Herbs & Botanicals · Ayurvedic blood-purifier root

Manjistha

Rubia cordifolia · also called Indian madder, manjistha, manjishtha, munjeet. Not the same as common madder (Rubia tinctorum).

Manjistha is the red root of Rubia cordifolia, used in Ayurveda as a blood purifier and for skin and periods. Almost all the research is in cells and animals, and we found only one small human trial, which looked at gut bacteria. The key caution: a related plant, common madder, contains compounds that caused kidney tumours in rats, and it is not known whether manjistha products carry the same risk. Avoid it in pregnancy.

General information, not medical advice. Last substantive update October 25, 2026 · Not medically reviewed. A named clinician has not signed off on this page. How this page is made

About Manjistha

Manjistha is the root of Rubia cordifolia, an Ayurvedic herb for skin, periods and blood cleansing. Human research is almost absent. The main safety question is whether anthraquinone compounds like rubiadin, which caused kidney tumours in rats in madder research, matter in manjistha products. Avoid it in pregnancy and breastfeeding, and ask a doctor if you take blood thinners.

What it is

Manjistha is the dried red root of Rubia cordifolia, a climbing vine in the coffee and madder family. In India it is also called Indian madder.

The root contains red anthraquinone compounds such as rubiadin, purpurin and munjistin, and it has long been used as a dye as well as a medicine.

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Not the same as common madder or a Chinese bleeding herb

Common or dyer's madder is Rubia tinctorum, a different plant. Most of the cancer and DNA-damage research was done on its root or its dye. The name "Indian madder" is sometimes used for both, so check the Latin name on the label.

The same plant is used in Chinese medicine (qian cao) mostly to stop bleeding, often as a decoction or a charred root. Those Chinese reports are not evidence for Ayurvedic root powder.

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What people use it for

Ayurveda uses manjistha as a "blood purifier" and for skin problems, wounds, dark spots, menstrual pain and urinary problems. Chinese medicine uses it for bleeding.

Long use is not proof that it works.

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What the research shows

We found one human trial: a 4-week pilot in 31 healthy adults that looked at gut bacteria and found no clear pattern. Two small Chinese reports on uterine bleeding are described second-hand.

Everything else is in cells and animals. A 2022 review says most studies are preclinical and that clinical safety data are lacking.

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At a glance

Traditional uses history, not proof

Ayurveda: skin problems, wounds, dark spots, menstrual pain, urinary problems, jaundice and "blood purifying" (per a 2022 review)
Chinese medicine: stopping bleeding, uterine bleeding, period pain, bruises
Korean and Unani medicine: period pain, arthritis, kidney stones, urinary problems
The red root is also a dye

Studied for research

Gut bacteria in healthy adults (one small pilot): very low certainty, no health outcome
Abnormal uterine bleeding (two small Chinese reports, root decoction): very low certainty
Kidney stones (rats only): insufficient
Platelet clotting (lab only): insufficient
Skin, joints, liver and kidney: tradition or animal findings only

Main compounds

Rubiadin
Purpurin
Munjistin
Mollugin

Common forms

Dried root powder
Root decoction (water boil)
Capsules and extracts
Topical pastes and medicated oils in tradition

Research links: PubMed: Rubia cordifolia comprehensive review (Front Pharmacol, 2022) · PubMed: triphala and manjistha gut bacteria pilot trial (2020) · PubMed: rubiadin and alizarin in a rat cancer model (Cancer Sci, 2009) · PubMed: rubiadin genotoxicity in rat kidney (Arch Toxicol, 2023) · Research Library · Genes & Biomarkers Library

The plant and its history

Accepted scientific name: Rubia cordifolia L.
Naming authority: L. GBIF backbone: accepted species, usageKey 2892192 (exact match, confidence 99). NCBI Taxonomy taxid 339321, rank species.
Common names: Manjistha (Sanskrit / Hindi (Ayurveda)); Indian madder (English); Munjeet / Manjith (Hindi trade names); Qian cao (Chinese (name from our earlier summary; not re-verified))
Botanical family: Rubiaceae (the coffee or madder family), order Gentianales.
Classification: Plantae > Tracheophyta > Magnoliopsida > Gentianales > Rubiaceae > Rubia > Rubia cordifolia
Native range: Not verified in a source read for this page. The 2022 review describes it as common at high altitudes in parts of India such as Mahabaleshwar and Amboli in Maharashtra, and as a perennial climbing vine.
Habitat: Not verified beyond the review's description of a climbing vine found at high altitude in India.
What the plant looks like: Roots: The dried dark-red root is the medicinal part (per the 2022 review).; Stems: Perennial climbing vine (per the review).; Leaves: Not verified.; Flowers: Flowers are pictured in the review; no description read.; Fruit: Fruit is pictured in the review; a crude fruit extract was harmful to rat livers in one animal study.
Cultivation: Not verified in a source read.
Harvest and processing: The review says processing changes the effect in Chinese medicine: the raw root is used to cool and move blood, while charcoal-fried root is astringent and used to stop bleeding. Ayurvedic processing was not verified.
Look-alikes and adulterants: Name: Rubia tinctorum L. (common or dyer's madder); Note: A different accepted species (GBIF usageKey 2892272). Its root is the source of madder colour. It contains lucidin, a mutagen, and is the subject of most of the genotoxicity work. It is not the manjistha plant.; Name: Other Rubia species; Note: Whether other Rubia species are sold as manjistha was not verified in the sources read.
Sustainability and conservation: Not verified. No IUCN assessment was retrieved.

Traditional use and history history, not clinical proof

Tradition or era	Documented use	Source
Ayurveda (India)	Root used for menstrual pain, urinary disorders, dropsy, paralysis, absent periods and jaundice; applied as a honey paste to brown spots and freckles and for wound healing; used to colour medicinal oils; applied to inflamed areas, ulcers and fractures.	p36160419
Chinese medicine	Root (the review treats the same species under its Chinese use) is bitter and cold, said to cool the blood, clear blood stasis and stop bleeding; used for nosebleed, vomiting of blood, metrorrhagia, wounds, injuries, abnormal uterine bleeding, dysmenorrhea, allergic purpura and other bleeding. The aerial part is used for diarrhoea.	p36160419
Korean, Unani and Philippine traditions	Dysmenorrhea, arthritis, rheumatism, urinary disorders (Korea); spleen, liver, jaundice, renal stones, blood detoxification (Unani); urinary tract disorders (Philippines).	p36160419
Dye use	The roots give a red dye used for wool, silk, cotton and red inks.	p36160419
European regulators	No EMA/HMPC monograph found. The review reports a 2004 European statement about Rubia tinctorum, not R. cordifolia.	s-ema-manjistha-nf

Traditional use shows how a plant was used. It does not show that a supplement works or is safe today.

What is inside, and how it may work

What the plant contains and how those compounds act in cells and animals. Laboratory and animal mechanisms are not proven effects in people.

Main compounds

Compound	Family	Where it is concentrated	Activity studied	Level of evidence
Rubiadin PubChem 124062	anthraquinone	Root	Genotoxic and carcinogenic in rat kidney in lab work with madder-colour compounds; protected rat liver from carbon tetrachloride in one report listed by the review. Listed by the 2022 review as a compound of R. cordifolia. ^{11 3 7}	Animal research
Purpurin PubChem 6683	anthraquinone	Root	One of the main red anthraquinones named for R. cordifolia and also found in madder colour. Role in safety not established. ^{11 5}	Laboratory research
Munjistin PubChem 160476	anthraquinone (carboxylic acid)	Root	Named by the review for R. cordifolia and by the rat study among madder-colour compounds; a pharmacokinetic method was developed for it in rat plasma. Not named as the carcinogen. ^{11 5}	Laboratory research
Alizarin PubChem 6293	anthraquinone	Root	Main dye compound of madder. Weaker kidney tumour effect than rubiadin in rats. ^{3 11}	Animal research
Lucidin PubChem 10163	anthraquinone	Rubia tinctorum root	Main mutagen of Rubia tinctorum root in bacterial tests. Not listed among R. cordifolia compounds in the review we read. ^{12 6}	Laboratory research
Mollugin PubChem 124219	naphthohydroquinone-type pyran compound	Root	Named by the review as a major compound of R. cordifolia. Anti-inflammatory in cells. Also noted as mutagenic in one bacterial test of R. tinctorum compounds. ^{11 6}	Laboratory research
Ring-shaped peptides (bicyclic hexapeptides)	ring-shaped peptides	Root	The review says quinones and ring-shaped peptides are the most abundant compound types; over 100 compounds in total. Details not read. ¹¹	Laboratory research

Mechanisms, receptors and pathways

Target or pathway	Gene or receptor	What was found	Level
Platelet-activating factor (PAF) receptor	PTAFR	A plant fraction blocked PAF binding and PAF-induced clumping of rabbit platelets. ¹⁰	Laboratory research
DNA damage by rubiadin and lucidin	DNA adduct and gene mutation (gpt, Spi-)	Rubiadin and its metabolites concentrated in the outer medulla of rat kidney with enlarged nuclei, DNA-damage markers and gene mutations. ^{7 5 4}	Animal research
Stone-forming minerals in urine	n/a	A root extract lowered urine calcium, oxalate and phosphate and kidney crystals in rats. ²	Animal research
Inflammation and oxidation (many)	various	The review lists many cell and animal findings (for example, mollugin lowering nitric oxide and inflammatory signals). None is confirmed in people. ¹¹	Laboratory research

Absorption, metabolism and elimination

Absorption: No human pharmacokinetic study of manjistha was found. The review notes few pharmacokinetic studies exist.
Distribution: In rats, rubiadin and metabolites accumulate in a specific region of the kidney.
Metabolism: In rats, madder glycosides are broken down, in rats and with rat liver enzymes, into alizarin, lucidin and rubiadin. Not studied for manjistha in people.
Elimination: Not established. Colour of urine and other fluids may change (madder, per a consumer reference).
Bioavailability: Unknown in people. A method to measure munjistin, purpurin and mollugin in rat plasma exists (per the review).

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Isolated compounds versus whole extracts

Most safety work uses isolated compounds (rubiadin, alizarin) or madder colour from R. tinctorum. Almost all efficacy work uses extracts in cells or animals. The only human trial used a manjistha supplement for 4 weeks to look at gut bacteria. We cannot tell how much rubiadin a typical manjistha root, extract or capsule delivers, so the isolated-compound results should be read as warnings, not as a measure of risk from the root.

Nutritional composition

Manjistha is used as a root powder, decoction or extract and as a dye. It is not a food and not a meaningful source of nutrients.

9benefits and uses looked at

17studies and sources checked

Very low certaintybest evidence rating found

5lab markers tracked in trials

2 very low certainty7 not enough evidence

What is Manjistha good for?

The main proposed uses and how strong the human evidence is for each. 'Very low' is the best rating any use receives, and most uses have no human trial at all.

Abnormal uterine bleedingVery low certaintyTwo small hospital reports from China say a root decoction beat the comparison treatments (one with other herbs). The reviewers say the detailed data were not published and the comparisons were not the usual first-line drugs. See a doctor for unusual bleeding. Menstrual pain and period problemsNot enough evidenceUsed traditionally in India, Korea and China. No trial was found. Gut bacteriaVery low certaintyA 4-week pilot in 31 healthy adults found no uniform change in gut bacteria with manjistha. No health benefit was measured. Skin conditions, wounds and blood purifyingNot enough evidenceTraditional Ayurvedic use, including a honey paste for dark spots. No human trial found. Kidney stonesNot enough evidenceA root extract reduced stone-forming changes in rats. No human study, and related compounds harmed rat kidneys. Not a reason to use it for stones. Platelets and blood clottingNot enough evidenceA plant fraction blocked a clotting signal on rabbit platelets. This matters for safety with blood thinners, not as a benefit. Kidney and liver protectionNot enough evidenceMixed animal reports: protection in some, harm from a fruit extract in another. No human data. Joint pain and arthritisNot enough evidenceTraditional use only. No trial found. Antioxidant, anti-inflammatory and anti-cancer effectsNot enough evidenceLab and animal findings only for extracts and over 100 compounds. None shows a benefit in people.

Benefits, one by one

Each card is a research question, not a promise. Tap a goal to filter. Open a card to see the studies, doses and limits.

Abnormal uterine bleeding (two small Chinese reports)

Very low certainty

A 2022 review describes two small hospital reports from China where a root decoction was compared with other treatments for unusual uterine bleeding, and both reported higher "effective rates" than the comparison. The review itself says the detailed data were not published and the designs have gaps. This is not enough to rely on.

1 studiesWater decoction of the root (Chinese medicine). Amounts are not discu…

Studies, doses and limits

What the trials found

Report 1: 110 women aged 25-49 with bleeding linked to an intrauterine device; decoction versus the patent medicine Yunnan Baiyao; effective rate 94.5% versus 81.8%. Report 2: 184 patients with dysfunctional uterine bleeding; decoction with other herbs (120) versus the hormone drug norethisterone (64); effective rate 90% versus 78.1%. The reviewers note no tranexamic acid group, no dose groups, and that the detailed data of these studies were not shown in the scientific literature. We did not read the original Chinese papers.

Results

Both reports say the root group did better than the comparison. Second report used a multi-herb decoction, so the root alone is not isolated.

Effect sizes as reported

Effective rate 94.5% vs 81.8% (report 1); 90% vs 78.1% (report 2). No confidence intervals or p-values were given in the review text we read.

Why this rating

Two second-hand reports, one with other herbs, unclear blinding and outcome definitions, wrong or limited comparators, original papers not read. No GRADE rating exists.

Form and dose studied

Water decoction of the root (Chinese medicine). Amounts are not discussed here; ask a doctor or pharmacist.

Who was studied

Adult women with uterine bleeding in Chinese hospitals.

Limits

Second-hand; designs not verified; likely unblinded; effective rate is a loose outcome; comparators were not the usual first-line drug.

Why researchers looked

In Chinese medicine the root (qian cao) is a long-standing bleeding-stopper.

Traditional use

Chinese medicine uses the root to cool the blood, clear blood stasis and stop bleeding (per the 2022 review). The charred root is used differently from the raw root. Ayurveda uses manjistha for menstrual disorders. Long use is not proof.

Proposed mechanism Laboratory research

Lab and animal work reports anti-platelet and anti-coagulant effects, which seems at odds with a bleeding-stopper use. The mechanism for bleeding in people is not established.

A proposed mechanism does not show that the effect happens in people.

Do not treat unusual bleeding yourself. See a doctor, because bleeding can have serious causes. Avoid in pregnancy (see safety tab).

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Menstrual pain and period problems (traditional use)

Not enough evidence

Ayurvedic, Chinese, Korean and Unani traditions use the root for period pain and missing periods. The 2022 review describes no human trial for menstrual pain.

2 studiesRoot decoction or powder in traditional practice. Amounts are not dis…

Studies, doses and limits

What the trials found

None found. The review says prescriptions with R. cordifolia are widely used for primary dysmenorrhea in China but gives no trial data.

Results

No trial results.

Effect sizes as reported

None.

Why this rating

Tradition and lab work only; no trial read.

Form and dose studied

Root decoction or powder in traditional practice. Amounts are not discussed here.

Who was studied

Not applicable.

Limits

No human data.

Why researchers looked

Traditional use only.

Traditional use

Used in India, Korea and in Unani medicine for period pain (dysmenorrhea) and missing periods (amenorrhea), per the 2022 review.

Proposed mechanism Pharmacological theory

Not established.

A proposed mechanism does not show that the effect happens in people.

A root that is used to bring on periods is a reason to avoid it in pregnancy. See the safety tab.

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Gut bacteria (one small pilot trial in healthy adults)

Very low certainty

One small, 4-week pilot trial gave manjistha, triphala or placebo to 31 healthy adults and looked at gut bacteria. No bacteria changed in the same way for everyone. It tested no health outcome, so it does not show a benefit.

1 studiesDaily supplement for 4 weeks (product details not read). Amounts are …

Studies, doses and limits

What the trials found

31 healthy adults at UC Davis were randomised to manjistha, triphala or placebo. 9 manjistha, 9 triphala and 11 placebo participants completed and were analysed. Responses were highly personal and no group of bacteria changed uniformly. Both herb groups showed a trend toward a lower Firmicutes-to-Bacteroidetes ratio and higher Akkermansia muciniphila, and both lowered Rikenellaceae (mainly Alistipes). No clinical outcome was measured.

Results

Gut bacteria changed in some ways in herb groups, with no clear signature. Pilot, not a test of benefit.

Effect sizes as reported

Trends only in the abstract; no effect sizes or p-values reported there.

Why this rating

Tiny pilot (9 completers on manjistha), 4 weeks, surrogate outcome with no health meaning, funding not read.

Form and dose studied

Daily supplement for 4 weeks (product details not read). Amounts are not discussed here.

Who was studied

Healthy adults in California.

Limits

Very small; surrogate outcome; no safety result in the abstract; full text not read.

Why researchers looked

Ayurvedic herbs are used for digestion and "blood cleansing", and almost nothing was known about their effect on gut bacteria.

Traditional use

Not a core traditional use.

Proposed mechanism Pharmacological theory

Not established. Some anthraquinone compounds are known to be changed by gut bacteria, but this was not tested here.

A proposed mechanism does not show that the effect happens in people.

The abstract does not report adverse events either way.

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Skin conditions, wounds and "blood purifying" (traditional use)

Not enough evidence

In Ayurveda manjistha is called a blood purifier and is used for skin problems and wounds, including as a honey paste for dark spots. No human trial of these uses was found. The root is a red dye, which is a reason to be careful with anything used on the skin.

2 studiesRoot paste, oil or powder in tradition. Amounts are not discussed her…

Studies, doses and limits

What the trials found

None found. Our searches did not find a human skin trial of Rubia cordifolia.

Results

No trial results.

Effect sizes as reported

None.

Why this rating

Tradition and lab work only.

Form and dose studied

Root paste, oil or powder in tradition. Amounts are not discussed here.

Who was studied

Not applicable.

Limits

No human data.

Why researchers looked

A main traditional use in India.

Traditional use

A paste made with honey is applied to brown spots and freckles and is used for wound healing; oils are coloured with it; it is applied to inflamed areas, ulcers and fractures (per the 2022 review). A consumer reference says madder is used on the skin for some conditions, with insufficient evidence.

Proposed mechanism Laboratory research

Lab work reports anti-inflammatory and antioxidant effects of extracts and compounds. This does not show a skin benefit in people.

A proposed mechanism does not show that the effect happens in people.

The same root contains compounds that are carcinogenic in rats when eaten (see safety tab). Skin use was not assessed.

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Kidney stones (rat study only)

Not enough evidence

A root extract reduced stone-forming changes in rats given a stone-causing chemical. No human study was found. A consumer reference rates the evidence for madder and kidney stones as insufficient, and the madder-colour compounds can harm the kidney in rats (see safety), so this is not a reason to use it.

3 studiesHydro-alcoholic root extract in rats. Amounts are not discussed here.

Studies, doses and limits

What the trials found

None found.

Results

Rats: fewer crystal deposits and less loss of kidney function.

Effect sizes as reported

Dose-dependent effect; no numbers read beyond the abstract.

Why this rating

One rat study read; no human study.

Form and dose studied

Hydro-alcoholic root extract in rats. Amounts are not discussed here.

Who was studied

Rats.

Limits

Chemical-induced stones in rats; no human trial.

Why researchers looked

A traditional use in Ayurvedic, Unani and Chinese medicine, and for madder.

Traditional use

The root is used for renal stones in Unani and traditional Asian medicine and for urinary tract disorders in the Philippines (per the 2022 review).

Proposed mechanism Animal research

In rats the extract lowered urine calcium, oxalate and phosphate and stone crystals; the authors suggest antioxidant and kidney-protective effects.

A proposed mechanism does not show that the effect happens in people.

Unsafe if you have kidney disease or a history of kidney tumours. See safety tab.

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Platelets and blood clotting (lab only)

Not enough evidence

A fraction of the plant blocked a clotting signal on rabbit platelets in the lab, and the review lists anti-platelet and anti-coagulant effects. Nothing was tested in people. This matters for safety (blood thinners, surgery) more than for benefit.

2 studiesPartially purified plant fraction in the lab.

Studies, doses and limits

What the trials found

None found. No human clotting study of manjistha was found.

Results

Rabbit platelets: PAF-induced clumping blocked; thrombin-induced clumping not blocked.

Effect sizes as reported

Dose-dependent; no numbers read.

Why this rating

One old lab study of a plant fraction.

Form and dose studied

Partially purified plant fraction in the lab.

Who was studied

Rabbit platelets.

Limits

Lab only.

Why researchers looked

Ayurvedic "blood purifier" idea and the Chinese blood-moving use.

Traditional use

Chinese medicine uses the root to clear blood stasis and promote blood circulation, and also to stop bleeding (per the 2022 review).

Proposed mechanism Laboratory research

A plant fraction blocked platelet-activating factor binding to rabbit platelets.

A proposed mechanism does not show that the effect happens in people.

Tell your doctor before surgery or if you take blood thinners.

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Kidney and liver protection (animal reports)

Not enough evidence

The 2022 review lists kidney-protective and liver-protective effects of extracts and of rubiadin in animals. The same review says a fruit extract harmed rat livers and that rubiadin is a carcinogenic concern, so the animal picture is mixed. No human data were found.

1 studiesRoot extracts and isolated rubiadin in animals.

Studies, doses and limits

What the trials found

None found.

Results

Protective in some rat models; harmful liver effects from a crude fruit extract in another.

Effect sizes as reported

Not read.

Why this rating

Animal reports described second-hand in a review; no human data.

Form and dose studied

Root extracts and isolated rubiadin in animals.

Who was studied

Rats and mice.

Limits

Second-hand; contradictory; same compound (rubiadin) is also linked to kidney tumours.

Why researchers looked

Traditional use for jaundice and for blood cleansing.

Traditional use

Used for jaundice in Indian and Unani medicine (per the 2022 review).

Proposed mechanism Animal research

In rats, rubiadin reduced liver injury from carbon tetrachloride with an effect the review says was similar to silymarin. The mechanism is unclear, per the review.

A proposed mechanism does not show that the effect happens in people.

Do not use for liver or kidney disease. See safety tab.

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Joint pain and arthritis (traditional use)

Not enough evidence

The root is used traditionally for rheumatism and arthritis in India and Korea. No human trial was found.

1 studiesNot applicable.

Studies, doses and limits

What the trials found

None found.

Results

No trial.

Effect sizes as reported

None.

Why this rating

Tradition and lab work only.

Form and dose studied

Not applicable.

Who was studied

Not applicable.

Limits

No human data.

Why researchers looked

Traditional use.

Traditional use

Used for rheumatism ("Shi Feng Bi") and arthritis in India and Korea (per the 2022 review).

Proposed mechanism Laboratory research

Lab work lists anti-inflammatory effects of extracts and compounds; this is not proof of a joint effect.

A proposed mechanism does not show that the effect happens in people.

See safety tab.

¹¹

Antioxidant, anti-inflammatory and anti-cancer findings (lab and animal only)

Not enough evidence

The 2022 review lists many lab and animal findings for extracts and for over 100 compounds. The review says most are preclinical and often lack positive controls. None shows a benefit in people.

1 studiesNot applicable.

Studies, doses and limits

What the trials found

None.

Results

Lab and animal reports only.

Effect sizes as reported

None.

Why this rating

Preclinical only.

Form and dose studied

Not applicable.

Who was studied

Cells and animals.

Limits

Lab only.

Why researchers looked

Interest in the plant's quinones and ring-shaped peptides.

Traditional use

Not applicable.

Proposed mechanism Laboratory research

Many suggested pathways; none confirmed in people.

A proposed mechanism does not show that the effect happens in people.

See safety tab.

¹¹

Connections to the rest of health

How Manjistha connects to the rest of our health knowledge graph. Every link says what kind of connection it is. A safety link (for example to the liver) is a warning, not a benefit. A study that merely mentions a topic never creates a benefit link.

Explore every connection: goals, body systems, organs, symptoms, genes

Kind of connection Connected to Search

A. Wellness goals

Connected to	Kind of connection	Evidence status	Context	Studies
Womens Wellness	Potential benefit	Very low certainty	Abnormal uterine bleeding (two small Chinese reports): A 2022 review describes two small hospital reports from China where a root decoction was compared with other treatments for unusual uterine bleeding, and both reported higher "effective rates" than the comparison. The review itself says the detailed data were not published and the designs have gaps. This is not enough to rely on.	¹¹
Womens Wellness	Traditional use	Not enough evidence	Menstrual pain and period problems (traditional use): Ayurvedic, Chinese, Korean and Unani traditions use the root for period pain and missing periods. The 2022 review describes no human trial for menstrual pain.	^{11 17}
Gut Health		Very low certainty	Gut bacteria (one small pilot trial in healthy adults): One small, 4-week pilot trial gave manjistha, triphala or placebo to 31 healthy adults and looked at gut bacteria. No bacteria changed in the same way for everyone. It tested no health outcome, so it does not show a benefit.	⁸
Microbiome Balance		Very low certainty	Gut bacteria (one small pilot trial in healthy adults): One small, 4-week pilot trial gave manjistha, triphala or placebo to 31 healthy adults and looked at gut bacteria. No bacteria changed in the same way for everyone. It tested no health outcome, so it does not show a benefit.	⁸
Healthy Skin	Traditional use	Not enough evidence	Skin conditions, wounds and "blood purifying" (traditional use): In Ayurveda manjistha is called a blood purifier and is used for skin problems and wounds, including as a honey paste for dark spots. No human trial of these uses was found. The root is a red dye, which is a reason to be careful with anything used on the skin.	^{11 17}
Detoxification Support	Traditional use	Not enough evidence	Skin conditions, wounds and "blood purifying" (traditional use): In Ayurveda manjistha is called a blood purifier and is used for skin problems and wounds, including as a honey paste for dark spots. No human trial of these uses was found. The root is a red dye, which is a reason to be careful with anything used on the skin.	^{11 17}
Detoxification Support		Not enough evidence	Kidney stones (rat study only): A root extract reduced stone-forming changes in rats given a stone-causing chemical. No human study was found. A consumer reference rates the evidence for madder and kidney stones as insufficient, and the madder-colour compounds can harm the kidney in rats (see safety), so this is not a reason to use it. Antioxidant, anti-inflammatory and anti-cancer findings (lab and animal only): The 2022 review lists many lab and animal findings for extracts and for over 100 compounds. The review says most are preclinical and often lack positive controls. None shows a benefit in people.	^{2 11 17}
Healthy Circulation		Not enough evidence	Platelets and blood clotting (lab only): A fraction of the plant blocked a clotting signal on rabbit platelets in the lab, and the review lists anti-platelet and anti-coagulant effects. Nothing was tested in people. This matters for safety (blood thinners, surgery) more than for benefit.	^{10 11}
Liver Support		Not enough evidence	Kidney and liver protection (animal reports): The 2022 review lists kidney-protective and liver-protective effects of extracts and of rubiadin in animals. The same review says a fruit extract harmed rat livers and that rubiadin is a carcinogenic concern, so the animal picture is mixed. No human data were found.	¹¹
Joint Support	Traditional use	Not enough evidence	Joint pain and arthritis (traditional use): The root is used traditionally for rheumatism and arthritis in India and Korea. No human trial was found.	¹¹

B. Body systems

Connected to	Kind of connection	Evidence status	Context	Studies
Reproductive System	Biological association	Very low certainty	Studied for: Abnormal uterine bleeding (two small Chinese reports) Studied for: Menstrual pain and period problems (traditional use)	^{11 17}
Digestive System	Biological association	Very low certainty	Studied for: Gut bacteria (one small pilot trial in healthy adults)	⁸
Integumentary System	Biological association	Not enough evidence	Studied for: Skin conditions, wounds and "blood purifying" (traditional use) Studied for: Antioxidant, anti-inflammatory and anti-cancer findings (lab and animal only)	^{11 17}
Urinary System	Biological association	Not enough evidence	Studied for: Kidney stones (rat study only) Studied for: Kidney and liver protection (animal reports)	^{2 11 17}
Cardiovascular System	Biological association	Not enough evidence	Studied for: Platelets and blood clotting (lab only)	^{10 11}
Hepatic System	Biological association	Not enough evidence	Studied for: Kidney and liver protection (animal reports)	¹¹
Musculoskeletal System	Biological association	Not enough evidence	Studied for: Joint pain and arthritis (traditional use)	¹¹

C. Body parts and organs

Connected to	Evidence status	Context	Studies
Kidneys	Animal	Kidney tumours and DNA damage in rats; none shown in people. Kidney tumours in rats with madder-colour compounds including rubiadin; not shown in people. Preparation or compound: Rubiadin and related madder compounds	^{3 7}
Uterus	Not enough evidence	Traditional menstrual use; pregnancy warning for madder. Preparation or compound: Root	¹⁷
Liver	Not enough evidence	Harm from fruit extract and protection by rubiadin in different rat reports. Preparation or compound: Fruit extract; rubiadin	¹¹

D. Symptoms

Connected to	Kind of connection	Evidence status	Context	Studies
Abnormal uterine bleeding	Potential benefit	Very low certainty	Two small Chinese reports of root decoction, described second-hand. Preparation or compound: Root decoction	¹¹

I. Biomarkers

Connected to	Kind of connection	Evidence status	Context	Studies
"Effective rate" for uterine bleeding	Biological association	Very low certainty	Measured in trials: raised. A lab change is not the same as a health benefit.	¹¹
Gut bacteria composition (16S profile of stool)	Biological association	Very low certainty	Measured in trials: mixed. A lab change is not the same as a health benefit.	⁸
Platelet count (blood test)	Biological association	Very low certainty	Measured in trials: raised. A lab change is not the same as a health benefit.	¹¹
Urine calcium, oxalate and phosphate (rats)	Biological association	Not enough evidence	Measured in trials: lowered. A lab change is not the same as a health benefit.	²
Platelet clumping (aggregation)	Biological association	Not enough evidence	Measured in trials: lowered. A lab change is not the same as a health benefit.	¹⁰

J. Genes, receptors and enzymes

Connected to	Kind of connection	Evidence status	Context	Studies
PAF receptor (PTAFR)	Preliminary mechanism	In vitro	Blocked by a plant fraction in rabbit platelets.	¹⁰

K. Biological pathways

Connected to	Kind of connection	Evidence status	Context	Studies
DNA damage response (gamma-H2AX, p21)	Preliminary mechanism	Animal	Markers raised in rat kidney by rubiadin.	⁷

L. Active compounds

Connected to	Kind of connection	Evidence status	Context	Studies
Rubiadin	Biological association	Animal	Genotoxic and carcinogenic in rat kidney in lab work with madder-colour compounds; protected rat liver from carbon tetrachloride in one report listed by the review. Listed by the 2022 review as a compound of R. cordifolia. Preparation or compound: Root	^{11 3 7}
Purpurin	Biological association	In vitro	One of the main red anthraquinones named for R. cordifolia and also found in madder colour. Role in safety not established. Preparation or compound: Root	^{11 5}
Munjistin	Biological association	In vitro	Named by the review for R. cordifolia and by the rat study among madder-colour compounds; a pharmacokinetic method was developed for it in rat plasma. Not named as the carcinogen. Preparation or compound: Root	^{11 5}
Alizarin	Biological association	Animal	Main dye compound of madder. Weaker kidney tumour effect than rubiadin in rats. Preparation or compound: Root	^{3 11}
Lucidin	Biological association	In vitro	Main mutagen of Rubia tinctorum root in bacterial tests. Not listed among R. cordifolia compounds in the review we read. Preparation or compound: Rubia tinctorum root	^{12 6}
Mollugin	Biological association	In vitro	Named by the review as a major compound of R. cordifolia. Anti-inflammatory in cells. Also noted as mutagenic in one bacterial test of R. tinctorum compounds. Preparation or compound: Root	^{11 6}
Ring-shaped peptides (bicyclic hexapeptides)	Biological association	In vitro	The review says quinones and ring-shaped peptides are the most abundant compound types; over 100 compounds in total. Details not read. Preparation or compound: Root	¹¹

Each connection is stored with the ingredient, the connected record, the kind of connection, the evidence status, the supporting studies, the preparation or compound involved, and a review date (last reviewed October 25, 2026).

Evidence at a glance: what changed in 5 lab markers

Tap a number to show only those markers. Counts are markers, not people.

Other221

The evidence

The research centre for Manjistha. Every record here was checked against PubMed or the publisher's page; we never list a study we have not verified.

Evidence by outcome

Abnormal uterine bleeding (two small Chinese reports) 1 studies Very low certainty Menstrual pain and period problems (traditional use) 2 studies Not enough evidence Gut bacteria (one small pilot trial in healthy adults) 1 studies · 31 people in trials Very low certainty Skin conditions, wounds and "blood purifying" (traditional use) 2 studies Not enough evidence Kidney stones (rat study only) 3 studies Not enough evidence Platelets and blood clotting (lab only) 2 studies Not enough evidence Kidney and liver protection (animal reports) 1 studies Not enough evidence Joint pain and arthritis (traditional use) 1 studies Not enough evidence Antioxidant, anti-inflammatory and anti-cancer findings (lab and animal only) 1 studies Not enough evidence

Bars show how many studies we found for each outcome, not how well it works. People are added up across trials only (reviews are not added, to avoid double counting).

How we rate evidence

High certainty

Several well-run trials or reviews agree; further research is unlikely to change the picture much.

Moderate certainty

Good trials point the same way, but some doubt remains.

Low certainty

Small, short or inconsistent trials. The finding could change with better research.

Very low certainty

Very little or very weak human data. Treat as a possibility only.

Mixed findings

Trials or reviews disagree with each other.

Not enough evidence

Not enough human research to say either way.

Evidence against

Good research found no benefit, or found harm.

We take the reviewers' own risk-of-bias and GRADE statements where they exist, and otherwise judge from study size, design, consistency, directness and whether a product matches what is sold. Many publications do not make evidence high. Method note: We started from our existing manjistha summary, re-read the key papers in PubMed, and searched for EU, NCCIH, LiverTox and LactMed entries, which were not found. Study design, people, product and result are recorded as reported, mostly from abstracts and one open-access review. Certainty ratings are the compiler's reading. No study is cited that we could not verify.

Study library: every study we checked 17

Design Research type Plant part Year from Search

Study	Design	People	Product, dose, length	Result
Blomeke B et al. 1992 Formation of genotoxic metabolites from anthraquinone glycosides, present in Rubia tinctorum L. Mutat Res · PMID 1370725 · DOI	Animal research animal	Rats, rat liver enzymes, rat liver cells, Salmonella tests	Alizarin primeveroside and lucidin primeveroside from Rubia tinctorum root root glycosides not restated n/a · vs n/a	Eaten glycosides were turned into alizarin, 1-hydroxyanthraquinone (a rodent carcinogen), lucidin and rubiadin. Rubiadin was highly genotoxic in Salmonella (needing metabolic activation) and in rat liver cells. The authors suggest therapeutic use of Rubia tinctorum may involve a carcinogenic risk. Genotoxic metabolites form from root glycosides Methods, limits and funding Outcomes: Metabolites and DNA-damage tests Limitations: Lab and rat work; Rubia tinctorum, not R. cordifolia. Funding and conflicts: Funding not read. Read: abstract
Divakar K et al. 2010 Protective effect of the hydro-alcoholic extract of Rubia cordifolia roots against ethylene glycol induced urolithiasis in rats. Food Chem Toxicol · PMID 20079795 · DOI	Animal research animal	Male Wistar rats given ethylene glycol to form kidney stones	Hydro-alcoholic extract of R. cordifolia root root not restated not stated in abstract · vs untreated stone-forming rats	The extract dose-dependently prevented the rise in urine calcium, oxalate and phosphate, reduced calcium-oxalate crystal deposits in the kidney and prevented kidney function impairment. Fewer stone-forming changes in rats Methods, limits and funding Outcomes: Urine calcium, oxalate and phosphate; kidney crystal deposits; kidney function Limitations: Rats only; stones were induced by a chemical; not tested in people. Funding and conflicts: Funding not read. Read: abstract
Inoue K et al. 2009 Carcinogenic potential of alizarin and rubiadin, components of madder color, in a rat medium-term multi-organ bioassay. Cancer Sci · PMID 19793347 · DOI	Animal research animal	Male F344 rats pretreated with five carcinogens, then fed test compounds	Isolated rubiadin or alizarin (compounds of madder colour from Rubia tinctorum) compounds 0.008% or 0.04% in the diet 23 weeks · vs untreated diet	0.04% rubiadin significantly increased atypical kidney tubules and hyperplasia and induced kidney adenomas and carcinomas; liver cell foci and large-bowel dysplasia also rose. 0.04% alizarin increased kidney tumours less strongly. Rubiadin: kidney tumours, liver and bowel changes; alizarin weaker Methods, limits and funding Outcomes: Kidney, liver and large-bowel lesions and tumours Limitations: Rats; a model that starts with other carcinogens; isolated compounds, not a root powder; compounds come from madder colour of R. tinctorum, though the 2022 review lists rubiadin in R. cordifolia. Funding and conflicts: Non-US government research support noted. Read: abstract
Inoue K et al. 2009 Possible contribution of rubiadin, a metabolite of madder color, to renal carcinogenesis in rats. Food Chem Toxicol · PMID 19167447 · DOI	Animal research animal	Male F344 rats	Lucidin-3-O-primeveroside, alizarin, lucidin or rubiadin compounds from madder colour not restated up to 26 weeks · vs untreated diet	Rubiadin, but not alizarin, caused atypical tubules (a precancer lesion) and enlarged nuclei in the outer medulla of the kidney after 26 weeks. Lucidin itself caused no kidney change at 1 and 4 weeks. Rubiadin is a potent carcinogenic metabolite of madder colour in rat kidney Methods, limits and funding Outcomes: Kidney tubule changes, cell growth, preneoplastic lesions Limitations: Rats; isolated compounds; precancer lesions rather than tumours at this time point. Funding and conflicts: Non-US government research support noted. Read: abstract
Ishii Y et al. 2022 Visualization of the distribution of anthraquinone components from madder roots in rat kidneys by desorption electrospray ionization-time-of-flight mass spectrometry imaging. Food Chem Toxicol · PMID 35139434 · DOI	Animal research animal	Rats given madder colour	Madder colour (Rubia tinctorum); components detected: alizarin, lucidin, munjistin, nordamnacanthal, purpurin, pseudopurpurin, rubiadin root-derived colour not restated single dose, blood at 1 hour · vs n/a	Lucidin and rubiadin specifically localised in the outer stripe of the outer medulla, the kidney region where tumours form. Munjistin and purpurin (also named as R. cordifolia compounds) were among the compounds detected but were not named as the cause. Genotoxic components reach the tumour-prone kidney site Methods, limits and funding Outcomes: Distribution of anthraquinones in kidney Limitations: Rats; madder colour from R. tinctorum, not manjistha. Funding and conflicts: Funding not read. Read: abstract
Kawasaki Y et al. 1992 The mutagenic constituents of Rubia tinctorum. Chem Pharm Bull (Tokyo) · PMID 1394669 · DOI	Laboratory research in-vitro	Salmonella typhimurium TA100 and TA98	Twenty compounds isolated from Rubia tinctorum roots root n/a n/a · vs n/a	Nine of the compounds, including lucidin, rubiadin and lucidin-3-O-primeveroside, were mutagenic; the most active were 1,3-dihydroxyanthraquinones with a methyl or hydroxymethyl group on carbon 2. Several madder root anthraquinones are mutagenic in bacteria Methods, limits and funding Outcomes: Mutagenicity Limitations: Bacterial test; R. tinctorum; does not say which are present in R. cordifolia. Funding and conflicts: Funding not read. Read: abstract
Mitsumoto T et al. 2023 Site-specific genotoxicity of rubiadin: localization and histopathological changes in the kidneys of rats. Arch Toxicol · PMID 37794257 · DOI	Animal research animal	Male gpt delta rats	Isolated rubiadin compound not restated 28 days · vs untreated	Rubiadin and its metabolites (including lucidin) concentrated in one part of the kidney (outer stripe of the outer medulla), where cells showed enlarged nuclei and DNA-damage markers. Mutation frequency rose dose-dependently, higher in the medulla than the cortex. Rubiadin damages DNA and mutates genes in rat kidney Methods, limits and funding Outcomes: Where rubiadin and metabolites go in the kidney, tissue damage and gene mutations Limitations: Rats; isolated rubiadin; not tested in people or with manjistha products. Funding and conflicts: Funding not read. Read: abstract
Peterson 2020 Modulatory Effects of Triphala and Manjistha Dietary Supplementation on Human Gut Microbiota: A Double-Blind, Randomized, Placebo-Controlled Pilot Study. J Altern Complement Med · PMID 32955913	Controlled trial	31 Healthy adults at the University of California Davis Department of Dermatology	Manjistha (Rubia cordifolia) dietary supplement; separate triphala and placebo groups not stated in abstract 2,000 mg daily (as reported in the abstract) 4 weeks · vs placebo	Responses were highly personal and no bacterial group changed uniformly. Both herb groups tended to a lower Firmicutes:Bacteroidetes ratio and higher Akkermansia muciniphila, and had lower Rikenellaceae (mainly Alistipes). 9 manjistha, 9 triphala and 11 placebo participants completed. Altered fecal communities without a clear response signature Methods, limits and funding Outcomes: Stool bacteria composition by 16S rRNA profiling Limitations: Pilot; very small; surrogate outcome; adverse events not reported in the abstract; full text and funding not read. Funding and conflicts: Funding statement not read. Registration: ClinicalTrials.gov NCT03477825 Read: abstract
Saper RB et al. 2004 Heavy metal content of ayurvedic herbal medicine products. JAMA · PMID 15598918 · DOI	Survey product-analysis	70 70 Ayurvedic products from South Asia bought in Boston-area stores in 2003	Ayurvedic herbal medicine products (not specific to manjistha) mixed as recommended by manufacturers n/a · vs US Pharmacopeia and EPA standards	14 of 70 (20%) contained lead, mercury and/or arsenic; if taken as recommended, each of the 14 could exceed regulatory intake limits. One in five tested Ayurvedic products contained metals above limits Methods, limits and funding Outcomes: Lead, mercury and arsenic content Limitations: Old (2003 purchases); Boston stores; products were not manjistha-specific; says nothing about any given manjistha brand. Funding and conflicts: Government research support noted. Read: abstract
Tripathi YB et al. 1993 Anti-platelet activating factor property of Rubia cordifolia Linn. Indian J Exp Biol · PMID 8406601	Laboratory research in-vitro	Rabbit platelets	Partially purified fraction of the whole plant of R. cordifolia whole plant lab concentrations n/a · vs n/a	The fraction blocked platelet clumping caused by PAF, but not by thrombin, and blocked binding of PAF to platelets in a dose-dependent way. Anti-PAF effect in rabbit platelets Methods, limits and funding Outcomes: Platelet aggregation caused by platelet-activating factor (PAF) or thrombin Limitations: Rabbit cells in the lab; fraction of the whole plant, not the root powder; no human data. Funding and conflicts: Funding not read. Read: abstract
Wen M et al. 2022 A comprehensive review of Rubia cordifolia L.: Traditional uses, phytochemistry, pharmacological activities, and clinical applications. Front Pharmacol · PMID 36160419 · DOI	Review review	Narrative review of traditional, chemical, lab/animal and clinical reports on R. cordifolia (mostly Chinese-language sources)	Rubia cordifolia (various extracts and compounds) root mainly; some fruit and aerial-part reports not restated n/a · vs n/a	Over 100 compounds, mainly quinones and ring-shaped peptides. Most studies are preclinical. Two clinical reports of uterine bleeding are summarised (see benefit entries). The review states that clinical safety data for R. cordifolia are lacking and that rubiadin is a carcinogenic concern. It also states that Commission of the European Communities (CPMP 2004) considers R. tinctorum a plant with serious risks. n/a Methods, limits and funding Outcomes: Traditional uses, compounds, lab and animal pharmacology, two small clinical reports, toxicity Limitations: Narrative review, not a systematic one. The clinical studies are described second-hand from Chinese-language sources that the reviewers say lack detailed data. Full text read via PubMed Central (PMC9500525); the title in our older summary differed slightly and is corrected here. Funding and conflicts: Funding not recorded here Read: abstract+full-text
Yasui Y et al. 1983 Identification of a mutagenic substance, in Rubia tinctorum L. (madder) root, as lucidin. Mutat Res · PMID 6621581 · DOI	Laboratory research in-vitro	Salmonella typhimurium TA100 and TA98	Extract of Rubia tinctorum root root n/a n/a · vs n/a	All the mutagenic activity of the madder root extract was due to lucidin. Lucidin is the main mutagen in madder root Methods, limits and funding Outcomes: Mutagenicity Limitations: Bacterial test; R. tinctorum. Funding and conflicts: Funding not read. Read: abstract
s-ema-manjistha-nf EMA/HMPC herbal monograph for Rubia cordifolia or Rubia tinctorum: not found · Source	Authoritative guidance n/a			Methods, limits and funding Read: not-found
s-identity-databases GBIF species match, NCBI Taxonomy and PubChem name lookups (2026-10-25) · Source	Database lookup n/a			Methods, limits and funding Read: full-text
s-livertox-lactmed-nf LiverTox and LactMed records for Rubia cordifolia / madder / manjistha: not found · Source	Authoritative guidance n/a			Methods, limits and funding Read: not-found
s-nccih-manjistha-nf NCCIH fact sheet for Rubia / manjistha / madder: not found · Source	Authoritative guidance n/a			Methods, limits and funding Read: not-found
s-rxlist-madder Madder (Rubia tinctorum): consumer drug reference page (RxList) · Source	Authoritative guidance n/a			Methods, limits and funding Read: full-text

What we do not know yet

What the evidence supports: tradition, lab and animal work, and one small pilot, all at very low certainty or lower.
No randomised trial of manjistha for any health condition.
Whether manjistha products carry the rubiadin or lucidin risks seen with madder colour is not established.
No pregnancy, breastfeeding, child, interaction or long-term safety data.
No EU, NCCIH, LiverTox or LactMed entry was found.

How new research is added

New studies are found by a saved PubMed search and placed in a review queue. A person reads each one before it changes any evidence rating or safety wording. New publications never change ratings automatically.

Lab markers

What changed in blood or saliva tests during trials. A changed number is not the same as feeling or being healthier, and we give no "normal ranges".

Other 5

▲

"Effective rate" for uterine bleeding

Raised in trials

The share of patients whose bleeding was judged to have improved, as defined by the hospital authors.

Very low certainty

Results and what it means

Why it was measured

Main result of the two Chinese reports.

Statistical vs. clinical meaning

A loose, locally defined outcome reported second-hand. Not a validated measure of blood loss.

Safety implication

None reported in the review text we read.

Study	Result	People	Product
¹¹	94.5% versus 81.8% (decoction versus Yunnan Baiyao); 90% versus 78.1% (multi-herb decoction versus norethisterone), as quoted in the review	110 and 184 women with uterine bleeding	Root decoction (second report with other herbs)

¹¹

↕

Gut bacteria composition (16S profile of stool)

Mixed results in trials

Which kinds of bacteria are present in a stool sample and in what proportion.

Very low certainty

Results and what it means

Why it was measured

The only outcome of the pilot trial.

Statistical vs. clinical meaning

A surrogate marker. There is no agreed "good" bacterial profile, so a change does not show a benefit.

Safety implication

None identified for this marker.

Study	Result	People	Product
⁸	No bacteria changed uniformly; trend to a lower Firmicutes:Bacteroidetes ratio and higher Akkermansia muciniphila; lower Rikenellaceae (mainly Alistipes)	31 healthy adults (9 manjistha completers)	Manjistha (Rubia cordifolia) supplement for 4 weeks

⁸

▲

Platelet count (blood test)

Raised in trials

The number of clotting cells in the blood.

Very low certainty

Results and what it means

Why it was measured

The review notes platelet levels were measured in report 1.

Statistical vs. clinical meaning

Second-hand, no numbers; may reflect recovery from bleeding rather than a herb effect.

Safety implication

None identified for this marker.

Study	Result	People	Product
¹¹	Platelet levels were higher after treatment in both groups (decoction and Yunnan Baiyao), as stated in the review; no numbers given	110 women with IUD-related bleeding	Root decoction

¹¹

▼

Urine calcium, oxalate and phosphate (rats)

Lowered in trials

Minerals in urine that make up common kidney stones.

Not enough evidence

Results and what it means

Why it was measured

Main outcomes of the rat stone study.

Statistical vs. clinical meaning

Rat result; not shown in people.

Safety implication

See safety tab for kidney concerns about related compounds.

Study	Result	People	Product
²	Extract dose-dependently prevented the rise in urinary calcium, oxalate and phosphate caused by ethylene glycol	Male Wistar rats	Hydro-alcoholic R. cordifolia root extract

▼

Platelet clumping (aggregation)

Lowered in trials

How readily platelets stick together, a step in clotting.

Not enough evidence

Results and what it means

Why it was measured

Main outcome of the lab study.

Statistical vs. clinical meaning

Lab only; the amount that would matter in people is unknown.

Safety implication

Possible added bleeding tendency with blood thinners is theoretical.

Study	Result	People	Product
¹⁰	Blocked PAF-induced aggregation of rabbit platelets, but not thrombin-induced	Rabbit platelets	Partially purified R. cordifolia fraction

¹⁰

Safety

What studies and official sources say about side effects, medicines and who should check first. Each point shows what kind of evidence it comes from.

Main points to know 5

Madder-colour compounds, including rubiadin, caused kidney tumours in rats. Rubiadin and alizarin, found in the madder colour of Rubia tinctorum, caused kidney tumours in rats; in one study rubiadin also raised liver and large-bowel changes. Rubiadin and the related lucidin also damage DNA in lab tests. A 2022 review lists rubiadin among the compounds of Rubia cordifolia (the manjistha plant) and advises avoiding exposure to rubiadin-containing substances. We found no study of whole manjistha root and no human data, so the risk to people taking manjistha is unknown. Do not read this as proven harm or as proven safety. Animal research ^{3 4 7 5 11}
Do not mix it up with common madder (Rubia tinctorum). Common or dyer's madder (R. tinctorum) is a different plant. Its root contains lucidin, a proven mutagen in bacteria, and the European Commission is reported (second-hand, through the 2022 review) to class the plant as one with serious risks. One consumer reference lists "Indian madder" as a name for R. tinctorum and calls oral madder likely unsafe. Lucidin was not listed among R. cordifolia compounds in the review we read, but the two plants share compounds such as rubiadin, purpurin and munjistin, and we found no study comparing them directly. Authoritative guidance ^{12 6 11 17}
Avoid in pregnancy and breastfeeding. The root is used traditionally to regulate periods. A consumer reference warns that oral madder may start a period and cause miscarriage, and may colour breast milk. We found no pregnancy or breastfeeding safety data on manjistha itself. Avoid until a clinician advises otherwise. Authoritative guidance ^{17 11 15}
Red-coloured urine and body fluids. A consumer reference says madder can turn urine, saliva, sweat, tears and breast milk red. This was not checked for manjistha products. Red urine can be dye, but it can also mean blood, so ask a doctor if it is new, painful or does not clear after stopping. Authoritative guidance ¹⁷
Official safety statements are missing. No EU herbal monograph, NCCIH fact sheet, LiverTox or LactMed record was found for manjistha or madder. This is a gap in what we could open, not proof of safety. Some Ayurvedic products have also contained lead, mercury or arsenic. Authoritative guidance ^{13 16 15 9}

Side effects 4

Effect	How often	Severity and recovery	Evidence
Red or orange colour of urine, sweat, tears, saliva From a madder (R. tinctorum) consumer page. Not confirmed for manjistha in a study.	Not established	mild, but new red urine needs checking Not studied	Authoritative guidance ¹⁷
Loose stools or laxative effect Some anthraquinone plants, such as senna, are stimulant laxatives. We found no report that manjistha root has this effect. The 2022 review mentions the aerial part being used for diarrhoea, which points the other way. The 2020 pilot trial abstract does not mention stools or any adverse event.	Not established	unknown Unknown	Pharmacological theory ¹¹
Adverse events in human trials The only trial found (31 healthy adults, 4 weeks) reports no adverse-event result in its abstract. This is not evidence of safety, and the full text was not read.	Not established	not applicable Not applicable	Controlled trial ⁸
Possible kidney stress or tumour risk (long-term) Seen in rats given isolated madder-colour compounds. No human case was found. Frequency in people is not established.	Not established	potentially serious Unknown	Animal research ^{3 7}

Liver

No human case of liver injury from manjistha was found in PubMed searches, and no LiverTox record was found. In animals the picture is mixed: a crude ethanol extract of the fruit harmed rat livers in a short study, rubiadin protected rat livers from carbon tetrachloride in another report, and in a different rat model rubiadin raised liver cell foci. Fruit is not the root normally sold as manjistha. This is absence of reports, not proof of liver safety. ^{11 3 15}

How often. No frequency of human liver injury was found. Not established.

Monitoring. No agency advice found. People with liver disease, or taking medicines that affect the liver, should ask a doctor first. Stop and seek care for yellow skin or eyes, dark urine, pale stools or severe tiredness. Root dye can also colour urine, so tell the doctor you take it.

This is a safety connection. It is not evidence that Manjistha supports liver health.

Medicines and supplements 5

With	Why it matters	Importance	Evidence	What to do
Blood thinners and antiplatelet drugs (warfarin, aspirin, clopidogrel, heparin and similar) prescription	A plant fraction blocked platelet-activating factor binding in rabbit platelets, and the 2022 review lists anti-platelet and anti-coagulant activity from lab and animal work.	Added bleeding is theoretical. No human clotting or bleeding study or case report was found. The root is also used traditionally to stop bleeding, so the direction is unsettled.	Laboratory research Not enough evidence ^{10 11}	Ask a doctor or pharmacist before combining. Tell your surgeon before an operation.
Medicines for bleeding disorders or heavy periods (such as tranexamic acid or hormones) prescription	Not studied. The Chinese bleeding reports compared the root with other treatments; they did not combine them.	Unknown. Do not replace a prescribed treatment with manjistha.	Pharmacological theory Not enough evidence ¹¹	Tell your prescriber.
Medicines or conditions that stress the kidneys (kidney disease, some painkillers and chemotherapy) prescription	Rubiadin and related compounds concentrate in a specific kidney region in rats and cause DNA damage there.	Theoretical for people. No human study.	Animal research Not enough evidence ^{7 5}	Avoid with kidney disease unless a kidney specialist agrees.
Medicines cleared by liver enzymes (narrow safe range) prescription	No enzyme or transporter study of manjistha was found.	Unknown.	Pharmacological theory Not enough evidence ¹¹	Ask a pharmacist if you take a medicine with a narrow safe range.
Other herbs: senna, cascara and other anthraquinone laxatives herb	Shared anthraquinone chemistry only; no study of combining.	Unknown; added gut effects are theoretical.	Pharmacological theory Not enough evidence ¹¹	Avoid stacking several anthraquinone herbs without advice.

Who should check first 6

Situation	Advice	Evidence
Pregnancy	Avoid. Traditional use for periods and a consumer warning about miscarriage for madder; no safety data on manjistha.	Authoritative guidance ^{17 11}
Breastfeeding	Avoid. The only statement found concerns madder and says it might harm the baby and colour milk; no data on manjistha.	Authoritative guidance ^{17 15}
Children	No safety data. Do not give without a clinician.	Pharmacological theory ¹¹
Kidney disease, kidney stones, or a history of kidney or bowel cancer	Avoid unless a specialist agrees. Do not self-treat stones with it.	Animal research ^{3 7 17}
Bleeding disorders, blood thinners, or surgery coming up	Ask a doctor first; stop before surgery on advice.	Laboratory research ¹⁰
Liver disease	Ask a doctor first. Animal findings are mixed and human data are lacking.	Animal research ¹¹

Overdose, product quality and regulators

Summary. Toxicity is mostly known from animals and lab tests of madder-colour compounds. For whole manjistha root there are no human toxicity data and few animal data.

Animal. Rubiadin at 0.04% of the diet for 23 weeks caused kidney tumours in rats, and alizarin did so more weakly; rubiadin also raised liver and bowel changes. A crude fruit extract (up to 1,000 mg per kg) harmed rat livers in a short test, with an LD50 above 1,000 mg/kg as quoted by the 2022 review.

Human doses studied. The only human trial found lasted 4 weeks in 31 healthy adults and reports no adverse-event result in its abstract. Long-term human safety is unstudied.

High dose or long term signals. Kidney tumours and DNA damage in rats with isolated madder-colour compounds; not shown in people.

Overdose response. No case of overdose was found.

Genotoxicity. Lucidin and rubiadin are genotoxic in bacterial and rat-liver-cell tests, and rubiadin causes gene mutations in rat kidney. These come from Rubia tinctorum work; manjistha root itself was not tested in the studies read.

Toxic plant parts. Fruit: crude ethanol extract harmed rat livers. Root: contains anthraquinones including rubiadin (per the 2022 review). Aerial part: used traditionally for diarrhoea; safety not assessed.

Two quality risks: look-alike plants (common madder or other Rubia) and metals in some Ayurvedic products.

Heavy metals in Ayurvedic products. In a 2003 Boston survey, 14 of 70 Ayurvedic products (20%) contained lead, mercury and/or arsenic; if taken as recommended, each could exceed regulatory limits. The survey was not about manjistha specifically. ⁹

Species mix-up with common madder. "Indian madder" is used as a name for R. cordifolia and is also listed as a name of R. tinctorum by one consumer reference. A product labelled "madder" may be the other plant. Other Rubia species sold as manjistha: not verified. ^{17 11}

Body	Action	Date

When to get medical help

Red or bloody urine that is new, painful or does not clear when you stop
Severe belly or back pain, or very little urine
Yellow skin or eyes, dark urine with pale stools, or severe tiredness
Unusual bleeding or bruising, especially on blood thinners
Vaginal bleeding or cramping in pregnancy

Stop the supplement and contact a clinician or emergency service. In the US, Poison Control is 1-800-222-1222.

General information only, not medical advice. Ask a clinician or pharmacist before use, especially with medicines, in pregnancy or with a health condition. See the Natural Remedy Safety guide.

Frequently asked questions

What is manjistha used for?

In Ayurveda it is used as a blood purifier and for skin problems, wounds, dark spots, menstrual pain and urinary problems. Chinese medicine uses the same plant to stop bleeding. These uses rest on tradition and a few small reports.

¹¹

Is manjistha the same as madder?

No. Common or dyer's madder is Rubia tinctorum, a different plant. Most cancer and DNA-damage findings come from it. The name "Indian madder" can be used for both, so look for Rubia cordifolia on the label.

^{14 17 12}

Does manjistha purify the blood or help the skin?

Not shown. This is a traditional idea. We found no human trial of manjistha for skin conditions or for blood cleansing.

¹¹

Is there any human research?

Very little. One 4-week pilot in 31 healthy adults looked at gut bacteria and found no clear pattern. Two small Chinese reports on uterine bleeding are described only second-hand in a review.

^{8 11}

Does it help abnormal uterine bleeding?

Unproven. Two small Chinese hospital reports say a root decoction did better than the comparison, but the details are not published, one used other herbs, and the comparisons were not the usual first-line drugs. See a doctor for unusual bleeding.

¹¹

Can it cause cancer?

Unknown for manjistha. Rubiadin and alizarin, compounds of madder colour, caused kidney tumours in rats, and a 2022 review lists rubiadin in Rubia cordifolia and advises avoiding exposure. Whether manjistha products contain enough to matter, and what this means for people, has not been studied.

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Is it good for kidney stones?

Not shown in people. A root extract reduced stone changes in rats, but related madder compounds harmed rat kidneys, and a consumer reference rates the evidence for madder and stones as insufficient. See a doctor for stones.

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Will it turn my urine red?

Possibly. A consumer reference says madder can colour urine, sweat, tears, saliva and breast milk red. It was not checked for manjistha. See a doctor if red urine is new, painful or does not clear after stopping.

¹⁷

Does it act as a laxative?

Not shown. Some anthraquinone plants, like senna, are laxatives, but we found no report of this for manjistha root, and the 2020 trial abstract mentions no stool effect. Unknown.

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Is it safe in pregnancy or breastfeeding?

Avoid. It is used traditionally to regulate periods, and a consumer reference warns that madder may start a period, cause miscarriage and colour breast milk. We found no safety data on manjistha itself.

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Is it safe with blood thinners or before surgery?

Unknown. A plant fraction blocked platelet clumping in the lab. No human bleeding study was found. Ask a doctor, and tell your surgeon before an operation.

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Do health agencies recommend it?

No EU monograph, NCCIH fact sheet, LiverTox or LactMed record was found. This is a gap in what we could open. Ask a doctor or pharmacist about amounts.

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Editorial transparency

Written by: AlternativeMed editorial team. Research compiled with AI assistance, then checked against PubMed records.
Medical review: None. This page has not been reviewed by a physician or pharmacist.
First published: 2026-10-25
Last substantive update: 2026-10-25
How we research: We started from our existing manjistha summary, re-read the key papers in PubMed, and searched for EU, NCCIH, LiverTox and LactMed entries, which were not found. Study design, people, product and result are recorded as reported, mostly from abstracts and one open-access review. Certainty ratings are the compiler's reading. No study is cited that we could not verify.
How we rate evidence: See "How we rate evidence" in the Evidence tab.
Independence: No product is promoted on this page. No affiliate links are shown. If one is added later it will be labelled and kept apart from the evidence.

Sources 17

Each source was opened and checked. Where we read only the abstract, it says so. The small numbers in the text point here.

Blomeke B et al.. Formation of genotoxic metabolites from anthraquinone glycosides, present in Rubia tinctorum L.. Mutat Res. 1992. PMID 1370725. DOI 10.1016/0027-5107(92)90055-7. (abstract)
Divakar K et al.. Protective effect of the hydro-alcoholic extract of Rubia cordifolia roots against ethylene glycol induced urolithiasis in rats.. Food Chem Toxicol. 2010. PMID 20079795. DOI 10.1016/j.fct.2010.01.011. (abstract)
Inoue K et al.. Carcinogenic potential of alizarin and rubiadin, components of madder color, in a rat medium-term multi-organ bioassay.. Cancer Sci. 2009. PMID 19793347. DOI 10.1111/j.1349-7006.2009.01342.x. (abstract)
Inoue K et al.. Possible contribution of rubiadin, a metabolite of madder color, to renal carcinogenesis in rats.. Food Chem Toxicol. 2009. PMID 19167447. DOI 10.1016/j.fct.2009.01.003. (abstract)
Ishii Y et al.. Visualization of the distribution of anthraquinone components from madder roots in rat kidneys by desorption electrospray ionization-time-of-flight mass spectrometry imaging.. Food Chem Toxicol. 2022. PMID 35139434. DOI 10.1016/j.fct.2022.112851. (abstract)
Kawasaki Y et al.. The mutagenic constituents of Rubia tinctorum.. Chem Pharm Bull (Tokyo). 1992. PMID 1394669. DOI 10.1248/cpb.40.1504. (abstract)
Mitsumoto T et al.. Site-specific genotoxicity of rubiadin: localization and histopathological changes in the kidneys of rats.. Arch Toxicol. 2023. PMID 37794257. DOI 10.1007/s00204-023-03610-4. (abstract)
Peterson CT, Pourang A, Dhaliwal S et al.. Modulatory Effects of Triphala and Manjistha Dietary Supplementation on Human Gut Microbiota: A Double-Blind, Randomized, Placebo-Controlled Pilot Study.. J Altern Complement Med. 2020. PMID 32955913. (abstract)
Saper RB et al.. Heavy metal content of ayurvedic herbal medicine products.. JAMA. 2004. PMID 15598918. DOI 10.1001/jama.292.23.2868. (abstract)
Tripathi YB et al.. Anti-platelet activating factor property of Rubia cordifolia Linn.. Indian J Exp Biol. 1993. PMID 8406601. (abstract)
Wen M et al.. A comprehensive review of Rubia cordifolia L.: Traditional uses, phytochemistry, pharmacological activities, and clinical applications.. Front Pharmacol. 2022. PMID 36160419. DOI 10.3389/fphar.2022.965390. (abstract+full-text)
Yasui Y et al.. Identification of a mutagenic substance, in Rubia tinctorum L. (madder) root, as lucidin.. Mutat Res. 1983. PMID 6621581. DOI 10.1016/0165-7992(83)90201-4. (abstract)
. EMA/HMPC herbal monograph for Rubia cordifolia or Rubia tinctorum: not found. . . (not-found)
. GBIF species match, NCBI Taxonomy and PubChem name lookups (2026-10-25). . . (full-text)
. LiverTox and LactMed records for Rubia cordifolia / madder / manjistha: not found. . . (not-found)
. NCCIH fact sheet for Rubia / manjistha / madder: not found. . . (not-found)
. Madder (Rubia tinctorum): consumer drug reference page (RxList). . . (full-text)

Education, not medical advice. This page is for general information. It does not diagnose or treat any condition and is not a substitute for care from a qualified health professional. Natural does not automatically mean safe. Ask a clinician or pharmacist before changing your care, especially if you take medication, are pregnant or breastfeeding, or have a health condition.