HERBAL
MEDICINAL PLANT
Cassia
Cassia
alata
(L) Roxb.
Cassia fistula L.
(Leguminosae)
Cassia grandis L.
f. ++
Cassia angustifolia
by
RETTODWIKART THENU
Cassia
alata
(L) Roxb.
BOTANICAL
DESCRIPTION (Ross, I. A. 2003)
This shrub of the LEGUMINOSAE family may grow up to about 3 meters
tall. Leaves are pinnately compound, 30 to 40 cm long, with 6-12 pairs of broad
oblong leaflets, blunt at the tip, unequal at the base, the terminal pair much
larger, about 15 cm long and 8 cm wide. Flowers are roundish in compact
axillary racemes, golden-yellow and very showy, about 20 to 30 cm long and 3-4
cm wide. The bracts are 2-3 by 1-2 cm. There are 5 unequal, oblong, 10-20 by
6-7 mm green sepals. The petals are bright yellow, ovate-orbicular to spathulate,
shortclawed, 2 by 1-1.5 cm. There are 9-10 stamens; 2 large, 4 small, and 3-4
reduced. The anthers open via apical pores. There is only 1 pistil and glabrous ovary. Fruit are 4- winged pods, 10-15 cm long, dark brown when
ripe. There are about 50 seeds, more or less quadrangular, arranged
transversely in the pod.
ORIGIN
AND DISTRIBUTION (Ross. I. A. 2003)
A native of tropical America, it is now widespread in warm
countries. The plant grows in waste places, often along streams, banks, and in
swamps.
TRADITIONAL
MEDICINAL USES (Ross. I. A. 2003)
Australia. Hot water extract of
dried leaves is taken orally as a catharticCAo61.
Bangladesh. Fresh leaves are
squeezed and rubbed into ringwormCAOl6.
Brazil. Decoction of dried leaves is taken orally as
an emmenagogue and abortifacientCAo63. Decoction of dried root is taken orally
for malaria. Data were obtained by interviews with more than 8000 natives of
various parts of BrazilcAOll.
Buka Island. Fresh leaves are
squeezed
until soft and rubbed regularly onto the
affected part of the body to treat ringwormCA046.
Fiji. Hot water extract of
dried leaves and stem is used externally for ringworm and skin diseasescAoss.
The juice of the leaves and stem is squeezed out and rubbed on the affected
area for ringworm and skin infectionscAo11, Infusion of dried leaves is taken
orally as a blood purifier for worms and diarrheac Ao51.
Guatemala. Hot water extract of
dried bark, leaves, and root is used externally for ringwormcAo34.
Guinea-Bissau. Hot water extract of
root is taken orally as an emmenagogueCA002.
Guinea. A strong decoction of hot water extract of
leaves is taken orally to promote abortion, and to treat leprosyCA034.
India. Fresh leaf juice is used for eczema. Juice
from leaves is applied to affected area 3 times daily until curedcAos4. Fresh
leaves are crushed and used for skin diseases, especially ringworm, eczema and
scabiescAosl,cAolo. Leaf juice is used externally to treat leukoderma; a
poultice of tender leaves is applied for over a monthCAosl.
Ivory Coast. Decoction of dried
leaves is used externally to treat infections caused by dermatophytes, and
orallycAol9 and externally to treat yeast infections caused by Candida albicans,
as well as orally to treat bacterial
infections caused by Escherichia colpol8.
Jamaica. Hot water extract of dried leaves is taken
orally for diabetesCAo49.
Malaysia. Decoction of root is
taken orally to ease stomachachecA028. Hot water extract of dried leaves is
taken orally as a laxative; leaves are used externally against ringworm and
scabies; the sap is used externally against external ulcersCA026 .
Mexico. Hot water extract of the plant is used
externally as an astringent and against inflammation of rashes, orally as a
purgative, anthelmintic and to relieve fevercAolO.
Nicaragua. Fresh leaves are used
externally for ringworm and athlete's foot; decoction of the fresh leaves is
taken orally for stomachache. It should not be given medicinally to pregnant women; it will induce
abortioncAo3o.
Nigeria. Dried leaf, powdered with equal amounts of Piper guineense, is divided
into small portions and taken orally with hot "Pap" to treat
indigestion. Decoction of the dried leaves is taken orally to hasten delivery
during labor; a strong decoction is taken orally to produce abortionCAol5.
Decoction of dried leaves is used externally for ringworm, eczema and pustular
skin infectionsCAOJ8. Infusion of dried leaves is taken orally as a
purgativeCAo21. Fresh leaf juice is used externally to treat skin
infectionscAo47. Leaf mixed with fruit pulp of Cucurbita pepo and Termitomyces microcarpus (mushroom)
is taken orally to treat gonorrheacAo29. The ground inflorescence is mixed with
"Pap" and taken orally to treat constipationcAol5.
Papau-New Guinea. Dried
leaves are used externally for skin eruptions such as Tinea imbricata.
Crushed leaves are rubbed on the skincA056 .
Fresh leaves are used to treat grille, a skin fungus. Crushed leaves are rubbed
into the skin affected by grilleCA024,CA025. Leaf juice is used externally for
skin eruptions such as Tinea imbricata and ringwormCA052.
Philippines. Fresh leaves are used
to treat fungal infection of the skin. The leaves are crushed and rubbed
vigorously on the infected area of the skin CAOJ7.
Sierra Leone. Decoction of dried
leaves is taken orally as a laxative CA05J.
Suriname. Fresh leaves are used
externally for ringworm and skin diseasescAo56.
Tanzania. Decoction of leaves is
taken orally as a purgativec Ao6o.
Thailand. Decoction of dried
leaves is taken orally for asthmac A062j the hot water extract is taken orally
as an antipyretic CA066 . Hot water extract of dried entire plant is taken
orally as a catharticCAo68. Pulverized flower is taken orally for asthmac Ao62.
Hot water extract of dried seeds is taken orally as an anthelminticCAo68.
Trinidad. Seeds and leaves are
used as anthelmntics cM77 .
West Africa. Hot water extract of
dried leaves is taken orally as an ecbolic and emmenagogueCA044. Hot water
extract of fresh leaf juice is used for parasitic skin diseases CAOJI. Strong
decoction of hot water extract of leaves is taken orally as an abortifacient
CAool. Water extract of the leaf is used to treat bacterial infections caused
by Escherichia coli and fungal infections caused by Candida
albicans and dermatophytes CA074.
West Indies. Hot water extract of flowers
is used externally as an antibacterialcAo41. Leaf teas are used for intestinal
worms CA04J. Seeds are taken orally as a vermifuge CAo43.
CHEMICAL
CONSTITUENTS (Ross. I. A. 2003)
(ppm unless
otherwise indicated)
Alatonal:
StCA009
Aloe emodin:
PICA012
Alquinone: Rt
10cAoo8
Anthraqu inone,
1-5-dihydroxy-2-methyl: StCA027
Anthraquinone,5-hydroxy-2-methyl
1-0-rutinoside: StCA027
Benzoquinone,
2-6-dimethoxy: StCA007
Beta sitosterol:
RtCA027
Chrysarobin: Lf
CAOOS
Chrysophanol:
PICA004
Chrysophanol
glycoside: LfCAOOS
Chrysophanic
acid: LfCA012
Chrysoeriol-7
-O(2-0-beta-Dmannopyranosyl)-beta D-allopyranoside: SdCA006
Dalbergin:
StCA007
Daucosterol:
StCA007
Deoxycoeluatin:
LfCAOll
Emodin: St
3.3CA020,CA007
Kaempferol:
LfCA017
Luteolin:
StCA007
Phytosterol: Lf,
St BkcA017
Rhamnetin-3-0-(2-0-beta-Dmannopyranosyl)-beta-D-allopyranoside:SdCA072
Rhein: PICA004
Rhein glycoside:
LfCA003
Santal: StCA007
Tannin: LfCAOOS
PHARMACOLOGICAL ACTIVITIES AND CLINICAL
TRIALS
(Ross,
I. A. 2003)
Abortifacient effect. Ethanol/water
(50%) extract of dried leaves, administered by gastric intubation to rats at a
dose of 125.0 mg/ kg, was inactiveCA06J.
Analgesic activity. Ethanol
(85%) extract of dried leaves, administered intraperitoneally to mice at a dose
of 100.0 mcg/kg, was activeCA058. Ethanol/water (1:1) extract of aerial parts,
administered intraperitoneally to mice at a dose of 500.0 mg/kg, was inactive
vs tail pressure methodCAo64. Leaf extract, administered intraperitoneally to
mice and rats, was active using tail clip, tail flick, tail immersion, and
acetic acid-induced
writhing methods. Maximum analgesic activity was apparent 2 hours after injection of the extract. Fifty
mg of kaempferol 3-0-sophoroside appeared equivalent to 100 mg of the
extractCA073.
Antibacterial activity. Chloroform
extract of dried leaves, at a concentration of 5.0 mcg/ml on agar plate, was
active on Pseudomonas aeruginosa, Bacillus subtilis, Escherichia coli, Micrococcus luteus, and Staphylococcus aureusCAOJ8. The chromatographic fraction, undiluted on agar plate, was active
on several Gram positive and Gram negative organismsCA04J. The acetic acid
extract of dried leaves, at a concentration of 5.0 mg/ml, was active on Bacillus subtilis, Escherichia coli, Micrococcus luteus, Pseudomonas aeruginosa, and Staphylococcus aureusCAOJ8. Chloroform extract of dried stem bark, at a concentration of 1.0
mg/disk on agar plate, was active on Bacillus
cereus, Bacillus
subtilis, Pseudomonas aeruginosa, Salmonella paratyphi B, Salmonella typhi, Shigella dysenteriae, Shigella flexneri, Shigella sonnei and Staphylococcus aureus. It was inactive on Aeromonas hydrophilia, Escherichia coli, Salmonella paratyphi A, Vibrio cholera, Vibrio mimicus and Vibrio parahemolyticus. The methanol extract was active on Bacillus cereus, Bacillus subtilis, Escherichia coli, Salmonella
paratyphi B, Salmonella
typhi, Shigella flexneri,
Shigella sonnei and Vibrio
cholera, and inactive on Aeromonas hydrophilia, Pseudomonas aeruginosa, Salmonella
paratyphi A, Vibrio
mimicus and Vibrio
parahemolyticus.
The petroleum ether extract was active on Salmonella paratyphi B and Shigella flexneri, and
inactive on Aeromonas hydrophilia, Bacillus cereus,
Bacillus subtilis, Escherichia coli, Salmonella paratyphi A, Salmonella typhi, Vibrio cholera, Vibrio mimicus,
and Vibrio
parahemolyticus; active on Shigella
sonnei at a concentration of 1.4
mg/disk, and Shigella dysenteriae and Staphylococcus aureus, MIC 0.8
mg/diskCA01J. Ethanol (85%) extract of dried leaves, at a concentration of
10.0% on agar plate, was active on Escherichia
coli, Proteus vulgaris,
Pseudomonas aeruginosa, and Staphylococcus aureusCAOJ5 . Methanol
extract of the dried leaves, at a concentration of 1.0 mg/disk on agar plate,
was active on Bacillus subtilis, Escherichia coli, Salmonella paratyphi B, Shigella flexneri, Shigella sonnei, and Vibrio cholera, and inactive on Aeromonas hydrophilia, Bacillus cereus, Pseudomonas aeruginosa, Salmonella paratyphi A, Salmonella typhi, Vibrio mimicus, and Vibrio parahemolyticus.
The methanol extract of dried leaves, on agar
plate, showed MIC 0.2 mg/disk for Shigella
dysenteriae and 0.4 mg/ disk for Staphylococcus aureus. Petroleum
ether extract of dried leaves, at a concentration of 1.0 mg/disk on agar plate,
was active on Salmonella paratyphi B, Shigella flexneri, and Shigella sonnei, and inactive on Aeromonas
hydrophilia, Bacillus cereus, Bacillus subtilis, Escherichia coli, Pseudomonas aeruginosa, Salmonella paratyphi A, Salmonella typhi, Staphylococcus aureus,
Vibrio cholera, Vibrio mimicus, Vibrio parahemolyticus, and Shigella dysenteriaeCA01J. Ethanol (95%) extract of dried leaves, at a concentration of 100.0 mg/disk
(expressed as dry weight of plant) on agar plate, was active on Bacillus subtilis, and
inactive on Escherichia coli, Salmonella typhosa, Shigella dysenteriae, and Staphylococcus aureus. Water
extract, at a concentration of 20.0 mg/disk, was inactive on Bacillus subtilis, Escherichia coli, Salmonella typhosa, Shigella dysenteriae, and Staphylococcus aureusCA040. Ethanol (95%) extract of dried leaves, at a concentration of 500.0
mg/ml on agar plate, was inactive on Escherichia coli, Proteus mirabilis, Proteus vulgaris, and Staphylococcus epidermidis. A concentration of 500.0 micromols/ml was inactive on Staphylococcus aureusCA026. A concentration of 5.0
mg/ml was active on Bacillus subtilis, Escherichia coli, Micrococcus luteus,
Pseudomonas aeruginosa
and Staphylococcus
aureusCA038. Ethanol
(95%) extract ofleaves, on agar plate, was active on Bacillus subtilis, Escherichia coli, Klebsiella pneumonia, Serratia marcescens, and Staphylococcus aureusCA045. Ethanol/water (1: 1) extract of aerial parts, at a concentration of 25.0 mcg/ml on agar
plate, was inactive on Bacillus subtilis, Escherichia coli, Salmonella typhosa,
Staphylococcus aureus and Agrobacterium tumefaciensCA064.
Water extract of dried leaves, at variable concentrations, was active on Pseudomonas aeruginosa and Staphylococcus aureusCAOl4. The water extract of
dried leaves, on agar plate, was active on Escherichia
coli, LCso 1.0 mg/unit and MIC 1.6 mg/ mL
cAo19,cAo18. The methanol extract of leaves, flowers, stem, and root bark
produced a broad spectrum of antibacterial activity. The activity was increased
on fractionation with petrol, dichloromethane and ethyl acetate. The dichloromethane
fraction of the flower extract being the most effectivecAo76. Methanol extract
of leaves, flowers, stem, and root barks produced a broad spectrum activity.
The activity was increased on fractionation with petrol, dichloromethane, ethyl
acetate. The dichloromethane fraction of the flower extract was the most
effectivecAo78.
Anticlastogenic activity. Juice of
leaves, administered by gastric intubation to mice at a dose of 25.0 ml/kg, was
active on bone marrow cells vs mitomycin C-, dimethylnitrosamine-, and
tetracycline-induced micronucleic Ao22.
Anticonvulsant activity. Ethanol/water
(1: 1) extract of
aerial parts, administered intraperitoneally to mice at a dose of 500.0 mg/kg,
was inactive vs electroshockinduced convulsionscAo64.
Antifungal activity. Chloroform,
acetic acid and ethanol (95%) extracts of dried leaves, at concentrations of
5.0 mg/ml on agar plate, showed weak activity on Aspergillus fumigatus, Lasiodiplodia
theobromae, Penicillium italicum and Trichophyton mentagrophytesCAo38. Dried leaf, at a concentration of 20.0% on agar plate, was
inactive on Aspergillus flavus, Aspergillus fumigatus, Mucor species, Penicillium species, and Rhizopus species. Water
extract of dried leaves, at concentrations of 80.0%, 90.0%, and 100.0% applied
externally on human adults, was active on Malassezia
furfur. The extract was applied to the neck, hands,
and trunk. Pityriasis versicolor was treatedCAo69. Methanol (85%) extract of
dried leaves, at a concentration of 2.5% on agar plate, was active on Microsporum gypseum, Trichophyton mentagrophytes, and Trichophyton rubrumCA059. Ethanol (95%) extract of dried leaves, at a concentration of 500
mg/ml on agar plate, was active on Microsporum
canis, Microsporum
gypseum, Trichophyton mentagrophytes, and Trichophyton rubrum, and weakly
active on Aspergillus niger, Cladosporium werneckii, Fusarium solani, and Penicillium species, and inactive on Candida
albicans, Rhodotorula rubra, and Saccharomyces cerevisiaeCA026. Ethanol/water
(1: 1) extract of aerial parts, at a concentration of 25.0 mcg/ml, was inactive on Microsporum canis, Trichophyton mentagrophytes, and Aspergillus nigerCAo64. Hot water
extract of dried bark, leaf and root, at a concentration of 1.0 ml in broth
culture, was inactive on Epidermophyton
floccosum, Microsporum canis, Microsporum gypseum, Trichophyton mentagrophytes vars. Algodonosa and Granulare, and Trichophyton rubrumCAOJ4. Juice of
the dried entire plant, on agar plate, was inactive on Epidermophyton floccosum, Microsporum gypseum and Trichophyton rubrumCA041. Hot water
extract of dried leaves, at a concentration of 5.0% on agar plate, was active
on Trichophyton mentagrophytesCAo48.
Antihistamine activity. Ethanol/water
(1: 1) extract of dried leaves, at variable concentrations, was active on
guinea pigileum cAo66.
Antihyperglycemic activity. Petroleum
ether extract of shade-dried leaves, administered by gastric intubation at a
dose of 100.0 mg/kg to rats, was active vs streptozotocin-induced
hyperglycemiacAol7.
Anti-inflammatory activity. Ethanol (85%)
extract of dried leaves, administered intraperitoneally to mice at a dose of
100.0 mg/kg, was active vs carrageenin-induced pedal edema and cotton pellet
granulomacAo39. Ethanol/water (1: 1) extract of aerial parts, administered
orally to rats at a dose of 500.0 mg/kg, was active vs carrageenin-induced
pedal edema. Animals were dosed 1 hour before carrageenin injectionscAo64.
Shade-dried leaves, administered by gastric intubation to rats at dose of 150.0
mg/kg, were activeCA033.
Antimutagenic activity. Methanolinsoluble
fraction of dried flowers was active vs methylnitrosamine, methyl
methanesul-fonate, or tetracycline-induced genotoxicity CA023.
Antipyretic activity. Ethanol/water
(1:1) extract of dried leaves, administered by gastric intubation at variable
concentrations to rabbit, was inactive vs yeastinduced pyrexiacAo66.
Antispasmodic activity. Ethanol/
water (1: 1) extract of dried leaves, at variable concentrations, was active on
guinea pigileumCA066. Ethanol/water (1: 1) extract of aerial parts was inactive
on guinea pig ileum vs ACh- and histamine-induced spasmsCA064.
Antitumor activity. Acid/water,
ethanol (95%) and water extracts of dried leaves, administered subcutaneously
to mice of both sexes at doses of 0.02 gm/kg, showed weak activity on Sarcoma
37cA067.
Antiyeast activity. Chloroform,
acetic acid, and ethanol (95%) extracts of dried leaves, at concentrations of
5.0 mg/ml on agar plate, showed weak activity on Candida albicanscA038.
Dried leaf, at a concentration of 20.0% on
agar plate, was inactive on Candida
albicanscAol9. Ethanol (95%) extract of dried leaves, at concentrations of 20.0 and
100.0 mg/disk on agar plate, were inactive on Candida
albicanscAo4o. Ethanol/water (1: 1 ) extract of aerial parts, at a concentration
of 25.0 mcg/ml
on agar plate, was inactive on Candida
albicans and Cryptococcus
neoformansCA064• Juice
of the dried entire plant, on agar plate, was inactive on Candida
albicans, Cryptococcus neoformans, and Saccharomyces cerevisiae CA041 . Water extract of dried leaves, on agar plate, showed lClo 28.0 mg/ml and MlC 0.39 mg/ml on Candida albicansCA019,CA018.
Barbiturate potentiation. Ethanol/
water ( 1: 1) extract of aerial parts, administered intraperitoneally to mice
at a dose of 500.0 mg/kg, was inactiveCA064.
Choleretic effect. Leaf
extract, administered orally to rats at doses of 15,30, and 60 mg/kg, was
active. Choleretic activity at the 15 mg/kg dose level was better that a group
treated with 15 mg/kg of hydroxycyclohexenyl butyrate, a synthetic choleretic.
At elevated doses, the extract tends to inhibit bile secretionCA074.
Diuretic activity. Ethanol/water
(1: 1) extract of aerial parts, administered intraperitoneally to male rats at
a dose of 250.0 mg/kg, was active. Urine was collected for 4 hours
posttreatment from saline-loaded animalscAo64.
Embryotoxic effect. Ethanol/water
(50%) extract of dried leaves, administered by gastric intubation to rats at a
dose of 125.0 mg/ kg, was inactivecA063.
Estrous cycle disruption effect. Ethanol/
water (50%) extract of dried leaves, administered by gastric intubation to rats
at a dose of 125.0 mg/kg, was equivocalcAo63.
Hypoglycemic activity. Ethanol/
water (1: 1) extract of aerial parts, administered orally to rats at a dose of
250.0 mg/kg, was inactive. Less than 30% drop in blood sugar level was
observedcAo64. Hot water extract of dried leaves, administered by gastric
intubation to dogs at a dose of 200.0 ml/ animal, produced weak activityCAo49. Petroleum
ether extract of shade-dried leaves, administered by gastric intubation to rats
at a dose of 400.0 mg/kg, was inactiveCAO\7. Leaf extract, administered orally
to streptozotocin-induced hyperglycemic rats, reduced the blood sugar value in
streptozotocin-induced hyperglycemic rats. The extract had no effect on glucose
levels in normoglycemic animalscAo71.
Hypotensive activity. Ethanol/
water (1: 1) extract of dried leaves, administered intravenously to dogs at
variable dosages, was inactiveCA066.
Hypothermic activity. Ethanol/
water (1: 1) extract of aerial parts, administered intraperitoneally to mice at
a dose of 500.0 mg/kg, was inactivecAo64.
Laxative effect. Ethanol/water
(1: 1) extract of dried leaves, administered orally at variable dosages to
human adults, was active. Patients with at least 72 hours of constipation were
treated with either placebo or Cassia. Out of 24 patients treated with Cassia,
83% passed stools in 24 hours. The success rate in the placebo group was only
18%CA012. Hot water extract of dried leaves, administered by gastric intubation
at a dose of 500.0 mg/kg to rats, was active. The extract had 70% of the
activity of senna, Cassia acutifoliaCAOJ6. The
infusion, at a dose of 800.0 mg/kg, was also activeCA021. Leaves, administered
orally to male albino rats, were active. The leaves of Cassia acutifolia Del. was
used as reference standardcAo70.
Molluscicidal activity. Ethanol
(95%) and water extracts of dried trunk bark, at concentrations of 10,000 ppm,
were inactive on Biomphalaria glabrata and Biomphalaria stramineaCA065.
Pityriasis versicolor effect. Leaf
extract has been effective in a 1 O-year human study with no side effectCA07j..
Semen coagulation effect. Ethanol/water (1: 1) extract of aerial parts, at a
concentration of 2.0%,
was inactive on rat semenCA064.
Spermicidal effect. Ethanol/water
(1: 1) extract of aerial parts, at a concentration of 2.0%, was inactive on rat
spermCA064.
Toxic effect (general). Ethanol
(85%) extract of dried leaves, administered intraperitoneally to mice at a dose
of 2.0 gm/kg, was inactiveCAOS8,CA039. Ethanol/water (1: 1) extract of dried
leaves, administered by gastric intubation and subcutaneously at doses of 10.0
gm/kg to mice, was inactivecAo42.
Toxicity assessment (quantitative). Ethanol/ water (1: 1) extract of aerial parts, administered
intraperitoneally to mice, showed LDso 1.0 gm/kgCA064.
Wound healing acceleration. Petrol
(gasoline) extract of dried leaves, applied externally to rabbits at a dose of
10.0%, was active. The extract, in the form of a polyethylene glycol ointment,
was applied daily to a skin wound that had been inoculated with Staphylococcus aureus or Pseudomonas aeruginosa. By 21 days, area of
wound was 87.6% healed over vs 56.2% on controlscAo61.
BENEFITS
DATA (Permenkes No.6. 2016)
Preclinical
Test:
Methanol extract, water, alkaloid salts and alkaloid
base of C. alata leaves showed very strong and significant activity against 2
microbes (Dermatophylus congoensis, Actinomyces bovis and 5 fungi, Microsporum
canis, Blastomyces dermatitidis, Trichophyton mentagrophytes, Candida albicans,
Aspergillus flav. the strongest was observed in methanol extracts, this result
supports the use of C. alata extract as an antifungal in the skin.
Clinical Test:
RCT research on 33 patients in prison (19 studies
and 14 controls) with skin infections of Tineasis versicolor and Tinea corporis
(microscopic visible fungal infections of Epidermophyton floccusum and
Cryptococcus sp) were asked to bathe and rub soap (leaf powder C. alata, NaOH,
and oil) coconut 1.5% ww) on diseased skin twice a day for 1 month. The results
showed that 16 patients (94.1%) who were given C. alata soap significantly lost
their skin infection, while the control group had no change. The results
confirm the use of C. alata as a therapy for dermatitis due to fungi. The
therapeutic effect of C. alata leaf extract on Pityriasis versicolor was
reported from a 10-year human study which showed that leaf extract was
effective for the treatment of Pityriasis versicolor.
DOSAGE
(Permenkes No.6. 2016)
Posology
Ointment: 2 x 1 / day
Soap: 2 x 1 / day
SIDE
EFFECTS (Permenkes No.6. 2016)
A
10-year study on the treatment of fungal dermatitis on the skin in India
reported no side effects.
Cassia fistula L.
(Leguminosae)
Golden Shower
Tree, Indian Laburnum, Purging Cassia
DESCRIPTION:
Cassia fistula L. is a large
tree, which grows to 10 m tall. Leaves are alternate, pinnate, 3–8 pairs of
leaflets, broadly ovate and pointed. Flowers are dense, bright yellow and about
4–5 cm across. Fruit pods are long, 30–60 cm, cylindrical, brown in colour and
contains many seed.[1–3]
Medicinal Parts:
The
medicinal parts of the plant are the bark, fruit and seeds.
Flower and
Fruit: The
flowers are in loose, hanging, 30 to 50 cm long racemes. There are 5 pale
yellow, ovate petals. The diameter of the corolla is approximately 3.8 cm. The calyx
is deeply divided and 5-toothed. There are 10 stamens. The fruit is a legume,
30 to 60 cm long, hanging and indehiscent.
Leaves, Stem and
Root: Cassia
fistula is a tree, that grows up to 9 m high. The leaves are 20 to 40 cm long,
4- to 8-paired pinnate. The leaf spindle is hairy and the leaflet is petiolate,
ovate to oval, acuminate, 5 to 12 cm long, 4 to 9 cm wide and silvery haired
underneath. The young bark is smooth and greenish-gray. Older bark is dark
brown and rough.
Habitat: India, Africa
and South America
Production: Cassia pods are
the dried ripe fruit of Cassia fistula.
Not to be
Confused With: Very
occasionally the tree has been confused with South American Cassia species.
Other Names: Canafistula.
Indian Laburnum, Pudding Pipe Tree, Purging Cassia
ORIGIN:
Native to India and Sri Lanka.[2,4]
PHYTOCONSTITUENTS:
Fistucacidin, chrysophanic acid, chrysophanol, clitorin,
sennosides A and B, chrysophanein and others.[2,4–9]
Anthracene
derivatives (1% in the mesocarp): sennosides, fistulinic acid
Monosaccharides/oligosaccharides
(50%): particularly
saccharose
Fruit acids: citric acid
Steroids: sterols (in the
seeds), including beta-sitosterol
Fatty oil (in
the seeds)
TRADITIONAL MEDICINAL USES:
The whole plant is used for anthrax, burns, cancer, constipation,
convulsions, delirium, diarrhoea, dysentery, dysuria, epilepsy, fever,
influenza, gravel, haematuria, pimples, syphilis, tumours and worms.[4,10]
The leaf is used for skin diseases (juice), healing ulcers, for
ringworm and irritation of skin (juice of young leaves), facial paralysis and
rheumatism (paste).[10] The raw black pulp found between the seeds is a popular
remedy for constipation.[3,4] It is also used as a cathartic, for rheumatism
and snakebite (pulp), treats bacterial infections (pulp mixed with leaves of Cassia angustifolia), liver
complaints, heart disease, reduce fever, as abortifacient, demulcent and is
useful in liver, throat, eye diseases, convulsions and sores.
The seed is an emetic, carminative, appetiser, and is used for constipation,
jaundice, cancer on face and syphilis.[10]
The roots act as a purgative while the rootbark is used for
cleansing wounds.[4] The root is also used as an astringent, tonic, febrifuge,
for skin diseases, leprosy, tuberculous glands, syphilis and epilepsy.[10]
Pharmacological Activities:
Antimicrobial,[11–14] Anticholinergic,[15] Antifertility,[16]
Anti-inflammatory,[17] Antineoplastic,[18] Antioxidant,[19–22] Depressant,[23]
Hepatoprotective,[24–26] Hypocholesterolaemic,[27] Antileishmanial,[28]
Larvicidal[29] and Wound healing.[30,31]
Abortifacient (f; ADP; JFM); Alexiteric (f; WO2);
Allergenic (1; VOD); Amebicide (1; JAC7:405); Analgesic (1; JAF50:5042; MPI;
WO2); Anthelmintic (f; WO2); Antidiabetic (f; X16242721); Antiinflammatory (f1;
WO2); Antioxidant (1; JAF50:5042; X12188605; X15652272; X15991578);
Antiperiodic (f; SKJ; WOI); Antiradicular (1; JAF50:5042); Antisecretory (f;
WO3); Antiseptic (1; PH2; X16678369); Antitumor (f1; ADP; X16242721);
Antitussive (1; JAF50:5042); Antiviral (1; ADP; PH2; WO2); Aperient (f; EFS);
Astringent (f; EGG; SKJ; WO2); Bactericide (1; JAF50:5042; MPG; X12608640;
X16678369); Demulcent (f; ADP); Dentifrice (f; WO2); Deobstruent (f; DEP);
Emetic (f; KAB; WO2); Febrifuge (f; DEP; SKJ; SUW); Fungicide (1; WO2); Hemagglutinant
(1; MPG); Hepatoprotective (f1; X15991578; X16242721); Hypocholesterolemic (1;
JAC7:405); Hypoglycemic (1; ADP; JAC7:405; MPG; WO2); Immunostimulant (1; MPG);
Interferonigenic (1; MPG); Laxative (f1; GHA; HHB; MPG; NPM; PH2; VOD);
Orexigenic (f; KAB; NPM); Polygalacturinase-Inhibitor (1; MPG); Protopectinase
Inhibitor (1; MPG); Purgative (f1; ADP; EGG; JAF50:5042; NPM); Refrigerant (f;
WO2); Stomachic (f; WO2); Tonic (f; NPM; SKJ; WO2); Uterotonic (1; WO3);
Vermifuge (f; VOD); Vulnerary (f; X16242721).
Indications:
Abscesses (f; WO2); Acne (f; ADP); Adenopathy (f;
JLH; SKJ); Amebiasis (1; JAC7:405; WO2); Amenorrhea (f; ADP); Anorexia (f; KAB;
PH2); Anthrax (f; WO2); Arthritis (f; SKJ; WO3); Asthma (f; NPM; WO2); Bacillus
(1; MPG); Bacteria (f1;
JAF50:5042; SKJ; X12608640; X16678369); Biliousness (f; NAD; SKJ); Bites (f;
ADP; NAD); Bleeding (f; WO2); Blindness (f; ADP); Blood (f; WO3); Boils (f;
WO3); Burns (f; ADP); Cancer (f1; ADP; JLH; MPG); Cancer, abdomen (f; JLH);
Cancer, colon (f; JLH); Cancer, face (f; SKJ); Cancer, gland (f; JLH); Cancer,
liver (f; JLH); Cancer, throat (f; JLH); Cancer, uterus (f; JLH); Cardiopathy
(f;
ADP; NAD; WO3); Cerebrosis (f; DEP; WO2);
Chilblains (f; ADP); Cholecocystosis (f; JFM); Colic (f; NAD); Conjunctivosis (f;
WO2); Constipation (f1; ADP; AHL; DEP; GHA; HHB; PH2); Convulsions (f; ADP);
Coughs (1; JAF50:5042; WO2); Delirium (f; ADP); Dermatosis (f; ADP; NPM; PH2;
VOD; WO2); Diabetes (f1; ADP; JAC7:405; NPM; WO2); Diarrhea (f; NPM);
Diphtheria (1; WO2); Dysentery (f; NPM; WO2; WO3); Dyspepsia (f; GHA); Dysuria (f;
ADP; WO2); Eczema (f; NPM); Enterosis (f; WO2); Epilepsy (f; ADP; SKJ); Escherichia (1; MPG; WO3); Fever (f; ADP; PH2; SUW); Flu (f;
AHL); Fracture (f; WO2); Fungus (1; WO2); Gas (f; NAD; PH2; VOD); Gastrosis (f;
GHA; WO2); Giddiness (f; NPM); Gonorrhea (f; WO2); Gout (f; DEP; VOD; WO2);
Gravel (f; ADP); Hematemesis (f; JAF50:5042); Hematuria (f; ADP); Hemorrhoids
(f; GHA); Hepatosis (f1; ADP; JLH; X16242721); Herpes (f; WO2); High
Cholesterol (1; JAC7:405); High Triglycerides (1; JAC7:405); HIV (f; VOD); Hyperglycemia
(1; JAC7:405; WO2); Impostume (f; JLH); Induration (f; JLH); Infection (f1; ADP;
PH2; X16242721; X16678369); Inflammation (f1; JLH; VOD; WO2); Itch (f; PH2; WO2);
Jaundice (f; ADP; PH2); Leprosy (f; WO2); Leukoderma (1; JAF50:5042); Malaria
(f; SKJ); Migraine (f; WO3); Mycosis (f1; ADP; JAF50:5042); Nausea (f; SUW);
Ophthalmia (f; ADP; WO2); Pain (f1; WO3; JAF50:5042; MPI; WO2); Paralysis (f;
DEP; NAD; SKJ); Parasites (f; VOD); Pharyngosis (f; WO2); Pregnancy (f; VOD);
Prickly Heat (f; JFM); Prurigo (f; WO2); Psoriasis (f; ADP); Pulmonosis (f;
ADP; IED); Pustule (f; DEP); Pyoderma (f; ADP); Respirosis (f; IED); Rheumatism
(f; DEP; SKJ; VOD; WO2); Ringworm (f; ADP; DEP); Salmonella
(1; WO2); Sarcoma (1;
MPG); Scabies (f; ADP); Snake Bite (f; NPM; SKJ; SUW); Sores (f; WO2); Sore
Throat (f; NPM; WO2); Staphylococcus (1; MPG); Stings (f; JFM); Stomachache (f; WO2); Swelling (f; JLH;
WO3); Syphilis (f; ADP; NPM); Tonsillitis (f; WO3); Toothache (f; NPM);
Tuberculosis (f; SKJ; VOD); Tumors (f1; JLH; MPG); Typhus (1; WO2); Ulcers (f;
GHA); Vaccinia (1; MPG); VD (f; ADP; NPM; WO2); Viruses (1; MPG;PH2); Wet Dream
(spermatorrhea, nocturnal emissions) (f; WO2); Worms (f; VOD; WO2); Wounds (f;
X16242721).
DOSAGES:
Mode of
Administration: Whole
drug preparations are for internal use.
Preparation: To prepare an
extract, use pulp and distilled water in a 1:1 ratio, macerate, then
exhaustively percolate with distilled water and filter. Evaporate to a soft extract.
FNFF = !! Flowers, leaves, and fruit pulp eaten,
the latter possibly purgative (FAC). Seed eaten (TAN).
4–8 g fruit pulp (HHB; PH2). Asian Indians use
the plant in clarified butter for g • landular tumors (JFM).
·
Curacaoans take the leaf
decoction for gallbladder problems (JFM).
·
Dominicans suggest a
floral syrup for constipation and flu (AHL).
·
Haitians take salted leaf
or fruit decoction for worms (VOD).
·
Jharkandi natives take
ca. 5 g endosperm with honey 2–3 mornings for diabetes (ADP).
·
Nepalese take 4 tsp fruit
pulp 3×/day for hematuria, diarrhea, and dysentery (NPM).
·
CNepalese take 6 tsp teaspoons pulp paste 4×/• day for giddiness
(NPM).
·
Oriyan women insert leaf
paste into genitals once daily for a week for amenorrhea (ADP).
·
Punjabi use root as febrifuge
and tonic (DEP).
·
Rhodesians use the plant
for anthrax, blackwater fever, blood poisoning, dysentery, and malaria (KAB).
·
Yunani consider leaves
antiinflammatory, flowers purgative, the fruits abortifacient, demulcent,
febrifuge, and purgative, using for chest, eye, liver, rheumatic, and throat
complaints (KAB).
OVERDOSAGE
In the case of
overdose, cramp-like gastrointestinal complaints could occur as a side effect
of the laxative effect of the drug. Prolonged administration leads to loss of
electrolytes, particularly of potassium ions, which in turn leads to
aldosteronism, albuminuria, hematuria, inhibition of intestinal motility,
muscle weakness, enhancement of the effect of cardioactive steroids and an
influence upon the effect of antiarrhythmics. In rare cases, administration of
the drug may lead to cardiac arrhythmia, nephropathy, edema and accelerated
osteoclasis.
EXTRACTS:
Oil from the pod was active against Klebsiella
at 500 ppm (FT67(2):173).
Pods have highest total phenolic, proanthocyanidin, and flavonoid contents and
antioxidant potentials (TEAC = 992 +/– 0.4 μM/g dry weight; FRAP = 811 +/- 23
μM/g dry weight) (X12188605).
Adverse Reactions: No
information as yet.
Toxicity: In cases of overdose or
prolonged administration, loss of electrolytes, especially potassium ions,
aldosteronism, albuminuria, haematuria, inhibition of intestinal motility and
muscle weakness may occur. Rarely, cardiac arrhythmia, nephropathy, oedema, and
accelerated osteoclasis may arise.[32]
Contraindications: Contraindicated
with acute inflammatory diseases of intestine and appendicitis. Should not be
used during pregnancy and while nursing. Should not be used in children under
12 years of age.[32]
Drug-Herb Interactions: Interaction
with anthranoid laxatives.[33] Enhancement of effects of cardioactive steroids
may occur. Effects of antiarrhythmics may also be affected.[32]
----------------------------------------‘’’’’’’’’’’’’’’’’’’’’’’’’’’’’------------------------------------------
SENNA
Cassia species
TRADE NAMES
Senna Extract,
Senna Leaf, Ex-Lax Regular Strength, Ex- * Lax Maximum Strength, X-Prep Bowel
Evacuant Liquid, SenokotXTRA, Senokot, Senokot Children's Syrup
DESCRIPTION
Medicinal Parts:
The
medicinal parts are the leaves, fruit and flowers.
Flower and
Fruit: The
flowers are yellow, occasionally white or pink. They are located in axillary or
terminal positions on erect racemes. The calyx is deeply divided with a short
tube and 5 regular, imbricate sepals. There are 5 layered petals. The 4 to 10
stamens are often irregular and partially sterile. The ovary is sessile or
short-stemmed with a short or oblong style. The pod can be cylindrical or flat,
angular or winged and often with horizontal walls between the seeds. The seeds
are numerous and either horizontally or vertically compressed.
Leaves, Stem and
Root: The
genus Cassia comprises shrubs, subshrubs, and herbaceous perennials with
paired-pinnate <J leaves. There are axes with stem glands either between the
leaflets or on the petiole. The stipules have varying shapes.
Habitat: Cassia species
is found in the tropical and subtropical regions of all continents except Europe.
Most varieties are indigenous to North, Central, and South America.
Other Names: Tinnevelly
Senna, India Senna, Alexandrian Senna, Khartoum Senna
PLANT MATERIAL OF INTEREST:
LEAFLETS
General
appearance
Macroscopically,
the leaflets are lanceolate or lanceolate-ovate, unequal at the base, with
entire margin, acute-mucronate apex and short, stout petioles; sometimes
broken; 1.5–5cm in length and 0.5–1.5cm in width, bearing a fine pubescence of
appressed hairs, more numerous on the lower surface (1–7).
Organoleptic
properties
The colour is
weak yellow to pale olive (1, 2). The odour is characteristic,
and the taste is mucilage-like and then slightly bitter (1, 3).
Microscopic
characteristics
Epidermis with
polygonal cells containing mucilage; unicellular thick-walled trichomes,
length, up to 260μm, slightly curved at the base, warty; paracytic stomata on
both surfaces; under the epidermal cells a single row of palisade layer;
cluster crystals of calcium oxalate distributed throughout the lacunose tissue;
on the adaxial surface, sclerenchymatous fibres and a gutter-shaped group of
similar fibres on the abaxial side containing prismatic crystals of calcium
oxalate (1).
Powdered plant
material
Light green to
greenish yellow. Polygonal epidermal cells showing paracytic stomata.
Unicellular trichomes, conical in shape, with warty walls, isolated or attached
to fragments of epidermis. Fragments of fibrovascular bundles with a crystal
sheath containing calcium oxalate prisms. Cluster crystals isolated or in fragments
of parenchyma (2, 3).
HOW
TO USE SENNA
Most senna preparations are standardized to contain a
predictable quantity of sennosides. In Sennokot, each tablet delivers 8.6
milligrams of sennosides, with the usual dosage ranging from two to four
tablets at a time. Other preparations usually provide a specific amount of
dried senna leaves or pods, ranging from 150 to 450 milligrams. Standard doses
are more difficult to get in herbal teas containing senna. If you prefer to use
a tea, become familiar with a specific brand, and steep it a consistent amount
of time to ensure a reproducible response.
AYURVEDA
AND SENNA
Senna is considered a laxative of moderate potency. With
its bitter and cooling effects on the physiology, it is pacifying to Pitta and
Kapha. Used excessively, it can be depleting and aggravating to Vata. According
to Ayurveda, the digestive tract should be prepared before taking senna by eating
lightly and increasing your intake of oily foods such as sesame seeds or ghee
(clarified butter). This “oleation” is said to ensure a smoother, more
comfortable elimination in response to the herbal laxative.
ACTIONS AND PHARMACOLOGY COMPOUNDS
Anthracene
derivatives (2.5-3.5%): chief components sennosides A, Al
and B, as well as sennosides C and D
Naphthacene
derivatives: including 6-hydroxymusizin glucoside
(0.85% in Cassia senna), tinnevellin-6-glucosides (0.3% in Cassia angustifolia)
Alexandrian and Indian senna leaves have similar chemical
compositions, especially in their anthracene derivatives. They contain as their
active constituents dianthrone glucosides (usually 1.5–3.0%), consisting mostly
of sennosides A and B (rhein-dianthrone glucosides), with minor amounts of
sennosides C and D (rhein-aloe-emodin-heterodianthrone glucosides) and
aloe-emodin dianthrone glucoside also present.4–10
These dianthrone glycosides are reportedly
absent in fresh leaves, and it appears that they are formed during the drying
process through enzymatic oxidation of monoanthrone glycosides that are present
in fresh leaves but normally absent in dried leaves (also see cascara).5,11
There is also evidence of the existence of primary glycosides of
the sennosides (with additional sugar molecules) that are more active than the
sennosides.6
Senna leaves also contain small amounts of free anthraquinones (rhein,
aloe-emodin, chrysophanol, etc.) and theirO-glycosides and C-glycosides.2,5–8,11,12 Alexandrian senna leaves generally have a higher
sennoside content than Indian senna leaves. Two benzophenone glucosides have recently been isolated from
Tinnevelly senna pods and were characterized as 60-carboxy-20,
6-dihydroxy- 2 - b - glucopyranosyloxy-40-hydroxymethyl benzophenone and 40,60-dicarboxy-20,6-dihydroxy-2-b-glucopyranosyloxy- 40-hy-roxymethyl benzophenone (cassiaphenone A-2-glucoside
and cassiaphenone B-2-glucoside, respectively). The naphthalene
glycosidetinnevellin- 8-glucosideandkaempferol were also isolated.13
Other constituents present in senna leaves include free sugars
(glucose, fructose, sucrose, and pinitol), a mucilage (consisting of galactose,
arabinose, rhamnose, and galacturonic acid), and polysaccharides (in C.
angustifolia);14,15 flavonoids
(isorhamnetin, kaempferol, etc.); a trace of volatile oil; and resins; among
others (LIST AND HO¨ RHAMMER). Senna pods normally contain 2–5%
sennosides, with Alexandrian pods having higher values than Indian pods. In
addition to sennosides A and B, a closely related glucoside, named sennoside A1, has been isolated from Alexandrian senna
pods.16 A
galactomannon consisting of D-glucose and D-mannose
in a 3:2 molar ratio has recently been isolated from the seeds of Indian senna.17
Sennosides are cathartic, with a similar mode of action as
cascarosides (see cascara). Sennosides A and C have equal purgative potency in
mice but sennoside C has potentiating effects on the activity of sennoside A, exerting
a potentiating effect of about 1.6 when 20% of the dose of sennoside A is replaced
by sennoside C.18 Senna
products along with cascara products are generally considered the drugs of choice
among anthraquinone cathartics, and are also generally considered safe (APhA).19,20 Products
containing purified sennosides (20 mg) reduced colonic transit time in healthy
human volunteers.21 Senna
preparations are continuously being evaluated as alternative laxatives in bowel
preparation for colonoscopy. In this respect, they have comparative efficacy as
sodium phosphate and PEG-electrolyte lavage solutions.22,23
There are controversial data on the adverse effects of senna. On
the one hand, it is reported that excessive or prolonged use of senna, as with
laxatives in general, may lead to colon damage and other problems (APHA; MARTINDALE).24 Stimulating
laxatives should not be used more than 1–2 weeks without medical advice.25 Daily treatment, as with any laxative, is
not recommended. Chronic abuse can disturb electrolyte balance, leading to
potassium deficiency, heart dysfunction, and muscular weakness, especially
under concomitant use of heart-affecting glycosides, thiazide diuretics,
corticoadrenal steroids, and licorice root.25Anumber of toxicity cases due to chronic use of senna have recently
been reported and include skin breakdown and blisters leading to severe diaper rash
in children,26 acute
liver failure with renal impairment,27 and subacute cholestatic hepatitis.28
On the other hand, it is reported that
senna can be safely administered when given in doses sufficient to produce a
motion of physiological water content, even over a long period of time. Senna
does not induce specific lesions in the nerve plexus of the intestinal wall,
and when used rationally, does not lead to electrolyte losses or habituation. 29 Nonsignificant side effects were observed in
rats receiving 750–1500mg/kg/day of senna for 13 weeks. The side effects completely
disappeared after 8 weeks of recovery.30 It was also found that daily administration of up to 300 mg/kg/day
of senna for 2 years was not carcinogenic to mice.31 Earlier studies showed that senna extracts
do not promote malignant tumors in rat colons at laxative doses and that there
was no genotoxic risk associated with the use of senna in animals and humans.32,33 One of the polysaccharides exhibited a significant
inhibitory effect against solid sarcoma 180 in CD1 mice.14 An ethanolic extract of a preparation
containing C. senna (Senokot_) inhibited the effects of different mutagenic agents (e.g.,benzo[a]pyrene,
aflatoxin B1) in the Ames test.34
EFFECTS
Laxative Effects
™
Senna is an
anthranoid-type stimulating laxative. The laxative effect is due to the action
of sennosides and their active metabolite, rhein anthrone, in the colon. The laxative
effect is realized by inhibition of water and electrolyte absorption from the
large intestine, which increases the volume and pressure of the
intestinal contents. This will stimulate colon motility resulting in
propulsive contractions. In addition,
stimulation of active chloride secretion increases water and electrolyte
content of the intestine. These changes in active electrolyte transport are
dependent on calcium in the serosal surface (Donowitz, 1984; Yamauchi, 1993).
The laxative action of Senna is partially via stimulation of colonic fluid and
electrolyte secretion, and this secretion is mediated by stimulation of
endogenous prostaglandin E2 formation (Beubler. 1988: Yamauchi, 1993).
CLINICAL TRIALS
Laxative Effects
A randomized,
single-blind study evaluated the efficacy of Senna compared to polyethylene
glycol (PEG) for mechanical preparation for elective colorectal resection. Five
hundred twenty-three patients included in the study were undergoing resection,
followed by anastomosis. All patients received 5% providone iodine antiseptic
enema before surgery, and ceftriaxone sodium and metronidazole were given at
anesthesia induction. Senna was significantly better than PEG with regard to
colonic cleanliness and less fecal matter in the colonic lumen. The risk for
moderate or large intraoperative fecal soiling was lower with senna and overall
clinical tolerance did not differ significantly between the treatment groups.
Senna was better tolerated in patients with stenosis. There was no statistical
difference between the treatment groups with postoperative infective
complications or anastomotic leakage (Valverde. 1999). A prospective randomized
trial evaluated the efficacy of the addition of senna to a polethylene glycol
electrolyte lavage solution (PEG-ELS). One hundred and twenty patients received
either a Senna extract with PEG-ELS or placebo with PEG-ELS before a total
colonoscopy. Superiority by physician assessment was seen in the group with
Senna. The colon was free of solid debris in 66.7% of patients after PEG-ELS
and in 90% after Senna/PEG-ELS administration, which was a significant
difference. Patient tolerance was similar in both groups, and significantly
less lavage fluid was needed in the Senna/PEG-ELS treatment group (Ziegenhagen,
1991).
A randomized,
open, parallel group study was conducted to determine the efficacy of senna
compared to lactulose in terminal cancer patients treated with opioids.
Ninety-one terminal cancer patients were treated with either senna (starting
with 0.4 mL daily) or lactulose (starting with 15 mL daily) for a 27-day
period. The main outcome measures were defecation-free intervals of 72 hr, days
with defecation, general health status, and treatment cost. Both treatment
groups had similar scores for defecation-free intervals and in days with
defecation. The final scores for general health status were similar in both
groups (Agra, 1998).
PURITY TESTS
Microbiology
The test for Salmonella
spp. in Folium Sennae products should be negative. The maximum acceptable
limits of other microorganisms are as follows (16–18). For
preparation of decoction: aerobic bacteria—107/g; moulds and yeast—105/g; Escherichia
coli—102/g; other enterobacteria—104/g. Preparations for internal use:
aerobic bacteria—105/g; moulds and yeast—104/g; Escherichia coli—0/g;
other enterobacteria—103/g.
Foreign organic
matter
Not more than
2.0% of stems (1) and not more than 1.0% of other foreign organic matter
(1, 4, 8).
Total ash
Not more than
12% (5).
Acid-insoluble
ash
Not more than
2.0% (1, 8).
Water-soluble
extractive
Not less than 3%
(1).
Moisture
Not more than
10% (6).
Pesticide
residues
To be
established in accordance with national requirements. Normally, the maximum
residue limit of aldrin and dieldrin in Folium Sennae is not more than 0.05
mg/kg (18). For other pesticides, see WHO guidelines on quality control
methods for medicinal plants (16) and guidelines for predicting dietary
intake of pesticide residues (19).
Heavy metals
Recommended lead
and cadmium levels are not more than 10 and 0.3mg/kg, respectively, in the
final dosage form of the plant material (16).
Radioactive
residues
For analysis of
strontium-90, iodine-131, caesium-134, caesium-137, and plutonium-239, see WHO guidelines
on quality control methods for medicinal plants (16).
Other purity
tests
Chemical tests
and tests of alcohol-soluble extractive are to be established in accordance
with national requirements.
INDICATIONS AND USAGE
• Constipation
Senna is used for constipation
and for evacuation of the bowel prior to diagnostic tests of the
gastrointestinal and colorectal area.
Indian Medicine:
The
herb is used for constipation, liver disease, jaundice, splenomegaly, anemia,
and typhoid fever.
Note: Stimulating laxatives
must not be used over a period of more than 1 to 2 weeks without medical
advice.
CONTRAINDICATIONS
The herb is not
to be administered in the presence of intestinal obstruction, acute
inflammatory intestinal diseases or appendicitis.
PRECAUTIONS AND ADVERSE REACTIONS
General: Spasmodic
gastrointestinal complaints can occur as a side effect to the drug's purgative
effect or from overdosage. In rare cases, prolonged use may lead to cardiac
arrhythmias, nephropathies, edema and accelerated bone deterioration. Senna
abuse has also resulted in tetany, aspartylglucosamine excretion, and .
hypogammaglobulinemia (Levine, 1981; Malmquist, 1980; Prior, 1978).
Electrolyte Abnormalies: Long-term use
leads to loss of electrolytes, in particular potassium ions. As a result of
hypokalemia, hyperaldosteronism, albuminuria, hematuria, inhibition of
intestinal motility, and muscle weakness may occur. Enhancement of cardioactive
glycosides and antiarrythics may also occur with hypokalemia.
Finger Clubbing: Senna abuse has
resulted in finger clubbing, which was reversible upon discontinuation of the
drug (Levine, 1981; Malmquist, 1980; Prior, 1978; Silk, 1975).
Cathartic Colon: Anatomic
alteration of the colon is seen secondary to chronic use with Senna (more than
three times weekly for 1 year or longer). The result is a loss of haustral
folds, a finding that suggests neuronal injury or damage to colonic
longitudinal musculature (Joo, 1998).
Carcinogenesis: Carcinogenic
activity in the colon following'" long-term administration of anthracene
drugs has not yet been fully clarified. Study findings are controversial
regarding the correlation between the administration of anthracene drugs and
the frequency of carcinomas in the colon (al- Dakan, 1995; Mereto, 1996).
Melanosis Coli: Prolonged use of
Senna may lead to melanosis coli. Precursors of the melanic substance in
melanosis coli may be derived from anthranoid laxatives (Benavides, 1997).
Occupational Sensitization: IgE-mediated
allergy, asthma, and rhinoconjunctivitis have been reported after occupational
exposure to senna products (Helin, 1996, Marks, 1991).
Tissue Damage: Chronic
treatment with anthranoids in high doses reduces vasoactive intestinal
polypeptide and somatostatin levels in the colon, which may represent damage to
the enteric nervous tissue (Tzavella, 1985).
General
Use for more than 2 weeks requires
medical attention (21, 31).
Drug
interactions
Decreased intestinal transit time may
reduce absorption of orally administered drugs (32, 33). The
increased loss of potassium may potentiate the effects of cardiotonic
glycosides (digitalis, strophanthus). Existing hypokalaemia resulting from
longterm laxative abuse can also potentiate the effects of antiarrhythmic
drugs, such as quinidine, which affect potassium channels to change sinus
rhythm. Simultaneous use with other drugs or herbs which induce hypokalaemia,
such as thiazide diuretics, adrenocorticosteroids, or liquorice root, may
exacerbate electrolyte imbalance (21, 22).
Drug and
laboratory test interactions
Urine discoloration by anthranoid
metabolites may lead to false positive test results for urinary urobilinogen,
and for estrogens measured by the Kober procedure (32).
Carcinogenesis,
mutagenesis, impairment of fertility
No in vivo genotoxic effects have
been reported to date (34–37). Although chronic abuse of
anthranoid-containing laxatives was hypothesized to play a role in colorectal
cancer, no causal relationship between anthranoid laxative abuse and colorectal
cancer has been demonstrated (38–40).
Pregnancy:
non-teratogenic effects
Use during pregnancy should be limited
to conditions in which changes in diet or fibre laxatives are not effective (41).
Nursing mothers
Use during breast-feeding is not
recommended owing to insufficient data on the excretion of metabolites in
breast milk (21). Small amounts of active metabolites (rhein) are
excreted into breast milk, but a laxative effect in breast-fed babies has not
been reported (21).
Paediatric use
Contraindicated for children under 10
years of age (21).
Other
precautions
No information available on teratogenic
effects in pregnancy.
DRUG INTERACTIONS:
Digitalis
Glycosides — With prolonged use or abuse of Senna, loss of potassium may
potentiate digitalis toxicity.
Antiarrythmics —
Loss of potassium associated with prolonged use of Senna may potentiate
arrhythmias when given concomitantly with antiarrhythmic medications.
Estrogen — The
serum level of estrogen is decreased when given concomitantly with Senna due to
the effect of intestinal transit on the absorption of estrogens (Lewis,1998).
Indomethacin
(NSAIDS) — Indomethacin given concomitantly with Senna pod extract had a
dose-dependent inhibition of net fluid transport due to~ the v inhibition of
prostaglandin E2 (SEE EFFECTS), which decreases the therapeutic effect of the
Senna (Beubler, 1985).
Nifedipine
(calcium channel blocker) — Therapeutic effects induced by rhein anthrone also
involve the calcium channel which can be blocked by nifedipine, but not
verapamil (SEE EFFECTS) (Yamauchi, 1993).
Pregnancy: The drug should
not be used during pregnancy or while nursing.
Pediatric Use: Not to be used
by children under 2 years of age. Children between the ages of 2-12 years
should follow proper dosage recommendations.
Elderly: Elderly patients
should initially take half of the normal prescribing dose.
ADVERSE REACTIONS
Senna may cause
mild abdominal discomfort such as colic or cramps (21, 22,33).
A single case of hepatitis has been described after chronic abuse (42).
Melanosis coli, a condition which is characterized by pigment-loaded
macrophages within the submucosa, may occur after long-term use. This condition
is clinically harmless and disappears with cessation of treatment (33, 43,
44). Long-term laxative abuse may lead to electrolyte disturbances
(hypokalaemia, hypocalcaemia), metabolic acidosis or alkalosis, malabsorption,
weight loss, albuminuria, and haematuria (21, 22, 33).
Weakness and orthostatic hypotension may be exacerbated in elderly patients
when stimulant laxatives are repeatedly used (21, 33). Conflicting
data exist on other toxic effects such as intestinal-neuronal damage due to
long-term misuse (45–54).
DOSAGE
Mode of
Administration: Comminuted
herb, powder or dried extracts for teas, decoctions, cold macerates, or
elixirs. Liquid or solid forms of medication exclusively for oral use.
How Supplied:
·
Capsule
— 25 mg, 450 mg
·
Chewable
tablet — 15 mg sennosides
·
Granules
— 15 mg sennosides per teaspoon
·
Liquid
— 2.5 oz. (alcohol 7% by volume), 8.8 mg sennosides per teaspoon
·
Tablet
— 8.6 mg sennosides, 15 mg sennosides, 17 mg sennosides, 25 mg sennosides
Preparation: To prepare an
infusion, pour hot water (not boiling) over 0.5 to 2 gm of comminuted drug,
steep for 10 minutes, then strain; or steep in cold water for 10 to 12 hours,
then strain. The cold water method, according to various authors, should result
in a solution containing less resin, which is responsible for abdominal pain.
The drug takes effect after a latency period of 10 to 12 hours.
PREPARATION FOR SURGERY
• Adult PO black draught: dissolve 3⁄4 oz in 2.5 oz
liquid; take between 2 and 4 PM the day before the procedure
Other
·
Adult PO cold infusion,
comminuted herb: pour cold water over 0.1-0.2 g herb, let stand 10 hr, strain;
1 _
dose
·
Adult PO granules: add 1⁄2-4
tsp granules to water or juice
·
Adult PO infusion, comminuted
herb: pour hot water over 0.1-0.2 g herb, let stand 10 min, strain; 1 _ dose
·
Adult suppositories: insert 1-2
suppositories at bedtime
·
Adult PO syrup: 1-4 tsp at
bedtime (7.5-15 ml)
·
Adult PO tablets (Senokot): 1-8
tabs/day
·
Child PO syrup _27 kg: use 1⁄2 adult dose
·
Child PO syrup 1 mo-1 yr: use
1.25-2.5 ml Senokot at bedtime
NOTE: Do not give black draught to children.
DAILY DOSAGE
·
Constipation
— The average dose is 20 to 60 mg sennosides.
·
Chewable
Tab — Adults and children 12 years of age and over, chew 2 tabs once or twice
daily. Children 6 to under 12 years of age, chew 1 tab once or twice daily
(Prod Info Ex- Lax®, 1998).
·
Granules
(15 mg sennosides per teaspoon) — Adults and children 12 years of age,
administer 1 teaspoon once daily with a maximum of 2 teaspoons twice daily.
Children 6 to 12 years of age, administer xh teaspoon once
daily with amaximum of 1 teaspoon twice a day. Children 2 to 6 years of age,
administer lU teaspoon daily
with a maximum of lh teaspoon twice
daily (Prod Info Senokot®, 1993).
·
Liquid
(8.8 mg sennoside per teaspoon) — Children 6 to 12 years of age, administer 1
to 1 'h teaspoon once daily witii a maximum of 1 xh teaspoon twice
daily. Children 2 to 6 years of age, administer lh to 3A teaspoon once
daily with a maximum of 3A teaspoon twice
daily (Prod Info Senokot®, 1991).
·
Pills
— Adults and children 12 years of age and over should take 2 pills once or
twice daily with a glass of water.
·
Children
6 to under 12 years of age: take 1 pill once or twice daily with a glass of
water. Children under 6 years of age: consult a doctor (Prod Info Ex-Lax®,
1998).
·
Tablets
(8.6 mg sennosides) — Adults and children 12 years of age, administer 2 tablets
once daily with a maximum of 4 tablets twice daily. Children 6 to 12 years of
age, administer 1 tablet once daily, with a maximum of 2 tablets twice daily.
·
Children
2 to 6 years of age, adminster xh tablet once
daily with a maximum of 1 tablet twice daily (Prod Info Senokot®, 1993).
·
Tablets
(17 mg sennosides) — Adults and children 12 years of age, administer 1 tablet
once daily with a maximum of 2 tablets twice daily. Children 6 to 12 years of
age, administer xh tablet once
daily with a maximum of 1 tablet twice daily (Prod Info SenokotXTRA®, 1993).
DOSAGES
0.5–2 g (0.5–1 tsp)/cup water (APA); 1–2 g fruit
(WHO); 3–6 alexandrian or 4–12 tinnevelly pods steeped in 150 ml warm water
6–12 hours (CAN); 0.5–2 g dry leaflets (CAN); 1–2 g dry leaf (PED; WHO); 1 g
dry leaf:5 ml alcohol/5 ml water (PED); 0.5–2 ml liquid leaf extract (1:1 in
25% ethanol) (CAN); 20–30 mg hydroxyanthracene derivatives/day calculated as
sennoside B (KOM); 2 (25 mg) StX extracts 1–2 ×/day (APA); 10–60 mg sennosides (SKY).
POSOLOGY
The correct
individual dose is the smallest required to produce a comfortable, soft-formed
motion (21). Powder: 1–2g of leaf daily at bedtime (11). Adults
and children over 10 years: standardized daily dose equivalent to 10–30mg
sennosides (calculated as sennoside B) taken at night.
Bowel Evacuation:
Liquid (alcohol
7% by volume) — Adults and children 12 years of age and older should take one
bottle between 2 and 4 p.m. on day prior to x-ray or other diagnostic
procedures. Drink entire contents of bottle. A strong bowel action can be
expected
approximately 6 hours after drinking the preparation (Prod Info X-Prep®,1998).
Storage: Senna should be
protected from light (DAB 10 EUR), and stored for a maximum of 3 years
(2.AB-DDR).
CONTRAINDICATIONS
Pregnancy category is 1; breastfeeding category is 3A.
Senna should not be given to children younger than 12 years
of age unless prescribed by a physician. It should not be used by persons with
intestinal obstruction, ulcerative colitis, gastrointestinal bleeding,
appendicitis, nausea, vomiting, congestive heart failure, or an acute condition
in the abdomen caused by surgery. Persons with hypersensitivity to senna should
not use it. This herb should not be used for longer than 1-2 weeks without
medical advice.
SIDE EFFECTS/ADVERSE REACTIONS
GI: Nausea, vomiting, anorexia, cramping, diarrhea, fl
atulence, acute
liver failure (senna abuse) (Vanderperren
et al, 2005)
GU: Pink, red, brown, or black urine; renal impairment
(senna abuse)
INTEG: Hypersensitivity reactions
META: Hypocalcemia, enteropathy, alkalosis, hypokalemia, tetany
INTERACTIONS
Drug
Cardiac
glycosides (digoxin):
Chronic use of senna may
potentiate cardiac glycosides
Disulfi ram: Do not use senna with disulfi ram (Antabuse).
Interactions—cont’d
Laxatives: Avoid the concurrent use of senna with other laxatives;
additive effect can occur.
Herb
Jimsonweed: The action of jimsonweed is increased in cases of
chronic use or abuse of senna.
Stimulant
laxative herbs: Senna may increase the laxative
effect of stimulant laxative herbs.
Lab Test
Serum, 24-hour
urine estriol: Senna may cause decreased serum
and 24-hour urine estriol.
Pharmacology
Pharmacokinetics
Onset of action 6 to 24 hours; metabolized by the
liver; excreted in the feces.
CLIENT CONSIDERATIONS
Assess
• Assess for hypersensitivity reactions. If present,
discontinue the use of senna and administer an antihistamine or other
appropriate therapy.
• Assess stools for color, consistency, character, and
presence of blood and mucus.
• Monitor blood and urine electrolytes if the client is
using this product often.
• Determine the cause of constipation (e.g., fl uids,
bulk, and/or exercise missing from lifestyle).
• Assess for cramping, rectal bleeding, nausea, and
vomiting. If these are present, discontinue the use of senna.
• Assess medication and herb use (see Interactions).
Administer
• Instruct the client to store senna products in a
sealed container away from heat and moisture.
• Instruct the client to dissolve granules in water or
juice before use.
• Instruct the client to shake oral solution before
use.
Teach
Client/Family
• Inform the client that pregnancy category is 1 and
breastfeeding category is 3A.
• Caution the client not to give senna to children
younger than 12 years of age.
• Advise the client that the use of laxatives on a
regular basis leads to loss of bowel tone.
• Advise the client that urine and feces may turn
yellow, brown, or red.
• Advise the client not to use senna if abdominal pain,
nausea, or vomiting are present.
Cassia obtusifolia
Cassiae
semen
Jue ming zi
Family:
Caesalpinaceae
Standard species: Cassia obtusifolia, C. tora
German:
Cassiae-Samen, Sicklepodsamen
English: cassia
seeds, foetid cassia seeds, ‘realized brightness seed’
Temperature
cold tendency
Taste
bitter
sweet
Organ
relationship
Liver
Gall bladder
Kidney
Direction
of action
sinking
Site
of action
Head and eyes
Actions/Indications
Cools heat
Red and swollen eyes
Drains fire
Red, painful,
light-sensitive eyes, lacrimation, glaucoma, dizziness, vertigo
Brightens the eyes
Blurred vision, red,
swollen, light-sensitive eyes, lacrimation
Expels wind-heat
Red, painful, itchy,
light and wind-sensitive eyes, lacrimation
Descends the yang
Rectal bleeding due
to heat, haematemesis
Unblocks the bowels/laxative
Constipation due to
Liver yin deficiency
PHYSIOLOGICAL/PHARMACOLOGICAL EFFECTS
arteriosclerosis,
elevated serum cholesterol (use high dosages 30 g), antibiotic, antihypertensive,
diuretic (use with care in combination with other diuretics), increases uterine
contractions.
DOSAGE
10–30 g, standard 10 g
COOKING TIME
20 minutes
COMBINATIONS
·
Liver
fire with red, painful and swollen eyes, lacrimation, glaucoma; Kidney
·
deficiency
➔
Astragali
semen (sha yuan ji li) p. 732, Ligustri lucidi fructus (nü zhen
·
zi) p. 794, Lycii fructus (gou qi zi)
p. 800, Rehmanniae radix (sheng di huang) p. 168
·
Liver
fire or wind-heat with red and painful eyes ➔ Chrysanthemi flos (ju hua)
·
p.
52, Mori folium (sang ye) p. 62
·
Liver
heat or fire with eye problems ➔ Prunellae spica (xia ku cao) p.
140,
·
Gardeniae
fructus (zhi zi) p. 126
·
Temporal
headache due to wind-heat ➔ Ligustici sinensis radix (gao ben)
p. 32,
·
Viticis
fructus (man jing zi) p. 72
·
Dryness
in the Intestines, constipation ➔ Angelicae sinensis radix (dang gui)
p. 768
·
Constipation
with foetor, red eyes, scanty red urine ➔ Bambusae folium
·
(xian
zhu ye)
COMPATIBILITY
·
Impaired
by Cannabis semen (huo ma ren) p. 96
·
Reduces
the toxicity of Cinnabaris (zhu sha) p. 418
CONTRAINDICATION
diarrhoea
due to Spleen deficiency
PREGNANCY
use
with caution
--------------------------------------------‘’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’--------------------------------------------
Cassia grandis L. f. ++
PINK SHOWER
CAESALPINIACEAE
SYNONYMS
Bactyrilobium
grande (L. f.) Horn.; B. molle (Vahl) Schrad.; Cassia brasiliana Lam.; C. mollis Vahl;
C.
pachycarpa Lam.; Cathartocarpus
brasilianus (Lam.) Jacq.; Cathartocarpus grandis
(L. f.) Pers.; fide (MPG; USN).
Notes:
Thai traditional medicines treat gastrointestinal ailments
with C.
grandis which may partly explain the lower
incidence of gastric cancer in Thailand (X14758718).
COMMON NAMES
Appleblossom Cassia (Eng.; USN); Arbol de Fuego (Sp.; USN);
Bacul (Ma.; TTS); Baton Casse (Haiti; AHL; AVP); Beef Feed (Bel.; Eng.; BNA); Bocot
(Ma.; JFM); Boocoot (Ma.; JFM); Bookut (Bel.; BNA); Bucut (Guat.; Maya; MPG);
Buk-et (Bel.; BNA); Canadonga (Col.; AVP); Canafistola (Brazil; Ven.; AVP); Canafistula
(Mex.; Pan.; AVP); Canafistula Burrero (Ma.; Ven.; JFM; LWW); Canafistula
Cimarrona (Dor.; Pr.; AHL); Canafistula de Castilla (Ma.; TTS); Canafistula
Grande (Ma.; JFM); Canafistula Gruesa (Col.; Ma.; JFM; TTS); Canafistula Macho
(Ma.; Ven.; JFM; LWW); Canaflote (Ven.; AVP); Canandonga (Cuba; Ma.; JFM; RyM);
Canandonga de Masa (Ma.; JFM); Carago (Sal.; AVP); Caragua (Sal.; AVP); Carague
(Guat.; Sal.; AVP; MPG); Caramano (Nic.; AVP); Carambano (Nic.; AVP); Carao
(Bel.; Guat.; Hon.; Pan.; AVP; BNA; MPG); Casia (Sp.; AVP); Casse (Haiti; AHL; AVP); Casse de Bresil (Fr.; USN); Casse Espagnol (Haiti; AHL;
AVP); Cassia (It.; AVP); Chacara (Dor.; AHL); Chacaro (Dor.; AHL); Coral Shower
(Eng.; USN); Coral Showertree (Eng.; VOD); Geneuna (Por.; AVP); Giganton (Ma.;
JFM); Great Cassia (Ma.; JFM); Grobfruchtige Kassie (Ger.; USN); Guayaba
Cimarrona (Dor.; AHL); Horse Cassia (Eng.; Jam.; AVP; VOD); Jeneuna (Por.;
AVP); Kas (Creole; Haiti; VOD); Kas Mawon (Creole; Haiti; VOD); Liquorice Tree
(Eng.; TTS); Macut (Ma.; TTS); Maremare (Ma.; JFM); Marimari (Brazil; Peru;
AVP; EGG; RAR); Marimary Preto (Ma.; JFM); Marimary Rana (Brazil; Ma.; JFM;
LWW); Marimary Sano (Brazil; Ma.; JFM; LWW); Mucut (Guat.; JFM; MPG); Pink
Shower (Eng.; FAC; JFM; USN); Pink Showertree (Eng.; VOD); Quauhuayo (Ma.;
Mex.; JFM; LWW); Sandal (Ma.; JFM); Sandalo (Ma.; JFM; TTS; USN); Santal (Guat.;
MPG); Saragundin (Cr.; IED); Sene Gran’ Fey (Creole; Haiti; VOD); Stinking Toe
(Bel.; AVP; BNA; FAC). (Nscn; American entries diacritically prepared).
ACTIVITIES
Abortifacient
(f; MPG; VOD); Anticancer (f1; MPG; X14758718); Antiseptic (f; MPG); Antitumor
(f; MPG); Astringent (f; EGG; MPG); Depurative (f; MPG);
Diuretic (f; MPG); Expectorant (f; MPG); Febrifuge (f; MPG); Fungicide (1; MPG;
X2056755; X8145577); Lactagogue (f; MPG); Laxative (f; MPB; TTS); Pectoral (f;
MPG); Purgative (f; AHL; MPG); Sedative (f; MPG); Stimulant (f; MPG); Tonic (f;
MPG).
INDICATIONS
Anemia (f; MPG); Arthrosis (f; VOD); Bleeding (f; MPG);
Cancer (f1; MPG; X14758718); Colds (f; MPG); Constipation (f1; IED; MPB; TTS);
Coughs (f; MPG); Dermatophyte (1; MPG; X2056755; X8145577); Dermatosis (f1;
AHL; IED; MPB; MPG; VOD); Dysmenorrhea (f; VOD); Dyspepsia (f; VOD); Enterosis
(f; IED; VOD); Epistaxis (f; MPG); Fever (f; MPG); Fungus (f1; MPG; X2056755;
X8145577); Gastrosis (f; VOD); Hepatosis (f; MPG); Herpes (f; MPG); Hysteria
(f; VOD); Infection (f1; MPG; VOD); Insomnia (f; MPG); Itch (f; VOD); Mange (f;
MPG); Mucososis (f; MPG); Mycosis (f; MPG); Nervousness (f; VOD); Parasites (f;
IED); Pulmonosis (f; IED); Respirosis (f; IED); Rheumatism (f; VOD); Sores (f;
IED); Tinea (f; MPG); Urethrosis (f; MPG); Viruses (f; MPG); Vitiligo (f; MPG);
Worms (f; IED); Wounds (f; MPG).
DOSAGES
FNFF = ! Pulp around seeds edible (IED; FAC; MPG).
Costa Ricans use the fruit pulp, cooked i • n milk, for
anemia (JFM).
·
Cubans consider the fruit pulp
abortifacient and useful in chest complaints (JFM).
·
Cubans steep roots 3 days in alcohol
as antiseptic for dermatosis and wounds (RyM).
·
Dominicans suggest mashed leaves with
bacon fat for veterinary skin ailments (AHL).
·
Guatemalans fashion an unguent from
the leaves for dermatosis, herpes, sores, tinea, and vitiligo (MPG).
·
Guatemalans take bark/fruit/leaf
decoction for anemia, cold, cough, hepatosis, hysteria, nosebleed, and urinary
infections (MPG).
·
Haitians apply macerated root
tincture for skin infections (VOD).
·
Haitians massage skin ailments, like
itch, with crushed leaves (VOD).
·
Haitians drink a beverage made from
leaf, flower, fruit pulp, a/o seeds as an abortifacient and for hysteria and
nervousness (VOD).
·
Haitians take root and bark infusion
for rheumatism (VOD).
·
Haitians take salted leaf decoction
for digestive tract ailments (VOD).
·
Nicaraguans use fruit and leaf
decoction, or juice syrup, orally or topically for constipation,
respiratory-pulmonary disorders, worms and intestinal parasites, skin rashes,
and sores (IED).
DOWNSIDES
Too much of the edible fruit pulp is said to be abortifacient
and certainly laxative. As of July 2007, the FDA Poisonous Plant Database
listed four titles alluding to toxicity of this species.
EXTRACTS
Methanolic leaf extract inhibited
growth of HP strains MIC = 50.0 μg/ml.
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