by
April Kostick, Ashley Fauver, and Kristen Bohan
Wilkes University, Wilke-Barre,
PA
July 2005
Cimicifuga
racemosa, commonly the black cohosh, is a member of the
buttercup family, Ranunculaceae (www.encyclopedia.com,
2005). It is also known as bugbane, black root, rattle root,
rattle top, rattle squawroot, rattle weed, and black snakeroot
(Dumaine, 1991). Black cohosh grows as a 3-8' tall perennial herb
that is native to the eastern deciduous forests of North America,
ranging from southern Ontario to Georgia, north to Wisconsin and West
to Arkansas (Foster, 2000). Flowering stems are topped by a long plume
of white flowers between June and September (Foster, 2000). The leaves
are large and pinnately compound (Foster, 2000). The leaflets are
irregularly shaped with toothed edges (Foster, 2000).
Cimicifuga racemosa is a native North American and folk remedy
that was introduced to the early settlers by the American Indians who
used it for female ailments such as menstrual cramps, uterine spasms,
fatigue, anxiety, rheumatoid arthritis, sore throat, and
diarrhea. It is used to help control hot flashes and vaginal
dryness, also headache and depression associated with menopause
(Greenbrook Farms Herbs & Such, 1998). Black cohosh rhizomes
and roots were routinely used to treat coughs, colds, constipation,
fatigue, and rheumatism, as well as to increase breast milk production
(Mahady et al., 2002). Korean folk medicine has widely used Cimicifuga racemosa as therapeutic
for pain and inflammation (Kim, et.al. 2005).
Black cohosh contains several important ingredients that make it
important medicinally (Foster, 2000). Examples include triterpene
glycosides (e.g. acetin and cimicifugoside), isoflavones (e.g.
formononetin), aromatic acids, tannins, resins, fatty acids, starches,
and sugars (Foster, 2000).
C. racemosa has been found to be therapeutic in several
different ways. It has been found to be an alternative therapy
for menopause as well as being used diaphoretic, antipyretic,
antifungal, and antibacterial (Foster, 2000). The safety of
using black cohosh was also tested to determine whether it caused DNA
damage, cancers, or allergies.
The active element formononetin binds to estrogen receptor sites
inducing an estrogen-like activity in the body (Foster, 2000). Clinical
studies in Germany have demonstrated that an alcohol extract of black
cohosh decreases luteinizing hormone (LH) secretions in menopausal
women (Foster, 2000).
A German study was performed to test the efficacy of black cohosh
extract, commercially known as Remifemin, with that of conjugated
estrogens for the treatment of climacteric symptoms and vaginal atrophy
(Stoll, 1987). Climacteric symptoms are characterized by
physiological and psychic change at the end of the reproductive
capacity of women and terminate with the completion of menopause
(www.dictionary.com,
2005). Vaginal atrophy is the diminution in
the size of the cells in the vagina from their normal size
(www.encyclopedia.com,
2005). At the end of the 12 week treatment
period, all groups showed improvements, in the group treated with the
black cohosh, however, a significant decrease in climacteric symptoms
was observed by a reduction in the Kupperman Index (KI) from 34 to 14,
which indicates an improvement in vasomotor symptoms. The group
treated with black cohosh extract also showed a significant decrease in
the Hamilton Anxiety Rating Scale (HAMA), and a significant improvement
in the proliferative status of the vaginal epithelium, which indicates
a possible estrogenic effect (Stoll, 1987).
In an open study, 50 women with climacteric symptoms, who had
previously been treated with intramuscular injections of estradiol
valerate and prasteronenantate, were alternatively treated with
Remifemin extract. Twenty-eight patients required no further
injections, 21 patients required one injection in six months, and one
patient required two injections. The Kupperman Index decrease to
below 15 points, indicating alleviation of symptoms (Petho,
1987). Placebos were also used.
An open multicenter drug-monitoring study of 629 patients with
menopausal symptoms assessed the efficacy of SBC-R extract at a dose of
80 mg daily for eight weeks of treatment. Symptoms such as hot
flashes, profuse sweating, headache, vertigo, nervousness, and
depression were improved in more than 80% of all cases after six to
eight weeks of treatment with the extract (Stolze, 1982).
Cimicifuga racemosa has been
further examined to determine if it possesses health benefits in
addition to aiding menopausal symptoms. Methanol extracts were
investigated for potential against menadione-induced DNA damage
(Burdette, et al, 2002). The extracts were observed to scavenge
1, 1-diphenyl-2-picrylhydrazyl (DPPH) free radicals (Burdette, et al,
2002). The extracts also showed dose-dependent decreases in DNA
single-stranded breaks and oxidized bases induced by the quinine
menadione-using comet and fragment length associated repair enzyme
assays (Burdette, et al, 2002). Nine compounds showing
antioxidant activity were subsequently isolated. Six of these
antioxidants were found to reduce menadione-induced DNA damage in
cultured S30 breast cancer cells in their respective order of potency:
methyl caffeate, caffeic acid, ferulic acid, cimiracemate,
cimiraceamate, fukinolic acid (Burdette, et al, 2002). On that
basis the authors determined that black cohosh could protect against
cellular DNA damage caused by reactive oxygen species by acting as
antioxidants (Burdette, et al, 2002).
Supplements containing Cimicifuga
racemosa were studied to determine the metabolism and possible
toxicity of metabolites because they are so widely used by women
(Johnson and van Breeman, 2003). After collecting urine samples from
each of the women who participated in the study, a total of eight
electrophillic metabolites of black cohosh were detected (Johnson and
van Breeman, 2003). These included quinoid metabolites of fukinolic
acid, fukiic acid, caffeic acid and cimiracemate B. Additional quinoid
metabolites were formed from hydroxytosol and dihydroxyphenyl lactic
acid neither of which had been previously isolated from black cohosh
(Johnson and van Breeman, 2003). Mercapturate conjugates of these
metabolites were not detected in urine samples from women who consumed
single oral doses of up to 256mg of standardized black cohosh extract
(Johnson and van Breeman, 2003). This shows that moderate doses
of a dietary supplement containing black cohosh shows no adverse
reactions for the formation of quinoid metabolites in women (Johnson
and van Breeman, 2003).
The safety of estrogen replacement for women with endometrial, ovarian,
and breast cancers has been questioned after reports that estrogen
stimulates proliferation of estrogen receptor positive tumors (Lancet,
1997). In vitro studies of isopropanolic black cohosh extracts on
estrogen-receptor positive breast cancer cell lines suggest that they
do not stimulate cell proliferation (Bodinet, et al, 1999;
Dixon-Shanies, et al, 1999; Freudenstein, et al, 1999). The model
used in this study was designed to evaluate the safety of black cohosh
extracts for treatment of menopausal complaints with a history of
breast cancer (Freudensein, et al, 2002). Mammary tumors were induced
in Sprague Dawley rats. Doses of black cohosh were administered or
controlled substances (placebo). Tumor number, size, plasma hormone
levels, and weight of estrogen-sensitive organs were analyzed
(Freudenstein, et al, 2002). On that basis, the authors concluded
that the black cohosh treatment did not stimulate cancerous growth
(Freudenstein, et al, 2002).
The potential effects of the extract on mast cell-dependant allergy
reaction were tested using in vivo and in vitro models (Kim, et.al.
2005). In local lymph node assay the extract showed no potential of
skin sensitization. The oral administration of the extract
significantly inhibited the anti-IgE-induced passive cutaneous
anaphylaxis reaction (Kim, et.al. 2005). There was also no inhibitory
potential on the compound 48/80 induced histamine releases from
peritoneal mast cells (Kim, et.al. 2005). These results demonstrate
that the black cohosh has an anti-allergic potential and it may be due
to the inhibition of histamine releases and cytokine gene expression in
the mast cells (Kim, et.al. 2005).
Black cohosh can have adverse effects when not taken in the proper
dosage. Large dosages can cause abdominal pain, nausea,
headaches, dizziness, symptoms of poisoning, and can also provoke
miscarriage (Foster, 2000). This herbal remedy has been also
shown to cause the body’s immune system to launch an attack on the
liver, known as autoimmune hepatitis. Autoimmune hepatitis causes
fatigue, abdominal discomfort, aching joints, and itching; without
proper treatment the illness will progress and may be fatal (Laino,
2003).
Black cohosh has been determined to be effective in several
therapies. One therapy where it has been successful is relief of
menopausal symptoms, such as hot flashes and menstrual cramps in
decreasing secretions of luteinizing hormones. Other therapies
that have shown positive results include anxiety and fatigue. Studies
have also demonstrated that cancerous growth does not arise from Black
cohosh. Cimicifuga racemosa
has anti-allergic potential and may prevent DNA cellular damage.
Black cohosh has been found in several studies to be both effective and
safe, when the recommended dosages are taken.
LITERATURE CITED:
Anonymous. 2005. http://www.dictionary.com.
Anonymous. 2005. http://www.encyclopedia.com.
Burdette, J.E., S.N. Chen, & Z.Z. Lu. 2002. Black cohosh (Cimicifuga racemosa L.) protects
against menadione-induced DNA damage through scavenging of reactive
oxygen species: bioassay-directed isolation and characterization of
active principles. J Argic Food Chem. 50(24):7022-8.
Dasenbrook, C., J. Freudenstein, & T. NiBlein. 2002. Lack of
promotion of estrogen-dependent mammary gland tumors in vivo by an
isopropanolic Cimicifuga racemosa
extract. Cancer Research 62: 3448-3542.
Dumaine, S.E. 1991. Bugbane. Horticulture 69.
Foster, S. 2000. Black cohosh; Cimicifuga
racemosa. The Steven Foster Group. Retrieved on July 12,
2005 from http://www.stevenfoster.com/education/monograph/bkcohosh.html.
Greenbrook Farms Herbs & Such. Herb Facts and Tips: Black
Cohosh. Retrieved June 29, 2005, from http://www.glenbrookfarm.com/herbs/blackcoh.htm.
Johnson, B.M. and R.B. van Breemen. 2003. In vitro
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cohosh). Chem. Res. Toxicol 7:838-46.
Kim, C.D., H.S. Cho, & M.H. Lee. 2004. Inhibition of
mast-cell dependent allergy reaction by extract of black cohosh (Cimicifuga racemosa).
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Mahady, G.B. & D. Fabricant. 2002. Black cohosh:
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Petho A. 1987. Klimakterische Beschwerden. Umstellungeiner
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Artliche Praxis. 38:1551-1553.
Stoll W. 1987. Phytopharmakon beeinflußt atrophisches
Vaginalepithel Doppelblindversuch Cimicifuga vs.
Ostrogenpraparat. Therapeutikon.1:7-15.
Stolze H. 1982. Der andere Weg, klimakterische Beschwerden zu
behandeln. Gyne.1:14-16.