Richard Mandelbaum RH

November 2016

Actaea racemosa
formerly Cimicifuga racemosa
Ranunculaceae

Black cohosh
black snakeroot
fairy candles
bugbane

Part used: rhizome

Native range: eastern North America

Harvestable status / sustainability: overharvested in the wild, widely cultivated (wild

black cohosh should not be used in commerce and is
listed as At-Risk by United Plant Savers)

Flavor: acrid, sweet, bitter

Energetics: cool, mildly drying

Actions: antispasmodic, emmenagogue, nervine and antidepressant, mildly sedative,

analgesic, cardiotonic, anti-inflammatory, anti-rheumatic, alterative, female
hormonal modulator/ regulator, antitussive, anti-cancer, vasodilative, mild
hypotensive and diuretic

Black cohosh, while a popular herbal remedy in modern times, is vastly underused by
herbalists for its breadth of values and indications. Energetically it moves in an ascending
direction which gives the herb a supportive nature. Its acrid flavor reflects its Liver Wind
calming qualities particularly in cases of tics, tremors, seizures, etc., as well as “stuck”
emotional qi. David Winston indicates black cohosh for “black cloud depression”.

Energetically black cohosh moves and regulates Qi and moves Blood, useful in patterns of
Stagnant Qi and Stuck Blood (Garran) that can manifest as menstrual / hormonal imbalances,
spasms and cramping, and pain. It also nourishes the Shen and upholds the Spleen Qi.

Eclectics and Physiomedicalists used Actaea, then known as Macrotys or Cimicifuga, widely
and according to most if not all of the indications listed here, and based their uses largely on
Richard Mandelbaum RH
November 2016

Native American traditional uses. Practitioners would do well to keep in mind Finley
Ellingwood’s specific indication of “a general tired feeling with aching of the muscles”.

Indications:
Shen and Heart remedy:
• Melancholy, depression, feeling of deep-seated dark emotional state with or without
insomnia; what David Winston calls “black cloud” depression; particularly when
associated with reproductive hormone imbalances.
• Cardiac remedy: Mildly slows and strengthens heart contractions and dilates the blood
vessels, increasing oxygen supply to the heart muscle; anxiety with tachycardia/
palpitations, angina, or hypertension. Can be combined with Leonurus, Lycopus, Salvia
miltiorrhiza.
Musculoskeletal and Neurological uses:
• Dull, aching pain and the following musculoskeletal indications, especially manifesting
as Wind-Damp:
o Rheumatic and arthritic complaints: rheumatoid arthritis, osteoarthritis, Lyme
arthralgia
o Muscular arthritis, fibromyalgia
o Other muscular pain, aching, and discomfort; stiff neck, back; “a general tired
feeling with aching of the muscles” (Ellingwood)
o Acute fever, especially with muscular spasm/pain
• Wind patterns: tics, tremors, periodic convulsions and seizures; chorea, dyskinesia or
hyperkinesia (Cook considered it the supreme remedy for chorea).
o Traditionally combined with Passiflora; other herbs to consider include Valeriana,
Lobelia, Scutellaria, Acorus
• Reduces cerebral and cerebro-spinal meningeal irritation and inflammation: meningitis,
Lyme (note that some people suffer headaches from taking black cohosh)
• Neuralgias, sciatica
Hormonal and Reproductive Uses:
• Hormonal modulator - Phytochemical mechanism of hormone regulation not well
understood. The best to-date research indicates no phytoestrogenic activity, while
earlier more preliminary research indicated some binding with estrogen receptor sites
and suppression of LH. Research to date indicates no direct estrogenic effect, no harm
when there is an estrogen-sensitive cancer (although more research needs to be
conducted) and possibly even some benefits. Ganora writes that the triterpene/
saponin glycosides found in Actaea do not bind to estrogen receptor sites like the
isoflavanoid phytoestrogens. These constituents appear to regulate LH, promote
apoptosis of breast cancer cells, and mitigate imbalanced perimenopausal symptoms.
• Gynecological indications include:
o Menopausal complaints (thought to potentially suppress surges of luteinizing
hormone): depression, anxiety, hot flashes, insomnia, vaginal dryness, loss of
libido, cognitive dysfunction
Richard Mandelbaum RH
November 2016

Ought to be combined with nourishing yin tonics like Avena, Asparagus,

Glycyrrhiza
o Moves Blood: dysmenorrhea (painful menses) with delayed menses, abdominal
fullness, amenorrhea, irregular menstrual cycle
o Ovarian pain, endometriosis
o PMS with anxiety, depression, melancholy (PMS-D)
o Delayed or difficult menarche / onset of menses, especially with mood swings,
stress/anxiety, depression, acne, etc.
o Difficult puberty especially for girls, with moodiness, depression
o Has shown some anti-cancer activity in estrogen-sensitive breast and ovarian
cancers
• Used by some midwives (as well as historically the Eclectic physicians) during the final
stages of pregnancy as a partus preparator; this should only be done under the
guidance of a qualified practitioner. Also used for post-partum pain (historically
combined with Mitchella, Cypripedium and Trillium, although the use of these last two
herbs is now limited by their diminished and threatened status).
Calms Lung Wind:
• Irritable coughs such as associated with acute bronchitis, pertussis (whooping cough)
and spasmodic asthma. Cook recommended adding tincture of black cohosh to
marshmallow syrup for spasmodic, irritated coughs. Also can be combined with
Glycyrrhiza, Lobelia, Inula.

Chinese traditional uses of related species:

• Cimicifuga foetida, C.dahurica and C. heracleifolia are used in Chinese medicine as sheng
ma. It is considered to have an ascending quality and is avoided in cases of Liver Yang
Rising or ascending qi patterns (Stomach, Lung). It is used to
o Release the exterior especially in cases of wind-heat manifesting as headache,
fever, rash, itching, and measles. For measles it is combined with Pueraria,
Arctium seed, Scutelleria baicalnesis, Glycyrrhiza, and Mentha. (Chen and Chen)
o Clear toxic heat in cases of mouth and/or gum ulcerations, sores with swelling
and pain, toothache, throat pain, abscesses and sores.
o To raise Yang Qi in cases of organ prolapse (for prolapse often combined with
Pueraria and Bupleurum)
*There are clearly some overlapping actions and qualities between sheng ma and black cohosh,
but they do not seem to be fully interchangeable.

Safety, Toxicity and Contraindications:

• AHPA Safety Class 2b, Interaction Class A: usage during pregnancy and lactation
should be only under the guidance of a qualified practitioner.
• May rarely cause GI upset or headache; a high dose can result in vertigo, dizziness,
nausea, headache, vomiting, hypotension although these side effects in some cases
dissipate after several hours and do not return, and may be more likely from the
tincture than the infusion or powder.
Richard Mandelbaum RH
November 2016

• May in some cases reinitiate menstruation in some perimenopausal women; is generally

not very helpful in early menopause induced by hysterectomies.
• No known herb-drug interactions but avoid combining with hypotensive drugs unless
under the supervision of a qualified practitioner.
• Reports of potential hepatotoxicity have not been well substantiated and appear to be at
least in part attributable to adulteration with other spp. of Actaea.
• Citations limiting the safe duration of usage to six months are based on a
misunderstanding/mistranslation. Safe for longer term use if indicated and especially
when formulated well.

Preparation:
Decoction (flavor is quite acrid)
Tincture
Capsule
Dosage:
1 tsp to 8 oz water as decoction, taken in 2-3 doses throughout day
½-1 ml three times per day as tincture
500 mg three times per day as capsule

Major plant constituents: triterpenes, glycosides, tannins, salicylates

Additional notes:
• Generally considered not interchangeable with other native Actaea spp. Such as Actaea
pachypoda and Actaea rubra (baneberry), although some indications may overlap.

Sources:
AHPA Botanical Safety Handbook, 1st and 2nd Editions
Blumenthal, ABC Clinical Guide to Herbs
Bone and Mills, Principles and Practice of Phytotherapy
Brinker, Herb Contraindications and Drug Interactions
Chen and Chen, Chinese Medical Herbology and Pharmacology
Cook, Physio-medical Dispensatory
Ellingwood, American Materia Medica
Felter-Lloyd, King’s American Dispensatory
Gaby, A to Z Guide to Drug-Herb-Vitamin Interactions
Ganora, Herbal Constituents
Garran, Western Herbs According to Traditional Chinese Medicine
Hoffmann, Medical Herbalism
PDR for Herbal Medicines, Third Edition
Skenderi, Herbal Vade Mecum
Tierra, Planetary Herbology
Trickey, Women, Hormones, and the Menstrual Cycle
Weiss, Herbal Medicine
Winston and Kuhn, Herbal Therapy and Supplements