Sennosides

The rhubarb root and the senna leaf are two commonly used laxative herbs for functional constipation, containing dianthrones and free anthraquinones. As a free anthraquinone, emodin is a crucial constituent isolated from laxative botanicals, and it is particularly abundant in the rhubarb root, a key ingredient in the classic Chinese medicine formula MaZiRenWan (or herbal medicine CDD-2101). This study explored emodin’s anti-malignancy, anti-inflammation, and underlying mechanisms. We examined emodin and other anthraquinones on human colorectal cancer cell proliferation, then used Apc Min/ [Formula: see text] mice to assess effects on animal lifespan, intestinal tumor multiplicity, inflammatory cytokines, and adaptive immunity. Results showed MaZiRenWan extract inhibited HCT-116/HT-29 human cancer cells. However, two primary dianthrone sennosides, sennoside A and sennoside B, did not demonstrate such pronounced effects. Three free anthraquinones, emodin, aloe-emodin, and rhein, displayed antiproliferative effects on cancer cells, which were observed to be significantly concentration- and time-dependent, with emodin demonstrating the strongest action. Emodin was found to induce cell cycle arrest during the S-G2/M phases and trigger apoptosis. In vivo, emodin extended Apc Min/[Formula: see text] mice lifespan, reduced gut tumors, downregulated gut tissue levels of key pro-inflammatory cytokines such as IL-1α, IL-1β, IL-6, IL-17A, IL-8, G-CSF, and GM-CSF; this result was supported by the IL-8 secretion test. Emodin had no inhibitory effect on regulatory Treg cell differentiation, yet it effectively suppressed the Th1 and the Th17 cell differentiation. In conclusion, emodin prevents colorectal cancer via inhibiting cell growth, anti-inflammation, and adaptive immunity modulation, highlighting its potential in inflammation-associated colorectal cancer prevention.

The Constipation Scoring System (CSS) is a validated tool for assessing constipation severity and has been previously applied in Parkinson’s disease (PD) populations. However, comparative data on post‐treatment CSS outcomes between individuals with and without PD remain lacking. This study aimed to compare post‐treatment constipation severity between PD and non‐PD patients in real‐world clinical settings, with particular focus on neurology and gastroenterology outpatient clinics.

This retrospective chart review included 67 patients with PD from a neurology clinic and 50 non‐PD patients with constipation from a gastroenterology clinic. Baseline characteristics were retrieved from electronic medical records. Follow‐up assessments were conducted through direct or telephone interviews to evaluate constipation severity using the CSS. Additional data were collected on patients’ self‐reported intake of water, coffee, carbohydrates, and fiber, as well as exercise habits.

Post‐treatment CSS scores did not differ significantly between groups (PD: 6.07 ± 3.57 vs. non‐PD: 5.24 ± 2.84; p = 0.172), with most participants classified as having mild constipation. No significant differences were observed in daily water, coffee, or fiber intake, or in exercise habits. However, non‐PD patients reported significantly higher carbohydrate intake compared to PD patients ( p = 0.003). PD patients more frequently reported long‐standing constipation symptoms (≥ 6 years) than non‐PD patients ( p < 0.001). Patterns of laxative use also differed: while sennosides were most commonly used in both groups, non‐PD patients more frequently used lactulose and mucilin, whereas PD patients more commonly used Unison enemas ( p = 0.020) and milk of magnesia ( p = 0.070).

Although constipation severity and treatment outcomes were comparable between PD and non‐PD patients, PD patients more often experienced long‐standing symptoms and demonstrated distinct patterns of laxative use. Prospective studies are warranted to evaluate standardized treatment protocols to better clarify treatment outcomes and inform clinical practice.