Fresh Phytomedicines: Traditional Applications, Chemical Composition, Pharmacological Activities, Challenges, and Strategies

Fresh phytomedicines (FPs), defined as medicinal plants used in their fresh, undried state, have long been applied in traditional medical systems worldwide and represent a diverse yet underexplored source of bioactive compounds derived from classical prescriptions, ethnomedicinal practices, and medicine-food homology plants. Increasing evidence suggests that FPs possess distinct chemical and pharmacological properties compared with dried phytomedicines (DPs), although their therapeutic value has not been systematically evaluated from a modern medical perspective. This review integrates ethnomedicinal knowledge with modern pharmacological evidence to clarify the therapeutic potential of FPs, while comparing them with DPs and evaluating their potential role as context-dependent alternatives or complementary strategies that warrant further clinical investigation. A comprehensive literature search covering the period from 1956 to January 2026 was conducted across Web of Science, PubMed, Scopus, CNKI, ProQuest, and SciELO, followed by bibliometric analysis using VOSviewer 1.6.20. Available evidence indicates that FPs and DPs exhibit distinct physicochemical and pharmacological profiles. Drying enriches thermally stable constituents or leads to the formation of new compounds in DPs, whereas FPs better preserve thermosensitive and labile compounds, including polysaccharides, flavonoids, alkaloids, and volatile oils. These preserved constituents contribute to context-dependent activities such as antimicrobial, antioxidant, antidiabetic, and immunomodulatory effects. Although FPs offer unique therapeutic potential, their application is constrained by instability, limited standardization, inconsistent dosing, and insufficient clinical evidence, and future efforts should focus on improved preservation technologies, comprehensive quality standards, systematic dosage studies, and well-designed clinical trials to substantiate their clinical applicability and facilitate evidence-based integration into modern therapeutic frameworks.