Reproductive conditions: Black Cohosh has a wealth of medicinal applications in the treatment of conditions of the female reproductive system and for neuro-muscular conditions.

It would be a great herb to consider using to help with painful menstruation, premenstrual syndrome or menopausal symptoms, depending on the nature of the condition (2, 7, 8). For example, premenstrual syndrome can be the result of specific hormonal imbalances, for some of which there may be a better alternative. This is something that a trained Medical Herbalist would be able to help you identify. Clinical herbalists can be found here and seeing one is the best option for chronic and complex conditions. 

Neurological conditions: Some of the most popular applications of Black Cohosh are in the treatment of headaches, tinnitus and vertigo. As a herb that balances constriction in the micro-capillaries, whilst acting to reduce nerve tension, it can be an effective option to support those who are prone to the above conditions (2, 7, 8). 

As a relaxant it can be used to treat a number of different types of headaches such as migraine, cluster and ophthalmic headaches (used with caution in cases of true migraines as can occasionally induce vomiting) (8). Anyone suffering from chronic headaches should seek professional medical advice, to identify the cause and rule out any more serious health conditions.

Rheumatic conditions: Perhaps one of its most renowned actions is as a powerful antispasmodic. This can be useful for the treatment of both nervous or muscular problems such as rheumatic conditions like rheumatoid arthritis, osteoarthritis and muscular problems as it acts both as a powerful anti-inflammatory and antispasmodic.

Respiratory conditions: Black Cohosh has some value in treatment of conditions that present with respiratory tension or spasmodic tissue state in the lungs. This would include that found in asthma and pertussis (whooping cough). It is herb that also supports the natural processes of a viral fever, such as to slow the heart rate whilst supporting a healthy sweat, which improves viral detoxification (7, 8, 9, 12).

A pungent cooling medicine, with an acridity known to soften and relieve tensions throughout the cardiovasular system and the nervous system. Black Cohosh can be applied for all of the physiological conditions mentioned above, however it would be an excellent choice where anxiety and panic attacks may be additional factors (7, 8). As a mildly bitter pungent herb, black cohosh will deliver a grounding effect. As it is able to offer a relaxant action upon the cardiovascular and nervous system, this plant brings a sense of earthing, whilst it directly neutralises overactivity in the ANS (autonomic nervous system). 

Black Cohosh works to reduce over activity in both the parasympathetic and the sympathetic nervous system. These are the two branches of the ANS which innovate all of our visceral organs and automatic processes. Overactivity in these systems can cause digestive and sleep issues or high blood pressure and a fast heart rate, among other symptoms respectively (7, 8). Black Cohosh would therefore be an excellent herb of choice to support the balance of the ANS, particularly where this imbalance is caused by prolonged exposure to stress hormones (6, 7).

Black Cohosh has been used in Native American medicine for a wide range of gynaecological conditions and rheumatic complaints. Traditionally used as a diaphoretic in agues and fevers of viral illness. Reportedly, it cured many cases of yellow fever and smallpox. It was also believed in Native American medicine to be an antidote to rattlesnake venom, used as a root poultice (10,12). 

The Eclectics prescribed Black Cohosh in the form of fluid extract for prophylactic treatment of smallpox, also for inflammatory rheumatism and the neuralgias (13).

It has long been used in Traditional Western Herbal Medicine as a herb to bring on a delayed menstruation, supporting the symptoms of menopause in the post- reproductive years. It is a vascular antispasmodic, that is also traditionally used in high blood pressure (10).

It has a long-standing history of use for persistent coughing, particularly that of whooping cough. Black cohosh acts as an expectorant (promoting coughing/ clearing of the lungs), whilst reducing rapidity of the pulse and increasing perspiration. In essence, it supports the process of a natural fever and is a traditional approach used by herbal physicians to increase recovery outcomes (12).

Anti-inflammatory herbs reduce inflammation in the body. There are different systems in the body that anti-inflammatory plants target. For example for the gastrointestinal tract chamomile, fenugreek and meadowsweet are useful. For the musculoskeletal system rosehips, turmeric and celery seed are useful. For inflammation against immune mediated inflammation gotu kola (centella asiatica), rehmannia (rehmannia glutinosa) and feverfew (tanacetum parthenium) can be useful.

Antirheumatic medicines prevent or relieve rheumatic symptoms such as joint pains, limited mobility and swelling. Plants that have this effect include celery seed (apium graveolens), black cohosh (cimicifuga racemose), nettle leaf (urtica dioca), devils claw (harpagophytum procumbens) and willow bark (salix alba).

Antispasmodic plants reduce or relieve smooth muscle spasm. They can be helpful for an array of issues including menstrual cramps. Also known as spasmolytics, these plants include aniseed (Pimpinella anisum), blue cohosh (caulophyllum thalictroides), cramp bark (viburnum opulus) and lavender (Lavandula angustofolia).

Emmenagogues are herbs that stimulate and promote menstruation. Examples include Marigold flowers (Calendula officinalis) and Chaste Tree fruits (Vitex agnus-castus), Turmeric root (Curcuma longa).

Nervines are herbs that soothe the nervous system and have a calming effect on the emotions. Examples include Oatstraw flowering tops (Avena sativa), passionflower (Passiflora incarnata), Lavender (Lavandula officinalis), St. John’s Wort (Hypericum perforatum), Rosemary leaf (Rosmarinus officinalis), and Gotu Kola leaf (Centella asiatica).

Uterine tonics are substances that increase the tone of the uterine muscle. Uterine tonics include black cohosh (cimicifuga racemose), blue cohosh (caulophyllum thalictroides), false unicorn root (chamaelirium luteum) and true unicorn (aletris farinosa).

This herb has long been regarded as an important medicine on the shelves of a herbalists dispensary, with a number of well documented applications for treatment of conditions in the neuromuscular system and the female reproductive system. The actions of this plant would likely be worked into a prescription for their powerfully physiological properties, as a main player so to speak. This herb is used for producing effective symptomatic relief of the earlier mentioned conditions of the reproductive system, such as painful menstruation and menopausal symptoms.

It is also an excellent choice where menopausal symptoms also present alongside osteoporosis or rheumatic arthritis. It is a herb that combines well with valerian for the treatment of neuralgic conditions such as lumbago, myalgia, chorea, sciatica, intercostal and trigeminal neuralgia (2, 7).

Many herbalists use this plant in the treatment of inner ear conditions such as tinnitus, vertigo and Menieres disease. This would be most useful where the cause is due to vaso-constriction, high blood pressure or of neuromuscular problems (7, 8).

Much of the research into the effects of Black Cohosh have been focused on the treatment of menopausal symptoms and whether or not it works via an oestrogenic pathways or indirectly via the CNS (central nervous system). 

However, the importance of this plant in treatment of other conditions such as those in the nervous system should not be overlooked. This is certainly a plant with a great value for many other health problems which requires more research.

Menopause

In a randomised, double-blind, placebo-controlled clinical trial 84 early or post-menopausal participants with a moderate to high Greene Climacteric Scale (GCS) score (a scale used to measure of menopausal symptoms) were randomly allocated into treatment using either 6.5 mg of dried extract of Black cohosh roots daily or a control (placebo). The participants took one tablet per day for 8 weeks (4).

The GCS total score in the treatment group was significantly lower than that in the control group at both week 4 and week 8. The results clearly displayed a significant improvement of menopausal symptoms than that of the control group in all GCS subscale scores (vasomotor, psychiatric, physical, and sexual symptoms (4).

In another double-blind, CE- and placebo-controlled study an extract of black cohosh demonstrated a clear reduction in oestrogen deficiency symptoms to the same degree as conjugated oestrogens. Improvements were measured on all climacteric complaints, somatic complaints, mental and emotional state, sweating episodes with a significant improvement in sleep quality among the test group (10).

The literature to date does not fully confirm a direct oestrogenic mechanism to explain the effects of black cohosh, though it is not ruled out entirely. It is however thought that black cohosh may instead act on the neural pathways via its effects on neurotransmitters in the CNS (central nervous system) that modulate the thermoregulation system (6).

Black Cohosh has been the subject of a huge amount of scientific research, both through clinical trials and studies on its active compounds. In both, there seems to be conflicting outcomes in terms of the directly oestrogenic effects of Black Cohosh. 

This is often the way with the scientific research carried out to assess the effectiveness of a chemically complex herbal medicine, whose efficacy is difficult to measure within the reductionist nature of modern research. 

It is generally agreed however among the herbal community that black cohosh is a hormonal amphoteric (herb that can balance, according to the body’s needs). This is an action often seen in medicinal plants due to the dynamic and synergistic actions of their chemistry (6,7).

Research has been unable to conclude whether Black Cohosh exerts these effects by acting as an oestrogen in the brain. It is most likely however that it may alleviate hot flashes by acting on neurotransmitter systems (specifically serotonergic neurons) in the thermoregulatory hypothalamus via selective serotonin reuptake. It is also considered that compounds in Black Cohosh, by this same mechanism may indirectly interact with the oestrogenic systems (6, 7, 8).

The origin of its folk name ‘black snakeroot’ or ‘rattlesnake root’, refers to its traditional use in North America to treat snakebites, including that of the rattlesnake). Also known as bugbane, the Latin word ‘Cimicifuga’ means ‘to chase insects away’ due to another early use of this plant as an insect repellant.

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