United States

Department

of Agriculture

Forest Service

Southern

Research

Station

General

Technical

Report

SRS–97

United States

Department

of the Interior

National 

Park Service
Black Cohosh (Actaea racemosa)

is one of the more prominent medicinal plants 

harvested from Appalachian forests. Concern

for the conservation of the plant is increasing.

The Authors:

Mary L. Predny, Research Associate, Virginia Polytechnic Institute and State 

University, Wood Science and Forest Products Department, Blacksburg, VA 24061.

Patricia DeAngelis, Botanist, U.S. Fish and Wildlife Service, Division of

Scientific Authority, Arlington, VA 22203.

James L. Chamberlain, Research Scientist, U.S. Department of Agriculture, 

Forest Service, Southern Research Station, Blacksburg, VA 24060.Cover photograph by Thomas G. Barnes
Black Cohosh (Actaea racemosa): An 

Annotated Bibliography

Mary L. Predny, Patricia De Angelis, and 

James L. Chamberlain

Statements made by authors in this document concerning 

medicinal uses and properties may not have been evaluated by 

the Food and Drug Administration, and are included for 

educational purposes only. Discussion of medical uses is not 

intended for diagnoses, treatment, cure, nor prevention of 

disease. Information in this publication about medicinal uses is 

intended for educational purposes only and is not a substitute 

for the advice of qualified healthcare professionals. Material 

presented in this document is for reader information only 

and does not imply endorsement by the U.S. Department of 

Agriculture.

November 2006

Southern Research Station

200 WT Weaver Boulevard

Asheville, NC 28804-3454

i
ii
Table of Contents

Nomenclature .............................................................................................. 1

Botany and Ecology..................................................................................... 2

Medicinal Uses............................................................................................. 5

Historical.................................................................................................. 5

Modern..................................................................................................... 6

Clinical Research ..................................................................................... 7

Other Uses.................................................................................................... 9

Market Trends........................................................................................... 10

Wild Harvest.............................................................................................. 10

Herbal Industry Reports: American Herbal Products

 Association Tonnage Surveys............................................................... 11

Permit Sales............................................................................................ 12

Seed Harvest........................................................................................... 12

Export......................................................................................................... 13

Phytosanitary Certificates ...................................................................... 13

Port Data................................................................................................. 14

Conservation Status.................................................................................. 15

Discussion .................................................................................................. 16

Acknowledgments ..................................................................................... 16

Literature Cited......................................................................................... 17

Annotated Bibliography ........................................................................... 27

Research Literature ................................................................................ 27

Popular Press.......................................................................................... 77

Other Information Sources..................................................................... 83

Vendors................................................................................................... 93

Author Index.............................................................................................. 95

Subject Index ............................................................................................ 97

Disclaimers................................................................................................. 99

iii
iv
Black Cohosh (Actaea racemosa): An 

Annotated Bibliography

Mary L. Predny, Patricia De Angelis, and 

James L. Chamberlain

Abstract

Black cohosh (Actaea racemosa, Syn.: Cimicifuga racemosa), a member of the buttercup 

family (Ranunculaceae), is an erect perennial found in rich cove forests of Eastern North 

America from Georgia to Ontario. Native Americans used black cohosh for a variety of 

ailments including rheumatism, malaria, sore throats, and complications associated with 

childbirth. Europeans have used this important medicinal plant to treat menopausal symptoms 

for over 40 years. Recent clinical evidence supports the efficacy and safety of black cohosh 

for these symptoms. Recent decisions by the U.S. Food and Drug Administration on hormone 

replacement therapy have increased the demand for black cohosh. In a 1-year period ending in 

1998, retail sales increased more than 500 percent. In 2001, when retail sales in other segments 

of the herbal products industry were down, black cohosh sales increased about 2 percent to 

an estimated value of $6.2 million. Nearly 100 percent of black cohosh raw materials is wild 

harvested. Though it has received an “apparently secure” ecological ranking on the global 

and national scales, conservation groups list the species as “at risk” in the United States and 

endangered in Illinois and Massachusetts. Research is underway to determine sustainable 

harvest levels and to establish suitable cultivation methods.

Keywords: Conservation, medicinal plants, menopause, nontimber forest products, 

phytoestrogens, poaching.

Nomenclature

The scientific name for black cohosh has changed several times throughout 

botanical history. According to Foster (1999), the first known classification 

was made in 1705 by Plukenet, as Christopheriana facie, Herba spicata, 

ex Provencia Floridiana. In pre-Linnaean times (before 1750) the plant 

was most commonly known as Actaea, though some botanists still used the 

genus Christopheriana. Linnaeus first classified black cohosh as Actaea, 

but later separated out the genus Cimicifuga based on differences in fruit 

characteristics, where Actaea had fleshy berries and Cimicifuga had dry 

follicles. The name Cimicifuga was used until Rafinesque noted that black 

cohosh did not fit clearly into Linnaeus’ classification and renamed the 

plant Macrotrys. Eton adopted this classification but dropped the second 

“r”, making it Macrotys. In the eclectic1 pharmacopeias of the late 1800s 

1

Eclectic physicians were doctors who treated patients with herbal medicines between the late 

1800s and early 1900s.

1
and early 1900s, Macrotys was commonly used both as the genus and the 

common name. The species name varied along with the genus name, though 

the most commonly used were “canadensis,” “spicata,” “racemosa,” or 

“serpentaria.” Modern botanists reverted back to Cimicifuga, the genus 

assigned by Linnaeus, until 1998 when Compton and others evaluated 

morphological traits and deoxyribonucleic acid (DNA) sequences and put 

all of the species in Cimicifuga and Souliea back under Actaea (Compton 

and others 1998a, 1998b; Foster 1999). There are differences of opinion in 

the botanical community about whether black cohosh should be treated as 

a separate genus; however, for the purposes of this publication, the authors 

have agreed to use Actaea racemosa.

Botany and Ecology

Black cohosh is an erect perennial that grows from 3 to 8 feet in height with 

a 2-foot spread (Foster 2000, Harding 1936). Leaves have sharply toothed 

edges, are alternate, three-pinnately compound, and terminate with a threelobed leaflet (Foster and Duke 2000) (fig. 1). 

In North America, several closely related plants that resemble black cohosh 

are harvested both intentionally to add bulk, and unintentionally due to 

misidentification (Ramsey 1986, 1988, 2000; Upton 2002). Black cohosh is 

often confused with other plants in Actaea, particularly yellow cohosh (A. 

podocarpa Syn.: Cimicifuga americana) or baneberry (A. pachypoda and A. 

rubra) (Upton 2002).

Figure 1—Black cohosh plant (Britton and 

Brown 1913).

2
Flowers are hermaphroditic and apetalous, with showy greenish-white 

stamens in tufts (Fern 1997–2000, Missouri Botanical Garden 2002). 

Flowers, buds, and seedpods are simultaneously borne on a tall arching 

raceme, 1⁄2 to 2 feet in length, from July through September (Foster and 

Duke 2000, Harding 1936, Sievers 1930). The flowers are pollinated by 

bees (Apis spp. and Bombus spp.)2 or flesh flies (Sarcophaga spp.) (Strauch 

1995). After the flowers have faded, the seedpods remain on the raceme 

throughout the winter. The dry seeds rattle in their pods when disturbed 

by wind, making the distinctive noise that is the source for the lesser 

used common names for black cohosh of “rattleroot,” “rattle snakeroot,” 

“rattletop,” and “rattleweed” (Sievers 1930).

The flowers are said to have an unpleasant odor, a trait of the genus 

Cimicifuga (Foster 2000). The name Cimicifuga comes from the Latin 

“Cimex,” the genus name for the bed bug, and “fugare,” meaning to put to 

flight or repel (Foster 2000, Missouri Botanical Garden 2002). Also known 

by the common names “bugbane” or “bugwort,” similar species in Europe 

were traditionally used as insect deterrents with leaves or flowers stuffed 

into pillows or mattresses (Foster 2000, Harding 1936).

The common name “cohosh” comes from an Algonquian Indian word 

meaning “rough,” which describes the dark, hard, and knotted rhizomes that 

contain the plant’s medicinal properties (Tetherow 2001). The rhizome is 

harvested in early autumn after the flowers have faded to fruit and the leaves 

have died back (Grieve 1931, Sievers 1930), then cut into pieces and dried 

(Harding 1936). Rhizomes can be divided in the spring to propagate new 

plants (Botany.com 2004, Fern 1997–2000).

Black cohosh tolerates a variety of soil types, but prefers rich cove 

habitats—cool, well-drained, moist, semishaded woodland locations (Fern 

1997–2000, Missouri Botanical Garden 2002). The hardiness range for the 

plant is 4A to 10A (Horticopia, Inc. 2001). Black cohosh is found from 

southern Ontario to northern Georgia and west to Wisconsin and Arkansas 

(Foster and Duke 2000; U.S. Department of Agriculture, Natural Resources 

Conservation Service 2001) (fig. 2). Plants growing in the warmer southern 

extent of the range require more shade and water (Blakley and Renaud 

1999). 

Several thousand populations of black cohosh are estimated to be extant 

rangewide—including 100 in Indiana, “hundreds” in Maryland, 750 to 

2

 Personal communication. 2004. Lorna Lueck, Research Fellow, Medicinal Plant Program, 

University of Massachusetts, Amherst, MA 01003.

3
1,000 on national forest lands in North Carolina, thousands in New York, 

20 to 30 in South Carolina, and “hundreds” in Tennessee (NatureServe 

Explorer 2002). In general, black cohosh is considered to be relatively more 

abundant in the southern portion of its range (NatureServe Explorer 2002). 

A standard rich cove forest in North Carolina may contain an estimated 

2,000 to 5,000 individual plants, or approximately 400 to 600 individuals 

per acre (1,000 to 1,500 individuals per ha3). Field data by Lueck (see 

footnote 2) reports population sizes between 80 (Delaware) and 50,000 

(West Virginia), with typical populations consisting of several hundred to 

several thousand individuals. 

3

Personal communication. 2001. Gary Kauffman, Botanical Forest Products Specialist, U.S. 

Department of Agriculture Forest Service, National Forests in North Carolina, Asheville, NC 28804.

Figure 2—Black cohosh range and distribution map (adapted from 

NatureServe Explorer 2002 and U.S. Department of Agriculture, Natural 

Resources Conservation Service 2001).

4
McGraw and others (2003) evaluated natural areas in northcentral West 

Virginia using habitat suitability models based on ecological characteristics 

of known populations. The population models indicated a large potential 

niche for black cohosh, but many factors limit the actual occurrence of the 

species. These include slow recovery after harvest, reproduction limitations, 

and increasing harvest due to market demand. 

Vegetative reproduction is by regrowth of buds from underground rhizomes. 

Mature plants also produce seeds. Across the range, seed set can begin as 

early as June and continue well into August. Seeds require a warm period 

to break radicle dormancy and a cold period to break epicotyl dormancy 

(Baskin and Baskin 1985, Strauch 1995). Under normal conditions, 

complete germination (both radicle and epicotyl) can occur in 6 months. 

However, if seeds are sown after temperatures have dropped in late autumn, 

radicle emergence will be delayed until after summer the following year 

(complete germination in 18 months). Cotyledons do not emerge until after 

radicles have broken dormancy (Baskin and Baskin 1985). 

Black cohosh has not been cultivated on any large scale (Miller 1988), and 

most of what is grown is for landscape use (Blakley and Renaud 1999). 

The main source of black cohosh rhizomes for the medicinal herb industry 

is wildcrafting (see the section Wild Harvest). As demand increases, 

there is an increasing interest in cultivation as a means to conserve wild 

resources (Popp and others 2003). Several groups are conducting research 

on germination and cultivation requirements, pest and disease problems, and 

cost/yield assessments for large-scale production (Adam 2002, Blakley and 

Renaud 1999, Popp and others 2003, Thomas and others 2001).

Medicinal Uses

Historical

Black cohosh was widely used by Native Americans, mainly as a treatment 

for various female conditions and for rheumatism, but also for malaria, 

general malaise, kidney malfunctioning, sore throat, childbirth, and 

snakebite (American Botanical Council 2002, Foster 2000, Foster and Duke 

2000, Moerman 1999). Common names that denote these early uses include 

“snakeroot,” “black snakeroot,” and “squawroot” (Foster 2000, Grieve 

1931). Early European settlers and eclectic physicians learned of these uses 

and incorporated them into their own medicinal practices, and also used 

the roots as a treatment for smallpox or chorea (Cook 1869, Ellingwood 

1919, Felter 1922, Felter and Lloyd 1898, Petersen 1905, Potter 1902). 

Black cohosh was the principal ingredient in Lydia Pinkham’s Vegetable 

5
Compound, a tonic sold in the late 1800s and early 1900s as a general 

treatment for women’s ailments (Tyler 1995). 

Modern

Medicinal actions ascribed to black cohosh include hypoglycemic, sedative, 

anti-inflammatory, antirheumatic, antispasmodic, alterative, antidote, 

astringent, cardiotonic, diaphoretic, diuretic, emmenagogue, expectorant, 

and vasodilator (Fern 1997–2000, Foster and Duke 2000, Grieve 1931)

Europeans have used black cohosh to treat menopausal symptoms for over 

40 years. According to the American Botanical Council (2002), 10 million 

retail units of standardized black cohosh ethanolic and isopropanolic 

extracts were sold in Germany, the United States, and Australia in 1996. 

In Germany, the German Commission E has approved black cohosh as a 

treatment for premenstrual discomfort or dysfunction (dysmenorrhea), 

and for menopausal symptoms such as hot flashes, heart palpitations, 

nervousness, irritability, sleep disturbances, tinnitus, vertigo, perspiration, 

and depression (American Botanical Council 2002, Blumenthal 1998). 

The recommended dosage is 40 mg per day of crude drug (Blumenthal 

1998, Liske and Wüstenberg 1998). Because of the lack of long-term safety 

studies, it is recommended that the use of black cohosh be limited to a 

maximum of 6 months (American Botanical Council 2002, Blumenthal 

1998). 

The most common side effect is occasional transient gastric upset (Dog and 

others 2003, Huntley and Ernst 2003, Stolze 1982). Overdose can result in 

vertigo, headache, nausea, vomiting, and vision or circulation impairments 

(American Botanical Council 2002, Foster 2000). Recently, a few case 

studies have reported a possible link between black cohosh and liver damage 

(Laino 2003, Lontos and others 2003, Whiting and others 2002). In some 

cases, the products causing the hepatoxic reaction contained a combination 

of herbs, which suggests that more research is needed to determine if 

black cohosh was the cause of the reaction (Dog and others 2003, Vitetta 

and others 2003). In addition, the products were not evaluated and may 

have contained contaminants. Several clinical studies examining potential 

toxicity in both humans and animals have determined that black cohosh is 

safe when used in moderate doses (Johnson and van Breemen 2003; Korn 

1991; National Institutes of Health, National Toxicology Program 1999, 

2002).

The bioactivity of black cohosh is not well understood. Medicinally active 

chemical constituents in black cohosh commonly used as markers for 

standardization include the triterpene glycosides actein, cimicifugoside, 

6
and 23–epi–26–deoxyactein (formerly classified as 27–deoxyactein) 

(Bedir and Khan 2000; Chen and others 2002b; Linde 1964, 1967a, 1967b; 

McKenna and others 2001; Newall and others 1996; Shao and others 

2000; Upton 2002; Watanabe and others 2002; Wende and others 2001). 

Commercially available black cohosh products such as Remifemin® are 

usually standardized to contain 1 mg of 23–epi–26–deoxyactein per tablet 

(Tetherow 2001). Although it was once believed that black cohosh contained 

phytoestrogens such as the flavonoid formononetin (Jarry and others 1985), 

more recent studies have failed to find formononetin or significant levels of 

other flavonoids in various commercially available products (Foster 1999, 

Kennelly and others 2002, Liske 1998, Liske and Wüstenberg 1998, Struck 

and others 1997). One study suggests that black cohosh roots do not contain 

any isoflavones (Hagels and others 2000). Other active compounds have 

been isolated, including aromatic acids such as ferulic acid, salicylic acid, 

and caffeic acid (Hagels and others 2000, Kruse and others 1999, Li and 

others 2003). Black cohosh roots also contain tannins, resins, fatty acids, 

starch, and sugars (American Botanical Council 2002, Foster 1999, Newall 

and others 1996, Upton 2002). Several clinical studies have evaluated the 

methods used to analyze black cohosh preparations to determine the quality 

and quantity of active constituents (Ganzera and others 2000, He and others 

2000, Li and others 2003, Xu and others 2001). A recent study used DNA 

fingerprinting to detect related plant species that can be misidentified and 

contaminate black cohosh bulk material (Zerega and others 2002).

Clinical Research

Most of the initial clinical research on black cohosh focused on the safety 

and efficacy of using it to treat menopausal symptoms. Early case studies 

simply observed and reported on beneficial effects in patients (Brücker 

1960, Langfritz 1962, Stefan 1959, Stiehler 1959). Later research used 

various assessment scales such as the Kupperman Menopausal Index Scale 

for neurovegetative symptoms (hot flashes, profuse sweating, headache, 

vertigo, heart palpitation, and tinnitus) and the Profile of Mood States, SelfAssessment Depression Scale, or Hamilton Anxiety Scale for psychological 

complaints (nervousness, irritability, sleep disturbances, and depression). 

Most studies demonstrated statistically significant improvements (Daiber 

1983, Foldes 1959, Vorberg 1984). Comparisons between black cohosh, 

hormone replacement therapy (HRT), and placebos determined black 

cohosh to be a safe and effective alternative to HRT (Lehmann-Willenbrock 

and Riedel 1988, Petho 1987, Stoll 1987, Stolze 1982, Warnecke 1985), 

though one study showed no significant difference between black cohosh 

and a placebo (Jacobson and others 2001).

7
Early research on the physiological actions of black cohosh debated 

the presence of compounds that could bind to estrogen receptors and, 

thus, reduce symptoms caused by the loss of estrogen production during 

menopause. Several studies claimed that black cohosh had an estrogenlike effect (Eagon and others 1997, 1999). However, a few studies on 

ovariectomized rats did not detect the appropriate physical and physiological 

changes (e.g., increase in uterine weight and changes in vaginal cytology) 

associated with estrogen and concluded that black cohosh did not have a 

hormonal effect (Einer-Jensen and others 1996, Knüvener and others 2000, 

Liske and others 1998). Jarry and Harnischfeger (1985), Jarry and others 

(1985), and Düker and others (1991) found that black cohosh reduced surges 

in the secretion of luteinizing hormone (LH) associated with hot flashes and 

sweating. Though the exact mechanism of action was not identified, it was 

believed that several constituents acted simultaneously in different ways to 

produce an overall estrogenic effect. Wade and others (1999) suggested that 

black cohosh had both estrogen-agonistic and estrogen-antagonistic effects 

on various target organs, indicating tissue selectivity. Contradictions in early 

clinical studies were most likely caused by variations in the dosage, duration 

of the study, number of participants, and lack of a standardized extract 

that was free of contaminants (Borrelli and Ernst 2002, Borrelli and others 

2003). Most current research uses standardized commercial preparations 

Remifemin® or Klimadynon®/Menofem® (CR BNO extract 1055).

Contradicting estrogenic or antiestrogenic actions were also clarified by 

the discovery of two different types of estrogen receptors (ERs): ER-α

and ER-β. Whereas ER-αs are primarily found in the reproductive organs, 

ER-βs are found in the skeletal and central nervous systems (SeidlováWuttke and Wuttke 2000). Researchers are investigating the possibility 

that constituents in the rhizomes act as selective ER modulators. Clinical 

research indicates that black cohosh may reduce hot flashes and sweating 

by reducing the secretion of LH from the hypothalamus/pituitary system in 

the brain through either mixed competitive binding to serotonin receptors 

(Burdette and others 2003, Seidlová-Wuttke and Wuttke 2000, SeidlováWuttke and others 2003, Wuttke and others 2003) or unidentified ERs (Jarry 

and others 2003), or through dopaminergic/antidepressant activity (Löhning 

and Winterhoff 2000, Winterhoff and others 2003). Black cohosh has also 

been associated with a significant reduction in the bone loss that leads to 

osteoporosis (Nisslein and Freudenstein 2000; Seidlová-Wuttke and others 

2000; Wuttke and others 2000, 2003).

The growing awareness of contraindications for HRT for individuals 

with estrogen-positive breast cancer has also raised concerns about the 

potential negative effects of phytoestrogens (plant chemicals that act like 

8
estrogen). Several studies have shown that black cohosh does not cause 

the proliferation of cancer cells (Amato and others 2001, Freudenstein and 

others 2002, Lupu and others 2002, Morris and others 2003), and may even 

possess cancer-fighting properties (Dixon-Shanies and Shaikh 1999, Dog 

and others 2003, Hostanska and others 2004). Einbond and others (2004) 

found that ethyl acetate extracts and the triterpene glycoside actein, both 

active constituents in black cohosh, demonstrated significant inhibition 

of both estrogen-positive and estrogen-negative tumors. Studies on drug 

interactions have shown that black cohosh can increase the effectiveness 

of some anticancer drugs (Freudenstein and Bodinet 1999, Muñoz and 

Pluchino 2003, Nesselhut and others 1993, Rockwell and others 2003), 

but can also increase the toxicity of others (Rockwell and others 2003). 

One study conducted on female mice found that groups treated with black 

cohosh had significantly higher rates of tumor metastasization to the lungs 

than the control groups (Davis and others 2003). Critics have responded 

that this study was conducted on mice that were specifically bred to develop 

cancer, and that black cohosh may not demonstrate the same physiological 

effect on humans (Decker 2003, Murray 2003). 

Several studies have looked at other medicinal applications of black cohosh. 

Burdette and others (2002) found that black cohosh possesses antioxidant 

activity and may protect against damage to DNA by reactive oxygen 

species. Burke and others (2002) examined the use of black cohosh to treat 

menstrual migraines. Takahira and others (1998) examined the antimalarial 

activity of triterpene glycosides found in black cohosh. Most recently, 

Sakurai and others (2004) discovered several constituents in black cohosh 

rhizomes that have moderate or potential anti-HIV activity. 

Patents have been issued for the use of black cohosh for treating menopause 

symptoms (Fasano 2003, Newmark and Schulick 2001), reducing hair 

loss (McCullough 2000), treating estrogen-dependent tumors (Nesselhut 

and others 2001), and reducing levels of peptides in the brain believed to 

contribute to the onset of Alzheimer’s disease (Eckman and others 2003).

Other Uses

Black cohosh is used in the landscape as a native border or woodland plant 

in moist, shady locations (Missouri Botanical Garden 2002, Perry 2001).

9
Market Trends

In 1936, Harding indicated a price range for black cohosh roots of $0.02 to 

$0.03 per pound. In 1988, Miller quoted a price of $0.80 per pound paid to 

harvesters for dried roots, $2.00 per pound for cut and sifted roots, and retail 

prices starting at $3.90 per pound. At that time the domestic market was 

estimated at < 50 tons, with some export to Germany (Miller 1988, Forest 

Service 1993). 

A summary by Lyke (2001) reported that the price for black cohosh raw 

materials peaked at $12.00 to $17.00 per pound of dry root in 2000. High 

prices paid to harvesters increased the wild collection of rhizomes. When 

the market became saturated, prices dropped. Greenfield and Davis4 listed a 

price range of $1.15 to $4.00 per pound of dried root in 2001. As stockpiles 

of black cohosh rhizomes are depleted and demand continues to increase, 

prices are expected to slowly increase. The 2003 price was $3.00 per pound.4

In 2004, Internet vendors listed the following retail prices: $9.50 to $10.00 

per fluid ounce, and $5.00 to $20.00 per 100 tablets or capsules of varying 

potencies (EstroGentle, no date; Green Canyon Inc., no date; NatureServe 

Explorer 2002; Nature’s Way Herbs, no date; Remifemin®, no date; 

RippleCreek.com, no date).

According to Blumenthal (1999), retail sales of black cohosh increased 511 

percent between 1997 and 1998, and rose another 477 percent in 1999. In 

2001, when total retail sales in the mainstream herbal supplement market 

were down 15 percent, black cohosh sales were up 2 percent, with an 

estimated sale of 936,979 units at a value of $6,153,796 (Blumenthal 2002). 

The 2003 estimated market demand for black cohosh was 500,000 pounds 

of dried root per year4. Estimated black cohosh supplement sales totaled 

$9.5 million from August 2001 to August 2002 (Brown 2002). 

Wild Harvest

Black cohosh is primarily harvested from wild rather than cultivated 

sources. In 2001, Indiana, Kentucky, Missouri, Ohio, Tennessee, and 

West Virginia were the main States supplying wild-harvested material 

(Johannesen 2001). In 2003, Kentucky and Tennessee were the primary 

producers, followed by Georgia, Michigan, North Carolina, South Carolina, 

4

Greenfield, J.; Davis, J. 2003. Western North Carolina non-timber forest products. 81 p. plus 

appendices. Draft final report. On file with: Forest Service, Southern Research Station, 1650 

Ramble Road, Blacksburg, VA 24060.

10
and Wisconsin. Ohio, Virginia, and West Virginia are also significant 

producers.5

Because the species is not monitored throughout its range, there is no 

accurate measure of actual harvest levels of black cohosh. At present, the 

sum of our knowledge is based on inferences from cultivation data and 

conservative estimates of harvest based on reports from the herbal industry 

and Federal collection permits.

Herbal Industry Reports: American Herbal Products 

Association Tonnage Surveys

The American Herbal Products Association (AHPA) conducted two 

surveys to determine wild-harvest levels of several popular native plant 

species (American Herbal Products Association 2000, 2003). Due to the 

voluntary nature of the surveys and the unknown percentage of the total 

market represented by the survey respondents, the information provided by 

these surveys should be taken as a conservative estimate of actual harvest. 

According to these tonnage surveys, almost 1,400,000 pounds (dry weight) 

of black cohosh was harvested between 1997 and 2001, nearly 98 percent 

wild-harvested (table 1). It should be noted that three of the five major bulk

traders in black cohosh (as identified in 2001) are not AHPA members. A 

large herb dealer based in the Southern Appalachians sold 55,000 to 60,000 

pounds (dry) in 1999 (NatureServe Explorer 2002), almost half of what 

AHPA reported for the entire year.

5

Suggs, R. 2003. Market profile: black cohosh. 12 p. Unpublished document. On file with: 

Forest Service, Southern Research Station, 1650 Ramble Road, Blacksburg, VA 24060.

Table 1—Harvest of black cohosh according to the American Herbal 

Products Association (2003) tonnage survey

Harvest year Cultivated Wild Total Wild harvest

percent

1997 0 227,002 227,002 100

1998 35,430 725,984 761,414 95

1999 2,600 145,367 147,967 98

2000 149 117,843 117,992 99

2001 6,521 177,681 184,202 96

 Total (pounds) 44,700 1,393,877 1,438,577

 Average 97.6

11
When experts were asked how many black cohosh rhizomes made up 1 

pound of dry material, they provided a broad range of estimates—from 

146 to 18 (see footnote 3), to as many as 40 (Johannesen 2001). Using a 

conservative estimate of 14 roots per dried pound, the number of individual 

plants wild-harvested during the 5-year period covered by the surveys 

exceeded 19.5 million. 

Permit Sales

Wild-harvesting is mostly done on public land, where plants are generally 

more accessible (Lyke 2001). Harvest is not allowed on national park land, 

but is permitted on Forest Service land. Examining black cohosh collection 

permits is one way to estimate wild-harvest; however, this method does 

not provide precise numbers because the amount of actual harvest is not 

monitored, and poaching is not taken into account. 

According to NatureServe Explorer (2002), the Forest Service issued 

black cohosh collection permits for 2,200 pounds in 1997, 12,000 pounds 

in 1998, and 2,150 pounds in 1999. This amounts to the harvest of nearly 

229,000 individual plants (estimating 14 roots per dry pound) during the 

3-year period. As there is no requirement to “weigh out” after harvest, the 

actual harvest weight cannot be stated with certainty. According to Matthew 

Albrecht,7 the number of black cohosh permits declined after 2000, possibly 

due to the market decline. 

Seed Harvest

The pressure that the horticultural industry exerts on wild black cohosh seed 

production is not quantifiable. Despite the development of several popular 

cultivars, pure black cohosh remains popular among horticulturalists. Whole 

plants and seeds are the primary commodities sold by the horticultural 

industry. Currently, there is no mechanism to monitor the trade in black 

cohosh seeds. Because black cohosh reproduces primarily from seed, the 

ability to quantify the seed trade is vital to the conservation of the species. 

6

Personal communication. 2001. Joe-Ann McCoy, Curator (Medicinals), U.S. Department of 

Agriculture, Agricultural Research Service, North Central Regional Plant Introduction Station, 

Ames, IA 50014.

7

Personal communication. 2003. Matthew Albrecht, Doctoral Candidate, Ohio University, 

Athens, OH 45701.

12
Joe-Ann McCoy8

 will soon publish a report on long-term population studies 

of several black cohosh populations that may help determine acceptable 

levels of seed harvest. 

Export

The actual amount of black cohosh raw materials exported from the United 

States is unknown. Estimates can be gleaned from industry market reports, 

phytosanitary certificates, and U.S. Customs port data.

Phytosanitary Certificates

Phytosanitary certificates (PCs) are required by the International Plant 

Protection Convention for exports of living plant material, including seeds, 

to document the inspection of plant materials for harmful insects or disease. 

In the United States, PCs are issued and recorded by the U.S. Department of 

Agriculture. PCs issued for black cohosh exports at U.S. ports between 1999 

and 2002 are shown in table 2.

It should be noted that there is no standard reporting volume on PCs. Thus, 

shipments are reported variously in pounds, roots, bags, bales, or seeds. 

This makes it difficult to interpret the data. For exports reported as bags 

or bales, there is insufficient information to determine either the amount 

(i.e, size), weight, or the nature of the material (i.e., roots or whole plants), 

being exported. It is estimated that 12 ounces of seeds equals approximately 

144,000 seeds.9

8

Personal communication. 2003. Joe-Ann McCoy, Curator (Medicinals), U.S. Department of 

Agri­culture, Agricultural Research Service, North Central Regional Plant Introduction Station, 

Ames, IA 50014.

9

Personal communication. 2004. Russ Richardson, Registered Forester, Weston, WV 26452. 

Table 2—Phytosanitary certificates for black cohosh exports, 1999–2002a

Year Pounds Roots Bags/bales Seeds

1999 1,199 ≈ 16,786 roots 150 0 0

2000 8,623 ≈ 120,722 roots 0 234 0

2001 9,100 ≈ 127,400 roots 5,600 179 0

2002 33,080 ≈ 463,120 roots 21,720 0 12 oz.

 Total 55,002 ≈ 728,028 roots 27,470 413 ≈ ? roots 12 oz. ≈ 144,000

a There are no standard reporting volumes on phytosanitary certificates. Quantities may be 

reported in pounds, roots, bags/bales, or seeds.

13
For exports reported in pounds, it is estimated that 1 pound of dried black 

cohosh roots is equal to approximately 14 roots. Thus, during the 4-year 

period from 1999 to 2002, in excess of 755,498 black cohosh roots were 

exported. Note the spike in 2002 exports, which coincides with damaging 

revelations about the risks of synthetic HRT.

Note: PCs represent only a conservative estimate of actual exports because:

1. Not all countries require PCs, so not all shipments of black cohosh will 

be accompanied by a PC.

2. When required, many countries request PCs only for live or fresh 

material; so shipments of dried material, derivatives, or processed 

material may not be accompanied by a PC.

3. Shipments are not reported in standard units; thus, PCs may not record 

sufficient information to determine the amount or type of material being 

exported. 

4. Information from PCs is neither centrally available nor electronically 

recorded, making it difficult to get accurate information and to follow up 

on inconsistencies.

Port Data

Table 3 shows U.S. Customs port data from July 2001 through October 

2002 (PIERS Exports 2003). Because PIERS is available only in 18-month 

increments the information spans portions of 2 years. The database reports 

that, between mid-2001 and late 2003, 40,124 pounds of black cohosh were 

exported to four European countries (PIERS Exports 2003). Previous import 

records showed that about 13 tons of black cohosh powder were imported 

into the United States from May 1998 to February 1999. This suggests 

that black cohosh exported as raw materials (dried roots) is re-imported as 

powder.

Table 3—Port data for black cohosh exports (PIERS 

Exports 2003)a

Year Pounds

Equivalent number of plants 

(14 roots per dry pound)

6-12/2001 28,984 405,776

1-10/2002 11,140 155,960

 Total 40,124 561,736

a PIERS data is available in 18-month increments, thus the information 

in this table spans portions of 2 years.

14
Note:

1. PIERS data reflects a conservative estimate of black cohosh exports 

because black cohosh does not have its own source code. Examples 

of the source codes that black cohosh may be exported under include 

“crude natural drugs and herbs,” “leaves, moss, polle, roots, veg prod,” 

“miscellaneous,” “herbs and spices,” “vat dyes,” “flavors, essences, 

esters,” etc.

2. The PIERS control officer may not record the common or scientific name 

of the plant material. 

3. Because PIERS is available only in 18-month increments, it is difficult to 

obtain accurate information for more than one harvest season. 

Further analysis of the PCs and port data revealed that the exports from 

these two sources do not overlap, but represent different shipments. Thus, 

by adding the total exports from these two data sources, a more accurate 

reflection of exports of black cohosh from 1999 through 2002 would be 

around 1,317,234 roots. 

Conservation Status

Wild-harvest and habitat destruction have led to the decline or 

disappearance of many black cohosh populations. Black cohosh is listed as 

endangered in Illinois and Massachusetts (U.S. Department of Agriculture, 

Natural Resources Conservation Service 2001), and is included on the 

United Plant Savers “At-Risk” list (United Plant Savers, no date). According 

to NatureServe (2002), black cohosh has a secure (G4) global heritage status 

rank; however, NatureServe acknowledges that increased market demand 

has put pressure on wild populations, and recommends that the conservation 

status be reviewed within the next 2 or 3 years (NatureServe Explorer 2002). 

In 2001, as evidence of conservation threats began mounting, black cohosh 

was considered for Appendix II listing on the Convention on International 

Trade in Endangered Species of Wild Fauna and Flora; lack of information 

led to its withdrawal from consideration (Lyke 2001).

Industry, academia, and the Federal Government are conducting research 

into various aspects of conservation. The Medicinal Plant Working Group, 

Forest Service, U.S. Fish and Wildlife Service, and Garden Club of America 

are cooperating on a long-term monitoring study to determine regeneration 

rates and the impact of varying harvest levels on black cohosh (Ford 2000, 

Kauffman 2002, Schlosser 2002). The University of Massachusetts and the 

New York Botanical Garden are collaborating on a rangewide study of the 

genetic diversity of black cohosh. Results from this study on the relatedness 

15
of natural populations will provide information to help managers make 

conservation decisions (see footnote 2). Samples collected from natural 

populations by Lueck and McCoy are housed at the U.S. Department of 

Agriculture, Agricultural Research Service, North Central Regional Plant 

Introduction Station in Ames, IA, as part of the National Germplasm 

Collection. 

Discussion 

Over the past few years, black cohosh has received increasing attention 

from industry, consumers, clinical researchers, biologists, conservationists, 

dealers, and wildcrafters. With the growing awareness of the harmful side 

effects of HRT, more women are turning to herbal remedies to alleviate 

symptoms of menopause. Research results are mixed on the safety and 

efficacy of extracts from certain plants, such as black cohosh, soy (Glycine 

max), dong quai (Angelica sinensis), and others, as safe and effective 

alternatives; particularly for women at risk of developing estrogen-related 

cancers. Products that contain black cohosh can be found in the mainstream 

market both within the United States and internationally. 

Rising demand and higher profits for harvesters have increased pressure on 

wild populations. Increased sales of permits to collect black cohosh reflect 

the growing popularity of the herb in the world market. The amount of plant 

material collected illegally is estimated to be equal to or greater than the 

amount collected with permits. More data on the distribution and abundance 

of black cohosh is needed to determine the sustainability of current harvest 

levels. 

Acknowledgments

This publication was produced in cooperation with Virginia Polytechnic 

Institute and State University, College of Natural Resources, Cheatham 

Hall, Blacksburg, VA 24060, under Agreement SRS–01–CA–11330142-

522; and the National Park Service, Shenandoah National Park, Luray, VA 

22835, under Cooperative Agreement 02–IA–11330142–283. This research 

was supported by funds provided by the Forest Service, Southern Research 

Station, Asheville, NC. 

The authors express their sincere appreciation to Joe-Ann McCoy (Curator, 

U.S. Department of Agriculture, Agricultural Research Service, North 

Central Regional Plant Introduction Station) and Lorna Lueck (Ph.D. 

Research Fellow, Medicinal Plant Program, University of Massachusetts, 

16
Amherst, MA) for their diligence and hard work reviewing this document, 

efforts that helped to ensure its quality of coverage. The authors also 

acknowledge Julie Lyke (Biologist, U.S. Fish and Wildlife Service) for 

initiating the accumulation of data that preceded the development of this 

report, and Michael McGuffin (President, American Herbal Products 

Association) for expressing the intention of industry to participate in 

addressing the issues raised.

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Annotated Bibliography

Research Literature

Adam, K.L. 2002. Ginseng, goldenseal, and other native roots. Hortic. 

Tech. Note. Fayetteville, AR: Appropriate Technology Transfer for Rural 

Areas. 12 p. http://attra.ncat.org/attra-pub/ginsgold.html. [Date accessed: 

September 13, 2004]. 

Provides well-documented overviews for American ginseng (Panax 

quinquefolius), goldenseal (Hydrastis canadensis), black cohosh, and blue 

cohosh (Caulophyllum thalictroides) that cover cultivation, regulations, 

and production. Covers research on black cohosh propagation and 

cultivation by several groups, including the New Crop Opportunities Center 

at the University of Kentucky, and the MU Center for Phytonutrient & 

Phytochemical Studies in Missouri. Provides resources on black cohosh 

cultivation. 

Keywords: Cultivation, propagation, regulatory status.

Amato, P.; Christophe, S.; Mellon, P.L. 2001. Estrogenic activity of herbs 

commonly used as remedies for menopausal symptoms. Menopause. 

9(2): 145-150. 

Evaluates the effects on the proliferation of breast cancer cells of four herbs 

used to treat menopausal symptoms. Dong quai (Angelica sinensis) and 

American ginseng (Panax quinquefolius) were found to induce growth of 

breast cancer cells, whereas black cohosh and licorice root (Glycyrrhiza 

glabra) did not. 

Keywords: Cancer, research.

27
American Cancer Society. 2004. Black cohosh. http://www.cancer.

org/docroot/eto/content/eto_5_3x_black_cohosh.asp?sitearea=eto. [Date 

accessed: September 13, 2004].

Discusses research on black cohosh and cancer. Medicinal uses are 

described. Although black cohosh has estrogen-like effects, there has been 

no evidence that it increases the risk of developing estrogen-associated 

cancers. There are reports that black cohosh can actually reduce cancer risk, 

but these have not been substantiated by clinical research. 

Keywords: Cancer, medicinal uses, research reviews.

American Chemical Society. 2003. Black cohosh may reduce hot flashes 

by targeting brain’s thermostat. http://www.intelihealth.com/IH/ihtIH/

WSIHW000/333/28815/369064.html. [Date accessed: September 13, 

2004].

Reports on a study presented at the 226th national meeting of the American 

Chemical Society. The study showed that black cohosh reduced hot flashes 

by binding to serotonin receptors in the brain. Previous research had shown 

that these receptors play a role in regulating body temperature, though the 

chemical constituents responsible for this mechanism of action had not been 

identified.

Keywords: Hot flashes, physiological actions, research.

American Herbal Products Association. 2000. 1999 tonnage survey 

results. Silver Spring, MD: American Herbal Products Association. 14 p.

Provides harvest data from 1997 to 1999 for the most widely traded 

medicinal herbs.

Keywords: Harvest, market.

American Herbal Products Association. 2003. 2000–2001 tonnage survey 

of North American wild-harvested plants. Washington, DC: American 

Herbal Products Association. 19 p.

Reports harvest levels for several medicinal herbs based on surveys of herb 

dealers. Surveys were sent to 221 American Herbal Products Association 

members and 20 industry nonmembers. Of the 59 respondents, only 21 

indicated that they were primary raw material producers of the herbs 

specified in the study. According to those respondents, black cohosh 

28
harvests peaked in 1998 at 381 tons, then dropped to 61 tons in 2000. 

Harvest levels of both wild and cultivated roots are provided from 1997 

through 2001.

Keywords: Harvest, market.

Baillie, N.; Rasmussen, P. 1997. Black and blue cohosh in labour. New 

Zealand Medical Journal. 110(1036): 20-21.

Responds to a report by Gunn and Wright (1996) that implicates the use 

of blue cohosh (Caulophyllum thalictroides) and black cohosh in the 

neurological dysfunction of a newborn infant whose mother had been 

given herbs by a midwife. The authors point out that the dosage, type of 

preparation, and administration of the herbs was not specified. They note 

that without this information it cannot be proven that the herbs themselves 

caused the birth defects, as it is possible that they were not used correctly by 

the midwife.

Keywords: Dosage, medicinal uses, preparations, side effects.

Baskin, J.M.; Baskin, C.C. 1985. Epicotyl dormancy in seeds of 

Cimicifuga racemosa and Hepatica acutiloba. Bulletin of the Torrey 

Botanical Club. 112(3): 253-257.

Examines the epicotyl dormancy of black cohosh seeds. Seeds require a 

warm period to break radicle dormancy and a cold period to break epicotyl 

dormancy. Complete germination in good conditions requires 6 months, but 

can take up to a year and a half if seeds are sown after temperatures have 

dropped in late autumn; in this case, radicle emergence is delayed until 

after the summer of the following year. Cotyledons do not emerge until 

after radicles have broken dormancy. This process allows the root system to 

begin development before the cotyledons emerge, facilitating the uptake of 

nutrients and water to the developing leaves.

Keywords: Research, seeds.

Beck, V.; Unterrieder, E.; Krenn, L. [and others]. 2003. Comparison of 

hormonal activity (estrogen, androgen, and progestin) of standardized 

plant extracts for large scale use in hormone replacement therapy. Journal 

of Steroid Biochemistry and Molecular Biology. 84: 259-268.

Evaluates the chemical constituents and in vitro estrogenic activity of 

black cohosh, soy (Glycine max), and red clover (Trifolium pratense). 

29
Black cohosh did not show estrogenic activity through binding to estrogen 

receptors, progesterone receptors, or androgen receptors. It is possible that 

metabolic action is required in order to produce estrogenic effects.

Keywords: Chemical constituents, clinical studies, physiological actions.

Bedir, E.; Khan, I.A. 2000. Cimiracemoside A: a new cyclolanostanol 

xyloside from the rhizome of Cimicifuga racemosa. Chemical and 

Pharmaceutical Bulletin. 48(3): 425-427.

Describes a recently identified compound isolated from black cohosh roots. 

Keywords: Chemical constituents.

Blakley, T.; Renaud, E. 1999. Black cohosh: adaptability to production, 

sunlight levels and identifying stratification and propagation methods for 

high yield of cultivated black cohosh. Research Farm Proposal No. 6078. 

National Center for the Preservation of Medicinal Herbs. http://home.

frognet.net/~rural8/6078A.html. [Date accessed: September 13, 2004].

Outlines research on black cohosh cultivation. Cultivation is best suited for 

hardiness zones 4 to 7, in woodlands and simulated woodland habitats. This 

project covers various cultivation issues such as overcoming seed dormancy, 

yield and cost production for seed vs. rootstock crops, optimum light 

levels, soils with or without added compost, water needs for various light 

conditions, identification of pest and disease problems, drying and storage 

of roots for commercial use, and budget analysis for crops under various 

light levels. Methods are described in detail in this in-progress research 

proposal.

Keywords: Cultivation, hardiness range, light requirements, propagation, 

research, seeds, soil requirements, water requirements.

Boblitz, N.; Liske, E.; Wüstenberg, P. 2000. Black cohosh: efficacy effect 

and safety of Cimicifuga racemosa in gynecology. Deutsche Apotheker 

Zeitung. 140(24): 107-114. In German.

Discusses the use of black cohosh in gynecology. 

Keywords: Medicinal uses, safety.

30
Borrelli, F.; Ernst, E. 2002. Cimicifuga racemosa: a systematic review of 

its clinical efficacy. European Journal of Clinical Pharmacology. 58: 

235-241.

Reviews four randomized clinical trials on the use of black cohosh to treat 

menopausal symptoms in women, and summarizes in vitro and in vivo

assays to determine the mechanism of action of the medicinal constituents 

in the rhizome. The randomized clinical trials yielded conflicting results: 

three studies showed that black cohosh significantly improved physical 

and psychological symptoms of menopause, though one of these studies 

also showed significant improvement in the placebo group. The fourth 

study showed no change in symptoms. The differing results may be due to 

variations in dosage, number of participants, and/or duration of the study. 

Early research on mice and rats indicated estrogenic effects; recent studies, 

however, have suggested a dopaminergic activity. Because earlier research 

did not use standardized extracts, estrogenic results may have been caused 

by contaminants.

Keywords: Clinical studies, physiological actions, research reviews.

Borrelli, F.; Izzo, A.A.; Ernst, E. 2003. Pharmacological effects of 

Cimicifuga racemosa. Life Sciences. 73(10): 1215-1229.

Investigates the physiological actions of black cohosh by analyzing in 

vivo and in vitro experiments. Early studies suggested that black cohosh 

increased uterine weight and induced menstruation in ovariectomized 

rats by binding to estrogen receptors, reducing levels of luteinizing 

hormone. The chemical constituent believed to cause these phytoestrogenic 

effects was later identified as an adulterant not found in black cohosh 

roots and rhizomes. Current research using a standardized extract at 

recommended doses suggests that black cohosh reduces hot flashes through 

a dopaminergic effect on the brain. The effects of black cohosh on estrogensensitive cancer has not yet been determined; research has produced 

conflicting results.

Keywords: Cancer, chemical constituents, clinical studies, hot flashes, 

luteinizing hormone, physiological actions, research reviews.

Brücker, A. 1960. Essay on the phytotherapy of hormonal disorders in 

women. Medizinische Welt. 44: 2331-2333. Abstract available at http://

www.chiro.org/nutrition/ABSTRACTS/Essay_on_the_Phytotherapy.

shtml. [Date accessed: September 13, 2004].

31
Concludes that black cohosh is safe and effective in treating symptoms of 

menopause, based on four years of clinical experience involving 517 female 

patients. Effects of the treatment are described as hormone-like and slightly 

euphoric. No adverse side effects, such as unphysiological bleeding, were 

observed.

Keywords: Case studies, menopause, safety.

Burdette, J.E.; Chen, S.; Lu, Z. [and others]. 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. Journal of Agriculture 

and Food Chemistry. 50: 7022-7028.

Shows that certain constituents of black cohosh act as antioxidants and can 

reduce damage to DNA caused by reactive oxygen species. The process of 

oxidative damage and the constituents of black cohosh that are capable of 

protecting DNA are thoroughly discussed.

Keywords: Antioxidant properties, clinical studies, medicinal uses.

Burdette, J.E.; Liu, J.; Chen, S. [and others]. 2003. Black cohosh acts as 

a mixed competitive ligand and partial agonist of the serotonin receptor. 

Journal of Agriculture and Food Chemistry. 51: 5661-5670.

Investigates the mechanism of action by which black cohosh reduces hot 

flashes. Previous research focused on the ability of constituents in the 

rhizomes of black cohosh to bind to estrogen receptors and, thus, reduce the 

levels of luteinizing hormone (LH), the same mechanism by which hormone 

replacement therapy reduces hot flashes. In this study, various signs of 

estrogenic activity were evaluated, including changes in body weight, 

uterine weight, vaginal cell differentiation, and direct binding to estrogen 

receptors. Anti-estrogenic activity was evaluated by combining black cohosh 

with estradiol to determine if black cohosh blocked the effects of estrogen. 

No estrogenic or anti-estrogenic activity was observed. Certain antidepressant medications, particularly selective serotonin reuptake inhibitors, 

have been shown to reduce hot flashes. Serotonin inhibits secretion of 

LH from the hypothalamus/pituitary system; therefore, the effect of black 

cohosh on serotonin receptors was evaluated as a possible mechanism of 

action. Black cohosh demonstrated mixed competitive binding for specific 

serotonin receptors. The active constituents were not identified.

Keywords: Chemical constituents, clinical studies, hormone replacement 

therapy, hot flashes, physiological actions.

32
Burke, B.E.; Olson, R.D.; Cusack, B.J. 2002. Randomized, controlled trial 

of phytoestrogen in the prophylactic treatment of menstrual migraine. 

Biomedical Pharmacotherapy. 56(6): 283-288.

Examines the use of phytoestrogens to reduce menstrual migraines. Soy 

(Glycine max), dong quai (Angelica sinensis), and black cohosh all showed 

significant effectiveness starting at 9 weeks after treatment until the 

completion of the study at 24 weeks.

Keywords: Medicinal uses, migraines, phytoestrogens.

Cech, R. 1999. Balancing conservation with utilization: restoring 

populations of commercially valuable medicinal herbs in forests and 

agroforests. United Plant Savers Newsletter. Winter: 4.

Discusses sustainable wildcrafting techniques for black cohosh, goldenseal 

(Hydrastis canadensis), and ginseng (Panax quinquefolius). 

Keywords: Conservation.

Chen, S.; Fabricant, D.S.; Lu, Z. [and others]. 2002a. Cimiracemosides 

I-P, new 9,19-cyclolanostane triterpene glycosides from Cimicifuga 

racemosa. Journal of Natural Products. 65(10): 1391-1397.

Identifies eight new triterpene glycosides in the rhizomes of black cohosh.

Keywords: Chemical constituents.

Chen, S.; Li, W.; Fabricant, D.S. [and others]. 2002b. Isolation, structure 

elucidation, and absolute configuration of 26-deoxyactein from 

Cimicifuga racemosa and clarification of nomenclature associated with 

27-deoxyactein. Journal of Natural Products. 65(4): 601-605.

Reports on the isolation of several triterpene glycosides from the 

rhizomes of black cohosh and discusses their chemistry. One constituent, 

26–deoxyactein, was a newly identified compound. Another constituent, 

previously identified in the literature as 27–deoxyactein, was evaluated by 

guidelines set by the International Union of Peer and Applied Chemistry 

standards and reclassified as 23­–epi–26–deoxyactein. This constituent 

has been used to standardize tablets containing black cohosh (such as 

Remifemin®) to contain 2.5 percent triterpene glycosides.

Keywords: Chemical constituents.

33
Compton, J.A.; Culham, A.; Gibbings, J.G.; Jury, S.L. 1998a. Phylogeny 

of Actaea including Cimicifuga (Ranunculaceae) inferred from nrDNA ITS 

sequence variation. Biochemical Systematics and Ecology. 26: 185-197.

Continues previous DNA analysis of Actaea, Cimicifuga, and Souliea. The 

results of this study suggested the reclassification of Cimicifuga racemosa

to Actaea racemosa.

Keywords: Classification, research.

Compton, J.A.; Culham, A.; Jury, S.L. 1998b. Reclassification of Actaea

to include Cimicifuga and Souliea (Ranunculaceae): phylogeny inferred 

from morphology, nrDNA ITS, and cpDNA trnL-F sequence variation. 

Taxon. 47: 593-634.

Reports on the analysis of the morphology and DNA sequences of plants 

in Actaea, Cimicifuga, Souliea, Eranthis, and Anemonopsis. The results 

supported reverting to the original classification by Linnaeus in 1753 where 

Souliea and Cimicifuga are part of the monophyletic clade with Actaea.

Keywords: Classification, research.

Daiber, W. 1983. Menopause symptoms: success without hormones. 

Ärztliche Praxis. 35: 1946-1947. Abstract available at http://www.chiro.

org/nutrition/ABSTRACTS/Success_without_Hormones.shtml. [Date 

accessed: September 13, 2004].

Summarizes an open study of 36 women using Remifemin® to relieve 

menopausal symptoms. Significant improvements were observed in 

climacteric and psychological symptoms based on standardized tests. No 

side effects were observed. 

Keywords: Case studies, menopause, Remifemin®, side effects.

Davis, V.L.; Jayo, M.J.; Hardy, M.L. [and others]. 2003. Effects of black 

cohosh on mammary tumor development and progression in MMTV-neu 

transgenic mice. American Association for Cancer Research. Abstract 

Number R910. Abstract available at http://www.annieappleseedproject.

org/blaccohonmam.html. [Date accessed: September 13, 2004].

Investigates the effects of black cohosh on breast cancer cells in female 

mice. Although primary tumor development (both incidence and latency) 

was not significantly different between the study and control group, 

34
metastasis of cancer to the lungs was higher in groups taking black cohosh 

(27.1 percent, n = 96 treatment group, versus 10.9 percent, n = 110, control 

group) after 14 weeks of treatment. The number of lung tumors increased 

with longer exposure to black cohosh. The results indicated that black 

cohosh did not increase the possibility of developing breast cancer in 

healthy individuals, but could accelerate metastasis of existing tumors.

Keywords: Cancer, clinical studies.

Dixon-Shanies, D.; Shaikh, N. 1999. Growth inhibition of human breast 

cancer cells by herbs and phytoestrogens. Oncology Reports. 6: 1383–

1387.

Evaluates the abilities of various agents to protect against breast cancer. 

Black cohosh extract was found to inhibit growth of T–47D cancer cells.

Keywords: Cancer, clinical studies, phytoestrogens, research.

Dog, T.L.; Powell, K.L.; Weisman, S.M. 2003. Critical evaluation of 

the safety of Cimicifuga racemosa in menopause symptom relief. 

Menopause. 10(40): 299-313.

Reviews clinical research on the safety of black cohosh for treating 

menopausal symptoms. Reports from both the U.S. Food and Drug 

Administration, Special Nutritional Adverse Events Monitoring System and 

the World Health Organization Collaborating Center for International Drug 

Monitoring are presented. Adverse effects reported included headache, high 

blood pressure, heart attack, diarrhea, chest pain, anxiety, and weakness. 

In most cases, the patients used a combination product that contained 

black cohosh and other herbs. The products named in the report were not 

investigated, and the cause of the reaction only speculated. A postmarketing 

survey conducted by the manufacturers of Remifemin® found that 7 percent 

of patients experienced temporary, mild gastrointestinal upset. No serious 

side effects were reported. Numerous clinical studies on the effect of black 

cohosh in vivo and in vitro are reviewed. These studies suggested that 

black cohosh is safe when used in the recommended dosage for a period 

of 6 months and possibly longer. Studies on black cohosh and estrogen 

receptor-positive breast cancer showed that black cohosh did not stimulate 

cell proliferation, and may have actually inhibited the development of 

tumors. The authors concluded that the long history of medicinal usage, low 

incidence of adverse effects, and numerous clinical studies demonstrating 

improvement in menopausal symptoms with a lack of serious side effects 

35
prove that black cohosh is a safe alternative to hormone replacement 

therapy.

Keywords: Adverse events, cancer, history, hormone replacement therapy, 

medicinal uses, research reviews, side effects, toxicity.

Düker, E.M.; Kopanski, L.; Jarry, H.; Wuttke, W. 1991. Effects of extracts 

from Cimicifuga racemosa on gonadotropin release in menopausal 

women and ovariectomized rats. Planta Medica. 57(5): 420-424.

Investigates the effects of black cohosh on luteinizing hormone (LH) and 

follicle stimulating hormone (FSH) levels. After 8 weeks, menopausal 

women receiving the treatment showed reduced levels of LH but not 

FSH. A black cohosh extract was subjected to Sephadex chromatography, 

and separate fractions were tested for their effects on LH levels in 

ovariectomized rats. Three types of active compounds were identified: one 

that did not bind to estrogen receptor sites but did decrease LH levels, one 

that did bind to estrogen receptor sites and suppress LH levels, and one that 

did bind to the estrogen receptor site but did not suppress LH levels. The 

authors believed that these three compounds act synergistically to reduce 

LH levels.

Keywords: Chemical constituents, clinical studies, luteinizing hormone, 

physiological actions.

Eagon, C.L.; Elm, M.S.; Eagon, P.K. [and others]. 1996. Estrogenicity 

of traditional Chinese and Western herbal remedies [Abstract #1937]. 

Proceedings of the American Association for Cancer Research. 37: 284.

Studies the estrogenic activity of several herbs. Black cohosh did not inhibit 

estrogen receptor binding. 

Keywords: Physiological actions.

Eagon, P.K.; Elm, M.S.; Teepe, A.G. [and others]. 1997. Medicinal 

botanicals: estrogenicity in rat uterus and liver [Abstract #1967]. 

Proceedings of the American Association for Cancer Research. 38: 293.

Evaluates the estrogenic activity of black cohosh and other herbs used 

to treat menopausal symptoms in vivo using rat studies. Three weeks of 

treatment with black cohosh caused uterine weight gain in ovariectomized 

rats, indicating that the herb has estrogenic activity.

36
Keywords: Clinical studies, physiological actions.

Eagon, P.K.; Tress, N.B.; Ayer, H.A. [and others]. 1999. Medicinal 

botanicals with hormonal activity [Abstract #1073]. Proceedings of the 

American Association for Cancer Research. 40: 161-162. 

Investigates the hormonal activity of several herbs used to treat menopausal 

symptoms, using in vitro estrogen or progesterone receptor binding assays 

and in vivo observations of ovariectomized rats. Black cohosh showed a 

dose-dependent inhibition of estradiol binding at estrogen receptor sites in 

vitro, and both uterine weight increases and hypothalamic/pituitary response 

in female rats. These results indicated an estrogen-like activity for black 

cohosh.

Keywords: Clinical studies, physiological actions.

Eckman, C.B.; Yager, D.; Haugabook, S.; Abdul, F., inventors; Mayo 

Foundation for Medical Education and Research, assignee. 2003. 

Methods of reducing .beta.-amyloid polypeptides. U.S. patent 6,649,196. 

November 18. 1 p. Int. CI2 A61K 035/78. http://patft.uspto.gov/

netacgi/nph-Parser?Sect1=PTO2&Sect2=HITOFF&p=1&u=/netahtml/

search-bool.html&r=1&f=G&l=50&co1=AND&d=ptxt&s1=6,649,

196.WKU.&OS=PN/6,649,196&RS=PN/6,649,196. [Date accessed: 

September 13, 2004].

Patents the use of black cohosh to reduce levels of .beta.-amyloid 

polypeptides. The accumulation of these peptides in the hippocampus and 

neocortex is believed to contribute to the onset of Alzheimer’s disease.

Keywords: Medicinal uses, patents.

Einbond, L.S.; Shimizu, M.; Xiao, D. [and others]. 2004. Growth inhibitory 

activity of extracts and purified components of black cohosh on human 

breast cancer cells. Breast Cancer Research and Treatment. 83: 221-231.

Examines various extracts and chemical constituents of black cohosh to 

determine their effects on human breast cancer cells. In vitro assays were 

performed with three extracted fractions: hexane, ethyl acetate, and water. 

The ethyl acetate fraction inhibited growth of estrogen positive MCF7 

and estrogen negative MDA–MB–453 human breast cancer cell lines at 

the highest potency of the three extracts. Three specific constituents—the 

triterpene glycosides actein, 23–epi-26–deoxyactein, and cimiracemoside 

37
A—inhibited growth of MCF7 human breast cancer cells and induced cell 

cycle arrest. Actein was the most potent constituent identified.

Keywords: Cancer, chemical constituents, clinical studies, medicinal uses, 

physiological actions.

Einer-Jensen, N.; Zhao, J.; Andersen, K.P.; Kristoffersen, K. 1996. 

Cimicifuga and Melbrosia lack oestrogenic effects in mice and rats. 

Maturitas. 25(2): 149-153.

Examines the estrogen-like effects of Cimicifuga and Melbrosia. Biological 

changes in animals tied to estrogen included uterine growth in immature 

mice and vaginal cornification in ovariectomized rats. Cimicifuga

and Melbrosia were separately administered to immature mice and 

ovariectomized rats in doses of various potencies for three days. No signs of 

estrogen-like biological effects were observed.

Keywords: Clinical studies, physiological actions.

Fabricant, D.; Li, W.; Chen, S.N. [and others]. 2001. Geographical and 

diurnal variation of chemical constituents of Cimicifuga racemosa (L.) 

Nutt. [Abstract]. In: Botanical dietary supplements: natural products at a 

crossroads; 2001 Nov 8-11; Asilomar, CA. Washington, DC: American 

Society of Pharmacognosy & Council for Responsible Nutrition: p. 34.

Discusses variations in chemical constituents for different populations of 

black cohosh. 

Keywords: Chemical constituents, ecology, research.

Fasano, S., inventor; [No assignee recorded], 2003. Herbal composition. 

U.S. patent 6,586,018. July 1. 1 p. Int. CI2 A01N 065/00; A61K 035/78. 

http://patft.uspto.gov/netacgi/nph-Parser?Sect1=PTO2&Sect2=HITOFF&

p=1&u=/netahtml/search-bool.html&r=1&f=G&l=50&co1=AND&d=pt

xt&s1=6,586,018.WKU.&OS=PN/6,586,018&RS=PN/6,586,018. [Date 

accessed: September 13, 2004].

Patents an herbal composition containing sage (Salvia spp.) leaf, red 

raspberry (Rubus idaeus) leaf, bayberry (Myrica cerifera) bark, capsicum 

(Capsicum frutescens) pepper, damiana (Turnera diffusa) leaf, ginger 

(Zingiber officinalis) root, licorice (Liquiritiae radix) root, valerian 

(Valeriana officinalis) root, black cohosh root, red clover (Trifolium 

pratense) extract, and kudzu (Pueraria lobata) root.

38
Keywords: Medicinal uses, patents.

Foldes, J. 1959. The actions of an extract of Cimicifuga racemosa. Ärztliche 

Forschung. 13(12): 623-624.

Summarizes a series of experiments assessing the estrogenic effects of 

black cohosh root (alcoholic extract Remifemin®). Various experiments 

on ovariectomized rats showed estrogenic effects that included a dosedependent induction of estrus within three days of treatment and increased 

uterus weight in four days of treatment. However, one experiment showed 

a lack of estrogenic effect with no histological changes in the ovaries of 

rats after two weeks of treatment. Other research on the effects of black 

cohosh on rats found no suppression of thyroid function, changes in 

thyroid hormone mobilization, or sedative effect. A later experiment on 

the sedative effects of black cohosh proved positive in 31 out of 41 preand perimenopausal women. Three of the 41 women experienced gastric 

symptoms as a result of the black cohosh treatment, but no other side effects 

were observed. The author concluded that black cohosh was beneficial for 

treating symptoms of pre- and perimenopause, with a sedative effect and a 

hormone-like action.

Keywords: Chemical constituents, physiological actions, Remifemin®, 

research reviews, side effects.

Ford, P. 2000. Pilot inventory study of the medicinal herb black cohosh 

(Actaea racemosa L.) in a mesophytic forest type of Southern 

Appalachian. Plant Conservation Alliance Medicinal Plant Working 

Group. http://www.nps.gov/plants/medicinal/pubs/pilotbcohosh.htm. 

[Date accessed: September 13, 2004].

Provides an overview of a monitoring study done by the Medicinal Plant 

Working Group in cooperation with the Forest Service, U.S. Fish and 

Wildlife Service, and Garden Club of America. The objectives of this 

study were to track changes in a population of black cohosh and determine 

regenerations rates after harvest. This summary describes data collection in 

the first year of this ongoing study.

Keywords: Conservation, harvest, monitoring.

Freudenstein, J.; Bodinet, C. 1999. Influence of an isopropanolic aqueous 

extract of Cimicifugae racemosae rhizoma on the proliferation of MCF–7 

cells. In: Abstracts of 23rd International LOF-Symposium on Phyto–

oestrogens. Belgium: University of Gent: 1.

39
Examines the effects of an isopropanolic black cohosh extract 

(Remifemin®) on human estrogen-receptor-positive breast cancer (MCF­­–7) 

cells that were induced by hormone replacement therapy. The authors 

concluded that the extract did not stimulate proliferation of these MCF–7 

cells; instead, in a dose-dependent manner, it inhibited the harmful DNAsynthesis estrogenic actions of estradiol. The anti-proliferative effects of 

tamoxifen were accentuated when used with black cohosh. The authors, 

therefore, concluded that Remifemin® was safe for use by patients with a 

history of breast cancer.

Keywords: Cancer, clinical studies, hormone replacement therapy, 

Remifemin®, safety.

Freudenstein, J.; Dasenbrock, C.; Nisslein, T. 2002. Lack of promotion of 

estrogen-dependent mammary gland tumors in vivo by an isopropanolic 

Cimicifuga racemosa extract. Cancer Research. 62: 3448-3452.

Evaluates whether black cohosh can be used to treat menopausal symptoms 

without increasing the proliferation of estrogen-receptor-positive breast 

cancer. Black cohosh extract was tested in vivo in ovariectomized rats with 

mammary tumors. After a six-week treatment, there was no significant 

increase in tumor number or size, suggesting that black cohosh could be 

used as a safe alternative to hormone replacement therapy.

Keywords: Cancer, clinical studies, hormone replacement therapy, safety.

Ganzera, M.; Bedir, E.; Khan, I.A. 2000. Separation of Cimicifuga 

racemosa triterpene glycosides by reversed phase high performance 

liquid chromatography and evaporative light scattering detection. 

Chromatographia. 52(5/6): 301-304.

Provides a detailed report on high performance liquid chromatography 

to separate three main triterpene glycosides from black cohosh market 

products and crude plant material. The method was successful in both 

determining quality and quantity of active constituents and in differentiating 

species of Cimicifuga.

Keywords: Chemical constituents, research.

Genazzani, E.; Sorrentino, L. 1962. Vascular action of acteina: active 

constituent of Actaea racemosa L. Nature. 194: 544-545.

40
Describes the vascular action of black cohosh liquid extracts in various 

experiments. In the studies covered, black cohosh had a hypotensive effect 

on rabbits and cats. It did not have a hypotensive effect on dogs or humans, 

though it did increase peripheral blood flow. The authors concluded that 

black cohosh acted by either directly or indirectly inhibiting or stimulating 

the vasomotor centers in the body.

Keywords: Chemical constituents, physiological actions.

Georgiev, D.B.; Iordanova, E. 1997. Phytoestrogens – the alternative 

approach [Abstract]. Maturitas. 27(Suppl. 1): 213.

Evaluates the effects of black cohosh extracts used by 50 postmenopausal 

women. Effectiveness was evaluated subjectively by the Kupperman 

Menopausal Index and the Hamilton Anxiety Scale, and objectively by 

physical indicators such as vaginal smears and measures of endometrial 

thickness. At the completion of the six-month study, 90 percent of patients 

showed significant improvement in subjective evaluations. Vaginal 

maturation was positively influenced in 40 percent of the patients, whereas 

endometrial thickness did not change for any patients.

Keywords: Assessment scales, medicinal uses, phytoestrogens, research.

Green, M. 2003. Cool the menopausal heat: black cohosh may help 

eliminate hot flashes and other symptoms. Natural Foods Merchandiser. 

24(3): 110, 112. http://www.newhope.com/nfm-online/nfm_backs/mar_

03/cool.cfm. [Date accessed: September 13, 2004].

Summarizes the medicinal uses and actions of black cohosh. Includes a 

review of clinical studies, history of medicinal uses, reported side effects, 

and recommended dosage.

Keywords: Medicinal uses, research reviews.

Greenfield, J.; Davis, J.M. 2003. Western North Carolina non-timber forest 

products. 81 p. plus appendices. Draft final report. On file with: Forest 

Service, Southern Research Station, 1650 Ramble Road, Blacksburg, 

VA 24060.

Presents findings from an ongoing study to define the non-timber forest 

products (NTFP) industry in western North Carolina and to estimate the 

social and economic values, as well as the market conditions, for black 

cohosh and other priority non-timber forest products.

41
Keywords: Market, research.

Gruenwald, J. 1998. Standardized black cohosh (Cimicifuga) extract 

clinical monograph. Quarterly Review of Natural Medicine. Summer: 

117-125.

Reviews black cohosh research articles from Germany, including 

information on historical use, constituents, climacteric complaints and 

treatments, use in gynecology, treatment of postoperative deficiency 

symptoms, dosage, safety, and references.

Keywords: Chemical constituents, dosage, history, medicinal uses, research 

reviews, safety.

Gunn T.R.; Wright, I.M. 1996. The use of black and blue cohosh in labour. 

New Zealand Medical Journal. 109(1032): 410-411.

Reports on the use of blue cohosh (Caulophyllum thalictroides) and black 

cohosh by a midwife to induce labor that resulted in maternal vasodilation 

and hypotension and severe respiratory and neurological problems in the 

infant at birth. Authors implied that the herbs that were used contributed to 

the outcome.

Keywords: Case studies, safety, side effects.

Hagels, H.; Baumert-Krauss, J.; Freudenstein, J. 2000. Composition 

of phenolic constituents in Cimicifuga racemosa [Abstract P1B/03]. 

In: International Congress and 48th annual meeting of the Society of 

Medicinal Plant Research (GA) and 6th International Congress on 

Ethnopharmacology of the International Society for Ethnopharmacology 

(ISE). Zurich, Switzerland. Abstract P1B/03. [Publisher name and 

location unknown]: [page numbers unknown].

Suggests that black cohosh does not contain isoflavones, and that 

formononetin, indicated in previous studies as the active phytoestrogenic 

constituent of black cohosh, does not occur in the dried root.

Keywords: Chemical constituents, phytoestrogens, research.

Hardy, M.L. 2000. Herbs of special interest to women. Journal of the 

American Pharmaceutical Association. 40: 234-242.

42
Summarizes current research on several medicinal plants used for female 

ailments, particularly focusing on controlled studies. Includes history, 

mechanism of action, clinical studies, safety, recommendations for usage, 

and guidelines on herbal medicinal use for women who are pregnant or 

lactating.

Keywords: History, physiological actions, research reviews, safety.

Harnischfeger, G.; Cillien, N. 1996. Influence of Cimicifuga racemosa

extract fractions on the proliferation of human carcinoma cells in vitro

with regard to their estrogen receptor sensitivity. Gottingen, Germany: 

44th Annual Congress of Georg August Universitat. P12: 40.

Examines the effects of black cohosh extracts on the proliferation of cancer 

cells in vitro.

Keywords: Cancer, clinical studies, physiological actions.

Harnischfeger, G.; Stolze, H. 1980. Well-proved active substances derived 

from natural products: black snakeroot. Notabene Medici. 10: 446-450.

Describes medicinally active chemical constituents of black cohosh roots.

Keywords: Chemical constituents.

He, K.; Zheng, B.; Kim, C.H. [and others]. 2000. Direct analysis and 

identification of triterpene glycosides by LC/MS in black cohosh, 

Cimicifuga racemosa, and in several commercially available black cohosh 

products. Planta Medica. 66: 635-640.

Reports on the use of reverse-phase chromatography to identify and 

quantify triterpene glycosides in black cohosh commercial preparations. The 

results showed that the method was successful for determining the quality of 

black cohosh products.

Keywords: Chemical constituents, products, research.

Hostanska, K.; Nisslein, T.; Freudenstein, J. [and others]. 2004. 

Cimicifuga racemosa extract inhibits proliferation of estrogen receptorpositive and negative human breast carcinoma cell lines by induction of 

apoptosis. Breast Cancer Research and Treatment. 84(2): 151-160.

43
Investigates the activity of isopropanolic and ethanolic black cohosh extracts 

on MCF–7 estrogen receptor-positive and MDA–MB231 estrogen receptornegative breast cancer cells in vitro. Both extracts showed a dose-dependent 

response, causing apoptosis (preprogrammed early cell death) of cancer 

cells.

Keywords: Cancer, clinical studies, medicinal uses.

Hunter, A. 1999. Cimicifuga racemosa: pharmacology, clinical trials, and 

clinical use. Materia Medica. 5(1): 19-25.

Reviews German literature on black cohosh. Includes pharmacology, 

traditional use, current clinical use, clinical trials, Remifemin® clinical 

trials, conservation, and references.

Keywords: Clinical studies, conservation, medicinal uses, physiological 

actions, Remifemin®, research reviews.

Huntley, A.; Ernst, E. 2003. A systematic review of the safety of black 

cohosh. Menopause. 10(1): 58-64.

Reviews research on black cohosh, focusing on various international 

adverse event reports. The most prevalent adverse events were 

gastrointestinal upset or rash. Evidence suggested that adverse events 

were rare, mild, and reversible; though a few cases of hepatic, cardiac, or 

circulatory disorders indicated areas of concern. In many of these last cases, 

the causality was not definitive; the authors concluded that black cohosh 

was a safe medication.

Keywords: Adverse events, research reviews, side effects.

Jacobson, J.S.; Troxel, A.B.; Evans, J. [and others]. 2001. Randomized 

trial of black cohosh for the treatment of hot flashes among women with 

a history of breast cancer. Journal of Clinical Oncology. 19(10): 2739-

2745. 

Investigates the safety and effectiveness of using black cohosh to treat hot 

flashes for breast cancer patients. Patients were given either black cohosh 

or a placebo for 60 days. Data were collected on occurrences of hot flashes 

and changes in luteinizing hormone (LH) and follicle stimulating hormone 

(FSH) levels. Both treatment and placebo groups reported a decrease in hot 

flashes and other menopausal symptoms. Changes in levels of LH and FSH 

were not statistically different between the two groups. The study concluded 

44
that black cohosh was not more effective than a placebo; however, the 

authors stated that most women use black cohosh in doses higher than those 

used in this study.

Keywords: Cancer, dosage, hot flashes, luteinizing hormone, safety.

Jarry, H.; Harnischfeger, G. 1985. Studies on the endocrine efficacy 

of the constituents of Cimicifuga racemosa: 1. Influence on the serum 

concentration of pituitary hormones in ovariectomized rats. Planta 

Medica. 51(1): 46-49.

Reports on the measurement of levels of serum concentrations of pituitary 

hormones in ovariectomized rats. After 3 days, there was a significant 

reduction in luteinizing hormone (LH) levels, but the follicle-stimulating 

hormone and prolactin levels were unaffected. Spikes in LH release have 

been linked to occurrences of hot flashes, and so served as a measure of 

endocrinological activity. The agents responsible for this selective reaction 

were believed to be a glycoside fraction and a lipophilic fraction (triterpene 

glycosides). This study provides evidence of an endocrine-like efficacy for 

black cohosh root.

Keywords: Chemical constituents, clinical studies, hot flashes, luteinizing 

hormone.

Jarry, H.; Harnischfeger, G.; Düker, E. 1985. Studies on the endocrine 

efficacy of the constituents of Cimicifuga racemosa: 2. In vitro binding of 

constituents to estrogen receptors. Planta Medica. 51(4): 316-319.

Investigates the mechanism of action by which black cohosh reduces 

symptoms of menopause. Results showed an estrogenic effect on the 

hypothalamus/pituitary glands, which control the release of the luteinizing 

hormone associated with hot flashes. The black cohosh extract did not bind 

to estrogen receptors (α or β), but did show estrogenic action in human 

endometrium cytosol. The authors speculated that black cohosh possibly 

binds to an unidentified estrogen receptor, and/or has dopaminergic active 

compounds. 

Keywords: Chemical constituents, clinical studies, luteinizing hormone, 

physiological actions. 

Jarry, H.; Metten, M.; Spengler, B. [and others]. 2003. In vitro effects 

of the Cimicifuga racemosa extract BNO 1055. Maturitas. 44(Suppl. 1): 

S31-S38. 

45
As a follow up to previous findings by Jarry and Harnischfeger (1985), 

attempts to further understand the mechanisms by which the active 

constituents in black cohosh produce an endocrinological effect in in vitro

estrogen receptor assays and in in vivo studies on ovariectomized rats. 

Three agents that competed with the hormone estradiol for binding at 

estrogen receptor sites were found: one fraction that did not bind to estrogen 

receptors but suppressed the release of luteinizing hormone (LH), a second 

fraction that did bind to receptor sites and suppressed LH release, and a 

third fraction that did bind to receptor sites but did not suppress LH release. 

The isoflavone formononetin was identified as one of the active constituents 

that did bind to estrogen receptor sites but did not suppress LH release. This 

led the authors to conclude that several active constituents may have acted 

together to produce an LH-suppressant effect.

Keywords: Clinical studies, luteinizing hormone, physiological actions.

Johannesen, S.J. 2001. An assessment of the threat to the survival of six 

medicinal plants native to the USA. Aberystwyth: University of Wales. 

Ph.D. dissertation for BSc Phytotherapy, College of Phytotherapy. 

Aberystwyth: University of Wales. 69 p.

Investigates factors that influence the survival of several medicinal plants.

Keywords: Conservation.

Johnson, B.M.; van Breemen, R.B. 2003. In vitro formation of quinoid 

metabolites of the dietary supplement Cimicifuga racemosa (black 

cohosh). Chemical Research in Toxicology. 16: 838-846.

Determines if the constituents of black cohosh are metabolized into toxic 

reactive metabolites. Urine samples from seven postmenopausal women 

taking black cohosh extracts at 32, 64, or 128 mg/day were evaluated. Eight 

electrophilic metabolites were detected; however, none of them were toxic. 

Black cohosh was concluded to be safe in moderate doses.

Keywords: Clinical studies, toxicity.

Kam, I.W.; Dennehy, C.E.; Tsourounis, C. 2002. Dietary supplement use 

among menopausal women attending a San Francisco health conference. 

Menopause. 9(1): 72-78.

Surveys the use of dietary supplements by peri- and postmenopausal women 

at a women’s health conference in San Francisco. Out of 100 women, 29 

46
percent used only hormone replacement therapy (HRT), 16 percent used 

HRT with dietary supplements, 32 percent used only dietary supplements, 

and 13 percent used no product or used supplements not included in the 

survey. The most commonly used dietary supplements were soy (Glycine 

max), gingko (Gingko biloba), and black cohosh. Respondents were asked 

whether black cohosh relieved various symptoms of menopause such as hot 

flashes, vaginal dryness, libido, and mood changes. The survey compared 

the various treatments in terms of perceived success and satisfaction.

Keywords: Hormone replacement therapy, menopause, surveys.

Kauffman, G. 2002. Black cohosh (Cimicifuga racemosa) harvest 

monitoring 2002. Plant Conservation Alliance Medicinal Plant Working 

Group. http://www.nps.gov/plants/medicinal/pubs/2002bcohosh.htm. 

[Date accessed: September 13, 2004].

Summarizes results of the second year of a field monitoring study in 

North Carolina on black cohosh. Twenty-five plots were established in the 

Nantahala National Forest; black cohosh plants were counted and measured 

in each plot. Nine plots were lightly harvested (33 percent), seven plots were 

heavily harvested (66 percent), and the remaining plots served as controls 

with no harvest. Harvested roots weighed an average of 61 grams, with a 

range of 4 to 301 grams. An estimated 15 to 20 plants made up a pound of 

dried root.

Keywords: Conservation, harvest, monitoring.

Kennelly, E.J.; Baggett, S.; Nuntanakorn, P. [and others]. 2002. Analysis 

of thirteen populations of black cohosh for formononetin. Phytomedicine. 

9: 461-467.

Reports on testing different populations of black cohosh for the presence of 

the isoflavone formononetin, using thin-layer chromatography and highperformance liquid chromatography. Two commercial products containing 

black cohosh were also evaluated. The compound formononetin was not 

present in any of the samples tested.

Keywords: Chemical constituents, clinical studies.

Knüvener, E.; Korte, B.; Winterhoff, H. 2000. Cimicifuga and 

physiological estrogens [Abstract]. Phytomedicine. 7(Suppl. 2): 12.

47
Evaluates black cohosh for estrogenic or antiestrogenic activity. 

Cornification of vaginal smears in castrated female mice was used as an 

indicator of estrogenic activity. Mice treated with mestranol or 17–ß– 

estradiol developed estrus, whereas mice treated with black cohosh did not. 

No antiestrogenic effects were observed in mice treated with both estrogen 

and black cohosh.

Keywords: Clinical studies, physiological actions.

Koeda, M.; Aoki, Y.; Sakurai, N. [and others]. 1994. Three novel 

cyclolanostanol xylosides from Cimicifuga rhizome. Chemical and 

Pharmaceutical Bulletin. 42(10): 2205-2207.

Reports the isolation of three new xylosides from a commercial black 

cohosh rhizome. The structures and chemistry of the compounds are 

presented.

Keywords: Chemical constituents.

Korn, W.D. 1991. Six-month oral toxicity study with Remifemin®-granulate 

in rats followed by an 8-week recovery period. Hannover, Germany: 

International Bioresearch. [Number of pages unknown].

Investigates chronic toxicity over a six-month period of administering black 

cohosh granulate to rats at up to 1800 mg/kg body weight, 90 times the 

therapeutic dose. After an eight-week recovery period, no detectable toxic 

effects were observed.

Keywords: Research, toxicity.

Kronenberg, F.; Fugh-Berman, A. 2002. Complementary and alternative 

medicine for menopausal symptoms: a review of randomized, controlled 

trials. Annals of Internal Medicine. 137(10): 805-813.

Reviews research on several herbs used to treat menopausal symptoms. 

Triterpene glycosides, organic acids, esters, or the isoflavone biochanin have 

all been suggested as sources for the the medicinal effects of black cohosh, 

though the active constituents and their physiological actions had not yet 

been identified at the time the article was published. Notes that no data was 

available on the long-term safety of using black cohosh. 

Keywords: Chemical constituents, research reviews.

48
Kruse, S.O.; Lohning, A.; Pauli, G.F. [and others]. 1999. Fukiic and 

piscidic acid esters from the rhizome of Cimicifuga racemosa and the in 

vitro estrogenic activity of fukinolic acid. Planta Medica. 65: 763-764. 

Reports the isolation of new compounds from black cohosh rhizomes and 

discusses their potential pharmacological actions. 

Keywords: Chemical constituents, physiological actions.

Kusano, G.; Hojo, S.; Kondo, Y.; Takemoto, T. 1977. Studies on the 

constituents of Cimicifuga spp. XIII. Structure of cimicifugoside. 

Chemical and Pharmaceutical Bulletin. 25(12): 3182-3189.

Reports on the isolation of several compounds from the roots of black 

cohosh, and proposes chemical structures for each compound. 

Keywords: Chemical constituents.

Laino, C. 2003. Dangers of black cohosh as HRT: popular herb linked to 

liver disease. WebMD Medical News. http://my.webmd.com/content/

article/75/89785.htm. [Date accessed: September 13, 2004].

Reports on a case study of a woman who developed autoimmune hepatitis 

from taking black cohosh. Autoimmune hepatitis is an inflammation of the 

liver caused by an attack from the body’s immune system; symptoms of the 

disease include fatigue, abdominal discomfort, aching joints, or itching. 

The patient developed symptoms three weeks after she started taking 

black cohosh. Two weeks after she stopped using the herb, the symptoms 

disappeared and the patient’s liver function returned to normal within nine 

weeks. A search of medical literature showed five reports of liver problems 

resulting from black cohosh use.

Keywords: Case studies, toxicity.

Langfritz, W. 1962. Essay on the therapy of menstrual anomalies and their 

concomitant phenomena in young girls and young women. Medizinische 

Klinik. 35: 1497-1499. 

Studies the effectiveness of black cohosh. Remifemin® has been used 

successfully to treat juvenile hormonal disorders such as dysmenorrhea, 

ogliomenorrhea, premenstrual syndrome, and similar complaints. Seventythree young female patients were treated with Remifemin® over a four-year 

period. All had uterine or ovarian hypoplasia, complaints of cold feet, 

and underdeveloped breasts. The Remifemin® treatment normalized these 

49
disorders and relieved or eliminated associated neurovegetative symptoms 

without side effects. The author considered the treatment not to be a 

hormone substitute, but a modifier of the autonomic hormonal processes.

Keywords: Clinical studies, medicinal uses, Remifemin®, side effects.

Lata, H.; Bedir, E.; Hosick, A. [and others]. 2002. In vitro plant 

regeneration from leaf-derived callus of Cimicifuga racemosa. Planta 

Medica. 68(10): 912-915.

Describes tissue culture of black cohosh.

Keywords: Tissue culture.

Lehmann-Willenbrock, E.; Riedel, H.H. 1988. Clinical and 

endocrinologic studies of the treatment of ovarian insufficiency 

manifestations following hysterectomy with intact adnexa. Zentralblatt 

fur Gynakologie. 110(10): 611-618. 

Compares the effectiveness of estriol, conjugated estrogens, estrogengestagen, and black cohosh for treating climacteric symptoms in 

hysterectomized patients. After 24 weeks of treatment, all groups showed 

significant improvements. There were no significant differences between the 

various treatment groups.

Keywords: Clinical studies, hormone replacement therapy, medicinal uses.

Li, W.; Sun, Y.; Liang, W. [and others]. 2003. Identification of caffeic 

acid derivatives in Actaea racemosa (Cimicifuga racemosa, black 

cohosh) by liquid chromatography/tandem mass spectrometry. Rapid 

Communications in Mass Spectrometry. 17(9): 978-982.

Reports on the utilization of high-performance liquid chromatography 

electrospray ionization tandem mass spectrometry to identify constituents in 

black cohosh rhizomes.

Keywords: Chemical constituents, research.

Lieberman, S. 1998. A review of the effectiveness of Cimicifuga racemosa

(black cohosh) for the symptoms of menopause. Journal of Women’s 

Health. 7(5): 525-529. 

50
Reviews eight human studies of black cohosh use, focusing specifically on 

the relief of menopause symptoms. The authors concluded that black cohosh 

is an effective and safe alternative to hormone replacement therapy. Review 

includes historical uses, clinical trials, constituents, safety, and references.

Keywords: Chemical constituents, history, hormone replacement therapy, 

medicinal uses, research reviews, safety.

Linde, H. 1964. The composition of Cimicifuga racemosa. 1. on the 

isolation of 2 glycosides. Arzneimittelforschung. 14: 1037-1039. In 

German.

Describes chemical constituents of black cohosh.

Keywords: Chemical constituents.

Linde, H. 1967a. Components of Cimicifuga racemosa. 3. Configuration of 

the A, B, and C rings of actein. Archiv Pharmazie. 300(12): 982-992. In 

German.

Describes chemical constituents of black cohosh.

Keywords: Chemical constituents.

Linde, H. 1967b. Contents of Cimicifuga racemosa. 2. On the structure of 

actein. Archiv Pharmazie. 300(10): 85-92. In German.

Describes chemical constituents of black cohosh. 

Keywords: Chemical constituents.

Liske, E. 1998. Therapeutic efficacy and safety of Cimicifuga racemosa for 

gynecologic disorders. Advances in Therapy. 15(1): 45-53.

Reviews clinical research and standardized assessments of black cohosh 

products for safety and effectiveness. Includes case reports, drug monitoring 

studies, clinical studies, constituents, safety, side effects, and extensive 

references. The authors concluded that black cohosh is a safe and effective 

means of treating menopausal symptoms.

Keywords: Chemical constituents, medicinal uses, products, research 

reviews, safety, side effects.

51
Liske, E.; Boblitz, N.; Henneicke-von Zepelin, H.H. 2000. Therapy of 

climacteric complaints with Cimicifuga racemosa; data on effect and 

efficacy from a randomized controlled double-blind study. In: Rietbrock, 

N.; Donath, M.F.; Loew, D. [and others], (eds.). Phytopharmaka VI. 

Darmstadt: Steinkopff:. p. 247-257. In German.

Describes a study on the effectiveness of black cohosh for treating 

climacteric complaints.

Keywords: Clinical studies, medicinal uses.

Liske, E.; Wüstenberg, P. 1998. Therapy of climacteric complaints with 

Cimicifuga racemosa: herbal medicine with clinically proven evidence. 

Menopause. 5(4): 250.

Compares the effects of two different dosages of Remifemin® (40 mg vs. 

127 mg isopropanolic black cohosh extract) in a double-blind randomized 

6-month clinical study of 152 female patients with climacteric complaints. 

The two dosages showed similar efficacy and safety. Levels of luteinizing 

hormone, follicle stimulating hormone, sex hormone binding globulin, 

prolactin and estradiol, and vaginal cytology were unaffected. The authors 

concluded that the product did not have an estrogen-like (hormone) effect.

Keywords: Clinical studies, dosage, Remifemin®.

Liske, E.; Wüstenberg, P.; Boblitz, N. 1998. Human-pharmacological 

investigations during treatment of climacteric complaints with Cimicifuga 

racemosa (Remifemin®): no estrogen-like effects. ESCOP, The European 

Phytojournal. http://www.ex.ac.uk/phytonet/phytojournal/poster71.pdf. 

[Date accessed: September 13, 2004].

Previous research has suggested estrogen-like effects for black cohosh, 

though recent findings have questioned this claim. This study, involving 152 

patients, showed that the commercial preparation Remifemin® had no effect 

on concentrations of luteinizing hormone, follicle stimulating hormone, 

sex hormone-binding globulin, prolactin, or estradiol. The proliferation 

of vaginal mucosa did not change in an estrogenic manner; however, the 

Kupperman Menopausal Index indicated a significant improvement in 

climacteric symptoms. The authors found black cohosh a safe and effective 

alternative to hormone replacement therapy. 

Keywords: Assessment scales, clinical studies, physiological actions, 

Remifemin®.

52
Liu, J.; Burdette, J.E.; Xu, H. [and others]. 2001. Evaluation of estrogenic 

activity of plant extracts for the potential treatment of menopausal 

symptoms. Journal of Agriculture and Food Chemistry. 49(5): 2472-2479. 

Evaluates the estrogenic activity of eight herbs commonly used to treat 

menopausal symptoms. Clinical research on black cohosh has shown 

decreased levels of the luteinizing hormone responsible for hot flashes. Yet, 

in this study, black cohosh did not demonstrate binding to estrogen receptors 

and was concluded to not have estrogen-like activity.

Keywords: Clinical studies, physiological actions.

Liu, Z.; Yang, Z.; Zhu, M.; Huo, J. 2001. Estrogenicity of black cohosh 

(Cimicifuga racemosa) and its effect on estrogen receptor level in human 

breast cancer MCF-7 cells. Wei Sheng Yan Jiu (Journal of Hygiene 

Research). 30(2): 77-80. 

Female mice receiving black cohosh showed an increased uterine weight 

and duration of estrus. The authors concluded that black cohosh showed an 

estrogen-like action. 

Keywords: Clinical studies, physiological actions.

Löhning, A.; Verspohl, E.J.; Winterhoff, H. 1998. Cimicifuga racemosa

in vitro findings using MCF-7 cells [Abstract]. Phytopharmakaforschung 

2000: 72. In German.

Investigates the effects of black cohosh on cancer cells. 

Keywords: Cancer, clinical studies, medicinal uses.

Löhning, A.; Verspohl, E.J.; Winterhoff, H. 1999. Pharmacological 

studies on the dopaminergic activity of Cimicifuga racemosa. In: 23rd

international LOF-symposium on phyto-estrogens; 1999 Jan 15; Belgium. 

Belgium: University of Gent. [Number of pages unknown].

Describes research on the dopaminergic activity of black cohosh. 

Keywords: Clinical studies, physiological actions.

Löhning, A.; Winterhoff, H. 2000. Neurotransmitter concentrations 

after three weeks treatment with Cimicifuga racemosa [Abstract]. 

Phytomedicine. 7(Suppl. 2): 13.

53
Reports on the detection of changes in neurotransmitter concentrations in 

response to treatment with black cohosh. Results showed that black cohosh 

had an antidepressant activity caused by the inhibition of monoamine 

oxidase.

Keywords: Clinical studies, physiological actions.

Lontos, S.; Jones, R.M.; Angus, P.W.; Gow, P.J. 2003. Acute liver failure 

associated with the use of herbal preparations containing black cohosh. 

Medical Journal of Australia. 179(7): 390-391.

Reports a case of liver failure caused by an herbal remedy containing 

fluid extracts of ground ivy (Nepeta hederaceae), goldenseal (Hydrastis 

canadensis), gingko (Gingko biloba), oats seed (Avena sativa), and black 

cohosh. Three months after beginning to use the herbal mixture, the patient 

had acute liver failure and required a transplant. The explanted liver 

showed massive hepatic necrosis. Based on previous reports of hepatic 

failure associated with black cohosh, the authors suggested that the adverse 

reaction was caused by the black cohosh in the herbal mixture.

Keywords: Case studies, toxicity.

Löser, B.; Kruse, S.O.; Melzig, M.F.; Nahrstedt, A. 2000. Inhibition of 

neutrophil elastase activity by cinnamic acid derivatives from Cimicifuga 

racemosa. Planta Medica. 66: 751-753. 

Evaluates several chemical constituents of black cohosh rhizomes, and 

describes their mechanism of action. 

Keywords: Chemical constituents, physiological actions.

Lupu, R.; Mehmi, I.; Atlas, E. [and others]. 2002. Black cohosh, a 

menopausal remedy, does not have estrogenic activity and does not 

promote breast cancer cell growth. International Journal of Oncology. 23: 

1407-1412.

Determines that black cohosh does not have estrogenic activity in vitro. 

Various assays indicated that black cohosh extracts did not bind to or 

otherwise modulate estrogen receptors, and did not cause estrogen-positive 

breast cancer cells to proliferate.

Keywords: Cancer, physiological actions.

54
Lyke, J. 2001. Summary of the conservation status of Cimicifuga ssp. 

(Cimicifuga rubifolia, C. americana, C. racemosa). http://www.nps.gov/

plants/medicinal/pubs/2001appendixf.htm. [Date accessed: September 

13, 2004].

Summarizes the conservation status of black cohosh, with references. 

Demand for black cohosh has steadily increased in the world herb 

market, with an estimated 97 percent of the supply from wildcrafting. The 

distribution and abundance of wild populations were estimated, but no 

formal tracking was in progress. An estimated 366,000 pounds of dried 

roots were collected from 1997 to 1999; at 25 roots per pound, this meant a 

total of 9.2 million plants. Permit sales, conservation status, and proposed 

government regulations are discussed.

Keywords: Conservation, distribution, harvest, market demand, permits, 

regulatory status, wildcrafting.

Macht, D.I.; Cook, H.M. 1932. A pharmacological note on Cimicifuga. 

Journal of the American Pharmaceutical Association. 21(4): 324-330.

Provides a historical account of black cohosh medicinal uses.

Keywords: History, physiological actions.

Mahady, G.B. 2003. What is the evidence for supplement use for 

menopausal symptoms? Bethesda, MD: NIH conference on dietary 

supplement use in the elderly. http://dietary-supplements.info.nih.gov/

pubs/elderly.14jan03.abst.mahady.pdf. [Date accessed: September 13, 

2004]. 

Discusses the safety of black cohosh as a treatment for menopausal 

symptoms. Although black cohosh has been shown to be effective for 

reducing hot flashes and vaginal dryness in healthy individuals, it has 

not been shown to be effective for individuals taking tamoxifen for the 

treatment of breast cancer. The article describes a one-year research trial 

in progress at the University of Illinois at, Chicago, National Institutes of 

Health Center for Botanical Dietary Supplement Research in Womens’s 

Health.

Keywords: Cancer, clinical studies, medicinal uses.

55
Mahady, G.B.; Fong, H.H.S.; Farnsworth, N.R. 2001. Botanical dietary 

supplements: quality, safety, and efficacy. Lisse, The Netherlands: Swets 

& Zeitlinger B.V. 271 p.

Provides information on several medicinal herbs, including history, 

medicinal uses, clinical research, physiological actions, and safety 

information. Clinical research has indicated that black cohosh can 

relieve symptoms of menopause such as hot flashes, sweating, anxiety, 

and insomnia. Beneficial effects have been observed after four to twelve 

weeks of treatment. Side effects such as nausea, vomiting, headaches, 

and dizziness have been reported, but are not common. Clinical trials 

investigating the constituents, mechanisms of action, and efficacy of black 

cohosh are discussed.

Keywords: Medicinal uses, physiological actions, research reviews, side 

effects.

McCoy, J.; Kelly, W. 1996. Survey of Cimicifuga racemosa for 

phytoestrogenic flavonoids. In: 212th ACS national meeting. Washington, 

DC: American Chemical Society. [Number of pages unknown].

Analyzes the chemical constituents of black cohosh roots. The isoflavone 

formononetin, previously reported to be a constituent of black cohosh roots, 

was not detected in this study.

Keywords: Chemical constituents, phytoestrogens, research.

McCullough, J.E., inventor; Hair Associates, LLC, assignee. 2000. Hair 

care formulations. U.S. patent 6,139,828. October 31. 1 p. Int. CI2 

A61K 007/075,A61K 007/08. http://patft.uspto.gov/netacgi/nph-Parser

?Sect1=PTO2&Sect2=HITOFF&p=1&u=/netahtml/search-bool.html&

r=1&f=G&l=50&co1=AND&d=ptxt&s1=6,139,828.WKU.&OS=PN/

6,139,828&RS=PN/6,139,828. [Date accessed: September 13, 2004].

Patents a hair care formulation designed to cleanse the scalp and open hair 

follicles, thus promoting hair growth. The product contains black cohosh 

and surfactants.

Keywords: Medicinal uses, patents.

McFarlin, B.L.; Gibson, M.H.; O’Rear, J.; Harman, P. 1999. A national 

survey of herbal preparation use by nurse-midwives for labor stimulation. 

Review of the literature and recommendations for practice. Journal of 

Nurse-Midwifery. 44(3): 205-216.

56
Surveys the use of herbal preparations by midwives during childbirth. 

Black cohosh was used to stimulate labor, alone or in combination, by 45 

percent of the respondents. Issues related to herbal use during childbirth are 

discussed, with a brief summary of black cohosh uses.

Keywords: Medicinal uses, preparations, surveys.

McGraw, J.B.; Bailey, B.; Sanders, S. 2003. Conservation status of 

medicinal plants in international trade. Award No. 1434—HQ–97–RU–

01563. Morgantown, WV: West Virginia University. 48 p. [Technical 

report produced for the U.S. Fish and Wildlife Service].

Reports on the use of habitat suitability models to predict potential habitat 

for goldenseal (Hydrastis canadensis) and black cohosh. Factors that limit 

the abundance of the plants include slow recovery after harvest, limited 

reproduction, and increasing harvest due to market demand. Habitat 

suitability models were developed based on ecological characteristics of 

both known populations and confirmed areas of absence. Natural areas 

in north central West Virginia were evaluated as potential habitat, using 

variables such as land cover/use, elevation, terrain shape, slope, planiform 

curviture (convex or concave areas), profile curvature, aspect, topography, 

relative moisture index, solar insolation, and distance to streams. Goldenseal 

showed a high level of habitat specificity, whereas black cohosh was less 

restricted and more abundant. However, slow vegetative reproduction and 

limited seed dispersal have made black cohosh populations susceptible to 

depletion from the harvest of rhizomes for medicinal purposes. Results of 

interviews with herb dealers are presented, providing insight into general 

market trends in the medicinal botanical industry.

Keywords: Conservation, ecology, habitat, harvest, market.

McKenna, D.J.; Jones, K.; Humphrey, S.; Hughes, K. 2001. Black 

cohosh: efficacy, safety, and use in clinical and preclinical applications. 

Alternative Therapies. 7(3): 93-100.

Reviews and summarizes research conducted on Remifemin®, a 

commercial black cohosh product. Includes botanical data, classification 

and nomenclature, history and traditional uses, chemical constituents, 

therapeutic applications, preclinical studies, clinical studies, dosage, 

safety, side effects, drug interactions, precautions, a thorough discussion of 

pharmacological actions throughout the body, and extensive references.

Keywords: Chemical constituents, drug interactions, dosage, history, 

physiological actions, Remifemin®, research reviews, safety, side effects.

57
Mielnik, J. 1997. Extract of Cimcifuga racemosa in the treatment of 

neurovegetative symptoms in women in the perimenopausal period 

[Abstract]. Maturitas. 27(Suppl. 1): 215.

Describes the use of black cohosh by 34 postmenopausal women evaluated 

by the Kupperman Menopausal Index of menopausal symptoms. After the 

first month of treatment, 26 patients showed significant improvement. Four 

patients showed no improvement, and four discontinued treatment in favor 

of hormone replacement therapy. No side effects were observed.

Keywords: Assessment scales, clinical studies, hormone replacement 

therapy, medicinal uses.

Morris, K.; Look, R.M.; Hudson, V. [and others]. 2003. The efficacy and 

safety of black cohosh for managing menopausal symptoms in breast 

cancer survivors. Breast Cancer Research and Treatment. 82(Suppl. 1): 

S159.

Investigates the safety of black cohosh use by breast cancer survivors. In 

vitro experiments showed that black cohosh did not cause proliferation of 

hormone sensitive (T–47D) or insensitive (HCC–1937) breast cancer cells. 

In vivo experiments on 21 women compared the efficacy of black cohosh 

to that of venlafaxine for two 60-day periods divided by a 7-day washout 

period. Although venlafaxine was more effective than black cohosh, both 

groups showed a significant reduction in hot flashes with no serious side 

effects.

Keywords: Cancer, clinical studies, side effects.

Moyer, P. 2002. ENDO: phytoestrogen black cohosh may have potential as 

a SERM. Doctor’s Guide. http://www.docguide.com/dg.nsf/PrintPrint/

A947E7526A16116785256BE3004F23CA. [Date accessed: September 

13, 2004]. 

Summarizes a study on black cohosh as a potential selective estrogen 

receptor modulator for treating symptoms of menopause. The 62 

participants in the study received either black cohosh, conjugated estrogen, 

or a placebo for a three-month period. Climacteric symptoms such as hot 

flashes were significantly reduced by both black cohosh and conjugated 

estrogen.

Keywords: Clinical studies, medicinal uses, phytoestrogens.

58
Muñoz, G.H.; Pluchino, S. 2003. Cimicifuga racemosa for the treatment 

of hot flushes in women surviving breast cancer. Maturitas. 44(Suppl. 1): 

S59-S65.

Examines the use of black cohosh (extract CR BNO 1055, found in 

Klimadynon®/Menofem®) to treat hot flashes for breast cancer survivors on 

tamoxifen. After masectomy, radiation, and chemotherapy, patients were 

divided into two groups: one group received tamoxifen and black cohosh, 

the other received tamoxifen only. After 12 months of treatment, the group 

receiving black cohosh and tamoxifen showed a significant reduction in the 

number and severity of hot flashes compared to the group receiving only 

tamoxifen.

Keywords: Cancer, clinical studies, hot flashes, medicinal uses.

Murray, M.T. 2003. Black cohosh – is there really a concern? http://www.

doctormurray.com/newsletter/1-16-2003.htm. [Date accessed: September 

13, 2004].

Responds to a study by Davis and others (2003) that found that mice 

bred to express breast cancer, when fed a diet with black cohosh, showed 

significantly higher rates of breast cancer cells metastasizing to the lungs. 

The author discusses several issues related to this study: (1) the research 

was conducted on mice and not on humans, and black cohosh may not have 

the same effects on two different organisms; (2) the mice used in the study 

were specifically bred to develop breast cancer, which may have skewed 

the results; and (3) previous research has shown that black cohosh has an 

inhibitory effect on cancer cells. Research on the safety of black cohosh by 

Dog and others (2003) is summarized.

Keywords: Research reviews, toxicity.

National Institutes of Health, National Toxicology Program. 1999. 

Summary of data for chemical selection: black cohosh. http://ntp.

niehs.nih.gov/INDEX.CFM?OBJECTID=03DA9AE1-E585-C748-

5328B384769DCD0F. [Date accessed: January 7, 2004].

Summarizes data on the chemical constituents, mechanism of action, 

and safety of black cohosh. Includes information on human and animal 

exposure, manufacturers and distributors, usage, history, regulations, and 

biological effects.

Keywords: Chemical constituents, medicinal uses, physiological actions, 

products, side effects, toxicity.

59
National Institutes of Health, National Toxicology Program. 2002. Black 

cohosh. http://ntp.niehs.nih.gov/index.cfm?objectid=07110B8E-B6F8-

602B-BFB961E97D06B225. [Date accessed: January 7, 2004].

Reviews research on black cohosh safety, including the identification and 

structure of chemical constituents, exposure information, use patterns, 

regulatory status, evidence for carcinogenic activity, biological effects, 

health effects of active constituents, and references.

Keywords: Cancer, chemical constituents, physiological actions, regulatory 

status, research reviews.

Nesselhut, T.; Bodinet, C.; Schneider, P.; Freudenstein, J., inventors; 

Schaper & Bruemmer GmbH & Co., assignee. 2001. Use of extract of 

Cimicifuga racemosa. U.S. patent 6,267,994. July 31. 1 p. Int. CI2 A61K 

035/78. http://patft.uspto.gov/netacgi/nph-Parser?Sect1=PTO2&Sect2=HI

TOFF&p=1&u=/netahtml/search-bool.html&r=1&f=G&l=50&co1=AND

&d=ptxt&s1=6,267,994.WKU.&OS=PN/6,267,994&RS=PN/6,267,994. 

[Date accessed: September 13, 2004].

Patents the use of a black cohosh extract to treat estrogen-dependent 

tumors. Black cohosh has been found to increase the effectiveness of the 

anticancer drug tamoxifen, reducing the dosage needed to treat cancer. This 

is beneficial both because tamoxifen can be toxic in high doses, and because 

black cohosh can reduce hot flashes experienced by breast cancer survivors. 

Keywords: Cancer, drug interactions, medicinal uses, patents.

Nesselhut, T.; Borth, S.; Kuhn, W. 1993. Influence of Cimicifuga extracts 

with estrogen-like activity on the in vitro proliferation of mamma 

carcinoma cells. Archives of Gynecology and Obstetrics. 254: 817-818.

Shows that Remifemin®, at concentrations of > 2.5 μgm/ml, inhibits the 

proliferation of E2 positive breast cancer cells. Inhibition decreased when 

Remifemin® was combined with estradiol, but increased when combined 

with tamoxifen, and was greater than for either Remifemin® or tamoxifen 

used alone. The authors suggested that the inhibition of breast cancer cells 

was mediated through the estrogen receptor and that the positive effects of 

tamoxifen were enhanced by black cohosh.

Keywords: Cancer, clinical studies, drug interactions, Remifemin®.

60
Nesselhut, T.; Liske, E. 1999. Pharmacological measures in 

postmenopausal women with an isopropanolic aqueous extract of 

Cimicifuga racemosa rhizoma [Abstract]. Menopause. 6(4): 331.

Evaluates the effects of a high dose of black cohosh (136 mg/day) on 

28 postmenopausal patients for 98 days. No changes were observed in 

endometrial thickness or vaginal cells, though 80 percent of patients 

reported an improvement in symptoms after therapy. The authors concluded 

that black cohosh acted as a phyto-selective estrogen receptor modulator 

with a non-estrogenic effect.

Keywords: Clinical studies, medicinal uses, physiological actions.

Newmark, T.; Schulick, P., inventors; [No assignee recorded], 2001. 

Herbal composition for promoting hormonal balance in women and 

methods of using same. U.S. patent 6,242,012. June 5. 1 p. Int. CI2 

A61K 035/78; A01N065/00. http://patft.uspto.gov/netacgi/nph-Parser?

Sect1=PTO2&Sect2=HITOFF&p=1&u=/netahtml/search-bool.html&

r=1&f=G&l=50&co1=AND&d=ptxt&s1=6,242,012.WKU.&OS=PN/

6,242,012&RS=PN/6,242,012. [Date accessed: September 13, 2004].

Patents an herbal composition containing ginger (species not specified), 

rosemary (Rosmarinus officinalis), evening primrose (Oenothera biennis), 

black cohosh, dong quai (Angelica sinensis), schizandra berry (Schizandra 

chinensis), and chaste tree berry (Vitex agnus-castus). The purpose of this 

herbal formula is to treat symptoms of hormonal imbalance in women, 

promote normal bone growth, improve sexual functioning, and act as an 

antioxidant to reduce signs of aging.

Keywords: Medicinal uses, patents.

Nisslein, T.; Freudenstein, J. 2000. Effects of black cohosh on urinary 

bone markers and femoral density in an OVX-rat model. Osteoporosis 

International. 11(Supplement 2): [Number of pages unknown]. Abstract 

number 504.

Suggests that black cohosh has potential benefits for retarding bone loss. 

Markers of bone metabolism declined significantly compared to controls in 

rats given black cohosh isopropanolic extract.

Keywords: Clinical studies, medicinal uses.

61
Nisslein, T.; Freudenstein, J. 2003. Effects of an isopropanolic extract of 

Cimicifuga racemosa on urinary crosslinks and other parameters of bone 

quality in an ovariectomized rat model of osteoporosis. Journal of Bone 

Mineral Metabolism. 21(6): 370-376.

Investigates the effects of black cohosh on bone loss associated with 

decreased estrogen levels. Ovariectomized rats on diets containing black 

cohosh showed significantly less bone loss starting 2 to 5 weeks after 

treatment began through the completion of the study at 7 weeks.

Keywords: Clinical studies, medicinal uses, physiological actions.

Noguchi, M.; Naga, M.; Koeda, M. [and others]. 1998. Vasoactive effects 

of cimicifugic acids C and D, and fukinolic acid in Cimicifuga rhizome. 

Biological and Pharmaceutical Bulletin. 21(11): 1163-1168.

Examines the vasoactivity of several constituents of black cohosh.

Keywords: Chemical constituents, clinical studies.

Onorato, J.; Henion, J.D. 2001. Evaluation of triterpene glycoside 

estrogenic activity using LC/MS and immunoaffinity extraction. 

Analytical Chemistry. 73(19): 4704-4710. 

Tests the estrogen-like activity of three triterpene glycosides present in the 

rhizomes of black cohosh. One glycoside, 27–deoxyacetin aglycon, showed 

weak binding (4 percent), whereas none of the other glycosides or their 

metabolic products showed binding to estrogen receptor sites.

Keywords: Chemical constituents, clinical studies, physiological actions.

Papps, F.A. 2000. Therapeutic use and associated biochemistry of 

Cimicifuga racemosa in the treatment of menopausal symptoms. 

Australian Journal of Medical Herbalism. 12(1): 22-26.

Reviews research related to the use of black cohosh to treat symptoms of 

menopause, with a focus on biochemical mechanisms and chemistry.

Keywords: Chemical constituents, medicinal uses, research reviews.

Pepping, J. 1999. Black cohosh: Cimicifuga racemosa. American Journal of 

Health-System Pharmacy. 56(14): 1400-1402.

62
Reviews black cohosh research; includes uses, pharmacology, 

pharmokinetics, clinical studies, dosage, adverse effects, drug interactions, 

contraindications, and references. The active constituents include triterpene 

glycosides such as actein, cimicifugoside, and 27–deoxyactein. The most 

popular commercial product, Remifemin®, is standardized to contain 1 

mg of 27–deoxyacetin per 20-mg tablet. Studies on the presence of the 

isoflavone formononetin have yielded conflicting results. Several clinical 

studies indicated estrogenic effects for black cohosh, such as decreased 

luteinizing hormone levels in menopausal women and increased uterine 

weight in rats. Other studies failed to show these results. Several clinical 

studies that demonstrated significant improvement in psychological 

and somatic symptoms of menopause as measured by the Kupperman 

Menopausal Index and the Hamilton Anxiety Scale are summarized. All 

studies utilized Remifemin® at dosages from 40 to 80 mg twice daily. 

Research conducted by the manufacturer resulted in a recommended 

dose of one tablet twice daily. Effects were apparent after two weeks of 

use, and maximum benefit seen after eight weeks. Side effects included 

gastrointestinal upset in a small percentage of consumers. Recent studies 

have concluded that black cohosh is safe for women with a history of 

estrogen-related cancer. The author noted that no drug interactions were 

known, and that black cohosh should not be used during pregnancy.

Keywords: Assessment scales, chemical constituents, dosage, medicinal 

uses, physiological actions, Remifemin®, research reviews, side effects.

Petho. 1987. Climacteric complaints are often helped with black cohosh. 

Ärztliche Praxis. 47: 1551-1553.

Reviews the effectiveness of Remifemin® for treating menopausal 

symptoms in an open study involving 60 female patients who replaced 

hormone injection therapy with black cohosh tablets (40 mg twice daily) 

over a 6-month period. The Kupperman Menopausal Index, subjective 

observations, and the number of hormone injections needed after initiation 

of Remifemin® therapy were used to measure efficacy. Eighty-two percent 

of patients reported the black cohosh therapy as good or very good, and 58 

percent did not need additional hormone injections. No side effects were 

reported over the six-month period.

Keywords: Assessment scales, clinical studies, hormone replacement 

therapy, medicinal uses, Remifemin®, side effects.

63
Popp, M.; Schenk, R.; Abel, G. 2003. Cultivation of Cimicifuga racemosa

(L.) Nuttall and quality of CR extract BNO 1055. Maturitas. 44(Suppl. 

1): S1-S7. 

Reports the results of experiments with propagation and cultivation 

techniques for black cohosh with the goal of producing a homogenized, 

standardized variety for pharmaceutical use. Germination of black cohosh 

seeds required two stratification periods. Gibberellic acid applications 

improved leaf development. Evaluation of triterpene glycoside content over 

several months showed peak levels in June, though extractable levels and 

quality of constituents peaked in August.

Keywords: Chemical constituents, cultivation, harvest, research, seeds. 

Ramsey, G. 2000. Actaea and Cimicifuga identification. Chinquapin. 8(3): 26. 

Identifies key points for distinguishing Cimicifuga from Actaea based on 

leaf characteristics.

Keywords: Identification.

Ramsey, G.W. 1986. A biometrical analysis of terminal leaflet 

characteristics of the North American Cimicifuga (Ranunculaceae). 

Virginia Journal of Science. 37(1): 3-8.

Identifies anatomical characteristics that can be used to differentiate Eastern 

North American Cimicifuga species, including stomatal apparatus length 

and number of stomates on terminal leaflets.

Keywords: Identification, related species.

Ramsey, G.W. 1988. A comparison of vegetative characteristics of several 

genera with those of the genus Cimicifuga (Ranunculaceae). Sida. 13(1): 

57-63.

Offers an analysis of morphological features of Cimicifuga, Actaea, 

Aruncus, Astilbe, Thalictrum, Caulophylum, and Trautvetteria, highlighting 

vegetative differences between the genera. A key is included to aid in field 

identification of specimens based on terminal leaflet characteristics.

Keywords: Identification.

64
Robbins, C. 1999. Medicine from U.S. wildlands: an assessment of native 

plant species harvested in the United States for medicinal use and 

trade and evaluation of the conservation and management implications. 

http://www.nps.gov/plants/medicinal/pubs/traffic.htm. [Date accessed: 

September 14, 2004]. [Prepared by TRAFFIC North America for the 

Nature Conservancy].

Provides information on black cohosh harvest and conservation status. A 

total of 4 permits were sold for black cohosh collection from national forests 

in 1995, 33 in 1996, and 50 in 1997.

Keywords: Conservation, harvest, permits.

Robbins, C. 2001. TRAFFIC analysis of U.S. exports and consumer interest 

in black cohosh (Cimicifuga racemosa). Washington, DC: TRAFFIC 

North America. 1 p.

Summarizes export data from the U.S. Department of Agriculture, Animal 

and Plant Health Inspection Service from 1999 to 2001. A total of 4245 kg 

of dried rhizomes were exported to Italy, France, Canada, Germany, and 

Switzerland. Sources of exported roots were Virginia, North Carolina, South 

Carolina, and Ohio.

Keywords: Export.

Rockwell, S.; Fajolu, O.; Liu, Y. [and others]. 2003. The herbal medicine 

black cohosh alters the response of breast cancer cells to some agents 

used in cancer therapy [Abstract]. American Association for Cancer 

Research. Abstract available at: http://www.annieappleseedproject.org/

efofblaccoho.html. [Date accessed: September 13, 2004].

Investigates the effects of black cohosh extracts on cancer cells in vitro. 

The black cohosh extract alone did not affect the growth of cancer cells. 

When combined with different anticancer drugs the results varied: black 

cohosh increased the efficacy of Cisplatin, but increased the toxicity of 

Adriamycin® and Taxotere®.

Keywords: Cancer, clinical studies, drug interactions, toxicity.

Sakurai, N.; Wu, J.H.; Sashida, Y. [and others]. 2004. Anti-AIDS agents. 

Part 57: Actein, an anti-HIV principle from the rhizome of Cimicifuga 

racemosa (black cohosh), and the anti-HIV activity of related saponins. 

Bioorganic and Medicinal Chemistry Letters. 14(5): 1329-1332. 

65
Evaluates constituents from black cohosh for anti-HIV activity. Actein, a 

tetracyclic triterpenoid, showed potent anti-HIV activity, and 12 saponins 

showed moderate anti-HIV activity.

Keywords: Chemical constituents, clinical studies, medicinal uses.

Schaper and Brummer, GmbH. 1997. Remifemin®: a plant-based 

gynecological agent. Salzgitter, Germany: Schaper and Brummer GmbH. 

[Number of pages unknown].

Summarizes a controlled, randomized, double-blind, multicenter clinical 

study involving 152 women before or after menopause (age 43 to 60 years) 

who were experiencing moderate neurovegetative climacteric complaints. 

Patients received either one or two 20-mg tablets twice daily for three 

months. Patients were examined before starting treatment, at 2, 4, and 8 

weeks of treatment, and after the study ended. Effectiveness was evaluated 

using the Kupperman Menopausal Index, the Self-Assessment Depression 

Scale, the Clinical Global Impression scale, and vaginal cytology indices. 

Levels of luteinizing hormone, follicle stimulating hormone, estradiol–17b, 

prolactin, and globulin were also measured. Both dosages showed similar 

effectiveness and safety results; the Kupperman Menopausal Index and SelfAssessment Depression Scale showed significantly decreased scores, but 

no changes were seen in vaginal cytology or hormone levels. No details are 

given on adverse effects, though the treatment was rated as well tolerated 

by 95 percent of patients and 92 percent of their doctors, and as “good” 

or “very good” in 80 percent of cases. This brochure is provided by the 

manufacturers of Remifemin®.

Keywords: Assessment scales, clinical studies, dosage, luteinizing hormone, 

medicinal uses, menopause, Remifemin®

Schlosser, K.K. 2002. Counting cohosh. North Carolina Wildflower 

Preservation Society. 14(2): [Number of pages unknown]. http://www.

nps.gov/plants/medicinal/pubs/countingcohosh.htm. [Date accessed: 

September 13, 2004].

Describes a monitoring study of black cohosh in the forests of North 

Carolina sponsored by the Plant Conservation Alliance - Medicinal Plant 

Working Group and the Forest Service, and executed by members of the 

Garden Club of America. In this study, black cohosh plants in designated 10 

X 10-meter plots were counted, measured, and evaluated for health status. 

Plots were divided into one of three groups: controls with no harvest, 33 

percent harvest, or 66 percent harvest. The purpose of the research is to 

66
provide forest managers with information about the regeneration of black 

cohosh to ensure that harvest levels remain within sustainable limits. 

Keywords: Conservation, harvest, monitoring.

Seibel, M.M. 2003. Treating hot flushes without hormone replacement 

therapy. Journal of Family Practice. 52(4): 291-296.

Summarizes information on herbs used as alternatives to hormone 

replacement therapy, including soy (Glycine max), dong quai (Angelica 

sinensis), black cohosh, evening primrose (Oenothera biennis), and red 

clover (Trifolium pratense).

Keywords: Hormone replacement therapy, medicinal uses.

Seidlová-Wuttke, D.; Hesse, O.; Jarry, H. [and others]. 2003. Evidence 

for selective estrogen receptor modulator activity in a black cohosh 

(Cimicifuga racemosa) extract: comparison with estradiol-17beta. 

European Journal of Endocrinology. 149: 351-362.

Compares the selective estrogen receptor modulator (SERM) activity of the 

black cohosh extract BNO 1055 (Klimadynon/Menofem) to estrogen. 

After a 3-month treatment with black cohosh or estrogens, ovariectomized 

rats showed both decreased luteinizing hormone secretion and reduced 

bone loss. The estrogen group also showed uterine weight gain and 

progesterone receptor activity, whereas the group using black cohosh did 

not. Results indicated that black cohosh has SERM properties that act in the 

hypothalamus/pituitary system and prevent bone loss without stimulating 

the uterus. The active constituents remained unidentified.

Keywords: Chemical constituents, clinical studies, medicinal uses, 

physiological actions.

Seidlová-Wuttke, D.; Jarry, H.; Heiden, I.; Wuttke, W. 2000. Effects 

of Cimicifuga racemosa on estrogen dependent tissues [Abstract]. 

Phytomedicine. 7(Suppl. 2): 11.

Evaluates the activity of black cohosh in the uterus, bone, liver, and aorta. 

Subacute and chronic treatments with black cohosh extract BNO 1055 were 

compared to treatments with estradiol in rats. Black cohosh showed no 

effect on uterine weight, but acted similarly to estrogen in the bone, liver, 

and aorta. These results suggested that black cohosh has phytoselective 

estrogen receptor (ER) modulator activity acting mainly upon ER-β.

67
Keywords: Clinical studies, physiological actions.

Seidlová-Wuttke, D.; Wuttke, W. 2000. Selective estrogen receptor 

modular activity of Cimicifuga racemosa extract: clinical data [Abstract]. 

Phytomedicine. 7(Suppl. 2): 11.

Discusses the selective estrogen receptor (ER) modulator activity of black 

cohosh. Two types of estrogen receptors have been identified: ER-β and ERβ. Black cohosh has shown beneficial effects in the central nervous system, 

bone, and arteries, but no effects on the uterus. The authors suggested that 

this indicates that black cohosh may selectively affect one type of estrogen 

receptor, though more research is needed to understand the mechanism of 

action. Recent studies have suggested that black cohosh may reduce hot 

flashes by influencing the hypothalamus, without estrogenic activity.

Keywords: Clinical studies, hot flashes, medicinal uses, physiological 

actions.

Shao, Y.; Harris, A.; Wang, M. [and others]. 2000. Triterpene glycosides 

from Cimicifuga racemosa. Journal of Natural Products. 63: 905–910.

Reports the discovery of eight new triterpene glycosides in root extracts of 

black cohosh.

Keywords: Chemical constituents, clinical studies.

Stefan, H. 1959. An essay on the manifestations and therapy of hormonerelated female biopathic syndrome. Ringelh Biol Umsch. 10: 149-152; 

11: 157-162.

Focuses on the use of black cohosh to treat juvenile menstrual irregularities, 

which can be accompanied by psychological symptoms such as mood 

swings, depression, and psychological instability. The author found that, 

within eight weeks of initiation, this treatment was particularly useful for 

restoring regular menstruation after disruptions caused by stress, transitions, 

or adjustment to new surroundings. The author concluded that, with its mild 

sedative action and hormone-like effect, black cohosh could be effectively 

used to treat females with hormone imbalances from pre-puberty to 

menopause. This conclusion was based on the study findings that the herb 

could induce normal menstruation without being habit-forming or having 

other negative side effects with long-term administration.

Keywords: Case studies, medicinal uses, mood, side effects.

68
Stiehler, K. 1959. On the use of a standardized Cimicifuga extract in 

gynecology. Ärztliche Praxis. 11(26): 916-917.

Concludes that black cohosh produces a normalizing effect by intervening 

with (without interfering with) hormonal mechanisms while still under 

pituitary control, in a study based on clinical observations of 53 patients. 

The author states that black cohosh was found useful for treating both 

premenopausal and menopausal symptoms and irregular menstruation with 

a shortened follicular phase in juveniles, but was not useful for menstrual 

disorders in general. A mild mood-enhancing effect was noted.

Keywords: Case studies, medicinal uses, mood, physiological actions.

Stoll, W. 1987. Phytotherapy influences atrophic vaginal epithelium. 

Therapeuticon. 1: 23-31. Abstract available at http://www.chiro.org/

nutrition/ABSTRACTS/Phytotherapy_Influences_Atrophic.shtml. [Date 

accessed: September 13, 2004].

Evaluates the effectiveness of black cohosh for treating symptoms of 

menopause. A double-blind study was conducted with 80 women for 

three months, comparing Remifemin® and a low-dose estrogen treatment 

to a placebo. At the end of the study, women taking Remifemin® showed 

significant improvement on the Kupperman Menopausal Index (measuring 

neurovegetative symptoms), the Hamilton Anxiety Scale (measuring 

psychological complaints), and proliferation of vaginal epithelium. The 

estrogen dose was too low for any significant results. 

Keywords: Assessment scales, clinical studies, medicinal uses, Remifemin®.

Stolze, H. 1982. An alternative to treat menopausal complaints. 

Gynakologe. 3: 14-16.

Reviews objective evaluations by 131 general practitioners and 

gynecologists and subjective evaluations by 629 of their patients on 

the effectiveness of a black cohosh treatment (40 drops Remifemin®

liquid twice/day) for menopausal complaints, in an open, multi-center, 

retrospective study. Favorable results were achieved in 80 percent of cases 

after six to eight weeks of treatment, and included varying degrees of relief 

from neurovegetative symptoms such as hot flashes, sweating, headache, 

vertigo, heart palpitation, and tinnitus. Varying degrees of relief were also 

found from psychiatric symptoms such as nervousness and irritability, sleep 

disturbances, and depressive moods. Symptoms were completely removed 

in 49 percent of cases, and 37.8 percent experienced improvement (but not 

cessation) of symptoms. Seven percent of the cases experienced transient 

69
stomach upset, but none discontinued treatment. Physicians considered 

the black cohosh treatment advantageous over hormone replacement in 72 

percent of the cases. The author concluded that black cohosh was a safe and 

effective nonhormonal treatment for menopausal symptoms.

Keywords: Clinical studies, medicinal uses, Remifemin®.

Struck, D.; Tegtmeier, M.; Harnischfeger, G. 1997. Flavones in extracts of 

Cimicifuga racemosa. Planta Medica. 63(3): 289.

Evaluates the active chemical constituents in black cohosh commercial 

preparations. Flavonoids were found in both extracts and medicines, but 

the isoflavone formononetin and the flavone kaempferol were not present in 

detectable amounts.

Keywords: Chemical constituents, products, research.

Suggs, R. 2003. Market profile: black cohosh. Robbinsville, NC: Yellow 

Creek Botanical Institute. 12 p. Unpublished document. On file with: U.S. 

Department of Agriculture, Forest Service, Southern Research Station, 

SRS-4702, 1650 Ramble Road, Blacksburg, VA 24060.

Describes the international market for black cohosh. Black cohosh is most 

commonly used to relieve symptoms of menopause and premenstrual 

syndrome. Although black cohosh is not currently threatened or endangered, 

increased demand in the late 1990s has qualified the herb for “At-Risk” 

status with the United Plant Savers, and the plant is considered a priority 

species for observation by the wildlife trade monitoring organization 

TRAFFIC. Black cohosh is regulated in the United States as a dietary 

supplement and is approved as a drug in Europe. Numerous clinical 

studies have supported the safety and efficacy of black cohosh, though the 

exact mechanism of action is not known. Active constituents in medicinal 

preparations are triterpene glycosides and flavonoids, often standardized 

to 1-mg triterpenes (27–deoxyactein) per tablet. In the field, yellow cohosh 

(Cimicifuga americana) is often confused with black cohosh, as the plants 

have similar characteristics and habitats. In China, sheng ma (Cimicifuga

foetida) is substituted for black cohosh, though no clinical studies have 

evaluated this species. Market prices for black cohosh peaked in 1998 at 

$4.50/lb for dried roots, with a total of 600,000 to 700,000 lbs of roots in 

the market at that time. An estimated 95 percent of this was supplied from 

the wild and only 5 percent cultivated. The high prices paid for rhizomes 

increased harvest and overstocked the market, causing prices to drop to 

$1.40/lb in late 2000. As stocks are diminishing, prices are slowly rising 

70
again. Major producers of black cohosh in the U.S. are in Kentucky and 

Tennessee, with additional harvest in Wisconsin, Michigan, North Carolina, 

South Carolina, Georgia, West Virginia, Virginia, and Ohio. An estimated 60 

percent of the total harvest is exported, mostly to Germany and Italy. Price 

variations along the market chain from harvest to retail are included for 

wild, cultivated, and certified organic roots.

Keywords: Chemical constituents, conservation, harvest, prices.

Sun, J. 2003. Morning/evening menopausal formula relieves menopausal 

symptoms: a pilot study. Journal of Alternative Complementary 

Medicine. 9(3): 403-409.

Evaluates the efficacy of a combination herbal formula for treating 

menopausal symptoms. The regimen consisted of a morning pill with Asian 

ginseng (Panax ginseng), black cohosh, soy (Glycine max), and green tea 

(Camellia sinensis) extracts, and an evening pill with black cohosh, soy, 

kava (Piper methysticum), hops (Humulus lupulus), and valerian (Valeriana 

officinalis) extracts. Beneficial effects were achieved within two weeks. By 

the 8th week, significant reductions in hot flashes, anxiety, depression, and 

insomnia were observed.

Keywords: Clinical studies, medicinal uses.

Takahira, M.; Kusano, A.; Shibano, M. [and others]. 1998. Antimalarial 

activity and nucleoside transport inhibitory activity of the triterpenic 

constituents of Cimicifuga spp. Biological and Pharmaceutical Bulletin. 

21(8): 823-828.

Examines triterpene glycosides from Cimicifuga for their antimalarial 

activity and nucleoside transport inhibition. Effective concentrations and a 

discussion of the mechanism of action are provided.

Keywords: Chemical constituents, clinical studies, medicinal uses, 

physiological actions.

Thomas, A.L.; Lubhan, D.; Folk, W. [and others]. 2001. Black cohosh 

cultivation in Missouri, and quantification of its medicinal compounds 

in response to various cultivation regimens. Mt. Vernon: Missouri 

Agricultural Experiment Station, Southwest Research Center. http://aes.

missouri.edu/swcenter/fieldday/page53.stm. [Date accessed: September 

13, 2004].

71
Describes research by the Center for Phytonutrient and Phytochemical 

Studies (a consortium between the University of Missouri, Columbia, and 

the Missouri Botanical Garden) that focuses on black cohosh cultivation. 

The article covers two experiments: one to evaluate ideal cultivation 

conditions to provide farmers with detailed recommendations, and the 

other to evaluate plants grown in various spacings and under various shade 

conditions to determine optimum growth and production of medicinal 

compounds.

Keywords: Cultivation, research.

Thomasen, M.; Schmidt, M. 2003. Hepatotoxicity from Cimicifuga 

racemosa? Recent Australian case report not sufficiently substantiated. 

Journal of Alternative and Complementary Medicine. 9(3): 337-340.

Disputes an article by Whiting and others (2002) which links a case of 

hepatoxicity to the use of black cohosh.

Keywords: Side effects.

Tyler, V. 1995. Was Lydia Pinkham’s Vegetable Compound an effective 

remedy? Pharmacy in History. 37: 24-28.

Discusses the modern clinical research on individual constituents of an 

herbal tonic that was popular in the early 1900s. Black cohosh was one of 

the main ingredients in this formula that was marketed for various female 

ailments.

Keywords: History, Lydia Pinkham’s Vegetable Compound, research 

reviews.

Vitetta, L.; Thomasen, M.; Sali, A. 2003. Black cohosh and other herbal 

remedies associated with acute hepatitis. Medical Journal of Australia. 

178(8): 411-412.

Responds to an article by Whiting and others (2002) on the association 

between black cohosh and acute hepatitis. The author points out that adverse 

effects may have been due to contaminants in the herbal product used, and 

that, without further investigation into the constituents of the product, black 

cohosh cannot be assumed to be the cause of the illness. Previous research 

has shown black cohosh to be a safe and effective herbal medicine.

Keywords: Research reviews, toxicity.

72
Vorberg, G. 1984. Treatment of menopause symptoms. Zeitschrift Für 

Alternsforschung. 60: 626-629.

Evaluates the effectiveness of Remifemin® in an open study with 50 women. 

After 12 weeks of treatment, significant improvements were observed for 

neurovegetative and psychological symptoms.

Keywords: Clinical studies, medicinal uses, Remifemin®.

Wade, C.; Kronenberg, F.; Kelly, A.; Murphy, P.A. 1999. Hormonemodulating herbs: implications for women’s health. Journal of the 

American Medical Women’s Association. 54(4): 181-183.

Reviews research related to black cohosh, particularly the effectiveness and 

safety of phytoestrogens. Phytoestrogens such as isoflavones, lignans, and 

coumestans can bind to estrogen receptors and produce both estrogenic and 

antiestrogenic effects to mediate hormonal imbalances. Research into the 

estrogen-like effects of black cohosh has yielded conflicting results. One 

study identified the isoflavone formononetin in a black cohosh preparation, 

whereas another study found no traceable amount. One study concluded 

that black cohosh could bind to estrogen receptors, whereas another study 

concluded that black cohosh did not increase the proliferation of breast 

cancer that would have resulted from binding to estrogen sites. The authors 

attributed inconsistencies in research findings to the lack of controlled, 

randomized studies with women of homogenous hormonal status.

Keywords: Cancer, chemical constituents, phytoestrogens, research reviews, 

safety.

Warnecke, G. 1985. Influence of a phytopharmaceutical on climacteric 

complaints. Medizinische Welt. 36: 871-874.

Evaluates the effectiveness of black cohosh, hormone replacement 

therapy, and a psychopharmaceutical drug for treating various symptoms 

of menopause in an open, controlled, comparative study. Sixty 

menopausal female patients were divided into three groups and received 

either Remifemin® (40 drops twice daily), estrogens (0.625 mg daily), 

or Diazepam (2 mg daily) for a 12-week duration. The Kupperman 

Menopausal Index, Clinical Global Impression Scale, and Profile of 

Mood States were used to evaluate the effectiveness of each treatment. 

All therapies were deemed comparatively good, and both Remifemin®

and estrogens similarly stimulated vaginal mucosa with an increase 

in cytological indices. Because it lacked any negative side effects and 

performed as well as the estrogens in treating neurovegetative menopausal 

73
symptoms and as well as the psychopharmaceutical for treating depression, 

black cohosh was considered an excellent choice for treating mild to 

moderate menopausal symptoms.

Keywords: Assessment scales, clinical studies, hormone replacement 

therapy, medicinal uses, menopause, Remifemin®.

Watanabe, K.; Mimaki, Y.; Sakagami, H.; Sashida, Y. 2002. Cycloartane 

glycosides from the rhizomes of Cimicifuga racemosa and their cytotoxic 

activities. Chemical and Pharmaceutical Bulletin. 50(1): 121-125.

Analyzes the chemical constituents in rhizomes of black cohosh. Twelve 

cycloartane glycosides are identified. Four of these compounds are new 

discoveries; their structures, activities, and cytotoxic potential were 

evaluated.

Keywords: Chemical constituents.

Wende, K.; Mugge, C.; Thurow, K. [and others]. 2001. Actaeapoxide 

3-O-ß-D-xylopyranoside, a new cycloartane glycoside from the rhizomes 

of Actaea racemosa (Cimicifuga racemosa). Journal of Natural Products. 

64: 986-989.

Identifies a new cycloartane glycoside from a triterpene fraction of an 

extract of black cohosh.

Keywords: Chemical constituents.

Whiting, P.W.; Clouston, A.; Kerlin, P. 2002. Black cohosh and other 

herbal remedies associated with acute hepatitis. Medical Journal of 

Australia. 177(8): 440-443.

Reports on six cases of hepatoxicity believed to be caused by various herbal 

remedies. The herbal products were not analyzed or evaluated in any of the 

cases presented, yet were assumed to have caused the illness, as no other 

causes were identified. One patient took black cohosh alone for 1 week 

before symptoms appeared, whereas other patients used various herbal 

combinations. A list of herbs believed to cause hepatoxicity is included.

Keywords: Toxicity.

Winterhoff, H.; Butterweck, V.; Jarry, H.; Wuttke, W. 2002. 

Pharmacological and clinical studies using Cimicifuga racemosa for 

74
climacteric complaints. Wien Med Wochenschr. 152(15-16): 360-363. In 

German.

Presents the results of clinical studies on the medicinal properties of black 

cohosh.

Keywords: Clinical studies, medicinal uses.

Winterhoff, H.; Spengler, B.; Christoffel, V. [and others]. 2003. 

Cimicifuga extract BNO 1055: reduction of hot flushes and hints of 

antidepressant activity. Maturitas. 44(Suppl. 1): S51-S58.

Shows a significant reduction in hot flushes and antidepressant activity in 

rats administered the ethanolic black cohosh extract BNO 1055 contained in 

Klimadynon®/Menofem®.

Keywords: Clinical studies, Klimadynon®/Menofem®, medicinal uses.

Woo, K.C.; Park, Y.S.; Jun, D.J. [and others]. 2004. Phytoestrogen 

cimicifugoside-mediated inhibition of catecholamine secretion by 

blocking nicotinic acetylcholine receptor in bovine adrenal chromaffin 

cell. Journal of Pharmacology and Experimental Therapeutics. 309: 641-

649.

Investigates the effects of cimicifugoside, a pharmacologically active 

compound found in the roots of black cohosh.

Keywords: Clinical studies, physiological actions, phytoestrogens.

Wuttke, W.; Jarry, H.; Heiden, I. [and others]. 2000. Selective estrogen 

receptor modulator (SERM) activity of the Cimicifuga racemosa

extract BNO 1055: pharmacology and mechanisms of action [Abstract]. 

Phytomedicine. 7(Suppl. 2): 12.

Tests the estrogenic effects of the black cohosh extract BNO 1055. 

Ovariectomized rats were treated with either estradiol or black cohosh for 

6 hours, 7 days, or 3 months. Estradiol stimulated the uterus, yet black 

cohosh did not. Both estradiol and black cohosh prevented the development 

of osteoporosis. Black cohosh also showed beneficial effects on hepatic and 

lipid metabolism and on the central nervous system, which may account for 

its ability to reduce hot flashes. The authors concluded that black cohosh 

contains phyto-selective estrogen receptor modulators that have no effect on 

the uterus but showed desirable effects on other organs.

75
Keywords: Clinical studies, physiological actions.

Wuttke, W.; Seidlová-Wuttke, D.; Gorkow, C. 2003. The Cimicifuga

preparation BNO 1055 vs. conjugated estrogens in a double-blind 

placebo-controlled study: effects on menopause symptoms and bone 

markers. Maturitas. 44(Suppl. 1): S67-S77.

Compares the selective estrogen receptor modulator (SERM) effects of 

the black cohosh extract BNO 1055 (Klimadynon®/Menofem®) to those of 

conjugated estrogens or a placebo in a randomized, double-blind clinical 

trial with postmenopausal women. Black cohosh showed similar results 

to estrogen in reducing hot flashes and bone loss and increasing vaginal 

superficial cells. Black cohosh did not show any effect on endometrial 

thickness. These results suggested that black cohosh had constituents with 

SERM activity that affected the brain/hypothalamus, bones, and vagina, but 

did not affect the uterus.

Keywords: Clinical studies, Klimadynon®/Menofem®, medicinal uses, 

physiological actions.

Xu, H.; Fabricant, D.S.; Johnson, H.E. [and others]. 2001. Using random 

amplified polymorphic DNA (RAPD) markers to identify plant species 

and variants. [Abstract]. In: Botanical dietary supplements: natural 

products at a crossroads; 2001 Nov 8-11; Asilomar, CA. Washington, 

DC: American Society of Pharmacognosy and Council for Responsible 

Nutrition: p. 32.

Reports on the use of random amplified polymorphic DNA markers to 

identify plant species, confirming the use of the technique to discern black 

cohosh from other medicinal plant species.

Keywords: Chemical constituents, research.

Zerega, N.J.C.; Mori, S.; Lindqvist, C. [and others]. 2002. Using 

amplified fragment length polymorphisms (AFLP) to identify black 

cohosh (Actaea racemosa). Economic Botany. 56(2): 154-164.

Reports on the use of DNA fingerprinting to analyze and identify rhizomes 

of black cohosh and related species (Actaea pachypoda, A. cordifolia, and 

A. podocarpa). Two black cohosh products were evaluated by amplified 

fragment length polymorphisms (AFLP) analysis and found to contain 

only black cohosh. AFLP was found to be a successful method to evaluate 

product quality. Wild populations of black cohosh in Virginia and North 

Carolina were also evaluated, but did not contain sufficient genetic markers 

76
to distinguish different populations of the same species. Results of this 

research supported the classification of the species under the genus Actaea.

Keywords: Chemical constituents, products, related species, research.

Zierau, O.; Bodinet, C.; Kolba, S. [and others]. 2002. Antiestrogenic 

activities of Cimicifuga racemosa extracts. Journal of Steroid 

Biochemistry and Molecular Biology. 80: 125-130.

Determines that black cohosh contains compounds with antiestrogenic 

properties. The effects of ethanolic and isopropanolic extracts of black 

cohosh were tested on MCF–7 cancer cells and gene expression. Results 

showed that black cohosh did not bind to estrogen receptors. The authors 

noted that the exact mechanism of action of the herb remains unknown, 

though it is believed that either there are several active constituents that 

work synergistically, or the components have selective estrogen receptor 

modulator-like capabilities.

Keywords: Cancer, clinical studies, physiological actions.

Popular Press

Blumenthal, M. 1999. Herb market levels after five years of boom: 1999 

sales in mainstream market up only 11% in first half of 1999 after 55% 

increase in 1998. HerbalGram. 47: 64-65.

Discusses trends in the market for herbal supplements. In 1999, the largest 

gain in sales for any single herb was for black cohosh. In the first 8 months 

of 1999, sales increased 477 percent, most likely due to publicity of research 

documenting the beneficial effects of black cohosh for treating menopause 

symptoms. In 1998, retail sales for black cohosh totaled $586,468, and in 

1999 sales were up to $3,385,393.

Keywords: Market, retail sales.

Blumenthal, M. 2002. Herb sales down in mainstream market, up in natural 

food stores. HerbalGram. 55: 60.

Discusses trends in sales of herbal products. In 2001, total sales of herbal 

dietary supplements were down 21 percent in food stores, drug stores, and 

mass market retailers. Black cohosh sales increased by 106 percent in the 

same year; ranking tenth on the list of 20 top-selling herbs, with sales of 

901,512 units at $9,639,506.

77
Keywords: Market, retail sales.

Botany.com. 2004. Cimicifuga. http://www.botany.com/Cimicifuga.html. 

[Date accessed: September 13].

Provides information on Cimicifuga botany, nomenclature, and propagation. 

The genus name Cimicifuga comes from the Latin words ‘cimex’ for bug 

and ‘fugare’ to flee. Bugbanes can be found growing in Europe, North 

America, China, Japan, and Mongolia. Plants prefer moist, fertile soil in full 

to partial shade. Supportive staking may be necessary. Propagation is done 

by seed and root division. Species and varieties are listed.

Keywords: Botanical description, nomenclature, propagation.

Brown, D. 2002. Women taking another look at ways to treat menopause: 

problems with hormone therapy may boost other remedies. The 

Washington Post. August 29, 2002: A3.

Discusses the potential increase in the use of black cohosh to treat 

menopausal symptoms in response to growing concerns about the negative 

side effects of hormone replacement therapy.

Keywords: Medicinal uses.

Decker, A. 2003. Black cohosh – the real story. PRWEB Newswire press 

release. http://www.prweb.com/releases/2003/7/prweb73024.htm. [Date 

accessed: September 13, 2004].

Outlines history, research, and examples of the safety of black cohosh in 

response to a research article by Davis and others (2003) suggesting a link 

between black cohosh and the metastasization of breast cancer.

Keywords: Cancer, research reviews, safety. 

Fern, K. 1997–2000. Plants for a future: the species database. http://www.

ibiblio.org/pfaf/cgi-bin/find_lat?LAT=&COM=black+cohosh&FAM=&R

ATING=1. [Date accessed: September 13, 2004].

Provides details on black cohosh habitat, medicinal uses, cultivation, and 

propagation. Black cohosh is hardy to zone 4. Blooms last from July to 

October, with seeds ripening from August to October. Flowers have a 

slightly unpleasant odor. Plants can grow in a variety of soils, but prefer 

moist, semishaded sites. Medicinal actions reported include alterative, 

78
antidote, anti-inflammatory, antirheumatic, antispasmotic, astringent, 

birthing aid, cardiotonic, diaphoretic, diuretic, emmenagogue, expectorant, 

homeopathic, hypnotic, hypoglycemic, sedative, tonic, and vasodilative. 

Roots are harvested in fall after leaves die down. The most common 

commercial uses are for feminine complaints related to menstruation and 

menopause. Reports other medicinal indications, including rheumatism, 

tinnitus, high blood pressure, and inflammation. The dried plant can be used 

to repel insects. Plants are well suited for use in the garden. Propagation is 

done by seed or by division of the rhizomes. Seed is sown in a cold frame 

or in the garden as soon at it is ripe. Stored seeds do not germinate as well. 

Root division is done in spring or fall.

Keywords: Cultivation, flowers, habitat, hardiness range, harvest, insect 

deterrent, medicinal uses, propagation.

Grieve, M. 1931. A modern herbal. Hypertext version by Botanical.com. 

1995-2002. http://www.botanical.com/botanical/mgmh/c/cohbla83.html. 

[Date accessed: September 13, 2004].

Presents a plant description and information on medicinal uses, 

preparations, and chemical constituents. Common names include black 

snake root, rattle root, squaw root, and bugbane. Details are provided on 

root characteristics and preparations.

Keywords: Botanical description, chemical constituents, common names, 

medicinal uses, preparations, rhizomes.

HeartSpring.net. 2003. Perimenopause symptoms – black cohosh. http://

www.heartspring.net/perimenopause_symptoms.html. [Date accessed: 

September 13, 2004].

Provides detailed information on menopause and black cohosh from the 

National Institutes of Health and the National Center of Complementary 

and Alternative Medicine.

Keywords: Medicinal uses, menopause.

Jackson, D.; Shelton, K. 1997–2001. Alternative nature online herbal. 

http://altnature.com/gallery/Black_Cohosh.htm. [Date accessed: 

September 13, 2004]

Provides information on black cohosh habitat, chemical constituents, 

medicinal properties, and folklore. Also serves as a retail venue for 

79
tinctures. Native Americans used the roots to treat snakebite, rheumatism, 

and female ailments.

Keywords: Habitat, medicinal uses, Native American uses, vendors.

Kliger, B. 2003. Black cohosh. American Family Physician. 68(1): 114-116. 

Summarizes information on the use of black cohosh to treat menopausal 

symptoms. Includes information on chemical constituents, physiological 

actions, adverse reactions, as well as a review of clinical studies.

Keywords: Medicinal uses, research reviews.

Missouri Botanical Garden. 2002. Actaea racemosa. http://www.mobot.

org/gardeninghelp/plantfinder/Plant.asp?code=J790. [Date accessed: 

September 13, 2004].

Presents information for cultivation and gardening. Black cohosh grows in 

hardiness zones 3 to 8. It is an herbaceous perennial in the Ranunculaceae 

family, growing four to six feet in height with a two to four feet spread. 

Plants prefer average, moist, rich, well-drained soil in partial to full shade. 

Flowers resemble those of bottlebrush (Callistemon spp.) and grow on 

long terminal racemes, with no petals but numerous white stamens. Leaves 

are deeply cut and compound. The name bugbane comes from the plant’s 

unpleasant smell, which repels insects. No serious pest or disease problems 

are known, though occasionally rust and leaf spot may appear. If soils dry 

out, leaves will turn brown at the margins. Best suited for woodland gardens 

or naturalized areas.

Keywords: Cultivation, flowers, habitat, hardiness range, insect deterrent, 

light requirements, pests and disease, Ranunculaceae family, soil 

requirements.

National Center for Complementary and Alternative Medicine. 

2003. Questions and answers about black cohosh and the symptoms of 

menopause. http://ods.od.nih.gov/factsheets/blackcohosh.html. [Date 

accessed: September 13, 2004].

Summarizes black cohosh medicinal uses in a question and answer format. 

Includes information about preparations, historical uses, reviews of 

significant clinical studies, physiological effects, regulatory status, and side 

effects. 

80
Keywords: History, medicinal uses, physiological actions, preparations, 

research reviews, side effects.

Perry, L. 2001. Cimicifuga. PSS 123 garden flowers. Plant and Soil 

Science, University of Vermont. http://pss.uvm.edu/pss123/percimic.html. 

[Date accessed: September 13, 2004].

Summarizes black cohosh cultivation information. Black cohosh is a 

member of the buttercup (Ranunculaceae) family. Plants flower after three 

to four years of growth. Leaves are ternately compound, with a dark green 

to blackish color. Flowers are long white racemes, with a distinct number 

of pistils for each species in the genus. For cultivation, soil should be 

moist and acidic. There are few pest and disease problems associated with 

cultivated plants. Propagation is done by seed and by division of roots. 

Stratified seeds have erratic germination, and roots of mature plants can be 

difficult to divide. In the landscape, plants are best suited for woodlands, 

borders, and native plantings. Common species and cultivars are listed.

Keywords: Cultivation, flowers, habitat, landscape uses, pests and disease, 

propagation, Ranunculaceae family.

Plyler, S.C. 2001–2002. Black cohosh (Cimifuga racemosa). Indian spring 

herbal encyclopedia. http://www.indianspringherbs.com/BlackCohosh.

htm. [Date accessed: September 13, 2004].

Provides general information, including nomenclature, history, medicinal 

uses, preparations, and dosage. The name cohosh comes from the 

Algonquian word for “rough,” which describes the physical characteristics 

of the roots. Other common names describe characteristics and properties 

of the plant, such as “snakeroot,” denoting its use as an antidote, and 

“rattleroot,” which describes the sound of the dried seeds in their pods. 

Medicinal properties attributed to black cohosh are antispasmotic, 

antitussive, sedative, emmenagogue, astringent, diuretic, and expectorant. 

Roots are collected in autumn and made into tinctures with alcohol. The 

chemical constituents are not soluble in water.

Keywords: Chemical constituents, common names, dosage, harvest, history, 

medicinal uses, nomenclature, preparations.

Sievers, A.F. 1930. Cohosh bugbane. The herb hunters guide. Misc. Publ. 

No. 77. Washington, DC: U.S. Department of Agriculture. Washington, 

DC. Hypertext version 8 Apr. 1998. http://www.hort.purdue.edu/newcrop/

herbhunters/cohoshbugbane.html. [Date accessed: September 13, 2004].

81
Offers information on black cohosh common names, habitat, botanical 

characteristics, and harvest. Common names include cohosh bugbane, 

black snakeroot, bugwort, rattlesnakeroot, rattleroot, rattleweed, rattletop, 

richweed, and squawroot. Plants prefer shaded woodlands, but occasionally 

will grow in fencerows, pasturelands, and open fields. The plant’s range is 

centered around the Ohio Valley, extending north to Maine and Wisconsin 

and south to Georgia and Missouri. Plants can grow to 8 feet in height. 

Leaves are divided into three toothed, multiply-divided leaflets. Flower 

spikes are six inches to two feet in length, with small white feathery blooms. 

Buds, flowers, and seeds appear along the spike at the same time. Seedpods 

ripen in the fall and rattle in the wind. Flowers have an offensive smell. 

Roots consist of a horizontal knotted rhizome with long fleshy rootlets. 

Roots are collected in the fall after seeds are ripe.

Keywords: Botanical description, common names, flowers, habitat, harvest, 

odor, range, rhizomes.

Stelling, K. 1994. Native botanical profile: Cimicifuga racemosa. Canadian 

Journal of Herbalism. April: 21-25.

Provides a profile of black cohosh. Includes botanical and common names, 

name origins, botany, habitat and harvest, pharmacognosy, constituents, 

actions, pharmacology, therapeutics (cardiovascular, genito-sexual, 

oncology, musculo-skeletal, respiratory, gastrointestinal, and neurological), 

pharmacy, toxicity, folklore, and references.

Keywords: Chemical constituents, common names, habitat, harvest, 

medicinal uses, physiological actions, research reviews.

Stolberg, S.G. 2001. The estrogen alternative – black cohosh. http://www.

mercola.com/2001/may/19/estrogen.htm. [Date accessed: September 13, 

2004].

Discusses the history of herbal medicine, the growing popularity of herbal 

remedies, and modern clinical research. Black cohosh is a popular remedy 

for the symptoms of menopause, with a substantial market in Germany and 

growing demand in the United States.

Keywords: History, market demand, medicinal uses, research reviews.

Strauch, B. 1995. An herb to know – black cohosh. The Herb Companion. 

October/November: 24-25.

82
Presents a general overview of black cohosh. Includes botanical description, 

nomenclature, medicinal uses, landscape uses, and cultivation.

Keywords: Botanical description, cultivation, landscape uses, medicinal 

uses, nomenclature.

SusanLoveMD.org. 2003. Black cohosh hits the headlines. http://www.

susanlovemd.org/community/flashes/hotflash030725.htm. [Date accessed: 

September 13, 2004].

Discusses research by Davis and others (2003) that suggests black cohosh 

may cause breast cancer to metastasize. The author points out that research 

done on mice that are bred to develop breast cancer may not apply to 

women.

Keywords: Research reviews, toxicity.

Other Information Sources

Anon. 2003. Cimicifuga racemosa monograph. Alternative Medicine 

Review. 8(2): 186-189.

Summarizes clinical studies on the medicinal applications of black cohosh. 

Includes nomenclature, constituents, and physiological actions. Most 

commonly used to treat symptoms of menopause, black cohosh is also 

beneficial for reducing menstrual migraines and tinnitus. The herb has 

been shown by various studies to be safe and effective when hormone 

replacement therapy is contraindicated due to the risk of developing breast 

cancer. Occasional cases of transient, mild gastrointestinal upset have been 

reported. No serious side effects are known.

Keywords: Chemical constituents, hormone replacement therapy, medicinal 

uses, migraines, nomenclature, research reviews, side effects.

American Botanical Council. 2002. Black cohosh monograph. The ABC 

clinical guide to herbs. http://www.herbalgram.org/default.asp?c=Black_

Cohosh_Monograph. [Date accessed: September 13, 2004].

Presents the latest information on black cohosh, summarizing results 

from clinical studies. This well-documented and fully referenced 

monograph includes sections on medicinal uses, dosage and 

administration, pharmacological actions, chemistry, mechanisms of action, 

contraindications, drug interactions, regulatory status, and commercial 

products.

83
Keywords: Chemical constituents, clinical studies, dosage, medicinal uses, 

physiological actions, products, regulatory status, research reviews.

Association of Natural Medicine Pharmacists. [n.d.]. Black cohosh 

monograph. http://www.anmp.org/monographs/. [Date accessed: 

September 13, 2004].

Summarizes current research on black cohosh. Includes sections 

on nomenclature, botanical data, history and traditional uses, active 

constituents, pharmacological activities, clinical applications, clinical data, 

dosage, safety, and side effects. Includes medicinal references.

Keywords: Botanical description, chemical constituents, history, 

nomenclature, physiological actions, research reviews, side effects.

Beuscher, N. 1996. Cimicifuga racemosa L.: black cohosh. Quarterly 

Review of Natural Medicine. Spring: 19-28.

Summarizes current research on black cohosh. Includes sections on history, 

botany and taxonomy, plant description, commercial products, chemical 

constituents and their identification, pharmacology, side effects, toxicity, 

applications and dosage, clinical trials, and references. Includes a table 

of information on commercial black cohosh products with product name, 

delivery form, effective ingredients, indications, and manufacturer (though 

some information has changed since the article was published).

Keywords: Botanical description, chemical constituents, history, 

physiological actions, products, research reviews, side effects, toxicity.

Blumenthal, M., ed. 1998. The complete German Commission E 

monographs. Austin, TX: American Botanical Council. 685 p.

Approves the use of black cohosh to treat climacteric menopause symptoms, 

dysmenorrhea, and premenstrual symptoms. Although there is a possible 

side effect of gastric discomfort, there are no known contraindications or 

drug interactions. Dosage is suggested at 40 mg of crude drug. Because of 

the lack of long-term research, it is suggested that use be stopped after 6 

months.

Keywords: Contraindications, dosage, drug interactions, German 

Commission E, medicinal uses, menopause, side effects.

84
Britton, N.L.; Brown, A. 1913. An illustrated flora of the Northern United 

States, Canada, and the British Possessions. New York: Charles Scribner’s 

Sons. Vol. 2. In: U.S. Department of Agriculture, Natural Resources 

Conservation Service. 2001. The PLANTS database. Version 3.1. Baton 

Rouge, LA: National Plant Data Center. Available at http://plants.usda.

gov. [Date accessed: September 13, 2004].

Provides a botanical illustration of black cohosh.

Keywords: Botanical description.

Cook, W. 1869. The physiomedical dispensatory. http://medherb.com/cook/

home.htm. [Date accessed: September 13, 2004]. [Scanned version by 

Medical Herbalism 2001]

Offers historical information on medicinal uses, properties, and 

preparations. Provides a description of the genus and species traits, and 

properties of the root as used in commerce. Black cohosh is said to have 

sedative powers on the nervous and circulatory systems, serous tissues, and 

the uterus. Instructions for making various preparations are included.

Keywords: Botanical description, eclectic physicians, history, medicinal 

uses, preparations.

Council of the Pharmaceutical Society of Great Britain. 1911. The 

British pharmaceutical codex. 18th ed., 3rd rev. http://www.ibiblio.org/

herbmed/eclectic/bpc1911/Cimicifuga.html. [Date accessed: September 

13, 2004]. [Scanned version by H. Kress 2001–2002].

Describes black cohosh roots, constituents, and various preparations and 

dosages used historically.

Keywords: Chemical constituents, dosage, history, medicinal uses, 

preparations.

Ellingwood, F. 1919. The American Materia Medica, therapeutics and 

pharmacognosy. http://www.ibiblio.org/herbmed/eclectic/ellingwood/

Cimicifuga.html. [Date accessed: September 13, 2004]. [Scanned version 

by M. Moore 2001–2002].

Offers a historical description of black cohosh medicinal uses. Preparations, 

physiological actions, and constituents are presented. Treatments are 

included for muscular aches, hysteria, acute fevers, angina pectoris, cough, 

pleurisy, chorea, stomach-ache, amenorrhea, dysmenorrhea, postpartum 

85
hemorrhage, epilepsy, smallpox, and gonorrhea. Medicinal actions are 

described.

Keywords: Chemical constituents, eclectic physicians, history, medicinal 

uses, physiological actions, preparations.

Felter, H.W. 1922. The Eclectic Materia Medica, pharmacology and 

therapeutics. http://www.ibiblio.org/herbmed/eclectic/felter/Cimicifuga.

html. [Date accessed: September 13, 2004]. [Scanned version by M. 

Moore 2001–2002].

Provides historical information on the medicinal uses of black cohosh as 

described by the eclectic physicians. Indications for use included muscle 

soreness, aching, rheumatism, lumbago, stomach-ache, pain in the ovaries 

or uterus, afterbirth pains, irregular menstruation, and chorea. Excessive 

doses have caused headache, nausea and vomiting, vertigo, vision 

impairments, and reduced circulation. The therapeutic effects of the drug 

are described in detail.

Keywords: Chemical constituents, eclectic physicians, history, medicinal 

uses, side effects.

Felter, H.W.; Lloyd, J.U. 1898. King’s American dispensatory. 18th ed., 

3rd rev. http://www.ibiblio.org/herbmed/eclectic/kings/Cimicifuga.html. 

[Date accessed: September 13, 2004]. [Scanned version by H. Kress 

2000–2001].

Presents a thorough historical account of black cohosh, with a technical 

botanical description, chemical constituents, medicinal uses and actions, 

and preparations. Common names and their sources are discussed. Native 

Americans used black cohosh medicinally long before European settlement. 

The eclectic physician John King introduced the plant to commercial use in 

the 1830s. The history of research into chemical constituents is provided. 

Small doses of black cohosh have been found to improve the appetite and 

digestion, although large doses increase secretions from the kidneys and 

skin and decrease circulation. Excessive doses can cause nausea, vomiting, 

vertigo, and impaired vision, but are not fatal. The most prominent 

medicinal treatments include those for rheumatism, neuralgia, muscular 

pains, conjunctivitis, dyspepsia, dysmenorrhea, amenorrhea, afterpains, 

chorea, asthma, spasmodic afflictions, headache, and fevers.

Keywords: Botanical description, chemical constituents, eclectic physicians, 

history, medicinal uses, physiological actions, preparations.

86
Foster, S. 1999. Black cohosh: Cimicifuga racemosa. A literature review. 

HerbalGram. 45: 35-50.

Includes thorough information on all aspects of black cohosh—etymology, 

botanical description, botanical history, new taxonomic twists, North 

American species of Cimicifuga, ethnobotany, medicinal history, 

development in eclectic medicine, chemical investigations, European 

experience (1743–1980), studies of the 1980s and 1990s, safety and toxicity, 

and cultivation. Includes extensive references, tables, and pictures.

Keywords: Botanical description, chemical constituents, cultivation, 

ecology, history, Native American uses, research reviews, toxicity.

Foster, S. 2000. Black cohosh (Cimicifuga racemosa). Steven Foster Group 

Herb Monographs. http://www.stevenfoster.com/education/monograph/

bkcohosh.html. [Date accessed: September 13, 2004].

Presents information on historical and modern uses of black cohosh, 

including references and a discussion of clinical trials. Black cohosh is a 

member of the buttercup (Ranunculaceae) family, and is found in deciduous 

forests from Ontario to Georgia, and west to Wisconsin and Arkansas. 

Leaves are divided into threes, with another three-lobed terminal leaflet. 

In May, plants send up a showy spike of white flowers three to eight feet in 

height. Individual flowers do not have petals but numerous stamens. The 

name Cimicifuga comes from “cimex,” the Latin word for bug—specifically 

the bed bug Cimex lectularius—and the Latin “fugare,” meaning to drive 

away. The American species Cimicifuga racemosa does not possess the 

strong odor of the European species. Native Americans used black cohosh to 

treat a variety of female ailments and rheumatism. In the nineteenth century, 

early American physicians used black cohosh as an anti-inflammatory for 

rheumatism and arthritis, to relieve pain during childbirth, and to regulate 

abnormal menstruation. Medicinal properties of the roots are attributed to 

a combination of constituents. Several clinical studies on the effectiveness 

and safety of black cohosh are summarized. Black cohosh is listed in 

the German Commission E Monograph for use in treating premenstrual 

ailments, dysmenorrhea, and climacteric menopausal symptoms. As the 

negative side effects of hormone replacement therapy become more widely 

known, the use of black cohosh is expected to increase.

Keywords: Botanical description, chemical constituents, flowers, history, 

medicinal uses, nomenclature, odor, Ranunculaceae family, research 

reviews.

87
Foster, S.; Duke, J.A. 2000. A field guide to medicinal plants and herbs of 

Eastern and Central North America. 2d ed. National Audubon Society, 

National Wildlife Federation, and the Roger Tory Peterson Institute. New 

York: Houghton Mifflin Co. 411 p.

Summarizes medicinal uses of black cohosh. Black cohosh is a perennial 

which grows 3 to 8 feet in height, with sharply toothed, thrice-divided 

leaves. Long spiked flowers appear from May through September. Rhizomes 

were used by Native Americans for menstrual problems and childbirth. 

In the 19th century, black cohosh was also used as an anti-inflammatory 

and treatment for bronchitis, chorea, fever, nervousness, and snakebite. 

Medicinal actions are hypoglycemic, sedative, and anti-inflammatory. Black 

cohosh is a popular herb for treating menopausal symptoms such as hot 

flashes, with several clinical studies supporting its efficacy. 

Keywords: Botanical description, medicinal uses, Native American uses, 

range.

Harding, A.R. 1936. Ginseng and other medicinal plants. http://www.

ibiblio.org/herbmed/eclectic/harding/Cimicifuga.html. [Date accessed: 

September 13, 2004]. [Scanned version by M. Moore 2002].

Presents common names, habitat and range, plant description, root 

description, and harvest. The tall flower spikes make black cohosh a 

conspicuous plant. This perennial herb belongs to the the Ranunculaceae 

family, which also includes goldenseal. Plants reach up to eight feet in 

height. Leaves have three leaflets again divided into threes. Each leaflet is 

two inches long, toothed and sharply pointed at the apex, and is smooth, 

thin, and dark green. The graceful raceme of flowers grows up to two feet 

in length, and buds, blooms, and seeds consecutively along the same spike. 

Flowers are apetalous, with numerous showy white stamens. Seed pods are 

dry, ribbed, thick, and leathery. Seeds are in two rows, and rattle in the pods 

when disturbed by wind. Roots are horizontal irregular knotted rhizomes. 

The top of the rhizome is covered with hard stumps and scars from previous 

stems, and long rootlets emerge from the bottom. Roots are dark reddish 

brown externally, and white with rays of a woody texture internally. Dried 

roots are dark inside and outside, but the cross of woody rays is a lighter 

color and still visible. Rhizomes should be collected after the seeds have 

ripened in September.

Keywords: Botanical description, common names, flowers, habitat, harvest, 

medicinal uses, Ranunculaceae family, range, rhizomes, seeds.

88
Horticopia, Inc. 2001. Horticopia® on-line plant information. http://www.

horticopia.com/hortpix/html/pc1487.htm. [Date accessed: September 13, 

2004].

Provides useful information for cultivating black cohosh. Plants grow in 

hardiness zones 4A to 8A, in partial shade, and moist soil.

Keywords: Cultivation, habitat, hardiness range.

Lloyd, J.U.; Lloyd, C.G. 1931. Cimicifuga racemosa. Bulletin of the Lloyd 

Library of Botany, Pharmacy and Materia Medica. 9(30 pt. 2): 224-288.

Provides a thorough historical account of black cohosh. Includes botanical 

description, nomenclature, history, distribution, similar species descriptions, 

medicinal uses, pharmacological actions, chemical constituents, 

microscopic structure, preparations, and dosage.

Keywords: Botanical description, chemical constituents, distribution, 

eclectic physicians, history, medicinal uses, nomenclature, preparations.

Miller, R.A. 1988. Native plants of commercial importance. Grants Pass, 

OR: OAK, Inc. 343 p.

Includes information on black cohosh ecology and growth range, botany, 

medicinal actions, use by Native Americans and eclectic physicians, 

chemistry, marketing, prices for dried roots, and demand.

Keywords: Chemical constituents, eclectic physicians, ecology, history, 

market, medicinal uses, Native American uses, prices, range.

Moerman, D. 1999. Native American ethnobotany: A database of foods, 

drugs, dyes, and fibers of native North American peoples, derived from 

plants. The University of Michigan-Dearborn. http://herb.umd.umich.

edu/. [Date accessed: September 13, 2004].

Provides ethnobotanical information on medicinal plants. Native Americans 

used black cohosh as a tonic, cold remedy, antirheumatic, blood purifier, and 

treatment for irregular menstruation and kidney problems.

Keywords: History, medicinal uses, Native American uses.

89
NatureServe Explorer. 2002. An online encyclopedia of life [Web 

application]. Version 1.6. Arlington, VA: NatureServe. http://www.

natureserve.org/explorer. [Date accessed: September 13, 2004].

Summarizes the conservation status of black cohosh. Includes heritage 

status, range, habitat, distribution, global trends, threats, economics, and 

references. Black cohosh has a secure global heritage status rank, though 

increasing commercial demand and a lack of cultivated sources are putting 

pressure on wild populations. Permit sales have been increasing for the 

National Forests in North Carolina.

Keywords: Conservation, distribution, habitat, market demand, permits, 

prices, range.

Newall, C.A.; Anderson, L.A.; Phillipson, J.D., eds. 1996. Cohosh, black. 

In: Herbal medicines: a guide for health-care professionals. London: 

Pharmaceutical Press: 80-81. 

Provides a guide to the use of black cohosh, including information on 

chemical constituents, the U.S. Food and Drug Administration (FDA) 

listing, medicinal uses, dosages for various preparations, pharmacological 

actions proven by clinical research on both animals and humans, side 

effects and toxicity, contraindications, and warnings. Chemical constituents 

include the alkaloids N–methylcytisine and other unidentified compounds, 

unspecified tannins, a mixture of terpenoids including 12–acetylactein 

and cimigoside, acetic acid, butyric acid, formic acid, isoferulic acid, 

oleic acid, palmitic acid, salicylic acid, racemosin, formononetin, 

phytosterols, cimicifugin, the resinous mixture acteina, and volatile oil. 

Herbal uses include treatments for myalgia, sciatica, whooping cough, 

chorea, tinnitus, dysmenorrhea, uterine colic, muscular rheumatism, and 

rheumatoid arthritis. Doses for various preparations are given. Several 

clinical studies are summarized, indicating a hypotensive effect in rabbits 

and cats, competitive estrogen receptor activity, hypocholesterolaemic 

activity, and antibacterial activity toward both gram-positive and gramnegative organisms. High doses may be toxic, resulting in nausea, vomiting, 

dizziness, visual impairments, nervousness, reduced pulse, and increased 

perspiration. Black cohosh should not be used during pregnancy. 

Keywords: Chemical constituents, contraindications, dosage, medicinal 

uses, physiological actions, preparations, research reviews, side effects, 

toxicity.

90
Pengelly, A. [n.d.]. Black cohosh (Cimicifuga racemosa Nutt). http://www.

ibiblio.org/herbmed/neat-stuff/cohosh.html. [Date accessed: September 

13, 2004].

Provides details on various medicinal uses of black cohosh. Includes 

chemical constituents; medicinal use by Native Americans, early European 

Americans, eclectic physicians, and physiomedical physicians; and 

medicinal actions and therapeutics on the nervous system, musculoskeletal 

system, female reproductive system, and respiratory tract. 

Keywords: Chemical constituents, eclectic physicians, medicinal uses, 

Native American uses, physiological actions, research reviews.

Petersen, F. 1905. Materia Medica and clinical therapeutics. http://www.

ibiblio.org/herbmed/eclectic/petersen/Cimicifuga.html. [Date accessed: 

September 13, 2004]. [Scanned version by M. Moore 2002].

Provides a historical summary of usage. Black cohosh has been used to 

relieve muscle contractions, regulate menstruation, and as a treatment for 

rheumatism, chorea, afterpains, and uterine diseases. 

Keywords: Eclectic physicians, history, medicinal uses.

PIERS Exports (U.S. Ports). 2003. Journal of Commerce. http://library.

dialog.com/bluesheets/html/bl0571.html. [Date accessed: September 13, 

2004].

Offers complete information on cargo exported from seaports in the United 

States.

Keywords: Export.

Potter, S.O.L. 1902. A compend of Materia Medica, therapeutics, and 

prescription writing. http://www.ibiblio.org/herbmed/eclectic/pottercomp/Cimicifuga.html. [Date accessed: September 13, 2004]. [Scanned 

version by H. Kress 2000–2002].

Summarizes historical medicinal use of black cohosh. Attributed actions 

are antispasmodic, aphrodisiac, diaphoretic, diuretic, and expectorant. The 

herb has been used to treat cardiac disease, chorea, bronchitis, rheumatism, 

neuralgia, uterine disorders, impotence, and childbirth afterpains.

Keywords: Eclectic physicians, history, medicinal uses, physiological 

actions.

91
Tetherow, H. 2001. Black cohosh [Website]. http://altmed.creighton.edu/

blackcohosh. [Date accessed: September 13, 2004].

Provides information on a variety of medicinal matters—chemistry, 

pharmacology, usage, dosage, side effects, and interactions. Various 

studies on the clinical applications and effectiveness of black cohosh are 

summarized, and references provided.

Keywords: Chemical constituents, dosage, medicinal uses, physiological 

actions, research reviews, side effects.

United Plant Savers. [n.d.]. “At-Risk” plants. http://www.plantsavers.org/. 

[Date accessed: September 13, 2004].

Provides information on the conservation status of several plants. Black 

cohosh is on the “At-Risk”plant list. Plants on this list are considered to 

be significantly declining in number due to overharvest, loss of habitat, or 

innate sensitivity and rareness.

Keywords: Conservation, United Plant Savers.

U.S. Department of Agriculture Forest Service. 1993. Income 

opportunities in special forest products: self-help suggestions for rural 

enterprises. Agric. Inf. Bull. 666. Washington, DC. 206 p.

Estimates the domestic market for black cohosh at under 50 tons, with some 

export to Germany.

Keywords: Export, market.

U.S. Department of Agriculture, Natural Resources Conservation 

Service. 2001. The PLANTS database. Version 3.1. Baton Rouge, LA: 

National Plant Data Center. http://plants.usda.gov. [Date accessed: 

September 13, 2004].

Provides information on range and distribution, conservation status, and 

scientific classification, with photographs. The native range within the 

United States includes Alabama, Arkansas, Connecticut, Delaware, Georgia, 

Illinois, Indiana, Iowa, Kentucky, Maine, Maryland, Massachusetts, 

Michigan, Mississippi, Missouri, New Jersey, New York, North Carolina, 

Ohio, Pennsylvania, South Carolina, Tennessee, Virginia, and West Virginia. 

Black cohosh is listed as endangered in Illinois and Massachusetts.

92
Keywords: Classification, conservation, distribution, range.

Upton, R., ed. 2002. Black cohosh rhizome: standards of analysis, 

quality control, and therapeutics. Santa Cruz, CA: American Herbal 

Pharmacopoeia. 36 p.

Provides a detailed, thorough overview of black cohosh. Includes 

nomenclature, history, botany, macroscopic and microscopic identification, 

harvest, cultivation, adulterants, preparations, chemical constituents, 

chemical analysis methods, medicinal uses, physiological actions, clinical 

research reviews, dosage, side effects, precautions, toxicity, and regulatory 

status.

Keywords: Chemical constituents, harvest, identification, medicinal uses, 

physiological actions, research reviews, side effects, toxicity.

Vendors

Note: The following list of vendors is included to provide access to current 

information about availability and prices. The authors do not intend to 

recommend these vendors over others not listed, or to recommend the 

products they feature for medical purposes.

Cefakliman. [n.d.]. Black cohosh product. http://www.zink-info.de/e/

kliman_mono1_e.html. [Date accessed: September 13, 2004]. 

Vendor of black cohosh for medicinal uses. 

Keywords: Medicinal uses, vendors.

EstroGentle. [n.d.]. Black cohosh product. http://www.thehormoneshop.

com/estrogentle.htm. [Date accessed: September 13, 2004].

Vendor of black cohosh for medicinal uses.

Keywords: Medicinal uses, vendors.

Green Canyon Inc. [n.d.]. Black cohosh product. http://www.greencanyon.

com/products/c100036.htm. [Date accessed: September 13, 2004].

Vendor of black cohosh for medicinal uses.

Keywords: Medicinal uses, vendors.

93
Nature’s Way Herbs. [n.d.]. Black cohosh product. http://www.naturesway.

com/products_catalog/. [Date accessed: January 10, 2005].

Vendor of black cohosh for medicinal uses.

Keywords: Medicinal uses, vendors.

Remifemin®. [n.d.]. Black cohosh product. http://www.remifemin.com/. 

[Date accessed: September 13, 2004].

Vendor of black cohosh for medicinal uses.

Keywords: Medicinal uses, vendors.

RippleCreek.com. [n.d.]. Black cohosh product. http://www.ripplecreek.

com/item-rc10.html. [Date accessed: September 13, 2004].

Vendor of black cohosh for medicinal uses.

Keywords: Medicinal uses, vendors.

94
Adam, K.L. 27

Amato, P. 27

American Botanical Council 83

American Cancer Society 28

American Chemical Society 28

American Herbal Products Association 28

Anon. 83

Association of Natural Medicine 

Pharmacists 84

Baillie, N. 29

Baskin, J.M. 29

Beck, V. 29

Bedir, E. 30

Beuscher, N. 84

Blakley, T. 30

Blumenthal, M. 77, 84

Boblitz, N. 30

Borrelli, F. 31

Botany.com 78

Britton, N.L. 85

Brown, D. 78

Brücker, A. 31

Burdette, J.E. 32

Burke, B.E. 33

Cech, R. 33

Cefakliman 93

Chen, S. 33

Compton, J.A. 34

Cook, W. 85

Council of the Pharmaceutical Society of 

Great Britain 85

Daiber, W. 34

Davis, V.L. 34

Decker, A. 78

Dixon-Shanies, D. 35

Dog, T.L. 35

Düker, E.M. 36

Eagon, C.L. 36

Eagon, P.K. 36, 37

Eckman, C.B. 37

Einbond, L.S. 37

Einer-Jensen, N. 38

Ellingwood, F. 85

EstroGentle 93

Fabricant, D. 38

Fasano, S. 38

Felter, H.W. 86

Fern, K. 78

Foldes, J. 39

Ford, P. 39

Foster, S. 87, 88

Freudenstein, J. 39, 40

Ganzera, M. 40

Genazzani, E. 40

Georgiev, D.B. 41

Green, M. 41

Author Index

Green Canyon Inc. 93

Greenfield, J. 41

Grieve, M. 79

Gruenwald, J. 42

Gunn T.R. 42

Hagels, H. 42

Harding, A.R. 88

Hardy, M.L. 42

Harnischfeger, G. 43

He, K. 43

HeartSpring.net 79

Horticopia, Inc. 89

Hostanska, K. 43

Hunter, A. 44

Huntley, A. 44

Jackson, D. 79

Jacobson, J.S. 44

Jarry, H. 45

Johannesen, S.J. 46

Johnson, B.M. 46

Kam, I.W. 46

Kauffman, G. 47

Kennelly, E.J. 47

Kliger, B. 80

Knüvener, E. 47

Koeda, M. 48

Korn, W.D. 48

Kronenberg, F. 48

Kruse, S.O. 49

Kusano, G. 49

Laino, C. 49

Langfritz, W. 49

Lata, H. 50

Lehmann-Willenbrock, E. 50

Li, W. 50

Lieberman, S. 50

Linde, H. 51

Liske, E. 51, 52

Liu, J. 53

Liu, Z. 53

Lloyd, J.U. 89

Löhning, A. 53

Lontos, S. 54

Löser, B. 54

Lupu, R. 54

Lyke, J. 55

Macht, D.I. 55

Mahady, G.B. 55, 56

McCoy, J. 56

McCullough, J.E. 56

McFarlin, B.L. 56

McGraw, J.B. 57

McKenna, D.J. 57

Mielnik, J. 58

Miller, R.A. 89

Missouri Botanical Garden 80

Moerman, D. 89

95
Morris, K. 58

Moyer, P. 58

Muñoz, G.H. 59

Murray, M.T. 59

National Center for Complementary and 

Alternative Medicine 80

National Institutes of Health, National 

Toxicology Program 59, 60

Nature’s Way Herbs 94

NatureServe Explorer 90

Nesselhut, T. 60, 61

Newall, C.A. 90

Newmark, T. 61

Nisslein, T. 61, 62

Noguchi, M. 62

Onorato, J. 62

Papps, F.A. 62

Pengelly, A. 91

Pepping, J. 62

Perry, L. 81

Petersen, F. 91

Petho 63

PIERS Exports (U.S. Ports) 91

Plyler, S.C. 81

Popp, M. 64

Potter, S.O.L. 91

Ramsey, G. 64

Ramsey, G.W. 64

Remifemin® 94

RippleCreek.com 94

Robbins, C. 65

Rockwell, S. 65

Sakurai, N. 65

Schaper and Brummer, GmbH 66

Schlosser, K.K. 66

Seibel, M.M. 67

Seidlová-Wuttke, D. 67, 68

Shao, Y. 68

Sievers, A.F. 81

Stefan, H. 68

Stelling, K. 82

Stiehler, K. 69

Stolberg, S.G. 82

Stoll, W. 69

Stolze, H. 69

Strauch, B. 82

Struck, D. 70

Suggs, R. 70

Sun, J. 71

SusanLoveMD.org 83

Takahira, M. 71

Tetherow, H. 92

Thomas, A.L. 71

Thomasen, M. 72

Tyler, V. 72

U.S. Department of Agriculture, Natural 

Resources Conservation Service 92

U.S. Department of Agriculture Forest 

Service 92

United Plant Savers 92

Upton, R. 93

Vitetta, L. 72

Vorberg, G. 73

Wade, C. 73

Warnecke, G. 73

Watanabe, K. 74

Wende, K. 74

Whiting, P.W. 74

Winterhoff, H. 74, 75

Woo, K.C. 75

Wuttke, W. 75, 76

Xu, H. 76

Zerega, N.J.C. 76

Zierau, O. 77

96
Subject Index

landscape uses 5, 9, 81, 83

light requirements 3, 30, 80

luteinizing hormone 8, 31, 36, 45, 46, 66, 97

See hot flashes

Lydia Pinkham’s Vegetable Compound 6, 72

market 10, 11, 12, 13, 16, 28, 29, 42, 57, 78, 89, 92

demand 5, 10, 15, 55, 82, 90

prices 10, 71, 89, 90

retail sales 6, 10, 78

mechanism of action

See physiological

medicinal uses 5, 6, 8, 9, 28, 29, 30, 32, 33, 36, 37, 38, 39, 41, 42, 44, 50, 51, 52, 53, 55, 56, 57, 58, 59, 60, 61, 62, 63, 66, 67, 68, 69, 70, 71, 73, 74, 75, 76, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94

See also Native American uses

menopause 6, 7, 8, 9, 16, 23, 32, 34, 47, 66, 74, 79, 84

mood 7, 68, 69

migraines 9, 33, 83

monitoring 15, 39, 47, 67

Native American uses 5, 80, 87, 88, 89, 91

nomenclature 1, 2, 78, 81, 83, 84, 87, 89

odor 3, 82, 87

other uses

See insect deterent

patents 9, 37, 39, 56, 60, 61

permits 11, 12, 16, 55, 65, 90

physiological actions 8, 28, 30, 31, 32, 36, 37, 38, 39, 41, 43, 44, 45, 46, 48, 49, 52, 53, 54, 55, 56, 57, 59, 60, 61, 62, 63, 67, 68, 69, 71, 75, 76, 81, 82, 84, 86, 90, 91, 92, 93

phytoestrogens 7, 8, 33, 35, 41, 42, 56, 58, 73, 75

poaching 12, 16

preparation 7, 8, 29, 57, 79, 81, 85, 86, 89, 90

products 6, 7, 16, 43, 51, 59, 70, 84

See vendors

propagation 5, 27, 30, 78, 79, 81

 tissue culture 50

range 3, 4, 5, 30, 79, 80, 82, 88, 89, 90, 93

Ranunculaceae family 80, 81, 87, 88

regulatory status 27, 55, 60, 84

related species 2, 64

Remifemin® 7, 8, 10, 34, 39, 40, 44, 50, 52, 57, 60, 63, 66, 69, 70, 73, 74, 94

research 5, 7, 8, 15, 16, 27, 28, 29, 30, 34, 35, 38, 40, 41, 42, 43, 48, 50, 56, 63, 64, 70, 72, 76, 78

See case studies

surveys 47

research reviews 28, 31, 36, 39, 41, 42, 43, 44, 48, 51, 56, 57, 59, 60, 62, 63, 72, 73, 78, 

80, 81, 82, 83, 84, 87, 90, 91, 92, 93

rhizomes 3, 8, 79, 82, 88

adverse events 36, 44

See side effects

Antioxidant properties 9, 32

botanical description 2, 3, 78, 79, 82, 83, 84, 

85, 86, 87, 88, 89

cancer 8, 9, 27, 28, 31, 35, 36, 38, 40, 43, 44, 

45, 53, 54, 55, 58, 59, 60, 65, 73, 78

case studies 6, 7, 32, 34, 42, 49, 54, 68, 69

chemical constituents 6, 30, 31, 32, 33, 36, 

38, 39, 40, 41, 42, 43, 45, 47, 48, 49, 50, 51, 

54, 56, 57, 59, 60, 62, 63, 64, 66, 67, 68, 70, 

71, 73, 74, 76, 79, 81, 82, 83, 84, 85, 86, 87, 

89, 90, 91, 92, 93

classification 1, 34, 93

clinical studies 6, 7, 8, 30, 31, 32, 35, 36, 37, 

38, 40, 43, 44, 45, 46, 47, 48, 50, 52, 53, 54, 

55, 58, 59, 60, 61, 62, 63, 65, 66, 67, 68, 69, 

70, 71, 73, 74, 75, 76, 84

assessment scales 7, 41, 52, 58, 63, 66, 

69, 74

common names 2, 3, 79, 81, 82, 88

conservation 12, 15, 16, 33, 39, 44, 46, 47, 

55, 57, 65, 67, 71, 90, 92, 93

contraindications 8, 84, 90

cultivation 5, 11, 16, 24, 27, 30, 64, 72, 79, 

80, 81, 83, 87, 89

pests and disease 5, 80, 81

distribution 4, 16, 55, 89, 90, 93

dosage 6, 8, 29, 42, 45, 52, 57, 63, 66, 81, 

84, 85, 90, 92

drug interactions 9, 57, 60, 65, 84

eclectic physicians 1, 5, 85, 86, 89, 91

ecology 2, 38, 57, 87, 89

ethnobotany

See Native American Uses

export 10, 13, 14, 15, 65, 92

flowers 3, 79, 80, 81, 82, 87, 88

fruit 1, 3

German Commission 6, 84

habitat 3, 5, 15, 57, 79, 80, 81, 82, 88, 89, 90

hardiness range 3, 30, 79, 80, 89

harvest 2, 3, 5, 10, 11, 12, 13, 15, 16, 28, 

29, 39, 47, 55, 57, 64, 65, 67, 71, 79, 81, 82, 

88, 93

history 1, 5, 6, 36, 42, 43, 51, 55, 57, 72, 81, 

82, 84, 85, 86, 87, 89, 91

hormone replacement therapy 7, 32, 36, 40, 

47, 50, 51, 58, 63, 67, 74, 83

hot flashes 6, 7, 8, 28, 31, 32, 45, 59, 68

identification 2, 64, 93

insect deterrent 3, 79, 80

Klimadynon®/Menofem® 8, 75, 76

97
safety 6, 7, 30, 32, 40, 42, 43, 45, 51, 57, 

73, 78

seeds 3, 5, 12, 13, 17, 29, 30, 64, 88

side effects 6, 8, 16, 29, 34, 36, 39, 42, 44, 

50, 51, 56, 57, 58, 59, 63, 68, 72, 81, 83, 84, 

86, 90, 92, 93

See toxicity

soil requirements 3, 30, 80

toxicity 6, 9, 36, 46, 48, 49, 54, 59, 65, 72, 

74, 83, 84, 87, 90, 93

See side effects

United Plant Savers 15, 92

vendors 10, 80, 93, 94

water requirements 30

wildcrafting 5, 55

98
Disclaimers

This annotated bibliography represents a comprehensive, but not exhaustive, 

review of the literature on black cohosh. The references included were 

identified through a detailed search of academic library-based databases, 

regional literature, government documents, Internet databases, as well 

as commercial Internet sites. Bibliographic references are organized into 

sections—Research Literature, Popular Press, Other Information Sources—

to indicate their origins. Research Literature includes references to peerreviewed articles published in scientific journals, while the references in 

Popular Press are not scientifically reviewed, but are included to indicate 

popular knowledge and perceptions. Other Information Sources include 

technical bulletins, horticultural lists, historical documents, and Web sites. 

Nonpeer-reviewed literature is covered in this publication to provide a wider 

and deeper presentation of the body of knowledge.

This document is available from the Non-Timber Forest Products Web site 

of the U.S. Department of Agriculture Forest Service, Southern Research 

Station at http://www.sfp.forprod.vt.edu/.

Web sites listed in the bibliography were active at the time this document 

was prepared, but Web addresses may change or disappear over time. The 

date accessed indicates the last time the Web sites were checked.

The use of trade or firm names in this publication is for reader information 

and does not imply endorsement by the U.S. Department of Agriculture of 

any product or service.

99
Predny, Mary L.; De Angelis, Patricia; Chamberlain, James L. 2006. Black 

cohosh (Actaea racemosa): an annotated bibliography. Gen. Tech. Rep. 

SRS–97. Asheville, NC: U.S. Department of Agriculture Forest Service, 

Southern Research Station. 99 p.

Black cohosh (Actaea racemosa, Syn.: Cimicifuga racemosa), a member of 

the buttercup family (Ranunculaceae), is an erect perennial found in rich cove 

forests of Eastern North America from Georgia to Ontario. Native Americans 

used black cohosh for a variety of ailments including rheumatism, malaria, sore 

throats, and complications associated with childbirth. Europeans have used this 

important medicinal plant to treat menopausal symptoms for over 40 years. 

Recent clinical evidence supports the efficacy and safety of black cohosh for 

these symptoms. Recent decisions by the U.S. Food and Drug Administration 

on hormone replacement therapy have increased the demand for black cohosh. 

In a 1-year period ending in 1998, retail sales increased more than 500 percent. 

In 2001, when retail sales in other segments of the herbal products industry 

were down, black cohosh sales increased about 2 percent to an estimated value 

of $6.2 million. Nearly 100 percent of black cohosh raw materials are wild 

harvested. Though it has received an “apparently secure” ecological ranking on 

the global and national scales, conservation groups list the species as “at risk” 

in the United States and endangered in Illinois and Massachusetts. Research 

is underway to determine sustainable harvest levels and to establish suitable 

cultivation methods.

Keywords: Conservation, medicinal plants, menopause, nontimber forest 

products, phytoestrogens, poaching.

100
Black Cohosh (Actaea racemosa)

is one of the more prominent medicinal plants 

harvested from Appalachian forests. Concern

for the conservation of the plant is increasing.

The Authors:

Mary L. Predny, Research Associate, Virginia Polytechnic Institute and State 

University, Wood Science and Forest Products Department, Blacksburg, VA 24061.

Patricia DeAngelis, Botanist, U.S. Fish and Wildlife Service, Division of

Scientific Authority, Arlington, VA 22203.

James L. Chamberlain, Research Scientist, U.S. Department of Agriculture, 

Forest Service, Southern Research Station, Blacksburg, VA 24060.Cover photograph by Thomas G. Barnes
United States

Department

of Agriculture

Forest Service

Southern

Research

Station

General

Technical

Report

SRS–97

United States

Department

of the Interior

National 

Park Service