Black cohosh

Encyclopedia of Alternative Medicine by Sharon Crawford

Black cohosh (Cimicufuga racemosa) is a member of the Ranunculaceae family. Its nicknames of squawroot and snakeroot denote its Algonquian heritage and differentiate it from the common snake root plant (Aristolochia serpentaria). It should also not be confused with blue cohosh (Caulophyllum thalictroides); their only similarity is that both are roots.

Black cohosh grows from a gnarled black root, hence its name, has a smooth stem and big multiple leaves with jagged edges. In summer, white flowers develop from what are called racemes. These flowers emit a stinky odor. The plant, which can grow to 9 ft (1 m) tall, is a native North American plant found on hills and in forests located at high levels. It is found from Ontario, Canada to Maine to the southern states of Georgia and Missouri.

Black cohosh contains several components, as outlined by James F. Balch, MD and Phyllis A. Balch, CNC in their book Prescription for Nutritional Healing, Second Edition:

• actaeine
• cimicifugin
• estrogenic substances
• isoferulic acid
• oleic acid
• palmitic acid
• pantothenic acid
• phosphorus
• racemosin
• tannins
• triterpenes
• vitamin A

Black cohosh has a history of usage for women's gynecological problems, dating back to the Algonquian natives living in the Ohio Valley. However, according to Michael Castleman in The Healing Herbs, the Algonquians also boiled the roots in water and drank the concoction for fatigue, arthritis, sore throat , and a typical occurrence of that time, rattlesnake bites. The Eclectic doctors of the 1800s also recommended black cohosh for what they called "hysterical" diseases, i.e. female reproductive diseases as well as fevers, rashes, sleeplessness and malaria. A popular patent medicine company of the same era, the Lydia E. Pinkham's Vegetable Compound, sold a potion containing black cohosh for menstrual complaints.

Today, black cohosh is still used for gynecological problems from menstruation to menopause, with several studies over the past 40 years backing this up. Michael T. Murray, ND, a well-known natural medicine author, outlines some of this research regarding menopause in his paper Hormone Replacement Therapy vs. Black Cohosh in Menopause.

The most famous research was a 1982 open study where 629 women took 80 mg of black cohosh over a period of six to eight weeks. Over 80% of the women showed, relief from several menopausal symptoms--hot flashes, perspiration, headaches, vertigo, heart palpitations, irritability, sleep disturbances and depression. A later random study focused on 60 women under 40 years of age who had hysterectomies, with one ovary remaining. The women were either given black cohosh or hormone replacement therapy (HRT) of estrogen or estrogen-progestin combinations. Although the HRT met with better results, the study concluded that black cohosh was a favorable natural alternative for post hysterectomy.

A 1998 German clinical study showed that black cohosh has good therapeutic results in treating symptoms of menopause and also that black cohosh did not show any hormone-like activity as previously thought.

Because the collective results of a number of studies show synthetic hormone replacement therapy, which contains estrogen, increases breast cancer risk by 1-30%, black cohosh is being considered as an alternative. A 1998 study at the University of Bridgeport in Connecticut reviewed eight previous studies of black cohosh as treatment for menopausal symptoms. This study stated that black cohosh is a safe alternative to estrogen replacement therapy (ERT) for women where ERT is contraindicated or declined. Some contraindicated conditions from ERT include a history of estrogen-dependent cancer, unidentified uterine bleeding, liver disease, gallbladder disease, endometriosis, fibroids in the uterus and fibrocystic breast disease .

In a 1999 in vitro study at the New York College of Osteopathic Medicine, several herbs, including black cohosh, hops, and vitex, were shown to inhibit the growth of T-47D cells. The study concluded that these herbs may be useful in preventing breast cancer.

A 1999-2000 study at Cedars-Sinai Hospital in Los Angeles, California, focused on the efficacy and safety of several traditional phytomedicines, including black cohosh root extract, to treat women's gynecological conditions, such as PMS and menopause. This study concluded that both dong quai and black cohosh are safe to use to relieve menopausal symptoms, but only black cohosh showed efficacy. The study stated that information regarding safety for use during pregnancy and lactation is still small in amount and suggested pharmacists study scientific literature to help decide the value of recommending these herbs for use.

A 1999 national survey of 500 midwives belonging to the American College of Nurse-Midwives and 48 nurse-midwife education programs was undertaken by the West Virginia University School of Medicine. The purpose was to determine if colleges were educating their students in the use of herbs to stimulate labor. Of the 172 surveys returned, 90 used herbal preparations and 82 did not. Herbal usage was broken down as: black cohosh (45%), evening primrose oil (60%), blue cohosh (64%), and castor oil (93%). Those who used these herbs did so because they are natural, and those who refrained from using them cited the lack of sufficient research about the safety.