Cimicifuga (U. S. P.)—Cimicifuga.

Botanical name: 

Fig. 71. Branch of a raceme of Cimicifuga racemosa. Photo: Cimicifuga racemosa 14. Preparations: Tincture of Cimicifuga - Compound Tincture of Cimicifuga - Resin of Cimicifuga - Extract of Cimicifuga - Fluid Extract of Cimicifuga - Compound Pills of Black Cohosh - Compound Syrup of Actaea - Tinctura Colchici Composita.—Compound Tincture of Colchicum.
Related entry: Actaea Alba.—White Cohosh - Oleoresinae.—Oleoresins - Blue Cohosh

Fig. 72. Fresh rhizome of Cimicifuga racemosa. The rhizome and roots of Cimicifuga racemosa (Linné), Nuttall"—(U. S. P.).
Nat. Ord.—Ranunculaceae.
COMMON NAMES: Black snakeroot, Black cohosh, Rattleroot, Rattleweed, Squawroot.
ILLUSTRATION: Drugs and Med. of N. A., by J. U. and C. G. Lloyd, Pl. 21, Vol. I.

Botanical Source.—This plant is a tall, leafy, perennial herb, having a large, knotty root, with long, slender fibers, and a simple, smooth, furrowed stem, from 3 to 9 feet high. The leaves are large, alternate, and ternately decompound. The leaflets ovate-oblong, incisely serrate, and opposite. The flowers are fetid, small, and borne in long, terminal, slender racemes. The sepals are 4 or 5 in number, rounded, and white; petals from 4 to 6, small, not so long as the sepals, resembling abortive stamens, and apt to be overlooked. The stamens are very numerous and showy; the anthers introrse and white. The stigma sessile, and lateral; pistils oval, forming dry, dehiscent, ovate, follicular capsules; the seeds numerous, small, and compressed (W.—G.).

History.—The black cohosh is a plentiful and conspicuous plant, growing in fence corners, on side hills and in rich woods. It blooms from the latter part of June until August. It grows from the Indian Territory to the Atlantic coast, extending as far north as the great lakes, and nearly as far south as Florida. The center of distribution is in the Ohio Valley. The part used in medicine is the rhizome, gathered in the autumn and carefully dried in the shade. It has an unpleasant, faint, earthy odor. Boiling water takes up its properties only partially; alcohol or ether wholly. The seeds probably possess active properties. The resin is but little used at the present time except in pill form, in combination with other agents.

Cimicifuga has several common names, as snakeroot and rattleroot, having been used to cure rattlesnake bites; rattleweed, from the fact that the seeds remaining in the pods through a part of the winter, rattle when blown by the winds, squawroot, a name more properly belonging to blue cohosh; and its pharmacopoeial name, black snakeroot. The name macrotys, adopted by some Eclectics, is an erroneous one, given by De Candolle, the celebrated French botanist. The proper word is macrotrys, from two Greek words meaning a large bunch, referring to its large raceme of fruit. Cimicifuga, its present botanical name, is derived from cimex (bedbug), and fugare (to drive away), the European species having been used as a bug exterminator. The drug is best known to the members of our school as MACROTYS.

This interesting remedy was a decided favorite with the early Eclectic practitioners, and to this day holds a very prominent place among the remedies originally placed before the medical profession by our school. As early as 1785, Schoepf merely mentioned the plant, but its medical uses were first recorded by Barton, in 1801, who called it squawroot, and writes: "Our Indians set a high value on it." He describes its use in putrid sore throat, itch, and in diseases of women, and further adds that it was used in the treatment of murrain in cattle. Other investigators wrote concerning it from time to time, but to Prof. John King belongs the credit of placing it before the medical profession, and it was through his valuable writings that it became an established and valued remedy. Prof. King began the use of macrotys in 1832, when but few physicians knew anything concerning it as a medicine. In 1835 he prepared the first resin of cimicifuga, often sold under the improper names of cimicifugin, macrotyn, or macrotin. In 1844 he called the attention of physicians to it, and again, in 1846, wrote of it in the Western Medical Reformer; though the remedy did not come into general use until about 1850. Finally, when the Eclectic Dispensatory appeared in 1852, Dr. King gave the remedy great prominence, and from that time on it has been used very extensively by the Eclectic physicians.

Description.—"The rhizome is of horizontal growth, hard, 5 Cm. (2 inches) or more long, about 25 Mm. (1 inch) thick, with numerous stout, upright or curved, branches, terminated by a cup-shaped scar, and with numerous, wiry, brittle, obtusely quadrangular roots, about 2 Mm. (1/12 inch) thick; the whole brownish-black, of a slight, but heavy odor, and of a bitter, acrid taste. The rhizome and branches have a smooth fracture, with a rather large pith, surrounded by numerous sublinear, whitish wood-rays, and a thin, firm bark. The roots break with a short fracture, have a thick bark, and contain a ligneous cord expanding into about 4 rays"—(U. S. P.).

Chemical Composition.—The root yields an impure mixture of resins, to which the names CIMICIFUGIN, MACROTIN, or MACROTYN, have been given. It may be readily prepared by precipitation of the alcoholic extract by the addition of water. Dr. G. W. Mears (Phila. Monthly Jour. Med. and Surg., Sept., 1827) first examined the plant chemically, obtaining therefrom gum, resin, starch, gallic, acid, tannin, extractive, and a bitter (acrid) substance, but failed to obtain an alkaloid, for which he searched (D. & M. of N. A., Vol. I, p. 262).

In 1871, Mr. T. Elwood Conrad announced the discovery of a neutral, "crystallizable principle in black snakeroot." By a circuitous process he obtained "a crystalline substance of a light yellow color, not of a very regular or decided shape, but of a massy appearance, resembling almost exactly the crystals of sulphate of aluminum on a small scale." In its behavior and most of its physical properties it resembled the resin. Mr. L. F. Beach (1876) claims to have found the same body in cimicifugin. M. S. Falck (1884) obtained from the fresh juice a body similar to Conrad's, and suspected it to be of an alkaloidal character. Both Profs. F. H. Trimble and J. U. Lloyd, who examined the drug in all conditions, failed to obtain a proximate crystalline substance. The same negative results attended the investigation of Prof. R. R. Warder. Prof. Lloyd believes the product obtained by Conrad to have been merely purified resin—i. e., the resin of cimicifuga (cimicifugin) purified from extraneous substances, and that the gentlemen, who supposed they had obtained a crystalline body, were mistaken as to its structure, or, if they obtained crystals, that they mistook a lead or aluminum salt for a product of cimicifuga. The fresh juice, from which Mr. Falck is said to have obtained crystals, is, according to Prof. Lloyd, composed chiefly of glucose and has no resin, or but very little of it. According to the latter, the resins are the important constituents of the drug. (See Drugs and Med. of N. A., by J. U. and C. G. Lloyd, Vol. I, p. 262).

Besides the above resinous body, black and green coloring matters, tannic acid, gallic acid, salts of iron, calcium, magnesium, and potassium were found in 1834 by J. H. Tilghman (Jour. Phil. Col. Pharm., VI, p. 20). Mr. G. H. Davis has found the root to contain gum, albumen, extractive, starch, uncrystallizable sugar, tannic acid, gallic acid, resin soluble in alcohol or ether, resin soluble in alcohol and insoluble in ether, fatty matter, waxy matter, volatile oil having the peculiar odor of the root, green and brown coloring matters, lignin and salts of potassium, magnesium, calcium, iron, and silica (Amer. Jour. Pharm., 1861, p. 391). Mr. E. C. Jones found the seeds of cimicifuga to contain gum, starch, fat, tannic acid, gallic acid, a resin soluble in alcohol or ether, a resin insoluble in alcohol, but soluble in ether, and salts of potassium and calcium (Proc. Amer. Pharm. Assoc., 1865, p. 186).

Action, Medical Uses, and Dosage.—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. In small doses the appetite and digestion are improved, and larger amounts augment the secretions of the gastro-intestinal tract. Excretions from the skin and kidneys are increased by it, the peculiar earthy odor of the drug being imparted to the urine; the secretions of the bronchial mucous surfaces are also augmented under its administration. Upon the heart and circulatory system its effects have been compared to those of digitalis, though being much less pronounced. The heart-beat is slowed and given increased power by it, while arterial tension is elevated. In large doses its action on the nervous system is very decided, producing vertigo, impaired vision, dilatation of the pupils, nausea, vomiting, and a reduction of the circulation, but no alarming narcotic effects. Three drops of the saturated tincture given every hour, for 20 hours, have been known to produce symptoms in every way simulating those of delirium tremens. Green tea is said to counteract its narcotic influences.

Upon the reproductive organs it exerts a specific influence, promoting the menstrual discharge, and by its power of increasing contractility of the unstriped fibres of the uterus, it acts as an efficient parturient. The venereal propensity in man is said to be stimulated by cimicifuga.

Few of our remedies have acquired as great a reputation in the treatment of rheumatism and neuralgia. As early as 1844, in the New York Philosophical Journal, Dr. King recommended the use of a saturated tincture of cimicifuga in acute rheumatism, stating that the remedy would permanently cure the disease. Prof. King's own statement of his use of it is as follows: "The saturated tincture of this article was recommended by me in acute rheumatism, in the New York Philosophical Journal, as early as in the year 1844; to be given in doses of 10 drops every 2 hours, gradually increasing to 60 drops, or until its action on the brain is observed, which action must be kept up for several days; it almost always removes the disease permanently, especially if it is a first attack." The experiences of other physicians since that day give abundant evidence of the truth of his statement. Indeed, few cases of rheumatism, or conditions depending upon a rheumatic basis, will present, which will not be influenced for the better by macrotys. Rheumatism of the heart, diaphragm, psoas muscles, "lumbago," "stiff neck," in fact all cases characterized by that kind of pain known as "rheumatic," dull, tensive, intermittent, as if dependent upon a contracted state of muscular fibre, soreness in muscular tissue, especially over the abdomen and in the extensor and flexor muscles of the extremities, all yield readily to it. If there be febrile and inflammatory conditions it should be associated with specific aconite, or specific veratrum; or possibly specific asclepias will be indicated. If the pain be greatly aggravated by motion, and especially if the serous tissues be involved, specific bryonia should be added to it. Should there be burning pain, aggravated by warmth of the bed, specific rhus. If effusion of serum into cellular structures be present, combine the macrotys with specific apocynum.

In cardiac rheumatism it should be given early and in quite full doses, withdrawing the remedy when the full and dull headache is produced by the drug. In this way confirmed rheumatism of that organ may often be averted. It is most useful in acute cases, being of value only to relieve the acute complications that may arise in chronic cardiac rheumatism.

Muscular pain of a rheumatoid character, when not amounting to a true rheumatic attack, and other rheumatoid pains, when acute and not of spinal origin, such as gastralgia, enteralgia, tenesmic vesical pain, pleurodynia, pain in the mediastina, orbits or ears, are relieved by cimicifuga. In diseases of the ear the drug is indicated when the condition is aggravated by rheumatic association, or in neuralgia of the parts with stiffness in the faucial and pharyngeal muscles. The dose should be about ¼ to ½ drop of specific macrotys every 2 hours. In eye strain, giving rise to headache, and associated with a sensation of stiffness in the ocular muscles, or a bruised feeling in the muscles of the frontal region, the same sized doses will give marked benefit. In doses of 1 fluid drachm of the tincture, repeated every hour, it has effected thorough cures of acute conjunctivitis, without the aid of any local application. Cimicifuga is a remedy for dyspeptic manifestations when due to rheumatoid states of the gastro-intestinal tube, or when associated with rheumatism of other parts of the body. It should be remembered in those cases where there is a dull or aching pain and tendency to metastasis, made worse by taking food or drink, and when the walls of the stomach seem to be contracting upon a hard lump, the patient having a rheumatic tendency or history (Webster).

Macrotys plays a very important part in the therapeutics of gynaecology. It is a remedy for atony of the reproductive tract. In the painful conditions incident to imperfect menstruation. its remedial action is fully displayed. By its special affinity for the female reproductive organs, it is an efficient agent for the restoration of suppressed menses. It is even a better remedy in that variety of amenorrhoea termed "absentio mensium." In dysmenorrhoea it is surpassed by no other drug, being of greatest utility in irritative and congestive conditions of the uterus and appendages, characterized by tensive, dragging pains, resembling the pains of rheumatism. If the patient be despondent and chilly, combine macrotys with specific pulsatilla, especially in anemic subjects. In the opposite condition associate it with gelsemium. It is a good remedy for the reflex "side-aches" of the unmarried woman; also for mastitis and mastodynia. It should be remembered in rheumatism of the uterus, and in uterine leucorrhoea, with a flabby condition of the viscus, its effects are decided. When there is a disordered action or lack of functional power in the uterus, giving rise to sterility, cimicifuga often corrects the impaired condition and cures. Reflex mammary pains during gestation are met by it, and in rheumatic subjects it promptly relieves such ovarian troubles as ovarialgia and neuralgia, the pain being of an aching character. Orchialgia and aching sensations of the prostate are conditions calling for macrotys, and as a tonic it is not without good effects in spematorrhoea.

Macrotys has proved a better agent in obstetrical practice than ergot. It produces natural intermittent uterine contractions, whereas ergot produces constant contractions, thereby endangering the life of the child, or rupture of the uterus. Where the pains are inefficient, feeble, or irregular, macrotys will stimulate to normal action. It is an excellent "partus praeparator" if given for several weeks before confinement. It is a diagnostic agent to differentiate between spurious and true labor plains, the latter being increased, while the former are dissipated under its use. It is the best and safest agent known for the relief of after-pains, and is effectual in allaying the general excitement of the nervous system after labor.

Macrotys exerts a powerful influence over the nervous system, and has long been favorably known as a remedy for chorea. It may be used alone or with specific valerian, equal parts. It is particularly useful here when associated with amenorrhoea, or when the menstrual function fails to act for the first time. Its action is slow, but its effects are permanent. It has been used successfully as an antispasmodic in hysteria, epilepsy when due to menstrual failures, asthma and kindred affections, periodical convulsions, nervous excitability, pertussis, delirium tremens, and many other spasmodic affections.

For headache, whether congestive or from cold, neuralgia, dysmenorrhoea, or from la grippe, it is promptly curative. As a palliative agent in phthisis pulmonalis, good results are obtained, in that it lessens cough, soothes the pain, especially the "aching" under the scapulae, lessens secretions and allays nervous irritability. Fevers, intermittent and remittent have been benefited by it, well-marked antiperiodic and tonic virtues having been observed in the drug. For rheumatic fever we have no better agent, when combined with aconite or veratrum. In the cerebral complications of the simple and eruptive fevers, especially in children, its action is prompt and decisive. It uniformly lessens the force and frequency of the pulse, soothes pain, allays irritability, and lessens the disposition to cerebral irritation and congestion. In febrile diseases especially, it frequently produces diaphoresis and diuresis. In the exanthemata, it is a valuable agent, controlling pain, especially the terrible "bone aches" of smallpox, rendering the disease much milder. In scarlatina and measles, it relieves the headache and the backache preceding the eruptions. It is stated that it has been used in the South with some success as a prophylactic against variola. Cimicifuga exerts a tonic influence over both the serous and mucous tissues of the system, and will be found a superior remedy in the majority of chronic diseases of these parts. In all cases where a acidity of the stomach is present, this should first be removed, or some mild alkaline preparation be administered in conjunction with the remedy, before any beneficial change will ensue. As a remedy for pain, macrotys is a very prompt agent, often relieving in a few hours, painful conditions that have existed for a long time.

The saturated tincture of the root is recommended as a valuable embrocation in all cases where a stimulant, tonic, anodyne, and alterative combined is required, as—in all cases of inflammation of the nerves, tic-douloureux, periodic cephalic pain, inflammation of the spine, ovarian inflammation, spasms of the broad ligaments, rheumatism, crick in the back or side, inflammation of the eyes, old ulcers, etc. If a more active preparation is desired, add tincture of grains of paradise in proper quantity, and if a more powerful anodyne be needed add tincture of sulphate of morphine. The specific macrotys will be preferable to the saturated tincture. The local use of the drug, however, is not extensive.

Cimicifugin, whose action differs somewhat from macrotys, was used by Prof. King in the treatment of "chronic ovaritis, endometritis, amenorrhoea, dysmenorrhoea menorrhagia, frigidity, sterility, threatened abortion, uterine subinvolution, and to relieve severe after-pains."

Preparations of cimicifuga, to be of any medicinal value, must be prepared from recently dried roots. In phthisis pulmonalis, cough, acute rheumatism, neuralgia, scrofula, phlegmasia dolens, amenorrhoea, dysmenorrhoea, leucorrhoea, and other uterine affections, the alcoholic preparations, as the saturated tincture or the specific macrotys, are the best modes of exhibition, and exert a therapeutic influence not to be obtained from the impure resin, termed cimicifugin.

As a partus accelerator, it may be substituted for, and should be preferred to, ergot; ½ drachm of the powdered root may be given in warm water every 15 or 20 minutes, until the expulsive action of the uterus is induced, and which it seldom fails to bring on speedily and powerfully. The powder, however, is seldom now used, the specific macrotys in from 15 drops to ½ fluid drachm being given in the same manner. In acute troubles, as acute muscular rheumatism, and in false pains, and as an oxytocic, Webster prefers the strong decoction of the recent root in tablespoonful doses. The fluid extract of black cohosh may be used in all cases where the article is indicated; its dose is from ½ fluid drachm to 2 fluid drachms. The ordinary dose of macrotys for its specific effects is a teaspoonful of a mixture of from 10 drops to 1 drachm of specific macrotys in 4 ounces of water, the larger or smaller dose being determined by the condition of the patient.

Specific Indications and Uses.—Dr. Scudder gives as the specific indications for this drug: "Muscular pains; uterine pains, with tenderness; false pains; irregular pains; rheumatism of the uterus; dysmenorrhoea. As an antirheumatic, when the pulse is open, the pain paroxysmal, the skin not dry and constricted."

To these may be added a sense of soreness, with dragging pains in the hips and loins; rheumatoid muscular pain; rheumatoid dyspepsia; chorea, associated with "absentio mensium."

King's American Dispensatory, 1898, was written by Harvey Wickes Felter, M.D., and John Uri Lloyd, Phr. M., Ph. D.