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What is it?
In herbal medicine we use the roots of Black Cohosh, a tall, long-lived herb that grows in woods and high grounds. The medicine made from the roots is bitter, penetrating and distinctive.
How has it been used?
Black Cohosh has always been seen as herb with a particular affinity for helping gynaecological problems and in modern times it is used almost exclusively as a herb to aid the menopausal transition. Rudolph Weiss M.D. writes 'Black Cohosh is primarily used for treatment of menopausal complaints and it is also used to treat premenstrual syndrome and juvenile menstrual disorders where mood disorders are a predominant factor.'
However Black Cohosh has much wider actions and effects, a fact that was not lost on the Native American Indians who were the first to extensively use it in their own highly developed system of medicine. Black Cohosh has been traditionally used to treat inflammatory conditions associated with cramping or spasm such as sciatica, rheumatism, painful periods, painful childbirth, low back pain and headaches.
The great eclectic tradition of herbal medicine from the 18th and 19th centuries regarded Black Cohosh so highly that many called it 'the premiere medicine for both depression and rheumatism'.
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Science on Black Cohosh
~ Black cohosh has been shown to exhibit an action on the central endogenous opioid system in postmenopausal women as evidenced by suppression of mean luteinizing hormone pulse frequency following opioid receptor blockade (Reame, N. E., Lukacs, J. L., Padmanabhan, V., Eyvazzadeh, A. D., Smith, Y. R., and Zubieta, J. K. Black cohosh has central opioid activity in postmenopausal women: evidence from naloxone blockade and positron emission tomography neuroimaging. Menopause 2008;15(5):832-840)
~ Laboratory study of cimicifugic acids C and D, and fukinolic acid in the rhizome of black cohosh show vasoactive effects. (Noguchi, M., Nagai, M., Koeda, M., Nakayama, S., Sakurai, N., Takahira, M., and Kusano, G. Vasoactive effects of cimicifugic acids C and D, and fukinolic acid in cimicifuga rhizome. Biol Pharm Bull 1998;21(11):1163-1168)
~ Extracts of black cohosh have protected against induced DNA damage through scavenging of reactive oxygen species in vitro. A sample of black cohosh collected in 1919 by the physician and plant explorer Henry Hurd Rusby, was recently identified in the collections of The New York Botanical Garden and analyzed. A comparison of the triterpene glycosidic and phenolic constituents of the 85 year-old plant sample with those of a modern collection of Actaea racemosa showed the similarity of the two samples, and both extracts showed similar antioxidant activity. This confirms the stability of the older sample, despite curation (Jiang, B., Yang, H., Nuntanakorn, P., Balick, M. J., Kronenberg, F., and Kennelly, E. J. The value of plant collections in ethnopharmacology: a case study of an 85-year-old black cohosh (Actaea racemosa L.) sample. J Ethnopharmacol 1-15-2005;96(3):521-528)
~ According to in vitro study, black cohosh was found to be consistent with a human mu opiate receptor (hMOR) agonist, with an EC50 of 68.8 ± 7.7mcg/mL, which may explain its purported beneficial role in alleviating menopausal symptoms (Rhyu, M. R., Lu, J., Webster, D. E., Fabricant, D. S., Farnsworth, N. R., and Wang, Z. J. Black cohosh (Actaea racemosa, Cimicifuga racemosa) behaves as a mixed competitive ligand and partial agonist at the human mu opiate receptor. J Agric Food Chem 12-27-2006;54(26):9852-9857)
~ Black Cohosh was tested on 28 menopausal women with 80% showing good or very good efficacy in relation to the symptoms measured. It was not found to alter the hormones: estradiol, prolactin, follicle-stimulating hormone (FSH) or leutenising hormone (LH). (Nesselhut T, Liske E: 10th Annual Meeting of the North American Menopause Society, New York, Sept 23-25, 1999)
~ A double-blind, placebo-controlled study involving 179 women showed that a combination of Black Cohosh and St John's wort was highly effective for reducing menopausal symptoms. (Boblitz N et al: Focus Alternat Comp Ther 5(1):85086, 1995)
~ A review of clinical trials shows that Black Cohosh has therapeutic effectiveness for moderate to severe neurovegetative symptoms of menopause. Good tolerability and low risks of side-effects have also been confirmed (Liske E: Adv Ther 15(1):45-53, 1998)
~ Black Cohosh does not contain estrogens and nor does it directly alter estrogen levels however compounds within the plant act as selective estrogen re-uptake modulators (SERMs) and it is this which is proposed to be the reason it helps reduce the symptoms of menopause (Third International Congress on Phytomedicine, Munich, October 11-13, 2000, Phytomed 7(supp 2):11-12, 2000)
Safety of Black Cohosh
~ Black Cohosh should not be used at the same time as the drug Tamoxifen although it should be noted that this caution comes about because of experiments that show it augments the action of the drug rather than reduces it! (Zierau, O., Bodinet, C., Kolba, S., Wulf, M., and Vollmer, G. Antiestrogenic activities of Cimicifuga racemosa extracts. J Steroid Biochem Mol Biol 2002;80(1):125-130)
~ Black Cohosh is said to be avoided in pregnancy and breastfeeding and one must always err on the side of caution in such matters but it is worth noting that a) there are no reports of adverse events in this regard, b) that the Indians certainly did not consider it unsafe to use at any time of life and that c) the concerns raised in this area are theoretical and based on its apparent ability to influence hormonally related problems.
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Having developed a relationship of especial warmth and regard towards this herb I wrote an article on it for the natural health professional's magazine Avena which can be read here (note that there is some duplication from there to other material written on this page)
Due to early testing (since the 1950s) in Europe with Black Cohosh for menopause related symptoms the appreciation of this great herb has become rather single-focused whilst its other traditional uses have largely been forgotten in modern times - this is unfortunate because it has so much else to offer.
For example Black Cohosh has a powerful effect on the mind. Thomas Bartram writes of it 'for melancholia, hysteria and nervous depression'. If someone is depressed or lacking creative flow I have often found Black Cohosh to be a phenomenal remedy to help. For the right person it can be even more potent than St John's wort at helping to break out of stagnation and melancholia.
Physically Black Cohosh is equally potent at breaking down the barriers to the innate healing process. One of the most common Indian uses for it was in rheumatism and it can certainly get right into the deepest parts of the body where there is pain, stiffness or stagnation.
I think of Black Cohosh as a blood and energy moving herb and I have developed a deep respect for the power of Black Cohosh to affect significant changes both physically and psychologically.
Black Cohosh is a very dynamic remedy where a little goes a long way - the 'body' (which you could also call the 'subconcious') will soon tell you what it thinks about the herb. The art of knowing when to use Black Cohosh and in what dose cannot be put in a simple summary but what I can say for a start is that if you who are reading this are studying herbal medicine then this is one of those remedies that will greatly reward your learning how to carefully test it on your patients before using it.
The best way I have found to do this is to quietly observe and at the same time gently feel the person's pulse before, during and after giving a few drops of Black Cohosh on the tongue. Observe what you feel and see with an open mind and I am sure you will get strong and clear impressions from that great laboratory of the human organism in front of you - it knows what is good for it and what is not; the pulse palpably strengthens or weakens and at the same time, the 'colour' of their complexion visibly improves or lessens, and if you notice it their breathing either constricts or relaxes and so forth. To some extent you can test these things on yourself in the same way but at the same time we are often much better at observing another than we are ourselves!
Dosage is always critical in herbal medicine; too little and nothing will happen, too much and you get to know about it in the wrong way! I find that for men (I do use this herb for men with aches and pains or a persistently low mood) higher amounts can be taken, even up to 5 or 6 mls in a day if that is what it takes to effect a shift.
For women smaller doses, perhaps just 1 or 2 mls a day seem to be ample. I will gently nudge the dose upwards if there are no ill effects and we don't think it is obviously working yet but just by 1 ml at a time.
I have used Black Cohosh in tea form and think it is very fast acting in this way but not well suited to longer term use. Further to this I think that, in most cases, Black Cohosh needs to be taken for not more than about 3 months before the system is given a rest from its influence and it might beneficially be taken again
Black Cohosh can combine perfectly with Wild Yam for rheumatic problems. For the right person it can be perfect with St John's wort to help lift a low mood and for the right woman it can be ideal combined with Paeony and Licorice for menopausal problems.
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Much of the information here about the traditional uses of Black Cohosh is consistent with the model of thinking whereby one may treat problem A with plant B. There is value in this approach, especially in how it helps us pass on useful knowledge to one another, but it falls short in one vital area; and that is that people are not all cut from the same cloth! Something that works brilliantly for one person may do less for another -- why is this?
The reason is that people vary in their constitutions as to whether they are more hot or cool and at the same time more dry or damp; more info about this here.
There is an old wisdom in treating the person first and the condition second and in this light Black Cohosh can particularly offer its benefits when an activation is needed in the 'cycle of healing' - something that is discussed here and shown in a chart here.
Excerpt from Felter & Lloyd's Kings Dispensatory from 1898
| Few of our remedies have acquired as great a reputation in the treatment of rheumatism and neuralgia.
Prof. King's own statement of his use of it is as follows: "The saturated tincture of this article was recommended by me in acute rheumatism, in the New York Philosophical Journal, as early as in the year 1844; to be given in doses of 10 drops every 2 hours, gradually increasing to 60 drops, or until its action on the brain is observed, which action must be kept up for several days; it almost always removes the disease permanently, especially if it is a first attack."
The experiences of other physicians since that day give abundant evidence of the truth of his statement.
Dr Gardner's Testimony (written in 1823)
'Shortly after commencing the use of this remedy, the hectic paroxysms (spasms) which had attended me for some time previously, were entirely checked. The nocturnal evacuations (night sweats) from the surface of the body began to diminish. The evaporation of a fluid from the vessels of the lungs and bronchia, resembling pus in appearance, was speedily arrested. The cough became less troublesome and frequent. My pulse, which for some time before was never lower than from 100 to 120 pulsations to the minute, was reduced to the minimum standard. The pain in my right breast and side left me. My strength and appetite began to improve. I speedily abandoned the use of all medicines or other means. A period of 12 months of more had elapsed from my initial ill-health to the time of using this medicine. It certainly possesses the power in an eminent degree of loosening arterial action, and at the same time imparting tone and energy to the general system'.
Published in the Bulletin of the Lloyd Library of Botany, Pharmacy and Materia Medica in 1931 and a good account of the diversity of the medicinal power of Black Cohosh.
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