Common Barberry in Traditional Medicine, Ayurveda, and Modern Science

Common Barberry as a Medicinal Shrub

Common barberry has a long tradition of use in herbalism and folk medicine across the Middle East and Europe, especially in Iran, where the dried fruits (zereshk) are a prized culinary ingredient and simultaneously considered a “medicine for the blood, liver, and digestion.” In recent decades, interest in barberry has increased significantly, primarily due to its main alkaloid berberine and its effects on glucose and lipid metabolism, as well as on the prevention of inflammation and oxidative stress.

Traditional Uses

A review by Rahimi Madiseh et al. (2017) describes in detail that various parts of the common barberry (root, bark, leaves, fruit) have been used in traditional medicine systems for a very wide spectrum of ailments. The oldest records of using common barberry for “cleansing the blood” date back to cuneiform tablets from the library of the Assyrian ruler Ashurbanipal (circa 650 B.C.). In Iranian traditional medicine, common barberry has been used for a broad range of problems. It is administered for jaundice, enlarged liver and spleen, gallbladder and digestive disorders (including hepatitis, diarrhea, and ulcers), for “blood cleansing” in skin diseases, for rheumatism and gout, for hypertension and metabolic syndrome, and for various inflammations and infections.

Phytochemical Composition

Common barberry is a rich source of isoquinoline alkaloids, polyphenols, organic acids, and vitamins. It contains berberine (a quaternary benzylisoquinoline alkaloid) as the main active constituent, along with other alkaloids such as berbamine, palmatine, oxyacanthine, jatrorrhizine, magnoflorine, and columbamine. The plant also provides phenolic compounds (flavonols, phenolic acids), tannins, and anthocyanins (especially in the berries), as well as vitamins (notably vitamin C) and minerals in its fruit.

Alkaloids are present in all parts of the plant – the highest levels are found in the root bark, lower amounts in the stem and leaves, and only trace amounts in the fruit. The berries contain a high amount of vitamin C, which further contributes to the plant’s antioxidant effect. 

Berberine acts on numerous targets in cells. Among other actions, it activates AMP-activated protein kinase (AMPK), influences LDL receptors in the liver, modulates the gut microbiota, inhibits α-glucosidase, and has broad-spectrum antimicrobial effects against a wide range of bacteria, fungi, and parasites.

Pharmacological Effects and Modern Research

Numerous in vitro and in vivo models confirm that B. vulgaris has strong antioxidant potential. Extracts of the fruits and roots have been shown to inhibit lipid peroxidation, hemolysis of erythrocytes, and non-enzymatic glycosylation of hemoglobin, while increasing the activity of antioxidant enzymes (SOD, catalase, glutathione peroxidase).

In a review on B. vulgaris and its active compound berberine, Shakeri et al. (2024) emphasize several key points:

• a reduction in levels of reactive oxygen species (ROS) in cellular models,
• an increase in internal antioxidant stores (e.g., glutathione),
• inhibition of the transcription factor NF-κB and pro-inflammatory cytokines (TNF-α, IL-1β, IL-6),
• modulation of COX-2 and 5-LOX, contributing to decreased production of prostaglandins and leukotrienes.

These mechanisms explain the plant’s anti-inflammatory and immunomodulatory effects. In chronic inflammation, B. vulgaris typically does not act as an immunosuppressant in the classical sense, but rather redirects the immune response into less destructive, more regulated pathways.

Metabolic Effects

The effects of common barberry and berberine are also being investigated in the context of type 2 diabetes and metabolic syndrome. A review by Belwal et al. (2020) summarizes numerous animal and cell studies in which extracts from the genus Berberis lowered fasting blood glucose and reduced insulin resistance. Among the key mechanisms noted are:

• activation of AMPK, which slows lipogenesis and gluconeogenesis and improves glucose utilization in muscles,
• inhibition of α-glucosidase and α-amylase – leading to slower absorption of carbohydrates,
• increased sensitivity of insulin receptors and improved glucose uptake into peripheral tissues,
• protection of pancreatic β-cells from oxidative stress,
• improvement of the adipokine profile and reduction of inflammation in adipose tissue.

The most cited randomized, double-blind, placebo-controlled study in patients is described by Shidfar et al. (2012). The results showed that, compared to placebo, common barberry significantly:

• lowered triglycerides, total cholesterol and LDL,
• lowered fasting blood glucose and insulin, as well as the index of insulin resistance,
• increased total antioxidant capacity (TAC),
• while no significant changes were observed in HbA1c or HDL.

Hypolipidemic and Cardiovascular Effects

A systematic review and meta-analysis by Hadi et al. (2019) analyzed the effects of barberry preparations on lipid parameters and found that preparations from the genus Berberis (including B. vulgaris) safely and modestly lower total cholesterol, LDL cholesterol, and triglycerides, and in some groups also slightly increase HDL levels.

Common barberry is most often used in support of the liver, and its positive effects on liver health are confirmed by modern experimental studies. For example:

• Laamech et al. (2017) demonstrated in a model of lead-intoxicated mice that an aqueous extract of B. vulgarisreduced lead accumulation in the liver, normalized liver enzymes (ALT, AST), improved antioxidant status (SOD, catalase, GSH), and prevented histological signs of necrosis.
• Hermenean et al. (2012) found that a complex of common barberry extract with β-cyclodextrin significantly protected liver tissue in acute carbon tetrachloride poisoning, reducing lipid peroxidation and normalizing antioxidant enzyme levels.

In the review by Rahimi Madiseh et al. (2017), the authors also summarized other models in which B. vulgaris improved phase II detoxification enzymes, reduced oxidative stress in the liver, and favorably influenced metabolic disturbances leading to non-alcoholic fatty liver disease (NAFLD). These findings place B. vulgaris among the promising hepatoprotective plants, especially in the context of metabolic syndrome, diabetes, and exposure to hepatotoxins. It also helps regulate bile function.

Clinically interesting is barberry’s effect on the skin. A randomized study in adolescents with moderate to severe acne vulgaris showed that an aqueous extract of B. vulgaris fruit is a safe and effective option for reducing inflammatory processes in the skin (acne lesions).

General Safety Profile

In humans, at standard doses used in clinical studies and traditional practice, the most common side effects are mild nausea and diarrhea. More serious complications have been reported mainly with excessive doses or in particularly sensitive individuals.

B. vulgaris and berberine are not recommended during pregnancy or breastfeeding, nor for infants, except under explicit medical supervision.

Common barberry has a mild anticoagulant effect and can influence blood clotting. Before surgical procedures, it is usually recommended to discontinue use at least two weeks in advance, especially for patients taking anticoagulant or antiplatelet medications.

In patients with severe liver or kidney disease, it is advisable to introduce B. vulgaris preparations cautiously and under professional supervision.

Interactions with Medications

Concurrent use of barberry or berberine with cyclosporine is not recommended (an influence on cyclosporine levels has been reported). Berberine can also reduce the absorption and effectiveness of tetracycline antibiotics.

Because of these and other potential interactions, individuals on long-term medication (especially anticoagulants, antidiabetic drugs, antihypertensives, immunosuppressants, or certain antibiotics) should consult their doctor or pharmacist before adding common barberry as a supplement.

Literatura:

Belwal, T., Bisht, A., Devkota, H. P., Ullah, H., Khan, H., Pandey, A., & Joshi, R. (2020). Phytopharmacology and clinical updates of Berberis species against diabetes and other metabolic diseases. Frontiers in Pharmacology, 11, 41.
Ciorîță, A., Erhan, S. E., Soran, M. L., Lung, I., Moț, A. C., Macavei, S. G., & Pârvu, M. (2024). Pharmacological potential of three berberine-containing plant extracts obtained from Berberis vulgaris L., Mahonia aquifolium (Pursh) Nutt., and Phellodendron amurense Rupr. Biomedicines, 12(6), 1339.
Hadi, A., Arab, A., Pourmasoumi, M., Ghavami, A., & Miraghajani, M. (2019). The effect of barberry (Berberis vulgaris) on lipid profile: A systematic review and meta-analysis of randomized controlled trials. Complementary Therapies in Medicine, 42, 20–26.
Imanshahidi, M., & Hosseinzadeh, H. (2008). Pharmacological and therapeutic effects of Berberis vulgaris and its active constituent, berberine. Phytotherapy Research, 22(8), 999–1012.
Laamech, J., El Hilaly, J., Fetoui, H., Chtourou, Y., Gouitaa, H., Tahraoui, A., & Lyoussi, B. (2017). Berberis vulgaris L. effects on oxidative stress and liver injury in lead-intoxicated mice. Journal of Complementary and Integrative Medicine, 14(1).
Rahimi Madiseh, M., Karimian, P., Kafeshani, M., & Rafieian Kopaei, M. (2017). Berberis vulgaris: Specifications and traditional uses. Iranian Journal of Basic Medical Sciences, 20(5), 569–587.
Rad, S. Z., Hosseini, M., Banach, M., Abasi, E., & Sathyapalan, T. (2017). Toxicology effects of Berberis vulgaris(barberry) and its active constituent, berberine: A review. Iranian Journal of Basic Medical Sciences, 20(5), 516–529.
Shakeri, F., Rahimi, H. R., & Sathyapalan, T. (2024). Anti-inflammatory, antioxidant, and immunomodulatory effects of Berberis vulgaris and berberine: Experimental and clinical evidence. Phytotherapy Research.
Shidfar, F., Ebrahimi, S. S., Hosseini, S., Heydari, I., Shidfar, S., & Hajhassani, G. (2012). The effects of Berberis vulgaris fruit extract on serum lipoproteins, apoB, apoA-I, homocysteine, glycemic control and total antioxidant capacity in type 2 diabetic patients. Iranian Journal of Pharmaceutical Research, 11(2), 643–652.
Srivastava, S., Rawat, A. K. S., Srivastava, M., & Chandra, H. (2013). Quality evaluation of Ayurvedic crude drug Daruharidra, its allied species, and commercial samples from herbal drug markets of India. Evidence-Based Complementary and Alternative Medicine, 2013, 472973.
Tahmasebi, L., et al. (2019). The effect of Berberis vulgaris root extract on glycemic control and lipid profile in patients with type 2 diabetes: A randomized clinical trial. European Journal of Integrative Medicine, 31, 100961. (as summarized by Belwal et al., 2020)
The Ayurvedic Pharmacopoeia of India. (2008). Part I, Vol. 2. Government of India, Ministry of Health and Family Welfare. (Monograph of Daruharidra – Berberis aristata).
Various clinical and toxicological monographs on barberry/berberine (Drugs.com, PeaceHealth, Verywell Health, Dr. Axe; available via online sources, used for summarizing safety and interactions).