Introduction

Gelenggang leaves or Senna leaves are herbaceous shrubs with an average height of 1 to 1.5 metres. Cassia senna leaves (C. acutifolia Delile) and Cassia angustifolia Vahl are the scientific names for gelenggang leaves. Gelenggang leaves were used traditionally in Arab for many years ago. It was brought to Europe in the ninth century by the Arab health practitioners.

Ungrounded dried gelenggang leaves are pale yellow in colour whereas the gelenggang leaf powder is greenish yellow. The main active compound of gelenggang leaves is antraquinone glucosides. Generally, gelenggang leaves contain not less than 2.5% of antraquinone glucosides. Active compound in dried gelenggang leaves is counted based on content of sennoside or otherwise known as senna glycoside. Sennoside is a derivative of antraquinone.

Picture 1: Gelenggang Leaves

Indication

Gelenggang leaves are used as laxative traditionally. Laxative acts to ease defecation in constipated person. It acts on the large intestine, in which it increases colonic peristaltic movement by stimulating mucus over the colon. As a result, constipation can be treated.

Recently, gelenggang leaves are also used in modern medicine, as a laxative agent. An active ingredient of senna namely sennoside is extracted and used as medicine.

The Ministry of Health of Malaysia has registered gelenggang leaves-containing products as traditional products and pharmaceutical products (non prescription products; over the counter, OTC). As a traditional product, the indication is as followed:

“Used traditionally to relieve mild constipation”

Ubat tradisional yang mengandungi daun gelenggang bersama dengan kombinasi bahan herba lain, indikasinya bergantung kepada kandungan dan formulasi keseluruhan ubat tradisional tersebut.

As a traditional product which contains gelenggang leaves in combination with other herbs, the indication is dependent on the content and formulation of such product. Should the dried gelenggang leaves content is less than 0.5 grams or less than 20 milligrams sennoside, this specific product is indicated as follows:

“Used traditionally for general health”

Gelenggang leaves are considerably safe to relieve constipation in a short period of time. It can be consumed by elderly adults, labouring women and cancer patients who are taking narcotic drugs. Consumers should follow the instructions in the product label. The doses are based on past experience and produced effects.

Side effects

Consumption of any medication, either a traditional medicine or pharmaceutical product might lead to side effects. Side effects are unwanted effects occur following a medicine consumption. Some side effects of gelenggang leaves include stomach ache and cramp, joint pain, diarrhoea, flatulence, urine discoloration, anatomical changes or damage on the colonic wall, chronic liver impairment and others.

Side effects can be minimised by following the doses recommendation and/or instruction in the product label. If the side effects are mild and not harmful, the consumption of gelenggang leaves can be continued. However, should the side effects become severe, consumers are advised to consult a doctor or pharmacist.

Warning on the Use

Consumption of gelenggang leaves should be avoided for gelenggang leaves allergic individuals. Consumers who show symptoms like nausea, vomiting or appendicitis, are not encouraged to take medicine containing gelenggang leaves.

Extra precautions should be considered by consumers with gastrointestinal tract problem, stomach ulcer and inflammation of the intestines as the products might exacerbate the conditions. There is no study that shows any interaction between gelenggang leaves with other herbs, health supplements, medications or food. Patients who are on digoxin, diuretics or other laxatives should take the products cautiously.

Products containing gelenggang leaves are only indicated for consumers aged more than 12 years old. There is no safety report on the use of gelenggang leaves for children below 12 years old. Besides, the products should only be used in a short period of time (not more than a week).

At present, the Ministry of Health of Malaysia has made it compulsory for all products containing gelenggang leaves to be labelled with the following advisory captions :

• “Do not use when abdominal pain, nausea or vomiting is present.”
• “Frequent or prolonged used of this preparation may result in dependence towards the product and ‘imbalaced electrolytes’”
• “Please consult a healthcare practitioner for use beyond 7days.”

Consumers should inform the healthcare practitioners (modern or traditional) if they have consumed other medications or health supplements together with gelengang leaves products. This might help to prevent any possible interaction.

Types of Preparations Available in the Market

There are more than 60 traditional products containing gelenggang leaves that are registered with the Ministry of Health of Malaysia. Most products are a combination of gelenggang leaves with other herbs.

These products are marketed in tablet, capsule, granules and herbal tea form. All of these products are taken orally.