The North American native peoples called Cascara Sagrada "sacred bark" and it is reputed to be the world's greatest laxative. Cascara itself is the aromatic bark of the one-year old tall shrub. The herb continues to be used primarily as a laxative and is listed in the United States pharmacopoeia for this purpose. The bark is ground up to produce an extremely bitter herb that is mostly taken in the form of capsules and pills.

The native peoples of North America used Cascara bark primarily to treat constipation and to relieve stomach problems and this very use has continued to this very day.

Constipation

Cascara sagrada has been shown to be one of the most effective laxatives in use. Some herbalists also consider Cascara to be a "tonic" for the gastrointestinal system and a stimulant for the liver, pancreas and gall bladder and it is reported to be of use for treating some forms of jaundice. As well as Beneficial Effectsing calcium based urinary stones by acting as a chelating agent.

• chronic intestinal inflammatory problems2,6,4,150 such as appendicitis, colitis, An eroded sore in the inner lining of digestive track,150 intestinal An eroded sore in the inner lining of digestive tracks2,24 An eroded sore in the inner lining of digestive trackative colitis or Crohn’s problem6,150 due to the irritation and soreness of the bowel caused by the anthroquinone cascarosides (empirical)2,6
• nursing mothers due to the excretion of anthroquinones in breast milk3,4,6,150 that may cause catharsis in infants (speculative)6 and passage into milk of potentially genotoxic components emodin and aloe-emodin 6
• menstruation (empirical)3 due to possible stimulation of endometrial activity (speculative)6
• acute diarrhea due to the increased hydration of the stools caused by cascarosides (empirical)3
• generally debilitated subjects3 due to loss of water and electrolytes (empirical)6
• intestinal obstruction due to stimulation of peristalsis by the anthroquinones (empirical)3,4,6,150
• abdominal Discomfort of unknown origin3,6,150 due to possible rupture from contraction of inflamed viscus such as the appendix (empirical)
• children under 12 years of age due to loss of water and electrolytes (empirical)6,150
• extended use for more than 8-10 days due to possible damage to intestinal muscle and loss of electrolytes (empirical)6,150
• recent bark aged less than 1 year due to its anthrone content leading to gastrointestinal upset (empirical)6,7,150

Drug Interactions

• overuse or misuse can cause potassium loss leading to increased toxicity of cardiac glycosides (empirical)4,6 such as those in Adonis, Convallaria, Urginea,2,6 Helleborus, Strophanthus, and Digitalis2
• reduced absorption of oral drugs due to a decrease in bowel transit time (speculative)6
• aggravates potassium loss caused by increased urinations (empirical)6

Anthraquinone glycosides, Cascarosides and Hydroxyanthracene (HAD) are said to cause irritation of the gastrointestinal tract inducing peristalsis, which relieve sluggish bowels. The glycosides are hydrolyzed by the naturally occurring bacteria present in the large intestine stimulating increased peristalsis.

Cascara sagrada due to the bitterness of the herb is taken in dosages of 50-100 mg of 25% standardized Anthraquinone glycosides, and Cacscarosides and it is most often recommended to be taken before bedtime.

The dangers of using Cascara for pregnant women outweigh the benefits. Nursing women should avoid using as the active ingredients of Cascara can travel through the breast and give the infant diarrhea. For healthy people taking Cascara for a short time there are no side effects as long as it is taken in the recommended doses. Infants under 2 should not take Cascara as well as people who have spastic colon, diverticulosis, esophageal reflux problem, spastic colitis and An eroded sore in the inner lining of digestive trackative colitis