|| Actaea racemosa L, Cimicifuga racemosa
|| Black Snakeroot, Bugbane, Bugwort, Rattle Weed,
More than two centuries ago, Native Americans discovered that the root of the
black cohosh plant (Cimicifuga racemosa) helped relieve menstrual cramps,
and symptoms of menopause including hot flashes, irritability, mood swings, and
sleep disturbances. Today, the roots of black cohosh are still often used for
these purposes. In fact, the herb has been widely used for more than 40 years in
Europe and is approved in Germany for premenstrual discomfort, painful
menstruation, and menopausal symptoms.
A dozen studies or more conducted
throughout the 1980s and 1990s confirm that the long-standing use of black
cohosh for menopausal symptoms has scientific validity. For example, in a German
study involving 629 women, black cohosh improved physical and psychological
menopausal symptoms in more than 80% of the participants within four weeks. In a
second study, 60 menopausal women were given black cohosh extract, conjugated
estrogens, or diazepam (a leading anti-anxiety medication) for three months.
Those who received black cohosh reported feeling significantly less depressed
and anxious than those who received either estrogens or diazepam. In another
study, 80 menopausal women were treated for 12 weeks with black cohosh extract,
conjugated estrogens, or placebo. Black cohosh improved anxiety, menopause and
vaginal symptoms. In addition, the number of hot flashes dropped from 5 to less
than 1 average daily occurences in the black cohosh group compared to those
taking estrogen in whom hot flashes dropped from 5 to 3.5 daily occurences.
Given these examples, and results of other studies, some experts have
concluded that black cohosh may be a safe and effective alternative to estrogen
replacement therapy (ERT) for women who cannot or will not take ERT for
The American College of Obstetricians and Gynecologists (ACOG) reports,
however, that many of these studies were poorly designed and did not evaluate
the safety and effectiveness of black cohosh beyond 6 months of use. Despite
this limited evidence, the ACOG still recognizes the value of black cohosh for
menopausal symptoms. Until further studies are conducted, however, the ACOG
recommends only short-term (less than 6 months) use of this herb for the relief
of hot flashes specifically.
Hot Flashes with treatment for Breast Cancer
cancer patients use black cohosh to ease hot flashes, a common side effect of
medications used to treat breast cancer such as tamoxifen. While black cohosh
may reduce the number and intensity of hot flashes in breast cancer patients,
two well-designed studies recently concluded that the herb is no more effective
In addition, although there is some debate about this, black cohosh may
contain plant based estrogens, called phytoestrogens. Therefore, there is some
concern that if there are phytoestrogens in black cohosh, they may stimulate the
growth of breast tumors. This idea has not been substantiated scientifically; in
fact, some studies suggest that black cohosh may inhibit the growth of breast
cancer cells in test tubes. Additional research is needed before conclusions can
be drawn about use of black cohosh in women with a history of or risk for
developing breast cancer (such as strong family history).
Preliminary studies also suggest that black cohosh
may help reduce inflammation associated osteoarthritis and rheumatoid arthritis.
In a review of scientific studies, researchers concluded that a combination of
black cohosh, willow bark (Salix spp.), sarsaparilla (Smilax
spp.), guaiacum (Guaiacum officinale) resin, and poplar bark
(Populus tremuloides) may help relieve symptoms of osteoarthritis.
Some experts suggest that the plant based
estrogens in black cohosh, in theory, could help prevent osteoporosis. This
theory has yet to be tested scientifically.
Black cohosh is a tall, flowering plant found in rich, shady woods in eastern
areas of North America. A member of the buttercup family, black cohosh is also
known as black snakeroot, bugbane, bugwort, and squawroot. Its rhizomes and
roots (both underground parts of the plant) are used for medicinal purposes.
|What's It Made Of?|
Black cohosh contains glycosides (sugar compounds), isoferulic acids
(substances with anti-inflammatory effects), and, possibly, phytoestrogens
(plant based estrogens), among several other active
Black cohosh is available in capsules, tablets, liquid tincture that can be
mixed in water, and dried root that can be simmered in water.
Black cohosh should not be confused with blue cohosh, an herb that is
reported to have similar effects, but has not been thoroughly tested for its
safety and effectiveness and may actually behave like nicotine.
|How to Take It|
There are no known scientific reports on the pediatric use of black cohosh.
Therefore, it is not currently recommended for children.
The recommended dose of black cohosh ranges from 40 to 80 mg per day. For
black cohosh tincture, that equals 2 to 4 mL, three times per day in water or
tea. Capsules or tablets may be preferred; two will likely provide the
recommended daily dose.
To make a black cohosh drink, put 20 g of dried root in 34 oz of water. Bring
to a boil and then simmer 20 to 30 minutes until the liquid is reduced by a
third. Strain, cover, and store in the refrigerator or a cool, dry place. The
liquid keeps for up to 48 hours. Drink one cup three times daily.
The use of herbs is a time-honored approach to strengthening the body and
treating disease. Herbs, however, contain active substances that can trigger
side effects and that can interact with other herbs, supplements, or
medications. For these reasons, herbs should be taken with care, under the
supervision of a practitioner knowledgeable in the field of botanical
Some individuals taking high doses of black cohosh have reported side effects
including abdominal pain, diarrhea, dizziness, headaches, joint pains, nausea,
slow heart rate, tremors, visual dimness, and vomiting.
It is not clear at this point whether black cohosh stimulates the growth of
breast cancer cells or inhibits their growth; research to date has been limited
and has produced mixed results. Women with a history of breast cancer,
therefore, and those at a high risk for developing breast cancer (for example, a
strong family history like a mother or sister with breast cancer) should not
take black cohosh without talking to a healthcare provider.
Pregnant and breastfeeding women should avoid black cohosh as the herb may
stimulate contractions and lead to premature labor.
There are no known scientific reports of interactions between black cohosh
and conventional medications.
Blumenthal M, Busse WR, Goldberg A, et al. The Complete German Commission
E Monographs: Therapeutic Guide to Herbal Medicines. Boston, Mass:
Integrative Medicine Communications; 19998:90.
Blumenthal M, Goldberg A, Brinkmann J, eds. Herbal Medicine: Expanded
Commission E Monographs. Newton, Mass: Integrative Medicine Communications;
Dixon-Shanies D, Shaikh N. Growth inhibition of human breast cancer cells by
herbs and phytoestrogens. Oncol Rep. 1996;6(6):1383-1387.
Ernst E, Chrubasik S. Phyto-anti-inflammatories. A
systematic review of randomized, placebo-controlled, double-blind trials.
Rheum Dis Clin North Am. 2000;26(1):13-27.
Foster S. Black Cohosh: Cimicifuga racemosa. A literature review.
Foster S, Tyler V. Tyler's Honest Herbal. Binghamton, NY: The Haworth
Herbal Press; 2000.
Guillaume G. Postmenopausal osteoporosis and Chinese medicine. Am J
Jacobson JS, Troxel AB, Evans J, et al. Randomized trial of black cohosh for
the treatment of hot flashes among women with a history of breast cancer. J
Clin Oncol. 2001;19(10):2739-2745.
Lieberman S. A review of the effectiveness of Cimicifuga racemosa
(black cohosh) for the symptoms of menopause. J Womens Health.
Liske E. Therapeutic efficacy and safety of Cimicifuga racemosa for
gynecologic disorders. Advances in Natural Therapy. 1998;75:45-53.
McFarlin BL, Gibson MH, O'Rear J, et al. A national survey of herbal
preparation use by nurse-midwives for labor stimulation. Review of the
literature and recommendations for practice. J Nurse Midwifery.
McKenna DJ, Jones K, Humphrey S, Hughes K. Black cohosh: efficacy, safety,
and use in clinical and preclinical applications. [Review]. Altern Ther
Health Med. 2001;7(3):93-100.
Pepping J. Alternative therapies: black cohosh: Cimicifuga racemosa.
Am J Health-Syst Pharm. 1999;56:1400-1402.
Rotblatt M, Ziment I. Evidence-based herbal medicine. Philadelphia,
PA: Hanley & Belfus, Inc.;2002:98-103.
Schulz V, Hänsel R, Tyler VE. Rational Phytotherapy. Berlin, Germany:
Taylor M. Alternatives to Hormone Replacement Therapy. Comprehensive
Thacker HL, Booher DL. Management of perimenopause: focus on alternative
therapies. Cleveland Clin J Med.
Wade C, Kronenberg F, Kelly A, Murphy PA. Hormone-modulating herbs:
implications for women's health. J Am Med Womens Assoc.
|Review Date: April 2002|
|Reviewed By: Participants in the review process include: Constance Grauds (April 1999),
RPh, President, Association of Natural Medicine Pharmacists, San Rafael, CA;
Jacqueline A. Hart, MD, Department of Internal Medicine, Newton-Wellesley
Hospital, Harvard University and Senior Medical Editor Integrative Medicine,
Boston, MA; Gary Kracoff, RPh (Pediatric Dosing section February 2001), Johnson
Drugs, Natick, MA; Steven Ottariono, RPh (Pediatric Dosing section February
2001), Veteran's Administrative Hospital, Londonderry, NH; R. Lynn Shumake, PD,
Director, Alternative Medicine Apothecary, Blue Mountain Apothecary &
Healing Arts, University of Maryland Medical Center, Glenwood, MD; Tom Wolfe,
P.AHG (April 1999), Smile Herb Shop, College Park, MD. All interaction sections
have also been reviewed by a team of experts including Joseph Lamb, MD (July
2000), The Integrative Medicine Works, Alexandria, VA;Enrico Liva, ND, RPh
(August 2000), Vital Nutrients, Middletown, CT; Brian T Sanderoff, PD, BS in
Pharmacy (March 2000), Clinical Assistant Professor, University of Maryland
School of Pharmacy; President, Your Prescription for Health, Owings Mills, MD;
Ira Zunin, MD, MPH, MBA (July 2000), President and Chairman, Hawaii State
Consortium for Integrative Medicine, Honolulu,
Copyright © 2004 A.D.A.M., Inc
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