Mushroom poisoning remains a significant public health issue in China, with 196 species identified in poisoning incidents by the end of 2022. In 2023, the China CDC investigated 505 cases across 24 provincial-level administrative divisions (PLADs), resulting in 1,303 patients and 16 deaths, with a case fatality rate of 1.23%. A total of 97 poisonous mushroom species were identified, including 12 newly documented in China. These species caused six distinct clinical syndromes, bringing the total number of mushroom species involved in poisoning incidents in China to approximately 220 by the end of 2023. The temporal distribution of cases showed a peak between May and October, with the highest number of cases in June. Geographically, Hunan, Yunnan, Guizhou, Sichuan, and Hubei were the most affected regions. The most deadly mushrooms were Amanita fuligineoides, A. subpallidorosea, and Russula subnigricans, causing 7, 2, and 2 deaths, respectively. Chlorophyllum molybdites was the most widely distributed and caused the most cases, with 150 incidents and 303 patients. In 2023, 7 Amanita species, 1 Galerina species, and 1 Lepiota species were identified as causes of acute liver failure. Amanita fuligineoides was the most dangerous, causing 7 deaths. Three species, Amanita oberwinklerana, A. pseudoporphyria, and A. kotohiraensis, were responsible for acute renal failure. Russula subnigricans caused rhabdomyolysis in 14 cases. Five species caused gastroenteritis, including three newly identified in China. Thirty-three species were associated with psycho-neurological disorders, with Amanita sychnopyramis f. subannulata, Amanita subglobosa, and Psilocybe cubensis being the most common. The study highlights the importance of collaboration among CDC staff, physicians, and mycologists for effective control and prevention of mushroom poisoning. The findings emphasize the need for improved education on toxic mushrooms to reduce poisoning incidents.Mushroom poisoning remains a significant public health issue in China, with 196 species identified in poisoning incidents by the end of 2022. In 2023, the China CDC investigated 505 cases across 24 provincial-level administrative divisions (PLADs), resulting in 1,303 patients and 16 deaths, with a case fatality rate of 1.23%. A total of 97 poisonous mushroom species were identified, including 12 newly documented in China. These species caused six distinct clinical syndromes, bringing the total number of mushroom species involved in poisoning incidents in China to approximately 220 by the end of 2023. The temporal distribution of cases showed a peak between May and October, with the highest number of cases in June. Geographically, Hunan, Yunnan, Guizhou, Sichuan, and Hubei were the most affected regions. The most deadly mushrooms were Amanita fuligineoides, A. subpallidorosea, and Russula subnigricans, causing 7, 2, and 2 deaths, respectively. Chlorophyllum molybdites was the most widely distributed and caused the most cases, with 150 incidents and 303 patients. In 2023, 7 Amanita species, 1 Galerina species, and 1 Lepiota species were identified as causes of acute liver failure. Amanita fuligineoides was the most dangerous, causing 7 deaths. Three species, Amanita oberwinklerana, A. pseudoporphyria, and A. kotohiraensis, were responsible for acute renal failure. Russula subnigricans caused rhabdomyolysis in 14 cases. Five species caused gastroenteritis, including three newly identified in China. Thirty-three species were associated with psycho-neurological disorders, with Amanita sychnopyramis f. subannulata, Amanita subglobosa, and Psilocybe cubensis being the most common. The study highlights the importance of collaboration among CDC staff, physicians, and mycologists for effective control and prevention of mushroom poisoning. The findings emphasize the need for improved education on toxic mushrooms to reduce poisoning incidents.