> the European Medicines Agency (EMEA) advises patients taking Cimicifugae Racemosae Rhizoma (Black Cohosh, root) to stop the medication and contact their doctor immediately if they develop signs or symptoms suggestive of liver disease, such as tiredness, loss of appetite, yellowing of the skin and eyes or severe stomach pain with nausea and vomiting or dark urine.

The European Medicines Agency and the Committee on Herbal Medicinal Products have been made aware of a number of cases purportedly linking Black Cohosh products to hepatotoxicity (liver injuries). They evaluated 42 case reports gathered from within Europe, of which only 4 were considered to have a possible link to the ingestion of Black Cohosh products. It should be stressed that this link has not been proved in any way.
There is no obvious mechanism by which a holistically standardised extract of Black Cohosh (i.e. one that has not been tampered with to alter the natural levels of constituents) could adversely affect the liver.