Cimicifuga. Cimicifuga racemosa.

Synonyms—Black Cohosh, Macrotys Racemosa.

CONSTITUENTS—

Macrotin, a resinoid volatile oil, tannic acid, gallic acid, gum, starch, fat, sugar.

PREPARATIONS—

Extractum Cimicifugae Fluidum, Fluid Extract of Cimicifuga. Dose, five to thirty minims.

Tinctura Cimicifugae, Tincture of Cimicifuga. Dose, one-half to one dram.

Specific Med. Macrotys. Dose, one-tenth to ten minims.

Macrotin or Cimicifugin, which possesses all the medicinal properties of the root, is a resinous powder of a dark-brown or yellowish color, a bitter, acrid taste, and slight odor. Dose, one-half to three grains.

Physiological Action—Cimicifuga in large doses produces general relaxation, dimness of vision, dizziness, tremors, slowing of the pulse, fall of arterial pressure, vomiting or gastric irritation; it stimulates expectoration and perspiration, causes intense headache and prostration. These phenomena are caused by the action of the drug on the vasomotor centers and the cardiac ganglia. The headache is chiefly frontal; in some persons the drug causes pain in the joints and limbs similar to rheumatism.

The agent is certainly an efficient nerve sedative, although its most pronounced action is on the unstriped muscles. It acts in very many cases where these muscles are involved, with general nervous irritation, in an immediate and positive manner. In such cases if the nerve irritation is dominant, its efficiency is greatly increased by combining it with gelsemium.

An overdose is promptly signalled by the appearance of the characteristic headache, which assumes a bursting, tearing character, with injected conjunctivae and flushed face. This will abate at once upon discontinuance of the agent.

Specific Symptomatology—Muscular aching, local and general, aching pains as from overworked, overstrained muscles, great muscular aching with chilliness and rapidly increasing temperature.

It is the agent for hysteria with flushed face and heat in the head, with restless and nervous excitement and general muscular aching.

Therapy—In the premonitory stage of acute fevers, or of acute inflammatory troubles of whatever character, a common symptom is a general tired feeling with aching of the muscles. In these cases there is usually a chill or chilliness, with more or less fever with the aching. One drop of the tincture of cimicifuga every hour will relieve this aching in from six to twelve hours. If given with aconite for the fever and belladonna for the rigors, the time may be reduced to three or four hours. When indicated, its influence upon the nervous system will probably abridge many of the other symptoms.

Through its influence upon the vasomotor centers and upon the nerve ganglia, it has a beneficial influence upon the heart. In rheumatic carditis or pericarditis it is a sovereign remedy acting directly in the line of its physiological influence. In neuralgia of the heart—angina pectoris and functional irregularity of the heart from exalted nerve influence, either alone or combined with gelsemium, it is prompt and reliable, and should be by no means neglected.

Prof. King advised this agent in coughs, and its value through its influence upon the nerve centers has been confirmed by many practitioners. It soothes the cough of excessive nerve irritation, and the reflex cough; the irritable cough of acute bronchitis is relieved by it, as it increases bronchial secretions to a notable extent.

A homeopathic writer says that in pleurisy, there are often strong indications for cimicifuga where it works in harmony with aconite and bryonia. This is our own experience.

It is given by many as a stomachic tonic, and it improves digestion by relieving excess of nerve influence over the functional operations of the digestive apparatus.

As a remedy for chorea it has become widely popular. Given in fifteendrop doses of the tincture four or five times daily, it is superior to any other known remedy. Its effects are permanent if the anemia and other concomitant conditions are correctly controlled by proper medication at the same time. Its sedative, tonic and antispasmodic influences are here fully exercised.

It may be combined with scutellaria lateriflora, with valerian or gelsemium, as the indications demand, with superb results. The writer has aired intractable cases by alternating it with minute doses of exalgine.

The characteristic aching pains above described are very constant in acute rheumatism and rheumatic fevers. Cimicifuga is certainly a royal remedy in these cases, and has become universally popular. If the condition be absolutely confined to the joint and does not involve muscular structure, it is not of as much value. The direct indications must be present.

The agent, however, has a specific influence in overcoming lithemia and in preventing and curing conditions resulting from an excess of uric acid conditions existing in the uric acid diathesis. It is therefore of value with auxiliary treatment in acute or subacute rheumatic arthritis with lithemia.

It will be found indicated in rheumatic neuralgia, in sciatica, in muscular rheumatism of the chest walls, in achings of the deep muscles of the back, in myalgia, in severe colds, in neuralgia from cold, in rheumatic headache, and in neuralgia of the ovaries; also with women in the intense muscular aching preceding the menses.

Cimicifuga operates directly upon the reproductive functions. In the female it is valuable as above indicated, in dysmenorrhea of a congestive character always, and in amenorrhea. In these cases aconite will aid its action greatly, if the condition be induced by sudden cold; and pulsatilla will do likewise if the conditions be caused by nervous shock or functional irregularity extending over a longer period. Helonias may be given with it, if there be weight and dragging in the lower abdominal region. If leucorrhea be present with the above indications, it is especially valuable. It is valuable to promote uterine contractions, and in subinvolution. In the aggravating rheumatic pains of parturition, or of the later stages of pregnancy, which deceive by closely simulating those of labor in some ladies of rheumatic diathesis, this is positive and prompt.

In hysterical conditions of the menstrual epoch, in hypochondriasis or melancholia at these times, with congestive dysmenorrhea with the above indications, it is specific. In puerperal hysteria with great nervous excitement and the above conditions, or with excitable mania or incipient puerperal insanity, it is a most efficient remedy, having a desirable sedative influence on the nerves of the womb.

The agent is excellent in relieving irregular pains and uterine distress occurring during the course of pregnancy. It may be given in small doses, and it thus prepares the patient for parturition and undoubtedly contributes largely to a short, easy and uncomplicated labor. The agent, either as the fluid extract, or from two to five grains of the resinoid, is a most efficient partus accelerator. It increases the expulsive pains in a regularly intermittent and normal manner, without spasmodic irritation. While the normal pains are increased, all erratic, rheumatic, irregular and nagging pains are relieved. It promotes uterine involution and hastens normal recovery.

Knox observed the action of this remedy as a partus preparator in a hundred and sixty cases. His observations, summed up, are that the remedy has a positive sedative influence upon the parturient women, quieting reflex irritability, nausea, pruritis and insomnia. It has a positive anti-spasmodic effect, correcting neuralgic cramps, and irregular pains of the first stage of labor, sometimes terminating the labor precipitately, if given in too large doses, often without prodomic symptoms.

It relieves undue irritation of the uterine muscular fiber, relaxes the soft parts of the parturient canal, and thus facilitates labor and diminishes the risks of laceration by controlling undue irritability of the muscular fiber.

It maintains a better contraction of the uterus after delivery, but for this purpose he administers a special dose of thirty minims of the fluid extract after the birth of the fetal head. It was his habit in using this remedy for its preparatory effects, to give fifteen minims, at the time of retiring each night, for six weeks prior to confinement.

In six cases where Dr. Coffin used this remedy for the above purpose, there was postpartum hemorrhage, and this caused the doctor to question whether or not the agent had such a relaxing influence, as he was not in the habit of giving either this or any other remedy to anticipate such hemorrhage. Others deny this influence. I have never observed it.

Webster claims to have observed a case of epilepsy, attended with amenorrhea which was kept under control with Cimicifuga in conjunction with the bromides, when the bromides alone had previously failed.

The elder Adolphus, treated ophthalmia with this remedy, especially when there was severe pain. He gave it in from two to five drop doses, every four hours, day and night. He claimed that in one severe epidemic it did not fail to cure. In the severe cases, he applied it externally, as well as administering it internally. In those cases where there was much nervous irritability, he combined it with gelsemium, which he was confident enhanced its influence.

The agent has been advised in the treatment of smallpox. One of the old writers claimed that he used it persistently through an entire epidemic, and the results caused him to entertain the highest confidence in this remedy. He believed he had aborted the disease in many cases, in forty-eight hours. If given with the appearance of the premonitory symptoms, the disease was so abridged, that no eruptions appeared. He usually gave it in the form of a decoction, in conjunction with equal parts of asclepias, and a small quantity of ginger. He gave enough of the remedy, to induce the physiological influence, such as aching in the muscles and pain in the head. The agent should have a further trial in this disease, as others have claimed to obtain results similar to those quoted above, and the influence of the remedy should be confirmed or disproved.

In the male it is valuable in gonorrhea, with aching, in the bladder and across the kidneys. We prescribe it oftener than any other agent in these cases. It soothes the nervous irritability and materially assists in relieving the active inflammation. We usually find indications for aconite in the acute cases, or gelsemium where there is irritation with a tendency to spasmodic stricture, or hydrangea where there are sharp, cutting pains in urination; and these properly combined have been our "sure cure" treatment for many years, with mild injections of zinc sulphate, hydrastine, or hydrogen peroxide, all warm, or of warm water alone. It is valuable also in orchitis with its own indications. In spermatorrhea with irritability and considerable sexual weakness and plethora, it will cure when other agents fail, if given in half-dram doses after meals.

The American Materia Medica, Therapeutics and Pharmacognosy, 1919, was written by Finley Ellingwood, M.D.
It was scanned by Michael Moore for the Southwest School of Botanical Medicine.