Monograph of Actaea (Cimicifuga) racemosa

Actaea racemosa / Cimicifuga racemosa   Images By H. Zell - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=12628603

Also known as Black Cohosh,  Baneberry2, Black Snake root2, Rattle-top2, Rattleweed2   Sheng Ma (Traditional Chinese medicine) Family Ranunculaceae Root and Rhizome are the parts used According to Traditional Chinese medicine ‘Sheng Ma’ is slightly sweet, slightly cool

Key Constituents: •       Triterpene glycosides •       Salicylic acids •       Phenolic acids •       Tannins •       Resins •       Volatile oil

Therapeutic Actions:          Antirheumatic1,6          Anti-imflammatory2          Spasmolytic1          Oestrogen modulating1,12,13, HPO Axis Regulator2,7,8          Serotonergic2  and Dopaminergic2          Uterine tonic1          Antitussive, expectorant6          Anti inflammatory2          Emmenagogue 6     Osteoprotective particularly protective against post menopausal bone loss2

Indications for use v  Traditional uses Ø  Amenorrhea1,2,7 Ø  Ovarian pain1 Ø  Partus preparator1 Ø  Arthritis 1,2,3 Ø  Rheumatism1,6 Ø  Neuralgia1,3 Ø  Myalgia1,3 Ø  Sciatica1,3 Ø  Whooping cough1,6 Ø  Tinnitus1 Ø  Inflammatory disorders2 Contemporary prescribing: v  Symptoms of menopause1,2,3,4,5,7,9 Hot flushes, vaginal thinning and drying; night sweats, sleep disturbances10; anxiety and depression4,5. v  Osteoporosis relating to menopause2 v  Dysmenorrhea1,2,7,8 v  Premenstrual syndrome1,2,7 including menstrual migraine v  Ovarian dysfunction and ovarian insufficiency1,2,7,12,13 v  Endometriosis7 v  Female infertility (primary and secondary), PCOS2,7,8,12,13 Current Studies: v    Theoretical usefulness for the treatment of prostate cancer2 v    Treatment for PCOS related infertility2,7,8,12,13

⚠ Contraindications v  Pregnancy (except for assisting birth during the last month)1 v  Lactation1 Oestrogen-dependent tumours such as breast cancer and possible interaction with Tamoxifen1 - although as Fritz et al.( cited in Braun and Cohen, 2015 p109) found in recent evidence: black cohosh does not pose a risk to those with breast cancer and Oestrogen-dependent tumours. There is also no consistent evidence to suggest Tamoxifen interacts with Black cohosh2

⚠ Cautions v  Avoid use in patients taking cisplatin, Doxorubicin and Docetaxel as part of their cancer therapy as evidence is still inconclusive as to their safety when interacting with black cohosh2. v  Traditional sources: Overdose has caused nausea and vomiting and may produce vertigo as well as visual and nervous disturbance1 v  Possible side effects1: Ø  High doses cause frontal headache. Ø  Stomach complaints

Dosage recommendations 1.5-3.0 ml of 1:2 liquid extract per day1 10-20 ml of 1:2 liquid extract per week1 0.3-2ml of 1:1 Fluid extract 3 times per day2 Decoction or powdered root 0.3-2gms 3 times per day2 Perimenopausal symptoms: 40-160mg per day2 Infertility: 20-120mg per day2 Recommended Combinations With St. John’s Wort (Hypericum perforatum) for menopausal symptoms In combination with Vitex agnus-castus, Zinc, Zingiber officinale and Hyaluronic acid within a nutraceutical (ElleN)11

References 1.     Bone K.  A Clinical Guide to Blending Liquid Herbs. St Louis: Elsevier; 2003. P 96-99 2.     Braun L and Cohen M. Herbs and Natural supplements: An evidence-based guide. 4th edition. Vol 2. Chatswood NSW: Elsevier, 2015. P 103-112 3.     Wuttke W and Seidlová-Wuttke D. Black cohosh (Cimicifuga racemosa) is a non-estrogenic alternative to hormone replacement therapy. Clinical Phytoscience International Journal of Phytomedicine and Phytotherapy. 2015 November 20 ( cited 2016 Apr 22); 1:12. DOI: 10.1186/s40816-015-0013-0 4.     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. Chin Med. 2013;8(1):20. DOI: 10.1186/1749-8546-8-20.  5.     Rostock M, Fischer J, Mumm A, Stammwitz U, Saller R, Bartsch HH. Black cohosh (Cimicifuga racemosa) in tamoxifen-treated breast cancer patients with climacteric complaints - a prospective observational study. Gynecol Endocrinol. Epub  2011 Jan 13; 27(10):844–8. doi: 10.3109/09513590.2010.538097. 6.     Grieve M. A Modern Herbal. Surrey: Merchant Book Company Ltd; 1973. P211 7.     Sarris J, Wardle J. Clinical Naturopathy: An evidence-based guide to practice. Chatswood, NSW: Elsevier; 2010. P353,355,365-366, 387-395, 406-416 8.     Trickey R. Women, Hormones and the menstrual cycle. 3rd edition. Victoria, Australia: Trickey enterprises; 2011 p166-170 9.     Ismail R, Taylor-Swanson L, Thomas A, Schnall JG, Cray L, Mitchell ES, Woods NF. Effects of herbal preparations on symptom clusters during the menopausal transition. Climacteric. 2015 Feb; 18(1):11-28. doi: 10.3109/13697137.2014.900746. 10.  Jiang K, Jin Y, Huang L, Feng S, Hou X, Du B, Zheng J, Li L. Black cohosh improves objective sleep in postmenopausal women with sleep disturbance. Climacteric. 2015; 18(4):559-67. doi:10.3109/13697137.2015.1042450. 11.  Cappelli V, Morgante G, Di Sabatino A, Massaro MG, De Leo V. Evaluation of the efficacy of a new nutraceutical product (ElleN®) in the treatment of postmenopausal symptoms. Minerva Ginecol. 2015 Dec; 67(6):515-521. 12.  Kamel H H. Role of phytooestrogens in ovulation induction in women with polycystic ovarian syndrome. European Journal of Obstetrics Gynecology and Reproductive Biology: 2013, 168 (1):p.60–63. 68. DOI: 10.1016/j.ejogrb.2012.12.025 13.  Shahin AY and Mohammed SA. Adding the phytoestrogen Cimicifugae Racemosae to clomiphene induction cycles with timed intercourse in polycystic ovary syndrome improves cycle outcomes and pregnancy rates-a randomized trial. Gynecol Endocrinol 2014, 30 (7):505–510. doi: 10.3109/09513590.2014.895983