Blue Cohosh

Overview
Blue cohosh is a plant native to North America that was used by the Native American women to help ease pain in menstruation and childbirth. Blue cohosh is mostly used today in combination with black cohosh or other herbs. With black cohosh it is thought to make a balanced antispasmodic (calms nervous and muscular spasms). With other herbs it may be used to treat anxiety, bronchitis, sore throat and urinary disorders. Blue cohosh is used for its uterine stimulatory action in inducing labor, but it must be used cautiously, as it also may constrict blood vessels, and be toxic to the myocardium. It is thought to have uterine tonic activity, and to be useful for instances where the uterus has loss of tone. It is also said to have an antispasmodic action that helps ease false labor pains or menstrual pains.
Comments
Blue cohosh may be dangerous if used by the general public, and is a good example of an herb that should be used only by qualified herbalists or midwives who have been trained traditionally to do so, as there is no clinical evidence to warrant or guide its use.
Scientific Support
A large-scale survey was conducted on the use of herbal preparations for cervical ripening, induction and augmentation of labor by 500 certified nurse-midwives (CNMs) and nurse-midwifery education programs. The herbal preparations used by the respondant CNMs for inducing labor were: 64% used blue cohosh, 45% used black cohosh, 63% used red raspberry leaf, 93% used castor oil, and 60% used evening primrose oil. None of the CNMs found out about these herbs through their formal education programs, whereas, 69% learned about them from other CNMs, and 4% through formal research publications (McFarlin et al., 1999).
Safety / Dosage
Blue cohosh is normally taken as an unstandardized herbal preparation. As a decoction, 1 teaspoon of the dried root in a cup of water can be boiled and simmered for 10 minutes, and drunk three times a day. As a tincture, it is recommended as 0.5-2 ml of the tincture three times daily. As an antispasodic, it is often combined with other herbs, such as scullcap and/or black cohosh. Blue cohosh should not be taken by people with high blood pressure. Do not take during prenancy or lactation unless under the care of a qualified health professional.
Blue cohosh has serious safety concerns, and should not be used by anyone who does not know the proper use. Blue cohosh contains compounds, such as callophyllosaponin, methylcytisin, and caulosaponin that may constrict coronary vessels (Jones and Lawson, 1998).
One case was reported of a woman who took blue cohosh to induce uterine contraction, and had a newborn with born with acute myocardial infarction associated with profound congestive heart failure and shock. Other causes of myocardial infarction were ruled out, and since blue cohosh contains vasoactive glycosides and one alkaloid that is known to have myocardium toxic effects, blue cohosh was indicated as the possible culprit. This is the first known reported case on toxic effects of blue cohosh on a newborn (Jones and Lawson, 1998).
In a case study of women with developed tachycardia, diaphoresis, abdominal pain, vomiting and muscle weakness after trying to induce abortion by blue coshosh, it was suspected that nicotinic toxicity form methylcytisine produced the symptoms (Rao and Hoffman, 2002).
References
1.Jones TK, Lawson BM.Profound neonatal congestive heart failure caused by maternal consumption of blue cohosh herbal medication. J Pediatr. 1998 Mar;132(3 Pt 1):550-2.
2.McFarlin BL, Gibson MH, O'Rear J, Harman P. A national survey of herbal preparation use by nurse-midwives for labor stimulation. Review of the literature and recommendations for practice. J Nurse Midwifery. 1999 May-Jun;44(3):205-16.
3.Rao RB, Hoffman RS. Nicotinic toxicity from tincture of blue cohosh (Caulophyllum thalictroides) used as an abortifacient. Vet Hum Toxicol. 2002 Aug;44(4):221-2.
EDITOR'S NOTE: This monograph can be found in The Health Professional's Guide to Dietary Supplements (Lippincott, Williams & Wilkins) by Shawn M. Talbott, PhD and Kerry Hughes, MS.