MAJOR CHEMICAL CONSTITUENTS

The major chemical constituents are quinolizidine alkaloids including thalictroidine, N-methlycytisine, anagyrine, magnoflorine sparteine, baptifoline, and caulophyllumine, and the saponins caulosaponin and caulophyllosaponin.^1–4

PRINCIPAL USES

TRADITIONAL AND HISTORICAL USES

Caulophyllum thalictroides (blue cohosh), a native of the eastern and central woodlands of the United States, is reported to have been used traditionally and historically as an anticonvulsant, antirheumatic, febrifuge, emetic, sedative, and most notably, a gynecologic aid.^5,6 Interestingly, in modern clinical practice, blue cohosh is used almost exclusively for gynecologic and obstetric purposes. It is not commonly used for anticonvulsant, sedative, or antirheumatic actions, whereas the unrelated herb Actaea racemosa syn. Cimicifuga racemosa is used for these purposes, as well as a uterine antispasmodic for the treatment of painful gynecologic conditions such as dysmenorrhea. It is this author’s suspicion that some of the uses of black cohosh have been overlaid on blue cohosh in the historical literature because of the similar common name, confounding an interpretation of the traditional uses of blue cohosh.

Blue cohosh has been used for labor induction, amenorrhea, dysmenorrhea, menorrhagia, and the induction of abortion.⁵ Blue cohosh was official in the United States Pharmacopoeia from 1882 to 1905 for labor induction, and in the National Formulary from 1916 to 1950. It was a major ingredient in the popular Eclectic preparation Mother’s Cordial, which also included Mitchella repens, Rubus idaeus, Cimicifuga racemosa, and Chamaelirium luteum. At least one company (Herbalist and Alchemist, NJ) still makes this preparation; however, the blue cohosh has been removed as an ingredient in the product because of safety concerns. The practice of labor induction with blue cohosh remains a popular choice both among self-prescribers and obstetric professionals in the United States and abroad, with large surveys indicating widespread use among nurse-midwives.⁷

Blue cohosh (Caulophyllum thalictroides).

(Photo by Martin Wall.)

CLINICAL INDICATIONS

Blue cohosh is listed in the British Herbal Pharmacopoeia (1983) as a spasmolytic and emmenagogue. It also may be used as a uterine and ovarian tonic, and for the treatment of a variety of menstrual complaints, including menorrhagia, amenorrhea, dysmenorrhea, and pelvic congestion syndrome. It is commonly used as a partus preparator to ease parturition, and for labor induction and augmentation. It has also been used as an abortifacient.

IN VITRO, ANIMAL, AND CLINICAL DATA

Uterine stimulant properties were observed using blue cohosh extract on isolated guinea pig tissue; however, subsequent in vivo studies with cats, dogs, and rabbits failed to demonstrate uterine activity. Smooth muscle stimulation has been seen in vitro on small intestine and in vivo on coronary blood vessels of small animals using caulosaponin. Caulosaponin has also demonstrated an oxytocic effect on tissue from rat uteri, in vitro constriction of carotid vessels, myocardial toxicity, and intestinal spasmogenicity on isolated intestinal tissue. Methylcystine has a nicotinic-like action resulting in blood pressure increases, respiratory stimulation, and increased intestinal motility. Clinical studies using blue cohosh are absent.

MECHANISMS OF ACTION

See Use in Pregnancy and Lactation.

RATINGS