Native to southern and western Europe, marshmallow has been used for centuries as both a food and a medicine. Althaea, the generic name for mallow plants, comes from the Greek word "altho," which means "to cure." Dioscorides revered the medicinal virtues of mallows, while Pliny advised taking a spoonful of mallows every day to be spared sickness. The Arabs used poultices made from the leaves of marshmallow as an anti-inflammatory. The Romans, Chinese, Egyptians, and Syrians used mallows as a source of food.

The high mucilage content in both the leaves and root, particularly the root, make marshmallow an excellent demulcent (soother) and emollient (skin softener and soother). Several pharmacological studies have shown that mucilaginous herbs generally act as demulcents. While the soothing properties of marshmallow have been substantiated, the pharmacological rationale for other therapeutic uses of marshmallow remains questionable.

Marshmallow is found in southern and western Europe, western Asia, and the northeastern region of North America. It originally grew on salty soils but now thrives in moist uncultivated ground. Its fleshy, erect stems reach a height of 3 to 4 feet. The stems give off simple branches or at most, a few lateral branches. The pale yellow roots are tapered, long, and thick, with a noticeably tough and pliant exterior. The short-stemmed leaves are roundish and ovate-cordate, with irregularly toothed margins and three to five lobes. A soft and velvety down of stellate hairs covers the leaves and stem. The flowers have five reddish-white petals. The whole plant, especially the perennial root, is filled with a mild mucilage.

Part Used/Pharmaceutical Designation

• Flowers
• Leaves
• Roots

Mucilages (supposedly range between 25% and 35%, but may actually be closer to 5% to 11%): major components include galacturonic acid, glucoronic acid, and rhamnose; also arabinose, galactose, glucose, mannose, and xylose. Flavonoids: hypolaeton 8-glucoside, isoscutellarein. Other constituents: asparagine (2%), calcium oxalate, pectin (11%), starch (37%), fat (1.7%), sucrose (10%), tannin, phenolic acids (caffeic, ferulic, syringic).

Both marshmallow leaf and root are used in commercial preparations. Herbal preparations for internal use are made from either the dried leaf or ground dried root (unpeeled or peeled). The medicinal effects are due to the mucilage content, which becomes lower during late autumn and winter. The roots are typically harvested during the fall from plants that are at least two years old. The actual mucilage content of the commercial product may vary, depending upon time of collection.

Expectorant, emollient, soothing diuretic, antilithic (prevents formation of stones or calculi), vulnerary (promotes wound healing), demulcent, anti-inflammatory.

Traditional internal uses: respiratory catarrh, cough, peptic ulceration, inflammation of the mouth and pharynx, enteritis, urethritis, and urinary calculus (stone)

Traditonal external uses: topical treatment for abscesses, boils, varicose and thrombotic ulcers; emollient, vulnerary

Conditions: gastroenteritis, peptic and duodenal ulceration, common and ulcerative colitis, enteritis, topical mouthwash or gargle for inflammation of mouth and pharynx; poultice or ointment/cream in furunculosis, eczema, and dermatitis

Clinical applications: irritation of the oral and pharyngeal mucosa, and concomitant dry cough, mild inflammation of the gastric mucosa

Many mucilaginous herbs such as marshmallow leaves and roots have demulcent properties. Both the root and leaf of marshmallow are effective demulcents because they reduce local irritation that causes acute gastritis.

Studies show that marshmallow root suppresses mucociliary action and stimulates phagocytosis. Marshmallow exhibits antimicrobial activity in vivo against Pseudomonas aeruginosa, Proteus vulgaris, and Staphlococcus aureus. When given intraperitoneally to nondiabetic mice, the mucilage from this plant produced significant hypoglycemic activity. In another investigation, however, marshmallow failed to show anti-inflammatory effects during the carrageenan rat paw edema test.

In one study, coughing was mechanically stimulated in unanesthetized cats. Marshmallow complex extract (100 mg/kg b.w.) and a polysaccharide (50 mg/kg b.w.) isolated from marshmallow roots was given to the test animals. The polysaccharide elicited an antitussive (cough preventive) effect comparable to that of non-narcotic cough suppressants, but the extract was less effective. Mucilaginous herbs such as marshmallow root inhibit coughing by forming a protective coating on the mucosal surface of the respiratory tract that shields it from irritants.

• Leaf: 5 g or equivalent preparations daily
• Flowers: 5 g mallow prescribed as gastrointestinal tea XII according to German Standard Registration
• Root: infusion or cold-water maceration (2% to 5%): 150 ml (1 to 2 tsp.) taken to soothe cough and sore throat
• Dried root: 2 to 6 g or equivalent preparations taken daily (cold infusion tid)
• Tincture: 5 to 15 ml (1:5, 25% ethanol) tid
• Marshmallow syrup (from root): 2 to 10 g per single dose (syrup contains sugar, which should be considered by diabetics)
• Root topical preparations: 5% to 10% drug in ointment or cream base

No adverse side effects have been reported (leaf and root)

No adverse side effects have been reported (leaf and root). There are no precautions concerning either the medicinal or food use of marshmallow since its constituents are declared safe. This plant reportedly poses no problem for use during pregnancy or lactation. Marshmallow has considerable blood-sugar-lowering effects because of its abundant mucilage.

No clinically significant interactions between marshmallow and conventional medications are known to have been reported in the literature to date, including the German Commission E monograph (Blumenthal 1998). Although clinical relevance is unknown, marshmallow may interfere with the absorption of certain medications; therefore, ingestion of marshmallow several hours before or after other herbs or medications may be warranted.

In the United Kingdom, marshmallow root is listed in Schedule 2, Table A of the General Sale List (GSL), and is also accepted in reviewed medicines for internal use. The root is accepted for specified indication in Belgium and France, and listed by the Commission E in Germany. It is permitted as a flavoring by the Code of Federal Regulations (CFR) in the United States, and by the Council of Europe.

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