Ziziphus (Ziziphus spp., Zizyphus spp.)

While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.

Related Terms

  • 3-O-[(2-O-\a/-D-fucopyranosyl-3-O-\b/-D-glucopyranosyl)-\a/-arabi nopyranosyl]jujubogenin, 3-O-[alpha-D-fucopyranosyl(1–>2)-beta-D-glucopyranosyl-4-sulphate(1–>3)-alpha-L-arabinopyranosyl]jujubogenin, 3-O-[alpha-L-fucopyranosyl(1–>2)-beta-D-glucopyranosyl(1–>3)-alpha-L-arabinopyranosyl]jujubogenin, 3-O-alpha-L-rhamnopyranosyl-(1–>2)-[(4-sulfo)-beta-D-glucopyranosyl-(1–>3)]-alpha-L-arabinopyranosyljujubogenin, 3-O-alpha-L-rhamnopyranosyl-(1–>2)-[(4-sulfo)-beta-D-glucopyranosyl-(1–>3)]-beta-D-galactopyranosyl-(20R,22R)-16beta,22:16alpha,30-diepoxydammar-24-ene-3beta,20-diol, 3-O-alpha-L-rhamnopyranosyl-(1–>6)-beta-D-glucopyranosyljujubogenin-20-O-(2,3,4-O-triacetyl)-alpha-L-rhamnopyranoside, 3-O-alpha-L-rhamnopyranosyl-(1–>6)-beta-D-glucopyranosyljujubogenin-20-O-alpha-L-rhamnopyranoside, 3-O-beta-glucopyranosyl(1 -> 2)-alpha-L-rhamnopyranosyl-(1–> 3)-alpha-L-arabinopyranosyl]jujubogenin, 3-O-cis-p-coumaroyl alphitolic acid, 3-O-cis-p-coumaroyl maslinic acid, 3-O-cis-p-coumaroylalphitolic acid, 3-O-cis-p-coumaroylmaslinic acid, 3-O-trans-p-coumaroyl alphitolic acid, 3-O-trans-p-coumaroyl maslinic acid, 3-O-trans-p-coumaroylalphitolic acid, 3-O-trans-p-coumaroylmaslinic acid, 4\DP/-\b/-D-glucopyranosyl swertisin, 6”’-feruloyl spinosin, 7-beta-(4-hydroxy-3′-methoxybenzoyloxy)-betulinic acid, 7-beta-(4-hydroxybenzoyloxy)-betulinic acid, (25 S)-3-alpha-hydroxy-5-alpha-spirostane-2,12-dione, 27-(4-hydroxy-3′-methoxybenzoyloxy)-betulinic acid, abyssenine A, acetyljujuboside B, alkaloids, alphitolic acid, anthraquinones, banarasi karaka, ber, beta-hydroxysteroid dehydrogenase inhibitor, beta-sitosterol, betulinic acid, betulonic acid, bilayati, buckthorn, caffeic acid, calcium, carbohydrates, ceanothane, ceanothane-type triterpenes, chhuhara, Chinese jujube, chlorogenic acid, christinin A, christinin B, christinin C, christinin D, chromium, cinnamic acid, Codonopsis pilosula, colubrinic acid, copper, cyclic AMP (adenosine-3′,5′-monophosphate), cyclopeptide, cyclopeptide alkaloids, dammarane saponins, dazao (Chinese), deachuine S10, epigouanic acid A, fatty acids, ferulic acid, fiber, flavonoids, flavonol glycoside, frangulanine-type cyclopeptide alkaloid, fructose, gallic acid, glucose, glycosides, gola, golden yellow, heizao (Chinese), hemicellulose, hongzao (Chinese), hyperoside, ilaichi, Indian jujube, iron, isozizyphursolic acid (18bH-urs-20(30)-en-2a-ol-28-oic acid), jubanine-C, jubanine-C scutianine-C, jubanine-E, jujubasaponine IV, jujube plum, jujuboside A, jujuboside A1, jujuboside B, jujuboside C, jujuboside C (3-O-beta-D-glucopyranosyl(1–>6)-beta-D-glucopyranosyl(1–>3)-[alpha-L-rhamnopyranosyl(1–>2)]-alpha-L-arabinopyranosyl jujubogenin), kaithli, kakrola gola, katha, lanosta-25(26)-en-9alpha-ol-21-oic acid, lanosta-25(26)-en-22beta-ol-18-oic acid 3(19)-olide, lanostane-type triterpene, lotogenin ((15R,16R,20R,22R)-16-beta,22-epoxydammar-24-ene-3-beta,15-alpha,16-alpha,20-beta-tetraol), lotoside I (3-O-alpha-L-rhamnopyranosyl(1–>2)-[beta-D-glucopyranosyl(1–>3)]-beta-D-galactopyranosyl lotogenin), lotoside II (3-O-alpha-L-rhamnopyranosyl(1–>2)-[beta-D-glucopyranosyl(1–>3)]-beta-D-glucopyranosyl lotogenin), lotusine G, lup-20(29)-en-32-ol-28-oic acid, lupane-type triterpenes, lupenoic acid, mauritine C, mauritine D, methylbetulinate, methylceanothate, Moroccan Zizyphus lotus (L.) Desf., mucronine A, mucronine B, mucronine C mucronine D, mucronine J, mundia murahra, nanche de la costa, nanche de la costa fruit, N-formyl cyclopeptide alkaloid, nickel, nummularine B, nummularine P, nummularine R, nummularogenin ((25 S)-3 alpha-hydroxy-5 alpha-spirostane-2,12-dione), oleanane-type triterpenes, oleanonic acid, oxalic acid, oxyphyl line-A, pathan, pectin, peptide alkaloids, phenols, polyphenol oxidase, polysaccharide, poria cocos, proanthocyanidins, protojujuboside A, protojujuboside B, protojujuboside B1, quercetin, quercetin-3-O-[beta-xylosyl-(1-2)-alpha-rhamnoside] 4′-O-alpha-rhamnoside, resins, Rhamnaceae (family), rutin, safeda rohtak, saiboku-to, sanjoinine A, sanjoinine A dialdehyde, sanjoinine Ah1, sanjoinine D, sanjoinine G2, saponins, sativanine C, sativanine E, sativanine H, sativanine M, sativanine N, sativanine O, scutianine C, seb, seo, sitogluside, sonaur-2, sonaur-3, sour date, sour jujube decoction, spinosin, spiny zizyphus, takadi, tannic acid, tannins, terephthalic acid, terpenic-delta-lactone, tikari, triterpenes, triterpenoid, triterpenoid saponin, umaran, unabi (Zizyphus mill), ursolic acid, vanillic acid, wild zizyphus, xylopyrine A, xylopyrine B, xylopyrine C, xylopyrine D, xylopyrine E, xylopyrine F, zao (Chinese), ZG-3, Zhanhua winter jujube, zinc, zivulgarin (4\DP/-\b/-D-glucopyranosyl swertisin), Ziziphus, zizyberenalic acid, zizyphine A, zizyphulanostan-18-oic acid (lanosta-25(26)-en-22beta-ol-18-oic acid 3(19)-olide), zizyphulanostane-21-oic acid (lanosta-25(26)-en-9alpha-ol-21-oic acid), zizyphursolic acid (18bH-urs-20(30)-en-3b-ol-28-oic acid), Zizyphus cambodiana, Zizyphus fructus, Zizyphus joazeiro, Zizyphus joazeiro Mart., Zizyphus joazeiro Martius, Zizyphus jujuba, Zizyphus jujuba Mill., Zizyphus jujuba Mill. cv. Dongzao, Zizyphus jujuba Mill. cv. Zhanhua, Zizyphus jujuba Mill. var. spinosa (Bunge) Hu, Zizyphus lotus, Zizyphus mauritiana, Zizyphus mauritiana Lam., Zizyphus mauritiana var. banarasi karaka, Zizyphus mauritiana var. bilayati, Zizyphus mauritiana var. chhuhara, Zizyphus mauritiana var. gola, Zizyphus mauritiana var. golden yellow, Zizyphus mauritiana var. ilaichi, Zizyphus mauritiana var. kaithli, Zizyphus mauritiana var. kakrola gola, Zizyphus mauritiana var. katha, Zizyphus mauritiana var. mundia murahra, Zizyphus mauritiana var. pathan, Zizyphus mauritiana var. safeda rohtak, Zizyphus mauritiana var. seb, Zizyphus mauritiana var. seo, Zizyphus mauritiana var. sonaur-2, Zizyphus mauritiana var. sonaur-3, Zizyphus mauritiana var. takadi, Zizyphus mauritiana var. tikari, Zizyphus mauritiana var. umaran, Zizyphus mauritiana var. ZG-3, Zizyphus Mill., Zizyphus mistol, Zizyphus mistol Griseb., Zizyphus mistol seed oil, Zizyphus mouritiana, Zizyphus mucronata, Zizyphus mucronata Willd., Zizyphus nummularia, Zizyphus oenoplia, Zizyphus oxyphylla, Zizyphus oxyphylla Edgew., Zizyphus sativa, Zizyphus sativa Gaertn., zizyphus seeds, Zizyphus sonorensis, Zizyphus spina, Zizyphus spina-christi, Zizyphus spina-christi (L.) Willd., Zizyphus spinosa Hu, Zizyphus spinosae semen, Zizyphus trinervia, Zizyphus vulgaris, Zizyphus vulgaris Lam., Zizyphus xylopyra, Zizyphus-nummularia, Zizyphussativa.

  • Select combination products: Kanbaku-taiso-to, Tea Garden Valerian Zizyphus Dreams, Suan Zau Ren Tang, Saiko.

Background

  • Ziziphus species are a group of spiny shrubs and small trees related to buckthorn. Plants may be found in many different warm and near-tropical regions, including Asia (China, India, Korea, Saudi Arabia), Africa (Morocco, Egypt), South America (Brazil), and Europe (the Mediterranean). Similar to dates, Ziziphus fruit often tastes sweet and sugary.

  • Early use of Ziziphus species reportedly dates back 2,000 years, to the Han Dynasty in China. According to traditional medicine practices, it is well known for its calming and sleep-promoting effects. Either alone or mixed with other herbs, Ziziphus species have been used to treat conditions such as diarrhea, erratic blood pressure, excess worrying, fevers, lack of sleep, menopausal symptoms, mental fatigue, nighttime emissions, sleepiness, and ulcers.

  • Limited research in humans suggests that Ziziphus species may be effective for treating insomnia, nighttime emissions, and stress. More research is needed in these areas as well as on the effects of Ziziphus species alone.

Scientific Evidence

Uses

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Insomnia

Suan Zao Ren Tang is a combination product containing Ziziphus spinosa and various other herbs. Early research suggests it may be useful in treating lack of sleep. However, the effects of Ziziphus spinosa alone are unclear. Further research is needed in this area.

Relaxation/stress/anxiety

Limited research suggests that herbal supplements containing Ziziphus spinosa may improve mood in teenage girls. More research with Ziziphus alone is needed in this area.

Sexual disorders (nighttime emissions)

Suan Zao Ren Tang is a combination product containing Ziziphus spinosa and various other herbs. Early research suggests it may be useful in treating nighttime emissions. Further research is needed in this area, as the effects of Ziziphus spinosa alone are not clear.

*Key to grades:

Tradition

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.

  • Alzheimer’s disease, angiogenesis (antiangiogenic – preventing new blood vessel growth), anthelmintic (destroying worms and parasites), antibacterial, antifungal, anti-inflammatory, antimicrobial, antimutagenic (reducing genetic mutations), antineoplastic (preventing cancer growth), antioxidant, antiviral, blood pressure control, burns, dental plaque, diabetes, diarrhea, fatigue, fever, flavoring, hair growth, hyperlipidemia (high blood lipids), increased strength, intestinal disorders, liver protection, malaria treatment, menopausal symptoms, mental disorders, neuroprotection (neuron protection), pain relief, restlessness, sedative, ulcers, vasoregulator (regulating blood vessels).

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (18 years and older)

  • For general use, Ziziphus mauritiana has been taken by mouth as candy. The exact dose taken has not been clearly stated.

  • For burns, a liquid treatment containing Ziziphus vulgaris cortex (powdered and mixed with 80% alcohol at a 1:2 ratio) has been applied to the skin.

Children (under 18 years old)

  • There is no proven safe or effective dose for Ziziphus species in children.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

  • Avoid in people with a known allergy or sensitivity to Ziziphus species.

  • Avoid in people with a known allergy or sensitivity to latex. Some people with latex allergy may also have a related allergy to various plant products, including Ziziphus fruit. This relationship is called latex-fruit syndrome. Ziziphus mauritiana is known to contain Ziz m 1, which is a compound involved in latex-fruit syndrome.

Side Effects and Warnings

  • Ziziphus fruits are likely safe when eaten in normal dietary amounts. Ziziphus species should be purchased from well-trusted sources, and the fruit should be washed carefully before use. Low levels of toxic compounds have been found on Ziziphus jujube fruits.

  • Ziziphus species may lower blood sugar levels. Caution is advised in people with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Blood glucose levels may need to be monitored by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.

  • Ziziphus may cause high or low blood pressure. Caution is advised in people taking agents that affect blood pressure.

  • Use cautiously when combined with prednisone, antidepressants, or agents that lower immune system activity.

  • Although it has not been well studied in humans, the extract of Ziziphus jujuba bark may lower a woman’s ability to have children. Use cautiously in women trying to conceive.

  • Avoid in people that are unable to sleep. Cases of chronic cough with yellow sticky mucus have been reported.

  • Drowsiness or sedation may occur. Avoid use if driving or operating heavy machinery.

  • Avoid use of amounts higher than those normally found in the diet in children and pregnant or lactating women, due to a lack of safety information.

  • Avoid with known allergy or sensitivity to Ziziphus species or latex.

Pregnancy and Breastfeeding

  • There is currently a lack of scientific evidence on the use of Ziziphus species during pregnancy or lactation. The use of amounts higher than those normally found in the diet should be avoided during these periods.

  • Although it has not been well studied in humans, Ziziphus jujuba bark may lower a woman’s ability to have children. Use cautiously in women trying to conceive.

Interactions

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

Interactions with Drugs

  • Ziziphus species may lower blood sugar levels. Caution is advised when using medications that may also lower blood sugar. People taking insulin or drugs for diabetes by mouth should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.

  • Ziziphus species may increase the amount of drowsiness caused by some drugs. Examples include benzodiazepines such as lorazepam (Ativan®) or diazepam (Valium®), barbiturates such as phenobarbital, narcotics such as codeine, some antidepressants, and alcohol. Caution is advised while driving or operating machinery.

  • Ziziphus may cause high or low blood pressure. Caution is advised in people taking agents that affect blood pressure.

  • Ziziphus species may also interact with agents that affect the immune system, agents that destroy mollusks, agents that inhibit new blood vessel growth, agents that prevent cancer growth, agents that simulate bowel movements, agents that widen blood vessels, antibiotics, antifungals, antiulcer agents, antivirals, fertility agents, fever-lowering agents, hair growth agents, inflammation-lowering agents, lipid-lowering agents, malaria treatment agents, memory-enhancing agents, nervous system agents, pain relievers, prednisone, and venlafaxine.

Interactions with Herbs and Dietary Supplements

  • Ziziphus species may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.

  • Ziziphus species may increase the amount of drowsiness caused by some herbs or supplements.

  • Ziziphus may cause high or low blood pressure. Caution is advised in people taking herbs or supplements that affect blood pressure.

  • Ziziphus species may also interact with antibacterials, anti-cancer agents, antidepressants, antifungals, antimalarials, antioxidants, antiulcer herbs and supplements, antivirals, bowel-stimulating agents, fertility agents, fever-lowering herbs and supplements, green tea, hair growth agents, healthy bacteria (probiotics), herbs and supplements that affect the immune system, herbs and supplements that destroy mollusks, herbs and supplements that widen blood vessels or inhibit new blood vessel growth, inflammation-lowering herbs, lipid-lowering agents, memory-enhancing herbs and supplements, nervous system herbs and supplements, and pain relievers.

Author Information

  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

References

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

  1. Adzu B, Amos S, Dzarma S, et al. Effect of Zizyphus spina-christi Willd aqueous extract on the central nervous system in mice. J Ethnopharmacol 2002;79(1):13-16. View Abstract
  2. Al-Reza SM, Yoon JI, Kim HJ, et al. Anti-inflammatory activity of seed essential oil from Zizyphus jujuba. Food Chem Toxicol 2010;48(2):639-643. View Abstract
  3. Chen FP, Jong MS, Chen YC, et al. Prescriptions of Chinese herbal medicines for insomnia in Taiwan during 2002. Evid Based Complement Alternat Med 2009. View Abstract
  4. Chen HC, Hsieh MT, Lai E. Studies on the suanzaorentang in the treatment of anxiety. Psychopharmacology (Berl) 1985;85(4):486-487. View Abstract
  5. Cisse, A., Ndiaye, A., Lopez-Sall, P., Seck, F., Faye, B., and Faye, B. [Antidiabetic activity of Zizyphus mauritiana Lam (Rhamnaceae)]. Dakar Med 2000;45(2):105-107. View Abstract
  6. Jarald EE, Joshi SB, Jain DC. Antidiabetic activity of extracts and fraction of Zizyphus mauritiana. Pharm Biol 2009;47:328-334.
  7. Kang SW, Choi JS, Bae JY, et al. Blockade of vascular angiogenesis by Aspergillus usamii var. shirousamii-transformed Angelicae Gigantis
    Radix and Zizyphus jujuba. Nutr Res Pract 2009;3(1):3-8. View Abstract
  8. Kumar EP, Joel J, William JW, et al. Prevention of hypercholesterolemia and atherosclerosis in rabbits after supplementation of Ziziphus mauritiana lam. leaf extract (MAPS-P-409). International Pharmaceutical Federation World Congress 2002;62:133.
  9. Lee MF, Tsai JJ, Hwang GY, et al. Identification of immunoglobulin E (IgE)-binding epitopes and recombinant IgE reactivities of a latex cross-reacting Indian jujube Ziz m 1 allergen. Clin Exp Immunol 2008;152(3):464-471. View Abstract
  10. Lee MS, Park M-S, Shin Y-I, et al. Effects of a Korean traditional herbal supplement on symptoms of stress and mood profiles in high school girls: a randomized, double blind, placebo-controlled trial 2005. Stress Health 2005;21(2):139-143.
  11. Montiel-Herrera M, Campista-Leon S, Camacho-Hernandez IL, et al. Physicochemical and nutritional characteristics of the fruit of Zizyphus sonorensis S. Wats (Rhamnaceae). Int J Food Sci Nutr 2005;56(8):587-596. View Abstract
  12. Nesseem, D. I., Michel, C. G., Sleem, A. A., and El-Alfy, T. S. Formulation and evaluation of antihyperglycemic leaf extracts of Zizyphus spina-christi (L.) Willd. Pharmazie 2009;64(2):104-109. View Abstract
  13. Nisar M, Adzu B, Inamullah K, et al. Antinociceptive and antipyretic activities of the Zizyphus oxyphylla Edgew. leaves. Phytother Res 2007;21(7):693-695. View Abstract
  14. Sarris J. Herbal medicines in the treatment of psychiatric disorders: a systematic review. Phytother Res 2007;21(8):703-716. View Abstract
  15. Wahida B, Abderrahman B, Nabil C. Antiulcerogenic activity of Zizyphus lotus (L.) extracts. J Ethnopharmacol 2007;112(2): 228-231. View Abstract

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.