Scientific Name: Actae racemosa L. syn. Cimicifuga racemosa (L.) Nutt.
Family: Ranunculaceae.
Other Common Names: black snakeroot, bugbane, bugwort, cimicifuga, rattleroot, rattleweed, rattle top squaw root.
Black cohosh can be found in eastern North America, from Maine to Ontario and Wisconsin, and south to Georgia. It is cultivated in Europe.
The medicinal part is the dried rhizome with attached roots .
The major characteristic compounds are triterpene gycosides (notably, actein, 26- deoxyactein, 26-deoxyacetylacteol), as well as organic acids and esters, and flavonoids. 1
Native Americans used the rhizome of black cohosh for general malaise, rheumatism, kidney ailments sore throat, cough and general conditions specific to women.
In vitro and in vivo estrogenicity studies have been mixed. Black cohosh increased uterine weights (an in vivo test of estrogenicity) in studies of ovariectomized mice; 3 another showed no estrogenic effects in mice given oral dose or rats given subcutaneously injected doses. 4A recent test of black cohosh in several in vitro estrogenicity assays showed no estrogenic acitivity. 5
Few controlled trials of black cohosh exist, and placebo-controlled trials are especially scarce.
Breast Cancer: Most breast cancer survivors experience hot flashes and related symptoms such as excessive sweating.
The estrogenicity of black cohosh
was tested in vivo and in vitro and its
effect on estrogen receptor concentrations of
human breast cancer MCF-7 cells was
investigated. Based on the body weight of
animals, 75, 150 and 300 mg/kg of black cohosh
were administered by tube feeding to immature
female mice for 14 days. Results showed that
uterine weight increased in a dose-dependent
manner and that the days of estrus were
significantly lengthened in the 300 mg/kg group
(p< 0.05). Concentration of black cohosh at 4.75
micrograms/L showed the strongest enhancement
effects (64.7%). The doubling time (TD) of cell
growth in the black cohosh group and the 17 beta-
estradiol group were 32.1 h and 31.7 h
respectively, which were shorter than that of the
blank control (TD = 35.3 h). Four and three
quarters mg/L of black cohosh significantly increased estrogen receptor concentrations compared with the blank control (p< 0.01). The results together showed that black cohosh may have estrogen-like action. The enhancing effect of A. racemosa on estrogen receptor concentrations is one of the potential mechanisms involved with its therapeutic role in the climacteric syndrome. 3
Patients diagnosed with breast cancer, who had completed their primary treatment, were randomly assigned to either black cohosh or placebo, and stratified on tamoxifen use. At baseline, 30 and 60 days, subjects completed a 4-day hot flash diary of menopausal symptoms. Serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) concentrations were measured in a subset of patients at the first and final visits. Both treatment and placebo groups reported declines in the number and intensity of hot flashes and menopausal symptoms. The differences between the groups were not statistically significant. Changes in blood concentrations of FSH and LH also did not differ between the two groups. Black cohosh was not significantly more efficacious than placebo against most menopausal symptoms, including the number and intensity of hot flashes. The study showed the feasibility and value of standard clinical trial methodology in assessing the safety and efficacy of herbal agents. 6 Menopausal Symptoms: A review of eight studies, looked at the effectiveness of an extract of A .racemosa (Remifemin„µ) in alleviating menopausal symptoms in women. Doses varied, some were noted to be 40 drops or 2 tablets of Remifemin two times per day from 6 to 12 weeks. Remifemin was found to be a safe, effective alternative to estrogen replacement therapy for those patients in whom estrogen replacement therapy is either refused or contraindicated. 7
Daily Dosage: Alcoholic-aqueous extracts (ethanolic-aqueous 40-60% (V/V) or isopropanolic-aqueous 40% (V/V)) corresponding to 40 mg of black cohosh (2x20 mg. tablets of Remifenin®)
N.B. Fugh-Berman and Awang. 1
American colonists used black cohosh for
amenorrhea, bronchitis, chorea, dropsy,
fever, hysteria, itch, lumbago, malaria,
nervous disorders, snakebit, uterine
disorders and yellow fever. 2
It has been suggested for use in the treatment of climacteric symptoms such as hot flashes, profuse sweating, sleeping disorders and nervous irritability. Black cohosh has also been used for the treatment of premenstrual syndrome and dysmenorrhea.
When black cohosh is concomitantly taken with oral contraceptives or synthetic estrogen products, the side effects of these drugs may be intensified. People on hormone replacement therapy should regularly consult with their primary physician and pharmacist.
Information on the relationship between substances and disease is provided for general information, in order to convey a balanced review of the scientific literature. In many cases the relationship between a substance and a disease is tentative and additional research is needed to confirm such a relationship.
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