Evidence supporting the use of: Cascara sagrada
For the health condition: Colon (atonic)

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Synopsis

Source of validity: Traditional
Rating (out of 5): 3

Cascara sagrada (Rhamnus purshiana) has a long history of use as a herbal remedy for constipation, particularly in cases referred to as "atonic colon"—a condition characterized by reduced muscular tone in the colon leading to sluggish bowel movements. The indigenous peoples of the Pacific Northwest originally used the bark as a laxative, and its use was adopted by European settlers and became widespread in North American herbal medicine in the late 19th and early 20th centuries.

The laxative effect of cascara sagrada is primarily due to its content of anthraquinone glycosides, which stimulate peristalsis (the contractions of the intestinal muscles) and increase water and electrolyte secretion in the colon. This mode of action is well-documented in pharmacognosy texts and supported by early pharmacological studies, but most of the evidence comes from traditional use and observational reports rather than modern, large-scale clinical trials. Cascara sagrada was formerly recognized as an over-the-counter laxative by the U.S. Food and Drug Administration, but concerns over safety and a lack of robust clinical trials led to its removal from the list of approved nonprescription drugs in 2002.

In summary, while cascara sagrada's use for atonic colon is primarily justified by tradition and supported by pharmacological rationale and limited clinical data, high-quality modern research is lacking. Caution is also advised due to potential side effects, including dependence and electrolyte imbalances with long-term use.

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