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Cimicifuga racemosa is one of the most important of all the indigenous remedies. Its range of action is quite extensive; it has been quite thoroughly proven; the clinical experience with it is already large; and it has great possibilities for future development.
Sphere of Action.—It is essentially a cerebro-spinal remedy. The brain and spinal cord are directly under its influence, upon which it acts primarily as a depressing irritant. Its action on the muscular system is probably not direct, but a result of its effect upon the spinal cord. It differs from nux and ignatia in that they are exciting irritants of the spinal cord. Cimicifuga indirectly affects the vegetative system-the functions of digestion and assimilation. It has but few symptoms of gastric or intestinal derangement not due to reflex irritation.
It has become one of our most potent remedies in disorders of the mental sphere, namely in melancholy and aberration of mind. The characteristic symptoms indicating its use are: "Great melancholy; the patient feels grieved, troubled with sighing; sensation as if a heavy black cloud had settled all over her, and enveloped her head; as that all was darkness and confusion, while at the same time it weighed like lead upon her heart. She was suspicious of everything and everybody; would not take medicine if she knew it; indifferent, taciturn; takes no interest in household matters; frequently sighs and ejaculates; great apprehensiveness and sleeplessness."
These symptoms are always promptly removed by cimicifuga. I have treated many cases of profound melancholy, even from disordered liver, with this medicine, and can truthfully assert that it has cured the majority, and even when the disorder of the mind depended on incurable physical disease, its palliative effect was remarkable. One keynote to be remembered is sleeplessness. Many physicians have informed me that if, in cases of melancholy, sleeplessness was present, cimicifuga nearly always cured.
In delirium tremens cimicifuga is indispensable. When there is nausea, retching, dilated pupils, heavy, pressing out headache, trembling of the limbs, incessant talking, changing from one subject to another, obstinate sleeplessness, imagines strange objects on the bed, with quick hard pulse, and a peculiar wild look in the eyes, the third dilution frequently repeated, aided by a good diet of milk, wine, whey, mutton broth, etc., will soon restore the patient.
A lady patient of mine who was taking five drops of the first dilution for rheumatism, was annoyed by an allusion of a mouse running from under her chair. This illusion disappeared upon suspending the medicine, and recurred when taking the same doses.
The nerves of sensation are very unfavorably affected by massive doses. it causes a pure neuralgia, and what the older authors called neuralgic rheumatism. The neuralgia is not confined to any particular set of nerves, as is the case with some remedies. Its depressing irritant action seems to be universal. The pains are aching, pressing, remitting, and are attended with great restlessness, and a weak exhausted feeling. It seems to affect the sensory nerves of the left side most. The nerves of motion are profoundly irritated. In the words of Dr. T. C. Miller) whose experience with it for fifteen years enabled him to judge of its powers: "It is one of the most remarkable remedies in all diseases of the ganglio-spinal system, particularly when the motor side is excited, and yet in the whole prevails atony in the muscular and nervous system."
This statement of its pathological action gives us the clue to its wonderful efficacy in chorea. It is indicated in many kinds of chorea, whether arising from rheumatic irritation of the cord, from uterine disease, or from purely psychical causes. The symptomatic indications are chiefly abnormal movements, uncontrolled by the will, in all those parts of the body supplied by motor nerves which affect both voluntary and involuntary muscles. The motions consist of twitching, jerking, twisting actions. They are sometimes attended by pains like neuralgia or rheumatism. The movements abate or are absent during sleep. They are aggravated by emotions, at the menstrual periods, or are caused by suppressed menses. They are attended by depression of spirits and sleeplessness,. and often by mental derangement.
Cimicifuga is useful in many kinds of tremors which resemble St. Vitus' dance, but due to functional' derangement of the nerve centers. If they are caused by structural changes this remedy is useless, or if they are caused by mercurial or other mineral poisoning. I do not think cimicifuga will be found very useful in convulsions of any kind, unless they resemble chorea; consequently it will not be available in ordinary puerperal convulsions or epilepsy. It bids fair to become a prominent remedy in cerebro-spinal meninitis and possibly myelitis.
Cimicifuga, in the lower dilutions, is indicated in the three grades of cerebro-spinal diseases, namely: cerebro-spinal meningitis; cerebro-spinal congestion; cerebro-spinal irritation. The following are the indications for its selection: delirium, like mania-a-potu, with nausea, retching, dilated pupils, tremor of the limbs, quick full pulse, and wild look out of the eyes.—Headache, pain over the eyes, extending along the base of the brain into the occiput.—Brain feels too large for the cranium, a pressing from within outwards, or a sense of compression in the temples.—Excruciating pain in the forehead and in the eyeballs, vertex, nape of the neck, and occiput, with fullness and throbbing, as if the top of the head would fly off.—Dull pains in the occiput, with shooting pains down the back; the head is jerked backwards.—Intense pain in the eyeballs, with black specks before the eyes, dilated pupils, double vision, congested conjunctive, and lachrymation.—Intense throbbing pain, as if a ball were driven from the neck to the vertex with every throb of the heart.—Tongue swollen, breath offensive, pharynx dry, dysphagia, roughness and hoarseness of voice.—Nausea and vomiting attend pain in the head.—Pains in the back, of a drawing, tensive character, or dull and heavy, with tenderness on pressure.—Alternate tonic and clonic spasms, night and day.—Spasmodic jerkings, like chorea.—Rigidity of the muscles of the neck and back.—Intense aching pains in the neck, head and all the joints of the extremities, like the pains which accompany the fever of variola.—Eruption of white pustules on the face and neck; sometimes large, red and papular.
In inflammatory muscular rheumatism cimicifuga has always had a deservedly high popularity, both with physicians and laymen. The rheumatic fever, for which it is specific, is marked by several very characteristic symptoms, namely, the suddenness of its onset, the severity of its manifestation, and its location in large muscles. In such cases it often acts with surprising rapidity, relieving the fever, pain, soreness and restlessness in a few days. It differs from Rhus in not acting on the tendons, or terminal attachments of muscles, and from colchicum, bryonia and asclepias, in not acting on serous tissues, at least I do not think it has that affinity for serous tissues which is possessed by other well known medicines. I would not give the impression that cimicifuga is not useful in chronic rheumatism, for some of its most brilliant achievements have been in that direction. But in such cases the location of the disease has been in the belly of the muscle, i. e., its longest or middle portion, and its inception was originally sudden and severe.
Cimicifuga has made some surprising cures of acute and chronic inflammation of the cervical and lumbar muscles ("stiff neck" and lumbago), in chronic inflammation of the muscles of the upper and lower extremities and intercostal rheumatism.
The febrile symptoms of cimicifuga, are more erethistic or irritative (reflex or sympathetic) than inflammatory or synochal. It will be rarely useful in fevers, except as an intercurrent remedy. I have found it useful in the myalgic troubles which often follow scarlet fever. It relieves those intolerable pains in the back and limbs, the stiff neck and muscular cramps which are such painful sequels of that malady.
Night sweats, when not due to suppuration or anemia, but to some fault in the proper supply of nervous energy to the skin are readily arrested by this drug.
In the provings it is observed that cold sweat is quite a common symptom, especially after 3 A. M., sometimes lasting all day, with weak, irregular pulse, and pain under the left breast. Also that these symptoms are very common in women, and sometimes men, whose nervous system has been weakened by long illness, trouble or care; and in all such cases, cimicifuga in the third to the sixth dilution will prove an admirable restorative.
No drug in our materia medica uniformly causes such severe pain in the head, both internal and external. Internally it causes passive congestion or anaemia, according to the constitution of the prover. Externally it causes pains in the muscles and the nerves supplying them.
The character of the pains and distress are:
Internally, "a sensation in the head as if the temples were compressed," dullness and heaviness in the head, as he had been on a "spree"; head felt as if it had been pounded, full of something heavy; moving the head or turning the eyes causing a sensation as if the cranium was opening and shutting; head feels if he had been without sleep for a long time; brain feels too large for the cranium, pressing from within outwards; severe pain in the forehead, extending to the temples and vertex, with fulness, heat and throbbing; when going up stairs, a sensation as if the top of the head would fly off; excruciating pain in the eyeballs. Nearly all the pains in the head extend to the eyeballs; they are aggravated by movement, relieved by the open air; attended by faintness and "sinking" at the pit of the stomach.
Externally—it has severe pain over the right or left eye, extending into the eye, and back into the base of the brain; pain over the eyes, extending along (around) to the base of the brain and occiput, and nape of the neck; pain in the occipital region, with shooting pains down the back of the neck; dull, boring pain over the left superciliary ridge, at 10 A. M.; pains in the occiput extending to the vertex.
Cimicifuga is indicated in headache resulting from loss of sleep, night watching, and abuse of alcoholic drinks; from mental strain and worry of mind, and from exposure of the head to draughts of cold, damp air. It is useful in the following kinds of cephalagia: congestive headache (passive, perhaps active); nervous headache (periodical or remittent); rheumatic headache (in the muscles-catarrhal); hysterical and menstrual headaches (at change of life); cerebro-spinal headaches.
In the cerebral irritation of children during teething, when they are fretful, feverish, sleepless, the sixth or thirtieth dilution has a soothing effect.
The eyes are severely acted upon by cimicifuga. Few drugs cause such intense and persistent pains in the eyeballs. The pains are chiefly aching, extending to different portions of the head. Many of the pains, however, seem fixed in the center of the eyeball, and simulate the rheumatic and neuralgic affections of the eyes. In some cases the eyelids become inflamed. One characteristic of the eye affection is that in the majority of cases no redness of the eyeballs exist; in other cases, as in Dr. Hill's proving, the "eyes were congested, so as to attract the attention of every one, although there was no disagreeable feeling in them." This discrepancy is probably owing to some difference in the constitution or idiosyncracy of the prover.
The action of cimicifuga on the stomach seems to arise from its depressing effect on the solar plexus and its sympathetic nerve connections. It resembles the action of sepia, digitalis, murex and ignatia, all of which produce, like cimicifuga, that peculiar sensation of faintness, sinking and emptiness which attended all the provings. This sensation is sometimes attended with nausea and vomiting. This faint sensation alternates during the same day with a sensation of fulness or repletion, both sensations resulting from a depression of the same nerve. In the nausea and vomiting of drunkards, tea drinkers and pregnant women, when attended by the above morbid sensations, it will act curatively.
It increases the quantity of urine, which is pale and limpid. Take the symptoms in connection with the general nervous depression, sinking at the stomach, etc., and we have good data for prescribing it in nervous diabetes, or that condition which frequently precedes or follows nervous attacks of various kinds, hysteria and the like.
Cimicifuga is one of our most important remedies in many of the diseases of women. In amenorrhoea, or delayed appearance of the menses in young girls, from deficient nervous energy in the ovaries, and when the abnormal nervous influence is directed to other organs, giving rise to chorea, hysteria, nervous headaches, etc., cimicifuga will restore the functions of the reproductive organs to a normal state. Should there be at the same time, with the above conditions, a chlorotic state, helonias or ferrum should be alternated with this remedy. In retarded menstruation, when pulsatilla or senecio are not indicated, and when at the usual menstrual period the discharge does not appear, but in its case comes a pressive, heavy headache, melancholy, palpitation of the heart, and other reflex symptoms, in these cases cimicifuga will restore the normal condition of the system and cause a regular return of the menses.
In suppression of the menses from a cold, mental emotions, or febrile conditions, when rheumatic pains in the limbs, or intense headache, or uterine cramps arc present, this remedy will be found very useful. In dysmenorrhoea cimicifuga has been used successfully by all schools. I have treated many cases of difficult and painful menstruation, arising from various causes, and while in all there was improvement, in many the morbid condition seemed to be permanently removed. I consider the following symptoms as indicating its use: Before the menses the peculiar headache similar to that caused by this medicine; during the menses aching in the limbs, severe pain in the back, down the thighs and through the hips, with heavy, pressing down, labor-like pains,
weeping mood, hysteric spasms, cramps, tenderness of the hypogastric region, scanty flow of coagulated blood, or profuse flow of the same character; between the menses, debility, nervous erethism, neuralgic pains, tendency to prolapsus, etc.
As a parturifacient it was in general use among the Indians in the early settlement of this country. Bigelow speaks of it as an active agent in facilitating parturition, and Tully says he has known many cases where it has produced abortion in pregnant women when prescribed for a cough. The evidence on this head is far more full and satisfactory in regard to its emmenagogue properties. Prof. Lee says: "It is believed to exert a specific influence on the uterine contractions, lasting longer than that of ergot, and followed by less torpor and greater susceptibility and capacity for action in the uterus than before its employment. After-pains are often readily relieved by small doses of cimicifuga, second or third, or cimicifugin third. I have used it with signal benefit in those cases which seemed to be kept up by a neuralgic disposition, or mental and nervous irritability, and the patient was sleepless, restless, sensitive and low spirited.
Suppression of the lochia is treated successfully with this remedy. It is also useful for the relief of those bearing-down pains, indications for prolapsus, which women frequently suffer from after confinement. It is eminently homeopathic to a tendency to abortion. It has been successfully used in instances of "habitual abortion" with the result of preventing the usual miscarriage in the second and third months.
Sterility when not due to extensive ulceration, or other structural changes in the uterus, may be cured by cimicifuga.
Prolapsus uteri is often removed by this remedy, especially when occurring in nervous, melancholy subjects, and is the result of abortions, cervical congestion, or defidient nerve inervation. Two key-symptoms indicate it in prolapsus, namely, melancholy and "sinking" at the pit of the stomach.
Ovarian disorders, of a nervous rather than inflammatory or structural character, will often find a specific in cimicifuga. Ovarian neuralgia is perhaps as often cured by it as by any other remedy. In this affection it is specially indicated when the ovarian pains are reflected or change their location to other portions of the body, as the leg of the same side, the region under the left breast, or extend up the whole side to the shoulder. As ovarian disorder is usually attended with abnormally depressed states of mind, cimicifuga, is as often indicated as platinum, with which it affiliates in many respects.
Dystocia is one of those abnormal conditions which come clearly under the domain of homeopathic medication. It is useless to cling to the antiquated superstition that a woman must suffer the "pangs of childbirth." Dystocia is always the result of an abnormal condition of the tissues concerned in the functions of childbearing. I do not wish it understood that a majority of cases of painful labor can be remedied by medicines. I have attended very many women who did not suffer to any degree. They expressed themselves as caring very little for the pains. Nor were these women all healthy. But this abnormal phase was somehow absent or nearly so. I have also attended many women whose previous labors had been very painful, almost unendurable without ether, but owing to the administration of cimicifuga, during the last weeks of pregnancy, they suffered very little. So many of these cases have occurred in my practice and in that of my colleagues that it is not proper to affect skepticism or unbelief. As a rule first labors are painful and protracted, while subsequent ones are less so. But if five or six are very painful, and each one seems to be more painful than the last., we can not expect the seventh to be painless, except from medicinal interference. Now, if in such cases cimicifuga is given, and the next labor is easy, what is the inference? Evidently that the medicine affected a change of condition from abnormal to normal. In such cases cimicifuga should be given at least two weeks before the expected date of labor, in doses of one to ten drops, two or three times a day, the doses repeated oftener as the date approaches.
In irritable uterus, that condition once described by Gooch, and lately declared by Hewitt to be a condition of flexion, cimicifuga is an admirable remedy when the pain seem like those of rheumatism or neuralgia.
Mammary pains of a reflex character, occurring during pregnancy, with dysmenorrhoea, or at the climateric, and even after confinement, are also included in the curative sphere of this medicine.
For those obstinate reflex pains in the left side, occurring in women, generally the unmarried, this remedy is as nearly a specific as can be.
Diseases of the heart are cured or greatly palliated by cimicifuga. It is useful in: endocarditis, especially idiopathic or rheumatic; pericarditis, in alternation with aconite, spigelia, or bryonia; cardiac myalgia, which is often mistaken for true angina pectoris; cardiac debility, characterized by irregular palpitation, with intermitting and weak pulse. Its symptoms are so similar to digitalis that it is often impossible to select between them. The history of the case will decide. If the symptoms of cardiac debility are primary, i. e., arising from nervous atony, cimicifuga is primarily indicated.
It is useful in chorea of the heart, a disorder now admitted to exist even when no other choreic symptoms appear. It is characterized by tumultuous, irregular, unexpected and strange motions of the heart, aggravated by emotions and subsiding during sleep.
I ought to add that I consider Actaea alba and rubra to be very similar to cimicifuga (once called Actaea racemosa) in many respects. I have frequently substituted the former for the latter species, especially in uterine disorders, with good results. Dr. Winterburne, of New York city, recently gave favorable experience with Actaea alba in nervous and uterine disorders,
THE USES OF CIMICIFUGA RACEMOSA IN THE ECLECTIC SCHOOL.—(Written for this publication by Prof. John King M. D., Professor of Obstetrics and Diseases of Women, in the Eclectic Medical Institute, Cincinnati).
The following is a concise statement of the therapeutical value of black-cohosh root, as determined in my own practice, and when its employment was not alternated nor combined with other medicines. I have prescribed this agent since 1832, at which time, as far as I am aware, very few practitioners had any knowledge of it as a medicine. A saturated tincture has always been, and is still preferred, prepared with stronger alcohol; and next to this, the alcoholic extract.
These preparations, when administered internally, lessen the action of the heart and arteries, diminish nervous irritability, and remove abnormal conditions of muscular tissues, as well as of certain glandular organs, while at the same time a mild narcotic influence is experienced in numerous instances. In inflammatory rheumatism, when given in the first attack, the tincture has not only removed the disease, but has likewise appeared to so change the rheumatic tendency, that a second attack is seldom to be anticipated; to effect this the tincture should be administered in doses of from ten to sixty minims, repeated every two hours until the patient's head becomes affected, after which the intervals between the doses should be sufficiently increased so as to continue and keep up this action upon the brain for several days, or until the disease has completely disappeared. In chronic rheumatism it has proved useful, diminishing the severity of the pain, and lessening the duration of the disease, but nothing more, unless in combination with other agents.
In conjunctivitis and in sclerotitis, in doses of from ten to sixty minims, repeated every hour or two, it has effected a complete recovery in a few days. It has also been attended with excellent results in relieving the more active symptoms attending the early stages of phthisis, in which disease a further investigation of its action is highly desirable, as well as in catarrhal affections of the respiratory organs.
In chorea this is the principal agent upon which I have relied for the last fifty years, preferring, however, in this malady, the alcoholic extract. Without entering into particulars, it may be stated that this agent has been successfully employed in neuralgic affections, in uterine leucorrhea attending endometritis, as well as congestion of the uterus, also in those affections of the female reproductive organs in which the menstrual function becomes deranged, as manifested by amenorrhea, dysmenorrhea, menorrhagia, frigidity, sterility, etc.
It is an ecbolic, as several instances are known in which the tincture, having been taken every three hours by pregnant women, effected the desired abortion; it undoubtedly exerts a very positive influence upon the generative organs of women. As an accelerator of labor, in cases of uterine inertia, the tincture or the powdered root proves a substitute superior to ergot, in the majority of cases arousing the uterus to contractions more nearly resembling the normal ones, and without any risk to the fetus, or impairment of uterine sensibility to its influence upon subsequent administration; though, as with ergot and similar agents, it occasionally fails in its action. Immediately subsequent to a protracted or severe labor, the tincture will allay any nervous excitement that may be present, will relieve severe after-pains, and will favor uterine involution. In subinvolution of the uterus, accompanied with menorrhagia, the tincture or the extract will be found an efficient remedy.
When the tincture is exhibited in sufficient doses to keep up a slight effect upon the brain, it proves a very remarkable remedy in certain forms of malarial disease, also in neuralgia. Gastric acidity undoubtedly interferes with its remedial action in all instances. The root is said to contain tannin, but no decidedly astringent effect has been observed from its use.
Although a large dose is given herein, yet it must be remarked that some care and watchfulness is necessary in its administration. as I have met with several instances in which two or three drops of the tincture, repeated every hour, have, after a few doses, occasioned symptoms closely resembling those of delirium tremens; indeed, in one case, the administration of but one drop was invariably followed by these symptoms, and its further employment had to be omitted. Black cohosh is one of the most peculiar agents met with in the vegetable kingdom; it appears to exert a remedial influence upon both the serous and mucous tissues of the system when in abnormal conditions, and consequently has proven a superior remedy in numerous chronic diseases.
The specific tincture of the root, as prepared by Messrs. Lloyd Brothers, appears to have nearly, if not quite, all the remedial influence of the saturated tincture, more especially in rheumatic and neuralgic affections, and in abnormal conditions of the principal organs of reproduction in the female. The fluid extract and the infusion of the root are less active in effecting the therapeutical influences just described; however, they will be found more especially beneficial in small pox and other exanthema, both as a prophylactic and a remedy. It will simply be remarked here, that in alternation or combination with other medicines, not only is the usefulness of black cohosh increased but its field of operation greatly enlarged.
The resin of cimicifuga, improperly called "cimicifugin," was first prepared by myself in 1835; then, having subsequently tested its therapeutical virtues for about ten years, I called the attention of practitioners to it; but, it did not come into general use until about 185o. This resin does not appear to possess exactly the same properties as the tincture, its narcotic influences being less decided. Alone, I have found this resin very efficacious in maladies of the female reproductive organs, as in chronic ovaritis, endometritis; menstrual derangements, as amenorrhea, dysmenorrhea and menorrhagia, frigidity, sterility, threatened abortion, uterine subinvolution, and to relieve severe after-pains. In alternation or combination with other medicines, it has exerted efficacious results in many diseases not necessary to name here. Other practitioners have related its employment in nervous, rheumatic and gastric affections, with much benefit, as well as in certain acute maladies.
The dose of the saturated tincture of black cohosh varies according to its effect upon the patient, from one minim to sixty minims, to be repeated three or more times per day; of the specific tincture, from one minim to ten minims, repeated every two or three hours; of the alcoholic extract from one-fourth to one grain; of the resin from one-half of a grain to three, and even six grains, three times a day; of the powdered root, from ten to sixty grains, as may be required.
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- 1872.—Druggists' Circular and Chemical Gazette, pp. 141, 143
- 1872.—American Journal of Pharmacy, p. 324.
- 1872.—Eclectic Medical Journal, Cincinnati, pp. 17, 107, 354.
- 1872.—Atlanta Medical and Surgical Journal.
- 1872.—Medical News and Library.
- 1872.—Journal of Materia Medica, Bates & Tilden, p. 349.
- 1873.—New Remedies, Wm. Wood & Co., p. 171.
- 1873.—Pharmaceutical Lexicon, Sweringen, p. 124
- 1873.—Journal of Materia Medica, Bates & Tilden, p. 160.
- 1874.—Eclectic Medical Journal, Cincinnati, pp. 254, 360.
- 1875.—Eclectic Medical Journal, Cincinnati. p. 477.
- 1876.—American Journal of Pharmacy, p. 385.
- 1878.—United States Homoeopathic Pharmacopoeia, Duncan Bros., p. 102.
- 1878.—Proceedings American Pharmaceutical Association, p. 97.
- 1878.—Eclectic Medical Journal, Cincinnati, p. 118.
- 1878.—American Journal of Pharmacy, p. 468.
- 1878.—Dispensatory and Pharmacopoeia of North America and Great Britain, Buchanan & Siggins, p. 113.
- 1879.—New Remedies, Wm. Wood & Co., p. 19.
- 1880.—Pharmacopoeia of the United States, pp. 73, 108,
- 1880.—Eclectic Medical Journal, Cincinnati p. 251.
- 1881.—Druggists' Circular and Chemical Gazette, p. 41.
- 1881.—Pharmaceutical Journal and Transactions, London, pp. 41 to 43, 62 to 66.
- 1882.—Druggists' Circular and Chemical Gazette, p. 74.
- 1882.—American Practice of Medicine, Goss, pp. 284, 290, 300, 309, 311, 331, 337, 359, 362.
- 1883.—Proceedings American Pharmaceutical Association, p. 128.
Drugs and Medicines of North America, 1884-1887, was written by John Uri Lloyd and Curtis G. Lloyd.