Warning: Blue cohosh is a toxic herb. Natural and Alternative Treatments (NAT) strongly recommends against using it.
Blue cohosh is a flowering herb native to North America, growing in forested areas from the southeastern United States to Canada. Sometimes known as squaw root or papoose root, the herb may have been used medicinally by native Americans, although this belief is controversial. Other common names for the herb include yellow ginseng and blue ginseng. Blue cohosh should not be confused with the similarly named (but unrelated and much safer) black cohosh. Blue cohosh was used in the 1800s by European settlers and African Americans, primarily for gynecologic conditions.1 Blue cohosh also has a reputation as an herb that can induce abortions, although concerns regarding its efficacy and safety make this use extremely ill-advised.2 In addition, it has been used for the treatment of arthritis, cramps, epilepsy, inflammation of the uterus, hiccups, colic, and sore throat.
Blue cohosh is widely prescribed by herbalists and midwives. A 1999 survey published in the Journal of Nurse-Midwifery found that 64% of certified nurse-midwives who prescribe herbal medicines use blue cohosh to induce labor.3 It has also been used for a wide variety of menstrual problems, including several for which it would not be logical to believe that the same treatment could help. For example, blue cohosh has been used to start menstrual periods that were late in coming and yet also to stop excessive or ongoing menstrual flow.
There is no credible evidence that blue cohosh is effective for any of the conditions for which it has been used. Furthermore, several published reports cite cases of serious side effects to infants apparently caused by blue cohosh. (See Safety Issues.)
Blue cohosh is usually used as a tincture. Common dosages range from 5 to 10 drops taken every 2 to 4 hours.
There are many serious safety concerns with blue cohosh.
Some of the compounds found in blue cohosh, such as caulophyllosaponin, methylcytosine, and caulosaponin, appear to constrict coronary vessels, limiting blood flow to the heart and reducing its ability to pump.4 One published case report documents profound heart failure in a child born to a mother who used blue cohosh to induce labor.5 Severe medical consequences were seen in another child as well.6 Other blue cohosh constituents are known to interfere with the ability of a newly fertilized ovum to implant in the uterus, damage the uterus and thyroid, and cause severe birth defects in cattle and laboratory rats.7,8,9
Given these reports, the availability of safe alternatives for stimulating labor, and the lack of studies to document the herb's efficacy and safety, NAT strongly advises against using blue cohosh.
1. Review of Natural Products. St. Louis, MO: Facts and Comparisons; 1992.
2. Irikura B, Kennelly EJ. Blue cohosh: A word of caution. Altern Ther Womens Health. 1999;1:81-83.
3. McFarlin BL, Gibson MH, O'Rear J, et al. 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;44:205-216.
4. Jones TK, Lawson BM. Profound neonatal congestive heart failure caused by maternal consumption of blue cohosh herbal medication. J Pediatr. 1998;132:550-552.
5. Jones TK, Lawson BM. Profound neonatal congestive heart failure caused by maternal consumption of blue cohosh herbal medication. J Pediatr. 1998;132:550-552.
6. Gunn TR, Wright IM. The use of black and blue cohosh in labour. N Z Med J. 1996;109:410-411.
7. Betz JM, Andrzejewski D, Troy A, et al. Gas chromatographic determination of toxic quinolizidine alkaloids in blue cohosh Caulophyllum thalictroides (L.) Michx. Phytochem Analysis. 1998;9:232-236.
8. Chandrasekhar K, Vishwanath CR. Studies on the effect of Caulophyllum on implantation in rats [abstract]. J Reprod Fertil. 1974;38:245-246.
9. Chandrasekhar K, Sarma GH. Observations on the effect of low and high doses of Caulophyllum on the ovaries and the consequential changes in the uterus and thyroid in rats [abstract]. J Reprod Fertil. 1974;38:236-237.
Last reviewed December 2015 by EBSCO CAM Review Board Last Updated: 12/15/2015