Black Cohosh

Cimicifuga racemosa ( l.) Nutt.  (Ranunculaceae)  Previous names Actaea racemosa L., Macrotys actaeoides.  The common name is black cohosh, bugbane and macrotys.  The Chinese name is sheng-ma.

Indigenous to the United States, Cimicifuga grows in moist, rich woods from Ontario to Georgia and west to Arkansas.  European settlers learned of it from the Native Americans and by 1732 it was growing in English gardens.  Cimicifuga has a long history of usage by the Native Americans for such things as a tonic, diuretic, remedy for women’s reproductive disorders and rheumatism.  Early white settlers used it to treat menstrual irregularities and to facilitate childbirth.

The Eclectic physicians of the 1800s held Cimicifuga in high esteem.  It was specific for muscular pains of a rheumatoid character, neuralgias, menstrual congestion and amenorrhea.  It was particularly esteemed for childbirth, used before, during and after labor.¹  It was an official drug in the United States Pharmacopoeia from 1820 to 1926.  Cimicifuga was one the ingredients of the old time remedy Lydia Pinkham’s Vegetable Compound.

Cimicifuga racemosa, a member of the buttercup family, is a dweller of moist, shady woodlands and is widely cultivated in gardens as an ornamental.  It has thrice-divided leaves with three lobed terminal leaflets and a 3 to 8 foot tall, branched spike of showy white petaless flowers.  The name “racemosa” refers to the arrangement of individual flowers on the elongated stock.

The genus of Cimicifuga contains fifteen species, of which one is native to Europe, six to North America and the remainder in northeastern Asia.  Several of these are used medicinally, the Chinese preferring C. heracleifolia, C. dahurica and C. foetida.

The root and rhizome are the parts used.  It is available as bulk herb, hydroalcoholic extract and capsules.  It is commonly found in many herbal blends.

Cimicifuga is used extensively in Germany for treatment of menopausal symptoms, and is also approved for use in the treatment of PMS and dysmenorrhea.²  There have been numerous trials and studies done there with menopausal women.  The tests have primarily been done with the Cimicifuga extract Remifeminâ.  The results have been favorable and it is suggested as an alternative to estrogen replacement therapy.³

It appears there are three endrocrinologically active constituents (most likely triterpene glycosides) that are responsible for the effectiveness of Cimicifuga.  One suppresses lutenizing hormone (LH) but does not bind to estrogen receptors.  A second, does bind to estrogen receptors in the pituitary and suppresses LH.  The final compound binds to estrogen receptors in the periphery, but does not effect LH.⁴    The suppression of LH is thought to be the primary reason for effectiveness of treating menopausal symptoms.  There have been some studies that did not establish this, so it is still open to further investigation.  There are studies being done in regard to Cimicifuga’s estrogen receptor blockage with breast cancer and osteoporosis.⁵  There is apparently no effect on follicle-stimulating hormone or prolactin.⁶

Cimicifuga is popularly used for relief of menopausal symptoms and PMS.  It is also used as a nervine, an antispasmodic, and as a peripheral vasodilator.  It is frequently used for arthritic and rheumatic pain.  It is sometimes used as a “partus praeparator” during the last weeks before birth, and to stimulate uterine contractions before and during labor.

A resinous material called cimicifugin constitutes 15 to 20% of  Cimicifuga.  Triterpene glycosides are considered the primary active ingredients and include acetin,cimicifugioside, acetylacteol, 27-deoxyactein, cimigenol and deoxyacetylacteol.  Flavonoid constituents include formononetin and the aromatic constituents of isoferulic and salicylic acids.  Alkaloids  including N-methylcytisine and others, also tannins, resins, essential oils, palmitic, gallic, butyric and oleic acids, and racemosin.

Extracts of Cimicifuga are standardized in Europe to contain 2.5% triterpene glycosides and the recommended dosage is 1 tablet 2x/day for a total of 2 mg  of the glycosides.  The standard dosage of the root is 40 mg. The hydroalcoholic extract, made with 60% alcohol, recommendation is 0.4 to 4 ml.  The German E Commission recommends it not be used over six months because of inadequate information about long term usage.  Historically, however, it has been used for longer periods of time.

Women taking hormone replacement therapy or any drugs that affect estrogenic or pituitary activity should be careful taking Cimicifuga.  Do not take it in the first eight months of pregnancy and during lactation.

 Overdose may produce nausea, vomiting, dizziness and may reduce pulse rate and induce perspiration.    Occasionally mild nausea is experienced with regular dosage.  In 40 years of extensive use in Germany there has been no evidence of serious side effects, contraindication or drug interactions.  There is the possibility that Cimicifuga could potentiate blood pressure medications leading to hypotension.