Black Cohosh

Medical herbalist Dee Atkinson tells us why she loves black cohosh

Visiting my sister’s herb farm on Vancouver Island in late autumn is a mixed pleasure. The days are long and warm with lots of outside eating interspersed with walks in the woods. The down side is the big harvest of medicinal plants that always seems to happen just as I arrive and the back-breaking work of digging, cleaning and drying roots, separating leaves and flower heads.

One of the plants that gets harvested in the cool of the day, dug out from its shady home at the edge of the woods, is black cohosh, known locally as ‘black snake root’. Having flowered in June, the thick black roots of a mature plant are woody and knotted. It is dug up, cut into pieces and then air dried in the shade. It can take the best part of an afternoon to harvest and prepare the roots, and the early evening air is full of the bitter smell of the resinous compounds released as the root is exposed to the air.

The demand for black cohosh has grown over the past 30 years. This traditional New World plant has become a mainstay of many European herbal practices and more recently has emerged as a major player in the move to bring herbal drugs into the mainstream.

Traditional use

Traditionally black cohosh was used to treat musculoskeletal problems, especially those that accompany the menopause, as well as hot flushes. It originally became popular in the UK as a treatment for rheumatism. I have come across it in many recipes combined with bogbean and willow bark, as a remedy for fevers and joint pain.

More recently black cohosh has become a favourite with practitioners for treating menopause symptoms, in particular hot flushes. Long considered to have hormone-balancing actions, black cohosh has now been shown to contain three types of hormonally-active substances. One suppresses lutenising hormone, while the other two have weak oestrogenic effects. Lutenising hormone surges are thought to trigger flushing and the suppression of this hormone by black cohosh is thought to help control the symptoms.

Clinical trials

There have been numerous clinical trials in Germany on the efficacy of black cohosh for easing menopausal complaints, and it has been shown to help symptoms as diverse as hot flushes, insomnia, menopausal joint pains and depression. The improvements in the clinical trials were seen from between four and twelve weeks. There have also been clinical trials involving younger women who have menopausal symptoms as a result of surgery.

For centuries herbalists have treated women’s health problems and especially problems associated with the different phases in a woman’s life. This is certainly one of the main areas of my practice, and the majority of that is made up of patients who want to look at alternatives to HRT.

HRT alternative

Increased press coverage of the potential problems associated with HRT have made many women look for an alternative way of treating their menopausal symptoms and I find that black cohosh can be used instead of HRT first to wean them off it and then to control symptoms. The huge benefit of black cohosh is the broad spectrum of its action - the way it eases hot flushes, mood fluctuations as well as joint pains. With long-term use, it can also help to ease vaginal wall thinning which can be a major stress for menopausal women.

I was very sceptical about the reports of black cohosh leading to possible liver damage. I have used it every day in my clinic, and never in my 19 years of practice have had any problems or reported side effects.

Often early reporting of the adverse effects of a drug does not provide us with enough information to adequately assess the validity of the claims which was certainly the case with black cohosh. I was therefore very pleased to see black cohosh vindicated in the recent Journal of Phytomedicine 16 (2009). The work of Teschke and Schwarzenboeck concludes that there is no casual relationship been black cohosh and liver disease.

It often takes time for medical research to catch up with something that herbal practitioners have known for centuries! So it is good to think that my sister’s black cohosh plants can continue to be grown, harvested and used to treat women’s health, in exactly the same way as they have been for centuries.

 

Dee Atkinson MCPP, Medical Herbalist, Napiers the Herbalists 

Black Cohosh can be found in SJW & Black Cohosh