This ancient Mediterranean women’s remedy has become familiar in modern times, and is particularly well known in Germany, where it was popularised early in the 20^th century. Its major reputation is in relieving symptoms of tension occurring either before a period or during the menopause, but it has been used for a whole range of gynaecological conditions, including various menstrual disturbances, disrupted periods, swollen breasts and fluid retention around periods and generally for improving fertility where this is linked to such disruptions.

Specifically it appears to reduce high levels of the hormone prolactin which can be associated with a wider range of hormonal disruptions, particularly in women. It has also been used successfully in treating acne for anyone.

Agnus castus has a relaxing and calming quality. It is called on for women suffering premenstrual and menopausal tensions, and has been used more widely by practitioners as a contribution to a soothing herb blend.

There is a consistent association of agnus castus with chastity (as referenced by male authors at least) but it was also a remedy that women considered as their own, with strong associations with motherhood and perhaps even to fend off unwanted male attentions.

It is worth reflecting on the notion of a women’s remedy. Since prehistory women have often been the community healers, for themselves in the case of childbirth and child rearing, but often taking on the role more widely. The ‘wise woman’ is more than a turn of phrase. Women chose the remedies that women needed, and they valued those that worked. From time to time exceptional ones emerge into the wider materia medica across a whole culture: shatavari in India, dong quai in China, and helonias root in North America (unfortunately now a threatened species and no longer recommended). Agnus castus is undoubtedly the women’s remedy of southern Europe.

An association with women’s health has been established in European tradition from Graeco-Roman times. Pliny in the first century AD refers to its use to maintain chastity and claimed it checked violent sexual desire. Perhaps the Roman physician Dioscorides was referring to the same quality when he said the remedy might fend off wolves!

The mediaeval herbalist Parkinson noted that “it also procureth milke in womens breasts, it procureth their courses (= menstrual flow) and the urine stopped…” and ” the decoction of the herbe and seede is very good for women troubled with the paines of the mother, or inflammations of the parts“. In reinforcement of its association also with chastity he also noted that it “refraineth also the instigations to Venery in any manner used and taken“.

Its traditional reputation was always intriguingly paradoxical, a point that modern herbal practitioners often take to point to an amphoteric effect. Thus Parkinson takes Galen to task: “although so famous a writer and Physician contraryeth himselfe in this one place…, for having affirmed before that the seede hereof is hot and dry…, he saith that the seede of Vitex doth refraine Venerous desires, and giveth little nourishment to the body, and that because it is cooling and drying.” He himself concludes that of the two positions the temperament of Vitex is “a meane between them both“. As we have noted in our taste test this is an appropriate conclusion for a remedy that is both hot and bitter.

Interestingly in nineteenth century North America the Eclectics, a leading group of doctors who had revived herbal approaches, did recognise the complexity of this remedy and as well as stabilising menstruation, encouraging lactation and ‘repressing sexual passions’, applied it also to impotence, sexual melancholia, sexual irritability with nervousness, melancholia or mild dementia. This hints at an amphoteric, tonic effect across a range of hormonal disturbances.

Another strong strand in the agnus castus story is its use to encourage lactation. This may be associated with its wider link to motherhood although as we see below the evidence for this effect is not clear.

Earlier there had been other uses recommended. In Galenic medical texts, as noted above, agnus castus is classified as “hot and dry in the third degree” (ie among the strongest of this category) suggesting that it was appropriate for any ‘cold-damp’ condition. Even earlier, in Hippocratic texts from the 4^th century BC, as well as its use for “issue of the blood” and “helping the afterbirth come away”, agnus castus was recommended for the treatment of wounds, inflammatory conditions, and swellings of the spleen (=liver disease). The latter is a classic damp-heat problem that is consistent with its bitterness.

Women’s health

Agnus castus is perhaps the western herbal practitioner’s favorite women’s remedy. It is used in a wide range of menstrual and also perimenopausal indications, now with increasing focus on conditions of high prolactin levels and progesterone deficiency (cystic hyperplasia of the endometrium is one diagnostic finding here). These include premenstrual syndromes (PMS), especially with fluid retention and breast swelling (though probably not so much those marked by hypoglycaemic sweet cravings), and other premenstrually- aggravated symptoms like sleeplessness and mouth ulcers. 

It may help regulate disturbed menstrual cycles and periods, including lengthened or shortened cycles, loss of periods (where pregnancy and other medical conditions have been ruled out). Here its effects seem to be greater where the menstrual disturbances can be linked to corpus luteum deficiency, ie.. where the post-ovulation timing is affected (learning when ovulation occurs with temperature or mucus testing can be a very useful guide). 

Some cases of bleeding outside the usual periods (metrorrhagia) may also be helped although this is a symptom that needs further investigations. Other menstruation-linked indications for this herb include polycystic ovarian syndrome (PCOS – although alongside other remedies to manage the insulin resistance element of this condition), endometriosis and fibroids (in both cases mostly symptom management). It is noteworthy that stress can itself raise prolactin levels and this can be another reason to use agnus castus (which has in general a calming quality).

Infertility is also a traditional indication for agnus castus. In this case it is most appropriate if there are problems with conception linked to disrupted menstrual cycles, for example affecting ovulation or later implantation. Herbal practitioners often note successful pregnancies among their previously infertile patients linked to the use of this herb.

As women go through the menopause they may find that premenstrual patterns merge into a wider and longer sometimes congestive pattern, as though the PMS is taking over. This is definitely a time to consider agnus castus as part of a wider menopause support strategy.

Skin

Agnus castus has a more recent use in helping to manage acne for anyone with that condition.

Endocrine

The research evidence suggests that agnus castus inhibits the hormone prolactin via dopaminergic activity in the anterior pituitary. A decrease of prolactin will affect the levels of follicle- stimulating hormone (FSH), oestrogen in women and testosterone in men. In terms of the menstrual cycle this has the effect of enhancing corpus luteal development (thereby correcting a relative progesterone deficiency) normalising the menstrual cycle, and encouraging ovulation.(1, 3).

Despite some methodological limitations, in one systematic review the results from randomised, controlled trials suggest benefits for agnus castus extracts in the treatment of premenstrual syndrome, premenstrual dysphoric disorder and latent hyperprolactinaemia (4). In other reviews, benefits in reducing premenstrual mood disorders (5) and infertility were noted (6). 

A meta-analysis and systematic review of the clinical evidence for the treatment of menstrual associated breast pain (cyclic mastalgia) also concluded that benefits were demonstrated (7).

Other reviews have been less sure of the strength of evidence, citing heterogeneity and publication bias (8, 9) and other shortcomings in the publications (10). 

Among the challenges in assessing the data is that menstrual problems like premenstrual syndrome are themselves heterogenous and barely medically defined and measurable. In an early study the authors found no benefits versus placebo in premenstrual mood disorders but found a trend to benefits for water retention symptoms, including breast pain – see recent review above – for which they were not applying measures. They also noted many more unprompted subject reports of notable benefits among the verum versus placebo group. A conclusion was that standard measures are poor at reflecting a wide range of subjective experiences of menstruation (11).

There are doubts also about the evidence for the use of agnus castus as a galactogogue, to encourage lactation. Much of this comes from mid-twentieth century clinical studies conducted in less rigorous ways than would be considered today (12).

In classical Greece the tree was called agnos, meaning holy, pure and chaste. They dedicated it to their mother goddess Demeter. At the festival of Thesmophoria held in her honour, Greek women, who aimed to remain chaste for the occasion, strewed their beds with branches of the tree, and wore garlands of it in the day, so that the aroma might subdue the ardour of any would-be suitor.

In Roman times the tree they called vitex was dedicated to the goddess Hera, the protector of motherhood and marriage, who was said to have been born under one. Vestal virgins carried twigs of the tree as a symbol of chastity.

Up to modern times in Italy agnus castus branches were strewn along the processional way taken by novices entering monasteries, where they would all have had to take a vow of chastity. Another common name is ‘monk’s pepper’. As well as referring to its peppery taste this was said to support its reputation for suppressing “the lusts of the flesh” in such institutions.

The botanical name for the plant reflects an apparent Greek-Latin translation confusion: the taxonomist may have transliterated agnosas agnus (meaning lamb) and then added castus (meaning chaste in Latin) to maintain that association, and by accident to create the concept of a chaste lamb (the common German word Schäffmülle and French agneau chaste still reflect this association)!

Native of the Mediterranean region and Central Asia. It is one of the few temperate-zone species of Vitex, which is on the whole a genus of tropical and sub-tropical flowering plants.

The ‘Nature Serve’ database states that in relation to endangered status this plant is unranked. The IUCN Red List of Threatened Species database states an assessment was made in 2012 on global prevalence of Vitex Agnus castus in the wild, the results have left this plant as being listed as ‘data deficient’.

Herbal Medicines are often extremely safe to take, however it is important to buy herbal medicines from a reputed supplier. Sometimes herbs bought from unreputable sources are contaminated, adulterated or substituted with incorrect plant matter.

Some important markers for quality to look for would be to look for certified organic labelling, ensuring that the correct scientific/botanical name is used and that suppliers can provide information about the source of ingredients used in the product.

A supplier should be able to tell you where the herbs have come from. There is more space for contamination and adulteration when the supply chain is unknown. 

Agnus cactus prefers a well-drained soil in full sun. Soil types: loam, chalk or sandy soils. In frost-prone areas with shelter from the cold and from drying winds. Best grown near a south or west-facing wall. Vitex will grow well in a sunny garden flower bed or border.

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2. Felter HW, Lloyd JU. (1905) King’s American Dispensatory. Vol 2. 18th ed., rev 3, Portland. Reprinted by: Eclectic Medical Publications: 1983: 2056.
3. Zahid H, Rizwani GH, Ishaqe S (2016) Phytopharmacological Review on Vitex agnus-castus: A Potential Medicinal Plant, Chinese Herbal Medicines, 8, 1: 24-29. doi /10.1016/S1674-6384(16)60004-7
4. Van Die MD, Burger HG, Teede HJ, Bone KM. (2013) Vitex agnus-castus extracts for female reproductive disorders: A systematic review of clinical trials. Planta Med. 79(7):562-75. doi: 10.1055/s-0032-1327831
5.  Cerqueira RO, Frey BN, Leclerc E, Brietzke E. (2017) Vitex agnus castus for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review. Arch Womens Ment Health. 20(6):713-719. doi: 10.1007/s00737-017-0791-0.
6.  Rafieian-Kopaei M, Movahedi M. (2017) Systematic Review of Premenstrual, Postmenstrual and Infertility Disorders of Vitex Agnus Castus. Electron Physician. 9(1): 3685-3689. doi: 10.19082/3685.
7. Ooi SL, Watts S, McClean R, Pak SC. (2020) Vitex Agnus-Castus for the Treatment of Cyclic Mastalgia: A Systematic Review and Meta-Analysis. J Womens Health (Larchmt). 29(2): 262-278. doi: 10.1089/jwh.2019.7770.
8.  Verkaik S, Kamperman AM, van Westrhenen R, Schulte PFJ. (2017) The treatment of premenstrual syndrome with preparations of Vitex agnus castus: a systematic review and meta-analysis. Am J Obstet Gynecol. 217(2): 150-166. doi:10.1016/j.ajog.2017.02.028.
9. Mollazadeh S, Mirghafourvand M, Abdollahi NG. (2019) The effects of Vitex agnus-castus on menstrual bleeding: A systematic review and meta-analysis. J Complement Integr Med. 17(1). doi: 10.1515/jcim-2018-0053.
10.  Csupor D, Lantos T, Hegyi P, et al. (2019) Vitex agnus-castus in premenstrual syndrome: A meta-analysis of double-blind randomised controlled trials. Complement Ther Med. 47: 102190. doi: 10.1016/j.ctim.2019.08.024.
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