Black Cohosh Research Articles

Estrogen receptor modulatory effects of germinated brown rice bioactives in the uterus of rats through the regulation of estrogen-induced genes

PurposeThe expression of genes regulated by estrogen in the uterus was studied in ovariectomized (OVX) rats treated with germinated brown rice (GBR) bioactives, and compared to Remifemin or estrogen at different doses to identify the regulation of these genes in the uterus and their molecular mechanisms.MethodsRats were treated orally with GBR bioactives (phenolics), acylated steryl glucosides (ASG), γ-amino butyric acid (GABA), and γ-oryzanol (ORZ) at 100 and 200 mg/kg, Remifemin (REM) at 10 mg/kg and 20 mg/kg, or estrogen (EST) at 0.2 mg/kg. Ribonucleic acid (RNA) was extracted from the uterus, and messenger (m)RNA expression of selected genes encoding estrogen receptor-beta (ER-β), calcium-binding protein (CaBP9k), complement protein (C3), heat shock protein 70 kDa (HSP70), and interleukin (IL)-4 receptor were quantified. Similarly, serum steroid hormone concentration was monitored at 2, 4, and 8 weeks after treatments. ER-β antibody binding to the uterus sections was also studied using immunohistochemistry.ResultsThe group treated with EST (0.2 mg/kg) upregulated ER-β, C3, and IL-4 receptor genes compared to other groups (P<0.001). GBR phenolics (200 mg/kg) treatment upregulated the ER-β gene almost to the level of the sham non-treated group. The CaBP9k gene showed upregulation in groups treated with ASG (200 mg/kg), EST (0.2 mg/kg), and ORZ (200 mg/kg) (P<0.05). Estrogen levels increased in groups treated with EST, ASG, and ORZ (200 mg/kg) compared to the OVX untreated group (P<0.05), and there was a slight non-significant decrease (P>0.05) in the progesterone levels in the OVX untreated group compared to the sham and other treated groups. There was a significant increase at 8 weeks in the level of FSH (P<0.05) in the treated groups compared to the OVX untreated group. There was no significant difference (P>0.05) in serum luteinizing hormone (LH) between the OVX untreated group and other groups. The sham and GBR phenolics treated group showed ER-β reactivity at the glandular epithelium, while the group treated with EST showed immunoreactivity at the glandular, luminal, and stromal epithelium.ConclusionGBR phenolics moderately regulate the expression of ER-β, HSP70, and IL-4 receptor genes, and gave a positive immunoreaction to ER-β antigen in the uterus. ASG regulates the expression of CaBP9k and IL-4 receptor genes, and ORZ regulates the expression of the CaBP9k gene, while GABA at 100 mg/kg regulates the expression of the HSP70 gene. GBR and its bioactives might have an effect on estrogen-regulated genes in the uterus of rats.

Efficacy of black cohosh (Cimicifuga racemosa L.) in treating early symptoms of menopause: a randomized clinical trial

BackgroundThis study aims to evaluate the efficacy of Black cohosh (Cimicifuga racemosa L.) in treating early menopausal symptoms.MethodsThis randomized, double-blind, placebo-controlled clinical trial was conducted on 84 early post-menopausal participants with Greene climacteric scale (GCS) scores of 15 to 42, who were referred to two public health care centers in Tehran, Iran, in 2011–2012. The participants were randomly allocated into treatment (6.5 mg of dried extract of Black cohosh roots daily) and control (placebo) groups with a ratio of 1:1. The participants took one tablet per day for 8 weeks. The GCS scores were recorded at baseline, and after 4 and 8 weeks of treatment. Data analysis was carried out using a general linear model with repeated measures with SPSS software. The level of significance was set at P < 0.05.ResultsThere was no loss to follow-up during the 8 weeks of treatment. The GCS total score (primary outcome) in the treatment group was significantly lower than that in the control group at both week 4 [adjusted mean difference: -7.8 (95% confidence interval: -11.1 to -4.4)] and week 8 [-12.9 (-16.2 to -9.3)]. The treatment group showed significantly more improvement than the control group in all GCS subscale scores (vasomotor, psychiatric, physical, and sexual symptoms; secondary outcomes). The differences between the treatment and control groups at week 8 were significantly higher (P < 0.001) than those at week 4 in terms of the total scores and the vasomotor and psychiatric subscale scores. No side effects were reported.ConclusionsBlack cohosh reduced the GCS total score and all GCS subscale scores (vasomotor, psychiatric, physical, and sexual symptoms) during 4 and 8 weeks of treatment.Clinical trial registrationThis study was approved (Code 9061) by the Ethics Committee of Tabriz University of Medical Sciences and registered at the Iranian Registry of Clinical Trials with IRCT201107186709N4 on 15 January 2012.

Black Cohosh (Cimicifuga Species) for Menopausal Symptoms

Black Cohosh (Cimicifuga Species) for Menopausal Symptoms

Expecting the Unexpected: Black Cohosh-induced Hepatotoxicity Leading to Early Cirrhosis

Purpose: Herbal supplements are commonly used by patients for various problems. It is a well-known fact that most patients do not tell their physicians regarding use of herbal supplements unless specifically asked. As a result, sometimes important points from drug side effects are missed in history taking. In this context, we present a rare case of Black Cohosh-induced hepatotoxicity leading to early cirrhosis. Case Description: A 44-year-old female with no PMH presented with complaints of painless jaundice for one month. She went to her PCP, where initial work-up revealed that she had elevated LFTs. She was noted to have normal LFTs on her prior lab works. Work-up for viral and autoimmune hepatitis was negative. She was given a trial of steroids on outpatient basis without much improvement. She was referred to inpatient evaluation because of gradual progression of her symptoms. She denied history of alcohol intake, IV drug use, unprotected sex, recent travel outside the U.S., NSAID ingestion or blood transfusions. She reported no abdominal pain, fever, chills, nausea vomiting or diarrhea. She did report generalized itching, arthralgia and fatigue. She interestingly reported that she started taking Black Cohosh for alleviation of her menstrual symptoms about one month back. Her exam was remarkable for marked scleral icterus and jaundiced skin. On admission, her LFT showed TBil =20, AST=420, ALT=215, AlkPhos=201, Platelets= 135, INR 1.2 and Albumin=2.4. Ultrasound abdomen showed nodular contour of liver consistent with cirrhosis. Further work-up ruled out Wilson's disease, Hemochromatosis, AMA negative PBC and autoimmune hepatitis. Liver biopsy was performed, which showed histologic pattern consistent with cholestasis, hepatocellular injury and early cirrhosis. Given patient's history of Black Cohosh use and the timing of her abnormal liver chemistries, it was clinically evident the culprit agent was Black Cohosh. Her symptoms improved, and her LFT's normalized after she stopped taking Black Cohosh. Discussion: Black Cohosh, also named as Cimicifuga racemosa, is among commonly used herbal supplements in the United States for menstrual symptoms. There are few case reports available in literature that attribute Black Cohosh to liver injury. In most instances, the liver injury ranges from jaundice, mild transaminasemia to rare cases of fulminant hepatic failure. Our case is unique, since it represents development of accelerated cirrhosis in our patient for a relatively short period of time. This case is to bring awareness amongst clinicians about this potentially unexpected outcome in the backdrop of much-expected drug induced hepatitis.

What botanicals are safe and effective for the estrogen deficiency symptoms of menopause?

Evidence-Based Answer Soy may reduce hot flash frequency (SOR: B, inconsistent RCTs). Red clover and black cohosh are not effective in treating vasomotor symptoms of estrogen deficiency (SOR: A, systematic review and RCTs). Safety has been shown with the use of some botanicals for up to 1 year (SOR: C, underpowered RCT).

Efficacy of black cohosh (Cimicifuga racemosa) medicines for treatment of menopausal symptoms – comments on major statements of the Cochrane Collaboration report 2012 “black cohosh (Cimicifuga spp.) for menopausal symptoms (review)”

Menopausal symptoms management with high-quality plant extracts from Actaea (Cimicifuga. racemosa rootstock is well-established. Efficacy and safety are supported by research and clinical trials since several decades and backed up by official monographs. However, the recent published Cochrane review on black cohosh neglects major evidence for beneficial effects. The authors’ negative conclusions are questionable and call for reply and clarification. Our careful reconsideration of all appropriate placebo-controlled clinical studies reveals a standardized mean difference of 0.385 in favor of black cohosh (p < 0.0001).

Herbal hepatotoxicity

Alternative explanations are common in suspected drug-induced liver injury (DILI) and account for up to 47.1% of analyzed cases. This raised the question of whether a similar frequency may prevail in cases of assumed herb-induced liver injury (HILI). We searched the Medline database for the following terms: herbs, herbal drugs, herbal dietary supplements, hepatotoxic herbs, herbal hepatotoxicity, and herb-induced liver injury. Additional terms specifically addressed single herbs and herbal products: black cohosh, Greater Celandine, green tea, Herbalife products, Hydroxycut, kava, and Pelargonium sidoides. We retrieved 23 published case series and regulatory assessments related to hepatotoxicity by herbs and herbal dietary supplements with alternative causes. The 23 publications comprised 573 cases of initially suspected HILI; alternative causes were evident in 278/573 cases (48.5%). Among them were hepatitis by various viruses (9.7%), autoimmune diseases (10.4%), nonalcoholic and alcoholic liver diseases (5.4%), liver injury by comedication (DILI and other HILI) (43.9%), and liver involvement in infectious diseases (4.7%). Biliary and pancreatic diseases were frequent alternative diagnoses (11.5%), raising therapeutic problems if specific treatment is withheld; pre-existing liver diseases including cirrhosis (9.7%) were additional confounding variables. Other diagnoses were rare, but possibly relevant for the individual patient. In 573 cases of initially assumed HILI, 48.5% showed alternative causes unrelated to the initially incriminated herb, herbal drug, or herbal dietary supplement, calling for thorough clinical evaluations and appropriate causality assessments in future cases of suspected HILI.

The value of complementary and alternative medicine in the treatment of climacteric symptoms: Results of a survey among German gynecologists

The present study aims to detect the attitude and experience towards complementary and alternative medicine (CAM) in the treatment of climacteric disorders among gynecologists in Germany. A self-administered questionnaire, containing 15 questions, was sent to all gynecologists in private practice in Germany (n=9589). Gynecologists were asked about their experience with several forms of CAM. They were asked to rate different procedures as "effective", "sometimes effective" or "unimportant". The response rate was 33.7% (n=3227). We report on 2549 (26.6%) eligible questionnaires. Well-known therapies were black cohosh (Cimicifuga racemosa), chaste tree (Vitex agnus castus) and St. John's wort. More than 98% had had experiences with these therapies. Fewer experiences were stated with hormone-yoga (42.9%), acupuncture (29.1%) and homeopathy (21.6%). The most effective alternative therapy rated was an alteration of lifestyle with 54.4% (n=1325) stating it was effective and 35.7% (n=871) stating it was sometimes effective. Only 3.9% (n=96) prescribed no efficacy to a change of lifestyle. Other treatments rated as effective were St. John's wort (25.0%, n=606) and Black cohosh (21.1%, n=527). Agents regarded most ineffective were hormone-yoga (4.7%, n=109), acupuncture (10.3%, n=243) and homeopathy (10.6%, n=250). Female gynecologists were more likely to vote for a therapy to be effective compared to their male colleagues. German gynecologists seem to have made positive experiences with CAM when observing their patients, in general. An alteration of lifestyle is seen as the most effective alternative therapy in menopause. Due to their widespread use, possible side effect of natural agents should be excluded.

Attenuation of nucleoside and anti-cancer nucleoside analog drug uptake in prostate cancer cells by Cimicifuga racemosa extract BNO-1055

This study aimed to investigate the mechanisms underlying the anti-proliferative effects of the ethanolic Cimicifuga racemosa extract BNO-1055 on prostate cells and evaluate its therapeutic potential. BNO-1055 dose-dependently attenuated cellular uptake and incorporation of thymidine and BrdU and significantly inhibited cell growth after long-time exposure. Similar results were obtained using saponin-enriched sub-fractions of BNO-1055. These inhibitory effects of BNO-1055 could be mimicked using pharmacological inhibitors and isoform-specific siRNAs targeting the equilibrative nucleoside transporters ENT1 and ENT2. Moreover, BNO-1055 attenuated the uptake of clinically relevant nucleoside analogs, e.g. the anti-cancer drugs gemcitabine and fludarabine. Consistent with inhibition of the salvage nucleoside uptake pathway BNO-1055 potentiated the cytotoxicity of the de novo nucleotide synthesis inhibitor 5-FU without significantly altering its uptake. Collectively, these data show for the first time that the anti-proliferative effects of BNO-1055 result from hindered nucleoside uptake due to impaired ENT activity and demonstrate the potential therapeutic use of BNO-1055 for modulation of nucleoside transport.

PCR-based authentication of commercial black cohosh products - implications for reported hepatotoxicity

Black cohosh (BC) (Actaea racemosa), is a popular herbal remedy to treat side effects of the menopause. In 2011 US sales were over $10,000,000 and it ranked at number eight amongst the most popular herbs. However, its credibility is being damaged by links to reported cases of hepatotoxicity, although investigation of these reports has not been able to confirm that BC plant material is responsible. This has raised the suspicion that some cases of adverse reactions may result from substitution or adulteration with Asian Actaea species, rather than to A. racemosa. This demonstrates the need for correct identification of A. racemosa in BC products, and the exploration into potential hepatotoxicity of these different Actaea species.

Actein induces calcium release in human breast cancer cells

BackgroundThe triterpene glycoside actein from the herb black cohosh preferentially inhibits the growth of breast cancer cells and activates the ER stress response. The ER IP3 receptor and Na,K-ATPase form a signaling microdomain. Since actein is lipophilic, its action may be limited by bioavailability. PurposeTo develop actein to prevent and treat cancer, we examined the primary targets and combinations with chemotherapy agents, as well as the ability of nanoparticles to enhance the activity. Materials and methodsTo reveal signaling pathways, we treated human breast and colon cancer, as well as 293T and 293T (NF-κB), cells with actein, and measured effects using the MTT, luciferase promoter, Western blot and histology assays. To assess effects on calcium release, we preloaded cells with the calcium sensitive dye Fura-2. To enhance bioavailability, we conjugated actein to nanoparticle liposomes. ResultsActein strongly inhibited the growth of human breast cancer cells and induced a dose dependent release of calcium into the cytoplasm. The ER IP3 receptor antagonist heparin blocked this release, indicating that the receptor is required for activity. Heparin partially blocked the growth inhibitory effect, while the MEK inhibitor U0126 enhanced it. Consistent with this, actein synergized with the ER mobilizer thapsigargin. Further, actein preferentially inhibited the growth of 293T (NF-κB) cells. Nanoparticle liposomes increased the growth inhibitory activity of actein. ConclusionsActein alters the activity of the ER IP3 receptor and Na,K-ATPase, induces calcium release and modulates the NF-κB and MEK pathways and may be worthwhile to explore to prevent and treat breast cancer.

Effects of black cohosh on the plasminogen activator system in vascular smooth muscle cells

ObjectiveThe rhizome of the Cimicifuga racemosa plant (commonly known as black cohosh) has been used for menopausal complaints. Studies regarding the cardiovascular effects of black cohosh are lacking. We investigated the effect of black cohosh on the plasminogen activator system in cultured vascular smooth muscle cells (VSMCs). MethodsVSMCs were isolated from rat aortae. Expression of plasminogen activator inhibitor type 1 (PAI-1) and tissue-type plasminogen activator (t-PA) proteins were evaluated by Western blot analysis and enzyme-linked immunosorbent assay, respectively. The activities of PAI-1 and t-PA in the conditioned media were assessed by fibrin overlay zymography. A 40% 2-propanol extract of black cohosh was used. ResultsBlack cohosh extract (BcEx) stimulated the protein expression of PAI-1, but it did not affect that of t-PA. Vitamin E, a potent antioxidant, inhibited the BcEx-induced increase in PAI-1 expression, while ICI 182,780, an estrogen receptor antagonist, had no effect. Fibrin overlay zymography revealed that BcEx increased the activity of PAI-1 in the conditioned media, while concurrently decreasing that of free t-PA by inducing a binding to PAI-1. ConclusionsBcEx induces PAI-1 protein expression in the VSMCs likely via an oxidant mechanism. It also stimulates the enzyme activity of PAI-1 and reduces that of free t-PA. These findings suggest that black cohosh might exert a negative influence on fibrinolysis.

ENDOTHELIAL PROTECTIVE EFFECTS OF KLYMADINON IN EXPERIMENTAL OVARIECTOMY

A Endothelial protective and antithrombogenic effects of Cimicifuga racemosa standardized extract (Klimadynon, Bionorica, Germany) in comparison with ethinylestradiol in experimental ovariectomy were investigated. Extract of Cimicifuga racemosa (klimadynon) contents phytoestrogens, that was the basis for studying of its effects in hypoestrogenic conditions for the purpose of prophylaxis and treatment of cardiovascular complications in climacteric syndrome as an alternatively of hormonal replacement therapy.The course administration of klimadynon (100 mg/kg p.o. daily during 14 days) decelerated the formation of intravascular thrombosis which was initiated by application of 10% FeCb solution on carotid artery. The ethinylestradiol in this conditions intensified prothrombogenic effect of application of 10% FeCh: blood flow in carotid artery stoped to 5 minutes of experiment and mass of the thrombus was on 28% more, than in control rats. For studying of possible mechanisms antithrombogenic action of klimadynon antiplatelet and vasodilator activity of endothelium were studied in rats after bilateral ovariectomy in comparison with effects of ethinylestradiol (25 µg/kg p.o. daily during 14 days). Treatment with klimadynon as well as ethinylestradiol increased the antiplatelet activity of endothelium, restoring its activity to level in sham-operated animals. The endothelium-dependent and endothelium-independence vasodilation by using of acetylcholine (5 µg/kg) and of sodium nitroprusside (30 µg/kg). respectively, were investigated. Coefficient of endothelium dysfunctions (CED) was estimated as ratio: area over curve of arterial pressure after sodium nitroprusside intravenous injection to value of this index after injection of acetylcholine. In rats after bilateral ovariectomy CED was increased by 66% in comparison with CED value in sharm-operated rats. The klimadynon and ethinylestradiol treatment decreased CED on 42% and 28% correspondingly in comparison with values of control group.In summary klimadynon has antytrombogenic and endothelial protective activities in the rats after ovariectomy. The ethinylestradiol decreases endothelial disfunction in ovariectomized rats, but unlike klimadynon demonstrates protrombogenic effect. The present findings suggest that klimadynon could be used as a therapeutic agent for menopausal vascular complication.

Plant derived alternatives for hormone replacement therapy (HRT).

Abstract Hormone replacement therapy (HRT) has undisputable positive effects on climacteric complaints, in the bone and on body weight but also several undesired side effects. Therefore, plant-derived alternatives are currently promoted. Phytoestrogens - primarily the isoflavones genistein, daidzein and coumestrol, stemming from soy (Glycine max) or red clover (Trifolium pratense) - were suggested to have the desired but not the undesired effects of estrogens. Most recently published placebo-controlled studies question the beneficial effects. When taken at the time of puberty however, phytoestrogens appear to protect against mammary cancer later in life. Extracts from the rhizome of Cimicifuga racemosa (black cohosh) have no estrogenic effects. In a narrow dose range they have beneficial effects on climacteric complaints, which are due to several compounds with dopaminergic, noradrenergic, serotoninergic and GABAergic actions that act together in the hypothalamus. Ecdysone is produced by several plants, including spinach (Spinacia oleracea) and was very early on shown to increase muscle mass. Later it became apparent that spinach extracts containing ecdysone decreased body fat load, thereby reducing secretion of proinflammatory cytokines by visceral adipocytes and oxidative stress. This had beneficial effects on body weight and serum lipids not only in obese postmenopausal but also in premenopausal women and in men. For the above-described plant extracts, solid placebo-controlled clinical trials are available. For other plant extracts claiming beneficial effects on climacteric complaints or postmenopausal diseases, no solid data are available.

Cimicifuga racemosa for treatment of menopausal symptoms in patients with early endometrial cancer after operation

Objective To evaluate the efficacy and safety of black cohosh(cimicifuga racemaosa,Remifemin) for treatment of menopausal symptoms in patients with early endometrial cancer after operation.Methods Sixty patients with early endometrial cancer,who suffered menopausal symptoms after operation,were evenly divided into experimental group and control group.Patients in the experimental group took Remifemin tablet(20 mg) twice a day for 24 weeks.Patients in the control group took no drugs.All the patients were followed up for 12 months.The Kupperman menopause index(KMI),bone mineral density(BMD),cancer recurrence rate,death rate,and hepatic and renal functions were compared between the two groups.Results The KMI score of the experimental group was significantly decreased 24 weeks after treatment with Remifemin(9±4 vs 26±7,P0.05),and that in the control group was not significantly changed(21±5 vs 25±8,P0.05).The BMD in the experimental group was significantly increased 24 h after treatment with Remifemin([0.891±0.21] g/cm2 vs [0.790±0.17] g/cm2,P0.05);and there was no significant difference in the control group([0.816±0.15] g/cm2 vs [0.808±0.19] g/cm2,P0.05).No adverse effects were observed in the experimental group.During 1-year follow-up,one patient died in the experimental group;one had recurrence and one died in the control group.Conclusion Black cohosh can improve the menopausal symptoms in patients with early endometrial cancer after operation,without increasing the risk of tumor recurrence.

Effect of black cohosh (cimicifuga racemosa) on vasomotor symptoms in postmenopausal women: a randomized clinical trial.

Hot flash is considered to be an early and common symptom of menopause. The present study aimed to determine the impact of black cohosh (Cimicifuga racemosa) on vasomotor symptoms in postmenopausal women. This was a randomized, double-blind, placebo-controlled clinical trial. This study was performed on 84 postmenopausal women. The participants were randomly divided into control and intervention groups. The participants of the intervention group received one black cohosh tablet per day and the control group received one placebo tablet per day for eight weeks. The severity of vasomotor symptoms and number of hot flashes were recorded during the pre-intervention phase, and 4 and 8 weeks after the intervention. The data were analyzed using repeated measures ANOVA and ANCOVA tests. The level of significance was considered lower than 0.05. There was a significant difference between the two groups in terms of severity and number of hot flashes in weeks 4 and 8 by controlling the intensity of vasomotor symptoms and number of hot flashes before the intervention. Moreover, using repeated measures ANOVA, the intergroup comparison indicated a significant difference in bothgroups (the test and control groups) in terms of severity of vasomotor symptoms and number of hot flashes. According to the findings of the study, it seems that black cohosh can be used as an effective alternative medicine in relieving menopausal vasomotor symptoms.

A pilot chemoprevention study of isopropanolic black cohosh extract in women with ductal carcinoma in situ.

TPS1609 Background: Recent evidence suggests that black cohosh (Cimicifuga racemosa) may be a potential agent for breast cancer prevention. The active ingredients in black cohosh preparations appear to be triterpene glycosides. Recent preclinical data suggest several mechanisms by which triterpenes may prevent and treat breast cancer, including anti-proliferative, pro-apoptotic, anti-estrogenic, and anti-inflammatory effects. Epidemiologic data demonstrate a significant protective effect of black cohosh against the development of breast cancer in healthy women, and prolonged disease-free survival in breast cancer patients. There is also abundant evidence demonstrating the safety and tolerability of black cohosh in several clinical trials studying its use for treatment of hot flashes. We hypothesize that efficacy of black cohosh can be demonstrated in a pilot pre-operative window trial in a cohort of women with ductal carcinoma in situ (DCIS). Methods: In this trial, we treat women with a 2-5 week pre-operative course of commercial standardized isopropanolic black cohosh extract (20 mg orally twice per day). We aim to demonstrate a reduction in breast epithelial cell proliferation as measured by Ki-67 staining in regions of DCIS using traditional IHC staining and AQUA analysis. We also assess safety and tolerability of black cohosh through monitoring of patient adherence, liver function tests and serum hormone levels. 22 patients will be enrolled onto the trial. Sample size is based on power calculations for the specific study aim of determining the mean change in the levels of Ki67, using a targeted effect size. Assuming a 10% drop-out rate, a sample size of 20 patients will achieve 91% power to detect a 0.8 standard deviation of difference with a two-sided significance level at 0.05 using Wilcoxon signed-rank test. Eligible subjects are pre- and post-menopausal women ≥ 18 years of age newly diagnosed with DCIS histologically confirmed on breast core biopsy, prior to definitive excision. Women who have recently taken any agent known to affect Ki67 levels in the breast (e.g. hormone therapy) are excluded. Enrollment is currently ongoing with 10 of 22 patients accrued. Clinical trial registry number NCT01628536. Clinical trial information: NCT01628536.

Acupuncture and Migraine Prophylaxis, Probiotics and C. Difficile-Associated Diarrhea, Preventive Group Counseling and Postpartum Depression, Black Cohosh and Menopausal Symptoms, Deep Needling Electroacupuncture and Trigeminal Neuralgia

Acupuncture and Migraine Prophylaxis, Probiotics and C. Difficile-Associated Diarrhea, Preventive Group Counseling and Postpartum Depression, Black Cohosh and Menopausal Symptoms, Deep Needling Electroacupuncture and Trigeminal Neuralgia

Immunomodulatory effects of black cohosh (Actaea racemosa) extract in female B6C3F1/N mice

Black cohosh extracts (BCE; Actaea racemosa) are being used worldwide as an alternative to hormone replacement therapy for the management of menstrual and menopausal symptoms, yet the effects of BCE on the immune system are largely unknown. Female B6C3F1/N mice were treated daily with BCE (0, 62.5, 125, 250, 500, or 1000mg/kg) for 28 days by oral gavage. Liver weights were significantly increased (26–32%) at the 1000mg/kg dose. Dose-related increases in mean corpuscular volume and mean corpuscular hemoglobin were observed. Decreasing trends were observed in all thymic T cell populations, with the most notable dose-responsive effects on immature thymocytes. In the spleen, dose-related decreases were observed in all cell phenotypes evaluated, reaching the level of statistical significance at the 1000mg/kg BCE dose. Splenic natural killer (NK) cell numbers were significantly decreased at all BCE doses, with the exception of absolute NK numbers at the 125mg/kg dose. No effects were observed on T-dependent antibody responses of the humoral immune system, including the antibody-forming cell response to sheep erythrocytes (sRBC) and IgM antibody levels to both sRBC and keyhole limpet hemocyanin. Cytotoxic T cell (TCTL) activity was increased, as was the mixed leukocyte response in one of two studies. Anti-CD3 mediated proliferation and the delayed-type hypersensitivity response were unaffected. No effects were observed on innate immunity or on bone marrow cellularity and colony-forming units. Overall, BCE exposure in B6C3F1/N mice for 28 days at doses up to 1000mg/kg had minimal immune effects, with the exception of an increased TCTL response.

The effect of a Cimicifuga racemosa extracts Ze 450 in the treatment of climacteric complaints – an observational study

BackgroundRoot extracts of Cimicifuga racemosa (L.) Nutt. have been successfully used in the treatment of climacteric complaints. MethodIn this observational study, Cimicifuga racemosa (CR) extract Ze 450 was studied in 442 unselected ambulatory female outpatients with menopausal complaints under daily practice conditions.Physicians were suggested to treat patients for the first 3 months with 13mg/d CR (high dose, HD) and to continue over additional 6 months either with this treatment or to switch to 6.5mg/d CR (low dose, LD). The choice of treatment and its dose, however, was fully at the discretion of the physician. ResultsAfter 3-months treatment with HD, symptom severity (Kupperman Menopause Index, KMI) decreased significantly (p<0.001) from baseline values. Continuation of treatment with HD or LD decreased total KMI and its sub-item scores further (HD, LD: p<0.001). However, more patients (84.9%) responded to HD than to LD (78.4%) and showed an improvement of symptoms (p=0.011). ConclusionThis observational study demonstrated that treatment with CR in unselected patients with climacteric complaints under the conditions of daily practice resulted in a significant improvement of menopausal symptoms assessed by the total KMI score and its sub-item scores with an effect size similar to that in a previous randomized, controlled clinical trial.