# Black cohosh (Actaea racemosa) *Black snakeroot, rattle root, squaw root, bugbane; *Actaea racemosa*, formerly *Cimicifuga racemosa* of Nuttall; in pharmacy *Cimicifugae rhizoma** **Known today as.** *Actaea racemosa*, a tall North American herb of the family Ranunculaceae, growing freely in shady woods in Canada and the United States, with feathery racemes of white flowers one to three feet long that “droop gracefully.” The part used is the stout, blackish, knotty rhizome with its roots, collected in autumn after the fruit has formed, with a faint disagreeable smell and “a bitter and acrid taste.” Kind: Plant Toxic: yes > **Caution.** Liver injury is the danger. The European agency reports hepatitis, jaundice, and abnormal liver tests with black cohosh products, asks people with a history of liver disorder to take it with caution, and says to stop at once and see a doctor at signs of liver injury: tiredness, loss of appetite, yellowing of the skin or eyes, severe upper stomach pain with nausea and vomiting, or dark urine. LiverTox rates products sold as black cohosh among the well-established causes of liver injury, “some cases of which have been severe and led to emergency liver transplantation or death,” though the trials, in more than 1,200 patients, found none. It is not to be taken with oestrogens unless a doctor advises, nor by anyone treated for breast cancer or another hormone-dependent tumour without medical advice; vaginal bleeding calls for a doctor. ## What was it used for? An American remedy of many uses. Grieve calls it astringent, emmenagogue, diuretic, alterative, and expectorant, “supposed to be an antidote against poison and the bite of the rattlesnake,” useful in small doses for children’s diarrhoea, given in consumption to allay the cough, in whooping cough, and with success in rheumatism, and “said to be a specific in St. Vitus’ Dance of children.” Overdoses, she warns, produce nausea and vomiting. ## What does modern science say? The European Medicines Agency’s herbal committee accepts the rhizome on clinical evidence, as ‘well-established use’: for the relief of menopausal complaints such as hot flushes and profuse sweating (monograph of 2018). The trials disagree with one another. A Cochrane review of 2012, of sixteen trials in 2,027 women, found no significant difference from placebo in the frequency of hot flushes or in menopausal symptom scores, and concluded that “There is currently insufficient evidence to support the use of black cohosh for menopausal symptoms.” A meta-analysis of 2023, pooling 22 studies of 2,310 women and including extracts combined with other ingredients, found the extracts associated with significant improvement in overall symptoms. The regulator’s monograph of 2018 is newer than the Cochrane review and older than the 2023 analysis. The agency’s first assessment report, of 2010, put the rhizome’s triterpene glycosides, among them actein, at about 40 to 70 mg per gram. ## Pharmacognosy and toxicology - **actein**: among the triterpene glycosides, about 40 to 70 mg per gram of rhizome **Mechanism.** Not established in the sources read for this entry. **Standing.** European Union herbal monograph (2018): well-established use, for menopausal complaints such as hot flushes and sweating. A Cochrane review (2012) found insufficient evidence; a 2023 meta-analysis found benefit. ## What lore surrounds it? It was called black snakeroot, Grieve says, to tell it from the common snakeroot, *Aristolochia serpentaria*. She records that its seed was sent to Europe every year, and that in England it flowered in June or early July and thrived in moist shady borders, but never ripened its seed. ## What did the older authorities say? **King’s American Dispensatory.** “This is a very active, powerful, and useful remedy, and appears to fulfil a great number of indications.” It “possesses an undoubted influence over the nervous system,” and in small doses improves the appetite and digestion, while larger amounts increase the secretions of the gut. ## Sources - Grieve, M. *A Modern Herbal*, “Cohosh, Black.” As published on botanical.com. - Felter, H. W., & Lloyd, J. U. (1898). *King’s American Dispensatory*, vol. 1, “Cimicifuga.” Internet Archive, kingsamericandis01kinguoft. - European Medicines Agency, Committee on Herbal Medicinal Products. *European Union herbal monograph on Cimicifugae rhizoma (Black Cohosh)*. EMA/HMPC/48745/2017, 27 March 2018. - European Medicines Agency, Committee on Herbal Medicinal Products. *Assessment report on Cimicifugae rhizoma*, first version (superseded). EMA/HMPC/3968/2008, 25 November 2010. - Leach MJ & Moore V (2012). Black cohosh (Cimicifuga spp.) for menopausal symptoms. *The Cochrane database of systematic reviews*. PMID 22972105. - Sadahiro R, et al. (2023). Black cohosh extracts in women with menopausal symptoms: an updated pairwise meta-analysis. *Menopause (New York, N.Y.)*. PMID 37192826. - LiverTox: Clinical and Research Information on Drug-Induced Liver Injury, “Black Cohosh.” National Institute of Diabetes and Digestive and Kidney Diseases, updated 2025. NCBI Bookshelf. - European Medicines Agency, Committee on Herbal Medicinal Products. *European Union herbal monograph on Cimicifugae rhizoma (Black Cohosh)*. EMA/HMPC/48745/2017, 27 March 2018. - European Medicines Agency, Committee on Herbal Medicinal Products. *Assessment report on Cimicifugae rhizoma*, first version (superseded). EMA/HMPC/3968/2008, 25 November 2010. - Leach MJ & Moore V (2012). Black cohosh (Cimicifuga spp.) for menopausal symptoms. *The Cochrane database of systematic reviews*. PMID 22972105. - Sadahiro R, et al. (2023). Black cohosh extracts in women with menopausal symptoms: an updated pairwise meta-analysis. *Menopause (New York, N.Y.)*. PMID 37192826. - LiverTox: Clinical and Research Information on Drug-Induced Liver Injury, “Black Cohosh.” National Institute of Diabetes and Digestive and Kidney Diseases, updated 2025. NCBI Bookshelf. --- *Black cohosh.* In *Materia Medica*, edited by B. C. P. Statema. Version 1, revised 2026-10-16. The Thinking Press. https://thethinkingpress.org/materia-medica/black-cohosh Historical description, not medical advice.