Family Name: Berberidaceae

Resources

Fact Sheet: Arthritis
Fact Sheet: Menopause
Fact Sheet: Hormone Regulation
Chapter from my PhD Thesis
Notes from the Eclectic Physicians

Fact Sheet: Arthritis

Part Used: Root

In a Word: Arthritis Cure

Uses: Reduces pain and inflammation in chronic arthritis, both rheumatoid and osteoarthritis, especially active in joint problems of an auto-immune origin

History
The Native Americans treated painful joints with Black Cohosh to great effect. In Lloyd’s Drugs and Medicines of North America we find several references to both Native American and Colonial use of Black Cohosh for problematic joints.

The aborigines of America already discovered medicinal virtues in this plant; finding it, as they did, growing in various parts of the country, they soon learned to use and value it highly for a variety of complaints, chief among which were rheumatism and amenorrhoea. In rheumatism they depended much more on a decoction of the roots externally than internally. A hole was made in the ground, into which they put a kettle containing a quantity of the hot decoction. The rheumatic limbs were placed over the kettle in such a manner as to receive the influence of the steam. It is probably that the effect of the heat had considerable to do in subduing some of the more annoying symptoms of rheumatism.

J. D. O’Connor (1858) used it successfully in rheumatic and neuralgic pains. He used it in chorea with as much confidence as he did quinine in intermittent fever. Dr. Simpson, of Edinburgh, in his own case, found it repeatedly to cure an attack of lumbago with wonderful rapidity.

Dr. F. N. Johnson found it extraordinarily efficient in acute rheumatism . In twenty of the worst cases the results were satisfactory in the highest degree, every vestige of the disease disappearing in 2, 8 or 10 days, without inducing any sensible evacuation or leaving behind a single bad symptom. An equally enthusiastic follower says, We have no more doubt of the efficacy of cimicifuga in the early stage of acute rheumatism than we have of the power of vaccine as a preventative of variola.”

As has been established, well before the Civil War, doctors were using Black Cohosh to treat joint inflammation. At the time this was known as rheumatism, today we separate rheumatism into a wide variety of conditions. However, whether the joint problem is as a result of wear and tear (osteo-arthritis) or the immune system attacking a joint (rheumatoid arthritis) the problem involves inflammation of the joints. When the joints are inflamed, Black Cohosh can be used to reduce the inflammation.

Science
Black Cohosh is thought to work on two levels. Firstly, it comes from a family of plants well known for their ability to deaden pain. Two well known relatives, Anemone and Aconite, are famous for their ability to block pain. Black Cohosh contains similar compounds to those found in its relatives. So, Black Cohosh acts as a painkiller. Beyond this, Black Cohosh contains a collection of steroid like compounds that are thought to be at the root of its anti-inflammatory activity. These compounds are thought to act locally (applied) and generally (taken internally) to reduce joint inflammation.

Practitioner’ Advice
Joint problems tend to be chronic. That is they do not go away. Even if they do go away, they certainly do not go away overnight. Joint problems’ requires management and often times, management for long periods of time. It is for this reason herbal medicine is ideal for those that have joint problems. Herbal medicine is mild medicine. It can be used for long periods of time and does not damage the body in the process. Unlike chemical drugs for joint problems, herbal medicine will not burn a whole through a stomach.

It is in this light practitioners see Black Cohosh. It is one of several herbal medicines that can be used to safely and effectively improve chronic joint problems. It does not work in all cases, but it does work in most cases. It must be used for a period of three months before its action can be judged. As it is a general tonic, and specifically a female tonic, general health will be improved along with the health of the joints. If it has been used for four months and no improvement is experienced, its time to move on.

QUICK REVIEW
History: Native American folk medicine
Science: Contains several anti-inflammatory compounds
Practitioners’ opinion: Must be used long term

Fact Sheet: Menopause

Part Used: Root

In a Word:The Menopause Plant

Uses: Found effective in reducing the severity of all symptoms associated with the menopause

Black Cohosh is a Native American plant found growing in rich open forests from the East Coast to the West Coast of the USA. The Native Americans gathered its roots and used them to improve general health and more specifically the female reproductive tract. Conditions such as debility, chronic coughs, poor digestion, as well as irregular menstruation were treated with Black Cohosh. As ginseng was the Asian cure all for men, Black Cohosh was the Native American fortifier of the female frame. The belief was that as Black Cohosh improved the vital forces of the body the gynecological functions were carried to higher ground in the process.

The Early American Eclectic physicians were rather keen on the plant and were responsible for lifting it from a domestic medicine to that of world acclaim. They used it to improve general health and normalise the female reproductive tract. Dr Fyfe MD, writing in 1911, echoes the Eclectic Physicians sentiment in regards Black Cohosh. “Cimicifuga is a remedy of great value in the treatment of many abnormal conditions of the reproductive organs of females. The influence of the drug on these organs is toward normal functional activity”. The Eclectics felt that regardless of what the female condition was, Black Cohosh would improve it. Menopause, irregular menses, infertility, and habitual miscarriage were regularly treated with Black Cohosh.

Where as it is true the general health affects the female reproductive tract, it is also true that the female reproductive tract impacts the body. Oestrogen, the chief hormonal product of the ovaries, effects the tissues that make up the other systems of the body.

Some women suffer from extreme emotional ups and downs during their menstrual cycles. Oestrogen effects nervous system function. Black Cohosh was previously the tonic of choice when it came to treating what we would now term PMT. Dr Felter, MD., said this of it, “Black Cohosh is a good remedy in nervous troubles. Few agents are better in hysteria, and nervous hysterical females are often radically cured by it. It is slow in its action, but permanent in its effects. It may be necessary in some cases to continue the treatment for some time, but it usually does quite nicely.”

The good doctor indicates that if the reproductive tract is negatively impacting the nervous system, Black Cohosh is an excellent choice to correct the problem at the source.

The Native Americans, the Eclectic physicians, and contemporary herbalists are in accordance in regards Black Cohosh. It is seen as an excellent daily tonic when the female reproductive tract is in need of a bit of shoring up. How Black Cohosh accomplishes this feat, for the most part, remains a mystery.

On the scientific front, Black Cohosh has been found to contain chemicals that effect the female reproductive tract, two noted examples being formononetin and cimicifugoside. Formononetin, an isoflavonoid, has been shown to stimulate the production of oestrogen and to have an anti-cancer activity.

Cervical, breast, and uterine cancer kill a lot of women. The predisposing factors for these dread diseases are still unclear. However, one thing is for certain, cancer in the family increases the risk of developing one of these cancers. As a consequence of Black Cohosh’s tonic nature and its proven anticancer constituents, modern herbalists suggest that, those who are vulnerable use Black Cohosh in their anticancer regimen.

Beyond this, formononetin has been shown to be a fungicide. Candida albicans, a fungal infection more commonly known as thrush, makes more than one woman’s life a misery. The presence of this anti-fungal agent may explain why some plagued by thrush experience an improvement while using Black Cohosh.

There was a day when heart disease was, for the most part, a male disease. As women have taken their rightful place in the work place, they too have become subject to heart disease. It is interesting to note that another compound found in Black Cohosh, cimicifugin, has been found to reduce blood pressure. High blood pressure being a risk factor for the development of heart disease. Beyond this, cimicifugin has been shown to increase coronary circulation to the heart which may make Black Cohosh of interest to women who have already developed heart disease.

Practitioners’ Advice
This is a realistic alternative to HRT! If you are interested in going the natural route, this herb makes that possible. Though we do not fully understand the complex manner in which Black Cohosh works, the rave reviews it has received past and present, the limited amount of research available, and its non-toxic nature suggests it is an excellent tonic for women in the menopause. As Doctor Felter said, it works slowly, but it works well. Clinical trials in Germany have established it to work as well as many of the chemical HRT products on the market minus the side effects. It works and a lot of women swear by it.

QUICK REVIEW
History: First used by Native Americans to ensure gynaecological health
Science:Found to reduce menopausal symptoms
Practitioners’ opinion: A realistic herbal alternative to HRT

Fact Sheet: Hormone Regulation

Part Used: Rhizome

Remember This: Hormone Helper

Reasonable Uses: Menopause, hot flashes, mood swings, dry skin, memory loss, poor concentration, irregular menstruation, painful menstruation, loss of menstruation, PMS, fertility aid, fertility aid for older women, erratic emotions based in hormones irregularity.

History and Traditional Uses
The name of this herb, which was introduced to early settlers by Native Americans, comes from the Algonquin word cohosh, meaning “knobby, rough roots.” Native American women traditionally relied on black cohosh for “women’s diseases.”

By the 1800s, herbalists became convinced that black cohosh was a panacea for most of the problems affecting women. By 1912, black cohosh was one of the medicinal herbs most frequently prescribed by American physicians. When chemical hormones tablets came onto the market, black cohosh use was abandoned for what seemed an advance.

Scientific Back Up
Black cohosh supplies estrogenic sterols and glycosides (chemicals that help the body produce and use a variety of hormones) and a host of micronutrients. According to the German Commission E, the expert panel that judges the safety and effectiveness of herbal medicines for the German government, black cohosh is effective for treating PMS, painful menstruation, and problems associated with menopause. In fact, studies indicate that it can be as effective as hormone replacement therapy for relieving hot flashes and other menopausal difficulties.

Herbalists Use It To…
Tame menopause
For some women menopause is no big deal, for others it is a nightmare that cannot end quickly enough. Herbalists find that this simple remedy is a realistic alternative to HRT(Hormone Replacement Therapy). Studies have shown it is equally effective at reducing the symptoms of menopause and has the advantage of being a natural product with a long history of uneventful use.

Foster fertility
Just when some woman start trying to have a family, what was a regular menstrual cycle loses its regularity. Fertility can be down when you want it to be up. Herbalists recommend older women trying to conceive use Black Cohosh to regulate their cycle and increase their chance of conception.

Make Menstruation Manageable
Herbalists say that for the women that suffer from irregular and painful menstruation, Black cohosh can bring the cycle into line. It must be used for several cycles for the effect to be felt, but in most cases menstruation will normalise.

Manage menstrual moodiness
Doctors in the last century used black cohosh to treat woman whose emotions suffered unnecessarily at the hands of the menstrual cycle. Today herbalists recommend the same treatment and find that some profoundly affected women experience relief with this Native American plant.

Shopping Tips
You won’t have trouble finding Black cohosh products at the health food shop or from online suppliers. Check all products to make certain they are made out of Cimicifuga racemose ROOT. Avoid all products containing other herbs.

Warnings
Do not use this herb if you suspect that you are pregnant.

Do not use while nursing.

Do not use if you are undergoing treatment for breast, cervical, uterine, or ovarian cancer.

If you develop bleeding between cycles, see your health care provider.

Alternatives
Angelica(Angelica sinensis)
Chasteberry (Vitex agnus-castus)

Chapter from My PhD Thesis

Part Used: Fresh root gathered in September.

Chemical Constituents: Significant phytochemicals include 27-desoxyacetylacteol, cimicifugin, formonetin, and racemoside. (17)

History
Barton, who called the plant squawroot, first mentioned the medicinal uses of Cimicifuga racemose in 1801 and said, “Our Indians set a high value on it.” He describes it being used in putrid sore throat, itch, diseases of women, and murrain in cattle. Dr. King established its uses and brought those uses to the attention of the medical community. He began working with the drug in 1832 and published his findings in 1846 in the Western Medical Reformer. When the Eclectic Dispensatory appeared in 1852, King extolled its virtues. From that moment forward, the drug was popular amongst the Eclectics and can be considered one of the Eclectic discoveries. (13)

Eclectic uses (1–15)
Actions
Anodyne, alterative, diaphoretic, diuretic, tonic, antiperiodic, aperient, digestive, increases digestive secretions, influences the nervous system, lessens the force and frequency of the pulse, allays irritability, lessens the disposition to cerebral irritation and congestion, partus preparator, increases force of uterine contraction, tonic effect over the serous and mucous membranes, removes acute rheumatism if treated in the first attack, tonic to the kidneys, uterus, and nervous system, corrects rheumatism by correcting the disease process which gives rise to the inflammation, corrects mild cases of rheumatism outright, normalises reproductive functions, prophylactic against variola .

Indications
“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 hot 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.” (12).

General
Acute rheumatism, rheumatism or conditions based on rheumatic condition, tuberculosis, phlegmasia dolens, malaria, remittent and intermittent fevers, rheumatic fever, cerebral complications of simple or eruptive fevers especially in children, bone aches of infections, small pox, scarlatina, measles, febrile and exanthematous disease, especially amongst children who have a strong tendency towards cerebral difficulty, majority of chronic diseases, dropsy, typhomalarial fever.

Cardiovascular
Rheumatism of the heart.

Digestive
Acidity of the stomach, dyspeptic conditions due to rheumatoid conditions.

Genito-urinary
Amenorrhoea, dysmenorrhoea, congestive dysmenorrhoea, leucorrhea, uterine affections, general nervous excitement following labour, after pains, painful ovarian inflammation, rheumatism of the uterus, false pains, unpleasant sensations of pregnancy, ovarian rheumatism, reflex side aches of unmarried women, mastodynia, mastalgia, reflex mammary pain during gestation, chronic ovaritis, endometritis, frigidity, sterility, threatened abortion, uterine subinvolution, orchialgia, aching sensations of the prostate, spermatorrhea.

Musculoskeletal
Acute rheumatism, chronic rheumatism, spasm of the broad ligaments, crick in the back or side, rheumatism of the psoas muscle, all cases characterised by rheumatic pain, dull, tensive, intermittent pain as if dependant upon a contracted state of muscle fibre, soreness in muscular tissue, especially over the abdomen, soreness in the extensor and flexor muscles of the extremities, muscular pain of a rheumatoid character, subclinical rheumatic muscular pain, rheumatic pains including gastralgia, enteralgia, tenesmic vesical pain, pleurodynia, pain in the mediastinum , orbits or ears, diseases of the ear associated with rheumatic disease, neuralgia of the parts with stiffness in the facial and pharyngeal muscles, 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, acute muscular pain of any cause, pain in the voluntary muscles.

Nervous
Nervous dysfunction, chorea, periodical convulsions, epilepsy, nervous excitability, delirium tremens, spasmodic affections, neuralgia, inflammation of the nerves, tic doloreux, periodic cephalic pain, inflammation of the spine, hysteria, all pain of a rheumatic character, rheumatic neuralgia, rheumatic headache, headache due to congestion, cold, neuralgia, dysmenorrhoea, or la grippe, ophthalmic conjunctiva, inflammation of the eyes.

Respiratory
Asthma, pertusis (spasmodic affections), phthisis pulmonalis, cough, diseases of the lungs, rheumatism of the diaphragm.

Skin
Old ulcers.

The drug from Selye’s perspective

State of Resistance
The drug was used to raise resistance to small pox, measles, scarlet fever/rheumatic fever, acute rheumatism, rheumatic conditions, tuberculosis, remittent and intermittent fevers, malaria, typhomalaria, lung disease, and most chronic diseases.

State of Exhaustion
The drug was used when resistance failed and State of Resistance set in. Examples of this would include kidney disease (kidney failure), end phase tuberculosis (phthisis), and rheumatism (systemic manifestations). Signs of State of Exhaustion treated with this drug included inflammation of the eyes, nervous disturbances and abnormalities, joint abnormalities, kidney failure, ulceration of the skin and mucous membrane, gastrointestinal disturbances, dyspepsia, and hyperacidity

Adaptation Energy

From Selye’s perspective, the drug augmented the GAS, which suggests it increases adaptation energy. Evidence to this effect includes the following. Cimicifuga was used to raise resistance to acute bacterial, viral infections, and protozoan infection. It was used to raise resistance to chronic infection such as malaria and tuberculosis. It was used to increase resistance to autoimmune disease of known aetiology (post streptococcal rheumatic disease) and unknown aetiology (blepharitis). Lastly, it was used when the body was no longer able to maintain resistance and State of Exhaustion set in.

Brekhman’s Adaptogen Criterion

An adaptogen should be innocuous and cause minimal disorders in the physiological functions of an organism.

Eclectic and contemporary literature indicates the drug is safe. (1–17)

The action of an adaptogen should be non-specific i.e. it should increase resistance to adverse influences of a wide range of factors of physical, chemical, and biological nature.

Clinically the drug was used to raise resistance to acute and chronic bacterial, protozoan, and viral infections, and autoimmune disease. (1–16)

Experimentally, compounds found in the drug have been shown to increase resistance to bacterial, viral, and fungal infections, cancer, Tumorgenesis, liver damage, and free radical damage. (17)

An adaptogen may possess normalising action irrespective of the direction of the foregoing pathological changes.

Clinically, the drug was used to correct perversions of physiology associated with the State of Exhaustion including joint abnormalities, kidney failure, ulcerations of the skin and GIT, and neurological defects. (1–16)

Experimentally, the drug contains compounds which normalise deviant physiological function, including hypocholesterolemia, hypertension, temperature abnormalities, inflammatory abnormalities, blood sugar irregularities, diarrhoea/dysentery, oedema, ulcer formation, and hyperactive immune function. (17)

Discussion

The drug exhibits properties consistent with Brekhman’s definition of an adaptogen. It is innocuous; it raises resistance to a spectrum of biological threats, and normalises physiological function.

Cimicifuga racemose is one of the most popular herbs in the modern world. Intriguingly, many of its former uses have been forgotten. Today, it is almost exclusively used to remedy perimenopausal and menopausal symptoms. The Eclectics, on the other hand, used it to raise resistance to acute and chronic disease, and to bolster patients having entered into State of Exhaustion . The drug was especially used when the signs of State of Exhaustion were prominent in the nervous and musculo-skeletal systems.

The drug was most frequently used when patients could no longer maintain resistance to chronic stressors and stage of exhaustion set in. Though the full gamut of the signs associated with State of Exhaustion were treated with this drug, when muscular and nervous abnormalities were prominent, the drug was seen as being especially useful.

Potential Clinical Applications
The drug may have potential in remedying nervous and muscular abnormalities associated with State of Exhaustion . In addition, it may be useful in the immunological abnormalities following on from acute or chronic infection.

Future research
• Cimicifuga racemose and its effects on the GAS. The drug should be tested in the animal model to determine its specific effects on the GAS.
• Cimicifuga racemose and autoimmune disease. Clinically, the drug was used to increase resistance to autoimmune disease. Experimentally, it has been shown to normalise inflammation and immune function. Its role in autoimmune disease should be examined.
• Cimicifuga racemose and the sequelae to infectious disease. The drug was used clinically to increase resistance to the sequelae of infectious disease (streptococcal infection/rheumatic disease, small pox/nervous lesions, etc.) Its role in increasing resistance to this type of sequelae should be examined. Reiter’s Syndrome might provide an ideal pathology to use for this study.
• Cimicifuga racemose and fibre myalgia. The drug was used to treat conditions, which would now be called fibre myalgia. The drug should be examined its role in raising resistance to fibre myalgia.
• Cimicifuga racemose and viral infection. The drug was used to raise resistance to viral disease and to prevent sequelae to these infections. Its role in raising resistance to viral disease should be examined.

Eco-availability
The drug is abundant in the wild.

References
• King, John. The American Eclectic Dispensatory. Moore , Wilstach, and Keys. Cincinnati . 1854. P. 342.
• Dyer, D. The Eclectic Family Physician A scientific System of Medicine on Vegetable Principles Designed for Families. 1855.
• Scudder, J. M. Specific Medication and Specific Medicines. Revised. Fifth Edition. Wilstach, Baldwin and Company. Cincinnati . 1874. P. 175.
• Scudder, J. M. the American Eclectic Materia Medica and Therapeutics. Published by the Author. Cincinnati . 1883. P. 423, 607.
• Lloyd, J.U. Pharmaceutical Preparations. Elixirs. Robert Clarke and Company. Cincinnati . 1883. P. 58.
• Scudder, J. M. the Eclectic Family Physician. Twenty first edition, fifth revision. Two volumes in one, with appendix. John K. Scudder. Cincinnati . 1887. P. 225.
• Watkins, Lyman. An Eclectic Compendium of the Practice of Medicine. John M.Scudder’s Sons. Cincinnati . 1895. P. 442.
• Felter, Harvey Wickes and Lloyd, John Uri. Kings’ American Dispensatory. Volume one and Volume two. Ohio Valley Company. Cincinnati . 1898. P. 1641.
• Webster, HT. Dynamical Therapeutics—A work devoted to the Theory and Practice of Specific Medication with special references to the newer remedies. Webster Medical Publishing Company. Oakland . Second Edition. 1898. P. 141, 250, 313, 475, 518, 572, 619.
• Felter, Harvey. Syllabus of Eclectic Materia Medica and Therapeutics. Compiled from notes taken from the lectures of F.J.Locke. Edited with pharmacological additions by H.W.Felter. Second edition, with appendix. Scudder Brothers Company. Cincinnati.1901. P. 387.
• Ellingwood, Finley. A Manual of the Eclectic Treatment of Disease designed for the many students and Practitioners. In two volumes. Volume one. Published by the Author.
1905 P. 153.
• Fyfe, John William. Pocket Essentials of Modern Materia Medica and Therapeutics. The Scudder Brothers Company. 1903. P. 90.
• Lloyd, JU. History of the Vegetable Drugs of the Pharmacopoeia of the United States . Bulletin number 18: pharmacy number 4. 1911. P. 17
• Lloyd, John Uri. Origin and History of all the Pharmacopeial Vegetable Drugs, Chemicals and Preparations. Volume 1: Vegetable Drugs. The Caxton Press. Cincinnati . 1921. P. 54
• Lloyd Brothers. Dose book of Specific Medicines. Lloyd Brothers, Cincinnati . 1930
• Dr. Dukes Phytochemical and Ethnobotanical DataBases. Agricultural Research Service. USDA.

Notes from the Eclectic Physicians

1854: JOHN KING – CIMICIFUGA RACEMOSA – BLACK COHOSH
Properties and Uses -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 has been successfully used in chorea, periodical convulsions, epilepsy, nervouse excitability, asthma, pertussis, delirium tremens, and many spasmodic affections. In chorea, it has been admnistered in teaspoonful doses of the powdered root, to be repeated three times a day; I, however, prefer the hydro-alcoholic extract, which I have used successfully, both alone, and in conjunction with the extract of scullcap. In phthsis pulmonalis, cough, acute rheumatism, neuralgia, scrofula, phlegmasia dolens, amenorrhea, dysmenorrhea, leucorrhea, and other uterine affections, the saturated tincture is the best mode of exhibtion, and which exerts a therapeutic influence not to be obtained from the cimicifugin. Its tonic and antiperiodic virtues are well marked in remittent and intermittent fevers, and I have found it very useful in other febrile and exanthematous diseases, especially among children, where there exists a strong tendency to cerebral difficulty. 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 especiallyy, it frequently produces diaphoresis and diuresis. In doses of one drachm of the tincutre, repeated every hour, it has effected thorough cures of opthalmitis conjunctiva, without the aid of any local application. As a a partus accelerator, it may be substituted for ergot; half a drachm of the powdered root, may be given in warm water, every fifteen or twenty minutes, until the expulsive action of the uterus is induced, and which it seldom fails to bring on speedily and powerfully; or half a drachm of the powdered root, may be given in warm water, every fifteen or twenty minutes, until the expulsive actin of the uterus is induced, and which it seldom fails to bring on speedily and powerfully; or half a drachm of a saturated tincture of the root may be given in the same manner. After labor, it will be found effectual in allaying the general excitement of the nervous system, and relieving after-pains. In large doses it produced vertigo, impaired vision, nausea, vomiting, and a reduction of the circulation but no alarming narcotic effects. I have known three drops of the saturated tincture given every hour, for twenty hours, to produce symptoms in every way stimulating those of delirium tremens. Green tea is aid to counteract its narcotic influences.

Dr CH Cleveland of Waterbury, Vt, recommends the saturated tincture of the root, as a valuable embrocation in all cases where a stimulant, tonic, anodyne, and alterative combined, is required as – in all cases of inflammatin of the nerves – tic-douloreux, periodic cephalic pain, inflammatin of the spine, ovarian inflammation, spasm of the broad ligaments, rheumatism, crick in the back or side, inflammatin of the eyes, old ulcers, etc. If a more active preparation is desired, he adds tincture of grains of paradise in proper quantity; and if a more powerful anodyne would be useful, he adds a solution of sulphate of morphia.

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. In all cases where acidity of stomach is present, this must first be removed, or some mild alkaline preparation be adminstered in conjuction with the remedy, before any beneficial chanage will ensue. Dose of the powder, from a scruple to a drachm, three times a day; of the saturated tincture, from five to sixty drops; of the decoction, from two to four ounces. The saturated tincture of this article was recommended by me in acute rheumatism, in the New York Philosohical Journal as early as in the year 1844; to be given in doses of ten drops every two hours, gradually increasing to sixty 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.

1855; Dyer (Vegetable Principles) – CIMICIFUGA RACEMOSE – BLACK SNAKEROOT
This is called cohosh sometimes.

Medical use – It is a mild tonic, of service to the kidneys, uterus and nervous system; rheumatism, dropsy, hysteria, and diseases of the lungs. Dose . – One ounce of the root to one pint of boiling water; from one half to a full glass taken four or eight times a day.

1874: Scudder
Prepare a tincture from the fresh root gathered in September, using 3viij. to Alcohol 76degree Oj. Dose from the fraction of a drop to ten drops.

For years I have employed Macrotys as a specific in rheumatism, and with excellent success. Not that it cures every case, for it does not, neither would we expect this, for this would be prescribing a remedy for a name. Rheumatism may consist of varied pathological conditions, thought in all there is the special lesion of the nervous system, which characterizes the disease. In one case we find the indications for the use of an Acid prominent, and this becomes a remedy for rheumatism. In another there are symptoms showing the need of Alkalies, and they prove curative.

Macrotys influences the nervous system directly, relieves rheumatic pain, when not the result of inflammation, and probably corrects the diseased condition (formation of lactic acid?) which gives origin to the local implammatory process. Thus in the milder cases, where the disease has not localized itself as an infalmmation, Macrotys is very speedy and certain in action. In rheumatic fever it is also positive in its action, and with the special sedatives gives excellent results.

Where rheumatism has localized itself in an inflammatory process.

All the benefit we attain from it is, that we remove the cause, and hence the reason for a long continuance of the inflammation.

It is a remedy for all pain having a rheumatic character, and for this we prescribe it with the best results. Those cases which go under the name of rheumatic-nerualgia, are very speedily relieved by it. In some cases the pains of weeks duration disappear in a single day. Whilst the continuance of the remedy will not unfrequently effect a cure in these cases, in many it will require the additional means necessary to give healthy functional activity to some organ or part especially impaired.

The Macrotys influences directly the reproductive organs. This influence seems to be wholly upon the nervous system, relieving irritation, irregular innervation, and strengthening normal functional activity. For this purpose it is unsurpassed by any agent of our Materia Medica, and is very largely used.

Its influence is very marked in functional disease of the reproductive organs of women. Associated with Pulsatilla it is specific in many cases of dysmenorrhoea; it should be given for three or four days before the expected period, and continued until the flow is free. In amenorrhoea it is also one of our most efficient agents. In rheumatism of the uterus, to relieve falso pains, or the many unpleasant sensations attending pregnancy, it has no equal in the Materia Medica.

Like all other direct remedies, it may be employed in any case, no matter what name the disease may have in our nosological classification, if the condition of the nervous system calls for it. The heavy, tensive, aching pains are sufficiently characteristic and need not be mistaken. So prominent is this indication for the remedy, in some cases (not rheumatic), that I give it with a certainty that the entire series of morbid processes will disappear under its use.

I had a very marked example of this in the severa thpho-malarial verer of this Fall. In one case, the disease had continued through the first week, growing worse daily under the treatment adopted, until the remarks of a night-watcher called my attention to these pains. Questioning elicited the fact that muscular pains had been severe from the first – but the patient “thought it was part of the disease, and there was no use to complain.” The treatment was changed from Veratrum and the Alkaline Sulphites, to Aconite and Macrotys, and the patient was convalescing in four days – there was marked relief in twelve hours.

This will serve as an innustration of the fact, “that a certain condition of disease may have that prominence in a case, that an entire seris of morbid phenomena will pass away when it is removed;” or, in other words, that a single remedy may prove curative, when a disease is complex – removing the first in a seris of morbid processes, the others disappear of themselves.

1883: Scudder
The rheumatism is uterine or ovarian, or the pains are muscular, or seem to be intensified by muscular contraction. In such cases, macrotys, by opposing the rheumatoid cause, and relieving irritation, brings the temperature down to the normal standard.

1884; LLOYD; DRUGS AND MEDICINES OF NORTH AMERICA
CIMICIFUGA

The Medical History and Physiological Action of Cimicifuga Racemosa. – (Written for this publication by Dr. Eric E. Sattler, Demonstrator of Anatomy and Clinical Lecturer on Diseases of the Nervous System in the Miami Medical College of Cincinnati.)

This native American plant, about which there exists such a diversity of opinions and results, well deserves our attention and scrutinizing study.

History of its Uses – The aborigines of America already discovered medicinal virtues in this plant; finding it, as they did, growing in various parts of the country, they soon learned to use and value it highly for a variety of complaints, chief among which were rheumatism an damenorrhoea. In rheumatism they depended much more on a decoction of the roots externally than internally. A hole was made in the ground, into which they put a kettle containing a quantity of the hot decoction. The rheumatic limbs were placed over the kettle in such a manner as to receive the influence of the steam. It is probably that the effect of the heat had considerable to do in subduing some of the more annoying symptoms of rheumatism. In facilitating parturition and as an emmenagogue it was also highly esteemed by the Indian women, whence its name – squaw-root . It was also used by the Indian doctors for ague and fevers, which it cured by profuse perspiration. As an antidote for the bite of snakes (the chewed roots applied externally to the wound), it also had some renown. These accounts are interesting to us only in an historical way, and not as the basis for scientific deductions. The Indians were probably not any too careful in their collection of plants, and the resulting product was often times a promiscuous decoction of numerous plants.

Benj. S. Barton (1801) was probably the first writer to describe the plant. He classed it under the head of astringents, the root of the plant having the astringent properties. He mentions the fact of a strong decoction of the roots having been used as a gargle, with great benefit, in an epidemic of putrid sore throat which prevailed in Jersey many years ago. A decoction was also believed to be a sure cure for the itch.

In 1823, the attention of the profession was called to an article in the American Medical Recorder, by T. S. Garden, on the Use of Actaea Racemosa in Phthisis pulmonalis. Dr. Gardner used it on himself when he was suffering from what he called incipients phthisis. He found it especially useful in checking the hectic paroxysms, diminishing night sweats, improving cough and expectoration, reducing an excited pulse and allaying irritation through its sedative properties on the nervous system and circulation. He found it to possess in an eminent degree the power of lessening arterial contraction, and believed it to have a tonic influence on the system. In 1850 Dr. Garden asserts that thirty years’ continued use of the drug has fully corroborated and confirmed his first favorable anticipations.

Chapman (1825) classified the drug with the expectorants. He never found it astringent to any degree, but says it is expectorant, narcotic, antispasmodic, diaphoretic, and in large doses emetic. In popular practice, at this time, it was reputed in pulmonary diseases, especially in asthma and consumption. In consumption it was said to lessen the frequency of the pulse, to allay cough, to quiet the mobility of the nervous system and to subdue hectic fever.

C. R. Rafinesque (1828) refers to it under the name of Botrophis serpentaria (black snake root). Its properties, according to this authority, are diuretic, sudorific, anodyne, repellent, emmenagogue and subtonic. It is valuable as a gargle, in dropsy, hysteria, and and as an auxiliary in acute and chronic rheumatism. In veterinary practice it was largely used, according to this and other authors, in the treatment of murrain, a decoction being employed which purged the cattle, expelled their worms and thus cured the disease.

Young (1842) speaks of it as valuable in incipient phthisis. He used it with benefit in asthma instead of lobelia, also in Chorea. Its narcotic properties he mentions as being similar to those of colchicum, veratrum and digitalis.

R. E. Griffith (1847) found it to act like a stimulant tonic and capable of increasing the secretions from the skin, kidneys and lungs. The action of the drug on the uterus he claims unsatisfactory and doubtful. In affections of the lung and in rheumatism he found, on extended trials, good reasons to believe in its efficacy.

The committee of the American Medical Association (1848), N. S. Davis, Chairman, were satisfied that the prevailing opinions in regard to the action of cimicifuga on the system were entirely erroneous. No two opinions agree, for while by some it was classed under the expectorants, by others it was termed a tonic, or narcotic, or diuretic, emmenagogue, etc. The committee never found it to produce any perceptible increase in any of the secretions of the system, nor have any stimulant properties. They uniformly found it, however, to lessen the frequency and force of the pulse, to soothe pain and allay irritability. In a word, they held it to be the most purely sedative agent we possess, producing its impresion chiefly on the nervous system of organic life.

G. B. Wood (1856) classified the drug under the nervous sedatives. He found it very serviceable in Chorea, and thought it should be considered among the standard remedies for this complaint. Although the value of this sylvania , Dr. Isaac Hays, in a note, stated that ten years before the publication of Dr. Young’s article, Dr. Physick had informed him that he had used the same remedy with good effect, in chorea, in 10 grain doses every two hours. Dr. Young gave 3I. of the powdered root three times a day. Dr. Wood also employed the remedy in epilepsy, but found it no material benefit.

J. D. O’Connor (1858) used it successfully in rheumatic and neuralgic pains. He used it in chorea with as much confidence as he did quinine in intermittent fever. Dr. Simpson, of Edinburgh , in his own case, found it repeatedly to cure an attack of lumbago with wonderful rapidity.

Dr. F. N. Johnson found it extraordinarily efficient in acute rheumatism. In twenty of the worst cases the results were satisfactory in the highest degree, every vestige of the disease disappearing in 2, 8 or 10 days, without inducing any sensible evacuation or leaving behind a single bad symptom. An equally enthusiastic follower says, We have no more doubt of the efficacy of cimicifuga in the early stage of acute rheumatism than we have of the power of vaccine as a preventative of variola.

H. C. Wood (1874) classed it under the antispasmodics, and says it is of undoubted value in simple chorea as it occurs in children. In inflammatory rheumatism it is at present rarely, if ever, used.

The preceding presents the important points culled from the literature concerning cimicifuga, and does not by any means exhaust it. A number of articles on the subject, being in the main, however, only repetitions of what has been said, will be found scattered throughout the pages of medical journals.

1887: Scudder: CIMICIFUGA RACEMOSA: BLACK COHOSH
Black cohosh is not only used as an alterative, but is also one of the best remedies for acute and chronic rheumatism, and in female onstructions. The tincture is generally employed, and may be given in doses of five to ten drops four or five times a day.

1895: Watkins: CIMICIFUGA RACEMOSE
Uterine pain and tenderness, sense or soreness with dragging pains in back, muscular pains in thighs and hips, theumatic pain, pulse open, skin soft and moist. Ten to twenty drops in four ounces water; teaspoonful every two hours.

1898: King
Few of our remedies have acquired as great a reputation in the treatment of rheumatism and neuralgia. Indeed, few cases of rheumatism, or conditions depending upon rheumatic basis, will present, which will not be influenced for the better by cimicifuga. Rheumatism of the heart, diaphragm, psoas muscle, lumbago , stiff neck, in fact all cases characterized that kind of pain known as rheumatic, dull, tensive, intermittent, as if dependant upon a contracted state of muscle fiber, soreness in muscular tissue, especially over the abdomen, and in the extensor and flexor muscles of the extremities will yield readily to it.

Muscular pain of a rheumatoid character, when not amounting to a true rheumatic attack, and other rheumatoidal pains when acute and not of spinal origin such as gastralgia , enteralgia, tenesmic vesical pain, leurodynia, 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 facial and pharyngeal muscles. In eye strain, giving rise to headache,a nd associated with a sensation of stiffness in the ocular muscles, or a bruised feeling in the muscles of the frontal region, it will give marked benefit.

Upon the repdoductive organs it exerts a specific influence, promoting the menstrual dishcage and by its power of increasing contractility of the unstriated fibres of the uterus. it acts as an effeicient parturient. The neveral propensity in man is said to be stimulated by cimicifuga. By its special affinity for the female reproductibe organs, it is an effeicient agent for the restoration of suppressed menses. It is even a better remedy in that cariety of amenorrhea termed absentio mesium. Cimicifuga plays an very im-ortant part in the therapuetics of gynecology. it is a remedy for atony of the reproductive tract, in the painful conditins incident to imperfect menstruation, its reedial action is fully displayred. in dysmeorrhea it is surpassed by no other drug, geing of greatist utility in irritative an dcongestive conditions of the uterus and appendages, characterized y tensive, dragging pains, resembling the pains of rheumatism.

If the patient be despondant and chilly combine cimicifuga with pulsatilla, especially in anemic subjects. it is a good remedy for the reflex side aches of the unmarried women, also for mastitis and mastodynia. it should be remembered in rheumatism of the uterus , and in uterine leucorrhea, 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 impaied condition and cures. Reflex mammary pains during gestation are met by it, and in rheumatic subjexts it promply relieves such ovarian troubles as ovarialgia and neuralgia, the pain being of an aching character. Orchialgia and aching sensations of the prostrate are conditions calling for cimicifuga. and as a tonic it is not without good effects in spermatorrhea.

1898: Webster : Digestive
Cimicifuga is adapted to the treatment of dyspeptic conditions in which the muscular wall of the gastrointestinal canal is affected by rheumatism. Rheumatoid conditions of the muscular walls of the alimentary canal are not uncommon, and are liable to affect persons who are subject to muscular rheumatism in other parts.

Dull, aching pain, with tendency to metastasis, aggravated by eating or drinking, a sensation as of a hard lump in the stomach with the walls contracting upon it in persons with a tendency to muscular rheumatism, as indicated by history of former attacks, would suggest cimicifuga. I have relieved many such cases with it, as well as with caulophyllin. I use the caulophyllin in the 1x or 2x trituration; the cimicifuga in the decoction of the recent root, in tablespoonful doses.

1898; Webster; (Muscles) – Cimicifuga Racemosa
This agent is variously known as actea racemosa, macrotys racemosa and cimicifuga racemosa. It is one of the oldest Eclectic antirheumatics, and has always sustained its reputation, though many have entered the field during its time.

This is another aboriginal remedy for rheumatism, and is described in Rafinesque’s Medical Flora, under the name, botrophis serpentaria, though it had been formerly named by different botanists, as actea, cimicifuga and macrotys.

Cimicifuga is Scudder’s specific for muscular pain, his favorite combination being this agent with aconite. It proves very efficacious in acute phases of this affection, whatever the disease it may occur in may be called. It is a remedy for a condition – muscular pain of rheumatoid character. Muscular pain may be one of the first symptoms of cardiac disease, especially cardiac rheumatism, and cimicifuga is the most positive remedy we possess to banish it promptly, if given early, in full doses of a decoction of the recently dried root. Similarly, it relieves pleurodynia, mediastinal pain, gastralgia, enteralgia, vesical pain and tenesmus, orbital and aural pain – when this is rheumatoid – as well as pain in the voluntary muscles.

In articular rheumatism it is of little account, and here must be superseded by jaborandi, the salicylates, and rhus tox. – though I have not much confidence in the last named remedy here.

On the Pacific Coast I have been rather disappointed in cimicifuga as a remedy for muscular pain. It certainly is not as effective here as in the interior country of the Middle and Western states, probably on account of the damp atmosphere. How it succeeds in the interior of California I have never ascertained.

However, it will always be found a reliable remedy for muscular pain in acute affections, and will continue to be a standard one, unless the pain be of spinal origin.

Form of Administration. – The specific medicine is a reliable preparation, though I prefer a decoction of the recently dried root for all purposes; this may be sweetened to suit the taste. But this will not always be obtainable and the specific medicine represents the recent plant properties reliably.

Dose . -The dose of the decoction will vary from a tablespoonful to a wineglassful; over-doses cause fullness and pain in the head, but these soon pass off without bad result. The dose of the specific medicine may vary, from the one-hundredth to the tenth of a drop.

1901: Locke
This remedy is indicated by muscular pain, uterine pain with tenderness, and false labor pains. It is valuable in many cases of rheumatism. There are few better remedies for rheumatism of the uterus or any other part of the reproductive organs of the female. Acute rheumatism of the male is often cured with it. it does best in those cases ehere the pulse is open, pain constant and drawing, not paroxysmal, and the skin is hot, dry, and constricted. Its physiological effects are as follows: large doses produce nausea with marked increase of the bronchial secretion, expectoration becomes free, cutaneous secretion is increased until the patient sweets freely, vertigo and dimmness of vision take place, the hearts action is reduced, and the circulation is depressed. It is sedative in large doses. It relaxes the muscles and overcomes muscular pain.

The effect of macrotys on the stomach is good, improving both digestion and the appetite. It is valuable in rheumatic headache when indicated as previously named. In such cases give the specific medicine or a weaker one. The following is a good tincture:take eight ounces of the root and macerate it for two weeks in oe pint of sixty or seventy percent alcohol. Filter and add enough more alcohol to give sixteen ounces when the process is finished. of this use the following for most disorders.

Tr.macrotys gtt.x.to xxx.aqua fi.3/5 iv.

Dose: a teaspoonful every one,two, three, or four hours. The same plan of treatment is good in myalgia, or give five drops of the above tincture every three hours.

1907: Ellingwood

“In menstrual disorders accompoanied with aching or muscular soreness and cook skin. relieves amenorrhea with hese symptoms;will control congestive dysmeorhea. its influence here is enhanced by aconite or belladona. It is beneficial in menorrhagia and metrorrhagia, is given in menstrual irregularities of young girls.

It excercises wide influence on nerbe centers and their blood supply. is a mild motor depressant and nerve sedative. positively relieves muscular soreness or aching, induced or idiopathic, from whatever cause. relieves erratic nervous condition;acts directly upon the reproductive functions.

1909: Felter and Lloyd: CIMICIFUGE (U.S.P.) – CIMICIFUGA
History – The black cohosh is a plentifull an dconspicous plant, growing in fence corners, on side hills an din 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 figare (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 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 cimicifugia, 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.

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 an dneuralgia. 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 upona 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 wil 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, an dother 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 inidcated when the condition is aggravated by rheumatic associated, or in neuralgia of the parts with stiffness in the faucial and pharyngeal muscles. The doese should be about 1/4 to 1/2 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 manfestations 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 flabby con….on 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 an dneuralgia, 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 spermatorrhoea.

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 pains, 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 along 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 benefitted 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 “boneaches” or smallpox, rendering the disease much milder. In scarlatina and measles, it relieves the headache and the back ache 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 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.

Cimicifugia, 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.”

Preparation 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; 1/2 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 1/2 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 1/2 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.”

1911: Fyfe:
Muscular pains in the back, loins, and thighs, sense of soreness, with dragging pains in the uterus, deep seated muscular pains, with hot skin and sweating, ovarian pains, dull, tensive, intermittent pain, as if dependant upon a contracted state of muscular fiber, soreness of muscular tissue, slow, irregular, scanty or protracted menstruation, dysmenorrhea, when evidence of a rheumatic diathesis is shown, afflictions incidental to pregnancy, and its contined use greatly modifes the many aches, pains and other unpleasant sensations of the child bearing women during gestation. Cimicifuga racemosa is diaphoretic, diuretic, antispasmodic, alterative, tonic, stimulant and nervine.

1911: LLOYD
Cimicifuga is abundantly distributed in rich woodlands over the greater portion of the United States east of the Mississippi River, except in New England and the extreme South. It is also found in Missouri and Arkansas . Cimicifuga was observed by the earliest European travelers in America , being carried to England in 1732, and first described by Plukenet (514a) in 1696. All pre-Linnaean writers classed the plant with actaea, mostly under Tournefort’s (649) name, Christopheriana. Linnaeus (385) gave it the name Actaea racemosa, under which it was classed until Pursh (528) referred it to the genus cimifuga. Rafinesque (535), 1808, by reason of the fact that the fruit of the plant does not accord with that of either actaea or cimicifuga, proposed the name Macrotys actaeoides, changing the name in 1828 to Botrophia serpentaria. Eaton (211) in the fourth edition of his Manual followed Rafinesque, calling the plant Macrotys serpentaria.

Cimicifuga was highly valued by the Indians, who employed decoctions of the drug for diseases of women, for debility, to promote perspiration, as a gargle for sore throat, and especially for rheumatism. These uses by the Indians introduced the drug to early “Domestic” American medicine, and it was consequently given much attention by the earliest writers, e.g., Schoepf (582), 1785; Barton (43), 1801; Peter Smith (605), 1812; Bigelow (69), 1822; Garden (256a), 1823; Ewell (230), 1827; Rafinesque (535), 1828; and Tonga and Durand’s (222) addition to Edward’s and Vavasseur’s Materia Medica, 1829. None of these authorities, however, added anything not given by the Indian, so far as the field of action of the drug is concerned, excepting perhaps the statement of Howard (329), 1832, who was an enthusiast in favor of macrotys in the treatment of smallpox, a claim supported forty years after by Dr. G.H. Norris, 1872, in a paper read before the Alabama State Medical Association. He reported that during an epidemic of smallpox in Huntsville, Ala., families using macrotys as a tea were absolutely free from smallpox, and that in those same families vaccination had no effect whatever, so long as the use of macrotys was continued. (See Lloyd Brothers’ Drug Treatise No. XIII, Macrotys.)

1921: Lloyd
CIMICIFUGA (MACROTYS) (Black Snakeroot, “Black Cohosh”)

While named in every edition of the U.S.P., it was, in the early editions, found in the Secondary List only. In the edition of 1840 it was promoted to the Primary List, and since that date it has been wholly official. According to the edition, its nomenclature varies. In 1820 and 1828, the name Cimicifuga Serpentaria is official. In the Philadelphia edition of 1830, C. Serpentaria and C. racemosa are named, while the New York edition of 1830 makes official C. Serpentaria and Actoea racemosa. The 1840 and all succeeding editions, including that of 1910, recognize C. racemosa alone, but base their authority upon different botanists, the editions of 1840, 1850 and 1860 naming Torrey and Gray, those of 1870 and 1880 Elliott, while all later editions name (Linne) Nuttall.

Cimicifuga, (Macrotys), is abundantly distributed in rich woodlands over the greater portion of the United States east of the Mississippi River, except in New England and the extreme South. It is also found in Missouri and Arkansas . Because of the color of the root and its reputed use in snake-bite, it was commonly known to the early settlers as black snakeroot. Other names commonly applied to it were “black cohosh,”*1 rattle weed, rattle root and rattle snakeroot, so named because the dried spikes carrying the seed rattle in the wind. These last terms are sometimes corrupted into rattlesnake root and blacksnake root. Because of its employment in female ailments by the Indians, the name “squawroot” was also given this plant, but this term was more extensively employed with reference to Caulophyllum thalictroides, or blue “cohosh,” the majority of writers giving the preference to that drug. The name cimicifuga suggested the common names “bugwort” and “bugbane,” but while these were applicable to the various European species, that were used to drive away insects, they were, so far as we know, misapplied in the direction of the American species. Still another common name was richweed, given by Gronovius, 1752, because the plant frequents rich woodlands. But the name “richweed” is now given by botanists to Pilea pumila, a very different plant.

Macrotys was observed by the earliest European travelers in America , being first described by Plukenet in 1705. That writer, who lived when new plants were pouring into England from this country, and whose publications were rich in descriptions of American plants, classed cimicifuga with the Actoea spicata of Europe , using the old generic name “Christophoriana Canadensis racemosa.” His inaccurate, but yet sufficient, drawing establishes the plant’s identity. His specimen is preserved in his herbarium in the British Museum . Following Plukenet, other pre-linnaean writers classed the plant with Actoea, mostly under Tournefort’s name, Christophoriana. Linnaeus gave it the name Actoea racemosa, under which it was classed until Pursh referred it to the genus Cimicifuga. Rafinesque, 1808, by reason of the fact that the fruit does not accord with that of either actaea or cimicifuga, proposed the name Macrotrys actoeoides, changing the name in 1828 to Botrophis Serpentaria. Eaton, in the fourth edition of his Manual, followed Rafinesque, but perpetuating the error of De Candolle, who preceded Eaton, he incorrectly spelled the name, calling the plant Macrotys Serpentaria, the latter being Pursh’s specific name. The following botanical history by C. G. Lloyd, from Drugs and Medicines of North America, is of such interest as to lead to its reproduction, verbatim:

“Cimicifuga is a very conspicuous and showy plant when in bloom, and hence was noticed by the earliest travelers in America and carried to the botanical gardens of Europe early in the 18th century. It was first described by Plukenet, and rudely figured in his Amaltheum Botanicum, 1705. Several other pre-Linnaean writers mentioned the plant, all classing it with Actoea, mostly under Tournefort’s name, Christophoriana, and designating it with specific adjectives indicating its long raceme or spikes.

“When Linnaeus first specifically named plants in his Species Plantarum, 1753, in common with previous writers, he included this plant with Actaea, to which it is very closely allied in habit, appearance, properties, powers, etc., and called it Actoea racemosa.

“At that time, but two of the species now constituting the genus Cimicifuga were known, the plant under consideration, and C. fetida of Eastern Europe . Had Linnaeus made a genus for these two, he would have had a genus containing two plants belonging to entirely different orders of his artificial system. He did, in after years, separate the European species from Actaea under the generic name Cimicifuga, but he did not include our plant in that genus.

“The Linnaean name, Actoea racemosa, was retained till the beginning of the 19th century by all writers excepting Walter, who called the plant Actoea monogyna.

“It was Pursh who first referred it to the genus Cimicifuga which Linnaeus had established for the European plant. Michaux had previously referred to this genus our mountainous species (Cimicifuga americana ), which he discovered. Pursh, in addition to this species, having seen our northwestern species, (Cimicifuga alata, that he considered identical with the European species, Cimicifuga fetida), noticed the great similarity of the three plants, and placed them all in a common genus. The plant under consideration he called Cimicifuga Serpentaria.

“Four years later, Nuttall, in enumerating the then known plants of the United States , restored the old specific name, calling it Cimicifuga racemosa. In the same year, but after the publication of Nuttall’s work, (as is evident from his mentioning that work), Barton used the same name, evidently taken from Nuttall’s work, but without giving him credit for it. Hence De Candolle and several other writers have incorrectly referred the authorship to Barton. It is remarkable, however, that in all the works of both Torrey and Gray, and in most recent works on American botany, the authorship of the name has been credited to a botanist (Elliott) who did not use the name until six years after it was published by both Nuttall and Barton, and that this same error should have been made in the last very carefully prepared edition of the United States Pharmacopeia, of 1880.

“The following are the distinctive characters between the two genera, Actaea and Cimicifuga, as established by Linnaeus. They are drawn entirely from the fruit, as there is no other point of distinction.

Actoea – Fruit, a solitary, fleshy berry.

Cimicifuga – Fruit, five or four dry follicles.

“It will be seen that Cimicifuga racemosa does not accord with either genus as defined by Linnaeus, as the fruit is a dry follicle, but solitary. On this account Rafinesque proposed to establish for it a new genus, Macrotrys, (from makros, large, and botrus, a bunch, referring to the large raceme of fruit. Eaton), calling the plant Macrotrys actoeoides. (Medical Repository, 1808).

“There is really some structural ground for Rafinesque’s genus, because the plant differs from all others of the genus Cimicifuga, as follows; but there is, however, such close relationship in every other particular that this difference can not be considered sufficient for maintaining the plant in a separate genus:

Cimicifuga racemosa Macrotrys Raf. – Follicle abrupt at the base, solitary, ovoid, seeds smooth, numerous, compressed horizontally.

All Other Species of Cimicifuga – Follicles five (or four) flattened, stipitate, seed rough with slender projections.

“In 1828 Rafinesque changed his generic name to Botrophis, calling the plant Botrophis Serpentaria. He gives his reasons for the change as follows: ‘The name Macrotrys is delusive and harsh. I have found a better one, meaning snake raceme, (from botrus a bunch, and ophis a snake), the raceme or long spike of flowers being mostly crooked and like a snake.’

“But one other American botanist has ever followed Rafinesque’s generic views. Eaton, in the fourth edition of his Manual adopted them, but used Pursh’s specific name, calling the plant Macrotys Serpentaria. In subsequent editions he used the old specific name, and called it Macrotys racemosa.

“Eaton was very positive regarding the rights of the plant to generic rank. He spelled the name, however, incorrectly – Macrotys instead of Macrotrys, an error that was made by De Candolle, from whom no doubt Eaton took it.

“About the time that black cohosh was beginning to be used by the Eclectic practitioners, Eaton’s Manual was the popular text book of botany. Hence it is that his name, Macrotys racemosa, was given tot he plant in the early medical works, and has persistently clung to it in spite of botanical authority, even to the present day.

“Forms. – Cimicifuga racemosa has but little tendency towards variation. Specimens from a number of widely distant stations show a constancy of character.

“In central Pennsylvania , there exist two plants distinguished by root gatherers as the tall and the small snakeroots. We are indebted to Kate F. Kurtz for specimens of the tops and rhizomes of both plants. A close examination, however, shows no difference except in development. The fresh rhizome of the tall plant is much larger and darker colored, and the roots coarser. We can only consider this plant a robust form.”

The name Macrotys is now so firmly established in Eclectic literature that it is not likely to be displaced, although in botanical works as well as in the Pharmacopeia the plant has become generally known as Cimicifuga racemosa.

Cimicifuga, (Macrotys), was highly valued by the Indians, who employed decoctions of the root for diseases of women, for debility, to promote perspiration, as a gargle for sore throat, and especially for treatment of rheumatism. These uses by the Indians introduced the drug to students of early “domestic” American medicine, and it was consequently given much attention by such early writers as Schopf, 1785, Barton, 1801, Peter Smith, 1812, Bigelow, 1822, Garden, 1823, Ewell, 1827, Rafinesque, 1828, and Tonga and Durand’s addition to Edwards’ and Vavasseur’s Materia Medica, 1829. None of the early writers added anything not already given by the Indians, so far as the field of action of the drug is concerned, excepting perhaps a statement by Howard, (Botanic), 1832, who was an enthusiast in favor of macrotys in the treatment of smallpox, a claim supported forty years after by Dr. G. H. Norris. In a paper read before the Alabama State Medical Association, 1872, he reported that during an epidemic of smallpox in Huntsville, Alabama, families using macrotys as a tea were absolutely free from smallpox, and that in these families vaccination had no effect whatever so long as the use of macrotys was continued. *2

In the early use of the drug, the infusion was employed, the following being Howard’s statement (1836) concerning it:

“Infuse a handful of the roots in a quart of boiling water, and take in doses of a common-sized teacup full, three or four times a day. We are constrained, however, to notice one circumstance connected with this subject; that the effect produced upon the system by a large dose of the tincture of the rattle-root, (which is sometimes used instead of the tea), in some instances is very alarming, though we have heard of no case in which any bad consequences have followed its use.”

It is interesting to note that Howard calls attention to the fact that the effect of the infusion is not marked by the alarming action of a large dose of the drug, as is the case with the tincture. The reason is evidently because the watery menstruum does not carry the energetic resinous compounds that are present in such large quantities in the alcoholic liquid. This indicates the watchful care of the early investigators of botanic drugs, and perhaps the error of the alcoholic substitutors. *3

Following the writers above mentioned came the Eclectic fathers, as well as the founders of the Pharmacopeia, and of the United States Dispensatory, all of whom gave to “Macrotys” its full value. Among these may be mentioned Beach, Dunglison, Wood, Griffith, Lee and King, to the last of whom (an ardent believer in macrotys) is unquestionably due the conspicuous position the drug has attained in Eclectic literature, as well, probably, as a large share of its popularity in other directions. Professor Dunglison, 1843, placed macrotys with the special sedatives, stating that “it unites with a tonic power, the property of stimulating secretions, particularly those of the skin, kidneys, and pulmonary mucous membrane.” He records its value in rheumatism, an ditalicizes the statement that “the more acute the disease, the more prompt and decided will be the action of the remedy.”

The Committee of the American Medical Association, 1848, Dr. N. S. Davis, Chairman, reported that the committee “uniformly found Macrotys to lessen the frequency and force of the pulse, to soothe pain and allay irritability.” In a word, they held it to be “the most purely sedative agent we possess, producing its impression chiefly on the nervous system of organic life.” (See Drugs and Medicines of North America ). (389).

*1 – The name “cohosh,” an Indian term of uncertain meaning, was given to four widely different American plants, namely, macrotys or “black cohosh,” Actaea alba or “white cohosh,” Actaea spicata or “red cohosh,” and Caulophyllum thalictroides, or “blue cohosh.”

*2 – This is of great interest and should be systematically verified.

*3 – In the opinion of the writer of these notes a pharmaceutical blunder has been made in the lavish use of alcohol in plant pharmacy.