Black Cohosh - Non-Timber Forest Products

and 23–epi–26–deoxyactein (formerly classified as 27–deoxyactein)
(Bedir and Khan 2000; Chen and others 2002b; Linde 1964, 1967a, 1967b;
McKenna and others 2001; Newall and others 1996; Shao and others
2000; Upton 2002; Watanabe and others 2002; Wende and others 2001).
Commercially available black cohosh products such as Remifemin ® are
usually standardized to contain 1 mg of 23–epi–26–deoxyactein per tablet
(Tetherow 2001). Although it was once believed that black cohosh contained
phytoestrogens such as the flavonoid formononetin (Jarry and others 1985),
more recent studies have failed to find formononetin or significant levels of
other flavonoids in various commercially available products (Foster 1999,
Kennelly and others 2002, Liske 1998, Liske and Wüstenberg 1998, Struck
and others 1997). One study suggests that black cohosh roots do not contain
any isoflavones (Hagels and others 2000). Other active compounds have
been isolated, including aromatic acids such as ferulic acid, salicylic acid,
and caffeic acid (Hagels and others 2000, Kruse and others 1999, Li and
others 2003). Black cohosh roots also contain tannins, resins, fatty acids,
starch, and sugars (American Botanical Council 2002, Foster 1999, Newall
and others 1996, Upton 2002). Several clinical studies have evaluated the
methods used to analyze black cohosh preparations to determine the quality
and quantity of active constituents (Ganzera and others 2000, He and others
2000, Li and others 2003, Xu and others 2001). A recent study used DNA
fingerprinting to detect related plant species that can be misidentified and
contaminate black cohosh bulk material (Zerega and others 2002).
Clinical Research
Most of the initial clinical research on black cohosh focused on the safety
and efficacy of using it to treat menopausal symptoms. Early case studies
simply observed and reported on beneficial effects in patients (Brücker
1960, Langfritz 1962, Stefan 1959, Stiehler 1959). Later research used
various assessment scales such as the Kupperman Menopausal Index Scale
for neurovegetative symptoms (hot flashes, profuse sweating, headache,
vertigo, heart palpitation, and tinnitus) and the Profile of Mood States, Self-
Assessment Depression Scale, or Hamilton Anxiety Scale for psychological
complaints (nervousness, irritability, sleep disturbances, and depression).
Most studies demonstrated statistically significant improvements (Daiber
1983, Foldes 1959, Vorberg 1984). Comparisons between black cohosh,
hormone replacement therapy (HRT), and placebos determined black
cohosh to be a safe and effective alternative to HRT (Lehmann-Willenbrock
and Riedel 1988, Petho 1987, Stoll 1987, Stolze 1982, Warnecke 1985),
though one study showed no significant difference between black cohosh
and a placebo (Jacobson and others 2001).
7