Black cohosh

Cimicifuga racemosa

Black cohosh consists of the underground parts (rhizome and roots) of the showy North American forest plant Cimicifuga racemosa (L.) Nutt., family Ranunculaceae. The plant's common names are numerous and include black snakeroot, rattleweed, rattleroot, bugbane, bugwort, and squaw root (not to be confused with blue cohosh). The genus Cimicifuga contains twenty-three temperate climate species: six from North America, one in Europe, the remainder from temperate eastern Asia. Similar to black cohosh, several Asian species are traditionally used for gynecological conditions.

The drug was introduced into medicine by the American Indians, who valued it highly. They boiled the root in water and drank the resulting beverage for a variety of conditions ranging from rheumatism, diseases of women, and debility to sore throat. Black cohosh was subsequently used, especially by eclectic physicians, for all these conditions but particularly for so-called uterine difficulties to stimulate the menstrual flow. Black cohosh was one of the principal ingredients in Lydia Pinkham's Vegetable Compound. Herbalists recommend it for all of the aforementioned ailments and also as an astringent, diuretic, alterative, antidiarrheal, cough suppressant, diaphoretic, and other uses.

Scientific studies designed to identify specific physiological activities in the drug have not been numerous, and most have been carried out abroad. The long-suspected estrogenic effects, based on its use to stimulate menstruation, could not be verified in comprehensive experiments in mice reported in 1960. Subsequent experiments have shown that a methanol extract of black cohosh contains substances that bind to estrogen receptors of rat uteri; the extract also causes a selective reduction in luteinizing hormone level in ovariectomized rats. These results are interpreted to mean that black cohosh possesses some degree of estrogenic activity.

A steroidal triterpene derivative called actein, was found to lower blood pressure in rabbits and cats but not in dogs. It produced no hypotensive effects in either normal or hypertensive human beings, although some peripheral vasodilation was observed.

Modern experience with black cohosh extracts dates to the mid-1950s. In Germany, gynecologists concerned with finding an alternative to hormone-replacement therapy, which by that time was showing unwanted side effects in a large number of patients, reported successful clinical experience in the treatment of menopausal symptoms with a black cohosh extract. By 1962, at least fourteen clinical reports, although not controlled clinical trials in the modern sense, involving over 1,500 patients were published in German. Practitioners reported efficacy in premenopausal and menopausal symptoms including reduction in hot flashes and improvement of "depressive moods."

Since the 1980s, five clinical studies (although none with a double-blind design) have compared a black cohosh extract with placebo and/or estrogen replacement in the treatment of menopausal symptoms. An open, multicenter study with data on 629 patients reported favorable results (in 80 percent of patients) after six to eight weeks of treatment. Improvements included relief of neurovegetative complaints such as hot flashes, sweating, headache, vertigo, palpitation, and tinnitus. Side effects (unspecified) were reported in 7 percent of patients, but they did not result in discontinuing therapy.

A 1991 study confirmed an LH secretion inhibitory effect in both ovariectomized rats and in 110 menopausal women, demonstrating that the extract selectively suppresses luteinizing hormone secretion in menopausal women.

A recent Japanese study reported positive effects of two Asian species, C. heracleifolia and C. foetida, on serum calcium and phosphate levels plus bone mineral density in rats. They concluded that "...Cimicifugae rhizome has potential in the treatment of osteoporosis, particularly in menopausal women."

Black cohosh is prescribed in Europe for various conditions, including symptoms associated with premenstrual syndrome (PMS), dysmenorrheal, and menopause. Reported activities include an estrogen-like action, binding to estrogen receptors, and suppression of luteinizing hormone. Occasional stomach pain or intestinal discomfort has been reported. Studies on mutagenicity, teratogenicity, and carcinogenicity have proven negative, and a six-month study on chronic toxicity in rats at about ninety times the human intake failed to prove deleterious. Further studies on black cohosh are warranted.

Gynecologically, in North America, it is thought that black cohosh balances estrogen by stabilizing it. In European herbalism it is thought to have an estrogenic action, which actively works to reduce progesterone and promote estrogen levels in the body. It is therefore used where there is a lack of estrogen and an excess of progesterone. In the musculoskeletal system it is used as an anti-inflammatory in arthritic conditions. Its sedative qualities have applications in other systems, for example, in lowering blood pressure, in reducing spasm and tension, and in the respiratory system.

Other names

• Black Cohush
• Bugbane
• Bugbane Squawroot
• Bugwort
• Cimicifuga
• Rattleroot
• Rattleweed

Parts used

Root, rhizome.

Uses

Gynecological uses - Black cohosh has long been used by Native Americans for female problems, for which reason it was also known as "squawroot." Black cohosh is used today for menstrual pain and problems where progesterone production is too high, and for menopausal symptoms, especially hot flashes, debility, and depression.
Inflammation - Black cohosh is useful for inflammatory arthritis, especially when it is associated with menopause, and it is also an effective remedy for rheumatic problems, including rheumatoid arthritis.
Sedative properties - The sedative action of black cohosh makes it valuable for treating a variety of conditions, including high blood pressure and tinnitus (ringing in the ears). Black cohosh is also valuable for whooping cough and asthma.

HOMEOPATHY
The rhizome of this plant was used by Native Americans as a cure for rattlesnake bites (hence its common name, rattle root) and for menstrual and labor pain. The root was also chewed as a sedative and to alleviate depression. A tea made with the herb was sprinkled in rooms to prevent evil spirits from entering. In herbalism, the root is still used as a diuretic, a cough suppressant, and to reduce inflammation and rheumatic pain.
Cimic. is largely a women's remedy that acts on the nerves and muscles of the uterus. It is used for menstrual symptoms, such as congestion in the head before menstruation and heaviness and cramps in the small of the back during menstruation. This remedy is good for early miscarriage and it is also helpful for common complaints in pregnancy, such as nausea and vomiting, sleeplessness and shooting pain in the uterus. Postpartum depression and menopausal symptoms, such as fainting spells and hot flashes are also helped by Cimic.
Neck stiffness that causes headaches is helped by cimic., as well as emotional symptoms due to a hormonal imbalance, such as sighing, sadness, anxiety, and irritability.

Habitat & cultivation

Black cohosh is native to Canada and the eastern states of the US, growing as far south as Florida. Black cohosh prefers shady spots in woods and shrubby areas. The herb is now grown in Europe and can be found in the wild, having self-seeded from cultivated plants. Black cohosh is grown from seed, and the root is harvested in autumn.

Research

Menopause herb - Research has confirmed the validity of traditional knowledge. The results of a German trial, published in 1995, revealed that black cohosh in combination with St. John's wort was 78% effective at treating hot flashes and other menopausal problems.
Estrogenic properties - Black cohosh has a well-established estrogenic action and is thought to reduce levels of pituitary luteinizing hormone, thereby decreasing the ovaries' production of progesterone.

Constituents

Black cohosh contains triterpene glycosides, isoflavones, isoferulic acid, volatile oil, and tannins.

How much to take

Black cohosh can be taken in several forms, including crude, dried root, or rhizome (300-2,000 mg per day) or as a solid, dry powdered extract (250 mg three times per day). Tinctures can be taken at 2-4 ml per day. Standardized extracts of the herb are available and contain 1 mg of deoxyacteine per tablet. The usual amount is 40 mg twice per day. Black cohosh can be taken for up to six months, and then it should be discontinued.

Side effects

Black cohosh has an estrogen-like effect, and women who are pregnant or lactating should not use the herb. Large doses of this herb may cause abdominal pain, nausea, headaches, and dizziness. Women taking estrogen therapy should consult a physician before using black cohosh.

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