Traditional Uses, Phytochemistry, and Multi-Target Pharmacological Activities of Senna alexandrina

Senna alexandrina has been widely used in traditional medicine for gastrointestinal, dermatological, metabolic, and musculoskeletal disorders. Despite extensive ethnobotanical knowledge, a comprehensive integration of its chemical constituents with pharmacological evidence remains limited. This review aimed to synthesize the traditional uses, pharmacological activities, and chemical constituents of S. alexandrina, highlighting the alignment between ethnobotanical applications and experimental evidence. Literature on ethnomedicinal usage, in vitro and in vivo pharmacological studies, and chemical characterization of S. alexandrina was systematically reviewed. A total of 219 chemical structures were compiled, along with the reported bioactivities and traditional applications. Extracts of leaves, pods, and aerial parts exhibit dose-dependent laxative, anticancer, anti-inflammatory, hepatoprotective, antioxidant, antimicrobial, antiviral, and metabolic regulatory activities. Anthraquinones, flavonoids, polysaccharides, and other secondary metabolites underpin these effects. The integration of 219 chemical structures, pharmacological data and traditional uses is rare and provides a unique resource for future mechanistic studies and drug discovery. The alignment between traditional usage and experimental pharmacology is promising, though the available evidence remains largely preclinical and extract based. Future research should isolate and characterize specific bioactive compounds to enable precise dosing, elucidate mechanisms, and advance clinical translation.