The fruit of Vitex agnus-castus (Chaste Tree) is well known in the Western herbal tradition, with medicinal references dating back to Hippocrates around 400 B.C.¹ The plant had important sacred and ritual use in ancient Rome and Greece, with the tree dedicated to goddesses associated with childbirth, fertility, abundance and death.^2,3 Native to the Mediterranean region and Asia, the plant has long spires of flowers, usually pale lilac in colour, and a reddish-black hard fruit which has a slightly aromatic and bitter taste.^4,5 Although the medicinal use of the fruit was documented in ancient Europe and up to 1633 when Gerard and other Renaissance herbalists reported its use as an emmenagogue, Chaste Tree was absent from most English herbals until the middle of the 1900s when it was once again acclaimed as a valuable herb for female reproductive imbalances.⁶ Clinical and experimental studies established that Chaste Tree enhances corpus luteal development, thereby correcting a relative progesterone deficiency via a dopaminergic activity on the anterior pituitary (which inhibits prolactin).⁷

The doses recommended for Chaste Tree vary widely, with some German practitioners tending to use very low doses (e.g. 30 to 40 mg/day equivalent dried fruit)⁸ compared to others recommending doses up to 3 g/day. For example, the dose outlined for French traditional use is 1 to 2 g/day when given as a fluid extract.⁹

As far as they have been defined, doses used in clinical studies dating from the 1950s to the present for female reproductive conditions (particularly menstruation disorders), range from 40 drops/day of diluted tincture¹⁰ to 360 mg/day (dried fruit equivalent).¹¹ (The dose information is based on the known formulation and strength of the branded products).

The clinically utilised doses for other applications is equally wide: from 40 drops/day of diluted tincture for acne¹² to 360 mg/day (dried fruit equivalent) for restless legs syndrome.¹³

Chaste Tree has been used traditionally for sleeplessness, including in France^9,14 and can be recommended for insomnia as it has also been shown to cause a dose-dependent increase of melatonin secretion, especially during the night when compared to placebo, in healthy men.¹⁵ Although the extract strength was not defined, a 70% ethanolic extract manufactured by the same company around the time of this trial was 10:1 in strength,¹⁶ suggesting the three doses of extract (given in three divided doses) corresponded to 1.2, 2.4 and 4.8 g/day of dried fruit.

Doses generally recommended by contemporary herbal practitioners range from 200 to 3000 mg/day (dried fruit equivalent).^7,17-22

Chaste Tree can be used for the following applications, with the following doses (except where indicated, provided as dried fruit equivalent):

- Premenstrual conditions (40-500 mg/day,^7,23 although doses below 180 mg/day
  may be less effective for premenstrual syndrome [PMS])²³

- Menstruation disorders (40 drops/day of diluted tincture to 500 mg/day)^7,24

- Uterine fibroids, endometriosis (up to 2500 mg/day)⁷

- Breast conditions including mastalgia (40-2500 mg/day)^7,25

- Female infertility (40 drops/day of tincture to 500 mg/day)^7,26

- Perimenopausal complaints (200-500 mg/day)⁷

- Restless legs syndrome (360 mg/day)¹³

- Acne (male or female; 40 drops/day of diluted tincture to 2500 mg/day)^7,27

- Insufficient lactation (less than 150 mg/day)⁷

- Insomnia, poor sleep maintenance (³ 2000 mg/day and more)^9,15 and jet lag
 (based on stimulation of melatonin: 5000 mg/day)²⁸

Conclusion

Chaste Tree has been prescribed in a wide range of doses informed by traditional use, mid-20th century clinical observations, newer clinical trials and extrapolation from pharmacological actions. Traditional use, contemporary practice and the need to exert significant pharmacological activity (such as dopaminergic, hormone antagonist or melatonin secretion effects) suggest doses at the higher end of the range may be required. Other conditions such as PMS, mastalgia and menstruation disorders may be adequately assisted with doses at the lower end of the range.

References

¹ Hobbs C. The chaste tree: Vitex agnus castus. Pharm Hist. 1991;33(1):19-24.

² Mills SY: Woman medicine: Vitex agnus-castus, the herb. Christchurch, UK: Amberwood Publishing Limited; 1992.

³ Frumin S, Maeir AM, Eniukhina M, Dagan A, Weiss E. Plant-related Philistine ritual practices at biblical Gath. Sci Rep. 2024 Feb 12;14(1):3513. DOI: 10.1038/s41598-024-52974-9.

⁴ World Health Organization. WHO monographs on selected medicinal plants, Volume 4. Geneva: WHO; 2009.

⁵ Barker J. The medicinal flora of Britain and northwestern Europe: a field guide including plants commonly cultivated in the region. West Wickham: Winter Press; 2001.

⁶ American Herbal Pharmacopoeia. Chaste tree fruit – Vitex agnus-castus: standards of analysis, quality control, and therapeutics. American Herbal Pharmacopoeia: Santa Cruz; 2001.

⁷ Bone KM, Mills SY. Principles and practice of phytotherapy: modern herbal medicine. 2nd ed. UK: Elsevier; 2013.

⁸ Blumenthal M. The complete German commission e monographs: therapeutic guide to herbal medicines. Austin: American Botanical Council; 1998.

⁹ Leclerc H. Précis de phytothérapie. 5th ed. Paris: Masson; 1983.

¹⁰ Bleier W. Therapie von Zyklus-und Blutungsstörungen und weiteren endokrin bedingten Erkrankungen der Frau mit pflanzlichen Wirkstoffen. Zentralbl Gynakol. 1959;81:701-9.

¹¹ Eltbogen R, Litschgi M, Gasser UE, Flüeli A, Nebel S, Zahner C. Vitex agnus-castus extrakt (Ze 440) improves symptoms in women with menstrual cycle irregularities. [In German] J Gynäkol Endokrinol. 2015 Jun 19;25(2):10-5.

¹² Giss G, Rothenburg W. [Phytotherapeutic management of acne]. Z Haut Geschlechtskr. 1968 Aug 1;43(15):645-7.

¹³ Brattström A, Kaiser WD. [Das restless-legs-syndrom (RLS)–erfahrungsbericht mit einem Vitex agnus-castus (VAC)-extrakt.] Z Phytother. 2010 Oct;31(5):247-50.

¹⁴ British Herbal Medicine Association. A guide to traditional herbal medicines: a sourcebook of accepted traditional uses of medicinal plants within Europe. Bournemouth: BHMA; 2003.

¹⁵ Dericks-Tan JS, Schwinn P, Hildt C. Dose-dependent stimulation of melatonin secretion after administration of Agnus castus. Exp Clin Endocrinol Diabetes. 2003 Feb;111(1):44-6. DOI: 10.1055/s-2003-37500.

¹⁶ Prilepskaya VN, Ledina AV, Tagiyeva AV, Revazova FS. Vitex agnus castus: Successful treatment of moderate to severe premenstrual syndrome. Maturitas. 2006 Nov 1;55:S55-63.

¹⁷ Hechtman L. Clinical naturopathic medicine. Revised ed. Sydney: Churchill Livingstone/Elsevier; 2012.

¹⁸ Christie S, Walker AF. Vitex agnus castus L.: (1) a review of its traditional and modern therapeutic use; (2) current use from a survey of practitioners. Eur J Herbal Med. 1997;3(3):29-45.

¹⁹ Burgoyne B. Survey of chaste tree use and dosage by Australian practitioners. Phytotherapist’s Perspective No. 144, May 2011.

²⁰ Bone K. The ultimate herbal compendium: a desktop guide for herbal prescribers. Warwick: Phytotherapy Press; 2007.

²¹ Mills S. The dictionary of modern herbalism. London: Thorsons; 1989.

²² Trickey R. Women, hormones & the menstrual cycle: herbal & medical solutions from adolescence to menopause. St Leonards, Australia: Allen & Unwin; 1998.

²³ Csupor D, Lantos T, Hegyi P, Benkő R, Viola R, Gyöngyi Z, et al. Vitex agnus-castus in premenstrual syndrome: A meta-analysis of double-blind randomised controlled trials. Complement Ther Med. 2019 Dec;47:102190. DOI: 10.1016/j.ctim.2019.08.024.

²⁴ Peters-Welte C, Albrecht M. [Regeltempostörungen und PMS. Vitex agnus castus in einer anwendungsbeobachtung.] TW Gynäkol. 1994;7(1):49-52.

²⁵ Ooi SL, Watts S, McClean R, Pak SC. Vitex agnus-castus for the treatment of cyclic mastalgia: a systematic review and meta-analysis. J Womens Health (Larchmt). 2020 Feb;29(2):262-78. DOI: 10.1089/jwh.2019.7770.

²⁶ Propping D, Katzorke T, Belkien L. Diagnostik und Therapie der Gelbkörperschwäche in der Praxis. Therapiewoche 1988;38:2992-3001. Cited by Gorkow C. Klinischer kenntnisstand von agni-casti fructus. Klinisch-pharmakologische untersuchungen und wirksamkeitsbelege. [In German] Z Phytother. 1999;20:159-68, and Agni casti fructus. ESCOP monographs: The scientific foundation for herbal medicinal products. 2nd ed. Exeter: European Scientific Cooperative on Phytotherapy; 2003.

²⁷ Giss G, Rothenburg W. [Phytotherapeutic management of acne]. Z Haut Geschlechtskr. 1968 Aug 1;43(15):645-7.

²⁸ Bone K. Functional herbal therapy: a modern paradigm for Western herbal clinicians. London: Aeon Books Ltd; 2021.