BLACK COHOSH
Botanical name: Actaea racemosa syn. Cimicifuga racemosa
Synonyms: Black bugbane; Black snakeroot
Black cohosh has gone through numerous taxonomic reclassifications, and until recently has been listed as Cimicifuga racemosa. As of 2002 it was reclassified and renamed Actaea racemosa. Black cohosh is of a different genus than blue cohosh (Caulophyllum thalictroides), having in common only the word cohosh in their common names, supposedly derived from the Algonquin word for knotty root. They are not medicinally related or interchangeable, although both are used for gynecologic and obstetric complaints.
MAJOR CHEMICAL CONSTITUENTS
Numerous triterpene glycosides (e.g., actein, cimicifugoside, cimigoside, 23-epi-26 deoxyactein, cimiracemoside A); aromatic acids (e.g., ferulic acid, isoferulic acid, acyl caffeic acid, fukinolic acid, salicylic acid); tannins, volatile oils, resin, phytosterols, starch, and sucrose. More recent studies suggest that black cohosh, contrary to prior alleged identification of isoflavones in the plant, does not contain isoflavones (e.g., biochanin A, formononetin). Kaempferol has been found in extracts of the leaf. The salicylic acid is in such as low concentration as to be unlikely to cause any allergic reactions in those sensitive to this agent. A unique bitter principle also has been identified.
PRINCIPAL USES
TRADITIONAL AND HISTORICAL USES
Black cohosh is an indigenous North American herb that was used widely by eastern Native American tribes including the Cherokee, Iroquois, Penobscot, and MicMac for gynecologic complaints and pain, including rheumatic pain, and also in the treatment of hives, constipation, colds, coughs, fatigue, sore throat, and snakebite. It appears in the botanical literature as early as the 1680s, and it was described by von Linne in 1749 as an herb primarily for female debility and pain relief, but also as a diaphoretic, stomachic, expectorant, cardiac tonic, and uterine tonic. Black cohosh was largely popularized by the Eclectics, who called it Macrotys, and who used it extensively for women’s “muscular pains, uterine pains
with tenderness, false pains, irregular pains, rheumatism of the uterus, dysmenorrhea.” They also recognized its value as a superb sedative. It was considered to have particular affinities for the uterus, heart, and circulatory system, supposedly improving (cardiac) contractile force; however, this indication has not been widely studied nor borne out by limited scientific evaluation of the plant. It was considered a reliable herb to aid in birth and relieve pain afterward, given in small doses before, during, and after labor. Its effects for the treatment of all manner of musculoskeletal and neuralgic pains were widely reputed. Listed in the USP from 1820 until 1920, it was and continues to be one of the most popular herbal medicines sold in Western nations.
CLINICAL INDICATIONS
Black cohosh is the most widely sold and used herb in western nations for the treatment of perimenopausal neurovegetative complaints. It is commonly used for such by herbal practitioners and research has largely centered on its use for these purposes. Herbal practitioners also use black cohosh as a reliable anti-inflammatory, antispasmodic, and analgesic for all manner of neuromuscular complaints, for premenstrual headache, as well as for treating spasmodic or paroxysmal coughs. Plant Profile Black Cohosh Table 2 lists the uses of this herb by contemporary herbalists and naturopathic physicians.
TABLE 2 Common Uses of Black Cohosh in Modern Herbal Practice
| Dysmenorrhea |
| Ovarian pain |
| Neurovegetative menopausal symptoms: hot flashes, reduction of sweating, headache, heart palpitations, anxiety, nervousness, insomnia, irritability, depression (for the latter in combination with Hypericum perforatum (St. John’s wort), and possibly vaginal dryness and atrophy |
| Musculoskeletal pain; i.e., myalgia, sciatica, arthritis, neuralgia |
| Premenstrual migraine |
| Cough |
| Osteoporosis |
| Possible additional indications include |
| Uterine contractions in threatened miscarriage (see Use in Pregnancy and Lactation) |
TABLE 1 Black Cohosh for Gynecologic and Obstetric Problems: Eclectic Medical Uses
| Treat uterine and ovarian neuralgia |
| Antispasmodic for generalized and uterine “rheumatic” pains |
| Uterine irritability |
| Irritated and congested pelvic conditions |
| Amenorrhea |
| Dysmenorrhea |
| Hysteria |
| Relieves irregular pains and uterine contractions |
| Partus accelerator |
| Partus preparator |
| Postpartum hemorrhage |
| Relaxes the soft parts of the parturient canal and facilitates delivery |
| Relieves insomnia, relieves reflex irritability thus quieting morning sickness |
| Relieves spasmodic pains of early labor and due to its relaxing effects, reduces laceration at birth |
| Maintains uterine contraction after birth |
IN VITRO, ANIMAL, AND CLINICAL DATA
Black cohosh has been used widely to treat menopausal complaints in Europe for over 50 years. However, in spite of numerous studies, few that are without methodologic flaws have emerged to solidly demonstrate efficacy. Two reviews of human studies on the effectiveness of black cohosh for alleviating menopausal symptoms concluded that it is safe and effective, with pronounced effects on the central nervous system. In a study of hot flashes caused by tamoxifen in breast cancer survivors, it was found to reduce the number and severity of hot flashes (almost half the patients in the intervention group were free of hot flushes, whereas severe flashes were reported by 24.4% of the intervention group and 73.9% of the usual-care group), with assessment at 2-month intervals over 1 year. Yet other studies have found no benefit in the treatment of these symptoms. A 6-month randomized, double-blind, controlled study (by the manufacturer of the extract) showed efficacy, tolerability, and lack of systemic estrogenic effect (no change in vaginal cytology or relevant hormone levels) with two dose levels of black cohosh.
The data on estrogenic effects of black cohosh are very contradictory, demonstrating everything along the spectrum from positive estrogenic effects to no effects to antiestrogenic effects; selective estrogen receptor modulation to no estrogen receptor binding whatsoever. Although on balance, it does not appear that there is estrogenic activity associated with use of this herb, it is prudent for women with a history of estrogen-sensitive cancer to avoid use of this herb.
In vitro and in vivo evidence from animal trials has clearly demonstrated anti-inflammatory effects with black cohosh extract, supporting its traditional use as an herb for the treatment of rheumatism and rheumatoid arthritis.
Osteoprotective effects have been demonstrated with black cohosh in postmenopausal women. In a double-blind study of 62 postmenopausal women, the effects of a Cimicifuga racemosa extract on markers of bone metabolism, hormones, sex hormone–binding globulin (SHBG), lipometabolism, vaginal maturity, and routine laboratory parameters were compared with those of conjugated estrogens (CE) and placebo over 12 weeks. Markers of bone turnover, estradiol, follicle-stimulating hormone (FSH), leuteinizing hormone (LH), sex hormone binding globulin (SHBG), triglycerides, total cholesterol, high-density cholesterol, low-density cholesterol, and routine clinical chemistry parameters were determined from blood samples. Vaginal “maturity index” was determined from vaginal smears. The analyses of bone turnover markers indicated beneficial effects with stimulated osteoblast activity with mild estrogen-like activity on vaginal tissue with the black cohosh extract. Although these findings are preliminary, this represents an area of possible new and interesting research on this herb.
