Dong Quai
Best-in-class: Dong Quai
A traditional Chinese herb for women's health. The main randomized trial of it alone was negative.
Dong Quai quick facts
| Suggested dose | As directed; traditionally used in combination. |
| How often | Daily, traditionally in combination |
| Who it's for | Traditional formulas under a practitioner. |
Monotherapy trials have been largely negative, which matters because that is how it is sold in the West and not how it is used traditionally. The real caution is anticoagulant: coumarin content plus antiplatelet activity means meaningful bleeding risk with warfarin, and it is photosensitizing. Avoid in pregnancy.
How Dong Quai actually works
Traditionally used in Chinese medicine almost always in formula rather than alone. Ferulic acid and ligustilide are the proposed actives, with vasodilatory and antispasmodic effects. It is often called phytoestrogenic, though the evidence for estrogen receptor binding is weak — the mechanism remains genuinely unclear.
Where to get Dong Quai
Find Dong Quai on iHerb →The evidence for Dong Quai
Graded by what exists behind each claim.
✅ Clinically validated
- A randomized placebo-controlled trial of dong quai alone for menopausal hot flushes found no benefit over placebo. Some combination formulas have shown effects, which makes attribution impossible.
📊 Correlative data
- Long-standing traditional use, almost always as part of a multi-herb formula rather than alone.
🧪 Theoretical / extrapolated benefits
- Coumarin content is proposed to underlie a mild vasodilatory effect.
How to read these tiers: they say how much human evidence exists, not how well something works — and ✗ flags harm, never a disappointing trial. How the evidence tiers work →
What Dong Quai actually does
Dong quai is the root of Angelica sinensis, and the constituent the pharmacology is written about is (Z)-ligustilide — a phthalide, not a steroid and not a flavonoid. Phthalides are small lipophilic lactones; ligustilide is the dominant one in the essential oil fraction and it carries most of the published activity, with a pharmacokinetic and pharmacological literature of its own Xie 2020. The second named constituent is ferulic acid, a hydroxycinnamate, and the third group are the furocoumarins, which is where the photosensitivity and the anticoagulant reputation come from.
The first thing to establish is what this molecule is not, because the whole product is sold on the wrong noun. Dong quai is marketed as a women's hormone herb, which implies an estrogen receptor. When it was put through the standard assays it did something more interesting than that. In MCF-7 breast cancer cells, dong quai induced 16-fold growth over control — and produced no transactivation of either ER-alpha or ER-beta Amato 2002. Fed to mice for four days, it produced no increase in uterine weight Amato 2002.
Read that combination carefully, because it is the most important sentence on this page. A sixteen-fold proliferation signal in an estrogen-responsive cell line, with the estrogen receptor reporter flat and the classical estrogen bioassay in a live animal negative, means dong quai stimulates the growth of breast cancer cells by a route that is not the estrogen receptor. It is not a phytoestrogen. It is a mitogen with an unidentified target. Those are not the same warning, and the second one is worse, because a woman avoiding phytoestrogens after a breast cancer would read the ‘not estrogenic’ result as permission.
What ligustilide actually does have mechanism for. The phthalide literature attributes vascular smooth muscle relaxation, platelet effects and anti-inflammatory activity to (Z)-ligustilide, and the review that pulls its pharmacokinetics together is explicit that the compound is the reason the plant is studied at all Xie 2020. Vasorelaxation is the honest mechanistic account of a herb traditionally used for cramping and for flushing — a vascular effect, not a hormonal one.
And ferulic acid is the constituent that connects to the bleeding story. Furocoumarins and coumarin-class molecules in Angelica species are the structural basis for both the photosensitizing and the anticoagulant reputation, and unlike most botanical bleeding warnings this one has a published human case with coagulation numbers attached Page 1999. That case is in the safety section below, where it belongs.
Cell, rodent, human — and where it stops
Cells, and the result is the one nobody quotes. MCF-7 proliferation up 16-fold, ER-alpha and ER-beta transactivation absent Amato 2002. For calibration, ginseng in the same experiment produced 27-fold growth, also without receptor transactivation Amato 2002 — so this is a property shared with at least one other extremely popular botanical, and neither is explained.
Rodent, four days, negative. Oral administration to mice for four days produced no uterine weight increase Amato 2002. The uterotrophic assay is the century-old standard for estrogenicity, and dong quai fails it. Both halves of that sentence are useful: it is not estrogenic, and the assay could not see whatever caused the 16-fold proliferation.
Human, women: 71 people, 24 weeks, nothing moved. Seventy-one postmenopausal women, mean age 52.4 ± 6 years with FSH above 30 mIU/mL, were randomized to dong quai or placebo for 24 weeks. There were no statistically significant differences between groups in endometrial thickness, vaginal maturation index, number of vasomotor flushes, or the Kupperman index Hirata 1997. Four endpoints, two of them tissue measurements rather than questionnaires, six months, all flat.
Human, men: an independent replication of the same negative. Twenty-two men on androgen deprivation therapy for prostate cancer were randomized to dong quai or placebo for three months; 17 completed. There was no significant decrease in hot flash duration between groups Al-Bareeq 2010. Hot flushes on androgen deprivation are physiologically the same vasomotor phenomenon as menopausal flushing, arriving through a different route — so this is a second, independent test of the same claim in a population with no estrogen of its own to confound the result. It also failed.
So the specific obstacle is not the usual translation gap at all. It is that dong quai is not used alone in the tradition it comes from, and every controlled trial has tested it alone. In Chinese herbal practice dang gui appears inside multi-herb formulas — si-wu-tang and its relatives — where the explicit claim is an interaction between constituents. A trial of the single herb is a fair test of the capsule on the shelf and an unfair test of the tradition, and both statements are true at once. Nobody has resolved that by taking a classical formula into a placebo-controlled trial with the herb removed as the comparator, which is the only design that would settle it.
The second obstacle is chemical and it is severe enough to undermine every trial listed above. (Z)-ligustilide is unstable. Work on the mass balance and stability of the compound isolated from Angelica sinensis was framed by its authors as bridging a ‘botanical instability–bioactivity chasm’ Duric 2019 — that is, the gap between what the plant contains and what an extract still contains by the time anybody tests it. If the principal active decomposes during extraction, storage or shelf life, then a negative trial may have tested a decomposition product, and no published dong quai trial reports the ligustilide content of the material it gave.
Dong Quai — which form, and does it matter
The stability problem is the form question, and it is unusually well documented for a botanical. (Z)-ligustilide is a reactive lactone that oxidizes and dimerizes; the analytical work on its mass balance in Angelica sinensis exists precisely because the chasm between the compound in the root and the compound in the bottle was large enough to need its own study Duric 2019. Practically: an essential-oil-bearing preparation, kept cool and dark, with a stated ligustilide content is the only version whose active is specified. Almost nothing on the retail shelf states one.
Which fraction you bought decides which pharmacology you bought. Dong quai is sold as a decoction, an ethanolic tincture, a dried powder and a CO2 or steam-distilled oil extract. Ligustilide is lipophilic and volatile and reports to the oil Xie 2020; ferulic acid and the polysaccharides report to the water fraction. A hot water decoction and a lipophilic extract of the same root are two different products with the same name on the front, and the traditional preparation is the decoction while the modern pharmacology is mostly about the phthalide.
Two species share the English name and they are not interchangeable. Angelica sinensis is dong quai. Angelica gigas — Korean angelica, the decursin-bearing root in EstroG-100 — and Angelica archangelica are different plants with different marker compounds. A capsule labeled ‘angelica’ without a species name is not identified, and the trials in this file are all A. sinensis Hirata 1997 Al-Bareeq 2010.
Root, tail and head. Traditional practice distinguishes the root head, body and tail as having different actions, and commercial material is usually whole root or an unspecified mixture. No modern analysis in this file supports or refutes the distinction, and that is worth saying plainly rather than either repeating it as fact or dismissing it: it is an untested claim about composition that would be straightforward to test by assaying the three parts separately.
What to do with all that. If you are buying dong quai for a traditional formula under a practitioner, the form question belongs to them and the tradition specifies it. If you are buying a single-herb capsule for menopausal symptoms, the two placebo-controlled trials of single-herb dong quai were both negative Hirata 1997 Al-Bareeq 2010, and no choice of extract changes that, because none of them has been tested either.
What would have to be true, and how you would know it was not
1. Vasomotor symptoms, and the prediction is nothing. Count flushes for two weeks before starting and again at 12 and 24 weeks. Predict no difference beyond the placebo response, because 24 weeks in 71 women produced none Hirata 1997 and three months in men on androgen deprivation produced none Al-Bareeq 2010. Two negative randomized trials in two physiologically distinct populations is a stronger prior than one.
2. estradiol, fsh and endometrial thickness — three read-outs of the same negative. Predict all three unchanged. The trial measured endometrial thickness and vaginal maturation directly and found nothing Hirata 1997, and the receptor assays say why: no ER-alpha or ER-beta transactivation Amato 2002. If somebody tells you dong quai is balancing their hormones, this is the panel that tests it, and the prediction is that it will not.
3. inr and platelet function — the prediction that says the product is not inert. On anticoagulation, predict the INR rises. A patient taking dong quai concurrently with warfarin showed a greater than two-fold elevation of prothrombin time and INR after four weeks, which normalized within a month of stopping Page 1999. Four weeks to onset and a month to resolution are the numbers to plan monitoring around. This is the one prediction on the page with a documented human outcome behind it, and it is a harm rather than a benefit.
4. The prediction that cuts against this page's dismissal. Everything above says dong quai does nothing measurable. The MCF-7 result says otherwise — 16-fold proliferation is not ‘nothing’, it is a large effect on a cell line, with the receptor route excluded Amato 2002. So predict that a properly designed cell experiment will find a reproducible, receptor-independent proliferative signal, and that its target is identifiable. If that holds, the correct description of dong quai is not ‘inactive herb’ but ‘active compound aimed at the wrong claim’, which changes the safety conversation more than the efficacy one.
5. Photosensitivity, which reports itself and needs no lab. Furocoumarins are the classic phototoxic class. Predict a lower threshold for sunburn within days of starting, most obviously on the hands and face. Anyone who starts dong quai in summer and burns unusually fast has run this experiment without meaning to, and the correct response is to stop rather than to buy stronger sunscreen.
What nobody has tested yet
Nobody knows what caused the 16-fold proliferation, and that is the most important open question about this plant. The receptor route was excluded and the uterotrophic assay was negative Amato 2002. Fractionate the extract, find the fraction that drives MCF-7 growth, and identify the target. It is a straightforward bioassay-guided fractionation, the finding is more than twenty years old, and the answer would decide whether the standard hormone-sensitive-cancer warning on this product is the right warning or entirely the wrong one.
Nobody has tested the herb inside the formula it belongs to. Every controlled trial gave single-herb dong quai Hirata 1997 Al-Bareeq 2010. The tradition uses it in combination and claims the combination is the point. A placebo-controlled trial of a classical formula with and without dang gui would test the traditional claim rather than a modern simplification of it, and it has never been run.
Nobody has reported the ligustilide content of the material in any human trial. The compound is unstable enough to have generated its own analytical literature Duric 2019 Xie 2020, so a trial that does not state how much of it the capsules contained cannot distinguish a null result from a degraded batch. Every human trial of dong quai has this hole in it, including the two negatives this page relies on — which is an argument against my own conclusion and belongs on the page for that reason.
And nobody has quantified the anticoagulant interaction. There is a case report with a doubled INR Page 1999 and no pharmacokinetic or pharmacodynamic study. Whether the interaction is a coumarin displacing warfarin from albumin, an effect on CYP2C9, or a direct platelet effect determines whether it also applies to apixaban and clopidogrel, which are cleared differently. One crossover study in twelve healthy volunteers with INR and platelet aggregometry would answer it.
Dong Quai — its own safety story, not its category's
The anticoagulant interaction is documented in a person, with numbers, and it is the reason this page exists. A 46-year-old patient taking dong quai alongside warfarin developed a greater than two-fold elevation in prothrombin time and INR after four weeks of concurrent use; the values normalized within a month of stopping the herb Page 1999. Most botanical bleeding warnings are inferred from a coumarin ring. This one has a time course, a magnitude and a dechallenge.
The hormone-sensitive-cancer warning needs rewriting rather than repeating. The standard line is that dong quai is a phytoestrogen and should be avoided after a hormone-sensitive cancer. The measured facts are that it does not transactivate ER-alpha or ER-beta and does not increase uterine weight in mice, but does induce 16-fold proliferation of MCF-7 breast cancer cells Amato 2002. The conclusion is the same — avoid it — but the reason is the opposite of the one printed everywhere, and the reason matters: an anti-estrogen drug cannot block a signal that does not run through the estrogen receptor. Somebody on tamoxifen or an aromatase inhibitor is not protected from this by their medication.
Photosensitivity is the distinctive one and it is a chemical class effect. Furocoumarins in Angelica absorb UVA and form adducts with DNA in skin. The practical consequence is phototoxic burning at exposures that were previously fine, and it is dose- and light-dependent rather than allergic — which means it will happen to anyone who takes enough and goes outside, not only to susceptible people.
Pregnancy: not a precaution, a contraindication. Dong quai is used traditionally as a uterine tonic and has uterine-stimulating activity in that tradition; combined with a documented anticoagulant interaction Page 1999 in a state where bleeding is already the leading obstetric emergency, there is no risk-benefit argument to be had. The trials in this file were run in postmenopausal women Hirata 1997 and in men Al-Bareeq 2010. There is no pregnancy safety data set at all.
The surgical point, stated as a date rather than an abstraction. The case that exists took four weeks to develop and a month to resolve Page 1999. Two weeks of abstinence before a procedure — the standard supplement advice — may be short for this one. Tell the anesthetist and the surgeon what you have taken and when you stopped, because a raised INR discovered on the morning of an operation cancels it.
Sources read for this page
- Hirata JD, et al. Does dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled trial. Fertility and Sterility 1997;68(6):981-986 · PMID 9418683
- Amato P, et al. Estrogenic activity of herbs commonly used as remedies for menopausal symptoms. Menopause 2002;9(2):145-150 · PMID 11875334
- Al-Bareeq RJ, et al. Dong Quai (angelica sinensis) in the treatment of hot flashes for men on androgen deprivation therapy: results of a randomized double-blind placebo controlled trial. Canadian Urological Association Journal 2010;4(1):49-53 · PMID 20165579
- Page RL 2nd, Lawrence JD. Potentiation of warfarin by dong quai. Pharmacotherapy 1999;19(7):870-876 · PMID 10417036
- Duric K, et al. Studying Mass Balance and the Stability of (Z)-Ligustilide from Angelica sinensis Helps to Bridge a Botanical Instability-Bioactivity Chasm. Journal of Natural Products 2019;82(8):2400-2408 · PMID 31478376
- Xie Q, et al. Z-ligustilide: A review of its pharmacokinetics and pharmacology. Phytotherapy Research 2020;34(8):1966-1991 · PMID 32135035
How you would know if it worked
There is no blood test for this one. That is not a criticism — it is a fact about the effect, and it changes how you should judge it.
- What to watch: On its own evidence, nothing it is marketed for: the randomized placebo-controlled trial of dong quai alone for menopausal flushes found no benefit. If you are taking it inside a traditional multi-herb formula under a practitioner, then the read-out belongs to the formula rather than to this herb, and changing one ingredient at a time is the only way to learn anything from it.
- How long before it means anything: Twelve weeks for a flush count if you run it anyway — but know going in that the experiment has already been done at proper scale and came back negative, so you are repeating a study with a sample size of one.
- What will fool you: Combination formulas taking the credit. Most positive reports come from mixtures where attribution is impossible. The safety points are sharper than the efficacy one: it contains coumarins with anticoagulant activity and interacts with warfarin and other blood thinners, it raises sun sensitivity, and it is avoided in pregnancy. Any of those outrank a symptom score.
Run it one variable at a time. Starting three things in one week means a result you cannot attribute, which is the same as no result.
Dong Quai — safety & side effects
- Photosensitivity is the distinctive one — it contains furocoumarins and can make you burn faster than you expect.
- Avoid in pregnancy — it has uterine-stimulating activity. Avoid with hormone-sensitive conditions.
The same on every page it applies to. Read it here; it is not repeated research.
- Additive bleeding risk with anticoagulants and antiplatelets — warfarin, apixaban, rivaroxaban, clopidogrel, and aspirin at any dose. The interaction is pharmacodynamic rather than metabolic, so it does not show up as a changed drug level; it shows up as bruising, nosebleeds or a raised INR.
Not medical advice. If you take prescription medication or have a diagnosed condition, check this against it with a pharmacist or doctor — pharmacists are underused and free.
- When to take it, and what to take it with
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- Fasted or with food, and when in the day
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- Around training, or deliberately away from it
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Unlock in Skool — $10/mo →Bloodwork to run alongside Dong Quai
Baseline first, then again at 8–12 weeks.
| Marker | What it’s watching for |
|---|---|
| TSH (Thyroid-Stimulating Hormone) | Thyroid sits upstream of most things labeled 'hormonal' |
| Free T4 (Thyroxine) | Distinguishes a real thyroid problem from a borderline TSH |
| Total Testosterone | The baseline, if any of this is aimed at androgens |
| Vitamin D (25-Hydroxy) | Behaves like a hormone and is commonly low |
The Basics — Start Here panel covers these in one order — 4 markers, $32.40 with the discount applied.
Check results you already have → · All 103 markers A–Z
Dong Quai — frequently asked questions
What is Dong Quai?
A traditional Chinese herb for women's health. The main randomized trial of it alone was negative.
What is the suggested dose of Dong Quai?
As directed; traditionally used in combination. This is a general reference for education only — statements have not been evaluated by the FDA and this is not medical advice.
Where can I find Dong Quai dosing and the full breakdown?
The suggested dose and the full evidence — clinical, correlative and theoretical — are on this page. What's inside Skool is when to take it, which form actually absorbs, the brand worth buying and Coach Cam's stacks.
Where can I buy Dong Quai?
Coach Cam sources Dong Quai from vetted, top-rated brands on iHerb — use the buy link on this page.
What Dong Quai is used for
Dong Quai appears under 1 goal in the goal router.
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Where this goes next
The pages here are the frameworks. The protocols — the dosing, the order to correct things in, the week-by-week schedule and what to retest — are inside Skool.