© Steven Foster |
Chaste Tree (Vitex agnus-castus) has been used for gynecological conditions since the days of Hippocrates (2500 years ago). With a rich traditional of use, modern research supports historical wisdom, and has made chaste tree fruit preparations a phytomedicine of choice by European gynecologists for treatment of various menstrual disorders, PMS, and other conditions.
Origins and Botany
The genus Vitex until recently has been associated for centuries with the verbena family (Verbenaceae), and includes about 250 species, primarily tropical shrubs and trees. Only a few Vitex species occur in temperate regions. Vitex agnus-castus L., commonly known as chaste tree, is the sole species to occur in Europe. Native to West Asia and southwestern Europe, the shrub was introduced throughout Europe at an early date. It was known in English gardens as early a 1570, and now occurs throughout the European continent.
Chaste tree is a shrub growing from nine to seventeen feet tall, though specimens twenty-five feet high, with trunks eight inches in diameter, have been recorded. It has palmate leaves, usually with five to nine (rarely three) leaflets, white hairy beneath, with densely hairy, resinous leaf stalks. The flowers are in a pyramidal-shaped showy cluster, with seven inch spikes, sporting tiny blue to lilac blooms. Chaste tree has a long blooming period, as early as April in the deep South, lasting into October in more northerly areas in the United States. Typically it blooms from June through August. The small round fruits (seeds) have a pungent scent and flavor. Introduced to American gardens by European immigrants in the early nineteenth, the shrub has become naturalized in much of the Southeastern United States, occurring in Florida, Georgia, Alabama, Mississippi, Louisiana, Arkansas, Texas, southeast Oklahoma, north to Maryland.
The genus name Vitex derives from an ancient designation, vei, meaning to “wind, bend or twine,” referring to the once common use of the tough, flexible branches in constructing woven (wattle) fences. Pliny was the first to apply the name Vitex to the plant, perhaps derived from the Latin “vitilium” (wicker-work). The species name “agnus-castus” derives from a historical mis-interpretation of the original Greek name, “ágnos,” first applied by Dioscorides, and translated as “holy, pure or chaste,” Castus derives from the Latin castitas, meaning chastity. Agnus the Latin for lamb, at some point in history, replaced the original Greek “agnos” in reference to this plant (Böhnert and Hahn 1990).
Chaste tree has been used for the treatment of menstrual difficulties for at least 2,500 years. The Greek physician Hippocrates (460-377 B.C.) wrote, “If blood flows from the womb, let the woman drink dark wine in which the leaves of the chaste tree have been steeped. A draft of chaste leaves in wine also serves to expel a chorion held fast in the womb” (as quoted by Bleier 1959). Use for gynecological conditions are also noted in the works of Pliny and Dioscorides (1st century A. D.), as well as Theophrastus (3rd century A.D.). “The trees furnish medicines that promote urine and menstruation,” wrote Pliny, “They encourage abundant rich milk. . .” (Jones 1966).
Dioscorides, quoted from Goodyer’s 1655 English translation, recognizes effects on females, “It doth brings downe the milke, and expells ye menstrua, being drank to ye quantity of a dragme in wine” (Gunther 1934). These recommendations survive to the time of Gerarde, “The decoction of the herbe and seed is good against pain and inflammations about the matrix, if women be caused to sit and bathe their privy parts therein; the seed being drunke with Pennyroiall bringeth downe the menses, as it doth also both in a fume and in a pessary. . .” (Gerarde 1633).
The tree was associated with ancient Greek festivals. In the Thesmophoria, a festival held in honor of Demeter, the Greek goddess of agriculture, fertility and marriage, women (who remained “chaste” during the festival), used the blossoms for adornment, while bows of twigs and leaves, were strewn around Demeter’s temple during the festival (Böhnert and Hahn 1990). Pliny wrote, “the Athenian matrons preserving their chastity at the Thesmophoria, strew their beds with its leaves.” (Jones 1966). In Rome, vestal virgins carried twigs of chaste tree as a symbol of chastity. According to Greek mythology, Hera, sister and wife of Zeus, regarded as protectress of marriage, was born under a chaste tree. Ancient traditions associating the shrub with chastity were adopted in Christian ritual. Novitiates entering a monastery walked on a path strewn with the blossoms of the tree, a ritual that continues to the present day in some regions of Italy (Böhnert and Hahn 1990).
The shrub’s ancient association with chastity led to later use of the fruits as an anaphrodisiac, quieting the desires of the flesh, especially of celibate clergy. “These seeds have been celebrated as antiaphrodisiacs, and were formerly much used by monks for allaying the venereal appetite; but experience does not warrant their having any such virtues,” wrote Andrew Duncan in the 1789 edition of the Edinburgh Dispensatory.
Robert John Thorton (1814), put it more eloquently, “As there are provocatives to procreations, as shell-fish, eggs, and roots of orchises made into salep for the male, and spare dict and use of steel for the female, so it is possible the chaste tree may have a contrary effect; and hence the seeds have been called Piper monachorum (Monk’s pepper), who flew to them when they found the spirit to be willing, but the flesh weak.”
Many of the common names of the shrub refer to this use of the plant, including, Abraham’s Balm, Chaste Lamb-Tree, Safe Tree, Monk’s Pepper-Tree. It has also been called Indian-Spice, and Wild-Pepper, referring to the use of the fruits as a pepper substitute. The small round fruits (seeds) have a pungent scent and flavor reminiscent of black pepper. The fragrant leaves have also been used as a substitute for hops in brewing beer.
Through the eighteenth and nineteenth century, the fruits were little used by European medical practitioners. In the late nineteenth century, Felter and Lloyd (1898) suggested use of a tincture of the fresh berries to Eclectic medical practitioners to increase milk secretions and useful as an agent in menstrual disorders. In small doses, it was said to be useful in the treatment of impotence, and perhaps useful for nervousness or mild dementia.
Early Modern Research (1938-1960)
Madaus (1938) was the first to initiate use of chaste tree in the twentieth century. Recognizing the long-recognized value of the plant in gynecological disorders, he designed a series of animal experiment to determine which part of the plant had the greatest biological activity. Madaus found that extracts of the leaves, fruits, and bark retarded estrus (heat) in female rats, without evidence of adverse effects on reproductive performance. The fruits had the greatest activity.
During the Second World War, medical practitioners in Germany recognized a stress-induced lactation repression in women, prompting a search for effective galactogogues (milk stimulating substances). Clinical confirmation of the efficacy of chaste tree fruit preparations in stimulating lactation were published in three separate papers by Janke, Hofmeir and Noack and Noack in 1941, 1942 and 1943 respectively (as reviewed by Böhnert and Hahn 1990). Later animal studies in the late 1950s further confirmed an experimental lactation-stimulating action. In 1954, Mohr reported on a study of 1000 maternity patients, comparing vitamin B1 and a chaste tree fruit preparation in stimulating lactation to a placebo. The author concluded that the chaste tree fruit preparation resulted in more successful lactation than vitamin B1 or the control group. Increased lactation has been attributed to an increase in prolactin secretion, increased progesterone synthesis, reducing estrogen secretions (which tend to inhibit milk production).
Active constituents and Actions
Results of these early studies led investigators to postulate that either the plant contained a component that replaced hormones produced by the body, or plant extracts, acting through the pituitary, might regulate hormone production (Haller 1961). Various studies, reviewed by Böhnert and Hahn (1990), indicate that a tincture of the seeds produces an effect on the hypothalamus-pituitary system, showing a gonadotropic function and causing an increased release of lutenizing homone with consecutive increase of progesterone level. Prolactin secretion is inhibited because of a dopaminergic action. In other words it acts on the pituitary gland to regulate the production of and induce normalization of the ovarian hormones, changing the ratio of estrogens and gestagens in favor of gestagens. The timing of the release of pituitary hormones, regulate menstruation, fertility, and other processes. Hence, an agent that will produce a balance of hormones can help to regulate these processes.
The biological activity of chaste tree cannot be attributed to a single chemical component. The fruits contain flavonoids including the major flavonoid casticin, as well as orientin and isovitexin (Belic et al., 1958, 1961, 1962). Other flavonoids include 3,6,7,4’-tetramethyl ether of 6-hydroxykaempferol, and quercetagetin (Wollenweber and Mann 1982). The dried fruits also contain an essential oil (up to 1.22%), as well as iridoid glycosides including aucubin, eurostoside and agnuside among others (Görler et al., 1985, Gomma et al. 1978). A recent study detected the probable presence of delta-3-ketosteroids in flower extracts include progesterone, 17-a-hydroxyprogesterone, testosterone, and epitestosterone; leaf extracts yield andostenedione. However, the reported results of this study were ambiguous (Saden-Krehula, et al. 1990). The vast majority of chemical, pharmacological and clinical studies have involved a proprietary extract, Agnolyt®, (capsules and liquid) manufactured by Madaus AG, Cologne, Germany.
Modern Clinical Use
An imbalance of estrogen and progesterone has also been associated with premenstrual syndrome (PMS). Symptoms appear seven to ten days before the beginning of menstruation, and cease once the cycle begins. Physical symptoms include painful breasts, abdominal discomfort and fullness, flatulence, edema (especially of the lower extremities, as well as the hands and the face), and headache. Mental symptoms may include mood swings, nervous irritability, depression, restlessness, and aggressiveness. It is estimated that between 5 and 30% of women may be affected by PMS. Therapeutic choices by health care professionals are based on severity of symptoms. In severe cases, the treatment of choice is likely to be steroidal hormones. In Europe, however, gynecologists have another choice, preparations made from the fruits of the chaste tree (Feldmann).
A clinical survey of German gynecologists published in 1992 evaluated the effect of a chaste-tree preparation (Agnolyt®) on 1542 women diagnosed with PMS. Treatment of 40 drops daily lasted an average of 166 days. Both physicians and patient assessed efficacy, with 90 percent reporting relief of symptoms, after an average treatment duration of 25.3 days. Two percent reported side effects, mostly gastrointestinal in nature (Dittmar et al 1992, Brown 1994).
In one clinical drug monitoring study of the efficacy and safety of long-term treatment with a chaste tree fruit tincture, 1571 women with menstrual disorders including corpus-luteum insufficiency and PMS were followed for a period of 7 days to six years (average 147.6 days). The preparations was 1:5 tincture, with a 58% alcohol content. The dose was 40 drops once a day taken on an empty stomach in the morning with water. In 90 percent of patients, the treatment eliminated or alleviated symptoms of PMS. Results for 465 patients were rated very good, 714 good, 220 satisfactory, 110 unsatisfactory, and in 62 cases no data was available. Adverse reactions were reported for 30 patients (1.9 percent), including 12 cases of nausea, malaise, gastric symptoms and diarrhea, and a single allergic reaction (Feldmann, et al., 1990).
Coeugniet, et al (1986), in a three month trial with 36 patients with PMS reported positive results in physical and psychological symptoms. A dose of 40 drops a day, taken over a three month period, produced a reduction in headaches, breast tenderness and pressure, bloating, and fatigue. Improvement in anxiety, mood swings, and other psychological symptoms were also reported. Given the positive results of experimental studies in the 1940s and 50s coupled with clinical experience, has lead to the use of chaste tree extracts in European phytotherapy in several major areas including: management of menstrual disorders, PMS, treatment of infertility produced by mild corpus luteum insufficiency, and hot flashes at the initial stages of menopause, among other conditions.
In Europe, the use of phytomedicines in the treatment of menstrual disturbances is often preferred over conventional treatment, if no contraceptives are indicated. Steroidal hormones are often considered unnecessary, and individual treatment initiated once differentiation has been made between cyclic and acyclic bleeding difficulties (Loch 1989). A benefit of chaste tree treatment is the relative lack of side effects compared with treatment with steroidal hormones. Another benefit is that the price of chaste tree preparation therapy is far below that of conventional treatment methods. The 1992 German Commission E monograph (now irrelevant as a regulatory document) on chaste tree fruits allowed use of preparations for menstrual disorders due to rhythmic disorders of menstruation, mastodynia (pressure and swelling in the breasts), and premenstrual syndrome. Preparations include alcoholic extracts of the pulverized fruits (tincture) formulated to an average daily dose equivalent to 30-40 mg of the seeds. No contraindications were listed. While no interactions with other drugs are reported, animal experiments indicate the possibility of interference with dopamine-receptor antagonists. Side effects noted include too early menstruation following delivery (resulting from activation of the pituitary), as well as rare instances of itching and rashes. Chaste tree preparations are contraindicated during pregnancy (Monograph Agni casti fructus).
In a review on the relationship between phytotherapy and orthodox medicine, Schilcher (1994) reports that an important reason for the acceptance of phytotherapy by many German physicians is the existence of the scientifically supported Commission E monographs (as cited above). He also notes that acceptance of phytotherapy rests with the fact that in Germany, their use is consider a component of orthodox medicine and not an alternative approach. In Germany chaste tree fruit preparations are considered a safe, effective, and low-priced tool available to, accepted by, and widely used by gynecologists.
Chaste tree, recognized for nearly 2,500 years in the treatment of gynecological conditions, has been widely used in European phytotherapy for over fifty years. The majority of clinical reports in that period have been non-controlled studies by gynecologists in clinical practice, who report positive results. Chaste tree preparations are frequently used in the safe and effective treatment of PMS, heavy periods, too frequent periods, acyclic bleeding, infertility, suppressed menses, and other conditions, many of which are linked to corpus luteum insufficiency. Vitex is an excellent example of a phytomedicine which serves as a low-priced tool in orthodox European gynecological practice, rather than an “alternative” treatment.
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