Black Cohosh.

Botanical name: 
Cimicifuga racemosa

Black Cohosh (Cimicifuga racemosa Nutt)
Family: Ranunculaceae

Photo: Cimicifuga racemosa 13. By Andrew Pengelly

INTRODUCTION

Other Names: Black snakeroot; Macrotys; Actea racemosa L.

Habitat: North America. Found as understory in rich, hardwood forests East of the Missippi River, esp. abundant in Ohio and West Virginia.

Related herbs:
Actea (very similar but for fleshy fruits),
Hydrastis, Helleborus & Aconitum spp. in Ranunculaceae family.
Caulophyllum (in Berberidaceae, a closely related family)

Part used: Rhizomes and roots

Botany: Perennial herb growing from a large, knotted rhizome. Radical compound leaves with sharply toothed margins. In summer produces a compound raceme of white staminate flowers with superior ovaries. Fruit a single follicle, splitting down the inner suture at the top, producing up to 10 angular brown seeds.

Constituents:

  1. Cimicifugin 15-20% [15], variously referred to as:
    • resin
    • coumarin,a furochromone closely resembling khellin.[1]
    • ranunculosides, bitter lactones which are only present in fresh root [9]
  2. Triterpene Glycosides (saponins) - actein, cimigoside, macrotin, racemoside.
  3. Isoflavones - formononetin [2]
  4. Tannins
  5. Isoferulic acid
  6. Salicylic acid
  7. Alkaloids (trace only).
  8. Fatty acids:
    • palmitic (sat.)
    • oleic (unsat.)
  9. Mucilage & starch [9]

MEDICAL HISTORY

American Indian Use:

  • Traditionally used as a diaphoretic in agues and general fevers. Reportedly cured many cases of yellow fever and smallpox.
  • Rheumatism - root decoctions used externally to steam painful joints.
  • Root decoctions for facilitating partruition, menstrual disorders and for 'chest difficulties' [Pedersen]
  • Snake-bite antidote - root poultices applied [3,4,9]

Early use by European Americans:

  • Early settlers extracted whole roots with whisky and drank it as rheumatism cure [9]
  • Barton (1801) in Collections &c.(reprinted by Lloyds) wrote up the plant as an astringent
  • Used a strong root decoction for 'putrid sore throat'.
  • Also used for 'the itch'.[10]
  • Dr.Garden reported on the use of Cimicifuga racemosa in treating pulmonary TB - American Medical Recorder 1823. He actually used it on himself when afflicted by TB with positive results. He reaffirmed his belief in this remedy in 1850.
  • Chapman (1825) classified Cimicifuga racemosa as an expectorant, and at this time it was widely used to treat pulmonary diseases, esp asthma & consumption.
  • 1830 - introduced into US Pharmacopoeia. Remained till 1936. In NF 1936-50.
  • Young (1831) described use of Cimicifuga racemosa in chorea and St.Vitus Dance.
  • Howard (1832) promoted use of Cimicifuga racemosa for smallpox, a claim supported later by Dr. Norris (1872) in a paper read to the Alabama State Medical Assn. who reported families in Alabama who used Cimicifuga racemosa tea during an epidemic were absolutely free from smallpox [11]
  • In 1848 an AMA committee analysed Cimicifuga racemosa and found it had no perceptible increase in any secretions, but "They uniformly found it to lessen the frequency and force of the pulse, to soothe pain and allay irritibility". Cimicifuga racemosa became widely recognized as a 'purely sedative agent'.

Use by Eclectics:

  • King - began prescribing it in 1823, using a 'saturated tincture'.
  • For 'Inflammatory rheumatism' eclectics used tincture in doses of 10-60 minims "until the patient's head is affected".
  • For chorea, and for neuralgias (eg.tic doloreux), eclectics preferred the alcoholic extract, in conjunction with fluid extract of Scullcap.
  • Promoted its use as a uterine agent and parturient, using it as a substitute for ergot. Especially useful for sub-involution of uterus.
  • King warned of occasional reactions - some patients reported symptoms closely resembling delirium tremens after only 2/3 drops of tincture.
  • Recommended fluid extract for prophylactic & remedy for smallpox.
  • Febrile diseases esp. children, promotes diaphoresis.
  • Acute conjunctivitis - 1 fl.drachm tinc.
  • Cimicifugin - 'resin':
    First chemical analysis of CR identified an amorphous resinous precipitate, which became known as macrotyn or cimicifugin. This 'resin' was prepared by King in 1835, who found it to have a less narcotic effect than the galenical preps, and to be esp. useful in female reproductive conditions [see p.287].
    The 'resin' was popular amongst Eclectic practioners who were philisohically attracted to this kind of non-galenical preps. However, despite several attempts no crystals could be obtained from the precipate, only an amorphous mixture partially soluable in several menstruums. Finally J.U.Lloyd asked Prof.V.Coblentz from the Cincinatti College of Pharmacy to obtain crystals from the pure precipitate.
    Conclusions see p.269 - no crystalline substance was obtained.
  • Culbreth claims there are 2 resins, one soluble in alcohol and ether, the other soluble in alcohol only. The 2 are obtained as a mixture by exhausting powdered drug with alcohol, precipitating with water, and drying the precipitate to produce a yellowish-brown hygroscopic powder [8]

Use by Physio-meds.

  • Preferred syrup preparations to fluid extract or 'resinoid' as these were less likely to cause headaches/dizziness
  • Used Cimicifuga racemosa as base for alterative preps, also as tonics/antispasmodics.
  • Soothes and stimulates nerves
  • Used in whooping cough, asthma, hysterical convulsions, chorea [5]: equal parts of:
    • Cimicifuga
    • Caulophyllum
    • Cypripedium
    • Helonias
    • Leonurus
  • Used in bronchial congestion/inflammation: equal parts of:
    • Cimicifuga
    • Aralia racemosa
    • Lycopus vir.
    • Anthemis nobilis
  • Use heaped teaspoon /1pt. barley water. Sweeten with honey, use for bronchial cough.
  • Use in Australia:
    Long history of use by Australian Herbalists. A major constituent of the Viburnum -compound used in dysmennorhoea, fibroids, and ovarian cysts. This formula used by Paul Wheeler:
    • Viburnum prunifolium 4 parts
    • Cimicifuga racemosa 4 parts
    • Tanacetum vulgare 2 parts
    • Anenome pulsatilla 2 parts
    • Achillea millefolium 2 parts
    • Scutellaria laterifolia1 parts
  • All 1/1 fluid extracts. Dose: 5 mls in water on empty stomach

Homeopathic indications [Ref.Boericke:204-205]

ACTION and ENERGETICS

  • Bitter
  • Chinese spp.(C.foetida & others)
    • -sweet, acrid, sl.bitter, cool.
  • Classified as cool,acrid herbs that release exterior conditions[18]

PHARMACOLOGY

  • Ranunculosides in fresh plant produce blistering of skin, but break down to protoanemine- unstable unsaturated lactone [See Schauenberg & Paris:130]
  • Moderate doses give slowly increased power to the heart [13]
  • Hypotensive in animals
  • Peripheral vasodilator
  • CNS depressant/a'spasmodic in mice
  • Racemoside - a'ulcer activity in mice
  • Isoferulic acid - lowers body temp in rats [2]
  • Oestrogenic action (Remifemin)- Suppresses LH release in ovariectomized rats and menopausal women. At least 1 constituent
  • binds to oestrogen receptors. [6]
  • actein - hypotensive in animals
  • anti-microbial action in vitro [7]

THERAPEUTICS

  • 'Primarily a remedy for rheumatoid & myalgic pain and disorders of the reproductive organs of women.' Felter [13]
  • Primary action is anodyne.
  • Despite widespread use (in 19thC) as febrifuge in acute infections esp. measles & smallpox, it is now used mainly for chronic conds. and for pain relief.

General Homoeopathic indications [Boericke]: Rheumatic, nervous subjects with ovarian irritation, uterine cramps & heavy limbs. Muscular/crampy pains occurring in nearly every part of body.

  • Symptoms < morning, cold (except headache), during menses. The more profuse the flow, the worse suffering.
    • > warmth, eating.
  • Regarded as brain/ spinal cord remedy [Hale:279 in [3]]

Note: Fresh plant preparations more likely to respond to these symptoms (and for sedative effect - due to anemonine) [9;14]

NERVOUS SYSTEM

Anodyne; sedative; anti-spasmodic

  • Indications: Conds. assoc. with spasms eg. chorea (combined with equal parts. Valerian); epilepsy; hysteria ..esp. when linked to menstrual problems
  • Sciatica; Intercostal myalgia; tinnitis aurium [16]

MUSCULAR SKELETAL SYSTEM

Anti-rheumatic; Anodyne

  • Muscular aching, local & general, aching pains as from overworked, overstrained muscles, great muscular aching with chilliness and rapidly increasing temp.
  • Aching of deep muscles of the back.[12]
  • Rheumatic fever (considered a specific)
  • Acute muscular pain <cold weather, torticollis, lumbago esp. when assoc. with change of weather [13]
  • Muscular rheumatism; Rheumatoid arthritis [16]

FEMALE REPRODUCTIVE SYSTEM

Emmenagogue; Parturient; Oestrogenic

  • A remedy for atony of the reproductive tract. Restores suppressed menstruation. Specific for congestive dysmennhorea, ovarian neuralgia, general aching of uterus or ovaries.[13]
  • Spastic Parametropathy - characterized by cramp-like pain in pelvic area, often not clearly defined to location, back pain, vaginal discharge, pruritis vulvae, painful breasts & dysmenorrhoea [17]
  • Uterine tonic to help fertility, restore tissue integrity after reproductive surgery or trauma, for bleeding between periods [Amanda Mcquade, P.C.]
  • Relieves uterine pains during pregnancy
  • Used in small doses to prepare patients for parturition. [12]
  • Produces natural intermittent uterine contractions, and is very effective for relieving post partum pain and nervous excitement [13]
  • Menopausal Symptoms: CR contains oestrogenic compounds incl. isoflavones, triterpenoid saponins. Considered by Weiss as a specific remedy for conds. assoc. with oestrogen deficencies, incl. problems at puberty & pregnency, but particularly for menopausal problems. Climacteric depression. [17]
  • Hot flushes [6]. Prevent osteoporosis.

RESPIRATORY TRACT

Mild expectorant; Febrifuge

  • Relieves cough and bronchial soreness
  • Previously used for pulmonary TB, pneumonia, measles, scarlet fever.
  • Relieves aching muscles and relieves fever in influenza.[13]
  • Asthma, whooping cough - mainly as anti-spasmodic.

TOXICOLOGY

  • Overdose causes characteristic bursting headache, flushed face, dizziness. [12]
  • Ingestion of large quantities of fresh plant may cause colic, gastro-enteritis, & Diarrhoea [14]
  • Animal studies inconclusive.[7]

PREPARATIONS AND DOSAGES

  • Dried herb: 0.3-2gm
  • Fluid extract (FE) (BP1898) 0.3-2Ml.
  • Tincture ( BPC1934) 1:10/ 60%, 2-4Ml.[16], (BP1895) 1:8; (USP) 1:5
  • Elixir (FE + Simple Elixir + Alc. + Carbonate of Mg.)
  • Comp. Elixir (FEs Cr/wild-cherry/liquorice/senega/ipecac) [19]

REFERENCES

  1. Waterman & Grunden (eds). Chemistry and Chemical Taxonomy of the Rutales. Academic Press, 1983.
  2. Potters New Cyclopaedia of Botanical Drugs & Preparations
  3. Lloyd J.& C. Bulletin No.30,1931. Repro.Series No.9,Pt.2. Drugs & Medicines of Nth.America
  4. Norman
  5. Lyle,T. 1897:132
  6. Duker et al. Planta Medica 57(1991)
  7. Marderosian & Liberti. 1988. Natural Product Medicine A Scientific Guide to Food, Drugs, Cosmetics. George Stickley Co, Philadelphia.
  8. Culbreth:202
  9. Pedersen,M. Nutritional Herbology
  10. B.Smith Barton 1801. Collections of an Essay towards a Materia Medica of the United States. Lloyds Reproduction Series No.1 1900.
  11. Lloyd J.U. 1911. History of the Vegetable Drugs of the Pharmacopeia of the United States. Bulletin No.18, Pharmacy Series No.4
  12. Ellingwood : 145
  13. Felter: 467
  14. Schauenberg & Paris
  15. Spoerke, D. Herbal Medications
  16. BHP 1983.
  17. Weiss:315
  18. Bensky & Gamble: 70
  19. JU Lloyd 1892 Elixirs and Flavouring Extracts. New York