Native American tribes, particularly those from the Eastern Woodlands, were among the first to harness the medicinal properties of black cohosh. They used it to treat a variety of conditions, including menstrual irregularities, childbirth complications, and even rheumatic pains. The herb was often prepared as a decoction or infusion, which allowed its potent compounds to be extracted and used in healing rituals.

Early European settlers quickly adopted the traditional knowledge of black cohosh, incorporating it into their own herbal practices. Over time, the herb became a staple in North American materia medica, prized for its ability to alleviate the discomforts associated with female reproductive health and its anti-inflammatory properties.