Cascara sagrada

Overview. Cascara sagrada is the dried and aged bark of a small tree native to the Pacific Northwest of North America, long used by Indigenous peoples and adopted by nineteenth century eclectic physicians as a gentler alternative to harsher purgatives of the era. It became one of the most widely dispensed laxatives in American and European pharmacy through the twentieth century, valued for producing a soft, well-formed stool without the griping associated with other anthraquinone drugs. The bark must be aged for at least a year, or artificially aged by heat, before use, since fresh bark contains free anthrones that cause significant cramping.

Clinical Notes. Cascara earns its old reputation as a laxative that restores rather than simply forces evacuation, provided it is dosed conservatively. The eclectic approach of starting with very small doses and slowly tapering as bowel tone returns remains sound practice: large initial doses provoke a cathartic effect that leaves the bowel more dependent, not less.

Action and Therapy. Cascara is a simple and practically non-griping purgative, acting with but little or no prostration and never causing a watery stool. It has, moreover, a tonic action upon the stomach and bowels, and does not produce an after constipation.

Therapy. Large doses of the agent produce colic and are seldom needed. In the temporary constipation of pregnancy or in the convalescence of acute disease, doses of from one-fourth to one-half dram in a tonic mixture, preferably of malt extract, taken at the bed hour will be most satisfactory.