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Cascara Sagrada.

Botanical name:

Synonyms—Rhamnus Purshiana, chittem bark, sacred bark, Bearberry, bear-wood.

CONSTITUENTS—
There are present a crystalline, bitter principle and three distinct resinoid bodies, not bitter, which are believed to be derived from chrysophanic acid which is thought to be present in the bark.

PREPARATIONS—

Fluid Extract Cascara Sagrada, not miscible with water. Dose, as a stomachic tonic and function restorer, three to ten minims; laxative, five to twenty minims four times a day; as a cathartic, twenty to sixty minims morning and evening.
Solid Extract Cascara Sagrada. Dose, as a laxative, one-half to two grains; as a cathartic, three to eight grains.
Powdered Extract Cascara Sagrada, produced by evaporating the solid extract at a low temperature and triturated with sugar of milk, same strength as the solid extract.
Cascara Cordial with elimination of the bitter principle. Dose, half a dram to a dram and a half.

Physiological Action—Dr. Bundy, the discoverer of cascara, writing in 1878, says: "I employ a fluid extract of cascara, using one ounce in a four ounce mixture in combination with other remedies or alone, as the case may require. It acts upon the sympathetic nervous system, especially upon the solar plexus, stimulating the nutritive and assimilative forces, increasing the digestive processes generally. It acts upon the secretory system in a marvelous manner, especially where the secretions are deficient and perverted, and this seems be one of its special indications. Constipation depends upon the nature of the diet, deficiency or a faulty composition of the intestinal secretions, disordered glands that pour their secretions into the intestines, impairment of muscular power, which leads to a deficiency in their propelling power which may result from nervous or mechanical influences, congestion of the portal circulation, normal secretion of intestinal juices interfered with, deficiency in biliary secretions of a healthy character, congestion of mucous membranes of intestines, and last and the most frequent, constipation which has been caused by resisting the calls of nature from carelessness or circumstances that prevent obedience at the proper time."

Scheltzeff in 1885 (London Med. Record) made the following observations: "In doses from four to ten cubic centimetres (with double quantity of water), cascara sagrada excites the secretion of gastric juice and increases it during digestion. It increases also the secretion of the pancreatic juice. It excites and increases the secretion of bile. It has no action on the secretion of saliva. It has not led to any rapid and considerable evacuations."

Cascara is a bitter tonic of specific value in its direct influence upon the function of the stomach and intestinal canal. It acts upon the vasomotor system, stimulating the glandular apparatus of the intestinal tract to more perfect secretion, and increasing peristaltic action. It is especially indicated in torpidity or atonicity, quickly restoring functional activity.

It is not a cathartic in the common acceptation of the term, but by restoring normal function, by its tonic influence, bowel movement of a natural character follows.

It does not mechanically liquefy and empty the intestinal canal, but it restores normal elasticity and tone to the relaxed structures, and natural vermicular motion and peristaltic action, exercising a direct influence upon muscular structure of the intestinal walls. It materially influences the venous and capillary circulation of the entire intestinal tract, thus proving of much value in hemorrhoids.

Administration—In prescribing cascara for the cure of chronic constipation, large doses at the first are undesirable. If a single dose, so large as to produce a cathartic effect be administered, subsequent small doses will prove insufficient to restore tone, and the constipation will remain unless the large dose is constantly repeated. If a dose of from two to ten drops in a proper vehicle be given, three, four or five times daily for many days, even if the constipation does not at first yield, the effects after a few days are usually salutary. There is a normal movement in the morning and the habit of regular evacuation can be soon fixed, and as the agent is continued the dose may be slowly decreased until a single drop at each dose is given. Finally, a single small dose morning and night may be continued for a time and then stopped, the bowels continuing their normal action.

If constipation pre-exists, it is well to give a simple laxative or to flush the bowels thoroughly with some other agent before beginning the use of this, to overcome the chronic condition. The results can be sooner obtained also by smaller doses.

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. Often a single dose followed by a glass of cold water on rising will have a salutary effect. This is true of constipation extending over a short period, not necessarily chronic. To produce an immediate effect as a physic, a dram of the fluid extract should be given, and it will probably induce some pain. The agent should not be used in this active form for its immediate effects during the pregnant term, as its irritating influence may be sufficient to produce miscarriage.

Cascara in medium doses is an efficient agent in gastric or intestinal catarrh. It quickly restores the normal tone of the mucous membranes, suspending undue secretion and acting in perfect harmony with other measures adopted.

It is a useful remedy in many cases of chronic indigestion and in chronic disease of the liver. It has been used in cirrhosis with the best of results. It is useful in jaundice with deficient excretion of bile, and corrects catarrh of the bile duct. It is useful in diarrhea, subacute or chronic, depending on deficient liver action, and upon catarrhal and atonic conditions of the intestinal tract.

In 1886 quite an interest was excited by the assertion of Goodwin, of New York, that cascara was an excellent remedy for rheumatism. Many experimented with it and some reported excellent results, but its use for this purpose has not been continued. It is, however, of value in the treatment of those cases where gastric and intestinal disorders are present, given in conjunction with more specific agents.


The American Materia Medica, Therapeutics and Pharmacognosy, 1919, was written by Finley Ellingwood, M.D.
It was scanned by Michael Moore for the Southwest School of Botanical Medicine.



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