The Uses of Cimicifuga Racemosa.
C. A. WEST, M. D.
This important remedy is constantly developing new uses. As these develop we are in danger of getting away from the important observation made by the original observers. I am quoting the following from an article written 25 years ago by Prof. John King for "Drugs and Medicines of North America":
The following is a concise statement of the therapeutic value of black cohosh root, as determined in my practice, and when in its employment it was not alternated or combined with other medicines. I have prescribed this agent since 1842, at which time, as far as I am aware, very few practitioners had any knowledge of it as a medicine. A saturated tincture has always been, and is still preferred, prepared with strong alcohol; and next to this, the alcoholic extract.
These preparations, when administered internally, lessen the action of the heart and arteries, diminish nervous irritability and remove abnormal conditions of muscular tissues, as well as of certain glandular organs, while at the same time a mild narcotic influence is experienced in numerous instances. (This influence has recently been overlooked. —ED.) In inflammatory rheumatism, when given in the first attack, the tincture has not only removed the disease, but has likewise appeared to so change the rheumatic tendency that a second attack is seldom to be anticipated; to effect this the tincture should be administered in doses from 10 to 60 minims, repeated every two hours until the patient's head becomes affected, after which the intervals between the doses should be sufficiently increased as to keep up this action upon the brain for several days, or until the disease has completely disappeared. In chronic rheumatism it has proved useful, diminishing the severity of the pain, and lessening the duration of the disease, but nothing more unless in combination.
In conjunctivitis and sclerotitis, in doses from 10 to 60 minims, repeated every hour or two, it has effected a complete recovery in a few days. It has also been attended with excellent results in relieving the more active symptoms attending early syphilis, in which disease a further investigation of its action is highly desirable, as well as in catarrhal affections of the respiratory organs.
In chorea, this is the principal agent upon which I have relied for the last forty years, preferring, however, in this malady the alcoholic extract. Without entering into particulars, it may be stated that this agent has been successfully employed in neuralgic affections, in uterine leucorrhea attending endometritis, as well as in congestion of the uterus, also in those affections of the female reproductive organs in which the menstrual function becomes deranged, as manifested by amenorrhea, frigidity, sterility, etc.
It is an ecbolic, as several instances are known in which the tincture, having been taken every three hours by pregnant women, effected the desired abortion, it undoubtedly exerts a very positive influence upon the generative organs of women. As an accelerator of labor, in cases of uterine inertia, the tincture or the powdered root proves a substitute to ergot, in the majority of cases arousing the uterus to contractions more nearly resembling the normal ones, and without any risk to the foetus, or impairment of uterine sensibility to its influence upon subsequent administration, though with ergot and similar agents it occasionally fails in its action. Immediately subsequent to a protracted or severe labor, the tincture will allay any nervous excitement that may be present, will relieve severe after-pains, and will favor uterine involution. In subinvolution of the uterus, accompanied by menorrhagia, the tincture or the extract will be found an efficient remedy.
When the tincture is exhibited in sufficient doses to keep up a slight effect upon the brain, it proves a very remarkable remedy in certain forms of malarial disease, also in neuralgia. Gastric acidity undoubtedly interferes with its remedial action in all instances. The root is said to contain tannin, but no decidedly astringent effect has been observed from its use.
Although a large dose is given herein, yet it must be remarked that some care and watchfulness is necessary in its administration, as I have met with several instances in which two or three drops of the tincture, repeated every hour, after a few hours, occasioned symptoms closely resembling those of delirium tremens, indeed, in one case, the administration of but one drop was invariably followed by these symptoms, and its further employment had to be omitted. Black cohosh is one of the most peculiar agents met with in the vegetable kingdom; it appears to exert a remedial influence upon both the serous and mucous tissues of the system when in abnormal conditions, and consequently has proven a superior remedy in numerous chronic diseases.
The specific tincture of the root, as prepared by Messrs. Lloyd Bros., appears to have nearly, if not quite, all the remedial influence of the saturated tincture, more especially in rheumatic and neuralgic affections, and in abnormal conditions of the principal organs of reproduction in the female. The fluid extract and the infusion of the root are less active in effecting the therapeutical influences just described; however, they will be found more especially beneficial in smallpox and other exanthema, both as a prophylactic, and as a remedy. It will simply be remarked here, that in alternation or combination with other medicines, not only is the usefulness of black cohosh increased but its field of operation is greatly enlarged.
The resin of cimicifuga, improperly called "cimicifugin," was prepared by myself in 1835, then, having subsequently tested its therapeutical virtues for about ten years. I called the attention of practitioners to it, but it did not come into general use until about 1850. The resin does not appear to possess exactly the same properties as the tincture, its narcotic influences being less decided. Alone, I have found this resin very efficacious in maladies of the female reproductive organs, as in chronic ovaritis, endometritis, menstrual derangements, as menorrhea, dysmenorrhea and menorrhagia, frigidity, sterility, threatened abortion, uterine sub-involution and to relieve severe after pains. In alternation or combination with other medicines it has exerted efficacious results not necessary to mention here. Other practitioners have related its employment in nervous, rheumatic and gastric affections, with much benefit, as well as in certain acute maladies.
The dose of the saturated tincture of black cohosh varies, according to its effect upon the patient, from one minim to sixty minims, to be repeated three or more times per day; of the specific tincture, from one minim to ten minims, repeated every two or three hours; of the alcoholic extract, from 1-4 to one grain; of the resin, from 1-2 of a grain to 3, and even 6 grains, three times a day; of the powdered root from ten to sixty grains, as may be required.
Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.