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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
Warfarin and Related Oral Vitamin K Antagonist Anticoagulants
Erythropoiesis-Stimulating Agents
theoretical, speculative, and preliminary interactions research, including overstated interactions claims
Acetaminophen
Cycloheximide, Scopolamine
Nifedipine
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

Ouabain and Related Cardiac Glycosides and Antiarrhythmic Drugs
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.