What is a tincture? A look at their benefits and uses

Tinctures are concentrated liquid herbal extracts. The plant part that is used can vary from plant to plant (e.g. some will be bark, some root, some seed, some leaf, some fruit or just flower). Some tinctures use a combination of plant parts.

Tinctures have long been revered for their health benefits. We recently launched our own range and so to celebrate, this week’s blog looks at the uses and benefits of each one.

Tinctures are made by soaking the relevant plant part in alcohol, which extracts the active nutrients to form a concentrated liquid. This makes them readily available for your body to absorb. In the process of making a tincture, a specific weight of the whole plant part is added to the menstruum (liquid part of the tincture), and that is then macerated (left to infuse) for a specific amount of time. The mixture is then strained and pressed, and what’s left is the plant part, which is discarded, and the liquid, which is the tincture. Tinctures are made at specific ratios of water, alcohol and plant material depending on the plant used.

What are the benefits of herbal tinctures?

Tinctures are quickly absorbed into the bloodstream and are a highly effective way to deliver the beneficial phytonutrients found in plants to the body, in a highly concentrated form, and can be targeted at a range of areas of health.  Botanical tinctures from whole plant extracts provide the benefits of the broadest spectrum of chemical constituents. The method involved in making a tincture naturally preserves the beneficial actives. Tinctures can be an easy alternative for those who do not like taking tablets or capsules.

Now let us have a closer look at some of the key herbal tinctures available, along with their uses and evidence of their health benefits:

Skip to Key Takeaways

Elderberry – uses and therapeutic benefits

Elderberry (Sambucus nigra fructus) is harvested in late August or early September from the Black Elder or European Elder tree. If the creamy-white flowers are left on the tree in the spring, these turn into small, round, deep purple-black berries over the summer months, and hang in clusters from umbels at the end of the branch¹. It belongs to the Honeysuckle family.

Traditionally, the plant was used to relieve fever and have a drying effect on the body, as well as improving urine flow. It was used to make an array of food and drinks, from wines to preserves and also used as a flavouring and clothing dye².

Today, elderberry is well known for its immune and respiratory health benefits, its antiviral action, and also its effect on blood lipids¹. Whilst containing Vitamin C itself, elderberry is often combined with added Vitamin C, and you can read more about the benefits of Vitamin C.

Whole extract benefit: the chemistry of Elderberry

Extracted as a whole organic dried berry liquid hydroethanolic extract, with 45% ethanol as its solvent, elderberry contains a number of constituents that relate to its health supportive actions. It contains monomeric anthocyanins which have an antiviral and anti-inflammatory action and vitamin C, providing further antiviral and antioxidant benefit³. Its malic acid assists with reducing arteriosclerosis, whilst also having an antioxidant action¹.

Evidence overview

There has been considerable research about elderberry across the world, with a variety of applications and results. Research commonly focuses on the antiviral, antioxidant, immune modulating and blood lipid lowering aspects, which largely produce promising results.

Antiviral

The antiviral effect of elderberry, especially against the influenza virus, is well-researched. A 2004-published randomised, double-blind, placebo-controlled study of the efficacy and safety of oral elderberry in the treatment of influenza types A and B, tested sixty adult patients who were experiencing influenza-like symptoms for 48 hours. After having been given an elderberry extract four times a day for five days, it was noted that symptoms were relieved four days earlier for those taking elderberry, against the placebo group, and that additional relief medication use was significantly less in those taking the elderberry extract⁴.

During the Coronavirus pandemic from 2020, there was discussion relating to a potential link between elderberry and cytokine storm, however more recent research concluded that elderberry extract did not affect the expression of pro-inflammatory cytokines⁵.

Upper respiratory symptoms

Part of the benefit of elderberry for increasing immune health comes from its anthocyanins, notably cyanidin 3-glucoside and cyanidin 3-sambubioside. With cough, sore throat, nasal discharge and other upper respiratory symptoms being common through the winter months, elderberry can play a valuable role in assisting the body to recover from such respiratory symptoms. A 2019 meta-analysis of randomised, controlled clinical trials, concluded that elderberry supplementation, when taken from the start of upper respiratory symptoms appearing, substantially reduced the overall symptom duration, in comparison with the control groups⁶.

Cholesterol and blood Lipids

The use of elderberry for reducing cardiovascular disease, through its anti-inflammatory, antioxidant and cholesterol-lowering effects has also been the subject of much research. A 2004 randomised, double-blind, placebo-controlled study looking into the intake of a low dose of elderberry juice, provided interesting results to support this. The objective of this study was to look at the impact of elderberry juice on cholesterol and triglyceride concentrations, in addition to antioxidant status across a group of 34 subjects, taking the juice for two weeks. A further six participants took a larger dose of elderberry along with a breakfast comprising of high fat foodstuffs.  The study concluded that there was a small change in cholesterol concentrations and antioxidant capacity compared with the placebo group⁷.

More recent cell culture studies published in 2021 relating to elderberry’s cholesterol-lowering action have explored gene expression involved in intestinal cholesterol biosynthesis and absorption. The study concluded that it supported the benefits of elderberry for the prevention of hypercholesterolemia⁸.

Further research will benefit the understanding of elderberry on cholesterol.

Safety: 

Elderberry is considered safe for children and adults, but the dosage does vary depending on age. Please check the label for more information. It should be noted that tinctures such as this contain alcohol.

Echinacea – uses and therapeutic benefits

Echinacea is a plant native to the Midwest in North America from Saskatchewan to Texas and is a traditional Native American herbal remedy that has gained worldwide popularity for its health properties since the late 1800s¹. It was used traditionally as a topical remedy for wounds, burns, insect bites and abscesses, as well as for poisonous snake bites¹. Its use today is focused on the internal use of the plant, mainly for its immune and respiratory benefits.

There are commonly 3 species of Echinacea that are used medicinally – Echinacea angustifolia, Echinacea purpurea and Echinacea pallida– of which it is usually the root and rhizome of the plant that is used. The narrow-leaved purple coneflower (Echinacea angustifolia) is the more commonly used species of the three².

A plant that can grow across the Northern Hemisphere, it is easily identified by its vibrant brown-orange spiky centre and long pale pink petals, and in the case of the species used for this extract, narrow leaves. Its spiky centre is how it gained the name ‘Echinacea’, with the Greek ‘echios’ meaning hedgehog³. It is part of the Asteraceae family, the Daisy family, and its flowers are synonymous with the shape of all flowers within that family, with its ray of florets.

Today, Echinacea is mainly known for its immune system benefits, having an action on innate immunity, assisting with resistance to infections, and being especially helpful in upper respiratory tract infection, but it is also known to have an anti-inflammatory, lymphatic and possibly adaptogenic action as well². It is a fascinating plant that has been extensively researched.

Whole extract benefit: the chemistry of Echinacea

Whole root extract of echinacea draws benefits from several active constituents. Alkylamides, particularly isobutylamides are responsible for the tingling mouth sensation that echinacea causes, and these are reported to have immunomodulatory, phagocytotic, antiviral and anti-inflammatory effects, amongst others⁴. Caffeic acid esters are present, such as cynarin, and echinacoside providing antioxidant benefit⁵.

Evidence overview

Most of the research about echinacea focuses on the immune system benefit, as an immune system modulating herb, with antiviral effects, particularly in relation to the common cold virus, as well as a potential antifungal action, amongst many other allied uses. Research uses species across the Echinacea genus, focusing on the three main species noted above, and employs different forms of extract, in both in vivo and in vitro scenarios.

Immune system benefit

Echinacea’s most common benefit comes from its immune modulating properties, especially in upper respiratory health, and this is where the bulk of in vitro and in vivo research has been carried out. Cytokine antibody arrays were used to look into the changes in pro-inflammatory cytokines and chemokines released from a cultured line of human bronchial epithelial cells exposed to a rhinovirus and echinacea extract. The virus infection stimulated the release of 31 cytokine-related molecules, including a number of chemokines known to attract inflammatory cells, and it was found that most of the effects were reversed by the echinacea extract⁶.

The way that echinacea is extracted is also an important aspect to consider, with differing types of extract producing differing immune responses. A lab comparison of five different species, that used a number of in vitro models of immunological activity, such as mononuclear cell proliferation and cytokine secretion, demonstrated that 50% ethanol tinctures produced the most immune stimulation, with Echinacea angustifolia extracts being the most efficacious across the assays⁷.

The alkylamides in echinacea have also been observed to inhibit prostaglandin production in vitro, influencing further research into the plant’s potential in natural killer cell enhancement. Whilst alkylamides are found in higher number in the ‘angustifolia’ species, the ‘purpurea’ species also contains the constituent. In vivo research found that echinacea enhanced natural killer cell activity by upregulating MHC II and TH-1 type cell responses, with the herb also increasing B cell proliferation, leukocyte counts and immunoglobulin levels⁸. Further research has also found the caffeic acid, cynarin exerting a potential immunomodulatory effect¹.

Given its evidence of reducing the duration and severity of acute respiratory tract infections, there was much debate about whether echinacea was appropriate for use with those with COVID-19, however contrary to discussion at the time, where it was suggested that echinacea may worsen the over-activation of the immune system in cytokine storm, clinical trials show that echinacea actually decreases the levels of immune molecules involved in cytokine storm⁹.

Antiviral: Common Cold (Rhinovirus) and Herpes Simplex (HSV-1)

As the immune system has a role to play in defeating viruses, there is naturally some overlap here, between the immune related, and antiviral aspects of echinacea. It is considered that the direct impact of echinacea on disabling viruses is relatively modest¹ however, results of research and analyses are promising. A meta-analysis evaluating the effect of the three main echinacea species on the duration and incidence of the common cold, including data from 14 unique studies, showed that the plant did have a benefit by reducing the odds of developing the common cold by 58%¹⁰.

Lab studies have also shown a potential benefit to the herpes simplex virus (HSV-1). A Canadian study showed that in vitro, eight species of echinacea had an antiviral action against HSV-1, when exposed to UV and visible light¹¹.

Antifungal effects: Candida

Recent Iranian studies have demonstrated that echinacea could also have an antifungal benefit. The research, taking note of the increased resistance of candida species fungi to chemical drugs, explored in vitro, the antifungal effect of an aqueous and ethanolic extract of Echinacea angustifolia alongside that of an essential oil from the plant with the drug fluconazole. The study used fifty Candida albicans samples isolated from candidate samples at a hospital, with the comparison using disk diffusion and microdilution methods. The results showed a significant difference in inhibition, from the Echinacea angustifolia ethanolic extract, with better antifungal performance than fluconazole¹². These results would warrant further research into its application as an antifungal, particularly with in vivo human trials.

Safety: 

• The tingling sensation on the tongue and in the mouth after taking echinacea is as a result of the alkylamides it contains¹.
• Long term use of echinacea is contraindicated for people taking immunosuppressants (e.g. those having undergone organ transplant)¹. Those with an allergy to Asteraceae family plants (such as Chrysanthemum, Daisy, Chamomile etc.) should avoid the use of echinacea. In the UK, the Medicines and Healthcare products Regulatory Agency recommends that Echinacea should not be used in children under the age of 12¹³.

Ginkgo tree leaf – uses and therapeutic benefits

Ginkgo biloba (commonly known as the Maidenhair tree), unlike many herbal extracts, is actually a fairly recent discovery, in terms of the medicinal actions of the leaf. Whilst an ancient tree, with fossilised remains having been dated to 180 million years ago, and a history of the nut being used in Traditional Chinese Medicine, the leaf has only been used as herbal medicine since the 1960s, following scientific research about the effect of herbs on the circulation¹.

A deciduous tree native to China, Japan and Korea, it is the only living example of the Ginkgoaceae family. In Mandarin and Japanese, ginkgo means ‘silver apricot’, referring to its fruit, whilst it’s English common name, the Maidenhair tree, relates to its resemblance to the Maidenhair Fern. ‘Biloba’ relates to the two-lobed appearance of the fan-shaped leaf².

Originally a tree often planted in temple gardens in China, it can now be seen regularly planted in urban streets and parks across the world, thanks to its tolerance to pollution. It is famed for its striking golden glow in the autumn, as the leaves turn a vibrant yellow³.

The original research about ginkgo leaf focused on its benefits for peripheral circulation, with later research discovering its neuroprotective effects^4,5. Its versatile uses are underpinned by a vast amount of human research and randomised controlled trials, solidifying its place as a valuable medicinal plant.

Whole extract benefit: the chemistry of Ginkgo

Ginkgo whole-leaf tincture contains a wide variety of constituents.  The terpene lactones of ginkgolide B and bilobalide inhibit platelet aggregating factor (PAF), increase glucose and oxygen uptake at a cellular level, have an action on improving memory, and increase circulation to the hands and feet. Its many flavonoids, including bilobetin and ginkgetin exert antagonistic effects on lipid peroxidation, and its flavanols, including quercetin, have an antioxidant action⁴.

Evidence overview

Ginkgo has long history of use in Traditional Chinese Medicine, but the use of its leaf is a more modern application, which has undergone significant research since the 1960s⁶. Many potential uses have been postulated as a result of studies on the leaf, with the following having been assessed in good number. Most of the research conducted uses standardised extracts of ginkgo leaf.

Memory and concentration

One of the main uses of ginkgo today, is for its neuroprotective effects. It is suggested that ginkgo may improve blood supply and enhance cerebral function, where cerebral blood flow is restricted, causing memory or cognitive impairment, especially in the elderly⁵. One study noted a significant increase in the number of appointments correctly remembered by middle-aged people⁷. Research has also been carried out in relation to vascular dementia, whereby ginkgo has been shown to play a part in protection against stroke, maintaining memory and protecting neuronal cell receptors relating to the ageing process⁸. 

Peripheral circulation

As was discovered during the original research, ginkgo improves circulation to the extremities, notably in peripheral artery disease. This occurs when vessels carrying blood supply to the legs, becomes narrowed or blocked⁹. In 2004, a systematic review of placebo controlled, randomised trials, revealed that seven out of nine studies showed, for patients with intermittent claudication (the most common symptoms of peripheral artery disease) there was a statistically significant improvement in pain-free walking for those taking a standardised extract of ginkgo, compared to placebo¹⁰.

Placebo-controlled research relating to the use of a standardised extract of ginkgo with Raynaud’s disease has also shown effectivity. A ten-week trial of patients recording frequency, duration and severity of attacks, revealed that the number of attacks saw a reduction of 56% in the number of weekly attacks, compared with the 27% of the placebo group¹¹.

Asthma

The anti-platelet aggregating factor activity of ginkgo may also be considered useful for those with asthma and certain respiratory allergic reactions. A number of uncontrolled and controlled trials have shown promising results varying from protecting those exposed to inhaled allergen, to improving atopic asthma with flow parameters showing significant improvement⁵.

Eye disorders

As a result of its circulation improving and vascular protective actions, ginkgo has also been researched in relation to its potential benefit for eye health. A double-blind trial of 10 recently diagnosed patients with age-related macular degeneration, compared an extract of ginkgo with placebo, and found that on assessment of visual acuity, fundoscopy and visual field, there was a statistically significant improvement in long-distance visual acuity with those that had received treatment with the ginkgo extract¹². Research has also demonstrated ginkgo’s ability to improve retinal health of patients with diabetic retinopathy by increasing retinal capillary blood flow, and it is considered that correct use of ginkgo could lower the incidence and progression of the condition¹³.

Safety: 

• Medication – those taking anticoagulant or antiplatelet medication should avoid the use of ginkgo
• Surgery – it is advisable to stop taking Ginkgo 5-7 days prior to medical surgery

Aesculus – uses and therapeutic benefits

Aesculus hippocastanum seed is more commonly known as the ‘conker’. It is the seed of the Horse Chestnut tree, commonly seen in parks and along urban streets, which feature white and pink spring flowers that turn to fruit by the early Autumn, and these enclosures of the spiky green cases then fall to the ground during Autumn, releasing the seed. They are part of the Hippocastanaceae family, of which Aesculus is the most common member.

The chemistry of Aesculus and its action on the venous system

Aesculus seed contains 3%-6% saponins¹. Saponins are soap-like compounds that form colloidal solutions in water, altering the surface tension of water, meaning that when a water infusion of a saponin-rich plant is shaken, bubbles or ‘froth’ will form on the surface². Saponins are found across many food plants, but it is the subgroup of triterpenoid saponins that are found in aesculus seed, notably aescin, which is a complex mixture of saponins, that has anti-inflammatory, antioxidant and vascular toning properties³. Coumarins also found within the seed, act synergistically with the aescin, and result in actions that have traditionally be used to support conditions relating to venous and lymphatic insufficiency³, including varicose veins and haemorrhoids¹.

Aescin specifically, counters the release of pro-inflammatory mediators at a vascular level, and produces an action that leads to an increased level of venous tension and capillary sealing, reducing capillary fragility⁴.

Chronic venous insufficiency

Chronic venous insufficiency (CVI) is described as an impairment of venous return, and it’s a term that usually relates to venous return from the legs, which is synonymous with oedema and sometimes leg ulcers, often resulting in the need for compression treatment¹. It occurs as a result of micro and macrovascular changes in the lower legs, including endothelial damage, basement membrane thickening and capillary bed malformation, which enables increased fluid permeability⁴.

A Cochrane review of seventeen trials involving aesculus seed extract for CVI, of which ten were placebo-controlled, noted an improvement in CVI related signs and symptoms for groups using aesculus seed extract compared to placebo, utilising leg volume used as part of the assessment method, with the review concluding that the extract is effective as a short-term treatment for chronic venous insufficiency⁵.

A randomised, partially blinded, placebo-controlled parallel study compared the efficacy of an aesculus seed extract in reducing oedema and safety of compression stockings in 240 patients, over a 12 week period. Results showed that lower leg volume of the more severely affected limb decreased on average by 43.8ml with those taking the aesculus extract, 46.7ml with compression therapy, yet increased by 9.8ml with the placebo group. A statistically significant effective outcome was observed for the aesculus seed and compression method, and the study also reported that the aesculus was well tolerated by those taking the extract⁶.

Heaviness, tension and calf cramps in chronic venous insufficiency

In another study, an aesculus tincture extract was trialed with 38 patients with chronic venous insufficiency, with a mean age of 56, over an average of 4 weeks of treatment. Ankle and lower leg circumference were measured at baseline and after treatment. 77% of patients experienced a clinically relevant therapeutic result, with over 60% rating the efficacy as good to very good for symptoms of leg swelling, sensations of heaviness and tension in the legs, calf cramps and pruritis⁷.

Safety: 

• Those with gastric reflux, cholestasis, coeliac disease, fat malabsorption, upper-digestive irritation and some vitamin deficiencies should seek medical advice before taking Aesculus extracts⁸.
• If taking anti-coagulant or anti-platelet medication, caution is advised, and advice should be sought from a qualified medical practitioner before use⁹.

Crataegus – uses and therapeutic benefits

Crataegus laevigata is a species of the hawthorn, known commonly as the Midland Hawthorn or English Hawthorn. The berry/fruit, and the leaf and flower combined, have a traditional use to support cardiovascular health, including high blood pressure, and also circulatory disorders.

Crataegus is part of the rose family (Rosaceae). A thorny shrub, often used as hedging, the hawthorn can also grow into a small tree. It has three-lobed glossy dark green leaves, and produces creamy-white, sometimes pink flowers in cluster from Mid-April. It is usually in flower by May, hence its other common name of Mayflower. In the autumn, these clusters of flowers have fully developed into deep red, oval berries, often called ‘haws’¹.

It was an Irish doctor by the name of Dr Green, that the first use of hawthorn as a cardiovascular remedy was attributed to, who used the berries in a liquid tincture extract. Since then, crataegus has gained a strong reputation as a valuable herbal medicine extract across the world, supported by a considerable body of research to support its use as a cardiotonic, cardioprotective, antioxidant and mild hypotensive herb².

Whole extract benefit: the chemistry of Crataegus

As with most plants, the medicinal benefit of crataegus lies in a combination of the constituents found with it, rather than one isolated constituent. Crataegus berries contain flavonoids, including the quercetin glycosides of hyperoside and rutin³. Rutin notably strengthens blood capillary walls and reduces their permeability. These flavonoids are responsible for increasing the contractility of the heart, and have a mildly positive inotropic effect, meaning that they reduce peripheral vascular resistance and reduce afterload, so increase cardiac performance and output⁴. Crataegus also inhibits angiotensin-converting enzyme (ACE), resulting in it being able to assist with lowering blood pressure⁵. Further constituents adding to its hypotensive effects include the procyanidins of epicatechin, and it also benefits from its oligomeric procyanidins (OPCs), which enhance circulation and have an antioxidant action⁶.

Evidence overview

Benefitting from a range of constituents that are considered to exert an action on the cardiovascular system, the use of crataegus to support mild hypertension, congestive heart failure and hyperlipidemia has been noted across randomised, double-blind, placebo-controlled trials.

Mild hypertension

A systematic review of four trials, involving 254 participants concluded that Crataegus extract may be effective in reducing the blood pressure of those with mild hypertension, when used for at least 12 weeks⁷. Of particular interest was a randomised, double-blind study from 2004, which noted that a hydroalcoholic extract of leaves and flowers administered to 92 people, aged 40-60, with primary mild hypertension, three times a day for more than four months, resulted in a decrease of both systolic and diastolic blood pressure, after three months⁸.

A more recent randomised, double-blind controlled trial published in 2021 investigated the effect of Crataegus on controlling the blood pressure of patients aged 35-60 with initial stage hypertension, along with sleep disorder. In this trial, involving 60 patients with hypertension and sleep disorder, a Crataegus berry extract and placebo capsules were administered, twice daily, for eight weeks across the group. After 8 weeks of treatment, the systolic and diastolic blood pressure across the crataegus group was statistically significantly lower. The intragroup analysis also showed a statistically significant decrease in sleep disorder severity in the crataegus group, although the nature of sleep disorder is not apparent from the published paper⁹.

Congestive heart failure

Much research has also been conducted relating to the use of crataegus with congestive heart failure. A randomised, double-blind placebo controlled Swiss study from 2004 explored this with a standardised extract of crataegus berry across 143 patients with a mean age of 64.8 years, with a diagnosis of congestive heart failure NYHA class II. Patients were treated with 30 drops of the extract (or placebo), three times a day for 8 weeks. Changes in exercise tolerance with bicycle exercise testing, and blood pressure and heart rate were used as the variables for evaluation of the efficacy of crataegus. A significant increase in exercise tolerance was noted in both groups, but more so for the crataegus extract group. Interestingly, the study did not note a statistically significant difference for blood pressure and heart rate between the two groups. They concluded that those patients recruited, may expect an improvement in their heart failure condition under long term therapy with the standardised extract of the crataegus berry. They also noted that the crataegus was well tolerated by those taking part in the study¹⁰.

Hyperlipidaemia

Through studies seeking to comprehend the effects of Crataegus in cases of coronary heart disease (CHD), it is now understood that it is possible that Crataegus can have a role to play in reducing blood lipids. A European double-blind placebo-controlled study looked into the effects of Crataegus on biomarkers of CHD in 49 people, aged between 45 and 75 years of age, with a pre-existing diagnosis of diabetes mellitus over a 6-month period. Across the biomarkers assessed, it was noted that neutrophil elastase levels decreased in the Crataegus group. The study also showed that the Crataegus extract, added to statins, showed a trend to decrease low-density lipoprotein cholesterol (LDL) levels compared with placebo, as an add-on treatment¹¹. A later randomised, double-blind placebo- controlled study, looking into the effects of a Crataegus extract on blood pressure and blood lipids, using a sample of 60 patients, found a statistically significant reduction in systolic and diastolic blood pressure, as well as serum total cholesterol and LDL cholesterol, with high density lipoprotein significantly increased in the patients that had been treated with the hawthorn extract¹².

Safety: 

• Those already using heart and blood pressure medication, including beta blockers, should seek advice from a qualified medical practitioner before taking Crataegus and blood pressure should be regularly monitored whilst using the extract².
• Crataegus is considered contraindicated for those with diastolic congestive heart failure⁵.
• Crataegus is considered safe for those who are breastfeeding².

Agnus Castus – uses and therapeutic benefits 

Agnus castus tincture is made from the dried, ripe berries of the Vitex agnus-castus tree, also know as the Chaste tree, or Monk’s pepper. A Mediterranean and Southern European shrub, often found growing along riverbanks, its berry can hold benefit for the female reproductive system¹.

Whole extract benefit: the chemistry of Agnus Castus

Agnus castus assists with the development of the corpus luteum, acting as a prolactin inhibitor, and agonist of dopamine, assisting with ‘normalising’ the menstrual cycle, promoting ovulation, and indirectly, through its action on the corpus luteum, having a progestogenic action².  The dopaminergic activity occurs as a result of the effects of its diterpenes³. The herb has also been shown to help with the regulation of the luteal phase of the menstrual cycle⁴. It is considered that high doses of agnus castus inhibit prolactin release, and lower doses increase it⁵.

Evidence overview

With a long traditional history of use, agnus castus can be a beneficial botanical alternative to address female hormonal imbalances and a range of symptoms associated with them.

Female hormonal health

Traditionally, agnus castus, has been used to assist with reducing menstrual cramps, and irregular menstrual cycles, as well as enhancing fertility². Modern research supports its use in assisting with a number of menstrual issues, such as mastalgia, oligomenorrhea and polymenorrhoea, as well as metrorrhagia and secondary amenorrhoea; in addition to reducing PMS-like symptoms in perimenopause² and alleviating irregular menstrual bleeding in perimenopause⁵.  It is also thought that agnus castus may also be of use in restless legs syndrome, through its effects on dopaminergic systems, modulating locomotor unrest⁵.

PMS

A clinical survey published in 1992 evaluated the effect of an agnus castus preparation on 1,542 women diagnosed with PMS. Treatment of 40 drops daily lasted an average of 166 days. Both physicians and patient assessed efficacy, with 90 percent reporting relief of symptoms, after an average treatment duration of 25.3 days⁶.

In other clinical trials, agnus castus reduced many symptoms associated with PMS, especially breast pain, irritability, depression and low mood, irritability, and headache^7-10. 

Safety:

• Not suitable for use in pregnancy or breastfeeding
• Should not be used by anyone undergoing fertility treatment
• Caution is advised if taking antipsychotic medication, contraceptive medication, dopamine agonist medication, or Metoclopramide.

---

References

Elderberry

1. Kuhn, M. and Winston, D. (2008) Winston and Kuhn’s herbal therapy and supplements: a scientific and traditional approach. Philadelphia: Lippincott Williams and Wilkins.
2. Sambucus nigra Sambucus nigra (Elderberry). (n.d.). Available at: https://altmedrev.com/wp-content/uploads/2019/02/v10-1-51.pdf.
3. Duke, J. Dr Duke’s phytochemical and ethnobotanical databases. Available at https://phytochem.nal.usda.gov/phytochem/plants/show/6559 (Accessed 12 August 2023)
4. Zakay-Rones Z, Thom E, Wollan T, Wadstein J. Randomized Study of the Efficacy and Safety of Oral Elderberry Extract in the Treatment of Influenza A and B Virus Infections. Journal of International Medical Research. 2004;32(2):132-140. doi:10.1177/147323000403200205
5. Torabian, G., Valtchev, P., Adil,Q., and Dehghani, F. Anti-influenza activity of elderberry (Sambucus nigra), Journal of Functional Foods, Volume 54, 2019, Pages 353-360, https://doi.org/10.1016/j.jff.2019.01.031.
6. Hawkins, J., Baker, C., Cherry, L., and Dunne, E. Black elderberry (Sambucus nigra) supplementation effectively treats upper respiratory symptoms: A meta-analysis of randomized, controlled clinical trials, Complementary Therapies in Medicine, Volume 42, 2019, Pages 361-365, https://doi.org/10.1016/j.ctim.2018.12.004
7. Murkovic, M., Abuja, P., Bergmann, A. et al. Effects of elderberry juice on fasting and postprandial serum lipids and low-density lipoprotein oxidation in healthy volunteers: a randomized, double-blind, placebo-controlled study. Eur J Clin Nutr 58, 244–249 (2004). https://doi.org/10.1038/sj.ejcn.1601773
8. Jeon, S.; Kim, M.; Kim, B. Polyphenol-Rich Black Elderberry Extract Stimulates Transintestinal Cholesterol Excretion. Appl. Sci. 2021, 11, 2790. https://doi.org/10.3390/app11062790

Echinacea

1. Kuhn, M. and Winston, D. (2008) Winston and Kuhn’s herbal therapy and supplements: a scientific and traditional approach. Philadelphia: Lippincott Williams and Wilkins.
2. Bone, K. and Mills, S. (2013) Principles and practice of phytotherapy: modern herbal medicine, second edition. Edinburgh: Churchill Livingstone.
3. Johnson, A. and Smith, H. (1986) Plant names simplified: their pronunciation, derivation and meaning. Cheltenham: Landsmans.
4. Elufioye TO, Habtemariam S, Adejare A. Chemistry and Pharmacology of Alkylamides from Natural Origin. Rev Bras Farmacogn. 2020;30(5):622-640. doi: 10.1007/s43450-020-00095-5. Epub 2020 Oct 9. PMID: 33071385; PMCID: PMC7546144.
5. Dalby-Brown L, Barsett H, Landbo AK, Meyer AS, Mølgaard P. Synergistic antioxidative effects of alkamides, caffeic acid derivatives, and polysaccharide fractions from Echinacea purpurea on in vitro oxidation of human low-density lipoproteins. J Agric Food Chem. 2005 Nov 30;53(24):9413-23. doi: 10.1021/jf0502395. PMID: 16302756.
6. Sharma, M., Arnason, J.T., Burt, A. and Hudson, J.B. (2006), Echinacea extracts modulate the pattern of chemokine and cytokine secretion in rhinovirus-infected and uninfected epithelial cells. Phytother. Res., 20: 147-152. https://doi.org/10.1002/ptr.1824
7. David S. Senchina, Dustin A. McCann, Jessica M. Asp, Jack A. Johnson, Joan E. Cunnick, Mark S. Kaiser, Marian L. Kohut, Changes in immunomodulatory properties of Echinacea spp. root infusions and tinctures stored at 4 °C for four days, Clinica Chimica Acta, Volume 355, Issues 1–2, 2005, Pages 67-82, https://doi.org/10.1016/j.cccn.2004.12.013.
8. Park, Soo-Jeung and Lee, Minhee and Kim, Dakyung and Oh, Dong Hwan and Prasad, Kodimule Shyam and Eun, Sangwon and Lee, Jeongmin, Echinacea purpurea Extract Enhances Natural Killer Cell Activity In Vivo by Upregulating MHC II and Th1-type CD4+ T Cell Responses, Journal of Medicinal Food, volume 24, number 10, 1039-1049, 2021, doi: 10.1089/jmf.2021.K.0064.
9. Aucoin, M., Cooley, K., Saunders, P., Carè, Anheyer, J.D. , Medina, D., Cardozo, V., Remy, D., Hannan, N., Garber, A, The effect of Echinacea spp. on the prevention or treatment of COVID-19 and other respiratory tract infections in humans: A rapid review, Advances in Integrative Medicine, Volume 7, Issue 4, 2020, Pages 203-217, https://doi.org/10.1016/j.aimed.2020.07.004.
10. Shah, Sachin A et al. , Evaluation of echinacea for the prevention and treatment of the common cold: a meta-analysis. The Lancet Infectious Diseases, Volume 7, Issue 7, 473 – 480
11. Binns, S. E. et al.(2002) “Antiviral Activity of Characterized Extracts from Echinacea Spp. (heliantheae: Asteraceae) against Herpes Simplex Virus (hsv-I),” Volume:68, 9: 780-783
    DOI: 10.1055/s-2002-34397
12. Piri Gharaghie T, Hajimohammadi S. Comparison of anti-candida effects of aqueous, ethanolic extracts and essential oil of E. angustifolia with fluconazole on the growth of clinical strains of Candida. NCMBJ 2021; 11 (43) :25-38
13. n.d. “UK Government Web Archive.” Gov.uk. Retrieved August 14, 2023 (https://webarchive.nationalarchives.gov.uk/ukgwa/20141206003656/
    http://www.mhra.gov.uk/NewsCentre/Pressreleases/CON180627).

 

Ginkgo

1. Conway, P. (2001) Tree medicine. London: Piatkus.
2. Holmes, P. (2007) The energetics of western herbs: a materia medica integrating Western and Chinese herbal therapeutics. Coati: Snow Lotus Press.
3. Hurst, K. (2015) Hidden histories: Herbs. London: Timber Press.
4. Weiss, R.F. (2001) Weiss’s herbal medicine: classic edition. Stuttgart: Thieme.
5. Bone, K. and Mills, S. (2013) Principles and practice of phytotherapy: modern herbal medicine, second edition. Edinburgh: Churchill Livingstone.
6. Kuhn, M. and Winston, D. (2008) Winston and Kuhn’s herbal therapy and supplements: a scientific and traditional approach.
7. Beck, S.M.; Ruge, H.; Schindler, C.; Burkart, M.; Miller, R.; Kirschbaum, C.; Goschke, T. Effects of Ginkgo bilobaextract EGb 761^® on cognitive control functions, mental activity of the prefrontal cortex and stress reactivity in elderly adults with subjective memory impairment—A randomized double-blind placebo-controlled trial.  Psychopharmacol. 2016, 31, 227–242.
8. Singh, S.K.; Srivastav, S.; Castellani, R.J.; Plascencia-Villa, G.; Perry, G. Neuroprotective and Antioxidant Effect of Ginkgo bilobaExtract against AD and Other Neurological Disorders.  J. Am. Soc. Exp. NeuroTher. 2019, 16, 666–674.
9. Centers for Disease Control and Prevention (2023) Peripheral artery disease: https://www.cdc.gov/heartdisease/PAD.htm#:~:text=Print,arteries%2C%20which%20is%20called%20atherosclerosis [accessed 19 August 2023].
10. Horsch S, Walther C. Ginkgo biloba special extract EGb 761 in the treatment of peripheral arterial occlusive disease (PAOD)–a review based on randomized, controlled studies. Int J Clin Pharmacol Ther. 2004 Feb;42(2):63-72. doi: 10.5414/cpp42063. PMID: 15180165.
11. Muir AH, Robb R, McLaren M, Daly F, Belch JJ. The use of Ginkgo biloba in Raynaud’s disease: a double-blind placebo-controlled trial. Vasc Med. 2002;7(4):265-7. doi: 10.1191/1358863x02vm455oa. PMID: 12710841.
12. Lebuisson, D.A., Leroy, L., Rigal, G. (1988). Treatment of Senile Macular Degeneration with Ginkgo Biloba Extract. In: Fünfgeld, E.W. (eds) Rökan. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-73686-5_25
13. Martínez-Solís, I., Acero, N., Bosch-Morell, F., Castillo, E., González-Rosende, M. E., Muñoz-Mingarro, D., … & Villagrasa, V. (2019). Neuroprotective potential of Ginkgo biloba in retinal diseases. Planta Medica, 85(17), 1292-1303.

Aesculus

1. Bone, K. and Mills, S. (2013) Principles and practice of phytotherapy: modern herbal medicine, second edition. Edinburgh: Churchill Livingstone.
2. Pengelly, A. (2004) The constituents of medicinal plants. Wallingford: CABI.
3. Ganora, L. (2009) Herbal constituents: foundations of phytochemistry. Louisville: Herbalchem Press.
4. Gallelli, L., 2019. Escin: a review of its anti-edematous, anti-inflammatory, and venotonic properties. Drug design, development and therapy, pp.3425-3437.
5. Pittler MH, Ernst E. Horse chestnut seed extract for chronic venous insufficiency. Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.: CD003230. DOI: 10.1002/14651858.CD003230.pub4. Accessed 13 September 2023.
6. Diehm, C., Trampisch, H.J., Lange, S. and Schmidt, C., 1996. Comparison of leg compression stocking and oral horse-chestnut seed extract therapy in patients with chronic venous insufficiency. The Lancet, 347(8997), pp.292-294.
7. Suter, A., Bommer, S. & Rechner, J. Treatment of patients with venous insufficiency with fresh plant horse chestnut seed extract: A review of 5 clinical studies. Adv Therapy23, 179–190 (2006). https://doi.org/10.1007/BF02850359
8. Mills, S. and Bone, K. (2005) The essential guide to herbal safety. Edinburgh: Churchill Livingstone.
9. Horse chestnut (no date) Natural Medicines. Available at: https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=1055#scientificName (Accessed: 13 September 2023).

Crataegus

1. Woodland Trust (n.d.). Midland Hawthorn (Crataegus laevigata). [online] Woodland Trust. Available at: https://www.woodlandtrust.org.uk/trees-woods-and-wildlife/british-trees/a-z-of-british-trees/midland-hawthorn/
2. Bone, K. and Mills, S. (2013) Principles and practice of phytotherapy: modern herbal medicine, second edition. Edinburgh: Churchill Livingstone.
3. Bone, K. and Mills, S. (2013) Principles and practice of phytotherapy: modern herbal medicine, second edition. Edinburgh: Churchill Livingstone.
4. Nasa Y, Hashizume H, Hoque AN, Abiko Y. Protective effect of crataegus extract on the cardiac mechanical dysfunction in isolated perfused working rat heart. Arzneimittel-forschung. 1993 Sep;43(9):945-949. PMID: 8240455.
5. Kuhn, M. and Winston, D. (2008) Winston and Kuhn’s herbal therapy and supplements: a scientific and traditional approach. Philadelphia: Lippincott Williams and Wilkins.
6. Upton, R. (1999) American Herbal Pharmacopoeia and Therapeutic Compendium. Santa Cruz: AHP.
7. Cloud,A., Vilcins, D., McEwen, B., The effect of hawthorn (Crataegus spp.) on blood pressure: A systematic review, Advances in Integrative Medicine, Volume 7, Issue 3, 2020, Pages 167-175, https://doi.org/10.1016/j.aimed.2019.09.002.
8. Asgary S, Naderi GH, Sadeghi M, Kelishadi R, Amiri M. Antihypertensive effect of Iranian Crataegus curvisepala Lind.: a randomized, double-blind study. Drugs Under Experimental and Clinical Research. 2004 ;30(5-6):221-225. PMID: 15700749.
9. Abbasi, M., Gohari, S., Ahangar, H., Bahrami, M., Kamalinejad, M., Reshadmanesh, T., & Nazari, S. S. (2021). Efficacy of Hawthorn Fruit Extract on Blood Pressure and Quality of Sleep in Patients with Hypertension along with Sleep Disorders: A Randomized Double-Blind Controlled Trial. Journal of Contemporary Medical Sciences, 7(4).
10. Degenring, F. H., Suter, A., Weber, M., & Saller, R. (2003). A randomised double blind placebo controlled clinical trial of a standardised extract of fresh Crataegus berries (Crataegisan®) in the treatment of patients with congestive heart failure NYHA II. Phytomedicine, 10(5), 363-369.
11. Dalli, E., Colomer, E., Tormos, M.C., Cosín-Sales, J., Milara, J., Esteban, E. and Sáez, G., 2011. Crataegus laevigata decreases neutrophil elastase and has hypolipidemic effect: a randomized, double-blind, placebo-controlled trial. Phytomedicine, 18(8-9), pp.769-775.
12. Al-Gareeb, A. I. A. (2012). Effect of hawthorn extract on blood pressure and lipid profile in patients with stage I hypertension: A placebo-controlled, double-blind randomized trial. Mustansiriya Med. J, 11, 52-57.

Agnus Castus

1. Kuhn, M. and Winston, D. (2008) Winston and Kuhn’s herbal therapy and supplements: a scientific and traditional approach. Philadelphia: Lippincott Williams and Wilkins
2. Bone, K. and Mills, S. (2013) Principles and practice of phytotherapy: modern herbal medicine, second edition. Edinburgh: Churchill Livingstone.
3. Jarry, H., Leonhardt, S., Gorkow, C.H. and Wuttke, W., 1994. In vitro prolactin but not LH and FSH release is inhibited by compounds in extracts of Agnus castus: direct evidence for a dopaminergic principle by the dopamine receptor assay. Experimental and Clinical Endocrinology & Diabetes, 102(06), pp.448-454.
4. Milewicz, A., Gejdel, E., Sworen, H., Sienkiewicz, K., Jedrzejak, J., Teucher, T. and Schmitz, H., 1993. Vitex agnus castus extract in the treatment of luteal phase defects due to latent hyperprolactinemia. Results of a randomized placebo-controlled double-blind study. Arzneimittel-forschung, 43(7), pp.752-756.
5. Brice-Ytsma, H. and McDermott, A. (2020) Herbal medicine in treating gynaecological conditions: herbs, hormones, pre-menstrual syndrome and menopause. London: Aeon Books.
6. Dittmar, F. W (1992) Premenstrual Syndrome (PMS): Treatment with a Phytopharmaceutical.  Gynäkol. 5(1):60-68.
7. R, S. (2001) “Treatment for the premenstrual syndrome with agnus castus fruit extract: prospective, randomised, placebo controlled study,” BMJ (Clinical research ed.), 322(7279), pp. 134–137.
8. C, L. et al. (1997) “Treatment of premenstrual tension syndrome with Vitex agnus castus controlled, double-blind study versus pyridoxine,” Phytomedicine : international journal of phytotherapy and phytopharmacology, 4(3), pp. 183–189.
9. D, B. et al. (2000) “Efficacy of Vitex agnus castus L. extract Ze 440 in patients with pre-menstrual syndrome (PMS),” Archives of gynecology and obstetrics, 264(3), pp. 150–153.
10. EG, L., H, S. and N, B. (2000) “Treatment of premenstrual syndrome with a phytopharmaceutical formulation containing Vitex agnus castus,” Journal of women’s health & gender-based medicine, 9(3), pp. 315–320.

---

If you have questions regarding the topics that have been raised or would like to discuss any other health matters, including supplement recommendations, please do contact our team of Nutritional Therapists.

nutrition@cytoplan.co.uk
01684 310099

Last updated on 10th April 2024 by cytoffice