Guest guest Posted March 16, 2002 Report Share Posted March 16, 2002 http://www.thorne.com/townsend/oct/herbal.html > ------------------------------ > Herbal Research Review > Vitex agnus castus Clinical Monograph > by Donald J. Brown, ND > from Quarterly Review of Natural Medicine, Summer 1994 > > c/o NPRC, Inc. > Pioneer Building, Suite 205 > 600 First Avenue > Seattle, WA 98104 > > Vitex agnus castus, also known as chaste tree, is a shrub with > finger-shaped leaves and slender violet flowers. Vitex agnus castus > grows in creek beds and on river banks in valleys and lower foothills > in the Mediterranean and Central Asia. The plant blooms in high summer > and, after pollination, develops dark-brown to black fruit the size of > a peppercorn. The fruit possess a pepper-like aroma and flavor. The > ripe, dried fruit of Vitex agnus castus is the part of the plant used > in medicinal preparations today. > > Historical Use > The genus name Vitex is derived from the Latin " vitilium " which means > plaiting. The flexible, but tough and hard branches were used for > construction of wattle fences. Plinius, 1st Century A.D., has the > earliest reference to the plant as Vitex. The species name Agnus > castus originates from the Latin " castitas " (chastity) and the > equating of the Greek " agnos " with the Latin " agnus " (lamb). > Vitex agnus castus belonged to the official medicinal plants of > antiquity and is mentioned in the works of Hippocrates, Dioscorides, > and Theophrast. The first specific medicinal indications can be found > in the writings of Hippocrates, 4th Century B.C. He recommends the > plant for injuries, inflammation, and swelling of the spleen, and the > leaves in wine for hemorrhages and the " passing of afterbirth. " In the > " Corpus Hippocratum " he states: > " If blood flows from the womb, let the woman drink dark red 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. " Dioscorides attributed to the fruit a hot and astringent > activity and recommended it for wild animal bites, swelling of the > spleen, and for dropsy. Decoctions of the fruit and plant were used as > sitz baths for diseases of the uterus. > The English name for Vitex agnus castus, " chaste tree, " is derived > from the belief that the plant would suppress libido in women taking > it. In Greek cities, festivals in the honor of Demeter included a vow > of chastity by the local women. The Catholic church in Europe > developed a variation on this theme by placing the blossoms of the > plant at the clothing of novice monks to supposedly suppress libido. > It is interesting to note that another common name for Vitex agnus > castus, " monk's pepper, " derived from the fact that monks in Southern > Europe commonly used the fruit as a spice in their cooking. > > Constituents > The majority of clinical studies with Vitex agnus castus (Vitex) have > been performed with a tincture of the fruit. Most medical texts, as > well as monographs in Europe, list the entire preparation as > " medicinally active. " 1 This is an indication that the medical activity > of the fruit is examined as a whole and that specific " active > constituents " have not been individually isolated. > The fruit of Vitex contains essential oils, iridoid glycosides, and > flavonoids.2 Essential oils include limonene, 1,8 cineole, and > sabinene.3 The primary flavonoids include castican, orientin, and > isovitexin. The two iridoidglycosides isolated are agnuside and > aucubin (see Figure 1).4 Agnuside serves as a reference material for > quality control in the manufacture of Vitex extracts. > One other report demonstrated delta-3-ketosteroids in the flowers and > leaves of Vitex. The authors report (albeit in a somewhat vague > manner) that this fraction of the leaves and flowers " probably " > contained progesterone and 17-hydroxyprogesterone. Testosterone and > epitestosterone were also presumed to be present.5 How this relates to > the content of these substances in the fruit remains to be > ascertained. > > The Menstrual Cycle: A Brief Overview > The female menstrual cycle is controlled by a complex interplay > between hormones of the hypothalamus, pituitary, and the ovaries (see > Figure 2).6 The actual center of control is the hypothalamus, which > produces a gonadotropin releasing hormone (GnRH) that stimulates the > anterior pituitary to release the gonadotropins follicle stimulating > hormone (FSH) and lutenizing hormone (LH). Pulsatile secretion of GnRH > is necessary for the pituitary to respond with adequate production of > LH and FSH. When there is continuous release or disturbance in > pulsatile secretion, the stimulus for follicle maturation is absent, > and sterility results. > FSH is the primary hormone responsible for the maturation of follicles > into fertile ova and the increased production of estrogen by the > ovaries. LH causes release of the ovum, conversion of the follicle > into the corpus luteum, and the subsequent production of progesterone. > The timing of the release of these pituitary hormones, as well as > estrogen and progesterone, during a normal menstrual cycle are > illustrated in Figure 3. At midcycle, estrogen is at its peak and > progesterone begins to rise. It is at this point that FSH levels > decrease and LH levels surge to cause ovulation. In the ovary, the > corpus luteum produces progesterone. This hormone ensures sufficient > blood supply to the endometrium so that the fertilized ovum can > establish itself in the uterus. If fertilization does not occur, the > corpus luteum recedes, hormone production decreases, the endometrium > is not sufficiently supplied with blood and menses occurs. FSH and LH > levels decline until menses and beginning of a new menstrual cycle. > A third hormone produced by the pituitary, prolactin, also plays an > important role in the menstrual cycle. Prolactin is controlled by an > inhibitory factor (PIF) produced by the hypothalamus (as opposed to > FSH and LH which are controlled by stimulatory factors). Prolactin > regulates the development of the mammary gland and milk secretion. In > non-lactating women, it is critical that this hormone be in balance > with FSH and LH. Increased production of prolactin can inhibit the > maturation of follicles in the ovary and induce menstrual > abnormalities and sterility. It is interesting to note that prolactin > release is often stress-dependent. Stress reduction should always play > a role in the management of menstrual abnormalities. > It should also be noted that estrogen and progesterone formed by the > ovary have a self-regulating effect on the hormones produced by the > pituitary and hypothalamus via a feedback mechanism. Androgens, like > testosterone, also play a part in this feedback mechanism. Disorders > of other endocrine glands, such as the thyroid, adrenals, or pancreas, > may also interfere with the normal functioning of this feedback > mechanism. > > Corpus Luteum Insufficiency > Corpus luteum insufficiency (also referred to as deficiency) is a > manifestation of suboptimal ovarian function. In laboratory terms, > corpus luteum insufficiency is usually defined as an abnormally low > progesterone level three weeks after the onset of menstruation (serum > progesterone below 10-12 ng/ml). This state is normal during puberty > and at menopause. However, it is usually considered abnormal when > occurring in women between the ages of 20 to 40 years.7 > Corpus luteum insufficiency points to abnormal formation of ovarian > follicles, an abnormality that may be so pronounced that no secondary > or tertiary follicles are produced with a resulting lack of ovulation > (anovulation). Corpus luteum insufficiency also leads to a relative > deficiency of progesterone. Insufficient levels of progesterone may > also result in the formation of ovarian cysts. > Corpus luteum insufficiency may result in a myriad of different > menstrual abnormalities. Table 1 lists the most common clinical > conditions in 1592 women diagnosed with corpus luteum insufficiency. > Foremost are hypermenorrhea (heavy periods), polymenorrhea (abnormally > frequent periods), and persistent anovulatory bleeding. It is > interesting to note that secondary amenorrhea (lack of a period) may > sometimes be observed in women with corpus luteum insufficiency. > Disturbances of other hormones may also be associated with corpus > luteum insufficiency. One study found hyperprolactinemia in 70% of > cases.9 Also noted are an exaggerated response to the thyroid > releasing hormone (TRH) test which is associated with manifest or > latent hypothyroidism. > > How Does Vitex Work? > According to Dr. Rudolf Fritz Weiss, Vitex acts on the > diencephalohypophyseal system p; in other words, the hypothalamus and > pituitary. > Vitex increases LH production and mildly inhibits the release of FSH > (see Figure 4). The result is a shift in the ratio of estrogen to > progesterone, in favor of proges-terone. This is, in fact, a corpus > luteum like hormone effect.10 The ability of Vitex to raise or > modulate progesterone levels in the body is therefore an indirect > effect and not a direct hormonal action.11 This is in contrast to > other phytomedicines, like Black cohosh, frequently used in gynecology > because of their direct binding of estrogen receptors > ( " phyto-estrogens " ).12 > Vitex also modulates the secretion of prolactin from the pituitary > gland. Early animal studies indicated an increase in lactation and > enlargement of the mammary gland following administration of Vitex.13 > It is interesting to note that Vitex has been historically used as a > lactagogue (substance to increase milk production) in lactating women > with poor breast milk production. As we will note below, clinical > studies have confirmed this effect. > Current research with Vitex has indicated usefulness in > hyperprolactinemia. In studies with rats, Vitex was shown to inhibit > prolactin release by the pituitary gland p; particularly under > stress. The mechanism of action appears to involve the ability of > Vitex to directly bind dopamine receptors and subsequently inhibit > prolactin release in the pituitary.14,15 Slight hyperprolactinemia is > commonly associated with corpus luteum insufficiency.16 > > Use of Vitex in Women's Healthcare > The causes of menstrual disorders are multifaceted and can vary > greatly in their manifestation. Frequently, therapeutic interventions > must be used on a trial and error basis over the duration of a number > of menstrual cycles to determine their efficacy. Nutritional > interventions like vitamin B6, magnesium, and vitamin E, as well as > phytomedicines like Black cohosh, Dong quai, and Evening Primrose oil, > have all shown greater efficacy when used over time periods of several > months. This reflects the gradual balancing effect that many of these > interventions have on the female hormonal system. Vitex certainly fits > this mold. > The majority of clinical studies completed with Vitex have been > non-controlled studies with large populations of female patients in > European gynecology practices. Vitex, which has a Commission E > Monograph in Germany, is frequently used in these practices as an > initial intervention in a number of menstrual disorders including > premenstrual syndrome, hypermenorrhea, polymenorrhea, anovulatory > cycles, secondary amenorrhea, infertility, and hyperprolactinemia. As > we will note, many of these cases can be linked to corpus luteum > insufficiency. Vitex is also used in cases of poor lactation, uterine > fibroids, and climacteric. > > Premenstrual Syndrome > Premenstrual syndrome (PMS) is one of the most frequent complaints > noted in gynecology practices. According to some estimates, 30 to 40% > of menstruating women are affected by PMS.17 Table 2 lists the > different categories for PMS and the symptoms associated with them. > Two monitoring surveys of gynecology practices in Germany examined the > effect of Vitex on 1542 women with a diagnosis of PMS.18 The mean age > of the patients was 34.7 with a range of 13 to 62 years. Additional > diagnoses noted with these patients included corpus luteum > insufficiency (n = 1016) and uterine fibroids (n = 170). Patients were > placed on a proprietary Vitex liquid extract known as " Agnolyt " and > instructed to take 40 drops daily. The average duration of treatment > was 166 days. > The efficacy of treatment was assessed by both patients and their > physicians. These assessments are depicted in Figures 5 and 6. In over > 90% of the cases, symptoms were completely relieved with a report of > side effects in only 2% of the patients (side effects are listed in > Table 3). Only 17 of the 1542 women studied had to stop treatment due > to side effects. Improvement in symptoms began after an average > treatment duration of 25.3 days. 562 patients continued taking Agnolyt > after completion of the monitoring period. > Another study with 36 patients with a diagnosis of PMS used 40 drops > of Vitex liquid extract ( " Agnolyt " ) daily over 3 cycles. A reduction > was noted in physical symptoms (headaches, pressure and tenderness in > the breasts, bloating, and fatigue), psychological changes (increased > appetite, craving for sweets, nervousness/restlessness, anxiety, > irritability, lack of concentration, depression, mood swings, and > aggressiveness). Additionally, the interval of the luteal phase was > normalized from an average of 5.4 days to 11.4 days and a diphasic > cycle was established.19 > > Abnormal Menstrual Cycles > The first major clinical study on Vitex was published in 1954. > Fifty-seven women suffering from a variety of menstrual disorders were > given Vitex on a daily basis. Fifty patients developed a cycle in > phase with menses while seven women did not respond. Of the fifty > women, six women with secondary amenorrhea demonstrated one or more > cyclic menstruations. Of nine patients with oligomenorrhea (scant or > infrequent menstrual flow), six experienced a shortening of the > menstrual interval and an increase in bleeding > Most striking was a dramatic improvement in menstrual regularity among > 40 patients with cystic hyperplasia (excessive proliferation of cells) > of the endometrium (the mucous membrane lining the inner surface of > the uterus). This condition is associated with a relative deficiency > of progesterone and characterized by dysfunctional uterine bleeding. > No side effects were observed with Vitex treatment.20 > An observational study with 126 women with menstrual disorders > utilized 15 drops of Vitex liquid extract three times daily over > several cycles. In 33 women suffering from polymenorrhea, the duration > between periods lengthened from an average of 20.1 days to 26.3 days. > In 58 patients with menorrhagia (excessive bleeding at the time of the > period in amount or number of days), a statistically significant > shortening of menses was achieved. Fourteen patients became pregnant > during the study; among them were 3 women with primary infertility > over 2, 3, and 8 years respectively, as well as 2 patients with > secondary infertility over 4 and 15 years.21 > Twenty patients with secondary amenorrhea were admitted to a 6 month > study using Vitex liquid extract at 40 drops daily. Laboratory > monitoring of progesterone, FSH, LH, and pap smears were performed at > pre-study, 3 months, and 6 months. At the end of the 6 month study, > data was available on 15 patients. The onset of cycles with > menstruation was observed with Vitex treatment in 10 out of the 15 > patients. The hormone values showed increased values for progesterone > and LH, while FSH values either did not change or decreased > slightly.22 > Propping and colleagues carried out two non-blind uncontrolled trials > to study the effect of Vitex on corpus luteum function in a total of > 48 infertile women of reproductive age between 23 and 39 years. The > inclusion criteria were normal prolactin levels (below 20 ng/ml), > normal results in the prolactin and thyroid stimulating hormone (TSH) > stimulation tests and an abnormally low serum progesterone below 12.0 > ng/ml on the 20th day of the cycle. Treatment consisted of Vitex > liquid extract, 40 drops daily, without any other medication for 3 > months. > Forty-five women completed the studies (3 were excluded because of > concurrent hormone use). The outcome of therapy was assessed by the > normalization of the midluteal progesterone level and by correction > (lengthening) of any preexisting shortening of the phases of the > cycle. Treatment was deemed successful in 39 out of the 45 patients. > Seven women became pregnant; in 25 patients, serum progesterone was > restored to normal (> 12 ng/ml) and in 7 cases there was a trend > toward normalization of progesterone levels.23,24 > > Hyperprolactinemia > As mentioned previously, Vitex has shown a modulating effect on > prolactin. A double-blind, placebo-controlled study examined the > effect of a proprietary Vitex preparation ( " Strotan " ) on 52 women with > luteal phase defects due to latent hyperprolactinemia. The daily dose > of the Vitex extract was 20 mg and the study lasted for three months. > Hormonal analysis was performed at days 5-8 and day 20 of the > menstrual cycle before and after three months of therapy. 37 cases > were available for analysis (20 placebo and 17 Vitex) after 3 months > of therapy. Prolactin release was significantly reduced in the Vitex > group. Shortened luteal phases were normalized and deficits in > progesterone production were normalized. No side effects were noted > and two women in the Vitex group became pregnant.25 > > Lactation > As mentioned previously, Vitex has been used historically to increase > milk production in lactating women p; another example of its > modulating effect on prolactin levels. Only one controlled study > exists examining the effect of Vitex in lactating women. Mohr found > that lactating women with poor milk production treated with Vitex > liquid extract were able to effectively increase production. Vitex > often took several weeks to show results but was then used effectively > over several months. This study and clinical use in Europe indicates > the safety of Vitex for breast-fed infants.26 > > Potential Indications > Anecdotal clinical reports have indicated a potential use for Vitex in > the management of climacteric (hot flushes) in the early stages of > menopause.27 Other clinical observations include: > · Uterine fibroids which are embedded into the muscle or are subserous > may have their growth arrested by use of Vitex. Submucosal fibroids, > however, are not likely to respond. > · Mild cases of endometriosis for which progesterone therapy are > indicated may respond to Vitex. > > How to Use Vitex > Since the early 1950's, the standard Vitex extract used for clinical > research and treatment in Europe has been an alcohol-based tincture of > the fruits of the plant known as " Agnolyt. " 100 ml of the solution is > standardized to contain 9 grams of the fruit. The recommended dosage > is 40 drops with some liquid in the morning over several months > without interruption. It is recommended that treatment with this > extract be continued over several weeks after relief of symptoms is > determined. The recent development of a solid extract equivalent of > the tincture has allowed use by alcohol-sensitive women. The capsules > which are 175 mg by weight, have a one-a-day recommendation also. > It is important to note that Vitex is not a fast-acting medication. In > cases of anovulatory cycles and infertility, treatment duration may be > as long as 5-7 months before conception occurs. For secondary > amenorrhea of more than two years duration, Vitex should be > administered for at least 1.5 years. In other conditions mentioned, > however, first indications of efficacy with Vitex are usually seen > within one or two cycles. Extensive or complete freedom of symptoms > usually occurs after 4 to 6 months of treatment. > > Is Vitex Safe? > Human and animal studies have determined Vitex to be safe for most > women of menstruating age. Vitex should not be used during pregnancy > but is safe for use during lactation. Safety has not been determined > in children. There are no known interactions with other drugs. > Side effects noted in one large population study are listed in Table > 3. Side effects noted in other clinical observations have included > itching and an occasional rash. Again, these side effects are rare and > have been noted in only 1-2 % of the patients monitored on Vitex. Some > women also report that menstrual flow increases during Vitex > treatment. This is often an indication of therapeutic efficacy. > > References > 1. Monograph Agni casti fructus (Chaste tree fruits). Bundesanzeiger > No. 90, May 15, 1985. > 2. Agni cast fructus (chaste tree fruits). Commission E Monograph, > December 2, 1992. > 3. Kustrak, Kuftinec J & Blazevic N: The composition of the essential > oil of Vitex agnus castus. Planta Medica 58 (Suppl l): A 681, 1992. > 4. Gomaa CS: Flavonoids and iridoids from Vitex agnus castus. Planta > Medica 33: 277, 1978. > 5. Saden-Krehula M, Kustrak D & Blazevic N: Delta-3-ketosteroids in > flowers and leaves of Vitex agnus castus. Planta Medica 56: 547, 1990. > 6. Principles and Practice of Clinical Gynecology (Kase NG & Weingold, > eds). John Wiley & Sons, New York, 1983. > 7. Propping D, Katzorke T & Beliken L: Diagnosis and therapy of corpus > luteum deficiency in general practice. Therapiewoche 38: 2992-3001, > 1988. > 8. Propping D, Bohnert KJ, et al: Vitex agnus-castus: Treatment of > gynecological syndromes. Therapeutikon 5 (11): 581-5, 1991. > 9. Muhlenstedt D, Wutke W & Schneider HPG: Short luteal phase and > prolactin. Fertil Steril 373-4, 1977. > 10. Weiss RF: Herbal Medicine. Ab Arcanum, Sweden, 1988. > 11. Amann W: Removing an ostipation using Agnolyt. Ther Gegenew 104 > (9): 1263-5, 1965. > 12. Reichert RG: Phyto-estrogens. Quart Rev Nat Med Spring 1994, pp. > 27-33. > 13. Amann W: Op. cit., 1965. > 14. Sliutz G, Speiser P, et al: Agnus castus extracts inhibit > prolactin secretion of rat pituitary cells. Horm Metab Res 25: > 253-5,1993. > 15. Jarry H, Leonhardt S & Wuttke W: Agnus Castus As Dopaminergous > Effective Principle In Mastodynon N. Zeitschrift Phytother 12: 77-82, > 1991. > 16. Schneider HPG, Goeser R & Cirkel U: Prolactin and the inadequate > corpus luteum. In: Lisuride and Other Dopamine Agonists. Raven Press, > New York, 1983. pp. 113-120. > 17. Lurie SR: The premenstrual syndrome. Obstet Gynecol 45 (4): 220-8, > 1990. > 18. Dittmar FW, Bohnert KJ, et al: Premenstrual syndrome: Treatment > with a phytopharmaceutical. TW Gynakol 5(1): 60-68,1992. > 19. Coeugniet E, Elek E & Kuhnast R: Premenstrual Syndrome (PMS) And > Its Treatment. Arztezeitchr Naturheilverf 27 (9): 619-22, 1986. > 20. Probst V & Roth OA: On A Plant Extract With A Hormone-like Effect. > Dtsch Med Wschr 79 (35): 1271-4, 1954. > 21. Bleier W: Phytotherapy in irregular menstrual cycles or bleeding > periods and other gynecological disorders of endocrine origin. > Zentralblatt Gynakol 81 (18): 701-9, 1959. > 22. Losh EG & Kayser E: Diagnosis and Treatment of Dyshormonal > Menstrual Periods In The General Practice. Gynakol Praxis 14 (3): > 489-95, 1990. > 23. Propping D & Katzorke T: Treatment of corpus luteum insufficiency. > Zeits Allgemeinmedizin 63: 932-3, 1987. > 24. Propping D, et al: Op. cit., 1988. > 25. Milewicz A, Gejdel E, et al: Vitex agnus castus extract in the > treatment of luteal phase defects due to hyperprolactinemia: Results > of a randomized placebo-controlled double-blind study. Arzneim-Forsch > Drug Res 43: 752-6, 1993. > 26. Mohr H: Clinical investigations of means to increase lactation. > Dtsch Med Wschr 79 (41): 1513-6, 1954. > 27. Du Mee C: Vitex agnus castus . Aust J Med Herbalism 5 (3): 63-5, > 1993. ------------- Someone wrote: > XXXX, > Did you write this or did someone else? From my end it looks as if > someone else wrote it and you just wrote " Thank you " but that doesn't > make sense. > I have a copy of the report plus a new version more geared to nurses > which I will send to Complementary Therapies in Nursing and Midwifery > as soon as Janina has sorted out a few queries regarding the > references. I think that Barbara only wanted the original report to > go to participants; however, it is being published in the Australian > journal " Aromatherapy Today " in June. > Both Janina's berry oil and some Turkish leaf oil were tested to see > if they helped with menopause symptoms. They did. However, they are > both powerful oils and should be used with care. Knowing Barbara's > views on the matter, I don't want to say anything more for the time > being, and I know she's away this week so can't ask what her views > are on releasing information. > All for now, > > > I heard that there has been a very positive report on the trial of > > Vitex oil. Would anyone care to share it with this group? Are any > > of the participants on this list and willing to share the results > >with us? Thank you ------------ Someone wrote: > > RE: The sexual frustration. Seriously, I would try inhalations of e.o. > vitex. It is a huge turn-off for men. One of the common names of this > plant is Monk's Pepper or Chaste Tree because it is so effective at > quelling male sexual desire that the herb was ground up and used as a > seasoning in the monasteries. > > I have reports from many women who are using the oil for menopausal > balancing that they must use it right after their mates leave the > house so no remnant of aroma remains to irritate the man. I had two > men bottle the two oils (0ne leaf, one berry) for a study. One had > instant nausea and the other an instant headache. Now, bottling is > pretty intensive inhalation--you could kick this way down for your > client. > > Another testimonial came from a male colleague who did not believe the > oil could be that effective a turn-off. He shall remain nameless, as > his experiment was to try to masturbate while diffusing the oil. He > found it impossible, and he said he really didn't care--just could not > work up any excitement. That's probably more than anyone wants to > know, but valuable information. Quote Link to comment Share on other sites More sharing options...
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