hepatic microsomes with various drug substrates found partial inhibition by dang gui extracts of CYP450 3A4, 2C9, and 2D6. ⁸ A Chinese study examined the effects of dang gui polysaccharide administration in normal and liver-damaged (by prednisolone) rodents and found that the herb fraction increased hepatic microsomal CYP450, glutathione- S-transferase, and reduced-glutathione content. ⁹ Pharmacokinetic interactions have not been reported, and in the case of warfarin have been ruled out as a mechanism of interaction ¹⁰ (see following discussion). Nonetheless, such effects seem theoretically possible, and further research is required to clarify the extent and significance of any potential pharmacokinetic interactions.

herb-drug interactions

Evidence: Warfarin (Coumadin, Marevan, Warfilone). Extrapolated, based on similar properties: Anisindione (Miradon), dicumarol, ethyl biscoumacetate (Tromexan), nicoumalone (acenocoumarol; Acitrom, Sintrom), phenindione (Dindevan), phenprocoumon (Jarsin, Marcumar); other drugs affecting hemostasis.

Minimal to Mild Adverse Interaction—Vigilance Necessary

Probability: 4. Plausible
Evidence Base:

Mixed

Effect and Mechanism of Action

Addition of dang gui to previously stabilized warfarin anticoagulation regimens may require the dose of oral anticoagulant to be adjusted to prevent excessive anticoagulation. Only one report is available, suggesting the interaction is unlikely to be clinically significant. Dang gui has multiple effects on hemorheological parameters, the mechanisms of which are not fully elucidated, and whether this is a strict interaction or merely an additive common pharmacodynamic effect has not been established.

Research

The literature on hemorheological activities of dang gui is dominated by an emphasis on isolated constituents (e.g., ferulate, butylidenephthalide) with parenteral administration at high dose levels in animal and human studies. The trend of the data supports a possible antiplatelet effect, probably operating through arachidonic acid metabolism. ^11-17 Other hemorheological effects were observed in a study using parenteral dang gui (200 mL aqueous solution, intravenous administration daily for 20 days), in a group of 50 patients after acute ischemic stroke, where administration resulted in significant reductions ( p<0.001) in platelet adhesion, red blood cell (RBC) and platelet electrophoresis times, erythrocyte sedimentation rate (ESR) and serum fibrinogen, and blood and plasma adhesion ratios. ¹⁸ Oral administration of an aqueous decoction of dang gui and the related Angelica acutilobawere given to six healthy patients, and whole-blood viscosity was reduced ( p<0.05) after 180 minutes compared with controls. ¹⁹

A study of warfarin and dang gui coadministration in rabbits investigated the effect of adding single-dose warfarin to animals pretreated with dang gui, as well as addition of dang gui to warfarin-stabilized animals, as measured by coagulation parameters. In the first case, adding warfarin to a dang gui pretreated group led to a ( p<0.05) lowering of prothrombin time (PT) compared with warfarin alone. Pharmacokinetic parameters of warfarin were not changed in the presence of dang gui pretreatment. Addition of dang gui to stable, warfarinized animals led to no significant change in PT or warfarin levels. In this study, warfarin was given at high dose levels subcutaneously, and a 2:1 extract of dang gui was given at 2 g/kg orally. The implication of this study appears to be that adding dang gui to stabilized warfarin is less problematic than adding drug to stabilized dang gui (in rabbits), although pharmacokinetic interactions were not observed. ¹⁰

Reports

In a single but much-cited report, a 46-year-old female warfarinized patient experienced an unexplained rise in international normalized ratio (INR) to 4.05. Investigations revealed no identifiable cause, and she was advised to discontinue her 5-mg warfarin dose for 24 hours. The INR remained elevated on retesting 1 week later. The patient admitted taking a herbal preparation (Nature's Way brand of dang gui), 565 mg twice daily. She was advised to stop the herb, and the INR declined to 3.41, then to 2.48 after 1 week. Concomitant medications included digoxin and furosemide. ²⁰ Fugh-Berman and Ernst ²¹ evaluated the interaction as “likely,” scoring 8 of 10 on their report reliability scale.

Clinical Implications and Adaptations

The lack of reports of spontaneous bleeding associated with dang gui consumption alone, with only one report of the warfarin–dang gui interaction to date, suggests that concerns about the incidence and severity of the interaction are exaggerated. As always, self-prescription is a separate issue, and many warfarinized patients are poorly compliant with their monitoring test schedules. As a guideline, prescribing dang gui to warfarinized patients should generally be avoided unless there are compelling reasons for coadministration. In such cases, close monitoring of INR is required.

However, as is often the case from an integrative perspective, the potential interaction may be beneficial under specific circumstances. Dang gui has cardioprotective and thrombolytic effects that may be beneficial depending on the situation. ^6,22 For example, patients receiving a typical 1 mg/day oral dose of Coumadin after temporary installation of vascular access ports/catheters for prevention of thrombosis at the catheter tip may benefit from the addition of dang gui, combined with natural antiplatelet and fibrinolytic agents, particularly if there are other indications for prescribing the herb. However, checking PT/INR weekly would be appropriate if coadministration is considered, because 1 mg Coumadin could affect PTs if circumstances altered (e.g., vitamin K deficiency).

Erythropoiesis-Stimulating Agents

Epoetin alpha (EPO, epoeitin alfa, recombinant erythropoietin; Epogen, Eprex, Procrit), epoetin beta (NeoRecormon), darbepoetin alpha (darbepoetin alfa; Aranesp).

Potential or Theoretical Beneficial or Supportive Interaction, with Professional Management

Probability: 4. Plausible
Evidence Base:

Inadequate

Effect and Mechanism of Action

Recombinant analogs of endogenous erythropoietin are used parenterally to correct anemia in seriously ill patients (cancer and chronic renal failure). The interaction is a pharmacodynamic additive effect on hematopoiesis. Dang gui may also help facilitate responsiveness to the drug.

Research

Several Chinese experimental studies have examined the effects of dang gui, particularly the polysaccharide fraction, in stimulating hematopoiesis and erythropoiesis. Hemoglobin, RBC count, and progenitor cells were all increased by the administration of the herb in normal and anemic mice as well as in cell culture systems. ^23-25 Murine studies have demonstrated myeloprotective effects of dang gui and its polysaccharide fractions against cyclophosphamide-induced and radiation-induced leukopenia. ^26,27

Reports

Bradley et al. ²⁸ reported a single case of an anemic hemodialysis patient who was apparently resistant to the recombinant drug. The patient started self-prescription of a decoction of dang gui and Paeonia lactiflora,and after 1 month the hematocrit increased from 29.7% to 34.4%, and the amount of the drug was reduced by more than 90%. The effect of the other component of the formula cannot be ascertained.

Integrative Therapeutics, Clinical Concerns, and Adaptations

Published data substantiating this interaction are currently inadequate. However, the Chinese materia medica for Supplementing the Xue/Bloodis an established part of protocols for supporting patients undergoing myelosuppressive chemotherapies in Chinese medicine. Dang gui is incorporated into many of these formulae, which are based on different patterns of bone marrow suppression according to traditional diagnostic criteria. Specialist review of these formulae is available from clinical texts, including Peiwen. ³ The risk/benefit ratios of this approach are favorable, and the combination requires further investigation by preclinical and controlled clinical studies.

theoretical, speculative, and preliminary interactions research, including overstated interactions claims

Acetaminophen

APAP, paracetamol (Tylenol); combination drugs: acetaminophen and codeine (Capital with Codeine, Phenaphen with Codeine, Tylenol with Codeine); acetaminophen and hydrocodone (Anexsia, Anodynos-DHC, Co-Gesic, Dolacet, DuoCet, Hydrocet, Hydrogesic, Hy-Phen, Lorcet 10/650, Lorcet-HD, Lorcet Plus, Lortab, Margesic H, Medipain 5, Norco, Stagesic, T-Gesic, Vicodin, Vicodin ES, Vicodin HP, Zydone); acetaminophen and oxycodone (Endocet, Percocet 2.5/325, Percocet 5/325, Percocet 7.5/500, Percocet 10/650, Roxicet 5/500, Roxilox, Tylox); acetaminophen and pentazocine (Talacen); acetaminophen and propoxyphene (Darvocet-N, Darvocet-N 100, Pronap-100, Propacet 100, Propoxacet-N, Wygesic).

Dang gui extracts and polysaccharide fractions have been shown to have some moderate hepatoprotective activity. One study examined CCl4 and acetaminophen-induced hepatotoxicity and found that hepatoprotective effects for dang gui extracts were more pronounced in the case of acetaminophen, suggesting a glutathione-dependent mechanism for the protective effects. ^29,30 The “interaction” of acetaminophen with dang gui described by Chen and Chen ⁶ is thus more likely an effect of general antioxidant hepatoprotective activity mediated by glutathione.

Cycloheximide, Scopolamine

Cycloheximide (Acti-aid, ActiDione, Actispray, actidone, hizaricin, kaken, naramycin, naramycin A, neocycloheximide), scopolamine (Scopace Tablet, Transderm Scop Patch).

A study with a rodent behavioral model examined the effects both hexane and methanol extracts of dang gui on amnesia induced by scopolamine and cycloheximide and p-chloroamphetamine. High doses of the hexane extract (1 g/kg) appeared to attenuate the amnesia induced by scopolamine and cycloheximide but not by chloramphetamine in this model. The authors suggest this implies an effect on memory function, but the significance of this for therapeutic doses of conventional extracts of dang gui in humans remains unclear. ³¹

Nifedipine

Nifedipine (Adalat, Adalat CC, Nifedical XL, Procardia, Procardia XL); combination drug: nifedipine and atenolol (Beta-Adalat, Tenif).

Coadministration of nifedipine and dang gui in 40 patients with chronic obstructive pulmonary disease (COPD) led to a greater degree of reduction of pulmonary arterial pressure than in untreated controls or those treated with nifedipine alone. ³² Dose of dang gui was high (250 mL 25% solution/day) and was administered parenterally, which makes extrapolation from this study problematic, although some clinical evidence suggests that dang gui alone may have a vasodilator effect on the pulmonary circulation. More investigation is needed before this is confirmed as a clinically consequential interaction, particularly in light of the in vitro evidence suggesting a pharmacokinetic reduction of nifedipine level by inhibition of CYP450 3A4 and 2D6 by dang gui. ⁸

Oral Contraceptives and Related Estrogen-Containing and Synthetic Estrogen and Progesterone Analog Medications

Oral contraceptives:monophasic, biphasic, and triphasic estrogen preparations:

Ethinyl estradiol and desogestrel (Desogen, Ortho-TriCyclen).

Ethinyl estradiol and ethynodiol (Demulen 1/35, Demulen 1/50, Nelulen 1/25, Nelulen 1/50, Zovia).

Ethinyl estradiol and levonorgestrel (Alesse, Levlen, Levlite, Levora 0.15/30, Nordette, Tri-Levlen, Triphasil, Trivora).

Ethinyl estradiol and norethindrone/norethisterone (Brevicon, Estrostep, Genora 1/35, GenCep. 1/35, Jenest-28, Loestrin 1.5/30, Loestrin1/20, Modicon, Necon 1/25, Necon 10/11, Necon 0.5/30, Necon 1/50, Nelova 1/35, Nelova 10/11, Norinyl 1/35, Norlestin 1/50, Ortho Novum 1/35, Ortho Novum 10/11, Ortho Novum 7/7/7, Ovcon-35, Ovcon-50, Tri-Norinyl, Trinovum).

Ethinyl estradiol and norgestrel (Lo/Ovral, Ovral).

Mestranol and norethindrone (Genora 1/50, Nelova 1/50, Norethin 1/50, Ortho-Novum 1/50).

Related, internal application: Etonogestrel/ethinyl estradiol vaginal ring (Nuvaring).

Hormone replacement therapy, estrogens:Chlorotrianisene (Tace); conjugated equine estrogens (Premarin); conjugated synthetic estrogens (Cenestin); dienestrol (Ortho Dienestrol); esterified estrogens (Estratab, Menest, Neo-Estrone); estradiol, topical/transdermal/ring (Alora Transdermal, Climara Transdermal, Estrace, Estradot, Estring FemPatch, Vivelle-Dot, Vivelle Transdermal); estradiol cypionate (Dep-Gynogen, Depo-Estradiol, Depogen, Dura-Estrin, Estra-D, Estro-Cyp, Estroject-LA, Estronol-LA); estradiol hemihydrate (Estreva, Vagifem); estradiol valerate (Delestrogen, Estra-L 40, Gynogen L.A. 20, Progynova, Valergen 20); estrone (Aquest, Estragyn 5, Estro-A, Estrone ‘5’, Kestrone-5); estropipate (Ogen, Ortho-Est); ethinyl estradiol (Estinyl, Gynodiol, Lynoral).

Hormone replacement therapy, estrogen/progestin combinations:Conjugated equine estrogens and medroxyprogesterone (Premelle cycle 5, Prempro); conjugated equine estrogens and norgestrel (Prempak-C); estradiol and dydrogesterone (Femoston); estradiol and norethindrone, patch (CombiPatch); estradiol and norethindrone/norethisterone, oral (Activella, Climagest, Climesse, FemHRT, Trisequens); estradiol valerate and cyproterone acetate (Climens); estradiol valerate and norgestrel (Progyluton); estradiol and norgestimate (Ortho-Prefest).

Hormone replacement therapy, estrogen/testosterone combinations: Esterified estrogens and methyltestosterone (Estratest, Estratest HS).

Selective estrogen response modulators (SERMs):Raloxifene (Evista), tamoxifen (Nolvadex), toremifene (Fureston).

Partly because of its reputation as a “female tonic” herb, some sources suggest interaction of dang gui with female sex hormones (ERT, HRT) or hormone-modulating drugs (e.g., SERMs, aromatase inhibitors). Known phytoestrogenic compounds have not been recorded in the root, and a controlled clinical trial of postmenopausal women found no changes in endometrial thickness or vaginal cell proliferation after 24 weeks’ administration of a standardized extract of dang gui. ³³ However, a cell line model found some evidence for both estrogen-dependent and estrogen-independent proliferative activity by a water extract of dang gui. ³⁴ Recent reviews of botanicals for menopause have found no positive evidence of effects of dang gui alone on menopausal symptoms. ^2,34,35 In the absence of estrogenic clinical effects or pharmacological estrogen receptor binding, suggestions of female hormone interactions with dang gui by some authors are unsupported at this time. ³⁶

Evidence: Ouabain (g-strophanthin).

Extrapolated, based on similar properties: Amiodarone (Cordarone, Pacerone), deslanoside (cedilanin-D), digitoxin (Cystodigin), digoxin (Digitek, Lanoxin, Lanoxicaps, purgoxin), disopyramide (Norpace), dofetilide (Tikosyn), flecainide (Tambocor), ibutilide (Corvert), procainamide (Pronestyl, Procan-SR), quinidine (Quinaglute, Quinidex, Quinora), sotalol (Betapace, Betapace AF, Sorine).

Some experimental evidence exists for an antiarrhythmic effect of parenteral dang gui extracts, in animal models, including ouabain-induced ventricular fibrillation, as well as in digitalis- and epinephrine-induced arrhythmias. ³⁷ Some secondary sources suggest that the herb must interact adversely with antiarrhythmic drugs, but logically a beneficial interaction would be suggested, and clinical reports of the adverse interaction are lacking.

Citations

1.Bensky D, Gamble A. Chinese Herbal Medicine: Materia Medica. Revised ed. Seattle: Eastland Press; 1993.
2.Low Dog T. Menopause: a review of botanical dietary supplements. Am J Med 2005;118:98-108.View Abstract
3.Peiwin L. Management of Cancer with Chinese Medicine. Shuzang M, Liling B, Translators. St Albans, UK: Donica; 2003.
4.Upton R. Dang gui root. American Herbal Pharmacopoeia. Scotts Valley, CA; 2003.
5.McKenna D, Jones K, Hughes K, Humphrey S. Dong Quai. Botanical Medicines. 2nd ed. Binghampton: Haworth Press; 2002:205-221.
6.Chen J, Chen T. Dang Gui (Radix Angelicae Sinensis). Chinese Medical Herbology and Pharmacology. City of Industry, CA: Art of Medicine Press Inc; 2004:918-923.
7.Guo LQ, Taniguchi M, Chen QY et al. Inhibitory potential of herbal medicines on human cytochrome P450–mediated oxidation: properties of umbelliferous or citrus crude drugs and their relative prescriptions. Jpn J Pharmacol 2001;85:399-408.View Abstract
8.Ishihara K, Kushida H, Yuzurihara M et al. Interaction of drugs and Chinese herbs: pharmacokinetic changes of tolbutamide and diazepam caused by extract of Angelica dahurica. J Pharm Pharmacol 2000;52:1023-1029.View Abstract
9.Xia X-Y, Peng R-X, Kong R et al. [Effects of Angelica sinensis polysaccharides on hepatic drug metabolism enzymes activities in mice]. Zhongguo Zhong Yao Za Zhi 2003;28:149-152.View Abstract
10.Lo AC, Chan K, Yeung JH, Woo KS. Danggui (Angelica sinensis) affects the pharmacodynamics but not the pharmacokinetics of warfarin in rabbits. Eur J Drug Metab Pharmacokinet 1995;20:55-60.View Abstract
11.Xu LN, Yu WG, Tian JY. [Effect of sodium ferulate on C14-arachidonic acid metabolism in rabbit platelets]. Zhong Xi Yi Jie He Za Zhi 1988;8:614-615, 583.View Abstract
12.Xu LN, Yu WG, Tian JY, Liu QY. [Effect of sodium ferulate on arachidonic acid metabolism]. Yao Xue Xue Bao 1990;25:412-416.View Abstract
13.Xue JX, Jiang Y, Yan YQ. [Effects of the combination of Astragalus membranaceus (Fisch.) Bge. (AM), tail of Angelica sinensis (Oliv.) Diels. (TAS), Cyperus rotundus L. (CR), Ligusticum chuanxiong Hort. (LC) and Paeonia veitchii Lynch (PV) on the hemorrheological changes in normal rats]. Zhongguo Zhong Yao Za Zhi 1993;18:621-623, 640.View Abstract
14.Xue JX, Yan YQ, Jiang Y. [Effects of the combination of Astragalus membranaceus (Fisch.) Bge. (AM), Angelica sinensis (Oliv.) Diels (TAS), Cyperus rotundus L. (CR), Ligusticum chuangxiong Hort (LC) and Peaonia veitchii Lynch (PV) on the hemorheological changes in “blood stagnating” rats]. Zhongguo Zhong Yao Za Zhi 1994;19:108-110, 128.View Abstract
15.Yin ZZ, Wang JP, Xu LN. [Effect of sodium ferulate on malondialdehyde production from the platelets of rats]. Zhongguo Yao Li Xue Bao 1986;7:336-339.View Abstract
16.Teng CM, Chen WY, Ko WC, Ouyang CH. Antiplatelet effect of butylidenephthalide. Biochim Biophys Acta 1987;924:375-382.View Abstract
17.Li CZ, Yang SC. [The effect of yimucao, chishao, danggui, sanleng, erzhu and zelan on blood coagulation in rats]. Zhong Xi Yi Jie He Za Zhi 1982;2:69, 111-112.View Abstract
18.Tu JJ. Effects of radix Angelicae sinensis on hemorrheology in patients with acute ischemic stroke. J Tradit Chin Med 1984;4:225-228.View Abstract
19.Terasawa K, Imadaya A, Tosa H et al. Chemical and clinical evaluation of crude drugs derived from Angelica acutilobae and A. sinensis. Fitoterapia 1985;56:201-208.
20.Page RL, 2nd, Lawrence JD. Potentiation of warfarin by dong quai. Pharmacotherapy 1999;19:870-876.
21.Fugh-Berman A, Ernst E. Herb-drug interactions: review and assessment of report reliability. Br J Clin Pharmacol 2001;52:587-595.View Abstract
22.Mak DH, Chiu PY, Dong TT et al. Dang-Gui Buxue Tang produces a more potent cardioprotective effect than its component herb extracts and enhances glutathione status in rat heart mitochondria and erythrocytes. Phytother Res 2006; 20(7):561-567.View Abstract
23.Ma L, Mao X, Li X, Zhao H. The effect of Angelica sinensis polysaccharides on mouse bone marrow hematopoesis. Zhonghua Xueyexue Zazhi 1988;9:148-149.
24.Wang Y, Zhu B. Effects of polysaccharide from Angelica sinensis on mice erythropoiesis. Chin J Hematol 1993;14:650-651.
25.Wang S, Wang Y, Dai Q et al. Study on effect of Angelica polysaccharide on modulation of human CFU-GM. Jiepou Xuebao 2001;32:241-245.
26.Hui MKC, Wu WKK, Shin VY et al. Polysaccharides from the root of Angelica sinensis protect bone marrow and gastrointestinal tissues against the cytotoxicity of cyclophosphamide in mice. Int J Med Sci 2006;3:1-6.
27.Sun Y, Tang J, Gu X, Li D. Water-soluble polysaccharides from Angelica sinensis (Oliv.) Diels: preparation, characterization and bioactivity. Int J Biol Macromol 2005;36:283-289.View Abstract
28.Bradley RR, Cunniff PJ, Pereira BJ, Jaber BL. Hematopoietic effect of radix Angelicae sinensis in a hemodialysis patient. Am J Kidney Dis 1999;34:349-354.View Abstract
29.Wang H, Peng RX. [Effects of paracetamol on glutathione S-transferase activity in mice]. Zhongguo Yao Li Xue Bao 1993;14 Suppl:S41-44.View Abstract
30.Wang H, Peng RX. [Sodium ferulate alleviated paracetamol-induced liver toxicity in mice]. Zhongguo Yao Li Xue Bao 1994;15:81-83.View Abstract
31.Hsieh MT, Lin YT, Lin YH, Wu CR. Radix Angelicae sinensis extracts ameliorate scopolamine- and cycloheximide-induced amnesia, but not p-chloroamphetamine-induced amnesia in rats. Am J Chin Med 2000;28:263-272.
32.Xu JY, Li BX, Cheng SY. [Short-term effects of Angelica sinensis and nifedipine on chronic obstructive pulmonary disease in patients with pulmonary hypertension]. Zhongguo Zhong Xi Yi Jie He Za Zhi 1992;12:716-718, 707.View Abstract
33.Hirata JD, Swiersz LM, Zell B et al. Does dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled trial. Fertil Steril 1997;68:981-986.
34.Lau CBS, Ho TCY, Chan TWL, Kim SCF. Use of dong quai (Angelica sinensis) to treat peri- or postmenopausal symptoms in women with breast cancer: is it appropriate? Menopause 2005;12:734-740.
35.Kronenberg F, Fugh-Berman A. Complementary and alternative medicine for menopausal symptoms: a review of randomized, controlled trials. Ann Intern Med 2002;137:805-813.View Abstract
36.Miller LG. Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med 1998;158:2200-2211.View Abstract
37.Cha L. Effects of Angelica sinensis on the experimental arrhythmias. Chin Pharmacol Bull 1981;16:259-260.

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Family

Related Species

Parts Used

Common Forms

Strategic Considerations

Effects on Drug Metabolism and Bioavailability

Effect and Mechanism of Action

Research

Reports

Clinical Implications and Adaptations

Effect and Mechanism of Action

Research

Reports

Integrative Therapeutics, Clinical Concerns, and Adaptations