What is Dong Quai?

Dong Quai is an herb used commonly in traditional Chinese medicine also called a ‘female ginseng’. It is used with a mixture of other herbs and was used to treat menopausal or menstrual symptoms. Most of the current medicinal property comes from its root extract. Several possible therapeutic effects are being found through animal studies but its effects on humans still need more research. Dong Quai possibly has anti-inflammatory, menstrual pain relief, anti-cancer, gastroprotective effects while its menopausal effect alone has shown no therapeutic effect.

 

Dong Quai Efficacies

 

Menopausal Therapy

• Dong Quai is widely used in Chinese medicine as a treatment for women with menopausal symptoms. Current hormonal therapy for menopausal symptoms shows good results but can have few detrimental effects on patients within certain conditions. Due to these side effects, people are trying herbal therapies to treat the symptoms. However, a clinical study showed that Dong Quai alone does not have any therapeutic effect. [1] It has to be used along with other Chinese herbal mixtures to show efficacy.

 

Treatment of Anemia

• Dong Quai can be used to treat anemia through two mechanisms. First, anemia can occur due to acute blood loss. Extracts from Dong Quai can help red blood cell proliferation and accelerate hemoglobin level restoration. Scientists showed significant improvement in the recovery rate from acute blood loss in the rat model [2].
• Secondly, low plasma iron levels can lead to anemia. A protein called hepcidin has a key role in regulating blood plasma iron concentration constant but an increase of hepcidin concentration can cause iron-restrictive anemias [3]. A study in 2011 with a mouse model showed that Dong Quai extract has the potential to inhibit hepcidin synthesis [4]. In 2018, a new study showed that Dong Quai successfully treated anemia in chronic kidney disease in the rate model [5].

 

Immune regulatory

• Immune Boosting: Dong Quai can stimulate the immune system by regulating chemicals called cytokines that send signals to immune cells. However, whether it will have the same effect when taken orally needs further research. [6]
• Anti-Allergy: Dong Quai has a potential to alleviate allergic responses. A mixture of Dong Quai with Huang Qi called Dangguibbohyul-Tang (DBT) was tested on its effect on eczema and asthma mouse model. Mouse with eczema applied with DBT showed a significant improvement compared to the control group [7]. In a mouse asthma model, DBT was orally administered in different doses. The group without DBT showed a severe breath way allergic reaction and lung damage while a DBT administered mice had just mild allergic reaction [8].

 

Gastroprotective

• Dong Quai is known to have anti-inflammatory and antioxidant properties. When orally administered, it can maybe protect gastrointestinal tracts. Colitis and ulcer were induced in rats and those orally administered Dong Quai extract showed significantly less damage in their intestines [9],[10]. In a subsequent study, Dong Quai extract also accelerated would healing in ulcer induced rat [11].

 

Antitumor

• Dong Quai other than polysaccharide, has another great therapeutically potent substance called N-butylidenephthalide (BP). This substance can inhibit formation of new blood vessels [12]. Since tumor cells are rapidly growing, they need constant supply of nutrients and oxygen and therefore attract nearby blood cells to grow to them. By halting this new blood vessel formation, Dong Quai extract can stop the tumor growth or even shrink its volume.
• Scientists have shown that BP, with this property can significantly suppress the growth of tumor in malignant brain tumor and bladder tumor model in mice. In addition, treatment with high dose of BP has shown reduction of tumor volume [13-26].

Toxicity

The toxicity of Dong Quai has not been thoroughly studied but most research shows no known toxicity. However, using it for a long time on a high dose is not recommended due to the yet unclear side effects. It is probably not safe for women in pregnancy. It may cause uterus contraction and increase the chance of miscarriage or birth defects. [17]

Due to its possible anticoagulative effect, Dong Quai should not be used along with blood thinners such as warfarin, aspirin, and ibuprofen for it might increase the risk of bleeding. Although Dong Quai extract did not show improvement of menopausal symptoms in a human clinical study, Dong Quai showed a weak estrogen-like property in several mouse models. Therefore, Dong Quai needs to be used cautiously to breast cancer patients. [18]

1. Hirata, J. D., Swiersz, L. M., Zell, B., Small, R., & Ettinger, B. (1997). Does dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled trial. Fertility and sterility, 68(6), 981–986

2. Liu, P. J., Hsieh, W. T., Huang, S. H., Liao, H. F., & Chiang, B. H. (2010). Hematopoietic effect of water-soluble polysaccharides from Angelica sinensis on mice with acute blood loss. Experimental hematology, 38(6), 437–445.

3. Ganz, T., & Nemeth, E. (2012). Hepcidin and iron homeostasis. Biochimica Et Biophysica Acta (BBA) - Molecular Cell Research, 1823(9), 1434-1443. 

4. Wang, K. P., Zeng, F., Liu, J. Y., Guo, D., & Zhang, Y. (2011). Inhibitory effect of polysaccharides isolated from Angelica sinensis on hepcidin expression. Journal of ethnopharmacology, 134(3), 944–948. https://doi.org/10.1016/j.jep.2011.02.015 

5. Wang, K., Wu, J., Xu, J., Gu, S., Li, Q., Cao, P., Li, M., Zhang, Y., & Zeng, F. (2018). Correction of Anemia in Chronic Kidney Disease With Angelica sinensisPolysaccharide via Restoring EPO Production and Improving Iron Availability. Frontiers in pharmacology, 9, 803.

6. Gu, P., Wusiman, A., Wang, S., Zhang, Y., Liu, Z., Hu, Y., Liu, J., & Wang, D. (2019). Polyethylenimine-coated PLGA nanoparticles-encapsulated Angelica sinensis polysaccharide as an adjuvant to enhance immune responses. Carbohydrate polymers, 223, 115128.

7. Choi, Y. Y., Kim, M. H., Hong, J., Kim, K., & Yang, W. M. (2016). Effect of Dangguibohyul-Tang, a Mixed Extract of Astragalus membranaceus and Angelica sinensis, on Allergic and Inflammatory Skin Reaction Compared with Single Extracts of Astragalus membranaceus or Angelica sinensis. Evidence-based complementary and alternative medicine : eCAM, 2016, 5936354.

8. Lin, C. C., Liou, C. J., Chiang, C. Y., Huang, W. Y., & Huang, W. C. (2011). Danggui Buxue Tang attenuates eosinophil infiltration and airway hyperresponsiveness in asthmatic mice. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology, 107(6), 501–509.

9. Cho, C. H., Mei, Q. B., Shang, P., Lee, S. S., So, H. L., Guo, X., & Li, Y. (2000). Study of the gastrointestinal protective effects of polysaccharides from Angelica sinensis in rats. Planta medica, 66(4), 348–351.

10. Liu, S. P., Dong, W. G., Wu, D. F., Luo, H. S., & Yu, J. P. (2003). Protective effect of angelica sinensis polysaccharide on experimental immunological colon injury in rats. World journal of gastroenterology, 9(12), 2786–2790.

11. Ye, Y. N., So, H. L., Liu, E. S., Shin, V. Y., & Cho, C. H. (2003). Effect of polysaccharides from Angelica sinensis on gastric ulcer healing. Life sciences, 72(8), 925–932.

12. Yeh, J. C., Cindrova-Davies, T., Belleri, M., Morbidelli, L., Miller, N., Cho, C. W., Chan, K., Wang, Y. T., Luo, G. A., Ziche, M., Presta, M., Charnock-Jones, D. S., & Fan, T. P. (2011). The natural compound n-butylidenephthalide derived from the volatile oil of Radix Angelica sinensis inhibits angiogenesis in vitro and in vivo. Angiogenesis, 14(2), 187–197.

13. Tsai, N. M., Lin, S. Z., Lee, C. C., Chen, S. P., Su, H. C., Chang, W. L., & Harn, H. J. (2005). The antitumor effects of Angelica sinensis on malignant brain tumors in vitro and in vivo. Clinical cancer research : an official journal of the American Association for Cancer Research, 11(9), 3475–3484.

14. Lin, Y. L., Huang, X. F., Chang, K. F., Liao, K. W., & Tsai, N. M. (2020). Encapsulated n-Butylidenephthalide Efficiently Crosses the Blood-Brain Barrier and Suppresses Growth of Glioblastoma. International journal of nanomedicine, 15, 749–760.

15. Tsai, N. M., Chen, Y. L., Lee, C. C., Lin, P. C., Cheng, Y. L., Chang, W. L., Lin, S. Z., & Harn, H. J. (2006). The natural compound n-butylidenephthalide derived from Angelica sinensis inhibits malignant brain tumor growth in vitro and in vivo. Journal of neurochemistry, 99(4), 1251–1262.

16. Chen, M. C., Hsu, W. L., Chang, W. L., & Chou, T. C. (2017). Antiangiogenic activity of phthalides-enriched Angelica Sinensis extract by suppressing WSB-1/pVHL/HIF-1α/VEGF signaling in bladder cancer. Scientific reports, 7(1), 5376. 

17. Lim, D. W., & Kim, Y. T. (2014). Anti-osteoporotic effects of Angelica sinensis (Oliv.) Diels extract on ovariectomized rats and its oral toxicity in rats. Nutrients, 6(10), 4362–4372.

18. Lau, C. B., Ho, T. C., Chan, T. W., & Kim, S. C. (2005). Use of dong quai (Angelica sinensis) to treat peri- or postmenopausal symptoms in women with breast cancer: is it appropriate?. Menopause (New York, N.Y.), 12(6), 734–740.

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