Black cohosh

Common name: Black cohosh
Other names: Squawroot, snakeroot, cimicifuga
Latin name: Actea racemose, cimicifuga racemosa
Affinities: Immune system, endocrine system, nervous system, reproductive system, musculoskeletal system
Actions: Antispasmodic, analgesic, emmenagogue, sedative, nervine, immunomodulator, alterative, antirheumatic, antidepressant
Specific indications: Joint or muscle pains and aches, dull aching pains, sharp shooting pains, pelvic inflammation, painful and delayed menstruation, pelvic cramps, depression, fatigue
Diseases: Fibromyalgia(3), arthritis(3), sciatica(3), bursitis(3), trigeminal neuralgia(3), endometriosis(3), prostatitis(3), insomnia(1), anxiety(3), migraines(3), hot flashes(3), depression(3), hypertension(3)
Parts used: Roots
Energetics: Cooling, drying


Characteristics: Black cohosh is a striking, 3 to 9 inches’ tall plant and member of the buttercup family, found growing in hardwood forests in the USA and Canada (Kuhn and Winston, 2000). It has small white flowers and blooms from July to September. Black cohosh is called ‘black’ because of the dark colour of the plants medicinal roots (Castleman, 2001). The word ‘cohosh’ is Algonquin (native American) for ‘rough’, another reference to the roots.

History: Black cohosh was used medicinally by the Native Americans and they boiled the gnarled roots in water and drank the decoction for fatigue, arthritis, sore throat, and rattle-snake bite (Castleman, 2001). Black cohosh was also used by Native American women for gynecological problems and for recovery post child birth. Wild black cohosh grew most abundantly in the Ohio River Valley, which is fitting as the Eclectic medical school was located in Cincinnati on the banks of the Ohio. The Eclectics, who were America’s 19th century physicians, used the herb for fever, rashes, insomnia, malaria, yellow fever, gynecological ailments, myalgia, neuralgia, and rheumatic conditions (Castleman, 2001; Mills and Kerry, 2000). The Eclectic’s held the herb in very high regard and in King’s American Dispensatory, it is stated, ‘(black cohosh) is a very active, powerful, and useful remedy, and appears to fulfil a great number of indications… Few of our remedies have acquired as great a reputation in the treatment of rheumatism and neuralgia.’ (Felter and Lloyd, 1898).

Current applications: Black cohosh is a versatile herb, inherited from the Native Americans, and is one of their most powerful remedies still in use today. David Hoffman in his text, Holistic Herbal, mentions that black cohosh is a most powerful relaxant and a normaliser of the female reproductive system (Hoffman, 1988). He states it may be of use in painful or delayed menstruation, ovarian cramps, cramping pain in the womb, rheumatic conditions of all kinds including rheumatoid arthritis, osteoarthritis, and those involving muscular and neurological pains. He mentions it finds use in sciatica and neuralgia. It may be of use in situations where a relaxing nervine is required such as in labour and reducing spasms in whooping cough.

An old Native American remedy for rheumatism is black cohosh, prickly ash, burdock, and poke-root (Gladstar, 2000). Although poke root is a toxic herb and must be used only with great caution at very small doses. A famous formula for nervous afflictions, by the late Dr. Christopher called the ‘B&B formula’, was black cohosh, blue cohosh, lobelia, blue vervain, and skullcap in equal parts (Christopher, 1976). However, from an energetic standpoint this would be a rather cooling drying formula, so it is important to bear the constitution in mind. Black cohosh is quite a strong anti-depressant and is good for those people with depressive dark moods and fibromyalgia. David Winston has mentioned it may be combined with kava, ashwagandha, and white peony for fibromyalgia.

Science: Black cohosh extracts have shown both anti-inflammatory and anti-oxidant activity in ex vivo experimental studies (Yang et al., 2009; Burdette et al., 2002). The main studied use of black cohosh in humans has been to treat hot flashes, however, evidence shows conflicting results (Pockaj et al., 2004; Pockaj et al., 2006). One double blind placebo controlled study demonstrated significant improvements in sleep in patients treated with black cohosh (Jiang et al., 2015).

Safety: Moderate. Black Cohosh must not be used at the same time as Tamoxifen as it increases its effects. Black Cohosh should also be avoided in pregnancy and breastfeeding. If combining black cohosh with sedative drugs it is best to be extra cautious regarding dosage. There is a case report that black cohosh irritates the nervous system at high doses, so it is best to stick with the lower dose range with this herb.

Dosage: Tincture: 5-30 drops 2-3 times daily. Low doses are better with this herb.

Form: Rosemary Gladstar and Matthew Wood point out in Rosemary Gladstar’s text, Planting the future: saving our medicinal herbs, the tincture of black cohosh made from fresh roots is more effective than dried (Gladstar, 2000).

Scientific Summary

Research on models

Anti-inflammatory: A study identified a compound in the roots of black cohosh called cimiracemate A which suppressed TNF-α production in the blood macrophages ex vivo (Yang et al., 2009).

Anti-oxidant: One study found that an methanol extract of black cohosh can protect against cellular DNA damage caused by reactive oxygen species by acting as an anti-oxidant (Burdette et al., 2002).

Research on humans

Hot flashes: One study (n = 21, double blind placebo controlled) found that a commercial extract of black cohosh called remifemin reduced mean daily hot flash frequency by 50% (Pockaj et al., 2004). Additionally, patients reported improvements with sleeping, less fatigue, and less sweating. Black cohosh was well tolerated and no patients discontinued due to adverse events.

Hot flashes(II): A follow up study to the one in 2004 (n = 132, double blind placebo controlled) observed no significant improvement in hot flashes, the authors used a 20mg dried extract taken twice daily (Pockaj et al., 2006).

Insomnia: One study (n = 42, double blind placebo controlled) found significant improvements in sleep in postmenopausal women with sleep disturbance (Jiang et al., 2015).


Burdette, Joanna E., et al. “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.” Journal of agricultural and food chemistry 50.24 (2002): 7022-7028.

Castleman, Michael. “The new healing herbs.” Bantam Book, New York (2001): 465-471.

Christopher, John R. School of Natural Healing. Christopher Publications, 1976.

Gladstar, Rosemary, and Pamela Hirsch, eds. Planting the future: saving our medicinal herbs. Inner Traditions/Bear & Co, 2000.

Hoffman, David. Holistic herbal. Element Books, 1988.

Jiang, K., et al. “Black cohosh improves objective sleep in postmenopausal women with sleep disturbance.” Climacteric 18.4 (2015): 559-567.

Felter, Harvey and Lloyd, John. King’s American Dispensatory, 1898.

Kuhn, Merrily A., and David Winston. Herbal therapy and supplements: a scientific and traditional approach. Lippincott Williams & Wilkins, 2000.

Mills, Simon, and Kerry Bone. Principles and practice of phytotherapy. Modern herbal medicine. Churchill Livingstone, 2000.

Pockaj, Barbara A., et al. “Phase III double-blind, randomized, placebo-controlled crossover trial of black cohosh in the management of hot flashes: NCCTG Trial N01CC1.” Journal of Clinical Oncology 24.18 (2006): 2836-2841.

Pockaj, Barbara A., et al. “Pilot evaluation of black cohosh for the treatment of hot flashes in women.” Cancer investigation 22.4 (2004): 515-521.

Wood, Matthew. The Earthwise Herbal, Volume I: A Complete Guide to Old World Medicinal Plants. North Atlantic Books, 2011.

Yang, Cindy LH, et al. “Identification of the bioactive constituent and its mechanisms of action in mediating the anti-inflammatory effects of black cohosh and related Cimicifuga species on human primary blood macrophages.” Journal of medicinal chemistry 52.21 (2009): 6707-6715.