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Agnus castus or chasteberry is the prime women’s remedy from the Ancient Greeks and Romans

Agnus Castus

Vitex agnus-castus L. Lamiaceae

This is the favourite women's remedy among herbal practitioners in the European tradition with multiple uses for menstrual and premenopausal problems.

  • How does it feel?

    The most striking feature of agnus castus in its habitat is the powerful and very evocative pungent, warm, heavy scent that emanates from the trees in the hot sun, and which is also released when crushing the fruits in your hands. From time immemorial, perhaps in reflection of this quality, it has been claimed by women as their own.

    When tasted, agnus castus delivers a powerful kick. First up is a hot peppery taste, followed by a bitter taste that persists for some minutes and a subtle sweetness that is transitory. Next up the peppery turns to a tingle which over some hours turns back to a most persistent pepperiness.

    Agnus castus comes across as a strong sensory agent promising some powerful impacts (and probably accounting for the relatively low doses usually recommended). In the old language it is definitely ‘drying’, appropriate to damp conditions as characterised by congestive, fluid retentive symptoms.

  • What can I use it for?

    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 20th 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.

  • Into the heart of Agnus Castus

    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.

  • Traditional uses

    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!

    Chasteberry Agnux Castus Vitex

    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 4th 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.

  • Traditional actions

    Western herbal medicine actions:

    • Galactagogues

     

     

  • What practitioners say

    Women’s health: Agnus castus is perhaps the western herbal practitioners favorite womens 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.

  • Research

    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).

  • Did you know?

    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 Thermophona 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)!

Additional information

  • Safety

    In general, agnus castus is well tolerated. Occasional mild and reversible nausea, headache, gastrointestinal disturbances, menstrual disorders, acne, pruritus, and erythematous rash have been reported in large studies (13). Among 352 nursing mothers given agnus cactus tincture, 15 cases of skin problems and some cases of early menstrual period occurred (14).

  • Interactions

    Agnus castus is best not taken in conjunction with progesterone drugs and hormone replacement therapy (HRT). There is however no evidence or likelihood that it will interfere with the effects of the contraceptive pill.

    Hormonal birth control: Vitex agnus-castus can change hormone levels in the body. Birth control pills contain hormones. Taking vitex agnus-castus along with birth control pills might decrease the effects of birth control pills and increase the chance of getting pregnant.

    Hormone-sensitive conditions such as endometriosis, uterine fibroids, cancer of the ovaries, uterus or breast: Vitex agnus-castus can affect hormones and might affect oestrogen levels. If you have a hormone-sensitive condition, it is best to consult a qualified medical herbalist before using Angus Castus.

    IVF (In-vitro fertilisation): Vitex agnus-castus can interfere with the effectiveness of in vitro fertilisation. Vitex agnus-castus is best avoided if you are undergoing this procedure.

    Parkinson disease: Vitex agnus-castus contains chemicals that affect the brain. These chemicals may interact with medications used in Parkinson disease. Consult a qualified medical herbalist before using agnus castus

    Psychosis/schizophrenia and other mental health illnesses: Vitex agnus-castus has an affect on levels of dopamine in the brain. Some medications for mental disorders help to decrease dopamine. Taking Vitex agnus-castus might affect treatment for certain mental disorders. Consult a Medical Herbalist before using Vitex- agnus castus if you have a mental health condition.

    Metoclopramide: Vitex agnus-castus affects levels dopamine. Metoclopramide also affects dopamine. Taking vitex agnus-castus along with metoclopramide might decrease the effects of metoclopramide.

  • Contraindications

    Use cautiously in pregnancy only under the supervision of a Medical Herbalist and ONLY in the most early stages for insufficient corpus luteal function. The dopaminergic activity might suggest that Agnus cactus is best avoided during lactation (15).

  • Preparation

    • Tincture
    • Dried
    • Capsule
    • Liquid extract
  • Dosage

    Often used for a maximum of 3-6 months

    Dried/Capsule: Between 200-500mg per day for most purposes, going up to 2.5g for short term use, e.g. for acne.

    Tincture (1:5) 60%: 2.5ml in a little water twice a day. 

    Infusion: 1 tsp of dried berries, infused for 10-15 minutes in a cup of boiling water, strained and drank 3 times a day.

  • Plant parts used

    Fruit (berries)

  • Constituents

    Essential oil, about 0.7%, containing monoterpenes and sesquiterpenes such as limonene, sabinene, 1,8-cineole [eucalyptol], beta-caryophyllene and trans-beta-farnesene.

    • Flavonoids including vitexin and orientin and methoxylated flavones casticin, eupatorin and penduletin.
    • Iridoid glycosides, including aucubin and agnuside.
    • Diterpenes of the labdane and halimane types (clerodadienols) including rotundifuran, vitexilactone, vitetrifolin B and C, and viteagnusins A to I

    The diterpenes bind to dopamine D2 receptors in the anterior pituitary and appear to be the constituents responsible for decreasing serum prolactin. The flavone casticin may also contribute to this effect (1).

Chasteberry Agnus Castus Vitex
  • Habitat

    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.

  • Sustainability

    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’.

  • Quality control

    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. 

  • How to grow

    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.

  • References

    1. Wuttke W, Jarry H, Christoffel V, et al. (2003) Chaste tree (Vitex agnus-castus) – pharmacology and clinical indications. Phytomedicine. 10(4): 348-57. doi: 10.1078/094471103322004866.
    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.
    11.  Turner S, Mills S (1993) A double-blind clinical trial on a herbal remedy for premenstrual syndrome: a case study Compl. Ther. Medicine 1 (2): 73-77.
    12.  Chasteberry. (2021) Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006–. PMID: 30000866.
    13.  Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006–. Chasteberry. 2021 Feb 15. PMID: 30000866.
    14.  Daniele C, Thompson Coon J, Pittler MH, et al. (2005) Vitex agnus castus: A systematic review of adverse events. Drug Saf. 28: 319–32. PubMed: 15783241.
    15.  Bone, K. and Mills, S. (2013). Principles and practice of phytotherapy modern herbal medicine. 2nd ed. Edinburgh Churchill Livingstone, Elsevier.
Aromatic
An ‘aromatic’ remedy, high in volatile essential oils, was most often associated with calming and sometimes ‘warming’ the digestion. Most kitchen spices and herbs have this quality: they were used both as flavouring and to ease the digestion of sometimes challenging pre-industrial foods. Many aromatics are classed as ‘carminatives’ and are used to reduce colic, bloating and agitated digestion. They also often feature in respiratory remedies for colds, chest and other airway infections. They are also classic calming inhalants and massage oils, and are the basis of aromatherapy for their mental benefits.
Astringent taste
The puckering taste you get with many plants (the most familiar is black tea after being stewed too long, or some red wines) is produced by complex polyphenols such as tannins. Tannins are used in concentrated form (eg from oak bark) to make leather from animal skins. The process of ‘tanning’ involves the coagulation of relatively fluid proteins in living tissues into tight clotted fibres (similar to the process of boiling an egg). Tannins in effect turn exposed surfaces on the body into leather. In the case of the lining of mouth and upper digestive tract this is only temporary as new mucosa are replenished, but in the meantime can calm inflamed or irritated surfaces. In the case of open wounds tannins can be a life-saver – when strong (as in the bark of broadleaved trees) they can seal a damaged surface. One group of tannins, the reddish-brown ‘condensed tannins’ are procyanidins, which can reduce inflammation and oxidative damage.
Bitter
Bitters are a very complex group of phytochemicals that stimulate the bitter receptors in the mouth. They were some of the most valuable remedies in ancient medicine. They were experienced as stimulating appetite and switching on a wide range of key digestive functions, including increasing bile clearance from the liver (as bile is a key factor in bowel health this can be translated into improving bowel functions and the microbiome). Many of these reputations are being supported by new research on the role of bitter receptors in the mouth and elsewhere round the body. Bitters were also seen as ‘cooling’ reducing the intensity of some fevers and inflammatory diseases.
Blue-purple colouring
Any fruits with a blue-purple colouring contain high levels of the polyphenols known as anthocyanins. These work 1) on the walls of small blood vessels, helping to maintain capillary structure to reduce a key stage in inflammation, and improving the microcirculation to the tissues; 2) to improve retinal function and vision; 3) to support connective tissue repair around the body.
Cooling
Traditional ‘cold’ or cooling’ remedies often contain bitter phytonutrients such a iridoids (gentian), sesiquterpenes (chamomile), anthraquinones (rhubarb root), mucilages (marshmallow), some alkaloids and flavonoids. They tend to influence the digestive system, liver and kidneys. Cooling herbs do just that; they diffuse, drain and clear heat from areas of inflammation, redness and irritation. Sweet, bitter and astringent herbs tend to be cooling.
Hot
Traditional ‘hot’ or ‘heating’ remedies, often containing spice ingredients like capsaicin, the gingerols (ginger), piperine (black or long pepper), curcumin (turmeric) or the sulfurous isothiocyanates from mustard, horseradich or wasabi, generate warmth when taken. In modern times this might translate as thermogenic and circulatory stimulant effects. There is evidence of improved tissue blood flow with such remedies: this would lead to a reduction in build-up of metabolites and tissue damage. Heating remedies were used to counter the impact of cold, reducing any symptoms made worse in the cold. .
Mucilaginous
Mucilages are complex carbohydrate based plant constituents with a slimy or ‘unctuous’ feel especially when chewed or macerated in water. Their effect is due simply to their physical coating exposed surfaces. From prehistory they were most often used as wound remedies for their soothing and healing effects on damaged tissues. Nowadays they are used more for these effects on the digestive lining, from the throat to the stomach, where they can relieve irritation and inflammation such as pharyngitis and gastritis. Some of the prominent mucilaginous remedies like slippery elm, aloe vera and the seaweeds can be used as physical buffers to reduce the harm and pain caused by reflux of excess stomach acid. Mucilages are also widely used to reduce dry coughing. Here the effect seems to be by reflex through embryonic nerve connections: reduced signals from the upper digestive wall appear to translate as reduced activity of airway muscles and increased activity of airway mucus cells. Some seed mucilages, such as in psyllium seed, flaxseed (linseed) or guar bean survive digestion to provide bulking laxative effects in the bowel. These can also reduce rate of absorption of sugar and cholesterol. .
New-mown hay aroma
The familiar country odour of haymaking, of drying grass and other plants, is largely produced by coumarins (originally isolated from tonka beans – in French coumarou) and widely used in perfumery. They are chemically categorised as benzopyrone lactones and are important phytochemicals, with strong antioxidant activity in the laboratory and likely effects in modulating inflammation. They were most often associated with the calming effect linked to their use in stuffing mattresses and pillows and plants, high In coumarins were commonly used for these properties.
Resinous
Resins are most familiar as tacky discharges from pine trees (and as the substance in amber, and rosin for violin bows). They were most valued however as the basis of ancient commodities like frankincense and myrrh (two of the three gifts of the Three Wise Men to the baby Jesus) and getting access to their source was one benefit to Solomon for marrying the Queen of Sheba (now Ethiopia). Resins were the original antiseptic remedies, ground and applied as powders or pastes to wounds or inflamed tissues, and were also used for mummification. With alcohol distillation it was found that they could be dissolved in 90% alcohol and in this form they remain a most powerful mouthwash and gargle, for infected sore throats and gum disease. They never attracted much early research interest because they permanently coat expensive glassware! For use in the mouth, gums and throat hey are best combined with concentrated licorice extracts to keep the resins in suspension and add extra soothing properties. It appears that they work both as local antiseptics and by stimulating white blood cell activity under the mucosal surface. They feel extremely effective!
Salty
The salty flavour is immediately distinctive. A grain dropped onto the tongue is instantly moistening and a sprinkle on food enkindles digestion. This easily recognisable flavour has its receptors right at the front of the tongue. The salty flavor creates moisture and heat, a sinking and heavy effect which is very grounding for the nervous system and encourages stability. People who are solid and reliable become known as ‘the salt of the earth'.
Sharpness
The sharp taste of some fruits, and almost all unripe fruits, as well as vinegar and fermented foods, is produced by weak acids (the taste is generated by H+ ions from acids stimulating the sour taste buds). Sour taste buds are hard-wired to generate immediate reflex responses elsewhere in the body. Anyone who likes the refreshing taste of lemon or other citrus in the morning will know that one reflex effect is increased saliva production. Other effects are subjective rather than confirmed by research but there is a consistent view that they include increased digestive activity and contraction of the gallbladder.
Sweet
In the days when most people never tasted sugar, ‘sweetness’ was associated with the taste of basic foods: that of cooked vegetables, cereals and meat. In other words sweet was the quality of nourishment, and ‘tonic’ remedies. Describing a remedy as sweet generally led to that remedy being used in convalescence or recovery from illness. Interestingly, the plant constituents most often found in classic tonics like licorice, ginseng are plant steroids including saponins, which also have a sweet taste.

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