Summary

The senna plant (Senna alexandrina or Cassia Officinalis) is the quintessential herb for acute constipation. The ancient Egyptians first recorded its use, and it remains one of the most popular constipation remedies. The active ingredients are the sennosides, a type of anthraquinone glycoside found in both the leaf and seed pods. These glycosides are prodrugs that are not significantly absorbed nor have an effect on the upper intestinal tract. Instead, bacterial enzymes in the colon cleave off sugars from the anthraquinones to liberate the active drug. Free anthraquinones stimulate the nerves of the intestines (myenteric plexus) to cause an influx of water and promote peristalsis. Take senna before bed to produce a bowel movement 6-9 hrs later upon rising.

Although senna is generally considered safe, it can produce significant cramping pains. Combine with carminative herbs like fennel to mitigate the effects. Senna is only recommended for short-term use because it may cause dependency after a week of use. Although anthraquinones are poorly absorbed, a small amount is excreted by the kidneys making the urine reddish-brown, which patients sometimes mistake for blood.

Indications

Gastrointestinal
• acute constipation

Actions

• Laxative (Stimulating)
• Cathartic
• Bitter

Constituents

• Anthraquinone (E.g. Emodin )

Posology

The correct individual dose is the smallest required to produce a soft-formed stool:
• Infusion (Alexandrian seed pods): 3-6 per cup of water
• Tincture • dosing not found in any books. Generally taking in tea or caspule form.

Safety

Contraindications: Use > 10 consecutive days, bulimia, intestinal obstruction, spastic constipation, acute intestinal inflammation, abdominal pain of unknown origin, children < 12 years old, pregnancy, lactation.

Side-effects: Red urine (benign), hypokalemia, colic; common with anthraquinones due to increased parastalsis and smooth muscle spasms. Carminatives decrease side-effects.

Warning: Discontinue use after 7-10 days.

Long-term use: Hypokalemia, dependency, intestinal paralysis, irritable bowel syndrome (IBS), pancreatitis, renal failure, melanosis coli.

Interactions

• Hypokalemic agents • caution taken it concomitantly with drugs and herbs that depleted potassium: antiarrhythmic drugs (e.g. quinine), cardiac glycoside (e.g. digitallis), diuretics, corticosteroids and licorice (Glycyrrhiza glabra).

References

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Barnes J, Anderson LA, Phillipson JD. Herbal Medicines, 3rd ed. London: Pharmaceutical Press, 2007.

Bone K. Principles and Practice of Phytotherapy. Edinburgh: Churchill Livingstone, 2000.

Bone K. A Clinical Guide to Blending Liquid Herbs: Herbal Formulations for the Individual Patient. St Louis, MO: Churchill Livingstone, 2003.

Brinker F. The Toxicology of Botanical Medicines, 3rd ed. Sandy, Oregon: Eclectic Medical Publications, 2000.

Felter HW, Lloyd JU. King's American Dispensatory. 1898. http://www.ibiblio.org/herbmed/eclectic/kings/main.html. Accessed: August 19, 2006.

Hoffman D. Medical Herbalism. Rochester, Vermont: Healing Arts Press, 2003.

Weiss RF. Herbal Medicine. Beaconsfield, England: Beaconsfield Publishers Ltd, 1988.

Williamson EM, ed. Major Herbs of Ayurveda. Edinburgh: Churchill Livingstone, 2002