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Used as an infusion, decoction, extract, tincture and syrup.

Senna pods are used the same way as the leaves.

As Grieve puts it: 'Senna pods, or the dried, ripe fruits, are official in the British Pharmacopoeia, though the quantity is restricted, as an adulterant, in the United States Pharmacopoeia.'

'They are milder in their effects than the leaflets, as the griping is largely due to the resin, and the pods contain none, but have about 25 per cent more cathartie acid and emodin than the leaves, without volatile oil. From 6 to 12 pods for the adult, or from 3 to 6 for the young or very aged, infused in a claret-glass of cold water, act mildly but thoroughly upon the whole intestine.'

The 1997 Commission E on Phytotherapy and Herbal Substances of the German Federal Institute for Drugs recommends Senna pod for 'Constipation.'

The Commission E defines 'Senna' as 'Cassia senna L. (C. acutifolia Del.) [Fam. Fabaceae], known as Alexandrian or Khartoum senna, or of C. angustifolia Vahl [Fam. Fabaceae], known as Tinnevelly senna...'

As Grieve puts it: 'Several species of Cassia contribute to the drug of commerce, and were comprised in a single species by Linnaeus under the name of Cassia Senna. Since his day, the subject has been more fully investigated, and it is known that several countries utilize the leaves of their own indigenous varieties in the same way. The two most widely exported and officially recognized are C. acutifolia and C. angustifolia (India or Tinnevelly Senna).'

'C. acutifolia, yielding the finest and most valuable variety of the drug is a small shrub about 2 feet high.'

'C. angustifolia or Tinnevelly Senna, Senna Indica, C. elongata is an annual growing in the Yemen and Hadramaut provinces of Arabia Felix, in Somaliland, Mozambique, Scind, and the Punjab. In Southern India it is cultivated and grows to a larger size. In the German and Swiss Pharmacopoeias, the official drug is restricted to Tinnevelly Senna, and also in the British Pharmacopoeia and the Pharmacopoeia of India.'

The 1997 Commission E: '1,8-dihydroxy-anthracene derivatives have a laxative effect. This effect is due to the sennosides, specifically, their active metabolite in the colon, rheinanthrone. The effect is primarily caused by the influence on the motility of the colon by inhibiting stationary and stimulating propulsive contractions. This results in an accelerated intestinal passage and, because of the shortened contact time, a reduction in liquid absorbed through the lumen. In addition, stimulation of active chloride secretion increases water and electrolyte content of the contents of the intestine....'

'Side Effects: In single incidents, cramp-like discomforts of the gastrointestinal tract. These cases require a dosage reduction. Stimulating laxatives must not be used over a long period (more than 1 - 2 weeks) without medical advice.'

'Dosage: Comminuted herb, powder or dried extracts for teas, decoctions, cold macerates, or elixirs. Liquid or solid forms of medication exclusively for oral use.'

Senna has been used for centuries in Western and Eastern systems of medicine as a laxative, usually taken as a tea or swallowed in powdered form. Senna leaf remains an important drug used in traditional Chinese medicine and traditional Indian Ayurvedic and Unani medicine. Senna pods are used the same way as the leaves.

Modern human studies have confirmed senna's utiltity for alleviating severe and chronic constipation, including that of children and cancer patients. The German Standard License for senna leaf tea indicates its use for constipation and for conditions in which easy bowel evacuation with soft stools is desirable, as doses the British Herbal Compendium. The World Health Organization approves senna leaf for short-term use in occasional constipation.

Grieve's classic 'A Modern Herbal':

'Medicinal Action and Uses: Purgative. Its action being chiefly on the lower bowel, it is especially suitable in habitual costiveness. It increases the peristaltic movements of the colon by its local action upon the intestinal wall. Its active principle must pass out of the system in the secretions unaltered, for when Senna is taken by nurses, the suckling infant becomes purged.'

'It acts neither as a sedative nor as a refrigerant, but has a slight, stimulating influence. In addition to the nauseating taste, it is apt to cause sickness, and griping pains, so that few can take it alone; but these characteristics can be overcome or removed, when it is well adapted for children, elderly persons, and delicate women. The colouring matter is absorbable, and twenty or thirty minutes after the ingestion of the drug it appears in the urine, and may be recognized by a red colour on the addition of ammonia.'

'The addition of cloves, ginger, cinnamon, or other aromatics are excellent correctives of the nauseous effects. A teaspoonful of cream of tartar to a teacupful of the decoction or infusion of Senna, is a mild and pleasant cathartic, well suited for women if required soon after delivery. Some practitioners add neutral laxative salts, or saccharine and aromatic substances. The purgative effect is increased by the addition of pure bitters; the decoction of guaiacum is said to answer a similar purpose.'

'Senna is contraindicated in an inflammatory condition of the alimentary canal, hemorrhoids, prolapsus, ani, etc. The well-known 'black draught' is a combination of Senna and Gentian, with any aromatic, as cardamom or coriander seeds, or the rind of the Seville orange.'

'Senna pods, or the dried, ripe fruits, are official in the British Pharmacopoeia, though the quantity is restricted, as an adulterant, in the United States Pharmacopoeia.'

'They are milder in their effects than the leaflets, as the griping is largely due to the resin, and the pods contain none, but have about 25 per cent more cathartie acid and emodin than the leaves, without volatile oil. From 6 to 12 pods for the adult, or from 3 to 6 for the young or very aged, infused in a claret-glass of cold water, act mildly but thoroughly upon the whole intestine.'

'The fluid extract was formerly treated with alcohol for the removal of the griping principles, but the process was deleted from the United States Pharmacopoeia. The fluid extract is a dark, blackish, thick and somewhat turbid liquid, with a strong flavour of Senna. It is well adapted for exhibition with saline cathartics, such as Epsom salt or cream of tartar. In this ease not more than half the full dose should be given at once. The British Pharmacopoeia 1898 'Liquor Sennae Concentratus' was more like a concentrated infusion than a fluid extraet, but had the same strength as the latter, the menstrum being distilled water; tincture of ginger and alcohol being added.'

'The infusion of Senna, or Senna Tea, consists of 100 grams of Senna leaves, 5 grams of sliced Ginger, 1,000 millilitres of distilled water, boiling. Infuse in a covered vessel for fifteen minutes, and strain, while hot. The United States Pharmacopoeia prefers coriander to ginger. The infusion deposits, on exposure to air, a yellowish precipitate, so it is advisable to make it in very small quantities, as the deposit aggravates its griping tendency. It is usual to prescribe manna and one of the saline cathartics with it. The cold infusion is said to be less unpleasant in taste, and equal in strength to the hot.'

'Syrup of Senna is prepared by mixing 8 fluid ounces, 218 minims of fluid extract of Senna, with 81 minims of oil of Coriander and sufficient syrup to make 33 fluid ounces (6 ½ fluid drachms).'

'The Aromatic Syrup includes also jalap, rhubarb, cinnamon, clove, nutmeg, oil of lemon, sugar, and diluted alcohol.'

'The Compound Syrup includes rhubarb, frangula, methyl salicylate, alcohol, and syrup.'

'Dosages: Powdered leaves, 1 drachm. Conct. solution, B.P., ½ to 1 drachm. Of compound or aromatic syrup, 2 fluid drachms. Of U.S.P. syrup, for an adult, 1 to 4 fluid drachms. Of B.P. syrup, 1 to 2 fluid drachms. Of Senna, ½ to 2 drachms. Of compound mixture, B.P., 4 to 16 drachms. Of infusion, B.P., ½ to 2 fluid ounces. Of fluid extract, for an adult, ½ to 2 fluid draehms. Of confection, B.P., 1 to 2 drachms.'

King's 1898 Dispensatory: 'Senna is a certain, manageable, and convenient cathartic, very useful in all forms of febrile diseases in which a laxative action is desired, particularly in the forming stage of bilious and other fevers, especially in children, and in other diseases where a severe impression on the bowels is not desired. Constipation does not follow its employment. It is also efficient in flatulent and bilious colics.'

'Its influence is chiefly exerted on the small intestines, augmenting their mucous secretions, exciting increased peristaltic motion, and producing loose, yellowish-brown evacuations. A nursing infant may be purged by the milk of the mother who has taken senna, and so susceptible are some persons to its action, that its odor is said to induce a cathartic action.'

'It does not act as a sedative, as is the case with some other cathartics, nor as a refrigerant; but has a slight stimulating influence, insufficient, however, to contraindicate its use in case of general excitement or reaction. Besides the nauseating taste of senna, it is apt to cause sickness at stomach, and very few persons can use it alone, without experiencing more or less griping pains and flatulence. The addition of cloves, ginger, cinnamon, or other aromatics, are excellent correctives of these unpleasant effects. A teaspoonful of cream of tartar to a teacupful of the decoction or infusion of senna, is a mild and pleasant cathartic, particularly suited for females, where it may be required soon after delivery. The addition of neutral laxative salts, as phosphate of sodium, Epsom, or Rochelle salts, is another mode, adopted by a certain class of practitioners, of preventing the tormina, and, at the same time, increasing the activity of the infusion of senna. These are, however, rarely used by Eclectics. Saccharine and aromatic substances are also combined for this purpose, as sugar, manna, aromatic seeds, electuary of senna, etc. The purgative effect of senna is much increased by the addition of the pure bitters; the decoction of guaiacum is said to answer a similar purpose.'

'Senna is contraindicated in an inflammatory condition of the alimentary canal, or even irritation of those parts, general debility, hemorrhoids, prolapsus ani, etc.'

'The dose, in powder, is from 30 to 50 grains; in tincture, from ½ to 2 fluid ounces; specific senna, 1 to 60 drops; electuary, 2 drachms; and of the infusion, which is the most usual mode of administration, from 2 to 4 fluid ounces. But, according to Mr. T. B. Groves, the tincture of senna is without action; the decoction is of less value than the infusion, and the infusion less than maceration; the solution by maceration alone purges without gripings, as by this method the larger portion of the cathartic principle is extracted, leaving behind the acrid constituents. Cathartic acid has the same action of senna, purging with griping in doses of 1½ to 3 grains. The seed-pods and leaf-stalks of senna are slower to act than senna, but are freer from griping and nauseating effects than the leaves.'

American Materia Medica, 1919 (Ellingwood): 'Senna is an efficient remedy, mild, kindly, certain and uniform in its action. It is a constituent of the larger number of the proprietary laxative or cathartic compounds, syrups, cordials or elixirs.'

'It is used in all cases of temporary constipation, however induced. An infusion of the leaves is not unpalatable and is promptly active. It produces normal evacuations of the bowels and if used carefully there is but little griping. It is used after surgical operations, after confinement, in the constipation of the feeble, and. in many cases of inactive bowels, among infants and children. It is not used where a powerful derivative is needed, or where active cholagogue or hydragogue influence is demanded. It has a narrow but important sphere.'

'Co-operatives—In combination with ginger, capsicum or black pepper, it is useful in atonic conditions with inactivity of the bowels. With magnesium sulphate, or potassium bitartrate, it will induce more of a hydragogue effect. In combination with leptandra it acts more specifically upon the liver; with jalap, and ginger it was long known as antibilious physic and was given whenever 'biliousness' was diagnosed; with rhubarb and peppermint it is a tonic, laxative and carminative of greatly improved value. It is the active constituent of the well known and popular, Compound liquorice powder.'

'The composition of this powder is, as follows:

Senna and liquorice in fine powder, of each two ounces;
fennel fruit, sublimed sulphur, of each one ounce;
refined sugar, six ounces.
Mix thoroughly. Dose, from one-fourth to one dram in water.'

'The following is an excellent, simple laxative:

A strong, infusion of senna leaves is made and strained. In the clear liquid good French prunes are stewed until thoroughly cooked. One of these three or four times daily will overcome many cases of constipation, especially when the tendency is only temporary, or due perhaps to other conditions, temporary in their character, as during tedious convalescence. Especially useful in pregnancy.
Figs and senna leaves, chopped together, finely, have been long in use for laxative purposes.'