Cascara is obtained from the dried bark of Rhamnus purshianus (Rhamnaceae), both a medicinal and poisonous plant. It is found in Europe, western Asia, and in North America from northern Idaho to the Pacific coast in mountainous areas. In Spanish, cascara sagrada means "sacred bark," perhaps because this woody shrub has provided relief for several constipated individuals. Cascara has been used as a tree bark laxative by Native American tribes and Spanish and Mexican priests since the 1800s. The cascara sagrada bark is aged for a year so that the active principles become milder, as freshly dried bark produces too strong a laxative for safe use.
Cascara possesses purgative, toxic, therapeutic, and tonic activity. It is most commonly used as an anthraquinone stimulant laxative for bowel cleansing. Stimulant and cathartic laxatives are the most commonly abused laxatives and have the potential for causing long-term damage.
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These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Early studies have examined the use of cascara for bowel preparation. Evidence is insufficient to suggest effectiveness over conventional treatments for this indication.
Cascara sagrada is widely accepted as a mild and effective treatment for chronic constipation. However, limited data is available. Additional study is needed before a strong recommendation can be made.