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An effective medicine traditionally used for neuralgic and rheumatic conditions and in womens health.

Black cohosh

Cimicifuga racemosa / Actaea racemosa Ranunculaceae

A native North American plant that has been used for thousands of years to treat illness in the neuromuscular and rheumatic conditions, as well as for women’s health issues in both the reproductive and menopausal years.

Sustainability Status

Sustainability status

At risk from overharvesting and habitat loss. Read more about our sustainability guide.

Potential replacement(s): Agnus castus, Motherwort,

Key benefits
  • Hormonal Amphoteric
  • Rheumatic conditions
  • Neuromuscular conditions
  • Inner ear conditions
  • How does it feel?

    Black Cohosh has a pungent, mildly bitter cooling effect. With an earthy, slightly mushroomy flavour (as is commonly found with roots). A fairly ground feeling is noticed after using this medicine which could be described as a sense of harmony in the nervous system.

  • What can I use it for?

    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).

  • Into the heart of black cohosh

    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).

  • Traditional uses

    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).

  • Traditional actions

  • Traditional energetic actions

    Herbal energetics are the descriptions Herbalists have given to plants, mushrooms, lichens, foods, and some minerals based on the direct experience of how they taste, feel, and work in the body. All traditional health systems use these principles to explain how the environment we live in and absorb, impacts our health. Find out more about traditional energetic actions in our article “An introduction to herbal energetics“.

  • What practitioners say

    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).

  • Research

    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.


    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).

  • Did you know?

    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.

Additional information

  • Botanical description

    Native to the deciduous woodlands of North America, Black Cohosh is a herbaceous perennial, reaching a height of approximately 2m or more. Flowering between June and September, this plant produces tall, flower stems that branch into several long narrows racemes (flower spikes) with small, creamy-white flowers. These flower spikes have a tendency to lean slightly towards the sun.

    Leaves are compound (made up of a number of smaller leaflets) and usually mid to dark green and serrated, with 2-5 sets branching out in groups of three along the petiole (leaf stem).

    Black cohosh grows primarily on the moist, fertile slopes of deciduous woodlands along the eastern United States and south Eastern Canada. A beautiful plant much loved as a garden ornamental in temperate regions.

    As the global demand increases for the medicinal uses of this plant, black cohosh has been under some concern by conservationists and regulators as it is almost exclusively harvested from the wild.

  • Common names

    • Black cohosh
    • Black snakeroot
    • Cohosh bugbane
    • Cohosh bugbane
  • Safety

    Black cohosh is safe when taken appropriately for up to one year, however it is a herb that has occasionally reported to have caused minor side effects (low incidence) and with some drug interactions to consider (see below).

    Black Cohosh is NOT to be taken during pregnancy or lactation.

  • Interactions

    Cisplatin: A medication the is used in cancer treatments. Black Cohosh may decrease the effectiveness of this drug.

    Medications metabolised in the liver: (Cytochrome P450 2D6 (CYP2D6) substrates). Black Cohosh might change how quickly these medications are broken down by the liver, possibly changing their effects or causing side effects.

    Medications that can harm the liver: such as Atorvastatin (Lipitor) and other hepatotoxic drugs interacts with Black Cohosh.

    Medications moved by pumps in cells (Organic anion-transporting polypeptide substrates): Some medications are moved in and out of cells by pumps. Black cohosh might change how these pumps work and change how much medication stays in the body. In some cases, this might change the effects and side effects of a medication.

  • Contraindications

    Side effects: Although rare, Black Cohosh has been noted to cause mild side effects in a small number of people such as gastric upset, headache, rash and a feeling of heaviness. Should these effects be experienced, consult a professional medical herbalist to assist with appropriate guidance.

    Liver disease: In a systematic review of published clinical trials, in a majority there is a clear indication of efficacy for use of extracts of black cohosh (Actaea racemosa L.) to improve menopause-related symptoms. However, there are some reports of hepatotoxicity. 

    These case reports were confounded on the basis of inadequate details/ evidence of pre-existing underlying liver disease, autoimmune diseases or those taking medications that may have impacted liver function. It would still however be advised to seek guidance from a professional medical herbalist before taking Black Cohosh if you have a liver condition (5, 6).

    Breast cancer: Black cohosh may worsen existing breast cancer. People who have breast cancer or who have had breast cancer in the past, and those at high-risk for breast cancer, should avoid black cohosh or consult a medical herbalist for appropriate guidance.

    Hormone-sensitive conditions: such as endometriosis, fibroids, ovarian cancer, uterine cancer. Black cohosh contains oestrogen like compounds therefore it may worsen conditions that are sensitive to oestrogen. Avoid black cohosh if you have a condition that could be affected by female hormones or consult a medical herbalist for appropriate guidance.

  • Preparation

    • Tincture
    • Dried root
    • Decoction
    • Capsule
    • Fluid extract
  • Dosage

    Tincture: (1:5 in 60%) dosage is 2- 4ml three times.

    Decoction: (1 cup of water/ 1 tsp dried root- simmered 10- 15 minutes and strained) to be drunk x 3 cups a day (alternatively make 3 cups worth and reheat throughout the day).

  • Plant parts used

    Root and rhizome (often dried root is preferred, this is because compounds in fresh root are more powerfully sedative, these compounds are less potent after drying).

  • Constituents

    • Tetrscyclic triterpene glycosides (steroidal saponins) – acetic and cimigoside (effects on the hypothalamic – pituitary receptor sites.
    • Isoflavone – formonocetin – binds to oestrogen receptor sites.
    • Resin (unto 20%) – cimicifugin – oestrogenic.
    • Ferrulic acid –  anti-inflammatory.
    • Tannins. Volatile oils. Fatty acids. Salicylic acid. 27 deoxyacetin –  oestrogen like activity.
    • Black Cohosh is thought to produce both anti-oestrogenic and anti LH (luteinising hormone) enhancing oestrogen activity (7).
  • References

    1. D. Hoffmann, (2003). Medical Herbalism: The Science and Practice of Herbal Medicine. Healing Arts Press. India. Replica Press Put. Ltd.
    2. British Herbal Medicine Association. Scientific Committee (2003). A guide to traditional herbal medicines : a sourcebook of accepted traditional uses of medicinal plants within Europe. London: British Herbal Medicine Association.
    3. Alliance for Clinical Trials in Oncology and National Cancer Institute (NCI) (2016). A Phase III Double-Blind, Randomized, Placebo-Controlled Crossover Trial Of Black Cohosh In The Management Of Hot Flashes. [online] clinicaltrials.gov. Available at: https://clinicaltrials.gov/ct2/show/NCT00060320 [Accessed 13 May 2022].
    4. Mohammad-Alizadeh-Charandabi, S., Shahnazi, M., Nahaee, J. and Bayatipayan, S. (2013). Efficacy of black cohosh (Cimicifuga racemosa L.) in treating early symptoms of menopause: a randomized clinical trial. Chinese Medicine, [online] 8(1), p.20. doi:10.1186/1749-8546-8-20.
    5. Mahady, G.B., Doyle, B., Locklear, T., Cotler, S.J., Guzman-Hartman, G. and Krishnaraj, R. (2006). Black Cohosh (Actaea Racemosa) for the Mitigation of Menopausal Symptoms: Recent Developments in Clinical Safety and Efficacy. Women’s Health, 2(5), pp.783–793. doi:10.2217/17455057.2.5.783.
    6. Ruhlen, R.L., Sun, G.Y. and Sauter, E.R. (2008). Black Cohosh: Insights into its Mechanism(s) of Action. Integrative Medicine Insights, [online] 3, pp.21–32. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3046019/.
    7. Menzies-Trull, C. (2013). Herbal medicine keys to physiomedicalism including pharmacopoeia. Newcastle: Faculty Of Physiomedical Herbal Medicine (Fphm).
    8. Kenner, D. and Yves Requena (2001). Botanical medicine : a European professional perspective. Brookline, Mass.: Paradigm Publications.
    9. Burdette JE, Liu J, Chen SN, et al. Black cohosh acts as a mixed competitive ligand and partial agonist of the serotonin receptor. Journal of Agricultural and Food Chemistry. 2003;51:5661–70. [PubMed] [Google Scholar] [Ref list]
    10. Wuttke, W., Rauš, K. and Gorkow, C. (2006). Efficacy and tolerability of the Black cohosh (Actaea racemosa) ethanolic extract BNO 1055 on climacteric complaints: A double-blind, placebo- and conjugated estrogens-controlled study. Maturitas, 55, pp.S83–S91. doi:10.1016/j.maturitas.2006.06.020.
    11. Trickey, R. and Trickey Enterprises (2011). Women, hormones & the menstrual cycle. Fairfield, Vic.: Melbourne Holistic Health Group.
    12. Grieve, M. (1998). A modern herbal : the medicinal, culinary, cosmetic and economic properties, cultivation and folklore of herbs, grasses, fungi, shrubs and trees with all their modern scientific uses. London England: Tiger Books International.
    13. www.henriettes-herb.com. (n.d.). Black Cohosh. | Henriette’s Herbal Homepage. [online] Available at: https://www.henriettes-herb.com/articles/cohosh.html [Accessed 16 May 2022].
An ‘aromatic’ remedy, high in volatile essential oils, was most often associated with calming and sometimes ‘warming’ the digestion. Most kitchen spices and herbs have this quality: they were used both as flavouring and to ease the digestion of sometimes challenging pre-industrial foods. Many aromatics are classed as ‘carminatives’ and are used to reduce colic, bloating and agitated digestion. They also often feature in respiratory remedies for colds, chest and other airway infections. They are also classic calming inhalants and massage oils, and are the basis of aromatherapy for their mental benefits.
Astringent taste
The puckering taste you get with many plants (the most familiar is black tea after being stewed too long, or some red wines) is produced by complex polyphenols such as tannins. Tannins are used in concentrated form (eg from oak bark) to make leather from animal skins. The process of ‘tanning’ involves the coagulation of relatively fluid proteins in living tissues into tight clotted fibres (similar to the process of boiling an egg). Tannins in effect turn exposed surfaces on the body into leather. In the case of the lining of mouth and upper digestive tract this is only temporary as new mucosa are replenished, but in the meantime can calm inflamed or irritated surfaces. In the case of open wounds tannins can be a life-saver – when strong (as in the bark of broadleaved trees) they can seal a damaged surface. One group of tannins, the reddish-brown ‘condensed tannins’ are procyanidins, which can reduce inflammation and oxidative damage.
Bitters are a very complex group of phytochemicals that stimulate the bitter receptors in the mouth. They were some of the most valuable remedies in ancient medicine. They were experienced as stimulating appetite and switching on a wide range of key digestive functions, including increasing bile clearance from the liver (as bile is a key factor in bowel health this can be translated into improving bowel functions and the microbiome). Many of these reputations are being supported by new research on the role of bitter receptors in the mouth and elsewhere round the body. Bitters were also seen as ‘cooling’ reducing the intensity of some fevers and inflammatory diseases.
Blue-purple colouring
Any fruits with a blue-purple colouring contain high levels of the polyphenols known as anthocyanins. These work 1) on the walls of small blood vessels, helping to maintain capillary structure to reduce a key stage in inflammation, and improving the microcirculation to the tissues; 2) to improve retinal function and vision; 3) to support connective tissue repair around the body.
Traditional ‘cold’ or cooling’ remedies often contain bitter phytonutrients such a iridoids (gentian), sesiquterpenes (chamomile), anthraquinones (rhubarb root), mucilages (marshmallow), some alkaloids and flavonoids. They tend to influence the digestive system, liver and kidneys. Cooling herbs do just that; they diffuse, drain and clear heat from areas of inflammation, redness and irritation. Sweet, bitter and astringent herbs tend to be cooling.
Traditional ‘hot’ or ‘heating’ remedies, often containing spice ingredients like capsaicin, the gingerols (ginger), piperine (black or long pepper), curcumin (turmeric) or the sulfurous isothiocyanates from mustard, horseradich or wasabi, generate warmth when taken. In modern times this might translate as thermogenic and circulatory stimulant effects. There is evidence of improved tissue blood flow with such remedies: this would lead to a reduction in build-up of metabolites and tissue damage. Heating remedies were used to counter the impact of cold, reducing any symptoms made worse in the cold. .
Mucilages are complex carbohydrate based plant constituents with a slimy or ‘unctuous’ feel especially when chewed or macerated in water. Their effect is due simply to their physical coating exposed surfaces. From prehistory they were most often used as wound remedies for their soothing and healing effects on damaged tissues. Nowadays they are used more for these effects on the digestive lining, from the throat to the stomach, where they can relieve irritation and inflammation such as pharyngitis and gastritis. Some of the prominent mucilaginous remedies like slippery elm, aloe vera and the seaweeds can be used as physical buffers to reduce the harm and pain caused by reflux of excess stomach acid. Mucilages are also widely used to reduce dry coughing. Here the effect seems to be by reflex through embryonic nerve connections: reduced signals from the upper digestive wall appear to translate as reduced activity of airway muscles and increased activity of airway mucus cells. Some seed mucilages, such as in psyllium seed, flaxseed (linseed) or guar bean survive digestion to provide bulking laxative effects in the bowel. These can also reduce rate of absorption of sugar and cholesterol. .
New-mown hay aroma
The familiar country odour of haymaking, of drying grass and other plants, is largely produced by coumarins (originally isolated from tonka beans – in French coumarou) and widely used in perfumery. They are chemically categorised as benzopyrone lactones and are important phytochemicals, with strong antioxidant activity in the laboratory and likely effects in modulating inflammation. They were most often associated with the calming effect linked to their use in stuffing mattresses and pillows and plants, high In coumarins were commonly used for these properties.
Resins are most familiar as tacky discharges from pine trees (and as the substance in amber, and rosin for violin bows). They were most valued however as the basis of ancient commodities like frankincense and myrrh (two of the three gifts of the Three Wise Men to the baby Jesus) and getting access to their source was one benefit to Solomon for marrying the Queen of Sheba (now Ethiopia). Resins were the original antiseptic remedies, ground and applied as powders or pastes to wounds or inflamed tissues, and were also used for mummification. With alcohol distillation it was found that they could be dissolved in 90% alcohol and in this form they remain a most powerful mouthwash and gargle, for infected sore throats and gum disease. They never attracted much early research interest because they permanently coat expensive glassware! For use in the mouth, gums and throat hey are best combined with concentrated licorice extracts to keep the resins in suspension and add extra soothing properties. It appears that they work both as local antiseptics and by stimulating white blood cell activity under the mucosal surface. They feel extremely effective!
The salty flavour is immediately distinctive. A grain dropped onto the tongue is instantly moistening and a sprinkle on food enkindles digestion. This easily recognisable flavour has its receptors right at the front of the tongue. The salty flavor creates moisture and heat, a sinking and heavy effect which is very grounding for the nervous system and encourages stability. People who are solid and reliable become known as ‘the salt of the earth'.
The sharp taste of some fruits, and almost all unripe fruits, as well as vinegar and fermented foods, is produced by weak acids (the taste is generated by H+ ions from acids stimulating the sour taste buds). Sour taste buds are hard-wired to generate immediate reflex responses elsewhere in the body. Anyone who likes the refreshing taste of lemon or other citrus in the morning will know that one reflex effect is increased saliva production. Other effects are subjective rather than confirmed by research but there is a consistent view that they include increased digestive activity and contraction of the gallbladder.
In the days when most people never tasted sugar, ‘sweetness’ was associated with the taste of basic foods: that of cooked vegetables, cereals and meat. In other words sweet was the quality of nourishment, and ‘tonic’ remedies. Describing a remedy as sweet generally led to that remedy being used in convalescence or recovery from illness. Interestingly, the plant constituents most often found in classic tonics like licorice, ginseng are plant steroids including saponins, which also have a sweet taste.

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