Cimicifuga, also known as bugbane or cohosh, is an important Chinese herb in the treatment of prolapse of uterus and anus. Its medicinal part is its rhizome and root, which is called Sheng Ma in Pinyin. The reason for this name is twofold: its leaf looks like hemp leaf, plus it is of ascending medicinal properties. This commonly used herb was first found as a top-grade drug in “Shen Nong’s Herbal Classic”. But as for who is the greatest master of cimicifuga in TCM history, undoubtedly Li Dongyuan is second to none. In his famous work of Pi Wei Lun (Treatise on the Spleen and Stomach), the astragalus-cohosh based recipes account for almost half of all prescriptions. More importantly, this combination plays a different and critical role in different formulas respectively.
What is cimicifuga?
When used as medicine, it mainly refers to the dried rhizomes of Cimicifuga heracleifolia Kom., Cimicifuga dahurica (Turcz.) Maxim., or Cimicifuga Foetida L. All of them are plants in the family Ranunculaceae. Therefore, they are sometimes referred to as Cohosh Rhizome, Bugbane Rhizome, Rhizoma Cimicifugae, Cimicifuga Rhizome, and more. But don’t confuse them with black Cohosh since all of them share the name cimicifuga, bugbane, and cohosh. Although black Cohosh is from the same Genus, it refers to another different species called Cimicifuga Cordifolia or Cimicifuga Racemosa. In China it is mainly produced in provinces of Liaoning, Jilin, Heilongjiang, Hebei, Shanxi, Shaanxi, Sichuan, and Qinghai. It is usually dug up in autumn. And next it still needs to remove soil, dry in the sun until the fibrous roots are dry, burn out or remove the fibrous roots, and then dry thoroughly in the sun again. It is used sliced and raw.
Cimicifuga Foetida is a perennial herb. Rhizome is in the shape of irregular blocks and with hole-shaped stem scar and many long fibrous roots. Erect stems are branched, 1 to 2 meters high, and sparsely pubescent. Compound leaves are biternate or triternate pinnately and with densely pubescent petiole; small leaf blade is ovate or lanceolate, 2 to 4cm long, 1 to 2.5cm wide, and with serrated edge, green pubescent upper surface, and gray-green pubescent lower surface. Compound raceme is axillary or acrogenous, narrow or sometimes in the shape of expanded panicles; flowers are bisexual; sepals are 5, ovate, imbricate, 3-veined, white, and with eyelashes; staminodes are 2 and with white 2-lobed apex; stamens are many and with filaments of varying lengths; carpels are 2 to 5, covered with glandular hairs, and with many ovules. Follicles are in the shape of long oblong, slightly flat, and with apex with short slightly bent persistent style on the front end. Seeds are 6 to 8. Flowering time is from July to August and fruiting time is in September. Habitats include forests and grass at hillside.
The rhizome of Cimicifuga Dahurica contains ferulic acid, isoferulic acid, caffeic acid, cimifugin, visnagin, norvisnagin, visamminol, cimicilen, 12-hydroxycimigenol arabinoside, β-sitosterol, cimigenol, cimigenyl xyloside, dahurinol, cimigenyl xyloside, 24-acetylhydroshengmanol xyloside, and so on.
Because of its weak ability of diaphoresis, it is seldom used for relieving superficies syndrome. But since it can promote the eruption, it is often combined with Ge Gen (Kudzu Root) to treat inadequate eruption of measles. Thanks to its effect of heat-clearing and detoxifying, clinically it is generally matched with Shi Gao (Gypsum) and Huang Lian (Coptis Root) to cure gum infection, mouth sores and sore throat that are caused by hyperactivity of stomach fire; it is often used along with Jin Yin Hua (Honeysuckle Flower), Lian Qiao (Forsythia), Chi Shao (Red Peonies), and Dang Gui (Dong Quai) to heal high fever, rash, and skin and external diseases. What’s more, it can invigorate splenic yang, which resembles Chai Hu (Bupleurum). Hence, these two herbs often appear in pair in combination of Dang Shen (Codonopsis) and Huang Qi (Astragalus Root) to raise the sagging Yang Qi. From the perspective of western medicine, it is used for the treatment of postpartum urinary retention, Belladonna poisoning, paranasal sinusitis, polymyositis, systemic lupus erythematosus, infantile autumn diarrhea, hemorrhoids, Parkinson’s syndrome, purulent infection, erythema multiforme exudativum, neurodermatitis, hot flashes, menopause, and bleeding from different orifices (nose, mouth, eyes, ears).
Modern pharmacological actions of cohosh
1) It has moderate antibacterial effect on Mycobacterium tuberculosis, Staphylococcus aureus and catarrhal cocci;
2) Cohosh extract has antipyretic, anti-inflammatory, analgesic, and anticonvulsant effects. In addition, it can elevate white blood cell count and inhibit platelet aggregation and release;
3) It has a certain extent inhibition on intestinal spasms induced by acetylcholine, histamine or barium chloride;
4) It can inhibit the heart, slow heart rate, lower blood pressure, and inhibit intestine and uterus spasms;
5) Its crude drugs and charcoal drugs can shorten the clotting time.
Sample bugbane recipes on herbal remedies
The Chinese Materia Medica concludes that it is acrid and sweet in flavor and slightly cold in nature. It goes to meridians of lung, spleen, large intestine, and stomach. Regular functions are clearing away heat and toxic materials, promoting the eruption of measles by inducing perspiration, and raising Yang and prolapse. Main cimicifuga uses and indications include seasonal epidemic, fire toxin, mouth sores, sore throat, rash, headache, chills and fever, carbuncles and boils, collapse of middle Qi, diarrhea due to spleen deficiency, tenesmus caused by chronic dysentery, abnormal vaginal discharge in women, and metrorrhagia. Recommended dosage for Yang-ascending purpose is from 3 to 6 grams and processed with honey and wine is required; recommended cimicifuga dosage for heat-clearing and detoxicating purpose is 15 grams and raw form is ideal. And other forms like powder, compound tablets, and pills are also available.
1) Shi Shen Tang from Tai Ping Hui Min He Ji Ju Fang (Formulas of the Peaceful Benevolent Dispensary). It is combined with Ma Huang (Ephedra), Zi Su Ye (Perilla Leaf), Bai Zhi (Angelica Dahurica), Chuan Xiong (Sichuan Lovage Root), etc. to treat wind-cold cold that is with chills and fever, no sweat, headache, and cough.
2) Qing Zhen Tang from Zheng Yin Mai Zhi (Pathoconditions: Causes, Pulses, and Treatments). It is formulated with Cang Zhu (Atractylodes), Kudzu Root, Xian He Ye (Fresh Lotus Leaf), etc. to cure Yangming headache, forehead ache, vomiting, vexation, and distention and fullness.
3) Sheng Ma Ge Gen Tang from Yan Shi Xiao Er Fang Lun (Yan’s Prescriptions for Infantile Diseases). It is coupled with Kudzu Root, Bai Shao (White Peony Root), Gan Cao (Licorice Root), etc. to heal the inadequate eruption or beginning of measles.
4) Xuan Du Fa Biao Tang from Dou Zhen Ren Duan Lu Dou Zhen. It is equipped with Kudzu Root, Bo He (Mint Herb), Niu Bang Zi (Burdock), Jing Jie (Schizonepeta), etc. to treat the retrocession of the eruption of measles accompanied with no sweat, fever, cough, sore throat, thirst, and dark urine.
5) Qing Wei San from Lan Shi Mi Cang (Secret Library of the Orchid Room). It works with Gypsum, Coptis, etc. to cure swollen painful gums and mouth sores.
6) Pu Ji Xiao Du Yin from Dong Yuan Shi Xiao Fang (Effective Formulas of Li Dong-Yuan). It joins with Huang Qin (Scutellaria Baicalensis), Coptis, Xuan Shen (Scrophularia), Ban Lan Gen (Isatis Root), etc. to heal fever with a swollen head, accompanied with head and face swelling and sore throat.
7) Sheng Ma Huang Lian Tang from Wai Ke Shu Yao (Pivotal Essentials of External Medicine). It cooperates with Coptis, Forsythia, Burdock, etc. to treat mumps.
8) Bu Zhong Yi Qi Tang from Pi Wei Lun (Treatise on the Spleen and Stomach). It is used along with Astragalus, Ren Shen (Ginseng), Bupleurum, etc. to heal heavy bloated abdomen, reduced appetite, fatigue, rectal prolapse caused by chronic diarrhea, uterine prolapse, nephroptosis, and more.
Cimicifuga side effects and contraindications
Cimicifuga rhizome is widely used to treat a variety of diseases. But overdose could lead to some side effects, including headache, tremors, tonic contraction of limbs, and priapism. Cimicifugadine has no special pharmacological effect but it can result in congested skin and even form ulcers. Oral administration of cohosh may lead to gastroenteritis or breathing difficulties and delirium in severe cases. And the oral mice and rat LD50 for isoferulic acid are 8.1g/kg and 7.9g/kg respectively. TCM wise, it shouldn’t be used in the cases of fully erupted measles, hyperactivity of fire due to yin deficiency, and yin deficiency and yang hyperactivity.