The herb black cohosh, or Actaea racemosa (formerly named Cimicifuga racemosa), is native to North America. The roots and rhizomes are widely used in the treatment of menopausal symptoms and menstrual dysfunction. Black cohosh was originally used by Native American peoples in the treatment of many conditions, especially gynecologic disorders.1 The most widely used and best studied commercial formulation available in the United States is Remifemin, an extract of the rhizome that is produced by a German company. Numerous other brands of black cohosh are available, but not all are standardized extracts. Black cohosh should not be confused with the blue cohosh herb (also known as Caulophyllum thalictroides), which is used for different indications and has a greater potential for toxicity.

For decades, women around the world have treated the symptoms of menopause with a simple herb called black cohosh. Now the N.I.H. is putting it to the test.

There isn't a 50-year-old woman in America today who isn't obsessed with menopause. In my grandmother's day, the loss of a woman's ability to have babies was chalked up, quietly, to "the change of life" -- if, that is, she lived that long.

Now aging baby boomers, never quiet about anything, can spend as many years without functioning ovaries as with them. Menopause, circa 2001, is no longer a life passage. It is a medical event.

Of all the symptoms of menopause, the hot flash is the most intriguing. A classic hot flash begins with an aura, a vague sensation in the face and neck that blossoms over a period of a minute or two, skin temperature rising, pulse quickening, into a full-blown wave of heat and blushing and drenching sweat, often followed by chills.

Japanese women, mysteriously, report fewer hot flashes than Americans. Spicy foods and hot drinks trigger hot flashes in some women but not others. Some women flash only sporadically. Some flash like clockwork, night and day, some only during sleep.

For decades, the standard therapy for hot flashes has been the hormone estrogen.

The good news about estrogen is that it prevents osteoporosis, and possibly heart disease; the bad news is that, taken long-term, it may increase the risk of breast cancer.

This has put the modern menopause generation in a pickle. Now comes a possible solution to the estrogen dilemma: black cohosh, the leading herbal therapy for hot flashes in Europe. A cousin of the buttercup, with tall spikes of brilliant white flowers and a gnarled, resin-scented root, black cohosh -- the name is believed to be Indian in origin -- grows wild in the deciduous forests of the eastern United States. American Indians have used it as a folk remedy for centuries.

The Cherokee relied on alcoholic spirits of black cohosh root to treat rheumatism and ground the root into teas to treat consumption and fatigue; the Algonquins used it for kidney trouble. By 1849, the newly formed American Medical Association was describing black cohosh as useful for "the debility of females attendant upon uterine disorder."

Today, the extract of black cohosh's roots and rhizome is sold in capsules or tablets of varying strength and dispensed in European pharmacies as a drug. Though no one is quite certain how the herb works, German studies show it is better at treating hot flashes than dummy pills, and Commission E, a German panel of scientific experts, recommends black cohosh for menopause and menstrual cramps.

Word has spread across the Atlantic; according to Nutrition Business Journal, a trade publication, sales of black cohosh preparations in this country jumped to $34 million in 1999, from $11 million the year before -- a trend that is occurring almost entirely outside the medical mainstream, because many American doctors behave as though herbal remedies don't exist.

Eighty percent of the world's population relies on traditional forms of medicine, chiefly herbal medicine. From a global perspective, the United States is a third-world country when it comes to herbal products.