Safety of medicinal and edible herbs from fruit sources for human consumption: A systematic review

Medicinal and edible herbs from fruit sources have been increasingly used in traditional Chinese medicine dietotherapy. There are no restrictions on who could consume the medicinal and edible fruits or on the dosage of consumption. However, their safety for human consumption has yet to be established.

This systematic review aimed to assess the safety of human consumption of 30 medicinal and edible fruits.

Seven English and Chinese databases were searched up to May 31, 2023, to collect AE reports following human consumption of medicinal and edible fruits. Eligible reports should include details on the occurrence, symptoms, treatments, and outcomes of AEs. AEs that were life-threatening or caused death, permanent or severe disability/functional loss, or congenital abnormality/birth defects were classified as serious AEs (SAEs). The causality between the consumption of fruits and AEs was graded as one of four ranks: "certain", "probable", "possible", or "unlikely".

Thirty AE reports related to the consumption of medicinal and edible fruits were included, involving 12 species of fruits: Crataegi fructus, Gardeniae fructus, Mori fructus, Hippophae fructus, Cannabis fructus, Siraitiae fructus, Perillae fructus, Rubi fructus, Longan arillus, Anisi stellati fructus, Zanthoxyli pericarpium, and Lycii fructus. No AE reports were found for the remaining 18 species. A total of 97 AEs, featuring predominantly gastrointestinal symptoms, followed by allergic reactions and neuropsychiatric symptoms, were recorded. Thirty SAEs were noted, with Zanthoxyli pericarpium accounting for the most (14 cases), followed by Perillae fructus (7 cases), Anisi stellati fructus (6 cases), and Gardeniae fructus, Rubi fructus, and Mori fructus (1 case each). Mori fructus was associated with one death. All AEs were concordant with a causality to fruit consumption, judged to be "certain" for 37 cases, "probable" for 53 cases, and "possible" for 7 cases.

Our findings suggest that among medicinal and edible fruits, 12 species have AE reports with a causality ranging from "possible" to "definite". SAEs were not scarce. Most AEs may be associated with an excessive dose, prolonged consumption, or usage among infants or young children. No AE reports were found for the remaining 18 species.