Black cohosh (Actaea racemosa formerly Cimicifuga racemosa)

Traditional Indications

Black cohosh is an alterative, anti-inflammatory, antirheumatic, antispasmodic, astringent, birthing aid, cardiotonic, diaphoretic, diuretic, emmenagogue, expectorant, hypnotic, hypoglycaemic, sedative, tonic, and vasodilator. Black cohosh is a traditional remedy of the North American Indians where it was used mainly to treat women's problems, especially painful periods and problems associated with the menopause. Black cohosh is the trophorestorative of the female reproductive system. This means it improves the blood flow to the organs within that system to improve the strength and tone and function of that system. It may be used beneficially in cases of painful or delayed menstruation. Ovarian cramps or cramping pain in the womb will be relieved by Black cohosh. It is very active in the treatment of rheumatic pains, but also in rheumatoid arthritis, osteoarthritis, in muscular and neurological pain. It finds use in sciatica and neuralgia, associated with the third trimester of pregnancy. (1)

Pharmacognosy

Black cohosh is an herb used by menopausal women to alleviate hot flashes and other symptoms of hormone withdrawal. It is clear that Black cohosh acts through a variety of biological pathways. Our evidence supports mechanisms involving inflammatory, rather than estrogenic, pathways via its ability to enhance NO production under suboptimal levels of IFNγ. (2)

A randomised clinical trial aiming to evaluate the efficacy of Black cohosh in treating early menopausal symptoms found Black cohosh reduced the Greene climacteric scale (GCS) total score and all GCS subscale scores (vasomotor, psychiatric, physical, and sexual symptoms) during 4 and 8 weeks of treatment (3) and another study found that 6 out of 9 trials demonstrated a significant improvement in the black cohosh group compared with the placebo group. (4)

Black cohosh is part of a combination of herbal medicines that have been traditionally used in the third trimester to prepare a woman for delivery. This preparation is called ‘mother’s cordial’ or ‘partus preparatus’. In addition to Black cohosh, a partus preparatus typically contains, Blue cohosh Caulophyllum thalictroides , Raspberry Rubus idaeus, Squaw vine / Partridge berry Mitchella repens (5) and Milk thistle Silybum marianum.

1. PFAF. Cimicifuga racemosa 2019.
2. Ruhlen RL, Sun GY, Sauter ER. Black Cohosh: Insights into its Mechanism(s) of Action. Integrative medicine insights. 2008;3:21-32.
3. Mohammad-Alizadeh-Charandabi S, Shahnazi M, Nahaee J, Bayatipayan S. Efficacy of black cohosh (Cimicifuga racemosa L.) in treating early symptoms of menopause: a randomized clinical trial. Chinese medicine. 2013;8(1):20-.
4. Shams T, Setia MS, Hemmings R, McCusker J, Sewitch M, Ciampi A. Efficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysis. Alternative therapies in health and medicine. 2010;16(1):36-44.
5. Edward Mills J-JD, Dan Perri, Gideon Koren. Herbal Medicines in Pregnancy and Lactation An Evidence-Based Approach: Taylor & Francis Medical, an imprint of the Taylor & Francis Group; 2006.