For over 2500 years chaste tree (Vitex agnus-castus) has been used for gynecological conditions since the days of Hippocrates. 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.

Chaste 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 chaste tree blossoms for adornment, while bows of twigs and leaves, were strewn around Demeter's temple during the festival. 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.

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 in his 1814 Family Herbal 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, and 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.

Vitex agnus-castus L., commonly known as chaste tree, is 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. Introduced to American gardens by European immigrants in the early nineteenth century, 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. Chaste tree is a shrub growing from nine to seventeen feet tall, though specimens can reach twenty-five feet high in the deep South.

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."Use for gynecological conditions is 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. . ."

These recommendations survive to the time of sixteenth century English herbalist John 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 Twentieth Century
In 1938, a German researcher, Gerhard Madaus, was the first to initiate use of chaste tree in the twentieth century. Recognizing the long 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 milk stimulating substances. Clinical confirmation of the effectiveness of chaste tree fruit preparations in stimulating milk production in German women under stress from Allied bombing were published in three separate papers in 1941, 1942, ands 1943. Later in the 1950s, animal studies further confirmed an experimental lactation-stimulating action. In 1954, a clinical study on 1000 maternity patients, compared vitamin B1 and a chaste tree fruit preparation in stimulating milk production to a placebo. Chaste tree preparations came out on top. Increased lactation has been attributed to an increase in prolactin secretion, increased progesterone synthesis, reducing estrogen secretions (which tend to inhibit milk production). 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. It was found that chaste tree fruit preparations act on the pituitary gland to regulate the production of, and induce normalization of the ovarian hormones. The timing of the release of pituitary hormones, regulates 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. Many chaste tree products are standardized to flavonoid content.

Modern Use in PMS
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. 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 is likely to be steroidal hormones. In Europe, however, gynecologists have another choice, preparations made from the fruits of the chaste tree.

A 1986 German clinical trial over a three month period with 36 PMS patients 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.

In a 1990 German 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 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, , gastric symptoms and diarrhea, and a single allergic reaction.

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 (tincture) 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.

The vast majority of chemical, pharmacological and clinical studies have involved a proprietary extract, Agnolyt®, (capsules and liquid) manufactured by Madaus AG, Cologne, Germany. Until the 1990s most studies involved the liquid preparation, a tincture of the fruits (1:5 tincture, with a 58% alcohol content). This liquid product has recently been reformulated into a solid extract available in capsules.

In order to test the effectiveness and tolerability of the new formulation, a research group in Germany conducted a controlled, double-blind study on the use of the product compared with vitamin B-6. The study was conducted in sixteen centers involving 175 female patients, 85 of whom received the chaste tree preparation, while 90 received pyridoxine. Efficacy was assessed by both the patient and physician at the end of the trial. Treatment was continued for three menstrual cycles. Those who received the chaste tree fruit dried extract (3.5-4.2 mg) took one capsule and one placebo capsule per day. Those in the pyridoxine group, received one capsule of placebo twice daily on days 1 to 15 and one capsule of pyroxidine-HCL (100 mg) twice daily from the 16th through the 35th days of the cycle.

Using a standard clinical global impression scale to record results, the researchers found that those who received the chaste tree extract had a marked reduction of PMS symptoms such as breast tenderness, edema, tension, headache, constipation and depression. It was found useful in 80 percent of the women, and results were rated by practitioners as excellent in over 24 percent of cases. Twelve patients in the chaste tree berry extract treatment group reported gastrointestinal complaints, transitory headaches, or mild skin reactions. These adverse effects were transient in nature. The researchers concluded that the dried berry extract of chaste tree was safe and effective in the treatment of PMS.

Modern Applications
In Germany, 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. 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 German Commission E monograph on chaste tree fruits allows 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 fruits. No contraindications are 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.

In a recent review on the relationship between phytotherapy and orthodox medicine, a leading German researcher, H. Schilcher, noted that an important reason for the acceptance of phytotherapy by many German physicians is the existence of the scientifically supported Commission E monographs (recently published in English, cited below). Dr. Schilcher 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.

References:

1. Blumenthal, M., et al., Eds. The Complete German Commission E Monographs. Austin, Texas: The American Botanical Council, 1998.
2. Böhnert, K.-J. and G. Hahn. Phytotherapy in Gynecology and Obstetrics - Vitex agnus-castus (Chaste Tree). Acta Medica Emperica. 1990, 9:494-502.
3. Brown, D. Vitex agnus-castus Clinical Monograph. Quarterly Review of Natural Medicine 1994 (Summer):111-121.
4. Coeugniet, E., E. Elek and R. Kühnast. Premenstrual Syndrome (PMS) and its Treatment. Ärztezeitschr. für Naturheilverf. 1986, 27(9):619-622.
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7. Foster, S. Herbs for Your Health. Loveland, Colorado: Interweave Press, 1996.
8. Gerarde, J. The Herball or Generall Historie of Plantes. 1633 (revised and enlarged by Thomas Johnson) Reprint. New York: Dover Publications, Inc., 1975.
9. Jones, W. H. S. Pliny Natural History with an English Translation in Ten Volumes. Vol. VII. Cambridge: Harvard University Press, 1966.
10. C. H. Lauritzen, et al. Treatment of Premenstrual Tension Syndrome with Vitex agnus-castus - Controlled, double-blind Study Versus Pyridoxine. Phytomedicine, 1997 4(3):183-189.
11. Schilcher, H.. Phytotherapy and Classical Medicine. Journal of Herbs, Spices, and Medicinal Plants 1994, 2(3):71-80.
12. Thorton, R. J.. A Family Herbal. London: B.&B. Crosby and Co., 1814.
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