Vitex agnus-castus
Verbenaceae
Common name: Chaste berry, monk’s pepper, Vitex
Habitat: Vitex is native to the Mediterranean and Central Asia. It prefers creek beds and river banks.
Botanical description: Vitex is a deciduous perennial shrub that grows to heights between 6 and 25 feet. The leaves are divided into
5-7 narrow, 2-6 inch long leaflets that are dark green above and gray underneath. Slender spikes of lavender blue flowers bloom in
summer and early fall. The fruit then appear. The fruit appear as tiny black peppercorns with a pepper-like aroma and flavor.
Parts used: Fruit; occasionally leaves, flowering tops
Historical Use: Vitex is a plant of medicinal antiquity being mention in the works of Hippocrates, Dioscorides and Theophrast. In the
Middle Ages, the berries were a symbol of chastity and were used to suppress sexual excitability as monks would use them to replace
pepper and suppress their libido. Vitex agnus- castus and other Vitex species have been used traditionally by many cultures in Africa,
India, and Southeast Asia for birth control purposes (at high dosage levels).
Energetics: Aside from these physiological indications, Vitex agnus-castus may be prescribed based on its subtle qualities. Vitex has
sweet and cool qualities. Dr. Alschuler describes it as exerting a centering influence. A person with the following characteristics will
benefit from Vitex: nervous energy, excess sympathetic states that are manifested by “excessive” sexual drive, nervousness,
palpitations, or menstrual irregularities. Vitex exerts a calming and strengthening effect.
Constituents: No single constituent has been identified as being the active one, in fact, with the exception of agnoside, all constituents
are found in other plants. The total sum of constituents appear to generate a synergistic effect.
 Flavonoids: castican, orientin, isovitexin
 Iridoid glycosides: agnuside (the reference constituent for standardization), aucubin
 volatile oil (0.8-1.6%): terpenoids (cineole, sabinene, limonene, camphene), - and -pinene
 3-ketostaroids: Vitex has been found to contain 3-ketosteroids (probably progesterone and 17 -a-hydroxyprogesterone) by thin-layer
chromatography. 1
The flowers and leaves may also possibly contain progesterone, 17-hydroxyprogesterone, testosterone, and epitestosterone although
further research is needed. Other constituents in the flowering tops include flavonoids (particularly C-glycosides), and iridoids (aucubin,
agnuside, eurostoside), 3-ketosteroids, essential oils(O.8-1.6%): O-cymol, f)-famescene, a- and f)-pinene, cineol, sabinene, limonene.
Pharmacology: Vitex affects the pituitary gland in two primary ways. First, Vitex has been shown to inhibit prolactin with both in vitro
(pituitary cell cultures) and in vivo studies by binding to dopamine receptors on the pituitary gland. 2, 3 Thus, the binding of Vitex causes a
suppression of prolactin synthesis and release by binding to the D2 receptor. The decreased prolactin results in increased corpus luteum
growth and increased progesterone.4
The second effect that Vitex has on the pituitary gland is by increasing the anterior pituitary’s production of luteinizing hormone (LH)
and inhibiting the production of follicle stimulating hormone (FSH).5 This results in a relative increase in progesterone and a decrease in
estrogen, and in men a decrease in testosterone. Vitex does not appear to affect GnRH. 6
The flavonoid fraction of some Vitex spp. has been found to have anti- androgen effects.7
The constituent volatile oils have demonstrated antibiotic effects. Aucubin has demonstrated hepatoprotective activity against
experimental hepatotoxicity induced by carbon tetrachloride and - amanitin.
Medicinal actions: Pituitary adjuvant, dopamine agonist, galactagogue, emmenagogue, FSH antagonist, LH agonist, prolactin
antagonist, hepatoprotective, antiseptic, and anaphrodisiac
Medicinal use:
 Gynecologic Conditions: Vitex has found a special application in Naturopathic Medicine for the treatment of endocrine disorders
involving corpus luteal insufficiency as evidenced by the absence of a midcycle thermal shift or a shortened luteal phase with basal body
testing, progesterone deficiency, and an abnormally low progesterone/estrogen ratio. Vitex has been found to normalize abnormally
shortened luteal phases. It has been used to treat hormone imbalance due to ovarian suppression after discontinuing oral
contraceptives.
All of the following conditions are manifestations of this relative progesterone deficiency and/or excess prolactin:
acne
dysmenorrhea
endometrial hyperplasia
endometriosis
infertility
insufficient lactation
menopausal syndrome
menorrhagia
metrorrhagia
oligomenorrhea
perimenopausal depression
polycystic ovary syndrome (PCOS)
polymenorrhea
premenstrual syndrome
secondary amenorrhea
threatened miscarriage
uterine myomas
Along with relative progesterone deficiency, prolactinemia is an indication for Vitex.Although Vitex has shown prolactin inhibiting effects,
it has been found to be an effective galactogogue. Studies have demonstrated that Vitex in breast feeding mothers is effective for
maintaining adequate breast milk production.8
Vitex has traditionally been used to decrease libido and can be used in androgen excess disorders. It is has been used to treat
virilization, and excessive sexual drive.
Menstrual disorders: Menstrual disorders, particularly secondary amenorrhea, ovarian cysts, cystic hyperplasia of the
endometrium (often a premenopausal disorder that causes excessive uterine bleeding) respond favorably to Vitex. 9,10,11 In both
of these cases, there is often corpus luteum deficiency resulting in abnormal or absent follicle development and lack of
ovulation. There have been several clinical trials done that demonstrate the efficacy of Vitex in restoring the luteal phase of the
menstrual cycle. (Note: these trials are open, uncontrolled studies.) Thus, the menstrual cycle approximates a more optimal
length, menstrual bleeding is reduced if excessive and cystic tissue resolves. For menstrual function to stabilize, many months
of Vitex administration are required.
Infertility: Vitex administration may restore fertility in women if they have anovulatory cycles as a consequence of shortened
luteal phase and decreased progesterone.12,13 There are potentially many confounding variables, not to mention the placebo
effects. Nonetheless, the restoration of fertility is a common usage of Vitex and seems to prove its reputation in current clinical
practice.
Premenstrual syndrome: Some cases of PMS may be helped with Vitex. The etiology of PMS in unclear, but at least in some
women, it appears to be the result of decreased progesterone to estrogen ratio. Interestingly, in these cases, progesterone
administration is not always successful. Vitex may be a more subtle and effective way to treat this type of PMS. A controlled
trial done in England found Vitex to be of benefit for all types of PMS except those women with a definitive picture of PMS-C
(headache, craving for sweets, palpitations, dizziness).14 Vitex also has been noted in several studies to reduce atypical
manifestations of PMS such as post-traumatic epilepsy15, mouth ulcers16, and orofacial herpes simplex17. In an unpublished
study comparing the efficacy of Vitex with placebo, women suffering from PMS symptoms such as breast tenderness,
abdominal bloating, migraine, and acne experienced a 40% reduction of symptoms compared to a 10% reduction of symptoms
in the women on placebo. Interestingly, the emotional symptoms of PMS were reduced by 70% in the Vitex group, but the
placebo group also experienced a 60% reduction of emotional symptoms!18
Acne: Vitex increases LH and lowers FSH, one consequence of which is lowered testosterone levels. This may explain the
benefit of Vitex in improving acne. In one placebo controlled trial of males and females, after 3 months of treatment with Vitex,
both males and females experienced a 70% improvement in their acne.19 This was significantly better than the placebo. Keep
in mind that if Vitex is given to someone who does not have a relative progesterone deficiency, his or her acne will worsen, and
in fact may be initiated by the prescription of Vitex.
Male Conditions: It may be useful in the treatment of benign prostate hypertrophy in conjunction with Seronoa, Urtica, and Pygeum.
According to Mills and Bone:20
 Gynecologic Conditions: A common cause of cyclical disorders involves hyperprolactinemia. The latent condition is generally
present throughout the cycle. At the end of the luteal phase the inhibitory effect of progesterone is removed. As a result, high quantities
of prolactin are released at night as a response to stress. (note: A relative insufficiency of the corpus luteum can also lead to a relative
hyperprolactinemia). Efficacy appears to be about 70%.
Breast Conditions: Because of it ovarian regulating function Vitex is a primary herb in the treatment of breast cysts and
fibroadenoma. Vitex will also promote milk production in the lactating mother.21,22
PMS: Vitex has been shown to be beneficial for PMS-A, PMS-D and PMS-H, particularly with the symptoms of breast
tenderness and fluid retention. PMS associated with hyperprolactinemia may be a more specific indication for Vitex. 23
Menstrual Disorders: Vitex is indicated for menorrhagia and secondary amenorrhea. (Note: Although these conditions appear
to be the opposite ends of the spectrum for menstrual bleeding, the fact that Vitex can be used to treat both indicates its vast
normalization ability in normalization of menstrual function).
Women with cystic hyperplasia of the endometrium respond well to Vitex as this condition is due to a relative
progesterone deficiency. In particular, women with corpus luteum deficiency are assisted by Vitex.
Infertility: Vitex may be indicated for difficult in conception. After using Vitex women tended toward a longer luteal and an
increase in LHRH suggesting enhanced corpus luteum function.8,9
Uterine Fibroids: Vitex is a primary component to treatment of uterine fibroids and may be given at high doses for severe
cases.
Endometriosis: Vitex is likely the most important herb for the treatment of endometriosis and usually is used in higher doses.
Postnatal depression: see formula below.
 Dermatological Conditions: Vitex has been used to treat acne in both men and women.24
According to the Textbook of Natural Medicine:25
 Gynecologic Conditions: The TNM mentions use for the above conditions including corpus luteum insufficiency, PMS, abnormal
menstrual cycles and hyperprolactinemia.
According to Weiss:26
 Gynecologic Conditions: The primary indication for Vitex is menstrual disorders due to corpus luteum insufficiency: hyper or
polymenorrhea and premenstrual syndrome base on hyperfolliculinism. Other premenstrual complaints may respond to Vitex such as
acne and oral herpes as well as premenstrual knee joint effusions and water retention.
Vitex may be used as a galactagogue although some time is necessary for the effect to occur. At the same time, it can be give for
weeks to months to maintain a good level of milk production without side effects.
According to King’s:27
This agent is a reported galactagogue and emmenagogue and is said to repress the sexual passions for which purpose the ancient
Athenian women employed it. It has been suggested in small doses in impotence and sexual melancholia. It is probably a remedy for
sexual irritability with nervousness or melancholia or mild dementia.
Pharmacy:
Vitex is not a fast-acting botanical requiring 1-2 menstrual cycles for effect to occur. Treatment for more difficult conditions such as
anovulatory cycles and infertility may take many months before demonstrating benefit. For secondary amenorrhea of greater than 2
years duration, administration should be for at least 1.5 years.28
It is best to dose Vitex first thing every morning in accordance with the diurnal rhythm of the pituitary gland. It may be prescribed during
the luteal phase of the menstrual cycle (day 15-28) or throughout the cycle. Vitex is slow acting and its efficacy should be assessed only
after 3 months of treatment, with the full therapeutic effect typically manifesting after 6 months. It should be discontinued if the length of
the menstrual cycle is excessively changed.
Infusion: steep 1/2 to one teaspoon (5-10 g)of the berries or seeds in 8 oz. of hot water for 15 minutes: 8 ounces of the infusion, 3
times/day, or once during the morning.
1:5 tincture: 3 to 10 ml per day in am
1:2 fluid extract: 1 to 4 ml per day
NMIMH lists 20 ml per week as maximum dose (but this seems low from my perspective) (Dipasquale drop doses for energetic
effect
Standardized extract (Agnolyt, Vitalex (German)): 40 drops or 1 capsule every morning (9 g of fruit per 100 ml extract )
Postnatal Depression29: Panax ginseng (10 ml), Hypericum perforatum (25 ml), Glycyrrhiza glabra (15 ml),Withania somnifera
(30 ml), Verbena officinalis (20 ml) (all 1:2 except Glycyrrhiza which is 1:1)
Contraindications: Vitex can aggravate spasmodic dysmenorrhea due to enhanced secretion of progesterone. Yet, spasmodic
dysmenorrhea that is present with congestive PMS will respond to Vitex.
Caution is advised in pregnancy due to its emmenagogue effect (empirical) though it has been used to help prevent miscarriage in
the first trimester when due to progesterone insufficiency (empirical).30 A report that Vitex may be inappropriate with in-vitro fertilization
treatment as a promoter of normal ovarian function is likely premature.31 Vitex is potentially inappropriate to administer in conjunction
with progesterone drugs, OCPs or HRT.32
Toxicity: In high doses (20 times therapeutic), Vitex inhibits all aspects of anterior pituitary function resulting in decreased pituitary,
adrenal and uterine function in guinea pigs.33 Rare occurrences of formication, abnormal menstrual cycle changes, itching, urticaria,
gastrointestinal and lower abdominal complaints and short term headaches have been reported in large scale trials.
Saden-Krehula M, et al. Delta-3-ketosteroids in the Flowers and Leaves of Vitex agnus-castus. Planta Medica 1990; 56: 547
Milewicz A et al. Armeim.-Forsch. 1993;43:752
3 Sliutz G, et al. Horm Metab Res 1993; 25(5): 253-255
4 Milewicz A, Gejdel E, Sworen H, et al, Vitex agnus-castus extract in the treatment of luteal phase defects due to latent hyperprolactinemia:
Results of a randomized placebo-controlled double-blind study. Arzneim Forsch Drug Res 1993; 43(7):752-6.
5 Haller J, Geb und Gynakol, 1961; 156:274.
6 Jarry H. et al. Exp Clin Endocrinol 1994: 102 (6):448-454
7 Bhargava SK. "Antiandrogen effects ora flavonoid-rich fraction ofVitex negundo seeds: a histological and biochemical study in dogs." Ethnoph.
1989 ;27(3):327-39.
8 Amann W. Improvement of acne vulgaris with Vitex agnus castus Ther. D. Gegenw. 1967;106:(1):124.
9 Loch E, Bohnert KJ, Peeters M, et al. The treatment of menstrual disorders with Vitex agnus-castus tincture. Der Frauenarzt, 1991; 32(8):867-70.
10 Probst V, Roth, OA, Dtsch Med Wschr, 1954, 79:2171.
11 Propping D, Katzorke T, Belkien L. Diagnosis and therapy of corpus luteum deficiency in general practice. Therapiewoche 1988; 38:2992-3001.
12 Propping D, Katzorke TH. Z Allgemeinmed, 1987, 63:932.
13 Propping D, Katzorke, T, Belkien L, Therapiewoche, 1988:2992-3001.
14 Gerard House, UK promotional brochure, 1988.
15 Ecker G, Landarzt, 1964; 40:872.
16 Hillebrand, H, Landarzt, 1964; 40:1577.
17 Albus GA, Z. Haut-und Gesch, 1964;36:220.
18 Communication with Kerry Bone, 1994.
19 Giss G and Rothenburg W Haut-und Gesch, 1968;43:645.
20 Mills S, Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Churchill Livingstone, 2000. p. 239-46, 328-333
21 Noack M. Dtsch Med Wschr 1943; 9:204-206
22 Mohr W. Hippodrates 1957; 28: 586-591
23 Bohnert, K. The Use of Vitex agnus-castus for Hyperprolactinemia. Quarterly Review of Natural Medicine 1997: Spring, p. 19-21.
24 Giss G, rothenburg W. Z Haut Geschlechstkr 1968; 43 (15):645-647
25 Murray M, Pizzorno E. Textbook of Natural Medicine, 2nd ed.. Churchill Livingstone 1999
26 Weiss RF. Herbal Medicine, 6th ed. Hippokrates Verlag GmbH 1996. p. p 317-9
27 Felter HW, Lloyd JU. King’s American Dispensatory, 18th ed. Eclectic Medical Pulbications, Sandy, OR 1983, p. 2056
28 Murray and Pizzorno, p. 1023
29 Mills and Bone p 246
30 Brinker, F. Herb Contraindications and Drug Interactions. Eclectic Medical Publications, Sandy, OR 1998. p. 55
31 Cahil DJ,etal. Hum Reprod 1994; 9 (8):1469-70
32 Mills and Bone and TNM and Brinker
33 Haller J. Z Geburtsh Gynakol 1961; 156(3):274-302
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