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Western herbalism

AngelicaAngelica archangelica

Aromatic bitter root, one of nine herbs in Iberogast (STW 5). Iberogast beat placebo in 315 people with dyspepsia; no trial tests angelica alone.

Botanical name
Angelica archangelica
Part used
root
Also called
Garden angelica, Angelicae radix (pharmacopoeia name)
Used in
Western herbalism
Taken for
Indigestion, Cramping and pain, Gas, Appetite
Sold as
tincture, tea, capsules, extract

Angelica, the plant and the part used

Garden angelica, Angelica archangelica, is a tall, aromatic member of the carrot family. The root is the part used for the gut: it is dried and steeped, tinctured, or extracted for combination products. It is one of the traditional European bitter-aromatic herbs, and it has a spicy, slightly bitter taste.

It should not be confused with dong quai, dang gui, which is Angelica sinensis and has its own entry here. The two species are used differently in their traditions, and findings for one do not transfer to the other.

In supplements, angelica root appears in digestive bitters and in combination products. Its best-known presence in research is as one of the nine herbs in Iberogast (STW 5), a liquid extract product sold in Europe and elsewhere for functional dyspepsia and irritable bowel syndrome. A later six-herb version of that product, called STW 5-II, no longer contains angelica, so some trial results come from versions with angelica and some from a version without it.

Traditional uses, in their own terms

Western herbalism

The Altmeyers encyclopedia, summarizing the German herbal reference works, reports that the German E monographs panel approved angelica root for loss of appetite and dyspeptic complaints such as mild gastrointestinal cramps, bloating and flatulence, and that a fixed combination of angelica root, gentian root and caraway was also positively monographed. ESCOP, the European scientific herbal cooperative, lists dyspeptic complaints such as mild gastrointestinal spasms and bronchitis as its indications for the root. We found no EU herbal monograph (HMPC) for Angelica archangelica root.

Compounds, and what the laboratory says about them

Angelica root contains furanocoumarins, which cause light sensitivity of the skin, and essential oil. Hensel and colleagues found angelica root among the plants richest in N-phenylpropenoyl amino acid amides, and one of those amides strongly reduced the adhesion of Helicobacter pylori to human stomach tissue in the laboratory. In a cell study of the full STW 5 product, Ulrich-Merzenich and colleagues found the angelica and caraway pair was effective at lowering release of the inflammatory messenger IL-8. These are laboratory findings, not results from people.

Trials in people, with the numbers

We found no randomized trial of angelica root alone. The human evidence is of Iberogast and its relatives, and the difference between versions matters. The nine-herb STW 5 contains angelica; the six-herb STW 5-II does not. The trials below are of the multi-herb products, not of angelica.

Nine-herb STW 5: von Arnim and colleagues randomized 315 people with functional dyspepsia to STW 5 at 3 x 20 drops a day or placebo for 8 weeks; symptom score improved 6.9 points against 5.9 (P less than 0.05). Melzer and colleagues pooled three placebo-controlled trials (138 on STW 5, 135 on placebo) and found an odds ratio of 0.22 (95 percent CI 0.11 to 0.47) for severity of the most bothersome symptom. In irritable bowel syndrome, Madisch and colleagues randomized 208 people; STW 5 (51 people) was better than placebo (52 people) for abdominal pain and symptom score at 4 weeks, as was STW 5-II (52 people), while a bitter candytuft extract alone (53 people) was not.

Six-herb STW 5-II, which has no angelica, also worked: in 272 people with dyspepsia, response after 8 weeks was 61.2 percent against 45.1 percent on placebo, and a patient-level pooling of four trials (613 people) found the symptom sum score improved by 1.74 at 4 weeks and 2.07 at 8 weeks. This suggests the benefit does not depend on angelica, though no trial has compared the two versions directly.

In healthy men, a 1.1 ml dose of Iberogast raised maximum proximal gastric volume from 104 to 174 ml. The open gap is angelica itself: no placebo-controlled trial of the root on its own turned up.

StudyDoseWhat it found
Randomized placebo-controlled trial of nine-herb STW 5, 315 people with functional dyspepsia PMID 175310133 x 20 drops a day for 8 weeksSymptom score improved 6.9 points vs 5.9 on placebo (P<0.05)
Meta-analysis of 3 placebo-controlled STW 5 trials (138 vs 135 people) in functional dyspepsia PMID 15606389STW 5, as used in the trialsOdds ratio 0.22 (95% CI 0.11 to 0.47) for severity of the most bothersome symptom
Randomized placebo-controlled trial, 208 people with IBS: STW 5, STW 5-II, bitter candytuft extract alone, or placebo PMID 14984373Product taken for 4 weeksSTW 5 and STW 5-II better than placebo for pain and symptom scores; candytuft alone not
Randomized placebo-controlled trial of six-herb STW 5-II (no angelica), 272 people with dyspepsia PMID 386994718 weeks of treatmentResponse 61.2% vs 45.1% on placebo (P=0.008)
Patient-level meta-analysis of four STW 5-II trials, 613 people PMID 382461344 and 8 weeks of treatmentSymptom sum score improved by 1.74 at 4 weeks and 2.07 at 8 weeks vs placebo

The doses on record

We found no dose of angelica root alone in a source we could read. The Iberogast trials used the whole product, for example 3 x 20 drops a day for 8 weeks in the von Arnim trial and a single 1.1 ml dose in the healthy-volunteer study, and the share of angelica in each dose is set by the manufacturer. The traditional preparations are a tea or tincture of the dried root and bitter liqueurs.

None of this is a dose recommendation. It is what the literature used, set down so a label can be compared with it; a pharmacist or clinician decides what applies to you.

The safety record

Angelica root contains furanocoumarins, which the Altmeyers summary says increase light sensitivity and can cause sun-triggered dermatitis at low UV exposure. The same summary lists stomach and intestinal ulcers as contraindications and advises caution in pregnancy, avoiding high doses and long-term use. For Iberogast, the nine-herb version contained greater celandine, which has been linked to liver injury; Leroy and colleagues report a 32-year-old woman with severe acute hepatitis, jaundice and itching attributed to the product, who recovered within 5 weeks of stopping it. The six-herb version removed celandine, angelica and milk thistle. Trials of both versions reported adverse event rates similar to placebo.

Medicines it can interact with

We found no formal interaction study of angelica root in people. In a liver cell line, Hensel and colleagues found that two of the amides found in angelica root and other plants did not change expression of the CYP3A4 enzyme gene but raised CYP1A2 gene expression; this is a cell-culture result that has not been tested in people. Because the furanocoumarins increase light sensitivity, products used alongside other medicines that cause light sensitivity are a point to discuss with a pharmacist.

Where angelica turns up in the catalog

Angelica appears on the labels below, alone or inside a blend; each product page gives the printed amount, the evidence for that product and the review picture.

Urban Moonshine Original Digestive Bitters 4.4 out of 5 from 1,409 ratings from Amazon · $0.68 a day

Is a angelica product right for you?

The quiz weighs your symptoms and medicines against every product researched here, angelica products included, and shows its working.

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Read next

Western Gentian Gentiana lutea TCM Dang gui (Chinese angelica) Angelica sinensis Ayurvedic / Western Caraway Carum carvi Western Chamomile Matricaria chamomilla (syn. Matricaria recutita) Western Peppermint Mentha x piperita

What people want to know

Is angelica the active herb in Iberogast?

Not shown. Iberogast has nine herbs, and its six-herb successor, which has no angelica, also beat placebo (response 61.2 percent against 45.1 percent in 272 people). Bitter candytuft is the main extract in the product, and no trial has tested angelica alone.

What did the Iberogast trials find?

In 315 people with dyspepsia, nine-herb STW 5 improved a symptom score by 6.9 points against 5.9 on placebo over 8 weeks. A pooling of three trials found an odds ratio of 0.22 for the most bothersome symptom. These are trials of the whole product.

Is angelica the same as dong quai?

No. Dong quai (dang gui) is Angelica sinensis, a Chinese herb with its own entry. The Iberogast herb is Angelica archangelica.

Does angelica make skin sensitive to sunlight?

The furanocoumarins in the root increase light sensitivity. A summary of the German reference works says sun-triggered dermatitis can occur at low UV exposure.

Has Iberogast been linked to liver problems?

The nine-herb version contained greater celandine, and a case report describes a 32-year-old woman with acute hepatitis attributed to it who recovered within 5 weeks of stopping. The six-herb version no longer contains celandine.

Sources