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Black Cohosh

(Actaea racemosa L [formerly Cimicifuga racemosa])
Family: Ranunculaceae
Synonyms: black snakeroot, rattleroot,(1) bugbane, bugwort, squaw root,(2) snakeroot, rattleweed, baneberry, Cimicifuga,(3) richweed, amerikanisches wanzenkraut, actee a grappes, herbe au punaise.(4)
(Not to be confused with blue cohosh or white cohosh).(3)

Downloadable PDF of this information sheet

Plant characteristics

Black cohosh is a member of the buttercup family, a native of eastern North America (5). It grows in upland woods and hillsides with a 3-9 foot stem and irregular divided leaves with a terminal 3-lobed leaflet, middle lobe largest (6,7). It has small, fragrant white flowers with very long spikes May through August (6-8).

Farmers may be able to grow black cohosh in the sun in cooler climates with adequate moisture (8), though it benefits from light shade. In the southern US, it prefers light shade, high humidity, and regular watering (8). Propagate by division of the rhizome in spring or fall or by seed (8). Harvest 3-5 years after planting in the fall or early spring (5,8).

Herb chemical constituents and properties

Biologically-active chemicals : phytosterin, isoferulic acid, fukinolic acid, caffeic acid, salicylic acid, sugars, tannins, long-chain fatty acids, and triterpene glycosides (3).

Herbal properties: antispasmodic, emmenagogue (promoting menstruation), diaphoretic, sedative, and alterative How herb is used today (based on scientific evidence) (1,9) with aphrodisiac, antitussive, and expectorant properties (10).

How herb was used traditionally

Native Americans used black cohosh for relieving pain during menstruation and child birth (7). In addition, they found it useful for rheumatism, kidney ailments, malaria, sore throat, and snakebite (3,11). Cimicifuga comes from the Latin "to drive away bedbugs" and reflects some of the common names of the herb:"

bugbane" and "bugwort" (7). Black cohosh was used by early European settlers and became a component of the famous Lydia Pinkham's Vegetable Compound, a patent medicine for women of the 19^th century (11). The Eclectic Physicians of the time prescribed black cohosh for treatment of rheumatism (11). Black cohosh was given to women in the last 4 weeks of pregnancy to aid in childbirth (12).

Preparation and dosage: 10-40 drops of standardized 1:5 alcohol tincture in water three times daily (12).

Herbalists also prescribe a decoction of 1 tsp. of the root simmered 15 minutes in 1 cup of water, taken at 1 cup three times daily (1,5).

How herb is used today (based on scientific evidence)

The North American Menopause Society recommends black cohosh for mild hot flashes (13).

Several scientific studies support the use of black cohosh for treatment of menopausal symptoms (11,12)

The German Commission E lists black cohosh as a treatment for menopausal symptoms, painful menstruation, and PMS (11). Over 2 million women worldwide use the herb (6).

Very few scientific trials have looked at the effectiveness of black cohosh for treating other complaints such as arthritis, menstrual migraine, PMS or pain with menstruation.

Modern capsules are now available: usually taken twice daily (11). Recommended doses are 20-40 mg daily of plant extract corresponding to 1-2 mg of 26-deoxyactein.

Safety issues

Side effects: mild gastric symptoms most commonly, with vomiting, and/or dizziness at higher doses (14). Headaches, weight gain (15), breathlessness, rash, rarely reported l(16).

Adverse events: Although seven cases of severe liver toxicity have been reported (17), it is not possible to tell if black cohosh was the culprit because most of the patients were taking multi-herb preparations (18) or other medications (16). Three cases of high blood pressure and slow pulse were reported and 1 case of seizures, but it is unclear if due to the herb (16).

Black cohosh has not been found to cause cancer or birth defects (3).

Precautions/contraindications: Not recommended for pregnant or nursing women or for children, due to lack of safety data in these groups (3,4). Use in breast cancer patients should be discussed with oncologist due to an animal study suggesting increased incidence of breast cancer migration to the lungs.

References

1.     Tierra M: The Way of Herbs New York, Pocket Books, 1998.
2.               Foster S, Tyler VE: Tyler's Honest Herbal: A sensible guide to the use of herbs and related remedies. Binghamton, NY, The Haworth Herbal Press, 1999.
3.               Jellin JM, Gregory PJ, Batz F, et al: Pharmacist's Letter/ Prescriber's Letter Natural Medicines Comprehensive Database, vol 2004. Stockton, CA, Therapeutic Research Faculty, 2004.
4.               Brinker F: Herb contraindications and drug interactions, Second ed. Sandy, Oregon, Eclectic Medical Publications, 1998.
5.               Bascom A: Incorparating Herbal Medicine into Clincal Practice. Philadelphia, FA Davis, 2002.
6.               Foster S, Duke J: A Field guide to Medicinal Plants and Herbs of Eastern and Central North America. New York, Houghton Mifflin, 2000.
7.               Hutchens AR: Indian Herbology of North America. Boston, Shambhala Publications, Inc., 1991.
8.               Sturdivant L, Blakeley T: The Bootstrap Guide to Medicinal Herbs in the Garden, Field, & Marketplace. Friday Harbor, WA, San Juan Naturals, 1999.
9.               Hoffman D: The New Holistic Herbal. Boston, MA, Element, 1990.
10.             Duke JA: Handbook of Medicinal Herbs. Boca Raton, CRC Press, 1985.
11.             Blumenthal M: The Expanded Commision E Monographs. Newton, MA, Integrative Medicine Communications, 2000.
12.             McKenna DJ, Jones K, Humphrey S, et al: Black cohosh: efficacy, safety, and use in clinical and preclinical applications. Altern Ther Health Med 7(3):93-100, 2001.
13.             Nishida S, Satoh H: Comparative vasodilating actions among terpenoids and flavonoids contained in Ginkgo biloba extract. Clin Chim Acta 339(1-2):129-33, 2004.
14.             Tesch BJ: Herbs commonly used by women: an evidence-based review. Am J Obstet Gynecol 188(5 Suppl):S44-55, 2003.
15.             Schulz VPDm, Hþnsel R, Tyler VEPB: Rational phytotherapy : a physician's guide to herbal medicine. New York, Springer, 2001.
16.             Huntley A, Ernst E: A systematic review of the safety of black cohosh. Menopause 10(1):58-64, 2003.
17.             Lontos S, Jones RM, Angus PW, et al: Acute liver failure associated with the use of herbal preparations containing black cohosh. Med J Aust 179(7):390-1, 2003.
18.             Thomsen M: Hepatotoxicity from Cimicifuga Racemosa? Recent Australian case report not sufficiently substantiated. J Altern Comp Med 9(3):337-340, 2003.
19.             Strategic Reports: Analysis of the economic viability of cultivating selected botanicals in North Carolina. A report commissioned for the North Carolina Consortium on Natural Medicinal Products. Raleigh, NC, North Carolina State University, 2002.
20.             Taylor M: Alternatives to HRT: an evidence-based review. Int J Fertil Womens Med 48(2):64-8, 2003.

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