Cimicifuga racemosa / Zilverkaars / Black cohosh

The ABC Guide is a 400-plus page, science-based, peer-reviewed text containing complete therapeutic monographs and clinical study details on 30 of the best-selling herbs in the United States at the time it was published, 2003. Most of these herbs are still found in the lists of top-selling herbs used as teas or dietary supplements.

An example from ABC Guide: Actaea racemosa L. (syn. Cimicifuga racemosa [L.] Nutt.)

[Fam. Ranunculaceae]


Black cohosh is indigenous to the Eastern U.S. and Canada and has a long and widely recognized medicinal tradition. Native Americans and early colonists used black cohosh root to treat conditions including general malaise, malaria, rheumatism, abnormalities in kidney function, sore throat, menstrual irregularities, and childbirth.

In Chinese medicine, rhizomes of many different species of Actaea have been traditionally used to treat inflammation, fever, headache, pain, sore throat, and chills. Black cohosh has been used in Europe for more than 40 years to treat symptoms associated with menopause. In 1996, nearly 10 million retail units of a standardized ethanolic and isopropanolic extract were sold monthly in Germany, Australia, and the U.S. The herb has become increasingly popular as a dietary supplement in the U.S., with retail sales in mainstream markets in 2000 ranking 14th among all herbals. Currently, black cohosh root is approved by the German Commission E to treat premenstrual discomfort, dysmennorhea, and neurovegetative complaints associated with menopause.


•Neurovegetative complaints associated with menopause, including hot flashes, heart palpitations, nervousness, irritability, sleep disturbances, tinnitus, vertigo, perspiration, depression

•Premenstrual discomfort

• Dysmenorrhea


•Surgical ovarian deficiencies


Early research suggested estrogenic activity (with alcoholic fractions) inhibiting LH secretion, but not FSH secretion, in menopausal women and proliferating vaginal epithelium. However, other more recent studies have refuted estrogen-like activity. Further research needs to be conducted to determine the herb’s mechanism of action.


The German Commission E monograph recommends a maximum treatment duration of six months. In Germany, prescriptions

for hormone replacement therapy (HRT) are limited to a six-month duration in order to ensure that women return to

their healthcare providers for general checkups.

In the case of black cohosh, the Commission E has based its limitations of therapy with black cohosh on the same criteria

as used for HRT.

DRIED RHIZOME AND ROOT: 40–200 mg daily.

DECOCTION: Daily dose, 240 ml boiling water poured onto 40–200 mg black cohosh (crude drug), simmered for 10–15 minutes.

FLUID EXTRACT: 0.3–1.0 ml, or 0.3–2.0 ml, or 5–30 drops [1:1 (g/ml) 90% alcohol].

TINCTURE: 0.4–2.0 ml daily, or 2–4 ml, or 40 drops twice daily [ 1:10 (g/ml) 40–60% alcohol].

STANDARDIZED DRY EXTRACT: 40%–60% ethanolic or isopropyl alcohol extracts of the rhizome with monitoring of active compounds (triterpene glycosides) corresponding to 40 mg of black cohosh daily.


None known.

PREGNANCY AND LACTATION: Not recommended during pregnancy due to emmenagogue and uterine-stimulant effects (based on empirical observations). Not recommended during lactation (based on empirical observations).


Occasional gastrointestinal discomfort has been reported. Vertigo, headache, nausea, vomiting, impaired vision, and impaired circulation have been reported in cases of overdose.


None known.