A 6-month double-blind, placebo-controlled RCT of the effect of Dang Gui Buxue Tang, a 1:5 combination of Angelica sinensis (dong quai) and Astragalus membranaceus (huang qi), on acute menopausal symptoms was conducted. A total of 103 symptomatic women were enrolled; three failed to meet the inclusion criteria, leaving 50 subjects for inclusion in each group. Overall, mild hot flushes were reported more frequently than either moderate or severe flushes. In analysis by severity of flushes, there was a significant reduction in the number of mild hot flushes per month in the treatment group but not in the placebo group (from 18.9 ± 23.5 at baseline to 8.6 ± 17.1 at 6 months in the treatment group and from 26.0 ± 43.5 to 12.4 ± 17.6 in the placebo group). For moderate flushes, there was a significant reduction in the placebo group compared with the treatment group (from 18.9 ± 28.7 at baseline to 11.1 ± 29.9 at 6 months in the placebo group and from 10.5 ± 22.3 to 6.0 ± 16.0 in the treatment group). There was no significant change in either treatment or placebo groups in the reporting of severe hot flushes. Episodes of night sweats decreased significantly in the placebo but not in the treatment group (from 6.8 ± 10.0 at baseline to 1.9 ± 5.7 at 6 months in the placebo group and from 5.4 ± 8.9 to 3.2 ± 8.5 in the treatment group). In the vasomotor domain of the Menopause Specific Quality of Life, there was a significant reduction in scoring in the placebo group (from 2.8 ± 1.6 to 1.7 ± 1.3) but not in the treatment group (from 2.8 ± 2.1 to 2.3 ± 1.6).