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Traditional Chinese medicine

Dang gui (Chinese angelica)Angelica sinensis

The classic blood-nourishing root, listed in the texts as lubricating the intestines; we found no gut trial of it, and one case of it doubling a warfarin reading.

Botanical name
Angelica sinensis
Part used
root
Also called
pinyin Dang gui (当归); Dong quai, Chinese angelica, Angelicae sinensis radix
Used in
Traditional Chinese medicine
Taken for
Constipation, Cramping and pain
Sold as
dried root slices, powder, pills in formulas, tincture, decoction

What dang gui (chinese angelica) is

Dang gui is the root of Angelica sinensis (Oliv.) Diels, a plant of the carrot family (Apiaceae) cultivated in China and used in Japan and Korea, where a review calls it a traditional medicinal and edible plant and one of the herbs most commonly used by practitioners of traditional Chinese medicine in China and in Europe. Dong quai is the usual name in English-language supplement trade. The root is sold dried and sliced, and the tradition prepares it in several ways: smoke-dried, stir-fried, or with wine.

Dang gui is mainly a gynecological herb in the texts. A review of the plant calls it principally used for dysmenorrhea, amenorrhea and menopause, and it is the first herb of the blood-nourishing formulas such as Danggui Buxue Tang (dang gui with astragalus). Its place in a digestive encyclopedia is narrower: Chinese medicine lists it for lubricating the intestines, which is the constipation use, and a few gut-focused studies in animals have tested its polysaccharides. This entry covers that narrow use and the reviewed safety points, and not the gynecological use.

What the traditions use it for

Traditional Chinese medicine (about TCM)

Dang gui is classed in the Chinese materia medica as sweet and pungent and warm, entering the liver, heart and spleen channels. The tradition says it nourishes and invigorates blood, relieves pain and moistens the intestines, and a review of the plant lists those uses together: tonifying and replenishing blood, relieving pain, lubricating the intestines and treating irregular menses. In the tradition’s vocabulary the bowel use is for dry stools in people the texts describe as blood-deficient, and the moistening quality is the reason the texts caution against it in loose stools. These are the tradition’s own statements, taken from a review of the plant and the standard English materia medica, and are not findings about the body.

The constituents

A review of the plant identifies polysaccharides, ligustilide, and ferulic acid as the main bioactive components, and reports in laboratory and animal work anti-inflammatory, antifibrotic, antispasmodic, antioxidant and neuroprotective activity. The root also contains natural coumarin derivatives, which a case report on its interaction with warfarin ties to antithrombotic, antiarrhythmic and phototoxic effects. In mice, Angelica sinensis polysaccharide has been reported to reduce chemotherapy-induced intestinal mucositis and to alter gut microbiota and short-chain fatty acids, and a compound called angelicone to ease experimental colitis. These are animal findings.

The human evidence

We found no randomized trial of dang gui for a gut outcome, constipation included, in the sources we searched. A review of the plant states that well-designed western-style clinical trials using authenticated, chemically standardized crude drug to confirm efficacy are in short supply, and lists identity, processing, the tradition of use in combination with other herbs and ethnic differences as the reasons results do not translate cleanly from one setting to another.

The gut evidence is therefore preclinical. In mice, Angelica sinensis polysaccharide reduced chemotherapy-induced intestinal mucositis in studies in Drosophila and mice, with effects on gut microbiota-mediated innate immunity and short-chain fatty acid production, and angelicone, a compound from the plant, ameliorated colitis in mice through changes in the gut microbiota. These are mouse and fly studies, and doses are not human doses.

The clinical trials that do exist use dang gui in formulas for other conditions, for example Danggui Buxue Tang, a two-herb decoction of astragalus and dang gui studied for menopause symptoms, and none of them is a bowel trial. The traditional constipation use is the moistening of dry stools in people the texts call blood-deficient, and no controlled study has tested that definition against a laxative or placebo.

What has not been tested: dang gui in constipation, the root against placebo for any gut outcome, and the effect of the different processed forms.

StudyDoseWhat it found
Review of Angelica sinensis in China: botany, ethnopharmacology, phytochemistry, toxicology PMID 27211015Not applicableLists traditional uses including lubricating the intestines; pharmacology is laboratory-based
Review: Danggui to Angelica sinensis root, are benefits lost in translation? PMID 24365638Not applicableWell-designed clinical trials with authenticated, standardized crude drug are in short supply
Mouse and Drosophila study of Angelica sinensis polysaccharide in chemotherapy-induced intestinal mucositis PMID 42702326Animal dosesReduced mucositis with changes in gut microbiota-mediated innate immunity and short-chain fatty acids
Case report: 46-year-old woman with atrial fibrillation stable on warfarin took dong quai for 4 weeks PMID 10417036Dong quai supplement, 4 weeksProthrombin time and INR rose more than 2-fold; returned to range a month after stopping

Doses, in trials and in practice

No gut trial reports a dose. The mouse studies used doses of Angelica sinensis polysaccharide that are not human doses. The warfarin case report does not give the dose of the dong quai product, but the interaction developed over 4 weeks of use. In the tradition the dried root is decocted with other herbs, made into pills, or cooked into soups; the tradition prepares it smoke-dried, stir-fried or with wine, and the review on translation of dang gui notes that these preparation choices change what is in the root. We found no single-herb gram dose that we could tie to a primary source.

The amounts above are what trials and pharmacopoeias record, not a dose for you; your medicines and conditions change the answer, and a clinician or pharmacist who knows them is the person to ask.

What is known about safety

The standing safety point is warfarin. A 46-year-old woman with atrial fibrillation, stable on warfarin, had a greater than two-fold rise in prothrombin time and INR after taking dong quai for 4 weeks, with no other cause found, and her values returned to range a month after she stopped. The case report notes the root’s natural coumarin derivatives, with antithrombotic, antiarrhythmic, phototoxic and carcinogenic effects reported in the literature. The review on translation lists efficacy, safety and potential for drug-herb interactions as under-studied, and notes ethnic differences. We found no controlled pregnancy or breastfeeding data in the sources, and the herb’s main use in the texts is gynecological. For patent-medicine products, one review of Asian herbal medicines reported toxic heavy metals and undeclared prescription drugs in some Chinese preparations, mostly as anecdotal reports; that is about the products reviewed and not every dang gui product.

Where it meets prescription medicines

The documented interaction is with warfarin: one case of a more than doubled prothrombin time and INR on dong quai in a woman stable on the drug, with a pharmacodynamic mechanism suggested in one animal study and the true mechanism unknown. A separate pair of case reports found that a Chinese medicine called Danggui Longhui appeared to lower clozapine levels, which the authors found by therapeutic drug monitoring and describe as a possible new inducer. Both are case-level evidence, and neither separates dang gui from the other components of the product.

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Herbs that sit beside it

TCM Astragalus Astragalus mongholicus (syn. A. membranaceus) TCM White peony Paeonia lactiflora Western Angelica Angelica archangelica Ayurvedic / TCM / Western Licorice Glycyrrhiza glabra

Questions people ask

Is dang gui the same as dong quai?

Yes. Dong quai is the usual English-language trade name for the dried root of Angelica sinensis, which Chinese medicine calls dang gui.

Is dang gui used for constipation?

The texts list it for lubricating the intestines, and the tradition applies this to dry stools in people it describes as blood-deficient. We found no controlled trial testing it for constipation.

Does it interact with blood thinners?

There is a case report of a more than two-fold rise in INR in a woman stable on warfarin after 4 weeks of dong quai. It is one case, with an unknown mechanism, but it is the main reason the herb appears in warfarin interaction lists.

How does TCM classify it?

TCM classes it as sweet, pungent and warm, entering the liver, heart and spleen channels, and uses it to nourish blood, relieve pain and moisten the intestines. That is the tradition’s framework.

Sources