Actaea racemosa

Actaea racemosa, the black cohosh, black bugbane, black snakeroot, rattle-top, or fairy candle (syn. Cimicifuga racemosa), is a species of flowering plant of the family Ranunculaceae. It is native to eastern North America from the extreme south of Ontario to central Georgia, and west to Missouri and Arkansas. It grows in a variety of woodland habitats, and is often found in small woodland openings.

The roots and rhizomes are used in traditional medicine by Native Americans.<ref name=nccih/> Its extracts are manufactured as herbal medicines or dietary supplements.<ref name=ods/> Most dietary supplements containing black cohosh are not well-studied or recommended for safe and effective use in treating menopause symptoms or any disease.<ref name="ods">Template:Cite web</ref><ref name=":1">Template:Cite web</ref> A thorough literature profiling suggests that Cimicifuga racemosa is more efficient compared to a placebo in treating vasomotor symptoms resulting from natural menopause. The present review clearly encapsulates the use of CR extract for effective and safe therapy to alleviate menopausal symptoms.<ref>Template:Cite journal</ref>

Taxonomy

The plant species has a history of taxonomic uncertainty. Carl Linnaeus, on the basis of morphological characteristics of the inflorescence and seeds, placed the species into the genus Actaea. This designation was later revised by Thomas Nuttall reclassifying the species to the genus Cimicifuga. Nuttall's classification was based solely on the dry follicles produced by black cohosh, which are typical of species in Cimicifuga.<ref name="Compton et al.">Template:Cite journal</ref> However, recent data from morphological and gene phylogeny analyses demonstrate that black cohosh is more closely related to species of the genus Actaea than to other Cimicifuga species. This has prompted the revision to Actaea racemosa as originally proposed by Linnaeus.<ref name="Compton et al."/> Blue cohosh (Caulophyllum thalictroides), despite its similar common name belongs to another family, the Berberidaceae, is not closely related to black cohosh, and may be unsafe if used together.<ref name=nccih/>

Description

Black cohosh is a smooth (glabrous) herbaceous perennial plant that produces large, compound leaves from an underground rhizome, reaching a height of Template:Convert.<ref name="Cech">Template:Cite book</ref><ref name="Predny et al.">Template:Cite journal</ref> The basal leaves are up to Template:Convert long and broad, forming repeated sets of three leaflets (tripinnately compound) having a coarsely toothed (serrated) margin.

The flowers are produced in late spring and early summer on a tall stem, Template:Convert tall, forming racemes up to Template:Convert long. The flowers have no petals or sepals, and consist of tight clusters of 55–110 white, Template:Convert long stamens surrounding a white stigma. The flowers have a distinctly sweet, fetid smell that attracts flies, gnats, and beetles.<ref name="Cech"/>

The fruit is a dry follicle Template:Convert long, with one carpel, containing several seeds.<ref name="Compton et al."/>

Cultivation

A. racemosa grows in dependably moist, fairly heavy soil. It bears tall tapering racemes of white midsummer flowers on wiry black-purple stems, whose mildly unpleasant, medicinal smell at close range gives it the common name "Bugbane". The drying seed heads stay handsome in the garden for many weeks. Its deeply cut, superficially maple-like leaves, burgundy colored in the variety "atropurpurea",<ref>Most "atropurpurea" selections on the market, however, are selections of Actaea simplex.</ref> add interest to gardens, wherever summer heat and drought do not make it die back, which make it a popular garden perennial. It has gained the Royal Horticultural Society's Award of Garden Merit.<ref>Template:Cite web</ref>

The plant was Virginia Native Plant Society's 2017 wildflower of the year.<ref>Virginia Native Plant Society wildflower of the year 2017</ref>

Traditional and alternative medicine

History

Native Americans used black cohosh in the belief it could treat gynecological and other disorders.<ref name="ods"/><ref name="Predny et al." /><ref name="drugs">Template:Cite web</ref> The plant appeared in the U.S. Pharmacopoeia under the name "black snakeroot" during the year 1830.<ref name="ods"/> In the 19th century, the root was used to treat snakebite, inflamed lungs, and pain from childbirth.<ref>Template:Cite book</ref>

Herbalism

Extracts from the underground parts of the plant — the rhizome (Cimicifugae racemosae rhizoma) and the root (Cimicifugae racemosae radix) — are used in herbal medicine.<ref name=nccih/> The rhizomes and roots contain various saponins (triterpene saponins and triterpene glycosides, such as actein) as well as cimifugic acids and other phenol carboxylic acids.<ref name=ods/><ref name=":1" />

In most European countries, China, Malaysia, Thailand, Argentina and some other countries, black cohosh products are available as herbal products which have been approved by regulatory authorities ensuring reliable pharmaceutical quality, safety and efficacy for the relief of menopausal complaints such as hot flushes and profuse sweating.<ref name=":1" /> In the U.S., India, and some other countries, black cohosh is used as a dietary supplement marketed mainly to women for treating menopausal symptoms and other gynecological problems.<ref name="Predny et al." />Template:R Meta-analyses of contemporary evidence support these claims on menopausal complaints only for products holding a marketing authorization for this indication,<ref name=":3">Template:Cite journal</ref> whereas there is no high-quality scientific evidence to support such uses for other products.<ref name="nccih">Template:Cite web</ref><ref name=ods/><ref name=":5">Template:Cite journal</ref>

Cancer

Black cohosh does not prevent or treat cancer. Some people attempt to manage the side effects of breast cancer treatments using black cohosh supplements, but there is no good evidence this has any benefit.<ref name=cruk/>

Safety concerns

There is a lack of long term safety information for black cohosh.<ref name=cruk>Template:Cite web</ref>

The Herbal Medicinal Product Committee (HMPC) at the European Medicines Agency (EMA) has summarized the adverse drug reactions of herbal medicines made from cimicifuga with mentioning allergic skin reactions (urticaria, itching, exanthema), facial oedema and peripheral oedema, and gastrointestinal symptoms (i.e. dyspeptic disorders, diarrhoea).<ref name=":1" />

Black cohosh does not show harmful effects on endometrium<ref name=":02">Template:Citation</ref> or breast cancer survivors.<ref name=":13">Template:Cite web</ref> In contrast, such studies have not been published for dietary supplements made from black cohosh.<ref name="ods"/><ref name="drugs" /><ref name="nccih" /> Most black cohosh materials are harvested from the wild. Lack of proper authentication and adulteration of commercial preparations by other plant species are risk factors in dietary supplements<ref name="Predny et al." /><ref name="Teschke et al.2011b">Template:Cite journal</ref> and a critical matter of quality control in herbal medicinal products holding a marketing authorization. Very high doses of black cohosh may cause nausea, dizziness, visual effects, a lower heart rate, and increased perspiration.<ref name="drugs" />

Worldwide, some 83 cases of liver damage, including hepatitis, liver failure, and elevated liver enzymes, have been associated with using black cohosh, although a cause-and-effect relationship remains undefined.<ref name="ods"/> The clinical picture is similar to an autoimmune hepatitis with centrilobular liver cell necrosis, which can be treated with corticosteroids.<ref name="Guzman">Template:Citation</ref> Package leaflets of phytomedicines made from black cohosh caution that people with liver problems should not take it,<ref name="nccih" /><ref name=cruk/>

In 2007, the Australian Government warned that black cohosh may cause liver damage, although rarely, and should not be used without medical supervision.<ref>Template:Cite web</ref> Other studies concluded that liver damage from use of black cohosh is unlikely.<ref name="Teschke et al.2011a">Template:Cite journal</ref><ref>Template:Citation</ref><ref>Template:Citation</ref>

But millions of women have taken black cohosh without reporting adverse health effects,<ref name="nccih" /> and a meta-analysis of clinical trials found no evidence that black cohosh preparations had adverse effects on liver function.<ref name="Naser2011">Template:Cite journal</ref>

Phytochemicals

The rhizomes and roots of black cohosh (Cimicifuga racemosa rhizoma) contain diverse phytochemicals, particularly triterpene glycosides, such as actein and cimicifugoside, cimicifugin, caffeic acid, various saponins, and phenolic acids.<ref name=ods/><ref name=":1" /><ref name="Viereck et al.">Template:Cite journal</ref><ref name="Nunt">Template:Cite journal</ref>

{{#invoke:Gallery|gallery}}

Gallery

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  Leaves
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  Budding plants in cultivation
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  Close-up of the flower
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  Mature plant

See also

• Caffeic acid
• Ferulic acid
• List of unproven and disproven cancer treatments
• Phenylpropanoids
• Triterpenoids