Angelica sinensis (Danggui) has long been revered as a "holy herb" in Traditional Chinese Medicine (TCM) for regulating menstruation and nourishing blood. Women, whose health is closely tied to blood, often brew Danggui at home to address gynecological issues. Similarly, TCM practitioners frequently include Danggui in formulas for various gynecological conditions. However, this widespread use has led to the misconception that Danggui is universally applicable to all gynecological disorders without the need for pattern differentiation. This approach contradicts the fundamental principle of TCM: tailoring treatments to the individual’s specific condition.
In reality, Danggui has its indications and contraindications in gynecological care and should not be used indiscriminately.
Properties and Indications of Danggui
Danggui is sweet, warm, and slightly pungent in nature. According to Mingyi Bielu (《名医别录》), it is classified as acrid and strongly warming. Such properties make it suitable for conditions characterized by deficiency-cold or cold stagnation. However, for individuals with blood deficiency and yin deficiency, Danggui, despite its blood-tonifying effects, may not be appropriate—or at least should not be used alone. Its warming and acrid nature can boost yang rather than nourish yin, potentially exacerbating yin deficiency. In such cases, moistening and blood-nourishing herbs like Rehmannia, Polygonatum, Goji berries, Fleeceflower root (Héshǒuwū), and Spatholobus stem are more suitable.
Contraindications in Gynecological Bleeding Disorders
Gynecological disorders often involve blood-related symptoms, such as:
Heavy menstrual bleeding
Uterine bleeding
Hemoptysis during menstruation
Intermenstrual bleeding
Threatened miscarriage with bleeding
Restless fetus with bleeding
Sudden bleeding during pregnancy
In these conditions, Danggui is generally contraindicated during active bleeding. Clinical experience has shown that its use can increase bleeding rather than stop it. The goal in such cases is to calm the blood vessels and stop bleeding, which Danggui, with its moving and activating properties, may counteract.
As stated in Jingyue Quanshu: Bencao Zheng:
"Danggui has an acrid and moving nature. Therefore, it should be avoided when stillness is desired. In cases of excessive fire in yin, Danggui can stir the blood and is thus unsuitable. Its key characteristics are 'moving' and 'slippery.' It is appropriate for conditions like menstrual stagnation, labor induction, and postpartum abdominal pain, where it can serve as the primary herb."
Appropriate Uses of Danggui
Danggui is suitable for conditions involving blood stagnation, such as:
Scanty menstruation
Irregular menstruation
Infrequent menstruation
Amenorrhea
Dysmenorrhea
Postpartum lochia retention
However, it is contraindicated in cases of excessive bleeding due to yang excess or fire hyperactivity.
Pharmacological Insights and Clinical Warnings
Modern pharmacological studies reveal that Danggui contains two types of compounds with opposing effects on the uterus: inhibitory and excitatory. The excitatory components, which are water-soluble, can stimulate uterine contractions. This explains why consuming Danggui during uterine bleeding can exacerbate bleeding.
A case recorded by the renowned physician Zhang Shanlei in Shen’s Gynecology: Commentary on Blood Collapse illustrates this point. A patient with uterine bleeding, initially stabilized by Zhang’s yin-nourishing and spleen-tonifying treatment, experienced a sudden and severe hemorrhage after another practitioner added 9 grams of Danggui to her formula. This case underscores the importance of avoiding Danggui during active bleeding.
Conclusion
While Danggui is a valuable herb in TCM gynecology, its use must be guided by pattern differentiation and an understanding of its contraindications. Indiscriminate use, especially during bleeding disorders or in yin-deficient individuals, can worsen symptoms. It is crucial to educate both practitioners and the public about the appropriate and safe use of Danggui to prevent misuse and ensure optimal therapeutic outcomes.
By adhering to these principles, we can honor the wisdom of ancient TCM texts while applying modern insights to achieve balanced and effective treatments.
