The rhizome and rootlets of Cimicifuga racemosa (Linné), Nuttall (Nat. Ord. Ranunculaceae). A conspicuously handsome perennial widely found in rich woodlands of the eastern half of the United States. Dose, 1 to 20 grains.
Common Names: Black Snakeroot, Black Cohosh, Rattleweed.
Principal Constituents.—No alkaloidal principles have been isolated from the drug, but it yields a mixture of resins upon which, according to some, the virtues of the plant depend. An impure mixture of the resins is variously known as cimicifugin, macrotin, or macrotyn, and was one of the early Eclectic resinoids. Though not without value, the latter is now scarcely ever employed.
Preparation.—Specific Medicine Macrotys. Dose, 1/10 drop to 20 drops.
Specific Indications.—Heavy, tensive, aching pain (Scudder); pain characterized as rheumatic-dull, tensive, intermittent, drawing, and seeming as if dependent upon a contracted state of the muscular fibers; soreness of muscular tissues, as if one had been pounded or bruised; the so-called rheumatoid pain; stiff neck; aching of whole body from colds, the onset of fevers, or from muscular exertion; lumbago; bruised feeling of muscles of the forehead, with stiffness of the ocular muscles; soreness and stiffness of the throat with sense of muscular drawing in the pharynx and fauces; muscular pains in the loins, thigh, or back, of a drawing character; deep-seated boring and tensive pains; rheumatoid dyspepsia, associated with rheumatism of other parts, and in those having a rheumatic diathesis who experience dull, aching pain and tenderness in stomach and bowels, with tendency to metastasis, and aggravated by food and drink, the stomach feeling as if painfully contracting upon a hard body or lump; the soreness and aching intestinal pains of abdominal grip, when of rheumatoid type; sore, bruised sensation in the respiratory tract; chronic muscular rheumatism; ovarian pains of a dull aching character; dragging pains in the womb, with sense of soreness; the dull tensive pains incident to reproductive disorders of the female, as well as the annoying pains accompanying pregnancy; false pains; after-pains; weak, irregular uterine contractions during labor; irregular, scanty, or delayed menstruation, with dull pain and muscular soreness; chorea, with absentio mensium; and rheumatism of the uterus.
Action.—Upon man moderate doses of cimicifuga give slowly increased power to the heart and a rise in arterial pressure. Large doses impress the cerebrum decidedly, and probably other parts of the nervous system not yet definitely determined—occasioning vertigo, impaired vision, pupillary dilatation, nausea, and vomiting of a mild character, and a reduction in the rate and force of the circulation. A condition closely resembling delirium tremens is said to have been produced by it. Full doses cause a severe frontal headache, with a dull, full or bursting feeling. This headache is the most characteristic effect observed when giving even therapeutic doses. While large amounts may poison, no deaths have been known to occur from its use. The physiological action has been well determined upon animals, but it gives no hint as to the possible relationship of the drug to its practical therapy and clinical worth, admitted as valuable by practitioners of all schools of medicine.
In small doses cimicifuga increases the appetite and promotes digestion. Larger amounts augment the gastro-intestinal secretions. It is excreted by both the skin and kidneys, imparting to the urine the peculiarly earthy odor of the drug. It also stimulates the bronchial secretion, making it a serviceable though not pronounced expectorant. That it acts upon the uterine, and possibly other smooth muscular fibers of the tubular organs or the nerves supplying them, is evident from its known power of increasing and normalizing weak and erratic contractions during labor. It also stimulates the function of menstruation and is said to increase the venereal propensity in man.
Therapy.—Macrotys is primarily a remedy for rheumatoid and myalgic pain and in disorders of the reproductive organs of women. It apparently possesses sedative, cardiac, anodyne and antispasmodic properties, and is an ideal utero-ovarian tonic. Macrotys was introduced into Eclectic medicine by King in 1844 as a remedy for acute rheumatism and neuralgia with such success that it gradually came to be recognized as a leading medicine for these disorders. The extensive list of indications given at the beginning shows sufficiently its general scope of application. While many still regard it as one of the first of antirheumatics, others, and we are among the number, regard it as less fully an antirheumatic than as an anodyne for pain simulating rheumatism, or the so-called "rheumatoid pain". The original indication as enunciated by Scudder is "heavy, tensive, aching pain". This is essentially different from the exquisitely sensitive and acute pain of acute articular rheumatism. It is not to be understood that it is of no value in this affection, but that it is of greater worth as an associate remedy. It assists in relieving the pain, but rheumatism is, without doubt, an infectious disorder and needs something more directly antagonistic to the infecting agent, and the salicylates prove better than any others for this purpose. As a matter of fact, the indications for both macrotys and sodium salicylate are usually present. As they do not interfere with each other, they may be judiciously given together, and administered in this manner aid the action of each other so that lesser doses of the salicylates are required. Rx Sodium Salicylate, 2 drachms; Asepsin, 10 grains; Specific Medicine Macrotys, 1-2 fluidrachms t; Fluidextract of Licorice, 2 fluidrachms; Water enough to make 4 fluidounces. Mix. Sig.: One teaspoonful every two or three hours as seems to be demanded.
When pain persists in spite of this medication, and fever is active, aconite, veratrum or gelsemium, particularly the first named, produces a marked change in the activity of the disease. Fever subsides, secretion becomes reestablished, pain is markedly decreased, and sleep, that has been impossible, is permitted. That it protects the heart and strengthens it during rheumatic invasions seems established. In so-called rheumatism of the heart and rheumatic endocarditis it may be given with expectation of relief, and in diaphragmatic rheumatism, pleurodynia, intercostal and other neuralgias its pain-relieving effects are apparent. Gastralgia, enteralgia, mediastinal pain, tenesmic vesical discomfort, pain in the orbits and ears, when acute and rheumatoid in character, derive quick relief from macrotys. When diseases of the ear are associated with rheumatism, macrotys aids in giving relief, as it does in neuralgia in the same area when accompanied by stiffness of the faucial and pharyngeal muscles. It is the remedy in acute muscular pain, such as occurs in the myalgias of the chilly seasons of the year, in torticollis, and in the pains, tensive and contractive, due to changes of weather and muscular exertion. Here macrotys is often the only agent needed. If febrile reaction occurs, either aconite or veratrum, as indicated, or possibly gelsemium, may be alternated with it.
According to Webster cimicifuga is a remedy for dyspeptic manifestations when due to rheumatoid states of the gastro-intestinal canal, or when associated with rheumatism of other parts of the body. It should be remembered in those cases where there is a dull or aching pain and tendency to metastasis, made worse by taking food or drink, and when the walls of the stomach seem to be contracting upon a hard lump, the patient having a rheumatic tendency or history.
In the acute infectious and non-infectious diseases it is a most important drug to relieve the muscular discomfort. Macrotys and eupatorium in liberal doses are the best remedies for the intense muscular aching and bone-breaking pains experienced at the onset of the rheumatoid type of influenza, and in other forms of la grippe. In the respiratory forms they also relieve cough and bronchial soreness. The amelioration of pain is prompt and enduring, and unlike aspirin and the coal-tar products, the drug is absolutely without danger to the heart or nervous system. Should a sense of fullness in the frontal region or a bursting headache be occasioned by full doses, it quickly subsides, with no after-effects, upon withdrawal of the drug.
For headache, whether congestive or from cold, neuralgia, dysmenorrhea, or from la grippe, macrotys is often promptly curative. In eye strain from over-use of the eyes, giving rise to headache, and associated with a sensation of stiffness in the ocular muscles, or a bruised feeling in the muscles of the frontal region, macrotys is one of the most successful of remedies. As a palliative agent in phthisis pulmonalis, good results are obtained, in that it lessens cough, soothes the pain, especially the "aching" under the scapulae, lessens secretions and allays nervous irritability. In the cerebral complications of the simple and eruptive fevers, especially in children, its action is prompt and decisive. It uniformly lessens the force and frequency of the pulse, soothes pain, allays irritability, and lessens the disposition to cerebral irritation and congestion. In febrile diseases especially, it induces diaphoresis and diuresis. In the exanthemata it is a valuable agent, controlling pain, especially, it is asserted, the terrible "bone aches" of smallpox, rendering the disease much milder. In scarlatina and measles it relieves the headache and the backache preceding the eruptions.
Macrotys is a very important drug in the therapeutics of gynecology It is a remedy for atony of the reproductive tract. In the painful conditions incident to imperfect menstruation its remedial action is most fully displayed. By its special affinity for the female productive organs, it restores suppressed menses. It is even a better remedy in that variety of amenorrhea termed "absentio mensium". In dysmenorrhea it is surpassed by no other drug, being of greatest utility in irritative and congestive conditions of the uterus and appendages, characterized by tensive, dragging pains, resembling the pains of rheumatism. If the patient be despondent and chilly, combine macrotys with pulsatilla, especially in anemic subjects. In the opposite condition associate it with gelsemium. It is a good remedy for the reflex "side-aches" of the unmarried woman; also for mastitis and mastodynia. Macrotys relieves soreness and tenderness of the womb when aggravated by walking or jarring of the organ when descending steps; and through its tonic power helps to reduce uterine subinvolution. It should be remembered in so-called rheumatism of the uterus, and in uterine leucorrhea, with a flabby condition of the viscus. When there is a disordered action or lack of functional power in the uterus, giving rise to sterility, cimicifuga has been known to do good. Reflex mammary pains during gestation are relieved by it, and in rheumatic subjects it promptly relieves ovaralgia and ovarian neuralgia, the pain being of an aching character. For the latter condition it is one of the best remedies known.
Orchialgia and aching sensations of the prostate are conditions sometimes relieved by macrotys, and as a tonic and nerve sedative it is not without good effects in spermatorrhea. Its effects are less apparent upon the male reproductive organs, however, than those of the female.
Macrotys has proved a better agent in obstetrical practice than ergot except for the control of hemorrhage. It produces natural intermittent uterine contractions, whereas ergot produces constant contractions, thereby endangering the life of the child, or threatening rupture of the uterus. Where the pains are inefficient, feeble, or irregular, macrotys will stimulate to normal action. For this purpose full doses should be given in hot water; many still prefer a decoction of the root for this purpose. Unfortunately it is less employed than formerly since pituitrin has come into use. Its simulation of normal parturient efforts, however, makes it still the ideal regulator of uterine contractions during labor. It is an excellent "partus praeparator" if given for several weeks before confinement. It is a diagnostic agent to differentiate between spurious and true labor pains, the latter being increased, while the former are dissipated under its use. It is the best and safest agent known for the relief of after-pains, and is effectual in allaying the general excitement of the nervous system after labor.
Macrotys has a powerful influence over the nervous system, and has long been favorably known and accepted as the best single remedy for chorea. It may be used alone or with valerian, equal parts. More especially is it useful when the incoordination is associated with amenorrhea, or when the menstrual function fails to act for the first time. Its action is slow, but its effects are permanent. It has been used successfully as an antispasmodic in hysteria, and as an aid to treatment in epilepsy when due to menstrual failures: and in spasmodic asthma and kindred affections, nervous excitability, and pertussis. In the latter it sometimes proves better than any other drug, and especially if the child is one subject to periodic choreic seizures. As the heart is never injured, but on the contrary is strengthened and toned by macrotys, the drug is very valuable as an auxiliary to other agents in nervous affections, particularly when the latter depend upon, or are associated with chorea.
The usual form of administration is: Rx Specific Medicine Macrotys, 10-30 drops; Water, enough to make 4 fluidounces. Mix. Sig.: One teaspoonful every two hours. In most instances the fuller doses, short of producing headache, are the most effective, and the maximum amount given in this prescription may be considerably increased (1-2 fluidrachms) for adults.
The Eclectic Materia Medica, Pharmacology and Therapeutics, 1922, was written by Harvey Wickes Felter, M.D.