Better mad with the rest of the world than wise alone.
Cimicifuga racemosa. Actæa racemosa. Black cohosh. N.O. Ranunculaceae.
CLASSIFICATION Cimicifuga belongs to the Ranunculaceae or Buttercup family. Comprising over 1800 species in about 50 genera, the family is centred in temperate and cold regions of the Northern and Southern Hemispheres. It contains a number of very poisonous plants, such as Helleborus and Aconitum, and a number of well-known garden ornamentals. The plants are mostly herbs, rarely woody climbers, such as Clematis. The Buttercup family is divided into two subfamilies: the Ranunculoideae and the Helleboroideae. The latter comprises two tribes: Delphinieae [containing Aconitum and Delphinium] and Helleboreae [containing Helleborus and Cimicifuga, among others].
CIMICIFUGA The genus Cimicifuga consists of 15 species of erect perennial plants only found in northern temperate regions. Cimicifuga racemosa is native to eastern North America and is found in rich, open woods, along the edges of fields, and on newly cleared hillsides. It is especially abundant in Ohio and West Virginia. Cimicifuga foetida is found in South Europe and Siberia and is commonly called bugbane.
FEATURES Cimicifuga racemosa is a hardy perennial that produces clumps of quadrangular stems, up to 2,5 metres high. It has large, alternate, 3-pinnately, compound leaves with toothed edges, with the middle lobe being the largest. Terminal leaflets are 3-lobed. The flowers lack petals and consist of greenish white sepals, borne in tall racemes well above the foliage, blooming from June through September. The flowers are thought to be pollinated by flies. The plant has a large, cylindrical, black rhizome that is hard and knotty and bears the remains of numerous ascending branches. Internally the root is whitish-yellow. This root is collected in the autumn after the fruit and leaves have fallen off, then cut into pieces and dried. Once dried the rhizome has a faint, disagreeable odour and a bitter, acrid taste.
|Cimicifuga racemosa flower|
NAME Linnaeus first classified this plant as Actaea racemosa but it was later renamed Cimicifuga by Pursh. The name Cimicifuga comes from L cimex, bug, and fugo, to drive away, alluding to the use of Cimicifuga foetida as a vermifuge. The common name ‘bugbane’ refers to the same purpose; pillows and mattresses were formerly stuffed with dried tops of C. foetida to repel insects. Racemosa refers to the arrangement of flowers on short stems from a longer stem. ‘Cohosh’ comes from an Algonquin word meaning rough and refers to the plant’s lumpy, black rhizomes. The common name ‘rattleweed’ derives from the sound of the dry seeds in their pods atop the flower stalks. Botanical synonyms are Actaea racemosa and Macrotys actaeoides. There are many common names: black snakeroot, squawroot, rattle root, rattle top, black cohosh, papoose root, and ‘the flower of the medicine woman’. Black cohosh should not be confused with blue cohosh. The latter is Caulophyllum thalictroides, an unrelated plant that belongs to the Berberidaceae. The name ‘snakeroot’ is rather confusing for it is connected to numerous different plants through history.
CONSTITUENTS The main constituent is a resinous substance termed cimicifugin [macrotin], which reportedly has oestrogenic effects. The bitter taste of the herb is caused by the crystalline principle racemosin. Contains furthermore triterpene saponins, tannins, ferulic and isoferulic acid, salicylic acid, traces of alkaloids, fatty acids [palmitic and oleic acid], mucilage, starch. The presence of ferulic, isoferulic and salicylic acids may explain the anti-inflammatory action of the plant. “Recent European studies of this herb have shown that it has several actions on the various symptoms associated with menopause. Certain complex chemicals, especially triterpenes and flavonoids, are believed to be the active constituents. Some of them apparently act on the pituitary gland to suppress the secretion of luteinizing hormone [LH]. High levels of LH in the blood are often associated with menopausal symptoms, including hot flashes, night sweats, headaches, heart palpitations and drying and thinning of the vagina. In contrast to standard hormonal therapy with oestrogens and progestins, however, black cohosh does not seem to affect levels of two other pituitary hormones, follicle-stimulating hormone [FSH] and prolactin. In other words, the action is more selective that normal hormonal ‘therapy’. That’s good, because it tends to lessen the side effects. Other constituents in black cohosh bind to oestrogen receptors, producing a weak oestriol-like effect. Oestriol, unlike its more potent cousin oestradiol, is not associated with increased risk of breast, ovarian or endometrial cancers. Still other constituents in the plant seems to promote mild relaxation.”1
TOXICOLOGY Toxic effects from ingestion may be severe. They include bradycardia, bursting headache, flushed face, vertigo, tremors, delirium, colic, gastroenteritis, and diarrhoea.
MEDICINE Cimicifuga was a popular medicine among the American Indian tribes and gained the name squawroot for its great ability to treat uterine disorders, aid in childbirth and what was referred to as ‘chest difficulties’. Indians also used it as a diaphoretic in agues and general fevers such as yellow fever and smallpox. For rheumatism Indians made decoctions of the root, which were used externally to steam painful joints. Root poultices were applied on snakebites as an antidote. Pluckenet was the first to describe Cimicifuga racemosa in 1696. Early European settlers in America extracted the root with whiskey and drank it as a rheumatism cure and also used it for ‘putrid, sore throats.’ For later herbalists it became something of a panacea since it was thought to act as an alterative, antispasmodic, antitussive, aphrodisiac, astringent, diaphoretic, diuretic, expectorant, narcotic, and nervine. Moreover, it was given for various infantile disorders including diarrhoea, whooping cough and paroxysmal coughing. The plant was promoted as a specific cure for smallpox by different doctors at different times. It was even claimed that certain families in Alabama drank Cimicifuga tea during smallpox epidemics as a successful prophylactic. In 1823, a Dr Garden reported in the American Medical Recorder on the use of Cimicifuga racemosa in treating pulmonary tuberculosis. He actually used it on himself when afflicted by TB with positive results. Two years later Chapman classified Cimicifuga as an expectorant, which further increased the employment of the plant in the treatment of pulmonary diseases, particularly asthma and consumption. This would however be reviewed in 1848 by a committee of the American Medical Association. The committee analysed the plant and found that it produced no perceptible increase in any secretions, but, on the other hand, “uniformly found it to lessen the frequency and force of the pulse, to soothe pain and allay irritability”. Based on the opinion of this committee, Cimicifuga racemosa now all of a sudden became recognised as a ‘purely sedative agent.’ Earlier, in 1831, the plant had been recommended for treating such disorders as chorea and St. Vitus dance. It quickly gained fame as a nerve tonic with the capacity to relieve depression that included fears. The overall reputation of Cimicifuga within regular medicine was probably declining by the early years of 1900. In 1908 Sajus gave an interesting explanation for the general decline of its reputation: “As may be surmised from its physiological properties, Cimicifuga has been recommended in almost every disease, but, being superior to very few drugs which possess special properties of more restricted kind, it has gradually been replaced by these.” [The plant was introduced 1830 into the American Pharmacopoeia in 1830 and remained there until 1936.]
ECLECTICS “The origins of the Eclectic Medical Institute go back to the late 1820s when Drs. Wooster Beach, Thomas Vaughn Morrow, Ichabod G. Jones and John T. Steele, all regular graduates in medicine, created the Reformed Medical Society of the United States to protest the heroic practices of blood-letting and mercurialization then prevalent in regular medicine. In 1830 they met in New York and decided that a medical college based on their reform principles should be established in the West to give the growing population there the advantage of botanical medicine. … The Reformed Medical College of Worthington, better know as the Medical Department of Worthington College, opened in 1830 with eight students and with Dr. Morrow as Dean of the Medical Faculty. The first years were marked by success. …This early success was attributable to the efforts of Dr. Morrow. Although in time his brave efforts would bring him the title ‘Father of Eclecticism in the West’ it was the extensive use in his practice of Macrotys [Cimicifuga racemosa] which earned him the nickname of ‘Old Macrotys’ early with his students.”2 In 1835, the prominent Eclectic physician John King developed a resinous Cimicifuga alcohol-based extract which he called Macrotin or Cimicifugin – one of the first famous ‘resinous concentrates’ of the Eclectics. [King, the author of The American Dispensatory, also is credited with discovering and introducing podophyllin, the resin of Podophyllum, and irisin, the oleoresin of Iris versicolor.] The enthusiastic use of Cimicifuga by the eclectics had its emphasis on female complaints and, to a lesser degree, on rheumatoid muscular pains, chorea, neuralgic pain, headaches and febrile diseases. The Eclectics carefully kept record of its specific use in multiparas with histories of difficult labours, and in cases where the uterus was lax. In 1885 the records contained 160 childbirths. In all 160 cases the tincture was used, the mildly sedating effect of which reduced discomfort in the first stages of labour. In the second stage it regulated the contractions, at the same time relaxing the cervical tissues and thus reducing the incidence of lacerations. For treatment of ‘female complaints’ black cohosh was combined with alcohol and several other ingredients in a product called ‘Lydia Pinkham’s Vegetable Compound’; it became the most popular turn-of-the-century nostrum.
MENOPAUSE A German study [by Stolze] involving 629 female patients showed that cimicifuga extract was beneficial in improving menopausal symptoms in over 80% of patients within 6-8 weeks. The results confirmed earlier clinical experience of herbalists that black cohosh has a balancing effect in conditions caused by oestrogen deficiencies, such as problems at puberty and pregnancy, but particularly hot flashes and depression associated with menopause. In the German study the following symptoms associated with the menopausal complaints were reported to be improved [first figure] or to have disappeared [second figure]: tinnitus [38% improved; 55% disappeared]; heart palpitation [35%; 55%]; profuse perspiration [39%; 50%]; vertigo [35%; 51%]; flushes of heat [43%; 43%]; headache [36%; 45%]; nervousness, irritability [43%; 42%]. Seven percent of patients reported side-effects consisting of slight stomach upsets.
FOLKLORE Cimicifuga was believed in both China and America to be a powerful antidote to snakebite, to wear off old age and to prevent any kind of disease from entering the body. A tea was made from the root and sprinkled in rooms in order to stop evil spirits from entering.
PROVINGS ••  Paine – 5 provers [4 males, 1 female], 1851-52; method: repeated doses of 10-40 drops of tincture; also 10-20 drops of 3x dil. and 3 drops of 1x dil.
••  Bacmeister – 4 provers [1 male, 3 females], 1871; method: single dose of half a teaspoonful of tincture, or four 10-drop doses of tincture every 4 hours.
••  Hill and Douglass – 46 provers [40 males, 6 females], approx. 1851; method: not stated.
••  Mezger – 17 provers [3 males, 14 females], 1951-53; method: for three weeks 3 daily doses of 12x, 3x, or mother tincture.
“Dr. Edwin Hale introduced Cimicifuga into homeopathy in 1855. It received several thorough provings and was widely used by homeopathic and botanical doctors towards the end of the century. Hering wrote in 1880 that it was a ‘polychrest’ and that it was well-proven, having been tested on forty men and six women. The provings revealed many characteristic psychological and physical symptoms. Temple Hoyne’s Clinical Therapeutics, which appeared about the same time, documents numerous case histories from homeopathic literature. Unfortunately, the enormously influential Dr. Kent downgraded the importance of Cimicifuga in his Lectures on Materia Medica, which appeared in 1905. He incorrectly states that it was ‘meagrely’ proved and gave as his opinion that it had some limited use. Perhaps this is why 20th-century homeopaths do not consider Cimicifuga to be the ‘polychrest’ Hering did.”3
 Tyler, The Bright Side of Black Cohosh; Prevention Magazine, April 1997; website.  Boyle, Herb Doctors: Pioneers in Nineteenth-Century American Botanical Medicine.  Wood, Seven Herbs : Plants as Teachers.
Mind. Occiput. Vertex. NERVES and MUSCLES [cerebro-spinal; eyeballs; ovaries and uterus; heart]. FEMALE ORGANS. Joints. Left side [ovary; breast, etc.]. Nape of neck. Front of thighs. * Left side. Right side.
Worse: Menstruation; suppressed. During labour. Emotions. Alcohol. Damp, cold weather. Wind. Drafts. Change of weather. Sitting. Taking cold. Motion. Excitement. Morning. Afternoon. Evening. Climacteric period. Alcohol.
Better: Warm wraps. Open air. Pressure. Gentle, continued motion. Eating. Grasping thighs. Rest.
c CIMICIFUGA – CAULOPHYLLUM
“The book says that in Cimicifuga there is soreness from overexertion, as in gymnastics, dancing, skating and the like. Unless, however, I have other distinct and clear-cut symptoms calling for this remedy, I turn most confidently to Caulophyllum, because I have learned that Cimicifuga is more likely to be of a lazy disposition physically, while Caulophyllum is inclined to be active. In a general way I distinguish the two remedies in rheumatism by the cramping and twisting and squeezing pains of Cimicifuga, and the general soreness in Caulophyllum – the pains in the wrists and fingers, the ankles and toes, where they can’t hold on to a cup or a pen, can’t stand without turning the ankle. Caulophyllum, too, has a Pulsatilla symptom, in that the pains fly from point to point. But Caulophyllum is more often indicated in dark-complexioned people of intense irritability, tears being a rare commodity, and good nature at a large premium.”
[Kraft, The Two Cohoshes; Transactions of the American Institute of Homeopathy, 1902]
“Calcarea phosphorica, Cimicifuga, and Ignatia, the main ‘sighing’ remedies of our materia medica, are all three in a conflicting situation: Calc-p. between security and change; Cimicifuga between attachment and unattachment; Ignatia between idealized feelings and reality.” [Karl-Josef Müller, Cimicifuga: Neue Aspekte und deren klinische Bestätigungen]
M Encaged in wires.
• “I have seen [in Cimicifuga cases] the feeling of being strongly tied to people [usually the family, the children or a partner] or either the need for close relations or the desire to free oneself from them. At the same time, parting from the loved ones, brings out of lot of anxiety and fear to be alone. Thus a strong clinging tendency became apparent. In all these cases, the family played an important role, in various ways. Sometimes the patient felt that he or she had the important task to keep the family happy and together. In other cases the family was very prominently present, although in a negative way, due to the sexual abuse that ran through the history of the family. Also religion seemed to play an important role. Strong moral and religious rules sheet off the family and estranged them from the outside world. Because of this, the internal support and bonding became more important. … The need and desire ‘to break free’ from these situations thus can be understood. ‘To break free’ is an expression I have often heard them saying. The ties feel too tight, it is choking them. So we can perceive a conflict between wanting to be free and needing to be connected.”1
• “Another remarkable thing was, in most cases, the creativity and artisticy. They were into writing, painting, acting. There was a lot of expression in the way they talked, their gestures, the way they would dress, sometimes even to the point of extravagance. … Most of them have a quite exalted way of talking, sometimes loquacious, sometimes just this exaltation. … What was striking to me, was their ability, in spite of severe pains or emotionally difficult situations, to remain open and expressive.”2
• “During the consultation the patient talks fast and is rather loquacious. … The speed of her talking increases the more she gets away from her emotions and when she is speaking about less important details. Sometimes she stops talking, sighs deeply, as if she would have to take a run to get something difficult out. In her explanations she theorises a lot. About herself she remarks: ‘I am a person attracted by luxury, that relates to clothes, furniture and beautiful things.’ Her behaviour is rather affected. She does not hesitate to let other people know how much difficulty she had to reach our practice, or to inform others when she is angry. She will yawn ostentatiously. During her leisure time she likes taking photographs, visiting concerts, films, art galleries and touristic places. In order to be able to do this she travels quite a lot and she enjoys travelling.”3
• “Dr. King found it in three cases, given for rheumatism, cause symptoms like those of delirium tremens. ‘In the cases referred to,’ he writes: ‘I gave 20-30 drops every hour, but on the occurrence of these symptoms omitted the medicine until they had disappeared, and again administered it, but in smaller doses, until I found that even 2 or 3 drops would be followed by the same results, and was therefore compelled to cease its use altogether. In one I was near being dismissed for insisting that patient had taken liquor. There was nausea, retching, dilated pupils, tremor of limbs, incessant talking, and changing from one subject to another without any order, though patients were perfectly sensible when addressed; great wakefulness, imagining strange objects on the bed, and in the room, as rats, sheep, etc.; sometimes arousing from their incoherent talkativeness as if startled, and requiring regarding persons present – ‘Who is that? what does he want here? etc.; with quick full pulse, wild look of eyes, and the peculiar, indescribable expression of face commonly observed among those who labour under delirium tremens.” [Hughes]
M Uneasiness / nervousness.
• “During forenoon continual restlessness, desire to move about, not knowing where to go or what to do.”
• “General uneasiness and disturbance in whole system was such that it was difficult to fix attention on any subject of business or study.”
• “General internal nervous chilly feeling all over.”
• “Peculiar uneasiness in teeth, wants to chew or pick at them.” [Hughes]
[Observed by four different provers, as well as by two of Mezger’s provers.]
M FEAR of INSANITY, esp. DURING menses or MENOPAUSE.
• “They are afraid to get insane because of strange sensations in the head, such as ‘something is pushing my brains upwards,’ ‘I have the sensation that my brains are full of air,’ ‘I have the sensation that my head is open,’ ‘I have the sensation as if wind is blowing in my brains,’ ‘I have the sensation that there is a tree in my head which makes holes in my skull.’ In all strange sensations concerning the skull, the brains or the mind, especially in relation with the menses: think of Cimicifuga.”4
M Fear and delusions of mice, rats, insects.
Alternation of mental and physical complaints.
• “Rheumatic pains can disappear while the case becomes depressive and melancholic. There is an alternation in the emotional condition, so that one time they are cheerful and another time they are sad. There is also an alternation in the physical complaints: the one time they can have a headache, the other time the headache will be gone but they will suffer from arthritis. … Cimicifuga can be loquacious or silent. Here too, you will see the changeability: the one time they can not be silent and change from one subject to another; the other time they may refuse to answer.”5
M SIGHING, esp. DURING MENOPAUSE, during MENSES.
Or and GYNAECOLOGICAL problems.
M LOQUACITY, jumps from one subject to another; about ordinary things.
Far less sharp-tongued and witty than Lach. [who takes delight in playing with words].
M SAD and gloomy, as if enveloped in a BLACK CLOUD.
• “Begins to cry for a known person, runs into the woods to weep out her soul.” [Julian]
• “I have treated very many cases of profound melancholy, even from disordered liver, by this medicine, and can assure you that it has cured the majority, and even when the disorder of the mind depended on incurable physical disease its palliative effect was remarkable. One keynote to be remembered, is sleeplessness. Many physicians have informed me that if, in cases of melancholy, sleeplessness was present, Cimicifuga nearly always cured.” [Hale]
• “I have found it useful in those depressed states of mind and body following the excessive use of tea, valerian and morphia.” [Hale]
G Ailments associated with MENSTRUAL DISORDERS or MENOPAUSE.
G Ailments and problems of nape of neck [stiffness, pain]; nausea and vomiting caused by pressure on spine and cervical region.
G Ailments during PREGNANCY.
[nausea, vomiting, sleeplessness, shooting pains, sadness, nervousness]
G Weakness from NURSING the SICK.
< COLD air. Cold air seems to penetrate the system. • “At first dry, stuffed condition of nostrils, which was soon followed by open, moist condition, with great sensitiveness to cold air, as if base of brain were laid bare, and every inhalation brought cold air in contact with it.” [Hughes] G JERKING in side lain on. G The MORE PROFUSE the menstrual flow, the GREATER the sufferings [reverse of Lach.]. Is called the “cold Lachesis”. G MENSES. Before menses: Confusion, hysteria, pain in hips, heaviness in head, aching of thyroid. During menses: Anxiety, confusion, excitement, hysteria, irritability, mental symptoms <, sadness, sighing, pressing headache, cramping pain in uterus [compelling to bend double], paroxysmal pain in uterus [bending double >, motion <], prolapse of uterus, heaviness lumbar region, labour-like pain in small of back, sore, bruised pain lumbar region, pain in extremities, convulsions, pain above the eyes, among many other symptoms. Between the menses: uterine bleeding, debility, nervous erethism, neuralgic pains, tendency to prolapsus. G Habitual abortion [third month]. G Sore, bruised pain in muscles after exertion. Sleeplessness from soreness of muscles of back; cannot lie on the back. G Rheumatic affections during MENOPAUSE. G Variability. • “Variability is a feature. Symptoms constantly change or alternate between the physical and the psychological. Neuralgic pains are shooting or like shocks. Muscle pains shift from site to site, and are accompanied by much soreness and sensation of bruisedness; the affected muscles are sore to the touch. Twitchings also occur with sudden jerky bouts of cramp, extorting cries or grunts. The cramp is brought on by movement, and relief which could be obtained by lying perfectly still is denied by the constant urge to alter position. Uterine disorders are often associated with symptoms in other sites.” [Gibson] P Pain around or behind eyes; wants to press with finger beneath upper edge of orbit. Painful eyeballs. • “Moving the head or turning the eyes causing a sensation as if the cranium was opening and shutting; head feels as if he had been without sleep a long time; brain feels too large for the cranium, pressing from within outward; when going up stairs, a sensation as if the top of the head would fly off; excruciating pain in the forehead, with coldness of the forehead, and severe pain in the eyeballs. Nearly all the pains in the head extend to the eyeballs; they are aggravated by movement, relieved by the open air, attended by faintness and ‘sinking’ at the pit of the stomach. Cimicifuga is indicated in headache resulting from loss of sleep, night-watching, and abuse of alcoholic drinks; from mental strain and worry of mind; and from exposure of the head to draughts of cold, damp air.” [Hale] P Severe dysmenorrhoea; pain extending to anterior part of thighs. Oversensitivity < during pain. Sharp, lancinating, electric-like pains. P NAPE of NECK very SENSITIVE to DRAFTS. P Locomotor system. • “Muscular soreness with darting pains affects various regions, but especially the nape of the neck, the shoulders and the Achilles tendon. These pains are worse from cold and wet but relieved somewhat by continuous movement. Low back pain brought on by exposure to cold or wet or by over-strain is made worse by first movement and eased by lying flat on the back; it is accompanied by stiffness, great restlessness and pains running down the thighs, esp. the left thigh. The lower extremities may be so weak and tremulous that walking is difficult.” [Gibson] [1-2] Corrie Hiwat, Encaged in Wires; HL 2/96.  Weidemann, Pains like electric shocks : A case of Cimicifuga; HL 4/97. [4-5] Ghegas, A heavy Black Cloud Enveloped Her; HL 2/96. Rubrics Mind Love for animals [1H]. Answering, evasively [1/1], irrelevantly , refusing to answer . Anxiety, about family [1H]. Cheerful, alternating with sadness . Confusion, before menses , during menses . Delusions, arms are bound to her body , a heavy black cloud enveloped her , encaged in wires [2/1], is away from home, must get there . Fear, threatening abortion from fear ; disease, of being incurable , of insects , in narrow places , during pregnancy , of thunderstorm [1H]. Hysteria, during menses . Indifference, to household affairs . Fear to be left alone, lest he should injure himself . Loquacity, alternating with taciturnity . Restlessness, must move constantly . Speech, cannot finish sentence . Desire for travelling . Weeping, > , when questioned , when spoken to .
Sensation of a ball rising up in head . Congestion, at every throb of heart , when pains suddenly cease . Falling of hair, from grief [1M], in menopause [1H]. Pain, accompanied by emptiness in stomach [1*], > bending head backward [1*], from loss of sleep, late hours ; vertex, on ascending stairs ; bursting, as if vertex would fly off ; opening and shutting, on moving head or turning eyes [2/1]. Wild feeling .
Unable to open eyes during menses [2/1]. Pain, in centre of eyeballs [1/1]; > lying , > pressure ; extending backward , extending to vertex .
Acute, during labour pains [1/1].
Pain, toothache, from sour things .
Constant disposition to swallow, at night .
Emptiness, when meeting a friend [1/1], during palpitations [1/1]. Nausea, from pressure on spine [1/1].
Menses, copious, after abortion or parturition ; painful, the more the flow, the greater the pain ; suppressed, from emotions . Pain, labour pains, ceasing from cramps in hip [1/1], ceasing from emotion [1/1].
Pain, rheumatic, alternating with diarrhoea .
Sleeplessness, after nursing the child [2/1], during pregnancy , from sadness [1*].
Constant change of symptoms . Chorea, from emotional excitement , with rhythmical motion .
* Repertory additions: * = Hughes / Hale. [H] = Hiwat. [M] = K-J. Müller.
“I have seen strong fear of thunderstorm in 3 cases. Love for animals in 3 cases. Anxiety about their family in 4 cases.” [Corrie Hiwat, Encaged in wires; HL 2/96]
Aversion: : Food; tobacco.
Desire: : Alcohol. : Cold drinks.
Worse: : Sour [= toothache]. : Alcohol; cold drinks [< cough]. Better: : Tea [> headache].