Actaea racemosa L.

Last updated: 18 Jan 2016

Scientific Name

Actaea racemosa L.

Synonyms

Actaea gyrostachya Wender, Actaea monogyna Walter, Actaea orthostachya Wender, Botrophis actaeoides Raf. ex Fisch. & C.A.Mey, Botrophis pumila Raf, Botrophis serpentaria Raf, Cimicifuga americana Muhl, Cimicifuga racemosa (L.) Nutt, Cimicifuga serpentaria Pursh [Illegitimate] Thalictrodes racemosa (L.) Kuntze [1]

Vernacular Name

English Snake root, black cohosh, black snake root [2], cimicifuga, cohosh bugbane, rattleroot, rattleweed, rattle top, squaw root [3].

Geographical Distributions

A. racemosa, commonly called black cohosh, is native to eastern North America. Black cohosh is a wildflower of moist or dry woods cultivated as an ornamental. It is found in shady, rich soil in woods from Maine to Ontario and Winconcsin, south to Georgia. [4]

Botanical Description

A. racemosa falls under the family of Ranunculaceae. It is a hardy perennial produces clumps of quadrangular stems up to 3m tall. [4]

It has large alternate, 3-pinnately compound leaves with toothed edges, and the middle lobe being the largest. The terminal leaflet is 3-lobed. [4]

The flowers are petalless, with greenish white sepals borne in tall racemes well above the foliage. Blooming from June through September, the flowers are thought to be pollinated by flesh flies. [4]

The roots are dark brown, 1-3 mm in diameter, brittle, nearly cylindrical or obtusely quadrangular and longitudinally wrinkled. [5]

Cultivation

No documentation.

Chemical Constituent

Ethanol (50%) extract of A. racemosa rhizome has been reported to contain hydroxycinnamic acid esters (e.g. fukiic acid and piscidic acid -E-caffeoylfukiic acid (fukinolic acid), 2-E-feruloylfukiic acid (cimicifugic acid A), 2-E-isoferuloylfukiic acid (cimicifugic acid B), 2-E-feruloylpiscidic acid (cimicifugic acid E) and 2-E-isoferuloylpiscidic acid (cimicifugic acid F), free caffeic, ferulic and isoferulic acids). [6]

A. racemosa rhizome has been reported to contain triterpene glycosides (e.g. cimiracemosides A-H, actein, 27-deoxyactein, cimicfugoside M, and cimicifugoside, cimicifugoside H-1 and cimicifugosides H-2-H-6). [7][8][9]

A. racemosa rhizomes and roots has been reported to contain a lignan (e.g. actaealactone), phenylpropanoid ester derivative, (e.g. cimicifugic acid G) polyphenols (e.g. protocatechuic acid, protocatechualdehyde, p-coumaric acid, caffeic acid, methyl caffeate, ferulic acid, ferulate-1-methyl ester, isoferulic acid, 1-isoferuloyl-beta-d-glucopyranoside, fukinolic acid, and cimicifugic acids A, B, D, E, and F). [10]

Plant Part Used

Rhizome and roots [11]

Traditional Use

A. racemosa is one of the most prevalent and widely used herbs in Appalachia. It has traditionally been used in “rheumatism” and disorders of menstruation (especially for delayed menses), slow parturition, dropsy and affections of the lungs [12][13]. Often, a tincture was prepared by soaking the root in alcohol to address rheumatic pains and coughs and occasionally to help a restless baby sleep [14]. A. racemosa is currently an ingredient in a common liver formula to address “torpid liver” conditions, and to treat non-specific menstrual problems [15]. It is said to slow the pulse and soothe pain effectively, offering a mild sedative effect upon the nerves [12].

Preclinical Data

Pharmacology

Anticancer activity

Studies have indicated that extracts of black cohosh and isolated components inhibits the growth of human breast cancer cells. The treatment with an extract of black cohosh resulted in a significant dose related reduction (p<0.05) of the incidence of mammary adenocarcinomas. Black cohosh inhibited the growth of MDA-MB-453 Her2-overexpressing breast cancer cells with an IC50 value, the concentration that caused 50% inhibition of cell proliferation of approximatley 8 μg/mL compared to that for the triterpene glycoside actein of approximately 9 μg/mL. [16]

Anti-inflammatory activity

Extracts from roots of black cohosh inhibit nitric oxide production by reducing iNOS expression without affecting activity of the enzyme. In inflammation nitric oxide acts as a regulatory and pro-inflammatory mediator. Thus, A. racemosa may contribute to the anti-inflammatory activities. [17]

Toxicity

There have been reports that black cohosh exerts toxicity in vitro and in vivo. An in vitro study conducted on HepG2 cells, cytotoxicity was apparent at concentration ≥ 75 µg/mL, and mitochondrial β-oxidation was impaired at concentrations ≥ 10 µg/mL. [18]

Clinical Data

Clinical findings

A randomized, double-blind and placebo controlled trial focuses on the effect of black cohosh towards sleep in early postmenopausal women. The study was undergone for 6 month and forty-eight postmenopausal women aged 45-60 years with sleep disturbance were enrolled and received daily administration of either black cohosh or placebo. Among test performed were polysomnography and the Pittsburg Sleep Quality Index (PSQI), Menopause-specific Quality of Life questionnaire and estradiol and follicle stimulating hormone test. [19]

76 women were interviewed, of whom 42 women completed the whole trial. Compared to placebo, black cohosh treatment led to significant polysomnographic changes, including increase sleep efficiency and decreased wake after sleep onset (WASO) duration, and tended to improve PSQI with a medium effect size. In conclusion, early postmenopausal women with a major sleep complaint, black cohosh effectively improved sleep and might be a safe measure in managing menopausal sleep disturbance. [19]

A randomized, double blind, placebo-controlled trial to test the efficacy of 3 herbal regimens and hormone therapy for relief of vasomotor symptoms compared with placebo was performed. 351 women age 45 to 55 years with 2 or more vasomotor symptoms per day. The participants are divided into groups of 1) Black cohosh, 160 mg daily; 2) multibotanical with black cohosh, 200 mg daily; 3) multibotanical plus dietry soy counselling; 4) conjugated equine estrogen, 0.625 mg daily, with or without medroxyprogesterone acetate, 2.5 mg daily; or 5) placebo. At 3 months, the black cohosh group had 0.38 less night sweat per day than the placebo group (CI, -0.72 to -0.04; p = 0.0030). Black cohosh used in isolation, or as part of a multibotanical regimen, shows little potential as an important therapy for relief of vasomotor symptoms. [20]

Another randomized double-blind, placebo-controlled clinical trial was conducted on 84 early post-menopausal participants with Greene climacteric scale (GSC) scores of 15 to 42, who were referred to two public health care centers in Tehran, Iran in 2011-2012. The participants were randomly allocated into treatment of 6.5mg of dried extract of Black cohosh roots daily and control group (placebo) with a ratio of 1:1. The GCS total score in the treatment group was significantly lower than that in the control group at both week (adjusted mean difference: -7.8 (95% confidence interval: -11.41 to -4.4)) and week 8 (-12.9(-16.2 to -9.3)). The differences between the treatment and control groups at week 8 were significantly higher (p < 0.001) than those at week 4 in terms of the total scores and the vasomotor and psychiatric subscale scores. [21]

Precautions

Adverse reaction

Black cohosh may cause adverse events like nausea, vomiting, headaches, dizziness, mastalgia, and weight gain have been observed in clinical trials. A few cases of hepatotoxicity have been reported, but a direct association with the ingestion of cimicifuga has not been demonstrated. [22]

Interaction & Depletion

No documentation

Dosage

Dosage Range

The current recommended dosage of black cohosh is 40-80 mg/day. Review of the published clinical data suggests that cimicifuga may be useful for the treatment of menopausal symptoms, such as hot flashes, profuse sweating, insomnia, and anxiety. However, the methodology used in most of the trials is poor and further clinical assessment of cimicifuga is needed.

Poisonous

No documentation

Line drawing

No documentation

References

  1. The Plant List. Ver1.1. Actaea racemosa L. [homepage on the Internet]. c2013 [updated 2012 Mar 23; cited 2015 March 17] Available from: http://www.theplantlist.org/tpl1.1/record/kew-2620567
  2. Quattrocchi U. CRC World Dictionary of Plant Names: Common names, scientific names, eponyms, synonyms, and etymology. Volume I A-C. Boca Raton, Florida: CRC Press LLC, 2000; p. 539.
  3. Khan IA, Abourashed EA. Leung’s encyclopedia of common natural ingredients used in foods, drugs and cosmetics. Hoboken, New Jersey: John Wiley & Sons, 2010; p. 48.
  4. McKenna DJ, Jones K, Humphrey S, Hughes K. Black cohosh: Efficacy, safety, and use in clinical and preclinical applications. Alternative therapies in health and medicine. New York: The Haworth Press, 2001; p. 93-100.
  5. Medicines and Healthcare products Regulatory Agency (MHRA). British pharmacopoeia 2014. Volume IV. London: The Stationary Office, 2014; p. 103.
  6. Kruse SO, Lohning A, Pauli GF, Winterhoff H, Nahrstedt A. Fukiic and piscidic acid esters from the rhizome of Cimicifuga racemosa and the in vitro estrogenic activity of fukinolic acid. Planta Med. 1999;65(8):763-764.
  7. Sakurai N, Nagai M. Chemical constituents of original plants of Cimicifugae rhizoma in Chinese medicine. Yakugaku Zasshi. 1996;116(11):850-865.
  8. Shao Y, Harris A, Wang M, et al. Triterpene glycosides from Cimicifuga racemosa. J Nat Prod. 2000;63(7):905-910.
  9. He K, Zheng B, Kim CH, et al. Direct analysis and identification of triterpene glycosides by LC/MS in black cohosh, Cimicifuga racemosa, and in several commercially available black cohosh products. Planta Med. 2000;66(7):635-640.
  10. Nuntanakorn P, Jiang B, Einbond LS, Yang H, Kronenberg F, Weinstein IB, Kennelly EJ. Polyphenolic constituents of Actaea racemosa. J Nat Prod. 2006;69(3):314-318.
  11. Lloyd JU, Lloyd CG. Bulletin of the Lloyd Library of Botany, Pharmacy and Materia Medica. Bulletin 30. Reproduction Series no 9, part 2. Cincinnati, Ohio: Lloyd Library and Museum; 1931.
  12. Crellin JK, Philpott J. A reference guide to medicinal plants. Durham, North Carolina: Duke University Press; 1990.
  13. Millspaugh CF. American medicinal plants. New York: Dover Publications; 1974.
  14. Howell P. Medicinal plants of the Southern Appalachians. Mountain City, Georgia: BotanoLogos Books; 2006.
  15. Cavender A. Folk medicine in Southern Appalachia. Chapel Hill, North Carolina: The University of North Carolina Press; 2003.
  16. Einbond LS, Soffritti M, Degli Esposti D, et al. Chemopreventive potential of black cohosh on breast cancer in Sprague-Dawley rats. Anticancer Res. 2012;32(1):21-30.
  17. Schamid D, Gruber M, Woehs F, et al. Inhibition of inducible nitric oxide synthesis by Cimicifuga racemosa (Actaea racemosa, black cohosh) extracts in LPS-stimulated RAW 264.7 macrophages. J Pharm Pharmacol. 2009;61(8):1089-1096.
  18. Lüde S, Török M, Dieterle S, et al. Hepatic effects of Cimicifuga racemosa extract in vivo and in vitro. Cell Mol Life Sci. 2007;64(21):2848-2857.
  19. Jiang K, Jin Y, Huang L et al. Black cohosh improves objective sleep in postmenopausal women with sleep disturbance. Climacteric. 2015;18(4):559-567.
  20. Newton KM, Reed SD, LaCroix AZ, Grothaus LC, Ehrlich K, Guiltinan J. Treatment of vasomotor symptoms of menopause with black cohosh, multibotanicals, soy, hormone therapy, or placebo: A randomized trial. Ann Internal Med. 2006;145(12):869-879.
  21. 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.
  22. Mahady GB. Black cohosh (Actaea/Cimicifuga racemosa): Review of the clinical data for safety and efficacy in menopausal symptoms. Treat Endocrinol. 2005;4(3):177-184.