Manjistha in Ayurvedic Medicine: Traditional Knowledge and Contemporary Scientific Validation

GRACE/Christina Bauer
CAM
August 2026

Abstract

Manjistha (Rubia cordifolia L.), also known as Indian Madder across South Asia, is a plant that occupies a central place in the Ayurvedic pharmacology of classical India as a blood purifier and lymphatic herb. The goals of this review are to examine the references to Manjistha that can be found in the classical Ayurvedic texts, such as the Charaka Samhita and Sushruta Samhita, as well as incorporate discussions of the pharmacological literature that examines the continuity between modern scientific use and ancient use. The paper surveys the plant’s botanical classification, phytochemical aspects and geographical distribution of the plant. The plant contains around one hundred identified compounds, including anthraquinones and cyclic peptides, that underlie its bioactivity. The pharmacological studies of these compounds include anti-inflammatory, antioxidant, antimicrobial, hepatoprotective, neuroprotective and antidiabetic properties, each of which relates to the traditional uses of the plant for treating conditions like blood disorders, skin disorders and menstrual disorders. The safety of Manjistha is also discussed within the review, including information regarding the hepatotoxic and carcinogenic properties of some of these compounds isolated from the plant. Thus, Manjistha is concluded to be a promising phytotherapy that bridges Ayurvedic medicine with science based phytotherapy, but one that warrants further investigation into its clinical effects.

Introduction

Few herbs have existed in the crossroads of ancient traditions and modern science as Manjistha, the root of the plant Rubia cordifolia L. For centuries before the discovery of its chemical components (anthraquinones), Ayurvedic medicine practitioners have used Manjistha to treat issues related to the blood, the skin, and the lymph system. The very name of Manjistha in Sanskrit points to its most obvious feature: a bright red dye that has colored textiles and skin preparations for thousands of years.1 Beyond being a plant used to make a red dye, Manjistha has for millennia also been recognized as a medicinal root to be used in treating a variety of ailments within systems as diverse as Chinese, Korean, Unani, and folk medicine systems, where it has been called upon for everything from wound healing to menstrual disorders.²

In classical Ayurveda, Manjistha is grouped among the raktashodhaka, or blood purifying herbs, and is prized for its rakta prasadana, or blood clarifying, properties. The Charaka Samhita lists Manjistha as the lead herb of the Manjishthadi Gana, a named group of blood clarifying substances, situating the plant within a broader Ayurvedic framework aimed at restoring balance among the three doshas.³ The Sushruta Samhita names the herb directly within its therapeutic prescriptions, recommending “a decoction of Manjishthá and (red) Chandana” in the treatment of Manjishtha-meha, a variety of Pittaja Prameha, putting the herb’s blood related and detoxifying qualities to direct clinical use rather than discussing them only in the abstract.⁴

What makes Manjistha an interesting topic to review regarding the literature is the amount of modern pharmacological research that has been published on the topic. Most of the published research dates to within the last five years. The literature to be reviewed encompasses the botany of the plant, the phytochemistry of its compounds, its pharmacology, safety, and traditional Ayurvedic uses to determine if the scientific literature supports the claims of the traditional medicine texts.

Botanical Classification and Description

Rubia cordifolia L. is a plant that belongs to the Rubiaceae family, which contains as many as 450 genera and 6,500 species of plants, from trees to herbs.⁵ The genus Rubia contains around 60 different species of plants, but R. cordifolia is characterized as a perennial, herbaceous vine that possesses long, cylindrical roots that are reddish-brown in color.⁶ The stems of the plant are slender, rough to the touch, and brittle in texture, and can grow to lengths of 0.3 to 6 meters in size, and are lined with curved prickles that allow the plant to grow as a vine and climb onto other vegetation.⁷

The leaves occur in whorls of four to eight leaves per node, each leaf being ovate to lanceolate in shape and measuring between two and six centimeters in length, with the margins of the leaves bearing curved prickles similar to those along the stem. The flowers are small, ranging in color from cream to greenish yellow colors, sometimes tinged with pink or purple colors, and grow in loose cymes that can be found either within the leaf axils or near the top of the plant, giving the vine a somewhat delicate appearance despite its otherwise coarse, climbing habit. The fruit of the species is a small, glabrous, brownish black berry that is only a few millimeters in diameter. While much less extensively studied than the root of the plant, some phytochemical research into the berry has revealed the presence of some toxicologically relevant compounds.⁸

The root is of primary interest as the part of the plant that earns it various regional names. In India, the plant is known as Manjistha or Manjith, in China it is known as Qiancaogen and in the West it has historically been known as India Madder, reflecting its historical use as a natural dye.⁹ The root contains a red pigment within a class of compounds known as anthraquinones pigments, the same class of compounds responsible for the plant’s medicinal properties.

Geographical Information

Manjistha grows throughout a very wide range of geographic locations. The extensive geographic distribution of Manjistha is likely one of the reasons for the development of similar uses for the plant by various groups of healers and medicine traditions across the planet. Manjistha can be found throughout Africa, tropical Asia, India, Malaysia, China, Japan and tropical Australia.¹⁰ Within China, Manjistha grows throughout the majority of the provinces, but is most abundant in the Shaanxi province in the Weinan and Songxian cities within the province.¹¹ Within India, Manjistha is found in the high-altitude regions of the nation, including locations like Mahabaleswar and Amboli in the state of Maharashtra, as well as in other hilly regions of the subcontinent.¹²

Its widespread distribution has allowed for Manjistha to appear independently in disciplines as diverse as Traditional Chinese Medicine, Ayurveda, Unani medicine, Korean traditional medicine, and even folk medicine in countries as remote from one another as Uganda and the Philippines, all with the same cluster of uses for the plant.¹³ While it may seem striking that these different cultures, with no historical contact with one another, and independently of one another and without any shared scientific framework for understanding those sciences, nonetheless arrived at the same conclusions of the beneficial effects of Manjistha, it is these non-coincidental determinations of the value of the herb that help to indicate that there is some reality to those outcomes.

The preference of Manjistha for well drained and elevated terrain is also reflected in its inclusion in classical Ayurvedic texts as an herb that grows in hilly and forested regions of the Indian subcontinent. These indications of the plant’s preferred growing regions in classical Ayurvedic texts indicate that the authors of those texts had observed the growth of the plant in those environments in the wild. These indications of the regions where Manjistha grows wild can help to indicate where the plant should be cultivated in modern times in a way that ensures that the plant develops the same concentrations of the beneficial compounds that are found in wild and traditionally-cultivated Manjistha roots.

Beyond the academic interest in the knowledge of traditional harvest methods is the need to cultivate Manjistha roots in such a way as to supply the growing demand for Manjistha extracts for both Ayurvedic and supplemental medicine uses. The requirements of harvesting Manjistha from the wild are inherently somewhat problematic in the face of rising demand; Manjistha roots take some time to mature, and are typically not harvested until they have reached maturity after three or four years of growth as discussed in later paragraphs of this review. Thus, the wild populations of Manjistha have the potential to be depleted by harvesting for roots at a rate that is much faster than the plant’s ability to produce new roots.

This information also indicates that it may be possible to utilize these classical texts to determine the types of growing conditions that will lead to the development of Manjistha with compounds similar to those that are discovered in the roots of wild Manjistha plants. Therefore, it would be beneficial to utilize these suggestions from the classical texts in the development of agricultural methods for Manjistha, which would allow for the plants to contain the desired compounds. Additionally, as discussed in earlier sections of this review, ensuring that the compounds present in the Manjistha root samples are consistent across different batches is one of the main challenges to be overcome in the evaluation of the effects of Manjistha root for medicinal purposes.

Pharmacological Activities

Modern pharmacological studies on R. cordifolia have been so extensive that a comprehensive review of the pharmacology of this plant was published in Frontiers in Pharmacology in 2022 was able to systematically summarize decades of traditional use alongside phytochemical and pharmacological findings. This review alone included searches of databases like PubMed, Web of Science, and even botanical databases like Kew Botanical Garden. Thus, the extent of research that has been performed on this one plant indicates the interest that exists in different countries in R. cordifolia and its potential use in the treatment of human illness.

Several different activity categories reappear in the research regardless of the research group that performed the research or the country in which they live. The anti-inflammatory, antioxidant, anti-tumor, antimicrobial, hepatoprotective, neuroprotective, and antidiabetic effects of certain extracts of the plants have been discussed in more depth below. The repetition of the same categories is discussed in different research papers that use different methods to extract the compounds from these plants, and that they use different animal and in vitro models to test for the presence of these activities, provides some confidence that the effects being observed are real rather than artifacts of any single experimental setup.¹⁴

Anti-inflammatory and antioxidant effects

The theory of traditional Chinese medicine attributes to Manjistha roots the abilities of cooling blood, removing blood stasis and relieving pain, all of which are properties related to the anti-inflammatory, anti-coagulant and anti-platelet properties of Manjistha.¹⁵ These findings are striking in that they are present in the various types of extractions of Manjistha root, as well as in the different research groups investigating the herb and its properties.

A phytochemical study that utilized Soxhlet extraction methods revealed that the root extracts that were prepared using methanol and ethanol contained significantly more phenol and flavonoid content than the extracts from the stems and leaves of the same plant. The study results also indicated that even after the removal of the polyphenolic components from the extract, the plant still exhibited antioxidant activity, which indicates that the non-phenolic components of the plant also contributed to its antioxidant properties.¹⁶

The antioxidant potential of the root extract was determined through a variety of different assays, including assays of DPPH, hydrogen peroxide, nitric oxide, and total antioxidant capacity. In each of these assays, the root extract outperformed the extract made from the stems and leaves of the same plant species. The ability of these antioxidant properties to perform well in each of these assays indicates the strength of the antioxidant properties overall, as each assay of antioxidant properties typically utilizes only a single assay to determine if a sample contains antioxidant properties.¹⁷

Anti-tumor and cytotoxic effects.

A cyclic hexapeptide compound isolated from the root of the plant and referred to as RC-18 has demonstrated significant anti-cancer activity against several murine tumor models, including ascites tumors and B16 melanoma, leading to prolongations of the survival time of the cancerous mice at fairly low doses of the compound, again noting the toxicity of many chemotherapeutic agents are comparable effective concentrations. Interestingly, RC-18 did not exhibit activity against each of the types of tumors that were tested, as it did not have any effect on solid tumors like Lewis lung carcinoma, which suggests its mechanism may be somewhat selective rather than broadly cytotoxic across all cancer types.¹⁸

Mollugin, an anthraquinone derivative and one of the more thoroughly studied compounds present within this plant, has shown an ability to reduce the viability of various cancer cell lines, such as those from glioblastoma, gastric, breast, lung and colon cancers, but has not exhibited any toxic effect upon normal mouse neurons, while showing no toxic effect on normal mouse neurons, an encouraging sign of selectivity that many purely synthetic anti cancer compounds lack.¹⁹ A more recent review, specifically of cytotoxic and antitumor agents from the genus Rubia specifically catalogued 71 different chemicals from Rubia belonging to five different categories, each of which has exhibited cytotoxic or antitumor activity, indicating that the cyclic peptides and quinones are the active components within the genus Rubia as a whole.²⁰

Antimicrobial and antibacterial effects

Methanol extracts of the root have exhibited activity against Gram-positive bacteria, including several species of Bacillus and Mycobacterium, as well as against the Gram negative bacterium Pseudomonas aeruginosa, in a concentration dependent manner.²¹ While the exact reason for such traditional uses of the plant in wound care and other skin treatments is not entirely clear, the antibacterial activity of the root against Gram-positive bacteria may at least help to explain such uses. Separately, Anthraquinones that were isolated from the aerial parts of the plant exhibited no antibacterial activity against the four bacterial strains tested.

Thus, this experiment helps to highlight the differences in the activities of the compounds that exist within the same plant species, and helps to indicate that the antibacterial properties of the root-based extracts of the plant species should not be assumed to be the same as those containing compounds from the aerial parts of the plants.²² This same study did, however, find that three of the isolated compounds had inhibitory activity for nitric oxide, indicating an activity that was stronger than the anti-inflammatory drug used as the positive control in that study, suggesting that although the aerial part of the plant may not exhibit anti-microbial properties, they may have beneficial anti-inflammatory properties worth further investigation in its own right.²³

Antidiabetic and neuroprotective effects

One of the more clinically oriented studies examined the effects of a hydroalcoholic extract of Manjistha root on streptozotocin-induced diabetic rats, and found that the treated diabetic rats exhibited significant improvements in each of the following parameters in comparison to the untreated diabetic rats over an eight-week period: pain thresholds, oxidative stress markers, blood glucose and body weight.

These improvements were dose dependent, with the higher dose group showing more pronounced benefits across nearly every measure tracked, which strengthens the case that the effect is genuinely attributable to the extract rather than incidental variation between animals.²⁴ The same study also found that the extract suppressed the activity of cleaved caspase 3 and the Bax to Bcl2 ratio in both sciatic and brain tissues, both of which are markers of apoptosis. This indicates the anti-apoptotic properties of the extract, which is an indication of the neuroprotective properties of the extract rather than a purely symptomatic effect on pain perception.

Histopathological analysis backed this up as well, revealing that the animals that received the higher dose of Manjistha had better preserved nerve tissue. Furthermore, previous studies have shown that Manjistha in the presence of vitamin E provides protective effects against drug induced movement disorders, hinting that its neuroprotective potential may extend beyond diabetes specific nerve damage into broader oxidative stress related neurological conditions.²⁵

Hepatoprotective effects

Rubiadin, a specific anthraquinone that is isolated from Manjistha has been shown to protect against carbon tetrachloride induced liver injury in rats to the same extent as silymarin, a well-established hepatoprotective reference compound widely used in conventional herbal medicine for liver support. In the study, rubiadin also significantly prevented the rise in the levels of the oxidative damage marker malondialdehyde in the liver tissue, as well as prevented the depletion of the antioxidant reduced glutathione in the liver tissue; both of these markers indicate that rubiadin functions, at least in part, through the same antioxidant mechanisms as the other components of the plant extract.

Histopathological examination of the treated rat liver tissue further confirmed this protective effect against the toxic effects of this compound. The liver tissue of these treated animals exhibited preserved architecture, in contrast to the damage to the livers of the untreated animals exposed to the same dose of the toxic compound. This finding is interesting in the context of the safety of rubiadin, which is discussed in more detail later in this review. Rubiadin has been shown to lead to carcinogenic changes in the liver of treated animals, though in separate research efforts. Taken on its own, though, this hepatoprotective effect offers reasonable support for Manjistha’s traditional use in supporting liver function, and it aligns with the broader Ayurvedic understanding of the liver as closely tied to blood quality and detoxification.²⁶

These findings provide fairly strong support for the traditional uses of Manjistha as a blood purifier and anti-inflammatory agent. The similarities between the observations of Ayurvedic and Chinese medicine practitioners for centuries what shows up now in DPPH assays, animal models, and cell culture work is genuinely striking, and it lends a certain credibility to the traditional knowledge of these plants in particular. However, the primary literature for Manjistha is somewhat honest in its discussion of the limitations of its study to date. To ignore these limitations would be dishonest to gloss over them. Much of the anti cancer research in particular depends upon a few cell lines, without positive controls to show how meaningful the effects of these treatments are in comparison to established cancer treatments. Very little of this research has advanced to clinical trials to test the treatments in human patients; the researchers in these fields are often the first to indicate that further research is needed in this area.²⁷

Phytochemical Composition

More than one hundred compounds have been isolated and identified from R. cordifolia, including compounds of the bicyclic peptide, terpene, polysaccharide, trace element, flavonoid, and quinone classes.²⁸ A detailed table compiles the findings of previous reviews of the chemical composition of R. cordifolia, and lists 125 named compounds that have been both identified and assigned a PubChem compound identifier; the vast majority of these compounds were isolated from the root of the plant.²⁹

The anthraquinones constitute the most pharmacologically significant group of compounds that have been identified from the plant. At least 28 different anthraquinones have been isolated from the plant, including compounds like alizarin, munjistin, rubiadin, purpurin, and xanthopurpurin.³⁰ Additionally, newer anthraquinones, named Cordifoquinone A through D, have been isolated from the aerial parts of the plant.³¹ Analysis of the structure of these new compounds reveals that the position of the hydroxyl and methoxyl groups on the anthraquinone molecule are the factors that contribute to the biological activity of these compounds, with hydroxyl groups at the C6 or C7 positions of the molecule enhancing the activity of the compounds in relation to the inhibition of nitric oxide production.³²

Bicyclic hexapeptides, sometimes referred to as RA series compounds, the second major group of compounds that are produced by the plant and that exhibit biological activity are the bicyclic hexapeptides, which are also referred to as the “RA series” compounds. Unlike the anthraquinone compounds, which exhibit activity in a variety of biological systems, albeit to a moderate extent, the bicyclic hexapeptide compounds appear to have biological activity only in the context of their cytotoxicity to tumor cells. Compounds like RA-XVIII, RA-XXIII, and RA-XXIV have exhibited strong activity in inhibiting the growth of leukemia cell lines at low concentrations, with RA-XVIII exhibiting potency within the microgram per millilitre range. Research into these compounds has revealed that they are active against tumor cell lines of various kinds, including gastric, lung and cervical carcinoma cells, although most research into these cancer cell lines has been relatively narrow in its focus, only testing the cytotoxicity of these compounds on a few different cell line models.³³

In addition to these two main groups of compounds, some of the other compounds that are contained within the plant include triterpenoids, such as oleanolic acid and hederagenin; sterols, such as beta-sitosterol; and phenolic acids, such as vanillic and rosmarinic acid.³⁴ Pharmacokinetic studies performed in the rat plasma to determine the distribution of these compounds after ingestion of the extract indicated that compounds like purpurin, munjistin, and mollugin each peaked within the range of one to three hours of ingesting the herbal preparations, though their concentrations within the plasma were relatively low.³⁵

Safety, Toxicity, and Contraindications

Despite its long history of traditional use, safety concerns have also been reported about Manjistha. The crude ethanol extract of the fruit of Manjistha has revealed harmful effects on the liver of animals at doses of up to 1,000 mg per kg of the body weight of the animals, and the compound dibutyl phthalate, which is found in the plant, has exhibited general toxicity in computational modeling of the compound.³⁶ More significantly, the compound rubiadin, which is one of the signature anthraquinones present within the plants and which is often cited as possessing potential protective effects for the liver, has also been shown to have potential carcinogenic effects. In a separate study that lasted over a long period of time with rats, it was discovered that rubiadin led to the development of adenomas and carcinomas in the rats’ kidneys, as well as precancerous changes to their liver and large intestine.³⁷ Thus, rubiadin is a compound that relates to the benefits of the plant, yet also presents a detrimental aspect to those same benefits. There is also a gap in the literature regarding the pharmacokinetics of the herb and its safety in long-term use. The pharmacokinetic and toxicity studies of the herb, however, are relatively scarce.³⁸ Thus, data regarding the safety of R. cordifolia in human clinical studies is lacking. Studies investigating potential contraindications to the use of R. cordifolia in pregnant or lactating women, or women taking pharmaceutical anticoagulants, have not been performed; knowledge of the herb’s anti-platelet aggregation properties would lead to the suggestion of its avoidance by these groups of individuals.³⁹

Harvesting and Handling of the Medicinal Parts

The root is harvested in the third or fourth year, usually in spring or autumn when the concentration of the compound is the highest.⁴⁰ Roots harvested in younger plants tend to be thinner and have less developed root systems, and leaving the roots in the ground for too long can lead to loss of potency of the root, as well as make it more difficult to process the root after extraction. The harvested roots are air dried under shade to preserve the compounds that are sensitive to heat, and then pulverized into a coarse powder prior to extraction of the compounds, a process noted in the various phytochemical studies of the roots of this plant species.

Most modern extraction protocols employ Soxhlet apparatus methods using solvents like ethanol, methanol, or water, depending on the type of compounds that the researchers are targeting. The use of these techniques at this stage of the Ayurvedic processes mirrors the instructions regarding the time of year to harvest the roots of these plants, suggesting that the calendars that were traditionally used to guide Ayurvedic healers to the best times of year to harvest these roots were developed with an understanding of the chemical composition of the plants prior to the existence of the chemical analysis techniques.⁴¹

The method of processing the herb also seems to have an impact upon the herb’s effects upon the body. The raw form of the root contains compounds that help to promote blood circulation and clear heat from the body, but frying the root in charcoal appears to have the effect of both reducing the amount of heat that is released by the root thus weakening its effects, and increasing the astringency of the root.⁴² This type of differentiation between the variously-processed forms of the same herb and the different effects that each of those processed herbs can have is another example of an herb whose effects have yet to be tested in the modern period and whose chemical analysis would though it would be a reasonable target for future phytochemical comparison studies.

This same principle of the processing altering the therapeutic effect of a herb is not limited to Manjistha. The concept of Samskara in Ayurvedic pharmacology refers to the methods of purifying and transforming the raw materials of herbs, and involves the assumption that each of these processes will alter the effect of the herb either within the body, or in relation to the doshas within the body. Thus, the change of Manjistha from a herb that acts as a blood moving, heat clearing agent to one that acts as an astringent, bleeding controlling agent after being charred is just one example of the types of changes that can be achieved through these processes.

What remains largely untested, however, is whether there has been a change in the chemistry of the plant as a result of this process; the degradation of some anthraquinones, or the synthesis of some new compounds, for instance, could be investigated with modern techniques like UPLC-UV-MS, a technique that has already been employed in other studies of the chemistry of this plant. Thus, such an investigation would provide potential validation for one of the claims of the traditional medicine without relying upon the observations that have been passed along to the physicians from the tradition itself.

Ayurvedic Uses

Manjistha is understood within Ayurvedic medicine as a form of raktashodhaka, or blood purifier, as well as an herb that supports the lymphatic system. Many of the uses of Manjistha in traditional medicine are based upon this understanding of the herb’s ability to provide rakta prasadana, and relate to topics like skin conditions, menstrual health, and detoxification protocols.⁴³ A recent scientific review of the uses of Manjistha in traditional medicine found that the plant has been used to treat a variety of conditions, ranging from skin diseases to menstrual disorders, snake bites, herpes, eye conditions, hemorrhoids, and even fractures, a remarkably broad list that nonetheless clusters fairly tightly around blood related and dermatological complaints.⁴⁴

Though limited in number, the modern clinical data regarding the blood related applications of Manjistha is supportive. One clinical study that assessed the efficacy of Manjistha in relation to 110 patients with abnormal uterine bleeding caused by the presence of an intrauterine device revealed that a decoction of Manjistha was effective in 94.5 percent of patients compared to 81.8 percent with the standard drug used to treat these patients.⁴⁵ Furthermore, another study that included 184 patients with dysfunctional uterine bleeding revealed that Manjistha decoction was effective in treating these patients in 90 percent of cases compared to only 78.1 percent with the hormonal drug norethisterone.⁴⁶ These figures should be interpreted with some caution since neither study employed a double-blind design or explored different doses of the herb, but the findings do provide some continuity between the uses of the herb’s traditional gynaecological use and measurable clinical outcomes.

Although Manjistha’s role as a lymphatic herb that affects the lymphatic system is somewhat less studied in the pharmacological literature, its properties as an antioxidant and anti-inflammatory agent support the traditional idea that Manjistha can support the role of the lymphatic system. Manjistha’s reputation as a wound healing herb, which recommends applying a paste of Manjistha and honey to wounds that exhibit discoloration or that heal slowly, may be supported by the antimicrobial and antioxidant activity of the herb.⁴⁷

Ayurvedic Management

Approaches to managing conditions with Manjistha typically incorporate the herb into a formula, rather than using it as an isolated medicine, an approach that is shared even with the traditional Chinese literature on the subject of Manjistha. For instance, formulas containing R. cordifolia have been used to treat conditions as diverse as nosebleeds, prostatitis, kidney and intestinal fevers, and even blood deficiency in women following childbirth.⁴⁸ This approach to combining herbs reflects the Ayurvedic principle of synergy within herbs in herbal formulas, where the combination of herbs works to address multiple aspects of the illness at once.

In managing skin and blood disorders, the herb is understood to possess properties that help to reduce the heat and inflammation that is causing those conditions in the blood, which in Ayurvedic terms is considered often to be related to excess pitta manifesting through the skin or reproductive system. The reduction in oxidative stress markers such as malondialdehyde, alongside the restoration of antioxidant defences such as glutathione, catalase, and superoxide dismutase activity in the diabetic neuropathy study discussed earlier, offers a biochemical parallel to this traditional framing, even though the two systems describe the underlying mechanism using very different vocabularies.⁴⁹

For neurological and metabolic conditions, more recent research has begun to explore the potential of Manjistha as an adjunct therapy. More specifically, research into the combination of Manjistha and vitamin E has revealed a synergistic effect in the treatment of drug induced movement disorders, suggesting that the combinations of Manjistha with other cooling or nervine herbs may have a genuine pharmacological basis worth investigating further, rather than functioning purely through inherited custom.⁵⁰

It should be noted throughout this section that the modern literature is supportive of the various traditional uses of Manjistha, but also that these outcomes all require additional large-scale and controlled human trials to be truly considered valid in relation to the standards of a pharmaceutical drug. This same sentiment is reflected in the majority of research regarding other plants or botanical medicine in general; it takes decades of research before these plants and treatments are finally permitted to undergo the clinical trials required to be recognized as a pharmaceutical drug.

What sets Manjistha apart, however, is the volume of uses for which it is credited in traditional medicine systems that are independent of one another and that span several continents. This alone, arguably, strengthens the case for prioritizing Manjistha in future clinical research, ahead of other herbs with similarly broad traditional use that have yet to be clinically validated. Until such research is performed, though, confidence in Manjistha’s benefits remains a well-supported hypothesis rather than an established clinical fact.

What such future research might prioritize is also worth considering for this topic. Standardization of the plant material and the processes used to extract the active compounds would likely be the first of these future steps, as the method used to extract the compounds, the parts of the plant that are utilized, and even the way in which the root is processed all appear to have an impact upon the compounds that are contained within the preparation, as discussed in relation to raw versus charcoal processed root. Thus, standardization of the root and extraction process would enable for the effect of the compound to be tested and compared between different research studies. Following the standardization of the compound, however, would be studies that attempt to determine the effect of different doses of the compound within human patients.

Finally, because some of the uses of the plant and its extracts have small clinical studies performed in relation to those uses, such as in relation to menstrual bleeding and skin conditions, those uses can be targeted for clinical trials before the others based on the preliminary research that has already been performed in those fields. Thus, performing clinical trials in the order in which the plant and its extracts are currently being studied, from standardizing the plant extract to dosing to clinical trials in the areas with already existing research, is the best path to performing clinical trials for the herb rather than attempting to test each of the traditional uses of the plant in turn.

Classical Ayurvedic treatment protocols also illustrate how Manjistha’s use fits within a broader system of formulation. In cases of Sarpir-meha, Sushruta prescribes that “a Kalka compound of Kushtha, Kutaja, Pátha, Hingu and Katu-rohini should be taken with a decoction of Guduchi and Chitraka,” with an accompanying note specifying that “honey should be added to all of these decoctions prescribed in cases Pittaja-meha.”51 In Ayurvedic medicine, herbs like Manjistha are rarely prescribed as stand-alone herbs, but are often incorporated into compound formulas that are specifically created for the certain subtype of that condition. Even the pharmaceutical manuals provided for these herbs describe the cultivation of the plants containing the herbs. Charaka Samhita’s Kalpasthana section classifies growing land into three categories, describing suitable soil as “unctuous, black, sweet or golden sweet soil, soft, unploughed, unaffected by other stronger plants,” a level of environmental specificity that underscores how seriously these texts treated the relationship between where a medicinal plant grows and its eventual therapeutic value.⁵²

Manjishtha also appears directly in Sushruta’s treatment of skin conditions. In the management of Pittaja Visarpa, a form of erysipelas, Sushruta specifies that the condition “readily yields to the application of a medicinal plaster composed of Prapaundarika, Yashti madhu, Payasyá, Manjishthá, Padmaka, Chandana and Sugandhiká pasted together”.⁵³ This dermatological application further reinforces the reputation of the plant as a remedy related to the skin and the blood, beyond its effects on the urinary and cultivation related issues, and further illustrates the role of Manjishtha in each of these categories of diseases as recognized by Sushruta.

Conclusion

Manjistha is one of the clearer examples of an Ayurvedic herb whose reputation and pharmacological properties are similar to each other. Used as a blood purifying and anti-inflammatory herb from at least four different traditions long before the existence of modern chemical analysis, Manjistha has been used as a treatment for a variety of issues related to the blood and inflammation. The reputation of Manjistha as a herb with anti-inflammatory and blood-purifying properties is borne out by the fact that the herb contains over a hundred different bioactive compounds within its root. Compounds like anthraquinones and cyclic peptides are responsible for the majority of the beneficial effects of the herb, including its anti-oxidative properties, anti-inflammatory properties, anti-tumor properties, and neuroprotective properties.

At the same time, an attempt has been made to be fair to the limitations of the existing evidence. Much of the research on Manjistha as an herb has been preclinical research using animal models or cell lines, and at least one of the compounds in the herb has been shown to have carcinogenic effects. The pharmacokinetics of the herb is relatively thin in comparison to the other research on the herb, indicating that this area of research will need to be developed prior to its integration into clinical practice based upon the traditional uses of the herb.

Despite the gaps in current knowledge, the existing literature on Manjistha is indicative of a plant that is certainly worth the attention that may be dedicated to fully understanding its therapeutic values. The knowledge of Manjistha that exists within both the Ayurvedic literature of centuries past, as well as the modern scientific literature on the plant, shows that Manjistha is an herb that has the potential to be utilized in modern medicine and practice though future research into the plant would help to fill the existing gaps in the knowledge of Manjistha’s effects.

Endnotes

1. Min Wen et al., “A Comprehensive Review of Rubia Cordifolia L.: Traditional Uses, Phytochemistry, Pharmacological Activities, and Clinical Applications,” Frontiers in Pharmacology 13 (September 2022), https://doi.org/10.3389/fphar.2022.965390.
2. Wen et al., “Comprehensive Review,” 2 to 3.
3. Charaka, Charaka Samhita, trans. P.V. Sharma, Sutrasthana, ch. 4 (Shadvirechana Shatashritiya Adhyaya), Manjishthadi Gana.
4. Sushruta, Sushruta Samhita, trans. Kaviraj Kunja Lal Bhishagratna, Chikitsa Sthana, “Treatment of Pittaja Prameha,” v. 6, p. 421.
5. Wen et al., “Comprehensive Review,” 2.
6. Wen et al., “Comprehensive Review,” 2.
7. Wen et al., “Comprehensive Review,” 4.
8. Wen et al., “Comprehensive Review,” 4.
9. Ravikiran B. Humbare et al., “Phytochemical Characterization, Antioxidant and Anti-Proliferative Properties of Rubia Cordifolia L. Extracts Prepared with Improved Extraction Conditions,” Antioxidants 11, no. 5 (2022): 1006, https://doi.org/10.3390/ antiox11051006.
10. Wen et al., “Comprehensive Review,” 2.
11. Wen et al., “Comprehensive Review,” 4.
12. Wen et al., “Comprehensive Review,” 2.
13. Wen et al., “Comprehensive Review,” 2 to 3.
14. Wen et al., “Comprehensive Review,” 1.
15. Wen et al., “Comprehensive Review,” 4.
16. Humbare et al., “Phytochemical Characterization,” 9 to 10.
17. Humbare et al., “Phytochemical Characterization,” 8 to 9.
18. Wen et al., “Comprehensive Review,” 14.
19. Wen et al., “Comprehensive Review,” 14.
20. Geng Xu et al., “Cytotoxic and Antitumor Agents from Genus Rubia,” Chemistry & Biodiversity 21, no. 12 (2024), https://doi.org/10.1002/ cbdv.202401498.
21. Wen et al., “Comprehensive Review,” 16.
22. Han Luo et al., “Anthraquinones from the Aerial Parts of Rubia Cordifolia with Their NO Inhibitory and Antibacterial Activities,” Molecules 27, no. 5 (2022): 1730–30, https://doi.org/10.3390/molecules27051730.
23. Luo et al., “Anthraquinones from the Aerial Parts,” 5.
24. Sweeti Bana et al., “Rubia Cordifolia L. Attenuates Diabetic Neuropathy by Inhibiting Apoptosis and Oxidative Stress in Rats,” Pharmaceuticals 16, no. 11 (2023): 1586–86, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10674165/.
25. Bana et al., “Diabetic Neuropathy,” 11 to 12.
26. Wen et al., “Comprehensive Review,” 17.
27. Wen et al., “Comprehensive Review,” 14.
28. Wen et al., “Comprehensive Review,” 4.
29. Humbare et al., “Phytochemical Characterization,” 2 to 5.
30. Wen et al., “Comprehensive Review,” 4.
31. Luo et al., “Anthraquinones from the Aerial Parts,” 1.
32. Luo et al., “Anthraquinones from the Aerial Parts,” 5.
33. Wen et al., “Comprehensive Review,” 14.
34. Humbare et al., “Phytochemical Characterization,” 2 to 5.
35. Wen et al., “Comprehensive Review,” 18.
36. Wen et al., “Comprehensive Review,” 17.
37. Wen et al., “Comprehensive Review,” 17.
38. Wen et al., “Comprehensive Review,” 1.
39. Wen et al., “Comprehensive Review,” 16.
40. Wen et al., “Comprehensive Review,” 4.
41. Humbare et al., “Phytochemical Characterization,” 5.
42. Wen et al., “Comprehensive Review,” 4.
43. Diksha Sharma et al., “Unveiling the Modern Therapeutic Properties and Folk Medicinal Riches of Rubia Cordifolia,” Recent Patents on Biotechnology 20, no. 3 (2026): 342–54, https://www.eurekaselect.com/article/148936.
44. Sharma, Jain, and Bhatia, “Unveiling the Modern Therapeutic Properties,” 342.
45. Wen et al., “Comprehensive Review,” 18.
46. Wen et al., “Comprehensive Review,” 18.
47. Wen et al., “Comprehensive Review,” 2.
48. Wen et al., “Comprehensive Review,” 5.
49. Bana et al., “Diabetic Neuropathy,” 11.
50. Wen et al., “Comprehensive Review,” 17.
51. Sushruta, “Treatment of Pittaja Prameha,” p. 421.
52. Charaka, Charaka Samhita, trans. P.V. Sharma, Kalpasthana, ch. 1, p. 539.
53. Sushruta, “Treatment of Pittaja Visarpa,” p. 419.

Bibliography

Bana, Sweeti, Nitin Kumar, Ali Sartaj, et al. “Rubia Cordifolia L. Attenuates Diabetic Neuropathy by Inhibiting Apoptosis and Oxidative Stress in Rats.” Pharmaceuticals 16, no. 11 (2023): 1586–86. https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC10674165/.

Charaka. Charaka Samhita. Translated by P.V. Sharma. Varanasi: Chaukhambha Orientalia, 2014.

Humbare, Ravikiran B., Joyita Sarkar, Anjali A. Kulkarni, et al. “Phytochemical Characterization, Antioxidant and Anti-Proliferative Properties of Rubia Cordifolia L. Extracts Prepared with Improved Extraction Conditions.” Antioxidants 11, no. 5 (2022): 1006. https://doi.org/10.3390/antiox11051006.

Luo, Han, Wei Qin, Hong Zhang, et al. “Anthraquinones from the Aerial Parts of Rubia Cordifolia with Their NO Inhibitory and Antibacterial Activities.” Molecules 27, no. 5 (2022): 1730–30. https://doi.org/10.3390/molecules27051730.

Sharma, Diksha, Divya Jain, and Deepika Bhatia. “Unveiling the Modern Therapeutic Properties and Folk Medicinal Riches of Rubia Cordifolia.” Recent Patents on Biotechnology 20, no. 3 (2026): 342–54. https://www.eurekaselect.com/article/ 148936.

Sushruta. Sushruta Samhita. Translated by Kaviraj Kunja Lal Bhishagratna. Calcutta: privately published, 1907 to 1916.

Wen, Min, Qi Chen, Wang Chen, et al. “A Comprehensive Review of Rubia Cordifolia L.: Traditional Uses, Phytochemistry, Pharmacological Activities, and Clinical Applications.” Frontiers in Pharmacology 13 (September 2022). https://doi.org/ 10.3389/fphar.2022.965390.

Xu, Geng, Meiyu Liu, Zuobin Wang, and Yujuan Chen(s). “Cytotoxic and Antitumor Agents from Genus Rubia.” Chemistry & Biodiversity 21, no. 12 (2024). https://doi.org/ 10.1002/cbdv.202401498.