How does it feel?
Black Cohosh has a pungent, mildly bitter and cooling effect with an earthy, slightly mushroomy flavour (as is commonly found with roots). You will notice a feeling of being ground after using this medicine which could be described as a sense of harmony in the nervous system.
All around the world the actions of traditional medicines were understood by their immediate sensory impacts. Click on each of Black Cohosh’s key qualities below to learn more:
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. 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. Trained herbalists can be found here.
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.
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 it can occasionally induce vomiting). 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 both as a powerful anti-inflammatory and antispasmodic.
Respiratory conditions: Black Cohosh has some value in the 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 also a herb that supports the natural processes of a viral fever, such as slowing down the heart rate whilst supporting a healthy sweat, which improves viral detoxification.
Into the heart of Black Cohosh
A pungent cooling medicine, with an acridity known to soften and relieve tensions throughout the cardiovascular system, particularly in 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.
As a mildly bitter pungent herb, Black Cohosh will deliver a grounding effect, whilst 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 overactivity 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.
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. Black Cohosh directly supports the nervous system, restoring balanced function.
Traditional use
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.
The Eclectics prescribed Black Cohosh in form of fluid extract for prophylactic & treatment of smallpox, also for inflammatory rheumatism and the neuralgias.
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. A vascular antispasmodic, that is also traditionally used in high blood pressure.
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 supporting the process of a natural fever is a traditional approach used by herbal physicians to increase recovery outcomes.
What practitioners say
This herb has long been regarded as an important medicine on the shelves of a herbalist’s dispensary, with a number of well documented applications for treatment of conditions in the neuromuscular system and the female reproductive system.
Most of which being of a very physiological nature, in that 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. A herb that combines well with valerian for the treatment of neuralgic conditions such as lumbago, myalgia, chorea, sciatica, intercostal and trigeminal neuralgia.
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 vasoconstriction, high blood pressure or neuromuscular problems.
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
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.
Traditional actions
Western herbal medicine actions:
- Emmenagogues
- Nervines
Traditional Chinese medicine actions:
- Plants with an acrid flavour in TCM are used to treat ‘wind and chill’, conditions that present with constriction.
Research
Much of the research into the effects of Black Cohosh have been focused on 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.
Hormones: 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 limiting conditions of modern research.
It is generally agreed however among the herbal community that Black Cohosh, it is a hormonal amphoteric (herb that can balance, according to the body’s needs), an action of seen in medicinal plants due to the dynamic and synergistic actions of their chemistry.
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.
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.
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.
In another double-blind, CE- and placebo-controlled study an extract of Black Cohsoh 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.
The literature to date does not fully confirm a direct oestrogenic mechanism to explain the effects of Black Cohosh, thought 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.
Black Cohosh is believed to be a hormonal amphoteric (a herb that creates balance according to the body’s needs). It has been found in scientific studies to produce oestrogenic activity whilst also exerting an anti-estrogenic effect in some instances.
The mechanism by which Black Cohosh is believed to improve menopausal symptoms is via an action upon the hypothalamic- pituitary unit (this is a hormonal control system within the brain that deals with release and metabolism of specific reproductive hormones).
Black Cohosh contains at least three types of hormonally active substances, one of which suppresses the secretion of LH (luteinising hormone- a hormone released by the pituitary gland that is essential for fertility during the reproductive years, but one that is believed to cause hot flushes and other menopausal symptoms).
Another two compounds found in Black Cohosh have oestrogen-like activity, which may explain why this herb is also sometimes useful in oestrogen deficiency conditions.
Reproductive
Black Cohosh is highly esteemed for the use in female reproductive health, with applications that may be indicated both during the reproductive or menopausal years.
Menstrual conditions: This herb can be applied during the reproductive years to treat painful menstruation, helping to relieve both menstrual cramps and those caused by ovulation. It is also used during adolescence for delayed menstruation bought on by hormonal imbalance, particularly where stress and emotional factors could be a cause.
The mechanism by which Black Cohosh exerts relief of problematic or painful menstruation is by its antispasmodic and anti-inflammatory actions upon the uterine muscle, whilst also being mildly analgesic.
Menopause: Probably one of the most popular applications for Black Cohosh is in the treatment of menopausal symptoms, working to smoothen both the associated physical and mental changes. Menopausal symptoms such as hot flashes, irritability, low mood, headache, heart palpitations, vertigo and sleep disturbances can all be effectively improved with the use of Black Cohosh, the popularity of this plant for use in menopause is unsurprising.
Black Cohosh can effectively help to reduce the symptoms of vaginal dryness and irritation found in menopausal women both topically and orally, thought to be as effective as synthetic oestrogen.
Black Cohosh contains at least three types of hormonally active substances, one of which suppresses the secretion of LH (leutenising hormone- a hormone essential for fertility during the reproductive years, but one that is believed to cause hot flushes and other menopausal symptoms). Another two compounds found in Black Cohosh have oestrogen- like activity, which may explain why this herb is also sometimes used in oestrogen deficiency conditions.
A herb that is described most accurately as a hormonal amphoteric (bringing balance according to the needs of the body).
Oestrogen deficiency: By the same means, it can be useful for hormonal deficits that result from hysterectomy (surgical removal of the female reproductive system) or ovariectomy (removal of the ovaries). However, for this application it would be advised to seek guidance from a professional Medical Herbalist to get the best outcome.
Cardiovascular
Heart health: A powerful antispasmodic, which means it can regulate or reduce muscular tensions of both nervous, cardiovascular and muscular origin. This is one of the mechanisms by which this herb supports cardiac health.
By this means, Black Cohosh is traditionally used for conditions of the heart, particularly those rooted in problems of the cardiac muscle, such as rheumatic pericarditis, arrhythmia and angina.
Blood pressure: As a vaso-dilator (dilates the capillaries) Black Cohosh can also help to reduce tension in the circulatory system and thus reducing blood pressure. Black Cohosh softens the heart beat whilst supporting the functional power of the cardiac muscle.
Please note: For high blood pressure and other chronic heart conditions, it is always best to seek professional support under guidance of a professional Medical Herbalist. As with all serious or ongoing health conditions, it is important to receive the correct intervention safely. Herbalists can be found here.
Nervous
Headaches and tinnitus: Black Cohosh is certainly a herb of value for treatment of various illnesses of the nervous system. With its anti-spasmodic, anti- inflammatory and mildly analgesic actions it is indicated for migraines and both opthalmic and cluster headaches.
Black Cohosh is also very specific for the treatment of tinnitus, vertigo and Ménière’s syndrome. In fact it has a great reputation among herbalists for use in tinnitus. This may work both via its relaxant effects upon the micro-capillaries or by its neuromuscular actions.
Neuralgic conditions: Black Cohosh relieves tension held in the central nervous system by its antispasmodic action, this is sometimes useful for conditions that present with nerve and muscular pain and also where there may be spasticity such as that found in many neurological conditions. This can make Black Cohosh a great option for supportive treatment of conditions such as lumbago, myalgia, chorea, sciatica, intercostal and trigeminal neuralgia.
Autonomic nervous system: Black Cohosh is also a balancer of the ANS (autonomic nervous system), this is a branch of the nervous system that deals with automatic functions such as breathing, digesting, sleep, heart rate and blood pressure. This part of the nervous system has two branches; the sympathetic – motivation and heart rate and parasympathetic – rest and digest. Sometimes one or the other branch of the ANS will find itself out of balance, often as a result of excess stress hormones.
Respiratory
Black Cohosh has a history of use in respiratory conditions such as asthma, bronchial catarrh and even whooping cough.
A plant that has antispasmodic, potent anti-inflammatory and astringent properties which can be useful for clearing respiratory congestion and reducing the inflammation of a persistent cough.
Musculoskeletal
Arthritic conditions: Due to its anti-inflammatory and mildly analgesic properties, Black Cohosh can be used in the treatment of rheumatic or arthritic disorders, including that of rheumatoid arthritis, osteoarthritis and muscular problems such as intercostal myalgia.
Neuromuscular conditions: Black Cohosh can also be used for neurological pain such as in sciatica and neuralgia. These actions are thought to be due to the anti-inflammatory and mild analgesic properties of this plant.
To see the references used in this summary check our downloadable Expert Herbal Reality Resource pdf
Expert Herbal Reality Resource
Preparation
Preparation: Tincture, dried root, decoction, capsule, fluid extract.
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).
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).
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 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.
Although 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.
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.
Interactions (moderate-mild)
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.
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.