It has been used since ancient times as a vegetable red dye for leather, wool, cotton and silk. For dye production, the roots are harvested after two years. The outer red layer gives the common variety of the dye, the inner yellow layer the refined variety. Madder is used as a food plant by the larvae of some Lepidoptera species including the hummingbird hawk moth.
According to Culpeper's herbal, the plant is "an herb of Mars" and "hath an opening quality, and afterwards to bind and strengthen". The root was recommended in the treatment of yellow jaundice, obstruction of the spleen, the melancholy humour, palsy, sciatica, and of bruises. The leaves were advised for women “that have not their courses” and for the treatment of freckles and other discolorations of the skin.