Table of Contents
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Senna was first used as a medicine by the Arabians. It was noted in their writings in the 9th century. The plant derives its name from the Arabic “sena” and from the Hebrew word “cassia,” which means “peeled back,” a reference to its peelable bark. Senna is obtained from the leaflets of Cassia acutifolia, Cassia obovate and Cassia elongata. Senna has a nauseous and bitter taste and a somewhat fragrant and sickening odor. Its aroma is based on a volatile oil. While its characteristic taste and laxative properties were believed to be based on a chemical contained in the leaf known as cathartin, studies at the time challenged this assumption. The active ingredients of senna are currently referred to as sennosides and its mechanism of action is to irritate the colon wall increasing fluid in the colon producing a bowel movement. Senna can turn the color of urine from yellow to pink to red to violet.1-4
Senna is primarily used as a laxative or a purgative. The difference between a laxative and a purgative is that a laxative is considered a mild or gentle cathartic. Purgatives are divided into several classes based on the severity or mode of action: drastic, simple, saline, hydragogue and laxative. During the mid-1800’s, Senna was considered to be a very safe laxative that could be given to children, females and the elderly. If judiciously dosed and managed, it produced an active, but not a violent or drastic bowel movement. It was a favorite remedy for both occasional and chronic constipation and was also used in cases requiring a prompt and copious evacuation of the bowels without causing a watery diarrhea. Senna, when taken during nursing was said to purge suckling infants. The primary objections to its use were the large dose required, its offensive flavor, cramping, flatulence, nausea and irritating and stimulating bowel movements. Therefore, senna was seldom given alone and usually administered with aromatics such as fennel, ginger, cinnamon or salines,[1] a sufficient quantity of fluid or administered with other laxatives. It was typically not recommended after childbirth or after abdominal and pelvic surgeries, such as hernia and lithotomy. Some physicians did use it in these settings without complications. Senna should be avoided if someone had inflammatory conditions of the alimentary canal, hemorrhoids or menorrhagia, threatening abortion and prolapse of the uterus or rectum.2,4,5-7
FORMULATIONS
Infusion of Senna (Infusum Sennae)
Senna infusions were made by adding 1 ounce of senna and 60 grains of bruised coriander to 1 pint of boiling water. The mixture was macerated for 1 hour in a covered vessel and then strained. However, a more convenient form of the infusion was made by pouring about 6 ounces of boiling water over 2 to 6 drachms of senna leaves in a tea pot and letting it stand for about an hour.8
Senna infusions were frequently used in the treatment of constipation and other acute diseases where a laxative effect was desired. It was also recommended as a treatment for round worms. The infusion had almost everything in its favor except its taste and was used when a single dose of an efficient but not drastic cathartic was required. It was less cramping than senna powder or a simple decoction because the infusion did not steep long enough to extract all the bitter and acrid constituents of the senna and because of the aromatics and salines added to the infusion to counteract its unpleasant effect. The unpleasant taste of the infusion was covered by the addition of tamarinds, sugar or the addition of aromatics such as coriander and ginger. The usual adult dose was 2 to 4 fluid ounces. It was recommended to add 1 grain of nitrate of potash to each ounce of infusion to preserve the infusion in warm weather.4,9,10
When tamarinds were added, the infusion was referred to as the compound infusion of senna. An infusion of senna mixed with salines, manna, and fennel seed was known as black draught and administered in an adult dose of 2 to 4 ounces. Senna was never administered as a decoction because of the decomposition of the active ingredients that produced its laxative effects. The tincture was never used because of the large volume of fluid required to administer an effective dose. 2-4,6-9
Fluid Extract of Senna (Extractum Sennae Fluidum)
The fluid extract was the most concentrated and active of all of the senna preparations. The fluid extract was made by mixing 16 ounces of moderately fine senna powder with 8 ounces of coarse powdered sugar and diluted in a sufficient quantity of alcohol. The senna was moistened with 6 ounces of the diluted alcohol and placed in and firmly pressed into a conical percolator. The diluted alcohol was gradually poured onto the mixture until a pint of tincture was obtained. The mixture was then set aside in a warm place until reduced by spontaneous evaporation to half a pint. Percolation was continued until 2 more pints of tincture were obtained. Sugar was then added to the mixture and evaporated with the aid of a water-bath down to a final volume of half a pint. Finally, the solution was mixed with the reserved tincture and strained. The dose as a laxative for children was a fluidrachm and ½ fluid ounce for an adult.2-4,8
Syrup of Senna (Syrupus Sennae)
Two ounces of senna powder was mixed with 1 ounce of bruised fennel seed, 1 pint of boiling water and 15 ounces of sugar. The senna and the fennel-seeds were soaked in the water with a gentle heat for 12 hours and then strained. The sugar was added, and the syrup evaporated to the proper consistency. The syrup was primarily used as a mild laxative for children in a dose 1 to 2 fluidrachms.2,4,6,11
Confection of Senna (Confectio Sennae)
Eight ounces of fine senna powder was mixed with 4 ounces of fine coriander powder, 16 ounces of finely bruised purging cassia, 10 ounces of tamarind, 7 ounces of sliced prunes, 12 ounces of bruised figs and 30 ounces of coarse powdered sugar and a sufficient volume of water. The mixture of the purging cassia, tamarind, prune, and fig in 3 pints of water was softened in a closed vessel and heated with a water-bath for 3 hours. Following this, the coarser portions were separated by hand and passed the pulpy mass, by rubbing, first through a coarse sieve and then through a fine one or a muslin cloth. The residue was mixed with a pint of water and softened for a short time, was then treated as before and added to the pulpy liquid first obtained. Then, by means of a water-bath, the sugar was dissolved in the pulpy liquid and evaporated until it weighed 96 ounces or until it was brought to the consistency of honey. Lastly, the senna and coriander were added and thoroughly mixed with the other ingredients while they were still warm.8
When properly prepared, it was one of the best, most pleasant, mild, and effective laxatives and was frequently used by pregnant women, persons afflicted with chronic constipation, hemorrhoids and other diseases of the rectum and constipation occurring when recovering from fevers and other acute diseases.Unfortunately,the preparation was rarely used because it was difficult to prepare, expensive and the sophistication of the preparation was not appreciated by the user.2,6
The confection of senna was a mild and efficient laxative in a dose of 120 grains. In doses of 1 to 2 drachms it was a useful laxative for pregnant women and for chronic constipation. The mean dose was 2 drachms taken at bedtime. When given alone in a full dose up to 6 drachms it was apt to cause cramping and therefore, was frequently used as the basis for other cathartic or purgative pills such as bitartrate of potash.2-4
Senna Powder
Senna powder was rarely used because of the large quantity of powder necessary for the dose and the uncertainty of its effect. The powder was usually mixed with black tea or coffee to cover its unpleasant flavor, and aromatics such as coriander and ginger were frequently mixed with the powder to prevent cramping and also to improve its flavor. Senna powder was given in doses of ½ to 1 drachm for adults, but due to the bulkiness of the dose, it was recommended to divide it into two doses and take one half in the morning and the other half in the evening. Another limitation to using the powder was that it underwent decomposition during storage and became moldy when exposed to damp air.2,6,7
Senna has been used as a laxative and purgative for over a thousand years and is still one of the most commonly prescribed laxatives. Its effects are predictable and when dosed appropriately it can produce a mild catharsis or an aggressive evacuation of the colon. It is available as a sole entity product (Senakot®) or combined with other laxatives. Senna leaves are available combined with other agents such as peppermint in the form of a tea. However, because it is often difficult to control the concentration of the active ingredients in the tea leaves, an unpredictable effect may be obtained.
This is the seventh in a series of posts about the Pry House Medicinal Garden. Click below to be directed to the others.
PART ONE PART TWO PART THREE PART FOUR PART FIVE Part Six part eight
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Endnotes
1. Khan MSA. A review on senna: An excellent prophetic herbal medicine. WJPM 2020:6:113-8
2. Wood GB and Bache F. The Dispensatory of the United States of America. 11th ed. Philadelphia: J. B. Lippincott and Co., 1858.
3. Stille A. Therapeutics and Materia Medica: A Systematic Treatise of the Action and Uses of Medicinal Agents, Including Their Description and History. 4th ed. Philadelphia: Henry C. Lea, 1874.
4. Edes RT. Therapeutic Handbook of the United States Pharmacopeia. New York: William Wood & Company, 1883.
5. Dorland WAN. The American Illustrated Medical Dictionary. Philadelphia: W. B. Saunders, 1951.
6. Pereira J. The Elements of Materia Medica and Therapeutics. Philadelphia: Lea and Blanchard, 1846.
7. Duncan A. The Edinburgh Dispensatory. 8th ed. New York: James Eastburn and Co., 1818
8. National Medical Convention. The Pharmacopea of the United States of America. 4th ed. Philadelphia: Lippincott, Grambo and Co., 1864.
9. Wythes JH. The Physician’s Pocket Dose and Symptom Book. Philadelphia: Lindsay and Blankston, 1861.
10. Bethard W. Lotions, Potions and Deadly Elixirs. Lanham: Taylor Trade, 2004
About the Author
Greg Susla has been a volunteer at the National Museum of Civil War Medicine since January 2011. Greg’s interest in the Civil War stems from his hometown, Torrington, CT, the birthplace of the abolitionist John Brown. Greg received his pharmacy degrees from the Universities of Connecticut and Florida and completed a critical care pharmacy residency at the Ohio State University Hospitals. Greg spent the majority of his career as the ICU pharmacist at National Institutes of Health in Bethesda, MD and is a Fellow in the American College of Critical Care Medicine. Greg retired as the Associate Director of Medical Information at MedImmune in Gaithersburg, MD. Greg is a University of Maryland Extension – Frederick County Master Gardener Intern. Greg and his wife Lisa live in Frederick, MD.
Further Reading List
- Stille A. Therapeutics and Materia Medica: A Systematic Treatise of the Action and Uses of Medicinal Agents, Including Their Description and History. 4th ed. Philadelphia: Henry C. Lea, 1874.
- Edes RT. Therapeutic Handbook of the United States Pharmacopeia. New York: William Wood & Company, 1883.
- Pereira J. The Elements of Materia Medica and Therapeutics. Philadelphia: Lea and Blanchard, 1846.
- Wood GB and Bache F. The Dispensatory of the United States of America. 11th ed. Philadelphia: J. B. Lippincott and Co., 1858.
- Standard Supply Table. In William Grace. The Army Surgeon’s Manual. New York: Baillier Brothers, 1864
- Surgeon General’s Office. C. S. A. Standard Supply Table of the Indigenous Remedies for Field Service and the Sick in Hospitals. Richmond, VA March 1, 1863.
- Duncan A. The Edinburgh Dispensatory. 8th ed. New York: James Eastburn and Co., 1818
- National Medical Convention. The Pharmacopea of the United States of America. 3rd ed. Philadelphia: Lippincott, Grambo and Co., 1851.
- Wythes JH. The Physician’s Pocket Dose and Symptom Book. Philadelphia: Lindsay and Blankston, 1853.
- National Medical Convention. The Pharmacopea of the United States of America. 3rd ed. Philadelphia: Lippincott, Grambo and Co., 1851.
[1] i.e., magnesium sulfate potash-tartrate of soda or tartrate of potash
