Hibiscus is a popular herbal tea that can be taken as a cold or hot infusion. It is rich in many nutrients and bioactive substances that have a wide range of benefits to health. One such group of compounds in hibiscus are anthocyanins. These powerful antioxidant compounds are what give hibiscus its rich red colour (1).

Hibiscus has many benefits to systemic health through these antioxidant qualities, supporting the cardiovascular system and improving the health of the mucous membranes throughout the body. Hibiscus helps to improve the appearance of the skin, brightening the complexion and promoting hair growth (2).

It is useful for those who are prone to urinary tract infections (UTIs) as it helps to nourish and repair the inflamed tissues. Hibiscus is an important herb for cystitis and as part of a healing strategy for recurrent UTIs both during and after. It works via an astringent and anti-inflammatory action. Hibiscus also has antimicrobial actives and mild diuretic actions which help to flush out the urinary tract (2,3).

NOTE: It is, however, important to note that whilst hibiscus may be able to assist in healing of the urinary tract, it cannot be used alone to treat the infection itself (3). One must ensure that UTIs are treated appropriately to tackle the infection, either by consulting a medical herbalist or under treatment of a qualified medical professional. Hibiscus is often used alongside diuretic herbs like corn silk and anti-infectives such as uva-ursi or juniper berry. A herbalist will often advise a course of herbal treatment along with dietary changes and other supplements to create a lasting resolution, as well as to reduce the chances of recurring infections.

One of hibiscus’s most popular uses is for the treatment of hypertension (high blood pressure). It is best to work alongside a quailed medical herbalist if you have moderate to severe hypertension. However, hibiscus can be used as a home remedy in mild hypertension or prophylactically to help maintain healthy blood pressure. It also offers great benefit to the physiological health of the cardiovascular system (4).

Hibiscus has a number of benefits to metabolic health, as it has been found to reduce blood lipids and blood sugars as well as to address obesity via a number of effects on body weight. Obesity and high blood pressure along with high levels of fat and sugar in the blood can lead to increased risk of serious cardiovascular disease. Hibiscus may be used to help maintain healthy metabolic function and reduce the risks of cardiovascular disease (5).

• rosa-sinensis cold infusion is an easy and effective remedy to help bring down a fever. It may also be helpful to reduce virally induced respiratory inflammation that leads to a cough (2).
• sabdariffa and H. rosa-sinensis are both often referenced for use in treating high blood pressure, although much of the research for this has been focused on H. sabdariffa — the most commonly used species. Both have powerful antioxidant and anti-inflammatory activities, whilst H. rosa-sinensis is referenced more frequently for coughs and bronchitis (6, 7).

Hibiscus is sweet, cooling and drying in terms of energetic qualities. It has a rejuvenating action on the cardiovascular system which is attributed to its antioxidant and blood purifying qualities. These combined actions reach out to every cell in the body (2). 

The tissue state that is most indicated for hibiscus is classically one that is inflamed, hot and ‘excited’. This may refer to pathological heat, which may be caused by excess toxins in circulation around the body, viruses and other pathogens, that classically refers to inflammation or excitation (overactivity) in the tissues. The sour, refrigerant energetic quality of hibiscus is classically applied in the treatment of conditions of this nature, to calm and regulate the physiological activities of the mucous membranes (8). 

In Ayurvedic medicine, H. rosa-sinensis is deemed to have cooling and refrigerant actions. These are applied where there is heat and inflammation or congestion and tension particularly — in the mucous membranes of the urinary and reproductive systems (2).

In Ayurveda, H. rosa-sinensis is considered a sacred herb that can be used to increase spiritual connectivity in meditation of devotional ceremonies. It is a remedy of the emotional, spiritual and physical heart that combines well with rose flowers (2).

The constitutional system in Ayurveda refers to the three doshas; vata, pitta and kapha. Their energies are believed to circulate in the body and govern physical, mental and emotional characteristics. They are described as follows; vata — controls basic bodily functions as well as the mind; pitta — governs metabolism, digestion and hormones linked to appetite; kapha — is responsible for strength and stability, muscle growth, weight and the immune system.

Hibiscus is PK- V+, which means that it is indicated where there is excess or imbalance of pitta and kapha in the body. It increases or rejuvenates the qualities of vata (2).

sabdaffira

So named ‘karkade’ in Egypt and Sudan, is used for its refrigerant properties to help lower the body temperature. An infusion of hibiscus is referenced for many medicinal uses including to treat cardiovascular and nervous disorders. It is also used to stimulate diuresis. In other parts of North Africa the flowers of hibiscus are used to relieve coughs, sore throats, and genital problems. A poultice of the leaf is used for treating external wounds and abscesses. In Iran, hibiscus tea is a traditional treatment for hypertension (1).

rosa-sinensis

The roots, leaves and flowers of H. rosa-sinensis have a long history of traditional use in Indonesia and Malaysia. A decoction of the root was used to relieve the symptoms of venereal disease, fever and sore eyes. It was also believed that roots made from plants with white or red flowers would serve as an antidote to poison. The juice of the white flower was used for mouth ulcers. Flowers were infused in hot water and drunk for their expectorant qualities in the treatment of bronchitis.  The white-coloured flower buds were ingested to treat hypertension, whilst the leaves were used topically as poultices for boils and sores, as well as to relieve headaches and inflammation (6).

Cardiovascular system

Hibiscus has been studied extensively for its ability to lower blood pressure with positive results in lowering both systolic and diastolic blood pressure (4). Hypertension is one of the most commonly indicated conditions for the use of hibiscus. The mechanism of hibiscus for the treatment of hypertension includes angiotensin-converting enzyme (ACE) inhibition, vasodilation, and diuretic effects (9).

Reproductive system

rosa-sinensis may be used as part of a treatment approach to address dysmenorrhea and menoragghia. It has antispasmodic and relaxant actions that may affect the uterine smooth muscle and reduce symptoms in these conditions (2). This application is most referenced in Ayurvedic medicine and less commonly seen in Western or traditional Chinese herbalism (2).

Urinary system

Hibiscus is commonly used for cystitis and painful urination. It is both anti-inflammatory and antispasmodic, which may help relieve the pain and discomfort of this condition (2). Hibiscus shows promise as a remedy that improves the health in the mucous membranes within the urinary tract. This is likely due to its rich anthocyanins content. Anthocyanins are antimicrobial and antioxidant compounds. As such, hibiscus may be useful to counteract the recurrence of urinary tract infections (2,3).

Hibiscus may be paired with propolis in the treatment of urinary tract infections. It may be incorporated into a prophylactic prescription for recurrent urinary tract infections and cystitis. It would be best used in combination with other herbs to address tissue condition, bacterial or inflammatory afflictions.

Respiratory system

rosa-sinensis is well documented for its anti-inflammatory properties with a strong history of use in bronchial asthma in India. This may also be partly due to its essential nutrient content, such as calcium, magnesium, zinc, and potassium, which can help in the management of bronchial asthma (7).

There has been a significant amount of research into the use of hibiscus for hypertension including clinical trials. A number of studies and systematic reviews have been included below to surmount the evidence for some of the traditional medicinal actions discussed in this monograph.

Effect of Hibiscus sabdariffa on arterial hypertension: A systematic review and meta-analysis of randomised controlled trials

A systematic review and meta-analysis of randomised controlled trials (RCTs) was carried out to assess the potential antihypertensive effects of H. sabdariffa. Five RCTs were included for the meta-analysis to investigate effects of systolic and diastolic blood pressure (SBP and DBP). In total, 390 participants were randomised, 225 of whom received H. sabdariffa supplementation and 165 received placebo. The meta-analysis confirms significant hypotensive effects in the intervention (4).

A controlled, randomized clinical trial was performed to identify the comparable antihypertensive effectiveness and tolerability of a standardised extract from H. sabdariffa against the pharmaceutical drug captopril. Patients aged 30 to 80 years old with diagnosed hypertension who had been without intervention for one month were recruited. Subjects were randomised to receive either infusion prepared with 10 g H. sabdariffa (standardised with 9.6 mg anthocyanins), daily before breakfast, or captopril 25 mg twice a day. The study period was four weeks. 

The study demonstrates that H. sabdariffa was able to decrease the systolic and diastolic blood pressure to within normal range. The study concludes that standardised H. sabdariffa extract and captopril were equally as effective in the treatment of mild to moderate hypertension (10).

A systematic review of studies as evidence for hypoglycaemic and hypocholesterolaemic effects of Hibiscus rosa-sinensis tea

A systematic review was carried out to evaluate the evidence for the use of H. rosa-sinensis tea in the management of high cholesterol and high blood sugar. The findings revealed that frequent intake of homemade tea of H. rosa-sinensis is adequate to induce anti-hyperglycemic and anti-hyperlipidemic actions, which may contribute to herbal therapeutic approach in controlling diabetes and hypercholesterolemia without causing acute toxicity (11).

Study on H. sabdaffira in the treatment of dyslipidemia in adolescents with obesity

This study carried out on H. sabdaffira investigated the herb’s effects on adolescents with dyslipidemia and obesity. This triple masked, placebo controlled trial enrolled 90 adolescents aged between 12–18 years old who were randomised to receive 6 g of powdered hibiscus or placebo in divided doses for a period of four weeks. The study demonstrated that hibiscus supplementation significantly modulated triglyceride and LDL concentrations in obese adolescents (12). This study is described as a triple-blind, however the paper does not elucidate to this methodology.

Sabdariffa in the treatment of obesity and fatty liver disease

Further research has been carried out to explore the effects of H. sabdariffa in obesity. One study showed a decrease in waist circumference, percent body fat, waist-to-hip ratio as well as improved liver steatosis in patients aged 18–65 who had been diagnosed with obesity and fatty liver disease. Hibiscus contains many bioactive compounds that have been shown to affect weight loss and lipid metabolism, including galloyl ester, chlorogenic acid, caffeic acid, quercetin, tiliroside, and anthocyanins (5).

These works afford us a deeper insight into the medicinal activities of these fascinating plants and show they have significant potential beyond many of their current uses.

In India, hibiscus flowers are sacred to Ganesh — the elephant god who is associated with wisdom (2).

Chinese hibiscus is the national flower of Malaysia. In the Malay language, the plant is known as bunga raya, which means “great flower” (6).

The native range of H. sabdaffira is West Africa and Sudan. It grows primarily in the seasonally dry tropical biome (15)

Hibiscus rosa-sinensis is understood to have been derived through hybridisation of around eight hibiscus species that are native to the West Pacific (16).

The IUCN red list of threatened species does not yet include information on the at risk status of this species.

Habitat loss and over-harvesting from the wild are two of the biggest threats faced by medicinal plant species. There are an increasing number of well-known herbal medicines at risk of extinction. We must therefore ensure that we source our medicines with sustainability in mind. 

The herb supplement industry is growing at a rapid rate and until recent years a vast majority of medicinal plant produce in global trade was of unknown origin. There are some very real and urgent issues surrounding sustainability in the herb industry. These include environmental factors that effect the medicinal viability of herbs, the safety of the habitats that they are taken from, as well as the welfare of workers in the trade.

The botanical supply chain efforts for improved visibility (transparency and traceability) into verifiably sustainable production sites around the world is now certificated through the emergence of credible international voluntary sustainability standards (VSS). 

Read our article on Herbal quality & safety: What to know before you buy and Sustainable sourcing of herbs to learn more about what to look for and questions to ask suppliers about sustainability.

A study was carried out to identify the best extraction method for hibiscus. The research suggests that water is the best solvent for extracting the four anthocyanins. An extraction time of ten minutes also presented with the highest level of phenolics in comparison to ethyl acetate and hexane extractions (17).

Herbal medicines are often extremely safe to take, however it is important to buy from a reputed supplier. Sometimes herbs bought from unreputable sources are contaminated, adulterated or substituted with incorrect plant matter.

Some important markers for quality to look for would be to look for certified organic labelling, ensuring that the correct scientific/botanical name is used and that suppliers can provide information about the source of ingredients used in the product.

A supplier should be able to tell you where the herbs have come from. There is more space for contamination and adulteration when the supply chain is unknown.

Hibiscus is easy to grow either outdoors or indoors. To grow outdoors hibiscus must be positioned in moist but well-draining soil in a warm and sunny location, ideally sheltered from winds. They also do well in pots of loam-based, peat-free compost.

To grow hibiscus indoors place in a bright position but away from full, direct sunlight. They need a minimum temperature of 7–10°C and a high humidity, so do well in bright, but not sunny, bathrooms.

Outdoor hibiscus plants may be fed annually in spring, with a slow-release, high potash formula, such as rose food. To suppress weeds and help maintain soil moisture levels mulch in autumn.

Once the plant reaches 1.5m or taller (it may take three years to reach this size) it will of benefit to prune annually to keep in shape. If left unpruned, the outer branches may become damaged from the weight of the leaves. It is best to prune after flowering, cutting each branch back to a leaf node at a desired height, removing old wood from the centre of the plant (18).

Hibiscus cold infusion

Ingredients

• 20–30g hibiscus (dried)
• 1 unwaxed organic lemon (whole)
• 2 litres of spring water 

Method

Simply place the hibiscus flowers into a large jug of spring water. Squeeze the lemon juice and then chop up the lemon rind, adding this into the infusion.

Infuse in the refrigerator for between 24–48 hours. You can then pour off the beautiful refreshing cold infusion into a glass and drink freely throughout the day for a refreshing cold and cleansing, health-enhancing tipple!

1. Engels. G. Herb Profile: Hibiscus. HerbalGram. 2007; 74:1-6 American Botanical Council. Accessed at. https://www.herbalgram.org/resources/herbalgram/issues/74/table-of-contents/article3102/ Accessed May 20, 2024.
2. Frawley D, Vasant Lad. The Yoga of Herbs: An Ayurvedic Guide to Herbal Medicine. Motilal Banarsidass; 2016.
3. Flower Power: Hibiscus sabdariffa extract to prevent UTIs and dyslipidemia. NutraIngredients USA. Published February 17, 2020. Accessed April 26, 2024. https://www.nutraingredients-usa.com/News/Promotional-Features/Flower-Power-Hibiscus-sabdariffa-extract-to-prevent-UTIs-and-dyslipidemia
4. Serban C, Sahebkar A, Ursoniu S, Andrica F, Banach M. Effect of sour tea (Hibiscus sabdariffa L.) on arterial hypertension. J Hypertens. 2015;33(6):1119-1127. doi:10.1097/hjh.0000000000000585
5. Chang HC, Peng CH, Yeh DM, Kao ES, Wang CJ. Hibiscus sabdariffa extract inhibits obesity and fat accumulation, and improves liver steatosis in humans. Food & Function. 2014;5(4):734. doi:https://doi.org/10.1039/c3fo60495k
   
6. Thulaja NR. Hibiscus (Hibiscus rosa-sinensis). National Library Board Singapore. December 2020. Accessed May 22, 2024. https://www.nlb.gov.sg/main/article-detail?cmsuuid=58f5f860-ace3-4819-82c5-be7d2477855f#:~:text=Hibiscus%20leaves%20are%20ovate%2C%20simple. 
7. Gulati K, Verma P, Rai N, Ray A. Chapter 7 – Role of nutraceuticals in respiratory and allied diseases. ScienceDirect. Published January 1, 2021. https://www.sciencedirect.com/science/article/abs/pii/B9780128210383000070
8. Wood M. The Earthwise Herbal: A Complete Guide to Old World Medicinal Plants. North Atlantic Books; 2003.
9. Salem MA, Ezzat SM, Ahmed KA, Alseekh S, Fernie AR, Essam RM. A Comparative Study of the Antihypertensive and Cardioprotective Potentials of Hot and Cold Aqueous Extracts of Hibiscus sabdariffa L. in Relation to Their Metabolic Profiles. Frontiers in Pharmacology. 2022;13. doi:https://doi.org/10.3389/fphar.2022.840478
10. Herrera-Arellano A, Flores-Romero S, Chávez-Soto MA, Tortoriello J. Effectiveness and tolerability of a standardized extract from Hibiscus sabdariffa in patients with mild to moderate hypertension: a controlled and randomized clinical trial. Phytomedicine : international journal of phytotherapy and phytopharmacology. 2004;11(5):375-382. doi:https://doi.org/10.1016/j.phymed.2004.04.001
11. Sanadheera S, Subasinghe D, Solangaarachchi MN, Suraweera M, Suraweera NY, Tharangika N. Hibiscus rosa-sinensis L. (red Hibiscus) Tea, Can It Be Used as A Home-Remedy to Control Diabetes and Hypercholesterolemia? Biology, Medicine, & Natural Product Chemistry. 2021;10(1):59-65. doi:https://doi.org/10.14421/biomedich.2021.101.59-65
12. Sabzghabaee A, Ataei E, Kelishadi R, et al. Effect of Hibiscus sabdariffa Calices on Dyslipidemia in Obese Adolescents: A Triple-masked Randomized Controlled Trial. Materia Socio Medica. 2013;25(2):76. doi:https://doi.org/10.5455/msm.2013.25.76-79
13. Egyptian herbal monograph. Hibiscus. Vol: 21. Published 2023. https://www.edaegypt.gov.eg/media/hzynjgnk/hibiscus-sabdariffa-l-كركديه.pdf. Accessed April 24, 2024. 
14. Hibiscus sabdariffa L. NYBG Steere Herbarium. Accessed April 24, 2024. https://sweetgum.nybg.org/science/world-flora/monographs-details/?irn=21841
15. Hibiscus sabdariffa L. | Plants of the World Online | Kew Science. Plants of the World Online. https://powo.science.kew.org/taxon/urn:lsid:ipni.org:names:326388-2
16. Hibiscus × rosa-sinensis L. | Plants of the World Online | Kew Science. Plants of the World Online. https://powo.science.kew.org/taxon/urn:lsid:ipni.org:names:560756-1#synonyms
17. HerbClip: Water Extraction Yields the Highest Concentration of Phenolic Compounds from Hibiscus Flowers. cms.herbalgram.org. Accessed April 25, 2024. http://cms.herbalgram.org/herbclip/513/091423-513.html
18. How to grow hibiscus. BBC Gardeners World Magazine. Published May 18, 2021 https://www.gardenersworld.com/how-to/grow-plants/how-to-grow-hibiscus/ Accessed April 21, 2024