Herbal Research Review - Vitex agnus castus Clinical Monograph

[Guest guest]

Below is a clinical monograph, which in direct reference to the HERB

Vitex agnus castus, and as we know, attributes of herbs do not always

(and sometimes not at all) show themselves in the essential oil of the

same plant. BUT I can say that in all my years of studying EO's and

herbs I haven't found or heard that simply SMELLING the essential oil of

a plant that is considered totally safe is harmful or dangerous.

 

There has been debate on this (and other lists) about the safety (or

lack there of) of sniffing Vitex oil. Although it is not a " tested " oil,

neither are a LOT of other EO's. Most EO's are untested, and in fact,

even looking through ALL the books I have on EO safety, including those

by Martin Watt and Tisserand and Balacs, do I find that the tested oils

were tested for how safe they are to smell (whether it be smelling it

for " therapeutic use " of one form or another, or just smelling for

pleasure, like in perfumery)!

 

I see info about the tests done regarding safety of taking a particular

oil orally, or applying it dermally, but I don't see safety tests or

info as to how much of it can or cannot be smelled, or if it can safely

be smelled at all even! The very closest thing I've found is a blurb of

info in Martin Watt's Plant Aromatics on Turpentine oil, which says that

" workers in a factory manufacturing shoe cream containing turpentine

were seen to suffer from toxic effects of turpentine due to the

inhalation and absorption of turpentine through the skin " .

 

My point here is that NO EO's have been tested for their safety and

efficacy in regards to a simple occasional sniff. So if I am sniffing

Rosemary EO to help get rid of a headache, and it helps me, one can

argue it was just placebo effect since it isn't " proven in tests " to get

rid of a headache. Or one can even call me a moron for using that and

not taking Tylenol, which is " proven safe " (even though over 100 people

die of acetaminophen use every year). Now of course, I want to get to

the root of why I have a headache in the first place, but first I want

to get rid of my headache, and sniffing Rosemary EO worked for me and

thousands of other folks out there. Do I have to be worried about

contraindications from Rosemary oil? Hmmmm, well some books say don't go

near it if you have seizures, are pregnant or have high blood pressure,

but it has been shown by Martin Watt that THAT info has never been

proven, so it is unproven mis-information on the potential dangers side,

but even THAT hasn't been clinically double blind tested or studied

specifically! So even popular ol' rosemary cineol essential oil is

unproven safe to sniff, unproven effective for anything, unproven

dangerous for anything, and it is for sale by " hucksters " like Butch and

myself and widely used and appreciated by millions of people worldwide

for various reasons

 

Put it all into perspective folks, weigh your pros and cons, educate

yourselves, take charge of your health, be happy, be nice and don't

throw the baby out with the bath water!

 

*Smile*

Chris (list mom)

http://www.alittleolfactory.com

 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~

 

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 the 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.