Marshmallow Root

When one hears the word “marshmallow,” one’s mind may conjure up images of the soft white confection without knowing that the actual marshmallow plant (in the mallow family, Malvaceae) that was the foundation for the original candy is indeed a plant that embodies softness. Its sturdy leaves and broad flower petals are velvety and inviting, and its root releases slippery soft mucilage when steeped in water. In fact, the entire plant “abounds with mucilage” (Grieve, 1931/1971, pp. 507). Marshmallow is surely a softie, and has been a gentle and nutritive plant ally to humans for many thousands of years, living aside us for so long that Culpeper said in 1653, “Common mallows are generally so well known that they need no description.” 

Indeed, the recorded use of marshmallow as food and wellness support dates back to the ancients of Greece, Egypt, Middle East, and Rome, with the physician Pliny later proclaiming that “whosoever shall take a spoonful of the mallows shall that day be free from all diseases that may come to him” (Grieve, 1971). Aristophanes (446-386 BCE) referenced consuming mallow shoots, the Greeks used the young aerial parts as food, and the Romans ate the root (McIntyre, 2014). Theophrastus (372-286 BCE) mentions in his writings that marshmallow root was combined in wine to address coughs (Chevallier, 2000). The genus Althaea is derived from the Greek “to heal.”

Marshmallow root has a rich history in traditional health systems across various cultures and those uses have persisted in contemporary culture. In traditional Persian medicine, marshmallow is known as “Khatmi,” “Panirak,” or “Moloukhia,” and is valued for its gentle, soothing properties, particularly for respiratory and gastrointestinal conditions and especially for children’s issues (Kianitalaei et al., 2019). 

Traditional and early uses include its employment as a poultice for inflammation, internal use for sore throats and gastrointestinal (GI) discomforts, and a soother of the urinary tract (Whelan, n.d.). Cooling, soft, gooey, and moist, marshmallow was noted by Culpeper to help with “all hot and sharp diseases” and “opening the strait passages, and making them slippery” (Culpeper, 1653). In 1919, Dr. Ellingwood described marshmallow as having a soothing influence on the intestines, helpful for inflammation and irritation of the GI tract as well as the bladder.

Marshmallow can help ease the symptoms of gastroesophageal reflux disease (GERD), a condition where stomach contents, including acid, flow backward into the esophagus instead of moving forward through the digestive tract (Luchterhand, 2012). This backward flow can cause frequent heartburn, a burning sensation behind the breastbone, and may result in damage to the esophageal lining. To use marshmallow for respite from symptoms, the usual dosage is 5-6 grams daily, equivalent to about 2-3 tablespoons; prepare a tea by infusing the leaves or roots in hot water, and drink 1 tablespoon (or less) of the tea three times a day (Luchterhand, 2012).

Like our predecessors, today’s herbalists use marshmallow leaf and root as demulcents for the mucous membranes. Marshmallow, as described by herbalist Matthew Wood (2004), tends to be particularly effective in situations where dryness coincides with irritation. It demonstrates its efficacy especially in cases where the tongue presents with redness and dry, cracked texture; its salty nature makes it useful in addressing conditions characterized by hardened tissues, as it draws in water (Wood, 2004). The German Commission E has approved the root for oral and pharyngeal mucosa irritation, dry cough, and mild irritation of the gastric mucosa, and the leaf for dry cough and oral/pharyngeal mucosal irritation. Marshmallow is demulcent, diuretic, anti-inflammatory, expectorant, and emollient (Hoffmann, 2003).

As an infusion or decoction, marshmallow’s mucilage eases sore, dry throats by coating and cooling the irritated tissues with its slippery gel. To extract this beneficial mucilage, Richo Cech (2000) suggests a cold-water infusion of the leaves and flowers and a water decoction of the dried root; however, other herbalists suggest that a cold infusion of the root is best. At any rate, when making a tincture, keep in mind that it is best to use low or non-alcoholic solvents because the mucilage is precipitated out of solution by alcohol (Cech, 2000). The plant is highest in polysaccharides in the fall and winter (Pedersen, 2010) so those harvesting their own marshmallow should keep that in mind in order to obtain the most potent herb.

Marshmallow is helpful for respiratory complaints, GI tract problems like irritable bowel syndrome (IBS) and colitis, and urinary tract discomforts. Both the root and the leaves can be used for these purposes, but Chevallier (2000) suggests the leaves for cystitis and frequent urination. Because the mucilaginous polysaccharides would not physically be able to coat the urinary tract or the lungs, it is believed that the soothing action of marshmallow on these areas is through a reflex action in the nervous system of the gut. In other words, the soothing demulcent action of the mucilage on the gut triggers a similar response in other mucous membranes throughout the body. However, herbal and nutritional expert Mark Pedersen theorizes that the tannins and volatile oils in the root may irritate the urinary tract, thereby stimulating urine and mucus production (Pedersen, 2010). Herbalist Matthew Wood (2004) notes that marshmallow root helps to calm the passages through which kidney and gallstones travel. In general, marshmallow’s cooling and moistening energetics make it useful for soothing inflamed tissues and diminishing swelling (Easley & Horne, 2016). 

Marshmallow root also helps the gut by providing a source of prebiotics to feed the beneficial bacteria that populate the gut. In addition, it is helpful for both diarrhea and constipation, depending on how it is prepared. For diarrhea, soak powdered root in just a small amount of cold water for at least an hour and then drink the mucilaginous result; the small amount of water used in this process will leave the rest of the powder capable of absorbing more water in the gut. For constipation, a teaspoon of powder can be soaked in 8 fluid ounces of cold water to form a fiber drink to help move gut contents out of the system.

The flowers may be used externally for skin inflammation, and the root is also excellent as a poultice for skin irritations. Simply soak the herb in water until it forms a gooey mass and apply to the affected area. It may also be incorporated into “drawing ointments used for abscesses and boils” (Hoffmann, 2003, p. 526). In traditional Persian healthcare, marshmallow extract is used to bathe babies, soothing itchy irritation and rashes (Kianitalaei et al., 2019). 

Within traditional Persian medicine, marshmallow holds a reputation for its multifaceted role in addressing ophthalmic conditions such as swollen eyelids, conjunctivitis, eye discharge, and styes; furthermore, the traditional use of marshmallow in Persian culture extends to its leaf juice, employed either as drops, compresses, or orally, to alleviate ophthalmic ailments (Kianitalaei et al., 2019). Marshmallow, when used as a compress on the eyes, has demonstrated efficacy in reducing both redness and swelling (Wood, 2004). Additionally, it finds extensive external use for its emollient properties, particularly in managing varicose veins and ulcers (Hoffmann, 2003). Herbalist Matthew Wood (2004) underscores marshmallow’s widespread application in addressing diverse skin issues, ranging from dryness and roughness to dandruff and insect bites. These days, marshmallow is used primarily by herbalists as a wellness support. However, as noted above it was once a food staple for the ancients and not-so-ancients, and the root is high in calcium and an excellent source of trace minerals including chromium, iron, magnesium, and selenium (Pedersen, 2011). The root can be added to broths or soups, and the root powder can be easily incorporated into yogurt or oatmeal. 

Marshmallow is considered a galactagogue and its nutritive properties can be helpful in enriching breastmilk (Easley & Horne, 2016). In Persian tradition, marshmallow is used in cases of mastitis and milk coagulation, often utilized in compress form for these purposes; topical applications can also be soothing for cracked nipples (Kianitalaei et al., 2019).

In the Ayurvedic tradition, marshmallow is considered sweet and cooling, and balances all three doshas, but in excess may increase kapha as well as ama (digestive toxins); it acts on the plasma, blood, muscles, marrow, nerves, and reproductive system (Frawley & Lad, 2001). In Chinese medicine, marshmallow is sweet yet slightly bitter and cold, and clears heat. It works through the Lung, Stomach, Kidney, and Bladder channels and addresses yin vacuity in the Stomach and Lung, easing such symptoms as dry cough, sore throat, and thirst (Garran, 2008). As in Western herbalism, it is also used for urinary tract infections.

Scientific research on marshmallow is sparse but growing, and interestingly, preclinical research has hinted at potential hepatoprotective, neuroprotective, and antimalarial actions. The use of marshmallow for coughs and sore throats has also been studied. To evaluate the traditional use of marshmallow root for irritated mucosal tissue, researchers Deters et al. (2010) tested aqueous extracts on epithelial cells and dermal human fibroblasts. The authors of the study concluded that, “Aqueous extracts and polysaccharides from the roots of A. officinalis are effective stimulators of cell physiology of epithelial cells which can prove the traditional use of marshmallow preparations for treatment of irritated mucous membranes within tissue regeneration.”

In an in vitro study conducted by Bonaterra et al. (2020), the anti-inflammatory and antioxidative properties of marshmallow root extract were investigated using human macrophages as the experimental model. The findings unveiled marshmallow’s remarkable capacity to shield against oxidative stress-induced damage while curbing the release of pro-inflammatory agents, akin to or even better than diclofenac (a nonsteroidal anti-inflammatory drug [NSAID] commonly used to relieve pain, inflammation, and swelling) (Bonaterra et al., 2020). Intriguingly, marshmallow extract also enhanced macrophage migration, crucial for immune defense (Bonaterra et al., 2020). These revelations not only underscore the beneficial promise of marshmallow in respiratory health but also advocate for its inclusion into advanced integrative strategies.

One double-blind and placebo controlled clinical trial in Iran studied the use of marshmallow extract in 63 individuals for 4 weeks, with the individuals showing a statistically significant reduction of dry cough associated with angiotensin converting enzyme (ACE) inhibitors, while the placebo group showed no change (Rouhi and Ganji, 2007).

A 2009 assessment of marshmallow root in the United Kingdom cited post-marketing surveillance of two studies on children using marshmallow root and said that while the studies were not controlled or randomized, they concluded that “on the basis of its long-standing use, these marshmallow root preparations can be used to treat irritation of the mouth or throat and associated dry cough. They can also be used to relieve mild discomfort of the stomach and gut;” with regard to the first indication, the use is not advised for children under 3 years of age (European Medicines Agency, 2016).

An alcoholic extract was found to have antibacterial activity against many periodontopathic bacteria tested (Iauk et al., 2003). A 2011 report on the pharmacological activity of Althea officinalis summarized a number of international studies, concluding that the plant:

…indicates significant pharmacological activity in the cough, irritation of the throat, gastric inflammation, anti-tumor, antiviral and immunostimulant. Anti-bacterial and anti-inflammatory activities, effects on mucociliary transport, adhesion of polysaccharide to buccal membranes and reduction of cough are reported (Shah et al., 2011).

Goodarzi et al. (2022) conducted a randomized clinical trial comparing marshmallow plant extract body wash to lukewarm water for fever reduction in 92 febrile children aged 6 months to 10 years, with both groups also receiving acetaminophen. The study found that the marshmallow extract group had a significantly shorter fever resolution time and a higher frequency of children without fever during the study period. Although the initial temperature reduction was greater in the intervention group, this difference was not significant after adjustments. There were no significant differences in heart rate changes, fever recurrence, or additional acetaminophen needs between the groups. The study concluded that marshmallow extract body wash is an effective and safe method to reduce fever in children, warranting further research (Goodarzi et al., 2022).

Naseri et al. (2020) conducted a pilot double-blind active-controlled clinical trial to evaluate the efficacy of marshmallow ointment in treating atopic dermatitis (AD) in children aged 3 months to 12 years. Participants were randomly assigned to use either 1% marshmallow ointment or 1% hydrocortisone ointment, applied twice daily for 1 week, then three times per week for 3 weeks. The severity of AD was assessed using the SCORAD score. Both groups showed significant reductions in SCORAD scores, but the reduction was greater in the marshmallow group compared to baseline and after the first week. Additionally, computational docking analysis identified 33 phytochemical compounds in marshmallow with high affinity for IL6, TNF-alpha, and PDE4 isoenzymes, especially glycosylated compounds; this is significant as it provides a molecular basis for the anti-inflammatory and antiallergic effects of marshmallow, supporting its beneficial potential. The study concluded that marshmallow ointment is more effective than hydrocortisone in reducing AD severity in children, suggesting it as a safer alternative, though further research is needed to confirm these findings (Naseri et al., 2020).

A clinical trial conducted by Amini et al. (2023) evaluated the efficacy of a vaginal cream combining 4% marshmallow extract with 1% clotrimazole (CLOT-M) for addressing vulvovaginal candidiasis (VVC) compared to clotrimazole alone. The study involved 100 women, divided into two groups, who used the creams for seven consecutive nights. Results indicated that the CLOT-M cream significantly improved symptoms such as itching, dyspareunia, and dysuria more effectively than clotrimazole alone, without causing significant side effects. These findings suggest CLOT-M cream as a promising complementary preparation for VVC, with larger sample sizes recommended for future studies (Amini et al., 2023).